Critical Care Medicine最新文献

{"title":"Association Between Type of Immunosuppression and the Incidence, Microbiology, and Outcomes of Bacterial Ventilator-Associated Lower Respiratory Tract Infections: A Retrospective Multicenter Study.","authors":"Louis Kreitmann, Constance Bayon, Ignacio Martin-Loeches, Pedro Póvoa, Jorge Salluh, Anahita Rouzé, Anne-Sophie Moreau, Alain Duhamel, Julien Labreuche, Saad Nseir","doi":"10.1097/CCM.0000000000006615","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006615","url":null,"abstract":"<p><strong>Objectives: </strong>Ventilator-associated lower respiratory tract infections (VALRTIs) are among the most common ICU-acquired infections in patients receiving invasive mechanical ventilation (IMV). Immunocompromised patients may have a lower incidence of VALRTI when compared with nonimmunocompromised patients, but the influence of the type of immunosuppression on the epidemiology of VALRTI has not been investigated. The study objectives were to assess the association of the type of immunosuppression with the incidence, microbiology, and outcomes (ICU mortality, ICU length of stay, and duration of IMV) of VALRTI related to bacterial pathogens.</p><p><strong>Design: </strong>Multicenter, international retrospective cohort study.</p><p><strong>Setting: </strong>One hundred eighteen ICUs (118) in nine countries.</p><p><strong>Patients: </strong>Eight hundred fifty-four immunocompromised adult patients (median age, 65 yr; 57.6% males) requiring IMV for greater than 48 hours, including 162 with hematologic malignancies.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Patients with hematologic malignancies had a lower 28-day cumulative incidence of bacterial VALRTI than patients with other types of immunosuppression (13.6% vs. 20.1%; adjusted cause-specific hazard ratio, 0.61; 95% CI, 0.37-0.97), mostly due to a lower incidence of ventilator-associated pneumonia (9.3% vs. 13.9%). The proportion of VALRTI cases related to multidrug-resistant bacteria was similar between groups. Occurrence of bacterial VALRTI was associated with an increased mortality and a longer ICU length of stay, but this effect was independent of the type of immunosuppression.</p><p><strong>Conclusions: </strong>Patients with hematologic malignancies had a lower 28-day cumulative incidence of bacterial VALRTI than patients with other types of immunosuppression, mainly due to a lower incidence of ventilator-associated pneumonia.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467182","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":"Development of a Core Critical Care Data Dictionary With Common Data Elements to Characterize Critical Illness and Injuries Using a Modified Delphi Method.","authors":"David J Murphy, Wesley Anderson, Smith H Heavner, Tamara Al-Hakim, Raul Cruz-Cano, Krzysztof Laudanski, Rishikesan Kamaleswaran, Omar Badawi, Heidi Engel, Jocelyn Grunwell, Vitaly Herasevich, Ashish K Khanna, Keith Lamb, Robert MacLaren, Teresa Rincon, Lazaro Sanchez-Pinto, Andrea N Sikora, Robert D Stevens, Donna Tanner, William Teeter, An-Kwok Ian Wong, James L Wynn, Xiaohan T Zhang, Jerry J Zimmerman, Vishakha Kumar, J Perren Cobb, Karin E Reuter-Rice","doi":"10.1097/CCM.0000000000006595","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006595","url":null,"abstract":"<p><strong>Objectives: </strong>To develop the first core Critical Care Data Dictionary (C2D2) with common data elements (CDEs) to characterize critical illness and injuries.</p><p><strong>Design: </strong>Group consensus process using modified Delphi approach.</p><p><strong>Setting: </strong>Electronic surveys and in-person meetings.</p><p><strong>Subjects: </strong>A multidisciplinary workgroup of clinicians and researchers with expertise in the care of the critically ill and injured.</p><p><strong>Interventions: </strong>The Delphi process was divided into domain and CDE portions with each composed of two item generation rounds and one item reduction/refinement rounds. Two in-person meetings augmented this process to facilitate review and consideration of the domains and by panel members. The final set of domains and CDEs was then reviewed by the group to meet the competing criteria of utility and feasibility, resulting in the core dataset.</p><p><strong>Measurements and main results: </strong>The 23-member Delphi panel was provided 1833 candidate variables for potential dataset inclusion. The final dataset includes 226 patient-level CDCs in nine domains, which include anthropometrics and demographics (8), chronic comorbid illnesses (18), advanced directives (1), ICU diagnoses (61), diagnostic tests (42), interventions (27), medications (38), objective assessments (26), and hospital course and outcomes (5). Upon final review, 91% of the panel endorsed the CDCs as meeting criteria for a minimum viable data dictionary. Data elements cross the lifespan of neonate through adult patients.</p><p><strong>Conclusions: </strong>The resulting C2D2 provides a foundation to facilitate rapid collection, analyses, and dissemination of information necessary for research, quality improvement, and clinical practice to optimize critical care outcomes. Further work is needed to validate the effectiveness of the dataset in a variety of critical care settings.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467185","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":"Lactated Ringer's or Normal Saline for Initial Fluid Resuscitation in Sepsis-Induced Hypotension.","authors":"Georg Gelbenegger, Nathan I Shapiro, Markus Zeitlinger, Bernd Jilma, Ivor S Douglas, Anselm Jorda","doi":"10.1097/CCM.0000000000006601","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006601","url":null,"abstract":"<p><strong>Objectives: </strong>To assess whether initial fluid resuscitation with lactated Ringer's solution compared with 0.9% saline is associated with improved clinical outcomes in patients with sepsis-induced hypotension.</p><p><strong>Design: </strong>Secondary analysis of the randomized controlled Crystalloid Liberal or Vasopressors Early Resuscitation in Sepsis (CLOVERS) trial.</p><p><strong>Setting: </strong>ICUs and emergency departments in 60 U.S. centers from March 2018 to January 2022.</p><p><strong>Patients: </strong>Participants from the CLOVERS trial. Adult patients with a suspected or confirmed infection and hypotension caused by sepsis.</p><p><strong>Interventions: </strong>Participants received 1-3 L of crystalloid fluid for initial fluid resuscitation before randomization. In this analysis, participants were categorized into a lactated Ringer's group and a 0.9% saline group based on the fluid type predominantly used for the initial fluid resuscitation (i.e., ≥ 95% of pre-randomization fluid).</p><p><strong>Measurements and main results: </strong>Of 1563 participants with sepsis-induced hypotension included in the CLOVERS trial, 622 (39.8%) received lactated Ringer's solution and 690 (44.1%) received 0.9% saline as solution for the initial fluid bolus. Death before discharge home by day 90 occurred in 76 of 622 participants (12.2%) in the lactated Ringer's group and in 110 of 690 participants (15.9%) in the 0.9% saline group, resulting in an adjusted hazard ratio of 0.71 (95% CI, 0.51-0.99; p = 0.043). Patients receiving lactated Ringer's solution had more hospital-free days at 28 days than those receiving 0.9% saline (16.6 ± 10.8 vs. 15.4 ± 11.4, respectively; adjusted mean difference, 1.6 d [95% CI, 0.4-2.8 d; p = 0.009]). Treatment with 0.9% saline was associated with higher levels of serum chloride and decreased levels of serum bicarbonate.</p><p><strong>Conclusions: </strong>Initial fluid resuscitation with lactated Ringer's solution, compared with 0.9% saline, might be associated with improved survival in patients with sepsis-induced hypotension.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143448253","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 Body Mass Index and Mortality Mediated by Medical and Mechanical Complications in Venovenous Extracorporeal Membrane Oxygenation.","authors":"Kevin W Hatton, Milo Engoren, David Furfaro, Colin McCloskey","doi":"10.1097/CCM.0000000000006617","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006617","url":null,"abstract":"<p><strong>Objectives: </strong>To estimate the associations between body mass index (BMI) and mortality and between BMI and complications in patients receiving venovenous extracorporeal membrane oxygenation (ECMO) and to estimate if any mortality association was mediated by complications.</p><p><strong>Design: </strong>Retrospective analysis of an international, multicenter registry.</p><p><strong>Setting: </strong>ICUs.</p><p><strong>Patients: </strong>Adults in the Extracorporeal Life Support Organization database who received venovenous ECMO between January 1, 2015, and December 31, 2021.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Logistic regression with BMI transformed using fractional polynomials was used to estimate the association between BMI and hospital mortality and between BMI and complications. Mediation analysis was used to estimate if the association between BMI and mortality was a direct effect or was mediated by complications. Of the 24,796 patient runs, 10,361 patients died (48%). After adjusting for confounders, we found nonlinear associations between BMI and mortality. Compared with BMI = 25 kg/m2, a BMI = 20 had an 11% higher risk of dying, odds ratio (OR) =1.11 (95% CI, 1.08-1.15); a BMI = 30 had an 8% lower risk, OR = 0.92 (95% CI, 0.90-0.95); and a BMI = 40 kg/m2 had an 18% lower risk of death OR = 0.82 (95% CI, 0.78-0.87). BMI was also associated with mechanical, renal, pulmonary, and neurologic complications. The association between BMI and mortality was both a direct effect and mediated via pulmonary complications, while mechanical, renal replacement therapy, and neurologic complications were suppressors having a negative association with improved mortality in patients with higher BMI.</p><p><strong>Conclusions: </strong>We confirmed that patients with higher BMI requiring venovenous ECMO were less likely to die. This finding was partially mediated by pulmonary complications and partially via a direct association between BMI and mortality. BMI was also associated with mechanical, renal replacement therapy, and neurologic complications that acted as suppressing mediators and were associated with increased mortality for increasing BMI despite the overall trend of improved survival.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143448331","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":"How Long Should Patients Be Treated With Postcardiotomy Venoarterial Extracorporeal Membrane Oxygenation? Individual Patient Data Pooled Analysis.","authors":"Fausto Biancari, Timo Mäkikallio, Camilla L'Acqua, Vito G Ruggieri, Sung-Min Cho, Magnus Dalén, Henryk Welp, Kristján Jónsson, Sigurdur Ragnarsson, Francisco J Hernández Pérez, Giuseppe Gatti, Khalid Alkhamees, Antonio Loforte, Andrea Lechiancole, Paola D'Errigo, Stefano Rosato, Cristiano Spadaccio, Matteo Pettinari, Antonio Fiore, Giovanni Mariscalco, Andrea Perrotti, Amr A Arafat, Monirah A Albabtain, Mohammed M AlBarak, Mohamed Laimoud, Ilija Djordjevic, Robertas Samalavicius, Marta Alonso-Fernandez-Gatta, Markus J Wilhelm, Alexander Kaserer, Giorgia Bonalumi, Tatu Juvonen, Gianluca Polvani","doi":"10.1097/CCM.0000000000006618","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006618","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate the optimal duration of venoarterial extracorporeal membrane oxygenation (ECMO) for cardiogenic shock refractory to medical therapies after cardiac surgery and whether its prolonged use is justified.</p><p><strong>Data sources: </strong>Previously published articles on postcardiotomy venoarterial ECMO.</p><p><strong>Study selection: </strong>Articles reporting on the early outcome after postcardiotomy venoarterial ECMO in adult patients were identified through a systematic review of the literature.</p><p><strong>Data extraction: </strong>Data on prespecified patients' characteristics, operative variables, and outcomes were provided by the authors of previous studies on this topic.</p><p><strong>Data synthesis: </strong>Individual data of 1267 patients treated at 25 hospitals from ten studies were included in this meta-analysis. In-hospital mortality rates were lowest among patients treated 3-6 days with venoarterial ECMO. Multilevel mixed-effects logistic regression considering the cluster effect of the participating hospitals adjusted for individual patient's risk profile and operative variables showed that the risk in-hospital mortality did not significantly increase in patients treated more than 6 days up to 20 days.</p><p><strong>Conclusions: </strong>The present study demonstrated that prolonged venoarterial ECMO support after adult cardiac surgery may be justified. However, the analysis was limited by the knowledge of only those circumstances known at the start of ECMO.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440073","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":"Nelonemdaz Treatment in Out-of-Hospital Cardiac Arrest: The Quest for the Grail Continues.","authors":"Jingxin Wang, Brian Joseph Wright","doi":"10.1097/CCM.0000000000006611","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006611","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440078","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":"Geospatial Access to Extracorporeal Membrane Oxygenation in the United States.","authors":"Adam L Gottula, Hannah Van Wyk, Man Qi, Melissa A Vogelsong, Chris R Shaw, Joseph E Tonna, Nicholas J Johnson, Anna Condella, Jason A Bartos, Veronica J Berrocal, Justin L Benoit, Cindy H Hsu","doi":"10.1097/CCM.0000000000006607","DOIUrl":"10.1097/CCM.0000000000006607","url":null,"abstract":"<p><strong>Objectives: </strong>To conduct a Geospatial Information System analysis of extracorporeal membrane oxygenation (ECMO) centers in the United States utilizing data from the U.S. Census Bureau to better understand access to ECMO care and identify potential disparities.</p><p><strong>Design: </strong>A cross-sectional descriptive and statistical analysis of geospatial access to ECMO-capable centers in the United States, accounting for demographic variables.</p><p><strong>Setting: </strong>The unit of analysis were U.S. Census block groups and demographic variables of interest obtained from the American Community Survey.</p><p><strong>Patients: </strong>Patients accounted for in the U.S. Census data.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Sixty-seven percent of the U.S. population had direct access to ECMO-capable centers. Disparities were present, with Puerto Rico, Wyoming, North Dakota, and Alaska having no access. Poverty, increased age, and lower population density consistently correlated with limited access. We identified significant racial and ethnic disparities in the Midwest and Northeast.</p><p><strong>Conclusions: </strong>While 67% of the U.S. population had access to ECMO-capable centers by ground transportation, significant disparities in access exist. These findings emphasize the need for thoughtful implementation of ECMO systems of care to ensure equitable access. Future work should focus on developing novel systems of care that increase access utilizing advanced technology, such as aeromedical transport services.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11952687/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440068","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":"Associations Between Social Economic Determinants and Long-Term Outcomes of Critically Ill Patients.","authors":"Dries van Sleeuwen, Floris A van de Laar, Koen S Simons, Daniëlle van Bommel, Dominique Burgers-Bonthuis, Julia Koeter, Laurens L A Bisschops, Inge Janssen, Thijs C D Rettig, Johannes G van der Hoeven, Mark van den Boogaard, Marieke Zegers","doi":"10.1097/CCM.0000000000006587","DOIUrl":"10.1097/CCM.0000000000006587","url":null,"abstract":"<p><strong>Objective: </strong>Differences in socioeconomic status (SES) may influence long-term physical, psychological, and cognitive health outcomes of ICU survivors. However, the relationship between SES and these three long-term health outcomes is rarely studied. The aim of this study was to investigate associations between SES and the occurrence of long-term outcomes 1-year post-ICU.</p><p><strong>Design: </strong>Prospective cohort study.</p><p><strong>Setting: </strong>Seven Dutch ICUs.</p><p><strong>Patients: </strong>Patients 16 years old or older and admitted for greater than or equal to 12 hours to the ICU between July 2016 and March 2020 completed questionnaires, or relatives if patients could not complete them themselves, at ICU admission and 1 year after ICU admission.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Validated scales were used for the outcomes: physical problems (fatigue or ≥ 3 new physical symptoms), psychological problems (anxiety, depression, or post-traumatic stress), cognitive impairment, and a composite score. Occurrence of outcomes were calculated for: origin, education level, employment status, income, and household structure. Adjusted odds ratios (aORs) were calculated with covariates age, gender, admission type, severity-of-illness, and pre-ICU health status. Of the 6555 patients included, 3246 (49.5%) completed the questionnaires at admission and after 1 year. Low education level increased the risk of having health problems in the composite score 1-year post-ICU (aOR 1.84; 95% CI, 1.39-2.44; p < 0.001). Pre-ICU unemployment increased the risk of having physical problems (aOR 1.98; 95% CI, 1.31-3.01; p = 0.001). Migrants and low income was associated with more psychological problems (aOR 2.03; 95% CI, 1.25-3.24; p < 0.01; aOR 1.54; 95% CI, 1.10-2.16; p = 0.01, respectively), and unpaid work with less psychological (aOR 0.26; 95% CI, 0.08-0.73; p = 0.02) and cognitive (aOR 0.11; 95% CI, 0.01-0.59; p = 0.04) problems.</p><p><strong>Conclusions: </strong>Indicators of lower SES, including low education level, low income, unemployment and migrants were associated with an increased risk of post-ICU health problems. Gaining insight into the complex relationship between SES and long-term health problems is necessary to decrease disparities in healthcare.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11952688/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143406043","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":"Health Care Disparities and Critical Illnesses-Related Mortality in the United States.","authors":"Yu-Che Lee, Francois Fadell, Ko-Yun Chang, Jessica Baek, Muhaimen Rahman, Corrine Kickel, Ali El-Solh","doi":"10.1097/CCM.0000000000006620","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006620","url":null,"abstract":"<p><strong>Objectives: </strong>To examine the association between social vulnerability index (SVI) and social deprivation index (SDI) with critical illness-related mortality in the United States and to guide future research and interventions aimed at reducing disparities in outcomes in patients with critical illness.</p><p><strong>Design: </strong>A cross-sectional study using county-level data.</p><p><strong>Setting: </strong>United States with data sourced from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research and the American Community Survey.</p><p><strong>Patients: </strong>County-level populations of all ages across the United States from 2015 to 2019.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Age-adjusted mortality rates for four categories of critical illnesses (respiratory, cardiac, neurologic, and renal/gastrointestinal) were analyzed against the county-level SVI and SDI. We assessed critical illness-related mortality associated with SVI and SDI through negative binomial regression models. Mortality rates per 100,000 were highest for cardiac (212.4; 95% CI, 212.2-212.6), followed by respiratory (116.8; 95% CI, 116.7-117.0), neurologic (30.8; 95% CI, 30.8-30.9), and renal/gastrointestinal illnesses (25.2; 95% CI, 25.1-25.3). Mortality was greater among adults 65 years old and older, males, Black or African American individuals, and those living in rural areas. Higher SVI and SDI were associated with increased mortality, with the strongest correlation found for cardiac critical illnesses, showing rate ratios of 1.52 (95% CI, 1.48-1.57) for SDI and 1.43 (95% CI, 1.39-1.47) for SVI. Specific diagnoses with the highest incidence rate ratios included sepsis (1.63 [95% CI, 1.58-1.69] for SVI and 1.75 [95% CI, 1.70-1.80] for SDI), cardiac arrest (1.92 [95% CI, 1.80-2.04] for SVI and 1.98 [95% CI, 1.86-2.10] for SDI), anoxic brain damage (1.62 [95% CI, 1.45-1.81] for SVI and 1.60 [95% CI, 1.45-1.76] for SDI), and acute hepatic failure (1.51 [95% CI, 0.92-2.46] for SVI and 1.49 [95% CI, 1.08-2.05] for SDI). The SDI demonstrated a stronger correlation with mortality compared with the SVI, with socioeconomic status, poverty, education, and unemployment being the most impactful indicators.</p><p><strong>Conclusions: </strong>Critical illness mortality is significantly associated with indicators of socioeconomic disadvantage. The SDI appears to be a more effective tool than the SVI for guiding resource allocation. Targeted interventions to address social determinants of health, including poverty, education, and unemployment, are essential to reduce disparities and improve outcomes in patients with critical illness. Public health strategies should focus on addressing these social determinants and enhancing support for vulnerable populations and areas.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143406050","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":"Ableism After Critical Illness: A Qualitative Translation of Key Concepts to the Post-ICU Context.","authors":"Leslie P Scheunemann, Janelle C Christensen, Erica M Motter, S Peter Kim, Peter Eisenhauer, Nimit Gandhi, Heather Tomko, Kelly M Potter, Timothy D Girard, Charles F Reynolds, Natalie E Leland","doi":"10.1097/CCM.0000000000006596","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006596","url":null,"abstract":"<p><strong>Objectives: </strong>Ableism-discrimination and social prejudice against people with disabilities-defines people by their disability and assumes that disabled people require fixing. We sought to characterize ableism after critical illness and to describe its relationship with care delivery.</p><p><strong>Design: </strong>A secondary analysis of semi-structured individual interviews (n = 42) and ten group interviews (n = 68 participants) using modified grounded theory. We identified categories of ableism informed by existing disability studies literature and used patterns in the analysis to describe overarching themes.</p><p><strong>Setting: </strong>A large healthcare system in western Pennsylvania.</p><p><strong>Participants: </strong>Critical illness survivors, family members, clinicians, and administrators.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Two overarching themes emerged: ableism presents multifaceted barriers to participation in meaningful activities after critical illness, and it is endemic. We observed examples of ableism in all interviews. The quotes characterizing ableism fell into six categories: 1) infantilization and patronization; 2) disability leading to inability; 3) denial of disability experience; 4) invasion of privacy and denial of meaningful relationships; 5) being ignored and excluded; and 6) pushing care providers beyond their perceived capacity. When participants expressed ableism toward others, it was typically matter-of-fact; however, when participants described experiencing or witnessing ableism, they expressed feelings ranging from anxiety to outrage. Participants explicitly and implicitly connected expressions of ableism to broader policies and practices, providing evidence that ableism is endemic to this healthcare system.</p><p><strong>Conclusions: </strong>Ableism presents multifaceted barriers to participation after critical illness, undermining resilience and wellbeing. We hypothesize that anti-ableist interventions could reduce disability-related barriers to resilience to optimize recovery after critical illness.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143405665","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}