Critical Care最新文献

{"title":"Neurological outcomes and mortality following hyperoxemia in adult patients with acute brain injury: an updated meta-analysis and meta-regression","authors":"Nekane Romero-Garcia, Chiara Robba, Berta Monleón, Ana Ruiz-Zarco, Maria Pascual-González, Alberto Ruiz-Pacheco, Felipe Perdomo, Maria Luisa García-Pérez, Ana Mugarra, Laura García, Jose Carbonell, Lavienraj Premraj, Fabio Silvio Taccone, Rafael Badenes","doi":"10.1186/s13054-025-05387-7","DOIUrl":"https://doi.org/10.1186/s13054-025-05387-7","url":null,"abstract":"The aim of this study was to evaluate the association of arterial hyperoxemia with neurological outcomes and mortality in adults with acute brain injury (ABI). Six electronic databases, including MEDLINE, Embase and online registers of clinical trials, were systematically searched from inception to June 1 st, 2024. Studies comparing the effects of hyperoxemia versus no hyperoxemia on outcomes of hospitalized adult patients with ABI-related conditions (e.g. traumatic brain injury, post-cardiac arrest, subarachnoid hemorrhage, intracerebral hemorrhage, and ischemic stroke) were included according to PRISMA guidelines. Data were pooled using a random-effects model for unadjusted and covariate-adjusted odds ratios. The primary outcome was poor neurological outcome as defined by each individual study, and the secondary outcome was all-cause mortality. Subgroup analyses were conducted based on principal diagnosis, timing of outcome measures, oxygenation thresholds, among other factors. Meta-regression was applied to identify sources of heterogeneity. After 7,849 nonduplicated records were screened, 66 studies fulfilled eligibility criteria for systematic review. The meta-analysis including 24 studies (16,635 patients) revealed that patients with hyperoxemia are 1.29 times more likely to develop poor neurological outcomes (unadjusted OR, 1.295; 95% Confidence Interval, CI 1.040–1.616) compared with those with no hyperoxemia, particularly in subarachnoid hemorrhage and ischemic stroke subgroups. The meta-analysis including 35 studies (98,207 patients) revealed that all-cause mortality is 1.13 times more likely (OR 1.13; 95% CI 1.002–1.282) in patients with hyperoxemia compared with no hyperoxemia. In our study we found that hyperoxemia is significantly associated with an increased risk of poor neurological outcomes and mortality in patients with acute brain injury compared to those with no hyperoxemia. Our results suggest the importance of carefully adjusting oxygenation strategies in neurocritical ICUs. ","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"6 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143862743","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":"Prevalence and incidence of cognitive impairment following acute respiratory distress syndrome of any cause: a systematic review and meta-analysis","authors":"Robert Pohl, Doreen Wolff, Ebru Özkan, Antonia A. Sprenger, Claudia Hasenpusch, Judith Wesenberg, Emrah Düzel, Christian Apfelbacher","doi":"10.1186/s13054-025-05375-x","DOIUrl":"https://doi.org/10.1186/s13054-025-05375-x","url":null,"abstract":"The aim of this systematic review and meta-analysis is to synthesize and appraise the evidence on prevalence of cognitive impairment following acute respiratory distress syndrome (ARDS) of any cause. We systematically searched PubMed, Scopus, and Web of Science for observational studies focused on cognitive impairment in adult survivors of ARDS. Risk of bias and certainty of evidence (GRADE) were assessed. A meta-analysis using a random effects model was performed to estimate the overall prevalence of cognitive impairment after ARDS, with subgroup analyses for COVID-19-related ARDS (C-ARDS). Additionally, a meta-regression was conducted to assess the influence of demographic and clinical predictors on cognitive outcomes. Heterogeneity was assessed using τ2 and the I2 statistic. We identified 14 studies with 1451 participants, with 650 participants (range: 13–98) included in the analyses. In the subgroup of C-ARDS, 12 studies with 563 participants (range: 13–98) were considered. The pooled prevalence of cognitive impairment following ARDS was 36% (95% CI 26–46%), with high heterogeneity between studies (I2 = 92%, τ2 = 0.03). In C-ARDS cohorts, the prevalence was 34% (95% CI 22–45%), with similar levels of heterogeneity (I2 = 92.7%, τ2 = 0.03). Meta-regression analysis showed that older age predicted a higher prevalence of cognitive impairment following ARDS (b = 0.02, p = 0.033), reducing between-study heterogeneity (I² = 60.04%, τ² = 0.01). ICU stay, sex, and time from ICU discharge to cognitive assessment showed no significant associations (p > 0.05). This meta-analysis corroborates previous findings that cognitive impairment remains a persistent issue for ARDS survivors. The prevalence of cognitive impairments following ARDS highlights the importance of future research to unravel the complex underlying mechanisms contributing to these deficits and to develop targeted strategies for prevention and rehabilitation in survivors.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"13 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143862746","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":"Outcomes and cost-effectiveness of intermediate care units for patients discharged from the intensive care unit: a nationwide retrospective observational study","authors":"Saori Ikumi, Kunio Tarasawa, Takuya Shiga, Takahiro Imaizumi, Yu Kaiho, Yudai Iwasaki, Shizuha Yabuki, Yukito Wagatsuma, Eichi Takaya, Kiyohide Fushimi, Yukiko Ito, Kenji Fujimori, Masanori Yamauchi","doi":"10.1186/s13054-025-05393-9","DOIUrl":"https://doi.org/10.1186/s13054-025-05393-9","url":null,"abstract":"The clinical and economic impacts of intermediate care units (IMCUs) on intensive care unit (ICU)-discharged patients remain unclear due to inconsistent outcomes in previous studies. Under Japan’s National Health Insurance Scheme, ICUs are categorized by staffing intensity (high or low). Using a nationwide inpatient database in Japan, we evaluated the clinical outcomes and cost-effectiveness of IMCUs for ICU-discharged patients. This retrospective observational study used a Japanese administrative database to identify patients admitted to the high-intensity ICU in hospitals with IMCUs between April 2020 and March 2023. Patients were categorized into the IMCU (IMCU group) and general ward (non-IMCU) groups. Propensity scores were estimated using a logistic regression model incorporating 14 variables, including patient demographics, and treatments received during ICU stay. One-to-one propensity score matching balanced baseline characteristics of each group. Clinical outcomes were compared between both groups, including in-hospital mortality, ICU readmission, length of ICU stay, length of hospital stay, and total medical costs. Surgical status and surgical area (e.g., cardiovascular) were considered in subgroup analyses. Data analyses were conducted using the chi-square test for categorical variables and t-test for continuous variables. Overall, 162,243 eligible patients were categorized into the IMCU (n = 21,548) and non-IMCU (n = 140,695) groups. Propensity score matching generated 18,220 pairs. The IMCU group had lower in-hospital mortality and ICU readmission rates than the non-IMCU group. However, total costs were higher in the IMCU group. Subgroup analyses revealed the IMCU group had significantly lower mortality and lower total costs than the non-IMCU group in the cardiovascular [open thoracotomy] surgery subgroup. Discharge to an IMCU is associated with lower in-hospital mortality and ICU readmission rates compared to general ward discharge. High-risk subgroups, such as cardiovascular surgery patients, experienced cost-effective benefits from IMCU care. These findings highlight an association between IMCU admission and improved patient outcomes, suggesting a potential role in optimizing resource use in intensive care. Given the likelihood of selection bias in admission allocation, these findings should be interpretation with caution. ","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"7 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143862764","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":"“High blood flow” versus “low blood flow” ECCO2R: how to classify—author’s reply","authors":"Clément Monet, Audrey De Jong, Samir Jaber","doi":"10.1186/s13054-025-05386-8","DOIUrl":"https://doi.org/10.1186/s13054-025-05386-8","url":null,"abstract":"<p>We sincerely thank Wang et al. [1] for their correspondence and thoughtful consideration of our article published in <i>Critical Care</i> [2]. We appreciate their acknowledgment of the valuable insights into lung protection provided by our work. Our study demonstrated that blood flow plays a predominant role in determining the feasibility of ultra-low tidal volume ventilation (≤ 3 mL/kg predicted body weight). We fully agree on the need for better standardization criteria for defining high- and low-blood-flow ECCO<sub>2</sub>R devices in the future [3]. As noted by the authors, an internationally validated definition of these terms is still lacking [4].</p><p>As underlined by the authors of the correspondence there is some threshold variability in defining high- and low-blood-flow devices. In the <i>Supernova</i> study [5] devices were categorized as follows: lower extraction (Hemolung Respiratory Assist System, blood flow between 300 and 500 mL/mn) and higher extraction (iLA activve, Novalung, and Cardiohelp, Gettinge, blood flow between 800 and 1000 mL/mn). We adopted the same definition for low-blood-flow devices in our study. Regarding high-blood-flow devices, the Supernova study specified: “Blood flow with the iLA activve (Novalung) and Cardiohelp HLS 5.0 (Getinge) can range between 0.5 and 4.5 L/min but was limited by study protocol to 800–1000 mL/min.” Similarly, in our study protocol, we set limits for high blood flow rates (albeit slightly higher than in the <i>Supernova</i> study). This ensured no overlap between low- and high-blood-flow rates, avoiding the ambiguities of a “gray area” where classification might become problematic. Indeed, devices using almost similar blood flow could have been more difficult to classify.</p><p>The authors of the correspondence mention the risk of misclassification of devices. Interestingly, had we adjusted the cut-off between high and low blood flow to 800 mL/mn our results would have remained unchanged. Indeed, under real-life conditions, blood flow rates in our study were either above 1000 mL/min or below 500 mL/min. Consequently, whether the threshold was set at 800 or 1000 mL/min would not have affected our findings. While several cut-off values could have been chosen, in the absence of a consensus, we adopted this approach. Recent clinical and experimental studies have highlighted that the combination of blood flow and sweep gas flow is the key determinant of CO<sub>2</sub> removal efficiency [6, 7]. With sweep gas flow reaching 10 to 15 L/min (standardize to 10 L/min in our study), blood flow remains the primary modifiable factor for enhanced CO<sub>2</sub> removal, as we demonstrated.</p><p>Wang et al. [1] suggest prioritizing membrane performance. However, our study was not designed to assess the in vitro capabilities of different membranes and/or devices. Instead, it aimed to analyze the factors contributing to the failure of ultraprotective ventilation in a clinical, rather than an experim","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"49 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143847139","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":"Peri-intubation adverse events and clinical outcomes in emergency department patients: the BARCO study","authors":"Ian Ward A. Maia, Bruno A. M. Pinheiro Besen, Lucas Oliveira J. e Silva, Rafael von Hellmann, Ludhmila Abrahao Hajjar, Benjamin J. Sandefur, Daniel Fontana Pedrollo, Caio Goncalves Nogueira, Natalia Mansur P. Figueiredo, Carlos Henrique Miranda, Danilo Martins, Thiago Dias Baumgratz, Bruno Bergesch, Diogo Costa, Osmar Colleoni, Juliana Zanettini, Ana Paula Freitas, Nicole Pinheiro Moreira, Patricia Lopes Gaspar, Renato Tambelli, Maria Cristina Costa, Samara Silveira, Wilsterman Correia, Rafael Garcia de Maria, Ubirajara A. Vinholes Filho, Andre P. Weber, Vinicius da Silva Castro, Carlos Fernando D. Dornelles, Barbara S. Tabach, Hélio P. Guimarães, Gabriela Stanzani, Thiago F. Gava, Aidan Mullan, Heraldo P. Souza, Otavio T. Ranzani, Fernanda Bellolio, Julio C. G. Alencar, Victor Paro da Cunha, Julio F. Marchini, Patricia Albuquerque Moura, Fernanda Greco, Yasmine Filippo, Rubens Yoshinori Kai, Guilherme Torres Abi Ramia Chimelli, Juan Valdivia, Edson Luiz Favero Junior, Felipe..","doi":"10.1186/s13054-025-05392-w","DOIUrl":"https://doi.org/10.1186/s13054-025-05392-w","url":null,"abstract":"Emergency tracheal intubation in critically ill patients carries a high risk of complications, and practices vary substantially across different settings. Identifying risk factors and understanding how peri-intubation adverse events affect patient outcomes may guide standardization of care and improve survival. This prospective cohort study involved 18 emergency departments in Brazil (March 2022–April 2024). We included adults (≥ 18 years) undergoing emergency intubation and excluded patients intubated electively or for cardiac arrest. We defined major peri-intubation adverse events as severe hypoxemia, new hemodynamic instability, or cardiac arrest occurring within 30 min of initiating intubation. The primary outcome was 28-day mortality. Multivariable regression analyses assessed associations between adverse events and mortality, controlling for potential confounders. Among 2846 patients, major adverse events occurred in 919 (32.3%) intubations, most frequently new hemodynamic instability (20.0%), followed by severe hypoxemia (12.5%) and cardiac arrest (3.5%). The overall 28-day mortality was 45.1%. Patients experiencing any major adverse event had a significantly higher 28-day mortality (57.6 vs 39.2%; aHR 1.43, 95% CI 1.26–1.62; p < 0.001). Sensitivity analyses confirmed these findings. Successful first-attempt intubation was associated with a reduced likelihood of major adverse events (aOR 0.52; 95% CI 0.41–0.65; p < 0.001). One in three patients undergoing emergency intubation experienced a major peri-intubation adverse event, which was associated with higher 28-day mortality. These results underscore the importance of optimizing intubation strategies to reduce complications and potentially improve patient outcomes in critically ill patients.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"29 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143847157","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":"Clinical features and treatments of VEXAS syndrome in critical care: a scoping review","authors":"Kasumi Satoh, Yasushi Tsujimoto, Daisuke Kasugai, Kazuki Okura, Sarah Kyuragi Luthe, Takao Ono, Yuki Miyamoto, Tasuku Matsuyama, Manabu Okuyama, Taketo Watase, Hajime Nakae, Tadahiro Goto","doi":"10.1186/s13054-025-05390-y","DOIUrl":"https://doi.org/10.1186/s13054-025-05390-y","url":null,"abstract":"Vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic (VEXAS) syndrome is a recently discovered severe disorder that predominantly affects adult males, characterized by systemic inflammation and hematologic abnormalities. Despite its profound impact on patient outcomes, awareness of VEXAS syndrome among critical care providers remains severely limited, often leading to delayed recognition, diagnosis, and initiation of appropriate treatment. This study aims to address this knowledge gap by conducting a scoping review on VEXAS syndrome in the critical care setting. This scoping review followed the PRISMA-ScR guidelines and Joanna Briggs Institute methodology, analyzing data from Cochrane CENTRAL, MEDLINE via PubMed, EMBASE, and Web of Science on May 19, 2024. We included studies that reported clinical features and treatments of patients with VEXAS syndrome requiring critical care. Of the 1262 reports identified, 78 reports met the inclusion criteria, including 45 case reports/series, 17 observational studies, 15 reviews, and one systematic review. Analysis of 55 cases revealed a median age of 69 with a strong male predominance (54/55). ICU admission rates ranged from 28 to 33%, with mortality rates between 18 and 40%. Critical manifestations included shock, hemophagocytic lymphohistiocytosis, acute respiratory distress syndrome, thrombosis, and airway edema. Sepsis was the leading cause of death, followed by other causes including VEXAS syndrome related organ failure, cardiovascular events, and intestinal perforation. Treatment approaches combined conventional critical care measures with immunosuppressive and immunomodulatory therapies, although infectious complications were frequently reported. This review revealed the lack of systematically analyzed studies focusing on VEXAS syndrome in the critical care setting, suggesting a significant gap in understanding the clinical characteristics and optimal treatments for VEXAS syndrome. Further research focused on VEXAS syndrome in the critical care setting is essential to improve early recognition, develop standardized treatment protocols, and ultimately improve patient outcomes in this complex patient population.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"50 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143841446","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":"Exogenous lactate infusion (ELI) in traumatic brain injury: higher dose is better?","authors":"Paul Vespa, Stephanie Wolahan, Manuel Buitrago-Blanco, Courtney Real, Jesus Ruiz-Tejeda, David L. McArthur, Jeffrey N. Chiang, Denes Agoston, Thomas C. Glenn","doi":"10.1186/s13054-025-05374-y","DOIUrl":"https://doi.org/10.1186/s13054-025-05374-y","url":null,"abstract":"Traumatic brain injury (TBI) is a life-threatening critical neurological injury resulting in widespread metabolic dysfunction in need of novel metabolic therapy. Exogenous lactate appears to improve brain metabolism, but the dose of lactate required remains uncertain. However, the ideal dose of lactate remains unclear. We present a comparison of low vs high dose exogenous sodium lactate infusion in a small cohort and the previous existing literature. We propose a systematic protocol to better study the question of dose–effect n in a future larger study. We analyzed the metabolic and physiologic effects of various doses of exogenous sodium lactate infusion (ELI) in the existing published literature and our own, single center cohort of patients with coma from severe TBI. Low dose ELI targeting arterial lactate concentration of 2–3 mMol was compared with high dose ELI targeting 4–6 mM. Effects of ELI on brain metabolism and intracranial pressure (ICP) were reviewed. A precision high-dose protocol was piloted and results compared against the existing literature. Across various studies, metabolic response to ELI was variable and not consistently beneficial. High-dose ELI targeting arterial concentration of 4–6 mM resulted in consistent metabolic improvement and in ICP reduction (p < 0.01). The precision high dose protocol reliably resulted in higher arterial concentration. High dose ELI appears to have more consistent beneficial effects on brain metabolism and intracranial pressure. ClinicalTrials.gov ID NCT02776488. Date registered: 2016-05-17. Retrospectively Registered.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"40 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143831802","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":"Caution when analyzing zero events in both arms: reanalysis of anaphylaxis risk for gelatin solutions","authors":"Hsiang‑Yi Hung, Pei‑Chun Lai, Yen-Ta Huang, Chao-Han Lai","doi":"10.1186/s13054-025-05388-6","DOIUrl":"https://doi.org/10.1186/s13054-025-05388-6","url":null,"abstract":"&lt;p&gt;Fluid administration is essential for maintaining organ perfusion in patients experiencing hypovolemic or vasodilatory shock. Succinylated gelatin, the main component of gelatin solution used clinically as colloid fluid, is one of the options for volume expansion. In the past five years, two randomized controlled trials (RCTs) have reported benefits of gelatin solutions [1, 2]. One RCT found that gelatin better maintains blood viscosity and stabilizes the body's oxygenation balance [1]. Another RCT demonstrated that a smaller volume of gelatin was as effective as a larger volume of crystalloid at expanding blood volume, increasing cardiac output, and causing less interstitial space expansion [2]. However, there remains insufficient research examining its role in shock reversal.&lt;/p&gt;&lt;p&gt;Systematic reviews with meta-analysis (SRMA) pooling RCTs are frequently used as references for developing critical care guidelines. The lack of statistical significance in improving mortality and kidney replacement therapy outcomes from studies included in meta-analyses (which are generally small and include mostly postoperative patients) has led to concerns about administering gelatin solutions in adults with sepsis/septic shock. The surviving sepsis campaign 2021 [3] has noted 'moderate' undesirable effects based on meta-analytic data indicating higher anaphylaxis risk compared to alternative fluids [4]. However, this statistical finding warrants further discussion after careful examination.&lt;/p&gt;&lt;p&gt;In meta-analyses examining anaphylaxis in patients receiving gelatin fluids versus albumin or crystalloid solutions, a significant proportion (7 out of 10) of trials have zero events in both intervention and control groups (so-called zero total event trials), resulting in 'not estimable' risk ratios (RRs) [4]. Consequently, pooled estimates with significant RRs are derived solely from a small subset (3 out of 10) of RCTs. Meta-analyses omitting zero total event trials yield larger effect sizes than those including them, though experts recommend their inclusion to provide the most generalizable estimate of treatment effect [5]. Several approaches exist for handling meta-analyses with zero total event trials, and a straightforward method is to present the data using risk difference (RD) [5]. When the meta-analysis by Moeller et al. [4] was re-calculated with RD as the effect measure, all ten studies were weighed in the analysis. We also performed an updated SR on this issue, and no new RCTs were suitable for inclusion. As shown in Fig. 1A, the pooled estimate revealed a RD of 0.02 (95% CI − 0.02 to 0.06). Among the included studies, the RCT showing a statistically significant increase in gelatin-associated anaphylaxis had its weight reduced from 83.3 to 6%. The pooled estimates not only fail to reach a statistically significant difference but, from an evidence-based-medicine perspective, may also not fully exceed the threshold of minimal important differences. Therefore","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"40 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143831804","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":"Fluid balance and outcome in cardiac arrest patients admitted to intensive care unit","authors":"Marie Renaudier, Jean-Baptiste Lascarrou, Jonathan Chelly, Olivier Lesieur, Jérémy Bourenne, Paul Jaubert, Marine Paul, Grégoire Muller, Pierre Leprovost, Thomas Klein, Mélany Yansli, Cédric Daubin, Matthieu Petit, Nicolas Pichon, Martin Cour, Ghada Sboui, Guillaume Geri, Alain Cariou, Wulfran Bougouin","doi":"10.1186/s13054-025-05391-x","DOIUrl":"https://doi.org/10.1186/s13054-025-05391-x","url":null,"abstract":"Although shock following cardiac arrest is common and contributes significantly to mortality, the influence of the modalities used to manage the hemodynamic situation, particularly with regard to fluid balance, remains unclear. We evaluated the association between positive fluid balance and outcome after out-of-hospital cardiac arrest (OHCA). We conducted a multicenter study from August 2020 to June 2022, which consecutively enrolled adult OHCA patients in 17 intensive care units. The primary endpoint was 90-day survival. Multivariate Cox analysis, propensity score matching and landmark analysis were performed, along with several sensitivity analyses. Of the 816 patients included in our study, 74% had a positive fluid balance, and 291 of 816 patients (36%) were alive at 90-day. A positive fluid balance was associated with mortality after adjusted multivariate analysis (HR = 1.8 [1.3 – 2.3], p < 0.001), after propensity score matching (n = 193 matched patient pairs, HR = 1.6 [1.1 – 2.1], p = 0.005) and after landmark analysis. We reported a dose-dependent association between fluid balance and mortality. Patients with a positive fluid balance were more likely to need renal replacement therapy (10% vs. 2%, p = 0.001) and had a lower minimum PaO2/FiO2 ratio in the first seven days (158 vs. 180, p < 0.001). After cardiac arrest, a positive fluid balance is consistently associated with a worse outcome. Pending further data, a restrictive fluid therapy strategy may be beneficial in post-OHCA patients. Trial registration: ClinicalTrial.gov cohort AfterROSC-1 NCT04167891 registered November 13th, 2019, ethics committees 2019-A01378-49 and CPP-SMIV 190901. ","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"37 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143831803","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":"Hallucinations in critically ill patients: understanding the unreal","authors":"Romain Sonneville","doi":"10.1186/s13054-025-05372-0","DOIUrl":"https://doi.org/10.1186/s13054-025-05372-0","url":null,"abstract":"&lt;p&gt;Hallucinations are perceptual experiences that occur in the absence of an external stimulus and can involve any of the five sensory modalities: visual, auditory, olfactory, gustatory, or tactile. Auditory and visual hallucinations are the most common forms encountered clinically. These phenomena may manifest as hearing voices, seeing images, or perceiving sensations that do not correspond with any external reality. Hallucinations are frequently associated with psychiatric disorders such as schizophrenia, neurological disorders such as Parkinson disease, severe sleep deprivation, or substance intoxication and withdrawal. They may also occur in individuals with sensory impairments, such as hearing or vision loss, where the brain may generate internal stimuli in response to the sensory deficit. The content of hallucinations can vary significantly, from benign to distressing or threatening, and may cause substantial psychological distress to the patient. The pathophysiology underlying hallucinations is not fully understood but is believed to involve dysregulation of neurotransmitters, particularly dopamine, and abnormal activity in brain regions responsible for sensory processing. Common risk factors or hallucinations are presented in the Table 1.&lt;/p&gt;&lt;figure&gt;&lt;figcaption&gt;&lt;b data-test=\"table-caption\"&gt;Table 1 Risk factors for hallucinations&lt;/b&gt;&lt;/figcaption&gt;&lt;span&gt;Full size table&lt;/span&gt;&lt;svg aria-hidden=\"true\" focusable=\"false\" height=\"16\" role=\"img\" width=\"16\"&gt;&lt;use xlink:href=\"#icon-eds-i-chevron-right-small\" xmlns:xlink=\"http://www.w3.org/1999/xlink\"&gt;&lt;/use&gt;&lt;/svg&gt;&lt;/figure&gt;&lt;p&gt;The ICU environment likely increases the risk of hallucinations due to multiple factors that disrupt normal cognitive function. Sleep deprivation is common in ICU patients, caused by frequent interruptions, noise, and continuous light exposure, which can precipitate delirium and hallucinations. Sensory overload from persistent alarms, machinery noise, and healthcare staff activity can overwhelm the sensory processing of patients, leading to perceptual distortions. Social and physical isolation in the ICU contributes to psychological stress and anxiety, further predisposing patients to hallucinations. Medications frequently administered in the ICU, including sedatives, analgesics, and anticholinergics, are known to have neuropsychiatric side effects, including hallucinations. Additionally, severe infections and metabolic disturbances, can impair cognitive function and contribute to delirium and associated hallucinations. The disorienting nature of the ICU—characterized by unfamiliar surroundings, lack of natural light, and frequent staff changes—further challenges patients’ ability to distinguish between reality and hallucinations [1].&lt;/p&gt;&lt;p&gt;The diagnosis of hallucinations remains challenging in the ICU, as no specific tool has been designed to quantify this symptom at the bedside. Among commonly used scales, the Intensive Care Delirium Screening Checklist (ICDSC) includes a qualita","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"6 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143827700","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}