Critical Care Medicine最新文献

{"title":"Optimizing Agreement Between Bedside Nurse-Documented and Trained Researcher Delirium Assessments in the ICU.","authors":"Kelly M Toth, Zahra Aghababa, Jason N Kennedy, Chukwudi Onyemekwu, Niall T Prendergast, Christopher A Franz, Michael E Reznik, Brian Jiang, Brett Curtis, Faraaz Shah, Georgios D Kitsios, Bryan J McVerry, Timothy D Girard","doi":"10.1097/CCM.0000000000006879","DOIUrl":"10.1097/CCM.0000000000006879","url":null,"abstract":"<p><strong>Objectives: </strong>Delirium is common and harmful in the ICU. The Intensive Care Delirium Screening Checklist (ICDSC) and Confusion Assessment Method for the ICU (CAM-ICU) are validated tools recommended for delirium identification. However, the accuracy of bedside nurse-documented delirium assessments in the ICU is inconsistent, limiting utility in clinical research. We sought to evaluate and optimize agreement between bedside nurse-documented and trained researcher delirium assessments.</p><p><strong>Design, setting, and patients: </strong>Critically ill adults with acute respiratory failure or sepsis in ICUs in large academic hospitals in a southwestern Pennsylvania health system were assessed daily for delirium by bedside nurses (using the ICDSC) and trained researchers (using the CAM-ICU). Using matched nurse-to-researcher delirium assessments, we categorized delirium status using validated cutoffs and evaluated agreement using Cohen's kappa. We derived and compared logistic regression models that used ICDSC documentation, mechanical ventilation status, and admission Sequential Organ Failure Assessment to predict delirium in noncomatose patients, using researcher CAM-ICU assessments as the reference standard. We internally validated models using ten-fold cross-validation.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>From a sample of 1535 matched assessments of 279 patients, there was moderate agreement between bedside nurse assessments using the established ICDSC delirium/normal cutoff (ICDSC ≥ 4) and trained researcher assessments using the CAM-ICU (Cohen's kappa = 0.42). A logistic regression model informed by individual ICDSC components and clinical data predicted a positive research CAM-ICU with good discrimination (area under the curve = 0.87) and performed well in cross-validation (F1 score = 0.72). In sensitivity analyses, models with more limited ICDSC information demonstrated fair to good discriminatory ability (F1 = 0.60-0.70), with the validated cutoff model having the lowest performance.</p><p><strong>Conclusions: </strong>A delirium model informed by bedside nurse ICDSC findings and clinical variables improves accuracy of delirium detected in the ICU and can be used in future pragmatic research that leverages large clinical datasets to advance understanding of delirium mechanisms, trajectories, and outcomes.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12548834/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145085351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early Enteral Nutrition and Clinical Outcomes in Critically Ill Pediatric Populations: A Systematic Review and Meta-Analysis.","authors":"Nicole Gilbert, Emma Schalm, Krista Wollny, Laurie Lee, Dana L Boctor, Tanis R Fenton","doi":"10.1097/CCM.0000000000006859","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006859","url":null,"abstract":"<p><strong>Objective: </strong>Guidelines recommend implementing early enteral nutrition (EN) (EEN) in critically ill children. The aim of the study was to determine if EEN for critically ill children is associated with improved clinical outcomes compared with delayed enteral nutrition (DEN), prioritizing associations adjusted for severity of illness. PROSPERO (CRD42021286271).</p><p><strong>Data sources: </strong>MEDLINE, Embase, CINAHL, and CENTRAL databases to October 2024.</p><p><strong>Study selection: </strong>The population was critically ill children, the intervention was EEN, the comparator was DEN, the outcome was mortality or clinical outcomes, and the study designs included randomized control trials (RCTs), quasi-experimental, observational cohort, or case-control.</p><p><strong>Data extraction: </strong>Screening, extraction, and risk of bias assessment using the Newcastle-Ottawa Scale and Cochrane Risk of Bias and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) assessment were conducted in duplicate by two reviewers. Eighteen of 8478 screened studies were included.</p><p><strong>Data synthesis: </strong>Mortality outcomes were pooled and meta-analyzed using random-effects models. Secondary outcomes were described qualitatively, and directions of associations were reported. Thirteen studies (1 RCT, 12 cohort) reported mortality; however, only three adjusted for illness severity. In the adjusted analysis, receiving EEN was associated with reduced mortality (adjusted odds ratio 0.36 (95% CI, 0.14-0.91), I2 = 78.6%, n = 5864). The certainty of evidence, as assessed by GRADE, was very low due to indirectness. In the qualitative review of 18 studies (1 RCT, 17 cohort studies, n = 9829), EEN had an association with reduced length of stay, length of invasive respiratory support, improved nutrition adequacy, reduced maximum pediatric logistic organ dysfunction score, and infection. No harmful effects of EEN were found after adjusting for confounding variables.</p><p><strong>Conclusions: </strong>EEN was associated with beneficial outcomes. However, the inclusion of mostly cohort studies with limited confounding adjustment, the small number of studies, the presence of between-study heterogeneity and residual confounding, and heterogeneity in measured outcomes and assessment methods resulted in very low certainty of evidence.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145074665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"We Really Do Think Early Venovenous Extracorporeal Membrane Oxygenation Is Best, But May Never Prove It.","authors":"Joseph E Tonna","doi":"10.1097/CCM.0000000000006887","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006887","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145063659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient-Ventilator Asynchronies: Do They Matter?","authors":"Erminio Santangelo, Sameer Jog, Niall D Ferguson","doi":"10.1097/CCM.0000000000006860","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006860","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145029174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Data Science to Improve ICU Benchmarking.","authors":"Jorge I F Salluh, Giulliana M Moralez, Filipe Amado, Gaston Burghi","doi":"10.1097/CCM.0000000000006851","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006851","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145014056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Propranolol As an Anxiolytic to Reduce the Use of Sedatives for Critically Ill Adults Receiving Mechanical Ventilation (PROACTIVE): An Open-Label Randomized Controlled Trial: Erratum.","authors":"James Downar, Julie Lapenskie, Salmaan Kanji, Irene Watpool, Jessica Haines, Uzma Saeed, Rebecca Porteous, Nadia Polskaia, Lisa Burry, Shuhira Himed, Koby Anderson, Alison Fox-Robichaud","doi":"10.1097/CCM.0000000000006815","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006815","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":"53 9","pages":"e1869-e1870"},"PeriodicalIF":6.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Initial Left Ventricular Systolic Dysfunction and Clinical Outcome in Sepsis: A Multicenter Cohort Study.","authors":"Hyunseung Nam, Ji Hyun Cha, Ki Hong Choi, Chi Ryang Chung, Jeong Hoon Yang, Gee Young Suh, Sunghoon Park, Chae-Man Lim, Ryoung-Eun Ko","doi":"10.1097/CCM.0000000000006771","DOIUrl":"10.1097/CCM.0000000000006771","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate the association between the severities of left ventricular (LV) systolic dysfunction and clinical outcomes in patients with sepsis, with a particular focus on in-hospital mortality.</p><p><strong>Design: </strong>Multicenter cohort study.</p><p><strong>Setting: </strong>Nineteen tertiary or university-affiliated hospitals in South Korea.</p><p><strong>Patients: </strong>A total of 2274 adult patients with sepsis or septic shock underwent echocardiographic examination within 24 hours of sepsis recognition.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Patients were stratified by left ventricular ejection fraction (LVEF) into three groups: normal (> 50%, n = 1803), mild-to-moderate dysfunction (30-50%, n = 356), and severe dysfunction (< 30%, n = 115). In-hospital mortality is significantly associated with LV dysfunction severity (normal: 25.73%, mild-to-moderate: 29.49%, severe: 40.00%; p = 0.023). After propensity score matching using three different methodologies, severe LV dysfunction remained independently associated with increased in-hospital mortality (adjusted odds ratio [OR] 1.81; 95% CI, 1.09-3.03). This effect was more pronounced in patients without preexisting cardiovascular disease (CVD) (OR 1.84; 95% CI, 1.08-3.13) and those with bacteremia (OR 2.20; 95% CI, 1.5-3.22). Cardiopulmonary arrest rates increased significantly with dysfunction severity (normal: 2.11%, mild-to-moderate: 3.93%, severe: 10.43%; p < 0.001), while other ICU complications showed no significant differences.</p><p><strong>Conclusions: </strong>Severe LV systolic dysfunction (LVEF < 30%) is associated with significantly increased in-hospital mortality in sepsis patients, particularly in those with bacteremia and without preexisting CVD. These findings highlight the importance of early cardiac function assessment in sepsis and suggest that infection status and underlying cardiovascular health modify the relationship between LV dysfunction and clinical outcome.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e1759-e1769"},"PeriodicalIF":6.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12393054/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144539326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Melatonin Use in the ICU: A Systematic Review and Meta-Analysis.","authors":"Brian Hao Yuan Tang, Judith Manalo, Saifur R Chowdhury, J Matthew Aldrich, Gerald L Weinhouse, Makayla Cordoza, Patricia R Louzon, Michele C Balas, Joanna L Stollings, Molly McNett, Karin Dearness, Jose Estrada-Codecido, Dipayan Chaudhuri, Kallirroi Laiya Carayannopoulos, Kimberley Lewis","doi":"10.1097/CCM.0000000000006767","DOIUrl":"10.1097/CCM.0000000000006767","url":null,"abstract":"<p><strong>Objectives: </strong>Melatonin has wide-ranging effects on the body, including the regulation of circadian rhythm, and potentiation of cellular immune and antioxidant activities. In critically ill patients, endogenous melatonin has been shown to be markedly deranged and reduced. Therefore, the purpose of this systematic review and meta-analysis was to determine if exogenous supplementation of melatonin improves patient-centered outcomes.</p><p><strong>Data sources: </strong>We searched five electronic databases.</p><p><strong>Study selection: </strong>Randomized clinical trials (RCTs) that compared melatonin to no melatonin in adults admitted to the ICU were identified.</p><p><strong>Data extraction: </strong>We aggregated data as relative risks, mean differences (MDs), and standard mean differences (SMDs) using a random-effects model. Supporting evidence for each effect was evaluated for certainty using the Grading Recommendations, Assessment, Development, and Evaluations approach.</p><p><strong>Data synthesis: </strong>In total, 32 RCTs ( n = 3895 patients) were included. We found that melatonin may reduce delirium (relative risk [RR] 0.72; 95% CI, 0.58-0.89; low certainty), may slightly reduce ICU length of stay (MD -0.57 d; 95% CI, -0.95 to -0.18 d; low certainty), and may improve reported sleep quality (SMD 0.54; 95% CI, 0.01-1.07; low certainty). Melatonin may result in a slight reduction in the frequency of adverse events (low certainty). Evidence was uncertain with regards to the frequency of sleep awakenings, anxiety level, agitation, and post-traumatic stress disorder incidence (all very low certainty), as well as to ICU mortality and post-ICU functional status (both low certainty).</p><p><strong>Conclusions: </strong>Our findings suggest that melatonin administration in the critically ill may improve perceived sleep and reduce delirium, without increasing adverse effects. Certainty of evidence was negatively affected by the risk of bias and inconsistency. Future RCTs should focus on identifying optimal dosing, administration timing, improving measurements of sleep outcomes, and target populations.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e1714-e1724"},"PeriodicalIF":6.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144636433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Consideration of Sociodemographics in Sepsis Risk Prediction: Implications and Next Steps.","authors":"Deepshikha C Ashana, William F Parker","doi":"10.1097/CCM.0000000000006777","DOIUrl":"10.1097/CCM.0000000000006777","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e1833-e1835"},"PeriodicalIF":6.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12313254/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144648716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Melatonin Use in the ICU: Mind the (Evidence) Gaps.","authors":"John W Devlin, Mark E Mikkelsen","doi":"10.1097/CCM.0000000000006775","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006775","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":"53 9","pages":"e1821-e1823"},"PeriodicalIF":6.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}