Critical Care Medicine最新文献

{"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}

{"title":"Refining Outcome Interpretations in Pediatric Sepsis: Mortality, Fluid Management, and Renal Recovery.","authors":"Lexi Huang, Dan Shan","doi":"10.1097/CCM.0000000000006497","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006497","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":"53 2","pages":"e515-e516"},"PeriodicalIF":7.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467246","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":"Executive Summary: Society of Critical Care Medicine Guidelines on Family-Centered Care for Adult ICUs.","authors":"David Y Hwang, Simon J W Oczkowski, Kimberley Lewis, Barbara Birriel, James Downar, Christian E Farrier, Kirsten M Fiest, Rik T Gerritsen, Joanna Hart, Christiane S Hartog, Gabriel Heras-La Calle, Aluko A Hope, Ann L Jennerich, Nancy Kentish-Barnes, Ruth Kleinpell, Erin K Kross, Andrea P Marshall, Peter Nydahl, Theodora Peters, Regis G Rosa, Elizabeth Scruth, Nneka Sederstrom, Joanna L Stollings, Alison E Turnbull, Thomas S Valley, Giora Netzer, Rebecca A Aslakson, Ramona O Hopkins","doi":"10.1097/CCM.0000000000006548","DOIUrl":"10.1097/CCM.0000000000006548","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":"53 2","pages":"e459-e464"},"PeriodicalIF":7.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467229","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 Ongoing Pursuit to Reduce the Burden of IV Vasopressor Infusions.","authors":"Patrick M Wieruszewski, Amos Lal","doi":"10.1097/CCM.0000000000006531","DOIUrl":"10.1097/CCM.0000000000006531","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e508-e510"},"PeriodicalIF":7.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142799670","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":"Enhancing Bereavement Care in Critical Care Settings: A Focus on Prolonged Grief, Posttraumatic Stress Disorder, and Depression Among ICU Surrogates.","authors":"Yanqi Wang","doi":"10.1097/CCM.0000000000006503","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006503","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":"53 2","pages":"e519-e520"},"PeriodicalIF":7.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467222","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 Endotracheal Intubation of Critically Ill Patients.","authors":"Andrew B Leibowitz","doi":"10.1097/CCM.0000000000006536","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006536","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":"53 2","pages":"e504-e507"},"PeriodicalIF":7.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467232","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":"Performance of the Healthy Aging Brain Care Monitor Self Report in Monitoring Post-Intensive Care Syndrome Among Acute Respiratory Failure Survivors.","authors":"Parth K Savsani, Sikandar H Khan, Anthony J Perkins, Sophia Wang, Samreen Jawaid, Salwa Moiz, Patrick O Monahan, Kurt Kroenke, Sujuan Gao, Babar A Khan","doi":"10.1097/CCM.0000000000006522","DOIUrl":"10.1097/CCM.0000000000006522","url":null,"abstract":"<p><strong>Objectives: </strong>To describe the performance of the Healthy Aging Brain Care Monitor Self Report (HABC-M SR) in assessment of post-intensive care syndrome (PICS) among Acute Respiratory Failure ICU survivors.</p><p><strong>Design: </strong>Secondary data analysis of a randomized controlled trial.</p><p><strong>Setting: </strong>Patients evaluated by a nurse care coordinator in an out-of-hospital setting.</p><p><strong>Patients: </strong>English-speaking adults 18 years old or older who were admitted to the ICU with acute respiratory failure requiring invasive or noninvasive mechanical ventilation for greater than or equal to 24 hours.</p><p><strong>Interventions: </strong>Patients randomized to the intervention arm of the mobile critical care recovery program, a negative trial testing multidisciplinary care to improve quality of life.</p><p><strong>Measurements and main results: </strong>HABC-M SR scale was used to assess PICS in the intervention group at ICU discharge, 3, and 6 months post-discharge. Hospital Anxiety and Depression Scale; Pain, Enjoyment of Life, and General Activity Scale; Timed Up and Go; and Patient-Reported Outcomes Measurement Information System sleep scores were obtained at the same time. Mini-Mental State Examination (MMSE) was administered at baseline and 6 months. ICU survivors reported mild PICS symptoms, which improved over 6 months (mean HABC-M SR scores: baseline [8.5, sd 7.6], 3 mo [5.3 mo, sd 6.6 mo], and 6 mo [5.2 mo, sd 6.9 mo; p < 0.001]). HABC-M SR total score had moderate internal consistency that improved over time (Cronbach's alpha = 0.78 at baseline and 0.84 at 6 mo). The psychological subscale of HABC-M SR was moderately correlated with standardized scales for mood, pain, and sleep. The cognitive subscale was not significantly correlated with MMSE.</p><p><strong>Conclusions: </strong>While HABC-M SR correlated with mood, physical, and sleep symptoms, the cognitive subscale was less sensitive compared with standardized scales.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e341-e352"},"PeriodicalIF":7.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11845300/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142616188","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 Need for Institutional Policies for Innovative Therapy: Existing Approaches and Key Elements.","authors":"Emily Rao, Christine Grady, David Wendler","doi":"10.1097/CCM.0000000000006517","DOIUrl":"10.1097/CCM.0000000000006517","url":null,"abstract":"<p><strong>Objectives: </strong>Innovative therapy is common in many areas of medicine. Yet, it is unknown whether medical centers have policies to ensure innovative therapy is conducted appropriately.</p><p><strong>Design: </strong>We contacted three informants at leading U.S. medical centers to determine whether the center has a policy for innovative therapy and, if so, what requirements the policies include and whether the policies lack any important elements.</p><p><strong>Setting: </strong>Existing policies and published recommendations.</p><p><strong>Patients: </strong>None.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Our search found that 46 of 58 responding centers (79%) do not have a policy for innovative therapy. Of the ten policies available for review, half lack requirements to report patient outcomes, and half do not explicitly coordinate innovative therapy with research.</p><p><strong>Conclusions: </strong>A majority of leading U.S. medical centers do not have a policy for innovative therapy. In addition, existing policies lack important elements, especially with respect to reporting patient outcomes and coordinating innovative therapy with research. Based on the existing policies and recommendations in the literature, we thus identify eight key elements that should be included in policies for innovative therapy. Future research should assess whether these elements can be feasibly implemented and whether, in practice, they offer patients appropriate protection.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e320-e327"},"PeriodicalIF":7.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142616192","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":"Sex Disparity in Extracorporeal Membrane Oxygenation Clinical Trial Enrollment.","authors":"Emily Damuth, Caitlin Baldwin, Nicole Schmalbach, Adam Green, Nitin Puri, Christopher W Jones","doi":"10.1097/CCM.0000000000006539","DOIUrl":"10.1097/CCM.0000000000006539","url":null,"abstract":"<p><strong>Objectives: </strong>Multiple studies have shown that extracorporeal membrane oxygenation (ECMO) is used clinically more often in men than women. Because clinical trials provide the basis for identifying patients who are likely to benefit from medical therapies, we hypothesized that sex-based imbalances in ECMO trial enrollment may both reflect and perpetuate these observed disparities. Our objective was to determine whether sex-based enrollment imbalances exist within the published ECMO clinical trial literature.</p><p><strong>Design: </strong>Cross-sectional analysis.</p><p><strong>Setting: </strong>Randomized controlled trials published between 2003 and 2023 that either tested ECMO as a treatment modality or tested another intervention among patients receiving ECMO.</p><p><strong>Patients: </strong>Not applicable.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>We used the Cochrane Highly Sensitive Search Strategy to search PubMed for eligible trials. Data on participant demographics, trial characteristics, and journal information were abstracted for each publication. The primary outcome of interest was the proportion of male and female participants in each published trial. The initial literature search identified 774 articles. Of these, 31 were eligible for inclusion, and 28 provided data on the sex of study participants. Twenty-six of these 28 trials (93%) enrolled more men than women, and in aggregate women comprised 28% (95% CI, 26-30%) of all trial participants (551/1956 subjects). Trials involving extracorporeal cardiopulmonary resuscitation (ECPR) exhibited the largest sex-based enrollment differences (83% men) followed by venoarterial ECMO for cardiogenic shock (73% men). Among trials published in journals with impact factors of ten or higher 74% (95% CI, 72-76%) of participants were men. Only two trials (7%) provided data on the race or ethnicity of study participants.</p><p><strong>Conclusions: </strong>Substantial sex-based disparity exists in published ECMO clinical trials. Underrepresentation of women relative to disease prevalence is most significant among trials utilizing venoarterial ECMO for cardiogenic shock and ECPR for cardiac arrest, limiting the applicability of findings from these trials for women.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e424-e428"},"PeriodicalIF":7.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142766953","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":"ABO Blood Group and Risk Associated With Sepsis-Associated Thrombocytopenia: A Single-Center Retrospective Study.","authors":"Rong Liufu, Yan Chen, Jing-Yi Wang, Yang-Yan-Qiu Wang, Yao Wu, Wei Jiang, Chun-Yao Wang, Jin-Min Peng, Li Weng, Bin Du","doi":"10.1097/CCM.0000000000006523","DOIUrl":"10.1097/CCM.0000000000006523","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to investigate the relationship between ABO blood group and sepsis-associated thrombocytopenia (SAT).</p><p><strong>Design and setting: </strong>The primary outcome was SAT within the first 72 hours of ICU admission.</p><p><strong>Patients: </strong>The retrospective study included 9113 patients diagnosed with sepsis from January 2014 to December 2022. A total of 6296 patients eventually were included into the study, who were divided into four groups based on ABO blood group.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>A total of 2494 patients (39.6%) were diagnosed with SAT, and 712 (11.3%) of them experiencing severe SAT. The occurrence of SAT among the ABO blood groups was significantly lower in AB blood group compared with the other groups ( p = 0.032). Individuals in AB blood group were less likely to experience severe SAT ( p = 0.028). In multivariate analysis, B blood group (odds ratio [OR], 1.32; 95% CI, 1.05-1.67) and O (OR, 1.37; 95% CI, 1.09-1.72) were significantly associated with a higher occurrence of SAT compared with AB blood group. In multivariate analyses, A blood group (OR, 1.68; 95% CI, 1.16-2.42), B blood group (OR, 1.74; 95% CI, 1.74-2.50), and O blood group (OR, 1.72; 95% CI, 1.20-2.48) remained significantly risk factors associated with a higher occurrence of severe SAT compared with AB blood group.</p><p><strong>Conclusions: </strong>B blood group and O were associated with an increased risk of SAT and severe SAT.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e353-e361"},"PeriodicalIF":7.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142945964","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}