Critical CarePub Date : 2026-10-23DOI: 10.1186/s13054-026-06403-0
Oscar Cavefors, Jonatan Oras
{"title":"Answer to: \"Left ventricular longitudinal function and hyperkinetic profile: a new echo world to explore?\"","authors":"Oscar Cavefors, Jonatan Oras","doi":"10.1186/s13054-026-06403-0","DOIUrl":"https://doi.org/10.1186/s13054-026-06403-0","url":null,"abstract":"","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"30 1","pages":""},"PeriodicalIF":11.4,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149243317","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}
Critical CarePub Date : 2026-10-22DOI: 10.1186/s13054-026-06397-9
Oscar Cavefors, Jonatan Oras
{"title":"Response to: \"MAPSE in critical illness: from prognostic association to clinical utility\".","authors":"Oscar Cavefors, Jonatan Oras","doi":"10.1186/s13054-026-06397-9","DOIUrl":"https://doi.org/10.1186/s13054-026-06397-9","url":null,"abstract":"","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"30 1","pages":""},"PeriodicalIF":11.4,"publicationDate":"2026-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149243356","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}
Critical CarePub Date : 2026-10-22DOI: 10.1186/s13054-026-06392-0
Leyi Xu, Ting Ye
{"title":"Much of the excess mortality in immunocompromised patients with viral severe acute respiratory infection occurs after ICU discharge.","authors":"Leyi Xu, Ting Ye","doi":"10.1186/s13054-026-06392-0","DOIUrl":"https://doi.org/10.1186/s13054-026-06392-0","url":null,"abstract":"","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"30 1","pages":""},"PeriodicalIF":11.4,"publicationDate":"2026-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149243292","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}
Critical CarePub Date : 2026-10-21DOI: 10.1186/s13054-026-06417-8
Manuel F Struck, Daniel Werner, Marcus Rudolph, Peter Hilbert-Carius
{"title":"Hydroxyethyl starch for prehospital fluid resuscitation: results of two helicopter emergency medical service operators in Germany.","authors":"Manuel F Struck, Daniel Werner, Marcus Rudolph, Peter Hilbert-Carius","doi":"10.1186/s13054-026-06417-8","DOIUrl":"10.1186/s13054-026-06417-8","url":null,"abstract":"","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"30 1","pages":""},"PeriodicalIF":11.4,"publicationDate":"2026-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13688812/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149237090","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}
Critical CarePub Date : 2026-10-19DOI: 10.1186/s13054-026-06404-z
Li-Xia Xu
{"title":"When pupillometry indices disagree: does QPi add prognostic information beyond NPi?","authors":"Li-Xia Xu","doi":"10.1186/s13054-026-06404-z","DOIUrl":"10.1186/s13054-026-06404-z","url":null,"abstract":"","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"30 1","pages":""},"PeriodicalIF":11.4,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13679214/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223542","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}
Critical CarePub Date : 2026-10-17DOI: 10.1186/s13054-026-06249-6
Felix Hieber,Lorenz Schiessl,Anne Herrmann,Cynthia Kohl,Moritz Lux,Sebastian Blecha,Dirk Lunz,Martin Kieninger,Christoph Eissnert,Martin G. Kees,Alexander L. Leibold
{"title":"Decision volume and temporal workload structure as dissociable correlates of fatigue and mood in intensive care physicians: a real-time observational study","authors":"Felix Hieber,Lorenz Schiessl,Anne Herrmann,Cynthia Kohl,Moritz Lux,Sebastian Blecha,Dirk Lunz,Martin Kieninger,Christoph Eissnert,Martin G. Kees,Alexander L. Leibold","doi":"10.1186/s13054-026-06249-6","DOIUrl":"https://doi.org/10.1186/s13054-026-06249-6","url":null,"abstract":"Abstract Background Intensive care physicians make hundreds of decisions per shift under sustained cognitive and emotional demands. Decision fatigue, the tendency towards less effortful choices as cumulative decision load increases, may affect clinician wellbeing and decision processes. However, the associations of decision volume and temporal workload structure with within-shift fatigue and mood in intensive care unit (ICU) physicians remain unclear. This study explored whether decision volume and temporal clustering show distinct associations with fatigue, sleepiness, mood, and post-shift decision responses. Methods Five physicians (two residents, three consultants) at a surgical ICU of a German university hospital were shadowed during 38 twelve-hour shifts (456 hours) between October and December 2025. Clinical decisions were classified by severity using a study-specific, non-validated Decision Severity Score. Because recruitment was feasibility-based and involved only five physicians, all analyses were considered exploratory and hypothesis-generating. Psychometric assessments of decision fatigue, sleepiness, and mood (Decision Fatigue Scale, Karolinska Sleepiness Scale, Profile of Mood States – Short Form) were administered at morning, midday, and shift end. Following each shift, physicians completed a standardised scenario task requiring three binary treatment decisions. Temporal workload structure was quantified using the burstiness metric; shifts were classified into four types by median split of decision density and burstiness (quiet-smooth, quiet-clustered, busy-smooth, busy-clustered). Linear and binomial mixed-effects models with physician as random intercept were used throughout. Results Across 17,953 recorded decisions (median 474 per shift; range 366–589), a higher mean decision rate was associated with greater end-of-shift decision fatigue: an increase of 0.5 decisions per 5-minute interval corresponded to a 2.1-point higher decision-fatigue score (95 % CI 0.6 to 3.6). Higher burstiness was associated with less mood disturbance, with a 0.10 increase in burstiness corresponding to a 6.3-point lower mood score (95% CI −10.2 to −2.3). Averaged across all shifts, changes between morning and evening were small and not statistically significant for any of the three scores. Within-shift trajectories differed by shift type, however, with mood disturbance increasing over the shift in quiet-smooth shifts only, a difference already apparent at midday. Quiet-smooth shifts, the least objectively demanding, showed the least favourable psychometric values. Response certainty in the post-shift scenario task was lower after shifts with more task interruptions, with each ten additional interruptions corresponding to a 0.29-point lower certainty score (p = 0.012), whilst a descriptive trend towards more conservative scenario responses was observed in busy-clustered shifts (odds ratio 2.25, p = 0.555). Conclusions Decision volume and temporal workload","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"84 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2026-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149208754","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}
Critical CarePub Date : 2026-10-17DOI: 10.1186/s13054-026-06405-y
Yong Soo Cho,Dong Hun Lee,Byung Kook Lee,Dong Ki Kim,Seok Jin Ryu,Yong Hun Jung,Hyoung Youn Lee,Jung Soo Park,Jin Hong Min,Seong-Woo Yun,Kyung Woon Jeung
{"title":"Validating the 2025 ERC/ESICM neuroprognostication algorithm using a restricted predictor set in a minimal WLST cohort","authors":"Yong Soo Cho,Dong Hun Lee,Byung Kook Lee,Dong Ki Kim,Seok Jin Ryu,Yong Hun Jung,Hyoung Youn Lee,Jung Soo Park,Jin Hong Min,Seong-Woo Yun,Kyung Woon Jeung","doi":"10.1186/s13054-026-06405-y","DOIUrl":"https://doi.org/10.1186/s13054-026-06405-y","url":null,"abstract":"Abstract Background The 2021 European Resuscitation Council (ERC)/European Society of Intensive Care Medicine (ESICM) neuroprognostication guidelines were highly specific but limited by strict entry criteria (Glasgow Coma Scale-Motor [GCS-M] ≤ 3), leaving nearly half of patients with an “indeterminate” prognosis. The updated 2025 guidelines introduced an expanded entry (GCS-M < 6) and a two-tiered sequential algorithm integrating favorable and unfavorable criteria to resolve this clinical uncertainty. This study validated the real-world performance of the 2025 algorithm using a pragmatic, restricted core predictor set in a cohort with a low frequency of withdrawal of life-sustaining therapy (WLST). Methods This retrospective observational study included adult comatose out-of-hospital cardiac arrest (OHCA) survivors treated with targeted temperature management who remained unconscious (GCS-M < 6) at 72 h between 2020 and 2025. Six-month functional outcomes were categorized using the modified Rankin Scale (poor: 4–6). The 2025 algorithm was applied using four unfavorable predictors (absent pupillary/corneal reflexes, status myoclonus, neuron-specific enolase [NSE] > 60 µg/L, gray-to-white matter ratio on brain computed tomography ≤ 1.10 via automated software) and two favorable predictors (GCS-M 4–5 on day 4, NSE ≤ 17 µg/L). Results Among 400 OHCA survivors, 129 were excluded due to early awakening ( n = 90) or death within 72 h ( n = 39). Of the 271 included patients, 233 (86.0%) had poor outcomes, and the withdrawal of life-sustaining therapy rate was low (5.5%). The integrated 2025 algorithm predicted poor outcomes with 76.2% sensitivity (95% CI, 68.4–82.9), 97.1% specificity (95% CI, 85.1–99.9), a 99.1% positive predictive value (95% CI, 95.0–100.0), and a 50.0% negative predictive value (95% CI, 37.6–62.4). Step 2 favorable criteria reclassified 48.9% (68/139) of patients who remained unclassified after Step 1, reducing the unclassified proportion from 55.8% (139/249) to a final indeterminate rate of 28.5% (71/249). Among patients with indeterminate outcomes, 97.2% (69/71) ultimately had poor outcomes. Among 22 patients with discordant favorable and unfavorable predictors, 6 (27.3%) had good outcomes. Conclusions In a cohort with a low frequency of WLST, the 2025 ERC/ESICM algorithm maintained high specificity, while Step 2 substantially reduced the proportion of unclassified patients. However, the restricted predictor set may have limited sensitivity and contributed to persistent indeterminate classifications.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"36 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2026-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149208753","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}
Critical CarePub Date : 2026-10-15DOI: 10.1186/s13054-026-06388-w
Emmanuel Hei-Lok Cheung,April Ip,Junjie Ma,Qi-Man Shi,Grace Sin-Man Lam,Hoi-Ping Shum,Dominic So,Yu-Yeung Yip,George Wing-Yiu Ng,Ka Ming Kwok,Steven K.H. Ling,Calvin Yuk Wang Tam,Tammy Sin-Kwan Ma,Wallace Chun-Wai Ngai,Jacky Y. Suen,Simon Wai-Ching Sin,Shannon M. Fernando,Carol L Hodgson,Eddy Fan,Peter Tanuseputro,Pauline Yeung Ng
{"title":"Weeks alive and out of hospital among adult ECMO survivors: a multicentre registry-based study","authors":"Emmanuel Hei-Lok Cheung,April Ip,Junjie Ma,Qi-Man Shi,Grace Sin-Man Lam,Hoi-Ping Shum,Dominic So,Yu-Yeung Yip,George Wing-Yiu Ng,Ka Ming Kwok,Steven K.H. Ling,Calvin Yuk Wang Tam,Tammy Sin-Kwan Ma,Wallace Chun-Wai Ngai,Jacky Y. Suen,Simon Wai-Ching Sin,Shannon M. Fernando,Carol L Hodgson,Eddy Fan,Peter Tanuseputro,Pauline Yeung Ng","doi":"10.1186/s13054-026-06388-w","DOIUrl":"https://doi.org/10.1186/s13054-026-06388-w","url":null,"abstract":"","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"47 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149208755","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}