Critical Care最新文献

{"title":"Association of epinephrine and outcome in cardiac arrest with refractory shockable rhythm: a population-based, propensity-score matched analysis","authors":"Lucie Fanet, François Javaudin, Florence Dumas, Frankie Beganton, Jean-Philippe Empana, Lionel Lamhaut, Daniel Jost, Eloi Marijon, Xavier Jouven, Alain Cariou, Wulfran Bougouin","doi":"10.1186/s13054-025-05417-4","DOIUrl":"https://doi.org/10.1186/s13054-025-05417-4","url":null,"abstract":"Epinephrine use in cardiac arrest is increasingly controversial, with contrasting results according to initial rhythm. We assessed the association between epinephrine use and favorable neurological outcome among patients with out of hospital cardiac arrest with refractory shockable arrest. In this multicentric population-based prospective registry, we included all patients with out-of-hospital cardiac arrest, with persistent ventricular fibrillation after at least 3 defibrillations from 15/05/2011 to 31/12/2021 in Paris and its suburbs. Primary outcome was survival with a favorable neurological outcome (Cerebral Performance Categories level 1 or 2 at hospital discharge). A multivariate logistic regression analysis and a propensity score analysis with adjustment, matching and inverse probability weighting were performed. Among the 3163 patients with refractory shockable arrest, 2572 (81%) received epinephrine. Primary outcome was achieved in 270 patients (11%) among those who received epinephrine, and in 294 patients (50%) among those who did not. After adjustment, epinephrine use remained negatively associated with favorable outcome (aOR 0.24, 95%CI 0.19–0.31, p < 0.001). This negative association between epinephrine and favorable outcome was consistent after adjustement for propensity-score (aOR 0.24, 95%CI 0.18–0.31, p < 0.001), matching on propensity score (aOR 0.40, 95%CI 0.31–0.51, p < 0.001), and in various sensitivity analyses. In a large population-based registry of patients experiencing refractory ventricular fibrillation, epinephrine use was consistently associated with worse outcome using various methodological approaches. These findings are challenging the systematic use of epinephrine in refractory ventricular fibrillation.The use of potential alternative therapeutic strategies might be evaluated in this population.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"15 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144319926","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":"Optimizing microbiological surveillance during selective digestive decontamination in the intensive care unit: an in silico simulation study","authors":"Jelle L. G. Haitsma Mulier, Fleur J. van Dijk, Valentijn A. Schweitzer, Marc J. M. Bonten, Lennie P. G. Derde, Olaf L. Cremer","doi":"10.1186/s13054-025-05494-5","DOIUrl":"https://doi.org/10.1186/s13054-025-05494-5","url":null,"abstract":"Selective Digestive Decontamination (SDD) prevents infections and reduces mortality in the intensive care unit (ICU). Microbiological surveillance is considered essential for effective decontamination and detecting antibiotic resistance. However, its optimal frequency is unclear. We compared microbiological yield and costs of different surveillance intervals during SDD. In a computational simulation study, using data from a Dutch ICU, three surveillance scenarios were compared: (A) twice-weekly, (B) once-weekly, and (C) no surveillance. The primary outcome was the number of clinically relevant potentially pathogenic microorganisms (PPMs) detected per scenario. Secondary outcomes included detection of colonisation persistence prompting SDD intensification and surveillance costs. We included 8,499 ICU admissions, 52,553 clinical and 75,567 SDD cultures. Scenario A yielded 911 (95% CI 905–917) PPMs per 1,000 days, of which 90 (88–94) were clinically relevant: 9 (9–10) multidrug-resistant microorganisms, 68 (66–71) microorganisms resistant to standard therapy, and 13 (12–14) infection-related microorganisms. Scenarios B and C yielded 85 (82–88) and 77 (75–80) relevant PPMs, respectively (94% and 86% compared to scenario A). Scenario A identified 56 (55–58) cases of colonisation persistence per 1,000 days while scenarios B and C detected 43 (42–45) and 12 (11–12), respectively. Total costs of SDD surveillance were €78,774, €55,208, and €31,522 per 1,000 days for scenarios A, B and C. Compared to twice-weekly surveillance, once-weekly microbiological surveillance reduces costs by 30% with 6% loss in clinically relevant PPM detections. No surveillance reduces costs by 60% with 14% detection loss.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"17 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144304641","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":"Sedation and analgesia in post-cardiac arrest care: a post hoc analysis of the TTM2 trial","authors":"Ameldina Ceric, Josef Dankiewicz, Tobias Cronberg, Joachim Düring, Marion Moseby-Knappe, Martin Annborn, Teresa L. May, Matthew Thomas, Anders Morten Grejs, Christian Rylander, Jan Belohlavek, Pedro Wendel-Garcia, Matthias Haenggi, Claudia Schrag, Matthias P. Hilty, Thomas R. Keeble, Matt P. Wise, Paul Young, Fabio Silvio Taccone, Chiara Robba, Alain Cariou, Glenn Eastwood, Manoj Saxena, Susann Ullén, Gisela Lilja, Janus C. Jakobsen, Anna Lybeck, Niklas Nielsen","doi":"10.1186/s13054-025-05461-0","DOIUrl":"https://doi.org/10.1186/s13054-025-05461-0","url":null,"abstract":"The routine use of sedation and analgesia during post-cardiac arrest care and its association with clinical outcomes remain unclear. This study aimed to describe the use of sedatives and analgesics in post-cardiac arrest care, and evaluate associations with good functional outcome, survival, clinical seizures, and late awakening. This was a post hoc analysis of the TTM2-trial, which randomized 1900 out-of-hospital cardiac arrest patients to either normothermia or hypothermia. In both groups, deep sedation (Richmond Agitation and Sedation Scale ≤ -4) was mandatory during the 40-h intervention. Cumulative doses of sedatives and analgesic drugs were recorded within the first 72 h from randomization. Outcomes were functional outcome (modified Rankin Scale) and survival status at 6 months, occurrence of clinical seizures during the intensive care stay, and late awakening (Full outline of unresponsiveness motor score of four 96 h after randomization). Cumulative propofol doses were divided into quartiles (Q1-Q4). Logistic regression models were used to assess associations between sedative doses and functional outcome and survival, clinical seizures, and late awakening, adjusting for the severity of illness and other clinical factors influencing sedation. A total of 1861 patients were analyzed. In a multivariable logistic regression model, higher propofol doses (Q3, 100.7–153.6 mg/kg) were associated with good functional outcome (OR 1.62, 95%CI 1.12—2.34) and (Q2 and Q3, 43.9–153.6 mg/kg) with survival (OR 1.49, 95%CI 1.05—2.12 and OR 1.84, 95%CI 1.27—2.65, respectively). Receiving fentanyl and remifentanil were associated with good functional outcome (OR 1.69, 95%CI 1.27—2.26 and OR 1.50, 95%CI 1.11—2.02) and survival (OR 1.80, 95%CI 1.35—2.40 and OR 1.56, 95%CI 1.16—2.10). Receiving fentanyl (OR 0.64, 95%CI 0.48—0.86) and higher propofol doses (Q2-4 (43.9–669.4 mg/kg) were associated with the occurrence of clinical seizures. The highest quartile of propofol dose (153.7–669.4 mg/kg, OR 3.19, 95%CI 1.91—5.42) was associated with late awakening. In this study, higher doses of propofol and the use of remifentanil and fentanyl were associated with good functional outcome and survival, occurrence of clinical seizures, and late awakening.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"7 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144304752","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":"Methodological considerations regarding cardiac arrest studies in hyperoxemia meta-analysis","authors":"Akihiro Sakai, Junichi Izawa","doi":"10.1186/s13054-025-05500-w","DOIUrl":"https://doi.org/10.1186/s13054-025-05500-w","url":null,"abstract":"&lt;p&gt;Dear Editor,&lt;/p&gt;&lt;p&gt;We read with great interest the study by Romero-Garcia et al. titled “Neurological outcomes and mortality following hyperoxemia in adult patients with acute brain injury: an updated meta-analysis and meta-regression” [1].&lt;/p&gt;&lt;p&gt;The analysis regarding oxygen concentration and neurological outcomes was particularly compelling. However, we would like to highlight a point regarding the cardiac arrest analysis that may affect the interpretation of results. Three studies included in this meta-analysis specifically examined the effects of hyperoxemia during cardiac arrest (intra-arrest period) rather than after return of spontaneous circulation [2,3,4]. These studies—Izawa et al. [2], Spindelboeck et al. [3], and Patel et al. [4]—all demonstrated beneficial outcomes associated with high oxygen concentrations during the active resuscitation phase [2,3,4].&lt;/p&gt;&lt;p&gt;All other post-cardiac arrest related studies cited in this meta-analysis, except for the three studies mentioned above, analyzed blood gas data obtained after ROSC or after ICU admission. Notably, these three studies were categorized as ‘favors hyperoxemia’ for neurological outcomes, which may significantly impact the overall results of the analysis.&lt;/p&gt;&lt;p&gt;Importantly, as Izawa et al. noted in their paper, outcomes associated with hyperoxemia differ substantially between the intra-arrest and post-cardiac arrest periods [2]. Although conducted in an animal model, Cavus et al. demonstrated that during CPR with 100% oxygen, brain tissue oxygen pressure (PbtO2) recovered to pre-arrest values, indicating that high-concentration oxygen provides beneficial effects during the low-flow state of CPR [5]. However, after ROSC, PbtO2 increased to levels four times higher than pre-arrest values with 100% oxygen administration. These animal study data demonstrate that the physiological requirements and tolerance for oxygen likely differ significantly between these two distinct phases of resuscitation.&lt;/p&gt;&lt;p&gt;Combining studies from these physiologically distinct phases may obscure phase-specific oxygen requirements and potentially lead to conflicting conclusions. We believe the relationship between oxygen concentration and neurological outcomes should be evaluated separately for the intra-arrest and post-return of spontaneous circulation (post-ROSC) periods. Heterogeneity analysis would also be important across the two periods.&lt;/p&gt;&lt;p&gt;We appreciate the authors’ valuable work and believe that evaluating the effect of oxygen concentration on neurological outcomes separately for the intra-arrest and post-ROSC phases would be beneficial for this field of study.&lt;/p&gt;&lt;p&gt;No datasets were generated or analysed during the current study.&lt;/p&gt;&lt;ol data-track-component=\"outbound reference\" data-track-context=\"references section\"&gt;&lt;li data-counter=\"1.\"&gt;&lt;p&gt;Romero-Garcia N, Robba C, Monleón B, Ruiz-Zarco A, Pascual-González M, Ruiz-Pacheco A, Perdomo F, García-Pérez ML, Mugarra A, García L, et al. Neurological ","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"6 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144304634","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":"Muscle weakness after critical illness: unravelling biological mechanisms and clinical hurdles","authors":"Alexandre Pierre, Raphael Favory, Claire Bourel, Michael Howsam, Raphael Romien, Steve Lancel, Sebastien Preau","doi":"10.1186/s13054-025-05462-z","DOIUrl":"https://doi.org/10.1186/s13054-025-05462-z","url":null,"abstract":"Survivors of intensive care unit (ICU) are increasingly numerous because of better hospital care. However, several consequences of an ICU stay, known as post-intensive care syndrome, worsen long-term prognoses. A predominant feature in survivors is reduced muscle strength, mass, and physical function. This leads to lower exercise capacity, long-lasting physical disability, higher mortality risk, and subsequent health costs. While ICU-acquired muscle weakness has been extensively studied these past decades, underlying mechanisms of post-ICU muscle weakness remain poorly understood, and there is still no evidence-based treatment for improving long-term physical outcomes. One hypothesis, among others, could be that the pathophysiology is dynamic over time, differing between the acute ICU and post-ICU recovery periods. This narrative review aims to address the clinical, physiological and biological determinants of persistent muscle dysfunction in ICU survivors, with particular attention to the molecular, cellular and systemic mechanisms involved. Specifically, pre-ICU health factors such as obesity and sarcopenia, ICU-related complications and treatments, and post-ICU management all influence recovery. Dysfunctions in the neuroendocrine, vascular, neurological, and muscle systems contribute as physiological determinants of the muscle weakness. Complex and multifaceted biological mechanisms drive the post-ICU muscle dysfunction with mitochondrial and autophagy dysfunction, epigenetic modifications, cellular senescence, muscle inflammation with altered cell–cell communication, including dysfunction of immune cells, stem cell exhaustion and extracellular matrix remodelling. The review also sheds light on new and innovative therapeutic approaches and discusses future research directions. Emphasis is placed on the potential for multi-approach treatments that integrate nutritional, physical, and biological interventions. Addressing these aspects in a holistic and dynamic manner, from ICU to post-ICU phases, may provide avenues for mitigating the long-term burden of muscle weakness and physical disability in ICU survivors.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"12 1","pages":"248"},"PeriodicalIF":15.1,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144311921","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":"Setting the record straight: revisiting the debate on extracorporeal therapies in sepsis","authors":"Klaus Stahl, Pedro David Wendel Garcia, Christian Bode, Sascha David","doi":"10.1186/s13054-025-05426-3","DOIUrl":"https://doi.org/10.1186/s13054-025-05426-3","url":null,"abstract":"&lt;p&gt;Dear editor,&lt;/p&gt;&lt;p&gt;We find ourselves grappling with certain aspects of Gabriella Bottari’s recent commentary, &lt;i&gt;“Rethinking Caution: A critical appraisal of extracorporeal blood purification in sepsis”&lt;/i&gt; [1], particularly in relation to our own comment a few weeks earlier &lt;i&gt;“A few word of caution on blood purification in sepsis” &lt;/i&gt;[2] in the journal.&lt;/p&gt;&lt;p&gt;We truly appreciate the encouragement of a rigorous scientific debate and would therefore like to take the chance to clarify a few concerns raised by this recent commentary.&lt;/p&gt;&lt;p&gt;We disagree with the list of limitations of the Wendel-Garcia [3] study by Bottari et al. [1]. First, the study is a &lt;b&gt;prospective, controlled trial&lt;/b&gt; with very strict inclusion criteria (severe, refractory septic shock, IL-6 ≥ 1000 ng/l and a vasopressor dependency index ≥ 3, despite adequate volume resuscitation) and not a retrospective trial. With all due respect, their trial had a sophisticated propensity matched historical control group but was by no means a retrospective trial since the treatment group was recruited prospectively following a controlled protocol. To us, the fact that their findings contradicted their own initial proposed hypothesis of improved outcome with adjunctive EBP, only further underscores the significance and reliability of these findings. Furthermore, the discussion surrounding CVVH’s potential mortality effect in this trial is not only perplexing but also overlooks key details. What Bottari criticizes as missing in Wendel-Garcia’s work is, in fact, &lt;b&gt;documented in the supplementary materials&lt;/b&gt;, including comparable rates of CVVHDF procedures in both groups.&lt;/p&gt;&lt;p&gt;Perhaps the most concerning issue, however, is the fundamental &lt;b&gt;misinterpretation regarding survival vs. mortality&lt;/b&gt; in the eXchange-1 trial [4]. In fact, the results were the opposite of what our esteemed colleagues reported—plasma exchange was associated with a 10% survival benefit. Moreover, we have never claimed confidence that plasma exchange is superior; we simply pointed out that it cannot be equated with &lt;i&gt;coupled plasma filtration and adsorption&lt;/i&gt; (CPFA), as the two techniques are fundamentally distinct and CPFA is a pure adsorption technology and thus closer to HA. Regardless of personal opinions and preferences, an &lt;b&gt;objective fact&lt;/b&gt; remains: plasma exchange has a &lt;b&gt;positive meta-analysis signal&lt;/b&gt; [5] whereas HA has a neutral signal [6].&lt;/p&gt;&lt;p&gt;Finally, we are not advocating for plasma exchange over hemoadsorption, we are advocating for the generation of &lt;b&gt;robust evidence.&lt;/b&gt; Our critique lies in the authors suggestion of best practice for hemadsorption in sepsis, which, in our view is based on insufficient evidence. This distinction is crucial.&lt;/p&gt;&lt;p&gt;No datasets were generated or analysed during the current study.&lt;/p&gt;&lt;ol data-track-component=\"outbound reference\" data-track-context=\"references section\"&gt;&lt;li data-counter=\"1.\"&gt;&lt;p&gt;Bottari G, Ranieri VM, Ince C, Pesenti A, Aucella F, Scandrogl","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"33 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144296234","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":"Post-extubation dysphagia in the ICU−a narrative review: epidemiology, mechanisms and clinical management (Update 2025)","authors":"Daniela Bertschi, Francesco Rotondo, Jan Waskowski, Philipp Venetz, Carmen A. Pfortmueller, Joerg C. Schefold","doi":"10.1186/s13054-025-05492-7","DOIUrl":"https://doi.org/10.1186/s13054-025-05492-7","url":null,"abstract":"Dysphagia (i.e. an impairment in swallowing function that impacts on safety or efficiency) is present in many intensive care unit (ICU) survivors, in particular following extubation (“post-extubation dysphagia”, PED). Despite the fact that pathomechanisms leading to PED are currently incompletely understood, local as well as central neurological and neuromuscular dysfunctions may be key to development of PED. Data from prospective large-scale clinical investigations with systematic screening demonstrate that PED affects about one out of five (about 20%) of mixed medical-surgical unplanned (emergency) ICU admissions. PED is associated with an increased risk for aspiration, aspiration-induced pneumonia, malnutrition, increased ICU resource use, decreased quality of life, prolonged ICU- and hospital length of stay and increased overall morbidity and mortality. Data demonstrate that PED is an independent predictor of 90-day mortality with increased risk of death up to about one year after ICU admission. PED may be a somewhat overlooked medical problem since in many ICUs, PED is currently not routinely screened for in all patients at risk (i.e. all ICU patients) following extubation. In this review, we update the available data on PED with a focus on epidemiology, risk factors, potential aetiology and treatment approaches, as well as clinical management on ICUs.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"32 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144304743","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":"Central nervous system infections rarely underlie presumed delirium in ICU admissions: insights from the Swiss ICU registry","authors":"Pascale Grzonka, Sebastian Berger, Simon A. Amacher, Lisa Hert, Tolga D. Dittrich, Martin Lohri, Paulina SC Kliem, Sabina Hunziker, Sarah Tschudin Sutter, Mark Kaufmann, Caroline E. Gebhard, Raoul Sutter","doi":"10.1186/s13054-025-05485-6","DOIUrl":"https://doi.org/10.1186/s13054-025-05485-6","url":null,"abstract":"&lt;p&gt;Delirium, a neuropsychiatric syndrome with high morbidity and mortality, affects up to 80% of mechanically ventilated intensive care unit (ICU) patients [1] with a recently decreasing 50% incidence due to improved care [2]. Given that central nervous system (CNS) infections induce cerebral dysfunction, guidelines recommend cerebral spinal fluid (CSF) analysis in cases of unexplained neurological impairment, particularly with infectious/inflammatory signs [3]. Due to overlapping clinical features between delirium and CNS infections—and implications of diagnostic delay—lumbar puncture is performed in up to 50% of delirious patients [4], despite procedural risks.&lt;/p&gt;&lt;p&gt;This study aimed to determine the proportion of adult ICU patients with presumed delirium, compare their characteristics to the general ICU population, and assess the prevalence of underlying CNS infections using Swiss ICU registry data.&lt;/p&gt;&lt;p&gt;Data were extracted from the prospective Swiss ICU registry (MDSi-Dataset), a mandatory national database managed by the Swiss Society of Intensive Care Medicine covering all certified adult ICUs. During the study, 100% of ICUs varied in numbers between 73 and 77. Patients admitted with presumed delirium were identified. We analyzed baseline characteristics, the Simplified Acute Physiology Score II (SAPS II), ICU resource use, and outcomes, including CNS infections as a leading ICU-diagnosis established during intensive care. Primary outcomes included clinical features of delirium-admitted patients and the proportion with confirmed CNS infections. Secondary outcomes assessed alternative main diagnoses (further methodological details in Supplemental Methodological Data&lt;b&gt;)&lt;/b&gt;.&lt;/p&gt;&lt;p&gt;Among 325,468 admissions, 302,023 patients (92.8%) received treatment on interdisciplinary ICUs, followed by surgical and medical ICUs. 33.1% were admitted to ICUs at regional, 29.1% at larger, and 19.5% at university hospitals. 197,597 patients (60.7%) were male, the median SAPS II was 31 (IQR:22–42), and the median Nine Equivalents of Nursing Manpower use Score of all nursing shifts was 90 (IQR:54–195). Figure 1A presents principal diagnoses established during intensive care. The 2,784 patients (0.9%) with presumed delirium were older (median age: 75 vs. 68 years without delirium, &lt;i&gt;p&lt;/i&gt; &lt; 0.001), predominantly male (72.2% vs. 60.6% without delirium, &lt;i&gt;p&lt;/i&gt; &lt; 0.001), and had higher illness severity (median SAPS II: 33 vs. 31 without delirium, &lt;i&gt;p&lt;/i&gt; &lt; 0.001). Figure 1B presents comparisons between patients with and without delirium at ICU admission. Of the 2,784 delirious patients, CNS infections were diagnosed in only eight (0.3%), a similar proportion as in the 321,249 patients without presumed delirium (1,435/32,149 [0.44%]). The latter had longer intensive care (median: 3.4 vs. 1.8 days, &lt;i&gt;p&lt;/i&gt; &lt; 0.001) but none died, five (62.5%) were transferred to the normal wards, and two (25%) to rehabilitation centers or home. Supplemental Table 1 p","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"12 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144288584","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":"From indication to initiation of invasive intracranial pressure monitoring time differences between neurosurgeons and intensive care physicians: can intracranial hypertension dose be reduced? TIMING-ICP, a multicenter, observational, prospective study","authors":"Lara Mariani, Stefano Calza, Paolo Gritti, Simone Maria Zerbi, Emanuele Russo, Cristian Deana, Dario Filippi, Chiara Robba, Anselmo Caricato, Paola Fassini, Giacomo Dell’Avanzo, Andrea Viscone, Lucio De Maria, Luca Pisapia, Luigi Vetrugno, Gianluigi Zona, Roberto Stefini, Corrado Iaccarino, Nicola Latronico, Simone Piva, Michele Bertoni, Antonio Biroli, Marco Maria Fontanella, Frank Rasulo","doi":"10.1186/s13054-025-05384-w","DOIUrl":"https://doi.org/10.1186/s13054-025-05384-w","url":null,"abstract":"The duration of episodes of intracranial hypertension is related to poor outcome, hence the need for prompt diagnosis. Numerous issues can lead to delays in the implementation of invasive intracranial pressure (ICP) monitoring, thereby increasing the dose of intracranial hypertension to which the patient is exposed. The aim of this prospective, observational, multicenter study was to assess the magnitude of this delay, evaluating the time required for initiation of invasive ICP monitoring, from indication (T1) to initiation of the maneuver (T2) when performed by neurosurgeons compared to intensive care physicians. We evaluated the impact of the operator performing the maneuver (neurosurgeon vs. intensivist) on the T2-T1 time interval, where T1 represents the time at which indication for invasive ICP monitoring is declared, and T2 the time at which the maneuver starts, defined as the skin incision. The effect of the operator performing the maneuver was evaluated through a parametric survival model. Both intraparenchymal catheters (IPCs) and external ventricular drains (EVDs) were considered as invasive ICP monitoring devices. Invasive monitoring could be performed in intensive care unit (ICU) or in operating room (OR). A total of 112 patients were included into the final analysis; 39 IPCs were placed by intensivists within the ICU, and a total of 73 IPCs and EVDs by neurosurgeons both within the ICU and OR settings. The mean difference in T2-T1 time for IPCs placement in the ICU was 69 min (CI 50.1–94.8) in the intensivist group and 145 min (CI 103.4–202.9) in neurosurgeon group. The mean difference between these groups, 76 min, was found to be statistically significant (p-value = 0.0021). In the group treated by neurosurgeons, no statistically significant differences were found in timing between the ICU and the OR. Invasive ICP monitoring performed with IPCs in ICU begins earlier when performed by intensivists rather than neurosurgeons. This finding suggests the possibility to obtain a prompt diagnosis of intracranial hypertension when intensivists intervein directly at patient’s bedside. Further studies are needed to confirm these findings and investigate their effect on outcome.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"7 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144278500","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":"Real-time changes in pulse pressure during a 10-second end-expiratory occlusion test reliably detect preload responsiveness","authors":"Francesco Gavelli, Nello De Vita, Christopher Lai, Danila Azzolina, Arthur Pavot, Mathieu Jozwaik, Rui Shi, Imane Adda, Alexandra Beurton, Jean-Louis Teboul, Xavier Monnet","doi":"10.1186/s13054-025-05483-8","DOIUrl":"https://doi.org/10.1186/s13054-025-05483-8","url":null,"abstract":"The end-expiratory occlusion (EEO) test detects preload responsiveness through changes in cardiac index (ΔCI) during a 15-second respiratory hold at end-expiration. We investigated the diagnostic accuracy of EEO-induced changes in arterial pulse pressure (∆PP), especially when the duration of EEO is reduced to 10’’ and 5’’, and whether adding an end-inspiratory occlusion (EIO) improves this diagnostic accuracy. In 143 mechanically ventilated patients with sinus rhythm, EEO and EIO were performed while recording ΔCI and ∆PP values. Either a fluid bolus-induced ΔCI ≥ 15% or a passive leg raising-induced ΔCI ≥ 10% defined preload responsiveness. The effects of the EEO and EIO tests on PP and CI were evaluated as the percentage difference between values averaged either over the last five seconds of the 15-sec respiratory holds (ΔPPEEO−15’’ and ΔPPEIO−15’’, ΔCIEEO−15’’ and ΔCIEIO−15’’), or between the 5th and the 10th seconds of the 15-sec respiratory holds (ΔPPEEO−10’’ and ΔPPEIO−10’’, ΔCIEEO−10’’ and ΔCIEIO−10’’), or during the five first seconds of respiratory holds (ΔPPEEO−5’’ and ΔPPEIO−5’’, ΔCIEEO−5’’ and ΔCIEIO−5’’) and baseline. Sixty-one (43%) patients were preload responders. Both ∆CIEEO−15’’ and ∆CIEEO−10’’ were higher in responders than in non-responders’ (5.8 [4.5–7.3]% vs. 1.1 [0.1–3.4]% and 3.0 [2.4–4.3]% vs. 0.6 [0.1–1.6]%, respectively; p < 0.001), whereas ∆CIEEO−5’’ did not differ between responders and non-responders. ∆PPEEO−5’’, ∆PPEEO−10’’ and ∆PPEEO−15’’ were significantly higher in responders than in non-responders (5.2 [2.8–8.7]% vs. 1.2 [0.3–2.8]%, 7.7 [5.0–12.4]% vs. 1.8 [0.5–3.1]% and 8.1 [5.1–11.8]% vs. 1.5 [0.5–3.0]%, respectively; p < 0.001). For detecting preload responsiveness, compared to the area under the receiver operating characteristic (AUROC) of ∆CIEEO−15’’ (0.935 [0.881–0.969]), the AUROC of ∆CIEEO−10’’ was similar (0.910 [0.851–0.951], p = 0.410), but the AUROC of ∆CIEEO−5’’ was smaller (0.541 [0.456–0.625], p < 0.001); the AUROC of ∆PPEEO−15’’ (0.913 [0.857–0.952], p = 0.346), and ∆PPEEO−10’’ (0.912 [0.860–0.947], p = 0.336) were similar, but the AUROC of ∆PPEEO−5’’ (0.834 (0.763–0.891, p = 0.005) was significantly smaller. Evaluation of ∆CIEEO+EIO and ∆PPEEO+EIO did not enhance reliability of the test at each test duration. In ventilated patients with sinus rhythm, real-time changes in PP during a 10-second EEO reliably detect preload responsiveness. No. IDRCB 2010A0095942. Registered 04 January 2010.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"9 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144288585","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}