Critical Care Medicine最新文献

{"title":"Editorial Board Acknowledgment.","authors":"","doi":"10.1097/CCM.0000000000006594","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006594","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":"53 2","pages":"e536-e541"},"PeriodicalIF":7.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467160","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":"Supersize or Right Size? Protein Intake in Critically Ill Obese Patients.","authors":"Flavia Julie do Amaral Pfeilsticker, Igor Dovorake Lourenço, Evandro Jose de Almeida Figueiredo, Rogério da Hora Passos","doi":"10.1097/CCM.0000000000006510","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006510","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":"53 2","pages":"e534-e535"},"PeriodicalIF":7.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467203","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":"Ketamine Versus Etomidate for Rapid Sequence Intubation: A Systematic Review and Meta-Analysis of Randomized Trials.","authors":"Alisha Greer, Mark Hewitt, Parsa T Khazaneh, Begum Ergan, Lisa Burry, Matthew W Semler, Bram Rochwerg, Sameer Sharif","doi":"10.1097/CCM.0000000000006515","DOIUrl":"10.1097/CCM.0000000000006515","url":null,"abstract":"<p><strong>Objectives: </strong>To compare the safety and efficacy of ketamine and etomidate as induction agents to facilitate emergent endotracheal intubation.</p><p><strong>Data sources: </strong>We searched MEDLINE, Embase, Cochrane Clinical Trials Register, and ClinicalTrials.gov from inception to April 3, 2024.</p><p><strong>Study selection: </strong>We included randomized controlled trials (RCTs) that compared ketamine to etomidate to facilitate emergent endotracheal intubation in adults.</p><p><strong>Data extraction: </strong>Reviewers screened abstracts, full texts, and extracted data independently and in duplicate. We pooled data using a random-effects model, assessed risk of bias using the modified Cochrane tool and certainty of evidence using the Grading Recommendations Assessment, Development, and Evaluation approach. We pre-registered the protocol on PROSPERO (CRD42023472450).</p><p><strong>Data synthesis: </strong>We included seven RCTs ( n = 2384 patients). Based on pooled analysis, compared with etomidate, ketamine probably increases hemodynamic instability in the peri-intubation period (relative risk [RR], 1.29; 95% CI, 1.07-1.57; moderate certainty) but probably decreases the need for initiation of continuous infusion vasopressors (RR, 0.75; 95% CI, 0.57-1.00; moderate certainty) and results in less adrenal suppression (RR, 0.54; 95% CI, 0.45-0.66; moderate certainty). Ketamine probably has no effect on successful intubation on the first attempt (RR, 1.01; 95% CI, 0.97-1.05; moderate certainty) or organ dysfunction measured as the maximum Sequential Organ Failure Assessment (SOFA) score during the first 3 days in ICU (mean difference, 0.55 SOFA points lower; 95% CI, 1.12 lower to 0.03 higher; moderate certainty) and may have no effect on mortality (RR, 1.00; 95% CI, 0.83-1.21; low certainty) when compared with etomidate.</p><p><strong>Conclusions: </strong>Compared with etomidate, ketamine probably results in more hemodynamic instability during the peri-intubation period and appears to have no effect on successful intubation on the first attempt or mortality. However, ketamine results in decreased need for the initiation of vasopressor use and decreases adrenal suppression compared with etomidate.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e374-e383"},"PeriodicalIF":7.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142681272","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":"Toward Precision in Nutrition Therapy.","authors":"Christian Stoppe, Aileen Hill, Kenneth B Christopher, Arnold S Kristof","doi":"10.1097/CCM.0000000000006537","DOIUrl":"10.1097/CCM.0000000000006537","url":null,"abstract":"<p><p>Precision in critical care nutrition is paramount, as it focuses nutrition interventions on those patients most likely to benefit, or those who might potentially be harmed. Critical care nutrition must therefore be tailored to individual metabolic needs as determined by factors that control the capacity for tissue homeostasis and anabolic responses. This ideally involves the accurate and timely assessment of macronutrient and micronutrient requirements, a careful evaluation of metabolic response mechanisms and the identification of circumstances that might interfere with the productive utilization of dietary substrates. Specific surrogate markers of metabolic response, such as blood glucose levels, urea levels, or nitrogen balance, might be used to evaluate the metabolic readiness for nutrition and to establish the timing, nature, and clinical effectiveness of nutrition interventions. Despite the pressing need to further develop more targeted approaches in critically ill patients, indices of immediate metabolic responses that correlate with favorable clinical outcomes are lacking. In addition, the development of precision approaches might address timely adjustments in protein, energy, or micronutrient supplementation based on evolving clinical conditions. Here, we review why precision tools are needed in critical care nutrition, our progress thus far, as well as promising approaches and technologies by which multidisciplinary healthcare teams can improve quality of care and clinical outcomes by individualizing nutrition interventions.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e429-e440"},"PeriodicalIF":7.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11801434/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142834535","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":"The Impact of Data Extraction Methods and Model Selection on Systematic Reviews and Meta-Analyses.","authors":"Chang Liu, Fan Zhang, Min Cao","doi":"10.1097/CCM.0000000000006474","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006474","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":"53 2","pages":"e529-e530"},"PeriodicalIF":7.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467214","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":"Diagnostic Uncertainty Among Critically Ill Children Admitted to the PICU: A Multicenter Study.","authors":"Christina L Cifra, Jason W Custer, Craig M Smith, Kristen A Smith, Dayanand N Bagdure, Jodi Bloxham, Emily Goldhar, Stephen M Gorga, Elizabeth M Hoppe, Christina D Miller, Max Pizzo, Sonali Ramesh, Joseph Riffe, Katharine Robb, Shari L Simone, Haley D Stoll, Jamie Ann Tumulty, Stephanie E Wall, Katie K Wolfe, Linder Wendt, Patrick Ten Eyck, Christopher P Landrigan, Jeffrey D Dawson, Heather Schacht Reisinger, Hardeep Singh, Loreen A Herwaldt","doi":"10.1097/CCM.0000000000006511","DOIUrl":"10.1097/CCM.0000000000006511","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to identify the prevalence of and factors associated with diagnostic uncertainty when critically ill children are admitted to the PICU. Understanding diagnostic uncertainty is necessary to develop effective strategies to reduce diagnostic errors in the PICU.</p><p><strong>Design: </strong>Multicenter retrospective cohort study with structured medical record review by trained clinicians using a standardized instrument to identify diagnostic uncertainty in narrative clinical notes. Diagnoses and diagnostic uncertainty were compared across time from PICU admission to hospital discharge. Generalized linear mixed models were used to determine patient, clinician, and encounter characteristics associated with diagnostic uncertainty at PICU admission.</p><p><strong>Setting: </strong>Four academic tertiary-referral PICUs.</p><p><strong>Patients: </strong>Eight hundred eighty-two randomly selected patients 0-18 years old who were nonelectively admitted to participating PICUs.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>PICU admission notes for 228 of 882 patients (25.9%) indicated diagnostic uncertainty. Patients with uncertainty decreased over time but 58 (6.6%) had remaining diagnostic uncertainty at hospital discharge. Multivariable analysis showed that diagnostic uncertainty was significantly associated with off hours admission (odds ratio [OR], 1.52; p = 0.037), greater severity of illness (OR, 1.04; p = 0.025), an atypical presentation (OR, 2.14; p = 0.046), diagnostic discordance at admission between attending intensivists and resident physicians/advanced practice providers (OR, 3.62; p < 0.001), and having a neurologic primary diagnosis (OR, 1.87; p = 0.03). Older patients (OR, 0.96; p = 0.014) and those with a respiratory (OR, 0.58; p = 0.009) or trauma primary diagnosis (OR, 0.08; p < 0.001) were less likely to have diagnostic uncertainty. There were no significant associations between diagnostic uncertainty and attending intensivists' characteristics.</p><p><strong>Conclusions: </strong>Diagnostic uncertainty at PICU admission was common and was associated with off hours admission, severe illness, atypical presentation, diagnostic discordance between clinicians, and a neurologic primary diagnosis. Further study on the recognition and management of diagnostic uncertainty is needed to inform interventions to improve diagnosis among critically ill children.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e294-e307"},"PeriodicalIF":7.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142709366","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":"Acetylsalicylic Acid Treatment in Patients With Sepsis and Septic Shock: A Phase 2, Placebo-Controlled, Randomized Clinical Trial.","authors":"Thiago M L Almeida, Flávio G R Freitas, Rodrigo C Figueiredo, Sandra G Houly, Luciano C P Azevedo, Alexandre B Cavalcanti, Lucas P Damiani, Bianca S Svicero, Maria A Souza, Cíntia L S Bustamante, Fernando J S Ramos, Rafael S V Alves, Fernanda C Atallah, Míriam Jackiu, Eduardo S Pacheco, Raysa C Schmidt, Felipe S C Serra, Daniere Y V Tomotani, Fernando G Zampieri, Flávia R Machado","doi":"10.1097/CCM.0000000000006564","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006564","url":null,"abstract":"<p><strong>Objectives: </strong>Platelets play a critical role in the inflammatory response and coagulation. We aimed to evaluate whether the use of acetylsalicylic acid (ASA) would reduce the intensity of organ dysfunction in septic patients.</p><p><strong>Design: </strong>Randomized, blinded, parallel-group, placebo-controlled trial.</p><p><strong>Setting: </strong>Five general ICUs in Brazil.</p><p><strong>Patients: </strong>Adults with sepsis for no longer than 48 hours who had at least one severe organ dysfunction (lactate > 4 mmol/L, platelets < 100,000/mm3, Pao2/Fio2 ratio < 200, or septic shock).</p><p><strong>Interventions: </strong>Patients were randomized to receive 200 mg of ASA or placebo for 7 days.</p><p><strong>Measurements and main results: </strong>The primary outcome was the change in the Sequential Organ Failure Assessment (SOFA) score between day 0 and day 7 or date of discharge/death. Safety outcomes were major bleeding and the number of blood transfusions within 14 days. The planned sample size was 218 with interim safety analyses after enrolling 109 and 163 patients. The study was discontinued due to higher frequency of major bleeding in the ASA group. We included 166 patients (ASA: 82 patients, placebo: 84). In the adjusted analysis, there was no difference in the SOFA change between the groups (mean placebo to ASA group difference, 0.60; 95% CI, -0.55 to 1.75; p = 0.30). There were no differences in any of the secondary outcomes. In the intervention group, there were a higher number of serious adverse events (9 [11%] vs. 1 [1.2%]; p = 0.009) and major bleeding (8 [8.5%] vs. 1 [1.2%]; p = 0.02).</p><p><strong>Conclusions: </strong>In this population of septic patients, ASA did not reduce the intensity of organ dysfunction. ASA increased the risk of severe bleeding compared with placebo.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":"53 2","pages":"e269-e281"},"PeriodicalIF":7.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467157","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":"Society of Critical Care Medicine Guidelines for the Treatment of Heat Stroke.","authors":"Jeffrey F Barletta, Tina L Palmieri, Shari A Toomey, Fayez AlShamsi, Rebecca L Stearns, Asad E Patanwala, Nicole F Siparsky, Neeraj Badjatia, Brian Schultz, Crystal M Breighner, Eric Bruno, Christopher G Harrod, Tanya Trevilian, Leandro Braz de Carvalho, James Houser, John M Harahus, Yang Liu, Ryan Swoboda, Paulin Ruhato Banguti, Heatherlee Bailey","doi":"10.1097/CCM.0000000000006551","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006551","url":null,"abstract":"<p><strong>Rationale: </strong>Predicted increases in heat-related weather phenomena will result in increasing heat exposures and heat injuries, like heat stroke. Prompt recognition, early intervention, and evidence-based management are necessary to optimize outcomes.</p><p><strong>Objectives: </strong>The objective of these guidelines was to develop evidence-based recommendations for the treatment of patients with heat stroke.</p><p><strong>Design: </strong>The Society of Critical Care Medicine convened a multidisciplinary panel of 18 international clinicians, comprising expertise in critical care, emergency medicine, neurocritical care, surgery, trauma/burn surgery, sports medicine, athletic training, military medicine, nursing, pharmacy, respiratory therapy, and one patient representative. The panel also included a guidelines methodologist specialized in developing evidence-based recommendations in alignment with the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. Conflict-of-interest policies were strictly followed during all phases of guidelines development including panel selection and voting.</p><p><strong>Methods: </strong>The panel members identified Patient, Intervention, Comparison, and Outcomes questions in two main areas: cooling modalities and medications that affect temperature. A systematic review for each question was conducted to identify the best available evidence, statistically analyze the evidence, and assess the certainty of the evidence using the GRADE methodology. The GRADE evidence-to-decision framework was used to formulate the recommendations. Good practice statements were included to provide additional clinical guidance.</p><p><strong>Results: </strong>The panel generated two strong recommendations, five good practice statements and one \"only-in-the-context of research\" statement. Active cooling measures are recommended over passive cooling methods, with cold- or ice-water immersion achieving the fastest cooling rate. This method should be prioritized where available. In heat stroke patients, there is no evidence to support pharmacological interventions that affect temperature control and they should be avoided.</p><p><strong>Conclusions: </strong>The guidelines task force provided recommendations for the management of patients with heat stroke. These recommendations should be considered along with the patient's clinical status and available resources.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":"53 2","pages":"e490-e500"},"PeriodicalIF":7.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467195","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":"Securing Jugular Central Venous Catheters With Dressings Fixed to a Liquid Adhesive to Prevent Dressing Failure in Intensive Care Patients (the STICKY Trial): A Randomized Controlled Trial.","authors":"Nicole Marsh, Catherine O'Brien, Emily N Larsen, Evan Alexandrou, Robert S Ware, India Pearse, Fiona Coyer, Maharshi S Patel, Ruth H Royle, Claire M Rickard, Kellie Sosnowski, Patrick N A Harris, Kevin B Laupland, Michelle J Bauer, John F Fraser, Craig McManus, Joshua Byrnes, Amanda Corley","doi":"10.1097/CCM.0000000000006533","DOIUrl":"10.1097/CCM.0000000000006533","url":null,"abstract":"<p><strong>Objectives: </strong>Central venous catheters (CVCs) are vital for treating ICU patients. However, up to a quarter of CVCs fail from mechanical or infective complications. Poor securement of CVCs to the skin contributes to catheter failure, particularly CVCs placed in the jugular vein, which are highly vulnerable to pullout forces. This study evaluated the effectiveness of medical liquid adhesive (MLA) for improving jugular CVC dressing adhesion.</p><p><strong>Design: </strong>Multisite parallel group, superiority, randomized controlled trial.</p><p><strong>Setting: </strong>Four metropolitan Australian ICUs.</p><p><strong>Patients: </strong>Eligible patients were 18 years old or older, within 12 hours of jugular CVC insertion, expected to need the CVC for greater than or equal to 72 hours, and remain in ICU for greater than or equal to 24 hours.</p><p><strong>Interventions: </strong>Patients were randomly allocated (stratified by hospital and gender) to standard CVC dressings with the application of MLA to skin under the dressing border (intervention) or standard care CVC dressings (control).</p><p><strong>Measurements and main results: </strong>The primary endpoint was dressing failure within 7 days due to lifting edges. Secondary outcomes included the total number of dressing changes, skin injury, and CVC failure. In total, 160 participants (82 control; 78 intervention) were enrolled. There were 22 (28%) and 41 (50%) cases of premature dressing failure in the intervention and control groups respectively (odds ratio, 0.39; 95% CI, 0.20-0.76; p = 0.005). The intervention group had fewer dressing changes (incidence rate ratio [IRR], 0.74; 95% CI, 0.55-0.99). Time to dressing failure (log-rank test; p = 0.12) and all-cause CVC failure (IRR, 1.44; 95% CI, 0.36-5.79) did not differ between groups. Three skin injuries occurred: one in the intervention (blister) and two in the control (maceration and skin tear) groups.</p><p><strong>Conclusions: </strong>MLA is associated with significantly decreased jugular CVC dressing failure and longer dressing dwell, with an acceptable safety profile. MLA should be considered to preserve jugular CVC dressings in ICU.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":"53 2","pages":"e282-e293"},"PeriodicalIF":7.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11801464/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467248","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":"Society of Critical Care Medicine Guidelines on Adult Critical Care Ultrasonography: Focused Update 2024.","authors":"José L Díaz-Gómez, Sameer Sharif, Enyo Ablordeppey, Michael J Lanspa, John Basmaji, Thomas Carver, Jayne Chirdo Taylor, Luna Gargani, Alberto Goffi, Allyson M Hynes, Antonio Hernandez, Jan Kasal, Abhilash Koratala, Smadar Kort, Peter Lindbloom, Rachel Liu, Pete Livezey, Viveta Lobo, Susan Malone, Paul Mayo, Carol Mitchell, Ng Niu, Nova Panebianco, Madhavi Parekh, Susana Price, Aarti Sarwal, Felipe Teran, Gabriele Via, Antoine Vieillard-Baron, Anthony Weekes, Brandon Wiley, Kimberley Lewis, Sara Nikravan","doi":"10.1097/CCM.0000000000006530","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006530","url":null,"abstract":"<p><strong>Rationale: </strong>Critical care ultrasonography (CCUS) is rapidly evolving with new evidence being published since the prior 2016 guideline.</p><p><strong>Objectives: </strong>To identify and assess the best evidence regarding the clinical outcomes associated with five CCUS applications in adult patients since the publication of the previous guidelines.</p><p><strong>Panel design: </strong>An interprofessional, multidisciplinary, and diverse expert panel of 36 individuals including two patient/family representatives was assembled via an intentional approach. Conflict-of-interest policies were strictly followed in all phases of the guidelines, including task force selection and voting.</p><p><strong>Methods: </strong>Focused research questions based on Population, Intervention, Control, and Outcomes (PICO) for adult CCUS application were developed. Panelists applied the guidelines revision process described in the Standard Operating Procedures Manual to analyze supporting literature and to develop evidence-based recommendations as a focused update. The evidence was statistically summarized and assessed for quality using the Grading of Recommendations, Assessment, Development, and Evaluation approach. The evidence-to-decision framework was used to formulate recommendations as strong or conditional.</p><p><strong>Results: </strong>The Adult CCUS Focused Update Guidelines panel aimed to understand the current impact of CCUS on patient important outcomes as they related to five PICO questions in critically ill adults. A rigorous systematic review of evidence to date informed the panel's recommendations. In adult patients with septic shock, acute dyspnea/respiratory failure, or cardiogenic shock, we suggest using CCUS to guide management. Given evidence supporting an improvement in mortality, we suggest the use of CCUS for targeted volume management as opposed to usual care without CCUS. Last, there was insufficient data to determine if CCUS should be used over standard care without CCUS in the management of patients with cardiac arrest.</p><p><strong>Conclusions: </strong>The guidelines panel achieved strong agreement regarding the recommendations for CCUS to improve patient outcomes. These recommendations are intended for consideration along with the patient's existing clinical status.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":"53 2","pages":"e447-e458"},"PeriodicalIF":7.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467199","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}