Critical Care Medicine最新文献

{"title":"Differentiating Lung From Chest Wall Mechanics Is Difficult Without Esophageal Manometry in Children With Acute Respiratory Distress Syndrome.","authors":"Yukie Ito, Meryl Vedrenne-Cloquet, Daniel Chang, Justin C Hotz, Miyako Kyogoku, Muneyuki Takeuchi, Rutger C Flink, Anoopindar K Bhalla, Christopher J L Newth, Robinder G Khemani","doi":"10.1097/CCM.0000000000006839","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006839","url":null,"abstract":"<p><strong>Objectives: </strong>Pediatric acute respiratory distress syndrome (PARDS) guidelines recommend limiting airway plateau pressure (Pplat) to 28 cm H2O, allowing for higher limits when chest wall compliance (CCW) is poor since less of the pressure is transmitted to lung (transpulmonary pressure). Transpulmonary pressure depends on Pplat and the ratio of lung elastance to respiratory system elastance (EL/ERS). EL/ERS measurement requires esophageal manometry, although it is not routinely available. We sought to determine if routinely available clinical data could reliably predict EL/ERS or changes in EL/ERS, to understand when Pplat greater than 28 cm H2O could be acceptable.</p><p><strong>Design: </strong>Secondary analysis of randomized controlled trial with esophageal manometry monitoring.</p><p><strong>Setting: </strong>Quaternary PICU.</p><p><strong>Patients: </strong>Mechanically ventilated children with PARDS.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Two hundred seven patients and 750 patient days were included. Using the first day per patient, median EL/ERS was 0.83 (interquartile range, 0.72-0.87), with a weak negative correlation with respiratory system compliance (CRS) (r = -0.26; p < 0.001). CRS was strongly correlated with lung compliance (Cl) (r = 0.94; p < 0.001) and moderately correlated with CCW (r = 0.53; p < 0.001). Multivariable analysis identified that higher CRS, younger age and peripheral neuromuscular disease were associated with higher CCW, while higher CRS was the only variable independently associated with higher Cl (all p < 0.01). When trying to predict high (> 0.9) or low (< 0.7) EL/ERS, CRS was the only variable retaining an independent association: lower CRS (CRS × 10 [mL/cm H2O/kg × 1/10]) with high EL/ERS (odds ratio [OR], 0.70; 95% CI, 0.54-0.86; p = 0.002; area under the receiver operating characteristic curve [AUC], 0.73) and higher CRS (CRS × 10 [mL/cm H2O/kg × 1/10]) with low EL/ERS (OR, 1.14; 95% CI, 1.02-1.28; p = 0.017; AUC, 0.60). Change in EL/ERS from day to day was not predictable.</p><p><strong>Conclusions: </strong>In PARDS, CRS is more strongly tied to Cl than CCW. While EL/ERS is not easily predictable from clinical variables, when CRS is low, EL/ERS is generally high. Therefore, increasing Pplat above the suggested thresholds when CRS is impaired may be inappropriate without measuring esophageal pressure.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144854808","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":"Multimodal Noninvasive Monitoring of Arterial Pressure: Do Limitations of Finger Cuff Monitoring Compromise Upper Arm Measurements? A Post Hoc Analysis of Two Prospective Cohorts.","authors":"Karim Lakhal, Jérôme E Dauvergne, Grégoire Muller, Stephan Ehrmann, Thierry Boulain","doi":"10.1097/CCM.0000000000006841","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006841","url":null,"abstract":"<p><strong>Objectives: </strong>To assess the reliability of conventional automated oscillometric upper arm cuff (cuffARM): 1) when finger cuff monitoring (cuffFINGER) of arterial pressure (AP) is suspected to be unreliable due to poor fingertip perfusion and/or hand edema or 2) fails to provide a reading.</p><p><strong>Design: </strong>Prospective observational study based on cohorts evaluating the CNAP (Dräger Medical) and ClearSight (Edwards Lifesciences) systems.</p><p><strong>Setting: </strong>Three ICUs.</p><p><strong>Patients: </strong>Adults with an arterial catheter and stable AP.</p><p><strong>Interventions: </strong>Three sets of triplicate AP measurements-simultaneous readings from the cuffFINGER, cuffARM and, as a reference, arterial catheter-were collected for each patient.</p><p><strong>Measurements and main results: </strong>We analyzed 352 patients: 214 with the CNAP and 138 with the ClearSight cuffFINGER. In the 102 patients (29%) with poor fingertip perfusion-defined as a capillary refill time greater than 4 seconds-and/or hand edema, cuffARM mean AP measurements (n = 304) never failed, met the International Organization for Standardization (ISO) 81060-2:2018 standard (bias ± sd: 2.2 ± 7.2 mm Hg), posed no or low risk of harm in 99.7% of cases, and demonstrated good ability to detect hypotension and hypertension (area under the receiver operating characteristic curve, 0.91 [95% CI, 0.87-0.94] and 0.92 [95% CI, 0.75-1], respectively). In these 102 patients, cuffFINGER failed to display a reading in 17 patients (17%), and if not, did not meet the ISO 81060-2:2018 standard. In 38 of 352 patients (11%) in whom the cuffFINGER failed to display an AP measurement, cuffARM met the ISO 81060-2:2018 standard for mean AP (bias ± sd: 1.7 ± 7.1 mm Hg). In the absence of failure and risk factors for erroneous measurements, ClearSight met the ISO 81060-2:2018 standard for mean AP, unlike the CNAP system.</p><p><strong>Conclusions: </strong>In a multimodal, noninvasive strategy for AP monitoring, ClearSight cuffFINGER may be suitable as a first-line tool due to its continuous nature. When unreliable or unavailable, cuffARM provides reliable measurements, effectively detects hypotension and hypertension, and poses no significant risk to the patient.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144854713","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":"Effect of Enhanced Versus Usual Mobilization Activities in Critically Ill Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.","authors":"Kallirroi Laiya Carayannopoulos, Dipayan Chaudhuri, Molly McNett, Michele C Balas, Michelle E Kho, Joanna Stollings, Bethany Young, Anna Krupp, Amy J Kim, Saifur R Chowdhury, Jason Z X Chen, Paige Harris, Sonya Kim, Jude Manalo, Etri Kocaqi, Karin Dearness, J Matthew Aldrich, Kimberley Lewis","doi":"10.1097/CCM.0000000000006840","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006840","url":null,"abstract":"<p><strong>Objectives: </strong>To conduct a systematic review and meta-analysis to capture updated evidence regarding the benefits and harms of enhanced mobilization activities and explore whether specific approaches may be more beneficial than others.</p><p><strong>Data sources, study selection, and data extraction: </strong>This study was prospectively registered PROSPERO: CRD42024550360. Parallel group randomized controlled trials (RCTs) that included adult patients (≥ 18 yr old) admitted to the ICU were included. The intervention group was required to receive enhanced mobilization activities above usual care while in the ICU, while the control group received usual care, which was required to include some degree of mobilization. Four databases and two trial registries were searched until May 2024. Review and data extraction of all potentially eligible articles was performed independently and in duplicate. The Grading of Recommendations Assessment, Development, and Evaluation approach was used to assess the quality of evidence for each outcome.</p><p><strong>Data synthesis: </strong>Fifty-nine RCTs (n = 8462) met eligibility criteria. Enhanced mobilization activities may reduce the incidence of ICU-acquired weakness (risk ratio, 0.79; 95% CI, 0.66-0.95; moderate certainty), duration of delirium (mean difference [MD], -1.34 d; 95% CI, -1.85 to -0.83; low certainty), and duration of invasive mechanical ventilation (MD, -1.07 d; 95% CI, -1.64 to -0.50 d; moderate certainty). ICU and hospital length of stay may also be slightly reduced by enhanced mobilization (low certainty). Enhanced mobilization may result in little to no difference in adverse events (low certainty).</p><p><strong>Conclusions: </strong>This review demonstrates that enhanced mobilization likely reduces the incidence of ICU-acquired weakness and may reduce duration of delirium, while supporting prior findings that there is little to no difference in risk of adverse events. Early mobilization may be the most promising avenue for optimizing mobilization activities and raise the question of whether the key to improving outcomes lies in early exposure to these activities rather than increased intensity.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144854709","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":"Mortality Trends Across Key Diagnostic Groups in Australian and New Zealand ICUs Over the Past 30 Years.","authors":"Julia K Pilowsky, Ryo Ueno, Josh McLarty, David Pilcher, Michael Bailey, Alastair Brown","doi":"10.1097/CCM.0000000000006817","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006817","url":null,"abstract":"<p><strong>Objectives: </strong>The Australia and New Zealand Intensive Care Society (ANZICS) Adult Patient Database (APD) has been operational for 3 decades. It is important to understand how mortality outcomes have changed across diagnostic groups over time to facilitate the planning of future healthcare resources. We evaluated the trends in risk-adjusted mortality for ICU patients over the last 30 years.</p><p><strong>Design: </strong>A retrospective cohort study.</p><p><strong>Setting: </strong>All ICUs in Australia and New Zealand that contributed data to the ANZICS APD from January 1993 to December 2022.</p><p><strong>Patients: </strong>Adult patients (≥ 16 yr) admitted to Australian and New Zealand ICUs.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>The final cohort included 2,838,654 patients from 209 ICUs. Compared with the first decade patients admitted during the final decade of the study were older (60.0 yr [18.2 yr] vs. 62.0 yr [17.8 yr]), more often had a least one major comorbidity (23.2% vs. 25.2%), and had higher Acute Physiology and Chronic Health Evaluation III scores (45.6 [28.1] vs. 50.9 [24.1]). The five diagnostic groups with the highest mortality rates were cardiac arrest (53.6%), stroke and intracranial hemorrhage (34.8%), subarachnoid hemorrhage (21.2%), pneumonia (19.2%), and sepsis (19%). Risk-adjusted mortality decreased until 2010 but then plateaued. Cardiac arrest saw the greatest improvement in risk-adjusted mortality between the third vs. first study decades (odds ratio [OR], 0.82 [0.81-0.83]), while pneumonia saw the least (OR, 0.87 [0.87-0.88]). The pattern of improvement for most diagnostic groups were similar; however, mortality from stroke and intracranial hemorrhage continued to improve, whereas mortality from cardiac arrest appears to have increased over the past 10 years.</p><p><strong>Conclusions: </strong>There have been substantial improvements in risk-adjusted mortality among ICU patients over the past 30 years; however, this improvement has plateaued recently. The reasons for this plateau warrant further investigation.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144854712","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":"Lung Ultrasound Findings and Algorithms to Detect Pneumonia: A Systematic Review and Diagnostic Testing Meta-Analysis.","authors":"Eduardo Messias Hirano Padrao, Bruno Caldeira Antonio, Tiffany Alexis Gardner, Isabele Ayumi Miyawaki, Cintia Gomes, Jose Eduardo Riceto Loyola Junior, Marianna Daibes Rachid de Andrade, Isabela Reis Marques, Isabela Azevedo Ferreira de Souza, Caroliny Hellen Azevedo da Silva, Vittoria Caporal Salles Moreira, Brian Pablo Bustos, Augusto Barreto do Amaral Neto, Jonah Rubin","doi":"10.1097/CCM.0000000000006818","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006818","url":null,"abstract":"<p><strong>Objective: </strong>Lung ultrasound is increasingly used for diagnosing pneumonia due to its accessibility, low cost, and lack of radiation exposure. This systematic review and meta-analysis aimed to evaluate the diagnostic accuracy of individual lung ultrasound findings and algorithms for pneumonia across various clinical settings compared with chest radiography and CT.</p><p><strong>Data sources: </strong>We systematically searched PubMed, Embase, and Cochrane databases.</p><p><strong>Study selection and data extraction: </strong>We searched for studies assessing the sensitivity and specificity of lung ultrasound findings and algorithms for pneumonia. Studies including adult patients with community-acquired, hospital-acquired, or ventilator-associated pneumonia (VAP) were eligible. Data on sensitivity, specificity, and likelihood ratios for ultrasonographic findings and algorithms were pooled using bivariate linear mixed models and Bayesian analyses. The risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool.</p><p><strong>Data synthesis: </strong>Twenty-six studies, totaling 3454 patients, were included. The Bed Lung Ultrasound in Emergency (BLUE) protocol demonstrated the highest sensitivity (0.88; 95% CI, 0.84-0.92) among all criteria studies, whereas dynamic air bronchograms had the highest specificity (0.96; 95% CI, 0.91-0.99). Focal B-lines had low sensitivity (0.24; 95% CI, 0.12-0.43) and high specificity (0.96; 95% CI, 0.86-0.99). Sensitivity analyses indicated reduced specificity for lung ultrasound in patients with VAP across all evaluated criteria. Bayesian analyses yielded consistent results across different prior assumptions.</p><p><strong>Conclusions: </strong>Lung ultrasound demonstrates good diagnostic performance for detecting community-acquired and hospital-acquired pneumonia. However, its utility in diagnosing VAP is limited, suggesting the need for complementary diagnostic tools in this patient group. This underscores the importance of lung ultrasound as a frontline diagnostic tool for pneumonia. To the best of our knowledge, this is the first meta-analysis to evaluate the specificity and sensitivity of each specific finding identified by lung ultrasound.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144854711","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":"Obesity- and Lipid-Related Traits May Causally Contribute to Sepsis-Associated Acute Kidney Injury.","authors":"Kyle R Campbell, Nozomi Takahashi, Tadanaga Shimada, Taka-Aki Nakada, James A Russell, Keith R Walley","doi":"10.1097/CCM.0000000000006812","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006812","url":null,"abstract":"<p><strong>Objectives: </strong>Acute kidney injury (AKI) is a major complication of sepsis resulting in substantial morbidity and mortality. We used genome-wide association study (GWAS) data together with Mendelian randomization (MR) analysis in multiple cohorts of different ancestries to identify traits potentially contributing to sepsis-associated AKI (Septic-AKI).</p><p><strong>Design: </strong>Natural experiment and case-control study.</p><p><strong>Setting: </strong>ICU patients, FinnGen (finngen.fi), and U.K. Biobank participants.</p><p><strong>Patients: </strong>Adults with sepsis or septic shock.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>We conducted a discovery GWAS in the U.K. Biobank by selecting, after quality control, 4584 European Septic-AKI patients as cases, and 7090 European sepsis patients without AKI as controls. Causal inference analyses using two sample MR combined these GWAS results with Integrative Epidemiology Unit Open Genome-Wide Association Studies results for 118 clinical risk factors and 386 metabolites and, separately, for 13 lipid classes from FinnGen GWAS results. We tested for replication of positive findings in two independent genotyped septic shock cohorts (Vasopressin and Septic Shock Trial [VASST] cohort n = 632 and Japanese Septic Shock Cohort [Chiba] cohort n = 536). Variants in the GALNTL6 gene were associated with Septic-AKI (rs149773593; odds ratio = 2.18; p = 3.0 × 10-8) in U.K. Biobank patients. GALNTL6 is associated with cardiometabolic traits, which we then focused on. Increased body mass index was associated with increased serum creatinine in both septic shock cohorts (p < 0.0001). Obesity and metabolic traits, most frequently related to very low-density lipoprotein, were identified as potentially causal contributors to Septic-AKI. Combining these GWAS results with FinnGen GWAS results identified associations with Septic-AKI, which replicated in both independent septic shock cohorts, for cholesterol ester (p = 4.8 × 10-44), lysophosphatidylcholine (p = 8.5 × 10-54), phosphatidylcholine (p = 2.7 × 10-39), and phosphatidylethanolamine (p = 2.1 × 10-28).</p><p><strong>Conclusions: </strong>For Septic-AKI, GWAS identified a novel genetic susceptibility locus (GALNTL6), which is also associated with cardiometabolic traits. We then further found that obesity- and lipid-related traits are possible contributors to the pathogenesis of Septic-AKI.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144854820","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":"Shock First, Epinephrine Later: Rethinking Resuscitation Priorities in Pediatric In-Hospital Cardiac Arrest With Shockable Rhythms.","authors":"Julia Garcia Mancebo, Cameron Dezfulian, Venessa L Pinto","doi":"10.1097/CCM.0000000000006829","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006829","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144834409","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":"Machine Learning to Predict Individualized Treatment Effects of Sodium Bicarbonate for Patients With Out-of-Hospital Cardiac Arrest.","authors":"Chi-Hsin Chen, Cheng-Yi Fan, Yi-Chien Kuo, Chih-Hung Wang, Hung-Wen Chiu, Edward Pei-Chuan Huang","doi":"10.1097/CCM.0000000000006792","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006792","url":null,"abstract":"<p><strong>Objectives: </strong>Current evidence regarding the effect of sodium bicarbonate (SB) on patients with out-of-hospital cardiac arrest (OHCA) remains unclear. This study aimed to develop a machine-learning model to predict the individualized treatment effect (ITE) of SB use in OHCA patients.</p><p><strong>Design: </strong>An eXtreme Gradient Boosting-based causal forest model was developed using an 8-year retrospective OHCA database after propensity score matching (PSM) for age, serum potassium, pH, bicarbonate, and Pco2 level.</p><p><strong>Setting: </strong>Multicenter study across three hospitals affiliated with the National Taiwan University Hospital system.</p><p><strong>Patients: </strong>Adult patients with nontraumatic OHCA.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>The main outcome was any return of spontaneous circulation (ROSC) following resuscitation in the emergency department. Covariates included age, sex, witness status, bystander cardiopulmonary resuscitation, arrest location, response time, scene-to-hospital time, defibrillation using automatic external defibrillators, prehospital advanced airway type and epinephrine administration, initial cardiac rhythm, and laboratory data. The PSM cohort included 2368 patients. The ROSC rate was not different between the SB-treated and untreated groups. The predicted ITE ranged from a 24.7% absolute increase to a 28.3% absolute reduction in ROSC when SB was administered. The tertile of the predicted ITE significantly modified the effect of the original clinician treatment assignment on outcome (p < 0.001), and it can discriminate patients who benefit from SB better than random allocation when assessed by the Qini curve and C-for-benefit (0.61). Factors associated with higher predicted benefit from SB administration included older age, poorer renal function, longer scene-to-hospital time, metabolic acidosis, and hyperkalemia.</p><p><strong>Conclusions: </strong>This study suggests the heterogeneous effects of SB on ROSC rates in patients with OHCA. The developed model may help identify specific subgroups more likely to benefit or be harmed by treatment. Further external validations and clinical trials are still needed to evaluate the model.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144834408","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":"Justifying Pharmacist Services in the ICU: When Is Enough, Enough?","authors":"Eric W Mueller, Sandra L Kane-Gill","doi":"10.1097/CCM.0000000000006831","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006831","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144820770","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":"The Association Between Patient-Ventilator Asynchrony and Clinical Outcomes in Mechanically Ventilated Patients: A Systematic Review.","authors":"Melissa J de Bie, Petra J Rietveld, Franciska van der Velde-Quist, Nan van Geloven, Jacob W M Snoep, Evert de Jonge, Abraham Schoe","doi":"10.1097/CCM.0000000000006816","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006816","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate associations between patient-ventilator asynchrony (PVA) and clinical outcome measures.</p><p><strong>Data sources: </strong>For this systematic review, the databases of PubMed, Web of Science, Embase, Cochrane Library, and Emcare were screened until June 20, 2024.</p><p><strong>Study selection: </strong>The main inclusion criterion was the assessment of the association of PVA with clinical outcome measures (length of ICU stay, mechanical ventilation duration, and mortality).</p><p><strong>Data extraction: </strong>All forms of PVA subtypes reported in the articles were systematically collected. Furthermore, the method used to identify asynchrony and the clinical outcomes described were recorded from each study.</p><p><strong>Data synthesis: </strong>A total of 19 studies were included with a total of 2672 patients. The results of the meta-analysis show that overall PVA and ineffective triggering and double triggering are associated with a longer duration of mechanical ventilation (mean difference, 3.29 d; 95% CI, 0.13-6.44 d), and with a longer ICU length of stay (mean difference, 3.65 d; 95% CI, 1.20-6.11 d). No association was found between PVA and mortality. In addition, reverse triggering appears to have a potential positive association with outcome.</p><p><strong>Conclusions: </strong>PVA and specifically ineffective triggering and double triggering, are associated with a longer duration of mechanical ventilation and longer ICU length of stay.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144820772","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}