Critical Care Medicine最新文献

{"title":"Proton Pump Inhibitors and the Upside Down.","authors":"Adam M Deane","doi":"10.1097/CCM.0000000000006747","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006747","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144282784","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":"P0.1 is an Unreliable Measure of Effort in Support Mechanical Ventilation in Comparison With Esophageal-Derived Measures of Effort: A Comparison Study.","authors":"Florence E Smits, Petra J Rietveld, Jacob W M Snoep, Franciska van der Velde-Quist, Evert de Jonge, Abraham Schoe","doi":"10.1097/CCM.0000000000006745","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006745","url":null,"abstract":"<p><strong>Objective: </strong>Respiratory effort should be assessed in patients on mechanical ventilation in support mode. With the insertion of esophageal balloons, it is possible to measure different parameters of effort, such as change in esophageal pressure (ΔPes), work of breathing (WOB), and pressure-time product (PTP). Although some studies advocate for the use of P0.1 as a measure of effort, there is significant controversy as it is considered more a measure of respiratory drive. This study investigates the correlation between P0.1 and esophageal-derived parameters of effort.</p><p><strong>Design: </strong>This was a retrospective observational comparison study.</p><p><strong>Setting: </strong>This study is conducted in the mixed medical-surgical ICU at the Leiden University Medical Center (Leiden, The Netherlands).</p><p><strong>Patients: </strong>Data were collected from 30 mechanically ventilated patients in spontaneous breathing mode.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>From each patient, a minimum of three different time frames of 5 minutes were used to collect the average values of P0.1, WOB, PTP, and ΔPes over this time frame. Statistical models accounting for repeated measurements were applied to assess correlations among these parameters. In total, 117 timeframes were analyzed from 39 patient cases. The analysis revealed poor correlations between P0.1, as measured in this study, and WOB (R2 = 0.111), PTP (R2 = 0.113), and ΔPes (R2 = 0.034), whereas the esophageal-derived parameters showed high correlations with each other (PTP vs. WOB, R2 = 0.886; ΔPes vs. WOB, R2 = 0.848; and ΔPes vs. PTP, R2 = 0.876).</p><p><strong>Conclusions: </strong>The results demonstrated poor correlations between P0.1 and the other effort parameters, whereas strong correlations were observed among ΔPes, WOB, and PTP. These findings underscore the need for careful consideration of monitoring tools to ensure appropriate assessment and management, and the importance of using esophageal catheters for accurate monitoring of respiratory effort, particularly in spontaneously breathing patients.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144607738","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 Machine Learning-Driven Sepsis Risk Prediction.","authors":"Katrina E Hauschildt, Annie Pan, Taylor Bernstein, Andrew J Admon, Bhramar Mukherjee, Theodore J Iwashyna, Lillian Rountree","doi":"10.1097/CCM.0000000000006741","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006741","url":null,"abstract":"<p><strong>Objectives: </strong>Use of machine learning (ML) and artificial intelligence (AI) in prediction of sepsis and related outcomes is growing. Guidelines call for explicit reporting of study data demographics and stratified performance analyses to assess potential sociodemographic bias. We assessed reporting of sociodemographic data and other considerations, such as use of stratified analyses or use of so-call \"fairness metrics\", among AI and ML models in sepsis.</p><p><strong>Data sources: </strong>PubMed identified systematic and narrative reviews from which studies were extracted using PubMed and Google Scholar.</p><p><strong>Study selection: </strong>Studies were extracted from selected review articles published between January 1, 2023, and June 30, 2024, and related to sepsis, risk prediction, and ML; we extracted studies predicting sepsis, sepsis-related outcomes, or sepsis treatment in adult populations.</p><p><strong>Data extraction: </strong>Data were extracted by two reviewers using predefined forms, and included study type, outcome of interest, setting, dataset used, reporting of sample sociodemographics, inclusion of sociodemographics as predictors, stratification by sociodemographics or assessment of fairness metrics, and reporting a lack of sociodemographic considerations as a limitation.</p><p><strong>Data synthesis: </strong>Thirteen of 96 review studies (14%) met inclusion criteria: six systematic reviews and seven narrative reviews. One hundred twenty of 170 studies (71%) extracted from these review articles were included in our review. Ninety-nine of 120 studies (83%) reported a measure of geography or where data was collected. Eighty (67%) reported sex/gender, 24 (20%) reported race/ethnicity, and 4 (3%) reported other sociodemographics. Only three stratified performance results (2%) by sociodemographics; none reported formal fairness metrics. Beyond a lack of geographic heterogeneity (39/120, 33%), few studies reported a lack of sociodemographic consideration as a limitation.</p><p><strong>Conclusions: </strong>The inclusion of sociodemographic data and stratified assessment of performance-essential steps in developing equitable risk prediction tools-are possible but have yet to be consistently adopted.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246868","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":"When Post-Intensive Care Syndrome Prevention Fails, Can Post-Discharge Rehabilitation Succeed?","authors":"Heidi Engel","doi":"10.1097/CCM.0000000000006734","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006734","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144233457","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":"Dyspnea Among Mechanically Ventilated Patients: A Systematic Review.","authors":"Kira A Grush, Ellie Svoboda, Peter J Dunbar, Arun Kannappan, Jenna Perrodin, Michael Z Root, Mark E Mikkelsen","doi":"10.1097/CCM.0000000000006664","DOIUrl":"10.1097/CCM.0000000000006664","url":null,"abstract":"<p><strong>Objectives: </strong>Dyspnea is a common and distressing symptom; yet, how frequently and intensely mechanically ventilated patients experience dyspnea remains unclear. We performed a systematic review to identify the prevalence and severity of dyspnea in communicative, mechanically ventilated critically ill adults. We also identified factors associated with dyspnea in the short-term and long-term and potential management strategies.</p><p><strong>Data sources: </strong>We performed a systematic search of the following databases: MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Web of Science Core Collection, PsycInfo, and CINAHL.</p><p><strong>Data extraction: </strong>Our search strategy used variations of these terms: dyspnea, mechanical ventilation, and critical care. We included prospective observational studies and randomized controlled trials. Two independent reviewers screened citations and extracted data using a predrafted report form to examine dyspnea prevalence and severity, association with short-term and long-term outcomes, and interventions to mitigate dyspnea.</p><p><strong>Data synthesis: </strong>Of 6290 records screened, we included 21 observational studies and 3 randomized controlled trials. We calculated percentages and 95% CIs for prevalence using Stata 17 se . Dyspnea was present in 475 of 1169 communicative, mechanically ventilated patients (40.6%, 95% CI, 37.8-43.5) and was found to be moderate to severe. In the lone study to examine long-term outcomes, dyspnea was associated with posttraumatic stress disorder (PTSD) at 90 days. Interventions to reduce dyspnea included: mechanical threshold inspiratory muscle training, ventilation adjustments, supplemental high-flow nasal cannula, opioids, hyperoxemia, and nonpharmacologic interventions, including music and fan therapy.</p><p><strong>Conclusions: </strong>In this systematic review, we found that dyspnea among mechanically ventilated patients is common and moderate to severe in its intensity. Dyspnea is associated with adverse long-term outcomes, including probable PTSD. Strategies to manage, or palliate, dyspnea were identified. Future study is warranted to examine how this information can be incorporated into clinical practice to improve short-term and long-term outcomes.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e1282-e1291"},"PeriodicalIF":7.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143965067","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":"Unseen But Urgent: Recognizing and Treating Dyspnea in Intubated Critically Ill Patients.","authors":"Maxens Decavèle, Alexandre Demoule","doi":"10.1097/CCM.0000000000006680","DOIUrl":"10.1097/CCM.0000000000006680","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e1320-e1322"},"PeriodicalIF":7.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143987173","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 authors reply.","authors":"Jaap Schuurmans, Santino R Rellum, Denise P Veelo, Alexander P J Vlaar, Jimmy Schenk","doi":"10.1097/CCM.0000000000006673","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006673","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":"53 6","pages":"e1338-e1339"},"PeriodicalIF":7.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144207901","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":"Beyond Hemoglobin Thresholds: A Retrospective Cohort Analysis of RBC Transfusion Decisions in ICU Patients.","authors":"Walter Sunny Dzik, Brian Healy, Maxwell Roth, Henry Paik, Patricia Brunker, Kristen Ruby, Julia Collins, Lorenzo Berra, Kenneth Shelton, Crystal M North, Robert Makar","doi":"10.1097/CCM.0000000000006666","DOIUrl":"10.1097/CCM.0000000000006666","url":null,"abstract":"<p><strong>Objectives: </strong>Blood transfusion is an essential therapy for patients receiving intensive care. The objective of the study was to better characterize the factors influencing the decision to transfuse RBCs during intensive care.</p><p><strong>Design: </strong>Retrospective cohort analysis using a new analytic method called decision time-interval analysis, which segments care into objectively defined sequential time intervals.</p><p><strong>Setting: </strong>Three ICUs during the period from January 2018 to June 2023.</p><p><strong>Patients: </strong>Adult ICU patients 18 years old or older.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>The pre-study planned outcome was the likelihood of RBC transfusion during each time interval of care. We analyzed 199,296 decision time-intervals occurring during 19,439 ICU encounters of 18,544 patients ranging in age from 18 to 103 years. The pre-transfusion hemoglobin concentration did not fully account for the likelihood of transfusion. Multivariable logistic regression analysis using either generalized linear mixed-effects or generalized estimating equations was used to model the impact of other clinical factors present at the time of the decision to transfuse for patients with hemoglobins in the 7-9 g/dL range. Factors that were significantly associated with an increased likelihood of transfusion included a decline in hemoglobin from the prior value, chest tube drainage, concurrent transfusion of plasma or platelets, prior RBC transfusion, use of extracorporeal membrane oxygenation, vasopressors, mechanical ventilation, renal replacement therapy, patient age, and male sex. The odds ratios for the principal clinical factors were significantly different in medical, surgical, and cardiac surgery ICUs.</p><p><strong>Conclusions: </strong>The decision to transfuse RBC during ICU care is multifactorial and not adequately explained by the pre-transfusion hemoglobin concentration alone. Our findings have direct relevance for clinical guidelines regarding transfusion care, the interpretation of prior studies of transfusion based on hemoglobin concentration, and the opportunity for predictive analytics to improve patient outcomes.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e1235-e1246"},"PeriodicalIF":7.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143728546","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":"Mechanical Power and Ventilator-Induced Lung Injury: A Step Forward.","authors":"Davide Chiumello, Francesca Panina","doi":"10.1097/CCM.0000000000006681","DOIUrl":"10.1097/CCM.0000000000006681","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e1323-e1325"},"PeriodicalIF":7.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143995376","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":"Breaking the Blind Spot in Prognostic Research on Cardiogenic Shock: A Multidimensional Interpretation of Right Bundle Branch Block and Left Bundle Branch Block.","authors":"Zhiling He, Quanfu Chen","doi":"10.1097/CCM.0000000000006630","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006630","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":"53 6","pages":"e1348-e1349"},"PeriodicalIF":7.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144207889","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}