Critical Care Medicine最新文献

{"title":"Surviving Sepsis: Don't Break the Chain.","authors":"Luciano Cesar Pontes Azevedo","doi":"10.1097/CCM.0000000000006832","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006832","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":"144820771","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":"Effects of Preoxygenation With Intratracheal Suctioning During Extubation: An Alternating Cluster-Controlled Trial (INtratracheal suctioning and oxygenation AT Extubation [INNOVATE]).","authors":"Josef Prazak, Noëlle Valérie Schenk, Joerg C Schefold, Kaspar F Bachmann, David Berger","doi":"10.1097/CCM.0000000000006819","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006819","url":null,"abstract":"<p><strong>Objective: </strong>Extubation is a critical event for patients in the ICU. Preoxygenation and intratracheal suctioning during extubation may contribute to atelectasis. However, evidence concerning extubation procedures and their impact on patient outcomes is limited. This study aimed to compare two extubation strategies: one using preoxygenation with 100% Fio2 combined with intratracheal suctioning, and the other using a low Fio2 (35%) without suctioning.</p><p><strong>Design: </strong>A single-center, alternating cluster-controlled trial.</p><p><strong>Setting: </strong>Tertiary level interdisciplinary adult ICU.</p><p><strong>Patients: </strong>A total of 3,675 patients were randomized into two groups: 1) Fio2 100% with suctioning (n = 1,877, 51.1%) and 2) Fio2 35% without suctioning (n = 1,798, 48.9%).</p><p><strong>Interventions: </strong>Comparison of two extubation strategies: Fio2 100% with suctioning vs. Fio2 35% without suctioning.</p><p><strong>Measurements and main results: </strong>The primary outcome was a composite of reintubation and/or noninvasive ventilation within 48 hours after extubation. Secondary outcomes included the components of the primary endpoint, the need for nasal high-flow oxygenation or changes in the ratio of arterial oxygen partial pressure to fractional inspired oxygen (P/F ratio) after extubation. Differences in outcomes were assessed via adjusted logistic or linear regression models. The low Fio2/no suctioning strategy resulted in a 23% reduction in the primary outcome (odds ratio 0.77; 95% CI, 0.60-0.98; p = 0.032) compared with the high Fio2/suctioning group. In addition, the P/F ratio in the low Fio2/no suctioning group was significantly higher, with an estimated mean difference of 4.72 kPa (95% CI, 4.12-5.32; p < 0.001).</p><p><strong>Conclusions: </strong>Extubation with a low-inspired oxygen fraction and without suctioning appears safe and may improve patient-relevant outcomes. Further research is necessary to optimize Fio2 settings and secretion management during extubation in critically ill patients.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144793700","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":"Rethinking Risk: How Body Mass Index Shapes the Impact of Frailty in Critical Care.","authors":"Snigdha Jain, Michaela R Anderson","doi":"10.1097/CCM.0000000000006820","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006820","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144793701","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 Aftermath of Acute Surge Events: Quantifying the \"Bystander Effect\" During the COVID-19 Pandemic.","authors":"George L Anesi, Rachel Kohn","doi":"10.1097/CCM.0000000000006821","DOIUrl":"10.1097/CCM.0000000000006821","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144788471","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":"Supplemental Prevention of Sepsis?","authors":"Alison E Fox-Robichaud","doi":"10.1097/CCM.0000000000006823","DOIUrl":"10.1097/CCM.0000000000006823","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144788470","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 Comprehensive Medication Management on Mortality in Critically Ill Patients.","authors":"Andrea Sikora, Wanyi Min, John W Devlin, Mengxuan Hu, David J Murphy, Brian Murray, Bokai Zhao, Ye Shen, Xianyan Chen, Susan E Smith, Sandra Rowe, Tianming Liu, Sheng Li","doi":"10.1097/CCM.0000000000006802","DOIUrl":"10.1097/CCM.0000000000006802","url":null,"abstract":"<p><strong>Objectives: </strong>Medication management in the ICU is causally linked to both treatment success and adverse drug events. The purpose of this evaluation was to explore the effect of comprehensive medication management (CMM) on mortality in critically ill patients.</p><p><strong>Design: </strong>Retrospective, observational, propensity-matched cohort study.</p><p><strong>Setting: </strong>Adult ICUs at the Oregon Health Sciences University.</p><p><strong>Patients: </strong>Consecutive adults admitted to an ICU greater than or equal to 24 hours between June 1, 2020, and June 7, 2023, with available pharmacist intervention data.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>CMM was measured by documented critical care pharmacist (CCP) medication interventions. Propensity score matching was performed to generate a balanced 1:1 matched cohort, and logistic regression was applied for estimating propensity scores. The primary outcome was the odds of hospital mortality. Hospital and ICU length of stay were also assessed. In a cohort of 10,441 ICU patients, the unadjusted mortality rate was 11% with a mean Acute Physiology and Chronic Health Evaluation II score of 9.54 ± 4.18 and Medication Regimen Complexity-ICU (MRC-ICU) score of 5.78 ± 4.09. Compared with CCP interventions less than 3, more CCP interventions was associated with a significantly reduced risk of mortality (estimate, -0.04; 95% CI, -0.06 to -0.03; p < 0.01) and shorter length of ICU stay (estimate, -2.77; 95% CI, -2.98 to -2.56; p < 0.01).</p><p><strong>Conclusions: </strong>The quantity of CCP-delivered CMM in the ICU is directly associated with reduced hospital mortality independent of patient characteristics and MRC.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144788458","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":"Hyperoxia and End-Organ Complications Among Cardiogenic Shock Patients Supported by Veno-Arterial Extracorporeal Membrane Oxygenation.","authors":"Jeffrey Wang, Apoorva Gangavelli, Joseph E Tonna, J Trent Magruder, Akram M Zaaqoq, Suraj Yalamuri, P Elliott Miller, Jacob C Jentzer","doi":"10.1097/CCM.0000000000006810","DOIUrl":"10.1097/CCM.0000000000006810","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate whether severe hyperoxia predisposes to end-organ complications and whether these complications contribute to in-hospital mortality among cardiogenic shock (CS) patients supported in veno-arterial extracorporeal membrane oxygenation (VA-ECMO).</p><p><strong>Design: </strong>Adult patients with CS from the Extracorporeal Life Support Organization Registry between 2010 and 2023 were categorized into normoxia (Pa o2 60-150 mm Hg), mild hyperoxia (Pa o2 151-300 mm Hg), and severe hyperoxia (Pa o2 > 300 mm Hg) based on their Pa o2 at 24 hours. The primary outcome was in-hospital mortality. End-organ complications were analyzed using multivariate logistic regression models, and causal mediation analysis was performed to estimate the direct and indirect effects of hyperoxia on mortality.</p><p><strong>Setting: </strong>Multicenter, multinational prospective cohort study.</p><p><strong>Patients: </strong>Adults with CS supported on VA-ECMO.</p><p><strong>Interventions: </strong>Partial pressure of oxygen at 24 hours after VA-ECMO cannulation.</p><p><strong>Measurements/main results: </strong>A total of 10,541 patients were included (normoxia: 48.4%, mild hyperoxia: 30.0%, severe hyperoxia: 21.5%). There was higher in-hospital mortality in patients with severe hyperoxia (71.7%, adjusted OR [aOR]: 2.17; 95% CI, 1.19-2.50) and mild hyperoxia (63.8%, aOR: 1.34; 95% CI, 1.19-1.50) compared normoxia (52.7%; referent group). Severe hyperoxia was associated with more end-organ complications, which incrementally predicted higher mortality (aOR: 1.42; 95% CI, 1.25-1.61). Mediation analysis demonstrated that hyperoxia primary exerted a direct effect on mortality (86%), with contributions from neurologic (3.1%), hepatic (3.9%), renal (3.5%), and bleeding (2.3%) complications.</p><p><strong>Conclusions: </strong>Severe hyperoxia in patients with CS receiving VA-ECMO is associated with increased mortality and more end-organ complications. However, most of the effect of severe hyperoxia on mortality occurs via direct effects, independent of end-organ complications. These findings highlight the potential direct toxicity of hyperoxia and underscore the need for strategies to optimize oxygen delivery in this critically ill population.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144788468","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":"Reframing Prone Positioning in Acute Respiratory Distress Syndrome: Mechanical Power as a Physiologic Biomarker of Response.","authors":"Rachel Bennett, Akram Khan","doi":"10.1097/CCM.0000000000006824","DOIUrl":"10.1097/CCM.0000000000006824","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144788469","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":"Acetylcholinesterase Inhibitors for Delirium Prevention: A Systematic Review and Meta-Analysis.","authors":"Leonardo Zumerkorn Pipek, Giovanna Salema Pascual, Rafaela Farias Vidigal Nascimento, Guilherme Diogo Silva, Luiz H Castro","doi":"10.1097/CCM.0000000000006786","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006786","url":null,"abstract":"<p><strong>Objectives: </strong>Delirium is a frequent complication in hospitalized patients, particularly in older adults, and is associated with significant morbidity and mortality. Acetylcholinesterase inhibitors (AChEIs) have been proposed as potential agents to reduce occurrence and severity of delirium. This study aimed to evaluate the efficacy of AChEIs for both prophylaxis and treatment of delirium in hospitalized patients.</p><p><strong>Data sources: </strong>We searched PubMed, Embase, and Web of Science. The study was registered on PROSPERO (CRD42024563798).</p><p><strong>Study selection: </strong>Studies comparing AChEIs and placebo for delirium in hospitalized patients.</p><p><strong>Data extraction: </strong>The main outcome of interest was delirium occurrence, while secondary outcomes included duration, severity, and hospital length of stay (LOS).</p><p><strong>Data synthesis: </strong>Subgroup analyses were performed based on prophylaxis or treatment of delirium. Statistical analysis was performed in RStudio 4.4.0 with a random effects model, and heterogeneity was assessed with I2. Risk of Bias 2 was used for bias assessment. We screened 1306 records and included ten studies: eight studies focusing on prophylaxis after surgery and two on treatment of established delirium. A total of 731 patients were analyzed: 365 in the AChEIs group and 366 in the placebo group. AChEIs significantly reduced delirium occurrence (risk ratio = 0.68 [0.47-0.98]; p = 0.039). No significant effects were observed for delirium duration (mean difference [MD] = -0.16 d [-0.9 to 0.62 d]; p = 0.23), delirium severity (standardized mean difference [SMD] = -0.08 [-0.58 to 0.41]; p = 0.74), or LOS (MD = -0.82 d [-2.03 to 0.40 d]; p = 0.19). Subgroup analysis showed a tendency for better outcomes when AChEIs were used as prophylaxis, with a significant reduction in delirium duration in this subgroup (SMD= -0.32 [-0.56 to -0.07]; p < 0.01). No significant differences in adverse events were identified.</p><p><strong>Conclusions: </strong>AChEIs are effective in reducing occurrence of delirium when used prophylactically in patients undergoing elective surgery. AChEIs did not significantly impact on delirium duration, severity, or hospital LOS. Further studies are needed to explore the potential benefits or harms of AChEIs in different patient populations and settings.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144774846","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":"An IV Sodium Bicarbonate Shortage in the Critically Ill: An Interrupted Time-Series Analysis.","authors":"Amanda Y Leong, Andrea Soo, Andrew Bond, Hannah Wunsch, Danny J Zuege, Sean M Bagshaw, Henry T Stelfox, Daniel J Niven","doi":"10.1097/CCM.0000000000006813","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006813","url":null,"abstract":"<p><strong>Objective: </strong>To examine effects of the 2017 worldwide shortage of IV sodium bicarbonate on outcomes of critically ill adults with acidemia.</p><p><strong>Design: </strong>Interrupted time-series analysis.</p><p><strong>Setting: </strong>Seventeen adult ICUs in Alberta, Canada.</p><p><strong>Patients: </strong>Adults (≥ 18 yr) with blood pH value of less than 7.3, admitted to study ICUs between June 1, 2015, and 31 December 2019.</p><p><strong>Interventions: </strong>The 2017 sodium bicarbonate shortage occurred between 8 June and October 4, 2017. Our health authority enacted emergency conservation measures during this time.</p><p><strong>Measurements and main results: </strong>The main data source was eCritical Alberta, a population-based ICU Registry. The primary outcome was the proportion of patients treated with IV sodium bicarbonate. Outcomes were examined via segmented regression. Among 18,865 admissions, median age was 62 years (interquartile range [IQR] 50-71), median Acute Physiology and Chronic Health Evaluation (APACHE) II was 23 (IQR 18-30), and 39.6% were female. Immediately after start of the shortage, patients treated with bicarbonate decreased from 29.3% to 21.5% (absolute -7.8%; 95% CI, -12.8 to -2.8%). During the shortage bicarbonate recipients more likely had pH less than or equal to 7.20 (78.8% vs. 69.0%, p < 0.01). Subgroup analysis among those with pH less than or equal to 7.20 who did not receive bicarbonate during the shortage suggested increased proportion treated with vasopressors (9.9%; 95% CI, 2.4-17.4%) and continuous renal replacement therapy (8.6%; 95% CI, 0.6-16.6%). Similar trends were observed among those with renal sequential organ failure assessment greater than or equal to 3 who did not receive bicarbonate during the shortage. There was no change in ICU length of stay or mortality in overall population or subgroups.</p><p><strong>Conclusions: </strong>Emergency conservation measures that accompanied a worldwide shortage of IV sodium bicarbonate were associated with a reduction in IV sodium bicarbonate use among critically ill patients with acidemia. This was not linked to changes in survival or length of stay outcomes. Future bicarbonate research should focus on subgroups such as those with severe acidemia and/or advanced renal insufficiency.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144774847","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}