Critical Care最新文献

{"title":"Evaluation of severe rhabdomyolysis on day 30 mortality in trauma patients admitted to intensive care: a propensity score analysis of the Traumabase registry","authors":"Thibault Martinez, Anatole Harrois, Anaïs Codorniu, Nicolas Mongardon, Matthieu Pissot, Benjamin Popoff, Marc Leone, Nathalie Delhaye, Eric Vicaut, Quentin Mathais, Vincent Legros, Jean-Luc Hanouz, Nicolas Gatulle, Véronique Ramonda, Benjamin Cohen, Mathieu Boutonnet, Julien Pottecher, Nicolas Libert","doi":"10.1186/s13054-024-05158-w","DOIUrl":"https://doi.org/10.1186/s13054-024-05158-w","url":null,"abstract":"Traumatic rhabdomyolysis (RM) is common and associated with the development of acute kidney injury and potentially with other organ dysfunctions. Thus, RM may increase the risk of death. The primary objective was to assess the effect of severe RM (Creatine Kinase [CK] > 5000 U/L) on 30-day mortality in trauma patients using a causal inference approach. In this multicenter cohort study conducted in France using a national major trauma registry (Traumabase) between January 1, 2012, and July 1, 2023, all patients admitted to a participating major trauma center hospitalized in intensive care unit (ICU) and with CK measurement were included. Confounding variables for both 30-day mortality and exposure were used to establish a propensity score. A doubly robust approach with inverse treatment weighting enabled the calculation of the average treatment effect on the treated (ATT). Analyses were performed in the overall cohort as well as in two subgroups: hemorrhagic shock subgroup (HS) and traumatic brain injury subgroup (TBI). Sensitivity analyses were conducted. Among the 8592 patients included, 1544 (18.0%) had severe RM. They were predominantly males (78.6%) with median [IQR] age of 41 [27–58] years and severely injured (ISS 20 [13 – 29]) mainly from blunt trauma (90.8%). In the entire cohort, the ATT, expressed as a risk difference, was 0.073 [-0.054 to 0.200]. Considering the 1311 patients in the HS subgroup, the ATT was 0.039 [0.014 to 0.063]. As in the overall cohort, there was no effect on mortality in the TBI subgroup. Severe RM was associated with greater severity of trauma and more complications (whether related to renal function or not) during the ICU stay. Mortality due to multiorgan failure (39.9% vs 12.4%) or septic shock (2.6% vs 0.8%) was more frequent among patients with severe RM. Severe RM was not associated with 30-day mortality considering the overall cohort. However, it was associated with a 4.0% increase in 30-day mortality among patients with concurrent hemorrhagic shock. Severe RM plays a significant role in ICU morbidity.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"20 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142690946","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":"D-PRISM: a global survey-based study to assess diagnostic and treatment approaches in pneumonia managed in intensive care","authors":"Luis Felipe Reyes, Cristian C. Serrano-Mayorga, Zhongheng Zhang, Isabela Tsuji, Gennaro De Pascale, Valeria Enciso Prieto, Mervyn Mer, Elyce Sheehan, Prashant Nasa, Goran Zangana, Kostoula Avanti, Alexis Tabah, Gentle Sunder Shrestha, Hendrik Bracht, Arie Zainul Fatoni, Khalid Abidi, Helmi bin Sulaiman, Vandana Kalwaje Eshwara, Liesbet De Bus, Yoshiro Hayashi, Pervin Korkmaz, Ali Ait Hssain, Niccolò Buetti, Qing Yuan Goh, Arthur Kwizera, Despoina Koulenti, Nathan D. Nielsen, Pedro Povoa, Otavio Ranzani, Jordi Rello, Andrew Conway Morris","doi":"10.1186/s13054-024-05180-y","DOIUrl":"https://doi.org/10.1186/s13054-024-05180-y","url":null,"abstract":"Pneumonia remains a significant global health concern, particularly among those requiring admission to the intensive care unit (ICU). Despite the availability of international guidelines, there remains heterogeneity in clinical management. The D-PRISM study aimed to develop a global overview of how pneumonias (i.e., community-acquired (CAP), hospital-acquired (HAP), and Ventilator-associated pneumonia (VAP)) are diagnosed and treated in the ICU and compare differences in clinical practice worldwide. The D-PRISM study was a multinational, survey-based investigation to assess the diagnosis and treatment of pneumonia in the ICU. A self-administered online questionnaire was distributed to intensive care clinicians from 72 countries between September to November 2022. The questionnaire included sections on professional profiles, current clinical practice in diagnosing and managing CAP, HAP, and VAP, and the availability of microbiology diagnostic tests. Multivariable analysis using multiple regression analysis was used to assess the relationship between reported antibiotic duration and organisational variables collected in the study. A total of 1296 valid responses were collected from ICU clinicians, spread between low-and-middle income (LMIC) and high-income countries (HIC), with LMIC respondents comprising 51% of respondents. There is heterogeneity across the diagnostic processes, including clinical assessment, where 30% (389) did not consider radiological evidence essential to diagnose pneumonia, variable collection of microbiological samples, and use and practice in bronchoscopy. Microbiological diagnostics were least frequently available in low and lower-middle-income nation settings. Modal intended antibiotic treatment duration was 5–7 days for all types of pneumonia. Shorter durations of antibiotic treatment were associated with antimicrobial stewardship (AMS) programs, high national income status, and formal intensive care training. This study highlighted variations in clinical practice and diagnostic capabilities for pneumonia, particularly issues with access to diagnostic tools in LMICs were identified. There is a clear need for improved adherence to existing guidelines and standardized approaches to diagnosing and treating pneumonia in the ICU. Trial registration As a survey of current practice, this study was not registered. It was reviewed and endorsed by the European Society of Intensive Care Medicine. ","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"428 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142684432","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":"Do prolonged infusions of β-lactam antibiotics improve outcomes in critically ill patients with sepsis? It is time to say yes","authors":"Xiaoming Li, Zhengying Jiang","doi":"10.1186/s13054-024-05139-z","DOIUrl":"https://doi.org/10.1186/s13054-024-05139-z","url":null,"abstract":"<p>Sepsis remains an important global health problem and a leading cause of death in critically ill patients worldwide [1]. The β-lactam antibiotics are widely used as an important component of antibiotic therapy for patients with sepsis. The bactericidal activity of β-lactam antibiotics is typically time-dependent, and their clinical effectiveness is affected by the duration of the free drug concentration remains above the minimum inhibitory concentration (MIC) of the target pathogen. Therefore, the prolonged (Extended or continuous) infusion of β-lactam antibiotics has been an attractive strategy, because it provides a more stable free drug concentration and a longer duration of free drug concentration above the MIC [2]. Many previous studies have shown pharmacological rationale and potential clinical advantages in favor of prolonged infusion of β-lactam antibiotics in critically ill patients with sepsis [3]. Therefore, many recent international consensus and guidelines recommend the use of prolonged infusion strategies for β-lactam antibiotics in critically ill patients [4,5,6]. And based on “moderate-quality” evidence, the Surviving Sepsis Campaign guidelines suggest a “weak” recommendation for prolonged infusion of β-lactam antibiotics for patients with sepsis or septic shock, rather than conventional intermittent infusion [7].</p><p>However, two well-conducted studies on this topic published in JAMA showed negative results. In the MERCY trial, a total of 607 patients were enrolled, and unfortunately there was no significant difference in the primary composite outcome or any secondary outcome between the two groups [8]. It may have been underpowered to detect small but still clinically meaningful results. Recently, the BLING III randomized clinical trial (RCT), the largest RCT on this topic to date, has been published [9]. Although only clinical cure was positive result in the continuous vs intermittent infusion group (55.7% vs 50.0%, respectively; <i>P</i> < 0.001), the absolute 90-days mortality (24.9% vs 26.8%, respectively), hospital mortality (23.3% vs 25.0%, respectively) and ICU mortality (17.1% vs 18.4%, respectively) were lower in the continuous infusion group than that in the intermittent infusion group. Thus, adding those data from the BLING III trial to previous meta-analysis would support rather than refute the previously reported benefits.</p><p>Abdul-Aziz and colleagues performed a systematic review and meta-analysis on this topic, including 18 RCTs with 9108 critically ill adults with sepsis or septic shock. And the results showed that prolonged infusion of β-lactam antibiotics was associated with lower 90-days mortality, ICU mortality and an increase in clinical cure [10]. To further verify the reliability of the conclusions and avoid false positive or false negative results, we conducted trial sequential analysis (TSA) based on the work of Abdul-Aziz et al. We used a random effects model to construct the cumulative Z cur","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"2 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142678170","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":"New definition of AKI: shifting the focus beyond mortality","authors":"Lihong Zhu, Juan Lin","doi":"10.1186/s13054-024-05170-0","DOIUrl":"https://doi.org/10.1186/s13054-024-05170-0","url":null,"abstract":"<p>To the editor,</p><p>We read with great interest the recent study [1] by Dr. Machado et al., which proposed a new definition for acute kidney injury (AKI) in critically Ill patients, based on varied urine output thresholds and time frames. This study uses in-hospital mortality as an outcome-oriented approach to compose the proposed UO-AKI classification, applying different time frames (3 h, 6 h, 12 h, and 24 h) and distinct cutoff points. Ultimately, the average UO over 6-h frame was used for the new classification, and AKI was redefined as follows: stage 1 (0.2–0.3 mL/kg/h), stage 2 (0.1–0.2 mL/kg/h), and stage 3 (< 0.1 mL/kg/h) over 6 h. this proposed classification demonstrated superior predictive accuracy over the KDIGO criteria, with improved NRI and IDI for mortality. However, some details need to be considered carefully when interpreting and applying the findings.</p><p>First, in the current study, the ability to predict death was used as a criterion to evaluate the quality of AKI criteria. However, the essence of the AKI definition is to reflect impaired excretion of metabolic waste due to damage to the renal tubules and/or renal interstitium. Moreover, not all AKI stages are associated with increased mortality. For instance, in a prospective study [2] including 4683 patients, Kaddourah et al. reported that severe AKI (stage 2–3) conferred an increased risk of death by day 28 after adjustment for 16 covariates while mild AKI stage 1 was not. Similarly, an analysis [3] of two large trials (COVID-19 Critical Care Consortium and LUNG-SAFE studies) showed that both 28-day and 90-day mortality risk was increased for patients with stage 2 (HR 2.00, <i>p</i> < 0.001) and stage 3 AKI (HR 1.95, <i>p</i> < 0.001), but not for stage 1. Therefore, using a mortality-oriented approach to define AKI may overlook the significance of mild AKI (stage 1) and may explain why the proposed classification's urine volume threshold for AKI stage 1 (0.2–0.3 mL/kg/h) is similar to the stage 3 threshold (0.3 mL/kg/h) in the KDIGO guidelines, albeit with different time frames. Also, this approach could introduce bias into the understanding of AKI’s clinical significance, as it focuses solely on the risk of death while neglecting the kidney dysfunction and injury that are essential to the definition of AKI. In addition, we are also somewhat unclear about the time frame definition. Were all time frames measured as the corresponding hours after ICU admission, or were they sliding windows? This distinction may be important for accurately defining AKI.</p><p>Finally, we commend Dr. Machado et al. for their significant work, and we hope our perspectives will help in the interpretation of these findings.</p><p>No datasets were generated or analysed during the current study.</p><ol data-track-component=\"outbound reference\" data-track-context=\"references section\"><li data-counter=\"1.\"><p>Machado GD, Santos LL, Liborio AB. Redefining urine output thresholds for acu","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"74 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142673904","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":"Three-year mortality of ICU survivors with sepsis, an infection or an inflammatory illness: an individually matched cohort study of ICU patients in the Netherlands from 2007 to 2019","authors":"Sesmu M. Arbous, Fabian Termorshuizen, Sylvia Brinkman, Dylan W. de Lange, Rob J. Bosman, Olaf M. Dekkers, Nicolette F. de Keizer","doi":"10.1186/s13054-024-05165-x","DOIUrl":"https://doi.org/10.1186/s13054-024-05165-x","url":null,"abstract":"Sepsis is a frequent reason for ICU admission and a leading cause of death. Its incidence has been increasing over the past decades. While hospital mortality is decreasing, it is recognized that the sequelae of sepsis extend well beyond hospitalization and are associated with a high mortality rate that persists years after hospitalization. The aim of this study was to disentangle the relative contribution of sepsis (infection with multi-organ failure), of infection and of inflammation, as reasons for ICU admission to long-term survival. This was done as infection and inflammation are both cardinal features of sepsis. We assessed the 3-year mortality of ICU patients admitted with sepsis, with individually matched ICU patients with an infection but not sepsis, and with an inflammatory illness not caused by infection, discharged alive from hospital. A multicenter cohort study of adult ICU survivors admitted between January 1st 2007 and January 1st 2019, with sepsis, an infection or an inflammatory illness. Patients were classified within the first 24 h of ICU admission according to APACHE IV admission diagnoses. Dutch ICUs (n = 78) prospectively recorded demographic and clinical data of all admissions in the NICE registry. These data were linked to a health care insurance claims database to obtain 3-year mortality data. To better understand and distinct the sepsis cohort from the non-sepsis infection and inflammatory condition cohorts, we performed several sensitivity analyses with varying definitions of the infection and inflammatory illness cohort. Three-year mortality after discharge was 32.7% in the sepsis (N = 10,000), 33.6% in the infectious (N = 10,000), and 23.8% in the inflammatory illness cohort (N = 9997). Compared with sepsis patients, the adjusted HR for death within 3 years after hospital discharge was 1.00 (95% CI 0.95–1.05) for patients with an infection and 0.88 (95% CI 0.83–0.94) for patients with an inflammatory illness. Both sepsis and non-sepsis infection patients had a significantly increased hazard rate of death in the 3 years after hospital discharge compared with patients with an inflammatory illness. Among sepsis and infection patients, one third died in the next 3 years, approximately 10% more than patients with an inflammatory illness. The fact that we did not find a difference between patients with sepsis or an infection suggests that the necessity for an ICU admission with an infection increases the risk of long-term mortality. This result emphasizes the need for greater attention to the post-ICU management of sepsis, infection, and severe inflammatory illness survivors.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"55 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142670816","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 venous catheter-related infections: a systematic review, meta-analysis, trial sequential analysis and meta-regression comparing ultrasound guidance and landmark technique for insertion","authors":"Nicolas Boulet, Joris Pensier, Bob-Valéry Occean, Pascale Fabbro Peray, Olivier Mimoz, Claire M. Rickard, Niccolò Buetti, Jean-Yves Lefrant, Laurent Muller, Claire Roger","doi":"10.1186/s13054-024-05162-0","DOIUrl":"https://doi.org/10.1186/s13054-024-05162-0","url":null,"abstract":"During central venous catheterization (CVC), ultrasound (US) guidance has been shown to reduce mechanical complications and increase success rates compared to the anatomical landmark (AL) technique. However, the impact of US guidance on catheter-related infections remains controversial. This systematic review and meta-analysis aimed to compare the risk of catheter-related infection with US-guided CVC versus AL technique. A systematic search on MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science databases was conducted until July 31, 2024. Randomized controlled trials (RCTs) and non-randomized studies of intervention (NRSI) comparing US-guided versus AL-guided CVC placement were included. The primary outcome was a composite outcome including all types of catheter-related infection: catheter-related bloodstream infections (CRBSIs), central line-associated bloodstream infections (CLABSIs), catheter colonization, or any other type of reported infection. The secondary outcomes included individual infection types and mortality at day-28. Subgroup analyses based on study type and operator experience were also performed. Pooling twelve studies (8 RCTs and 4 NRSI), with a total of 5,092 CVC procedures (2072 US-guided and 3020 AL-guided), US-guided CVC was associated with a significant reduction in catheter-related infections compared with the AL technique (risk ratio (RR) = 0.68, 95% confidence interval (CI) 0.53–0.88). In the RCT subgroup, the pooled RR was 0.65 (95% CI 0.49–0.87). This effect was more pronounced in procedures performed by experienced operators (RR = 0.60, 95% CI 0.41–0.89). In inexperienced operators, the infection risk reduction was not statistically significant. The pooled analysis of CRBSIs and CLABSIs also favored US guidance (RR = 0.65, 95% CI 0.48–0.87). US-guided CVC placement significantly reduces the risk of catheter-related infections compared to the AL technique, particularly when performed by experienced operators. Trial registration PROSPERO CRD42022350884. Registered 13 August 2022.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"65 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142673905","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 relation between inflammatory biomarkers and drug pharmacokinetics in the critically ill patients: a scoping review","authors":"Letao Li, Julia Zinger, Sebastiaan D. T. Sassen, Nicole P. Juffermans, Birgit C. P. Koch, Henrik Endeman","doi":"10.1186/s13054-024-05150-4","DOIUrl":"https://doi.org/10.1186/s13054-024-05150-4","url":null,"abstract":"The level of inflammation alters drug pharmacokinetics (PK) in critically ill patients. This might compromise treatment efficacy. Understanding the specific effects of inflammation, measured by biomarkers, on drug absorption, distribution, metabolism, and excretion is might help in optimizing dosing strategies. This review investigates the relationship between inflammatory biomarkers and PK parameters absorption, distribution, metabolism and excretion (ADME) in critically ill patients, providing insight in the complexity of dosing drugs in critically ill patients. Following PRISMA guidelines, we conducted a comprehensive search of Medline, Embase, Web of Science, and Cochrane databases (January 1946–November 2023). Studies examining inflammatory biomarkers, PK parameters, or drug exposure in critically ill patients were included. Records were screened by title, abstract, and full text, with any discrepancies resolved through discussion or consultation with a third reviewer. Of the 4479 records screened, 31 met our inclusion criteria: 2 on absorption, 7 on distribution, 17 on metabolism, and 6 on excretion. In general, results are only available for a limited number of drugs, and most studies are done only looking at one of the components of ADME. Higher levels of inflammatory biomarkers may increase or decrease drug absorption depending on whether the drug undergoes hepatic first-pass elimination. For drug distribution, inflammation is negatively correlated with drug protein binding capacity, positively correlated with cerebrospinal fluid penetration, and negatively correlated with peritoneal penetration. Metabolizing capacity of most drugs was inversely correlated with inflammatory biomarkers. Regarding excretion, inflammation can lead to reduced drug clearance, except in the neonatal population. Inflammatory biomarkers can offer valuable information regarding altered PK in critically ill patients. Our findings emphasize the need to consider inflammation-driven PK variability when individualizing drug therapy in this setting, at the same time research is limited to certain drugs and needs further research, also including pharmacodynamics.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"23 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142673907","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":"How to define parenteral nutrition","authors":"Annika Reintam Blaser, Antonella Cotoia, Mette M. Berger, Martin Padar, Yaseen M. Arabi, Michael P. Casaer, Jan Gunst, Imre W. K. Kouw, Manu L. N. G. Malbrain, Stefan J. Schaller, Joel Starkopf, Martin Sundström Rehal, Arthur R. H. van Zanten, Kaspar F. Bachmann","doi":"10.1186/s13054-024-05153-1","DOIUrl":"https://doi.org/10.1186/s13054-024-05153-1","url":null,"abstract":"<p>In the context of an international, multicentre observational study—the GUTPHOS study [1]—the investigators documented the use of parenteral nutrition (PN), including daily energy intake via this route. A secondary outcome, “days free of PN,\" was planned to validate a gastrointestinal dysfunction score. During data quality check, we observed that the definition of PN varied among the participating sites. This observation was further confirmed in a subsequent survey, in which the sites were asked to report the approach they used to document PN. All 28 GUTPHOS study sites (21 from Europe, four from Asia, one from North America, one from South America and one from Oceania) responded and reported their approach (Fig. 1A). In addition to some expectable differences in practice (e.g., using multi-chamber bags vs. separate components), relevant conceptual variability was observed, leading the steering committee to develop a consensus definition for PN in GUTPHOS: “The administration of intravenous amino acids or lipids alone, or any combination of at least two macronutrient components is considered as being PN, whereas administration of only glucose in any concentration is not.” Sites adjusted their data accordingly.</p><figure><figcaption><b data-test=\"figure-caption-text\">Fig. 1</b></figcaption><picture><source srcset=\"//media.springernature.com/lw685/springer-static/image/art%3A10.1186%2Fs13054-024-05153-1/MediaObjects/13054_2024_5153_Fig1_HTML.png?as=webp\" type=\"image/webp\"/><img alt=\"figure 1\" aria-describedby=\"Fig1\" height=\"615\" loading=\"lazy\" src=\"//media.springernature.com/lw685/springer-static/image/art%3A10.1186%2Fs13054-024-05153-1/MediaObjects/13054_2024_5153_Fig1_HTML.png\" width=\"685\"/></picture><p>Results of the survey among 28 sites participating in the GUTPHOS study. <b>A</b> Frequency of Positive Responses for PN Options. Bubble chart representing the frequency of responses for different Parenteral Nutrition (PN) options in the survey with 28 sites. Each bubble represents a PN option. Each bubble's size and colour intensity correspond to the number of positive responses for that option, with larger and brighter bubbles indicating more frequent selection. The number inside each bubble indicates the exact count of positive responses. PN options are labelled beneath each bubble. <i>AA</i> amino acids. <b>B</b> Summary of minimum requirements to label a solution as PN. Bar chart illustrating the diversity in defining Parenteral Nutrition (PN) among survey respondents. The x-axis shows five categories of increasing complexity in PN definition, from \"Any single component\" to \"Only commercial preparations.\" The y-axis and bar heights represent the number of responses in each category. The sites were categorised according to the minimal definition (left-to-right on the x-axis)</p><span>Full size image</span><svg aria-hidden=\"true\" focusable=\"false\" height=\"16\" role=\"img\" width=\"16\"><use xlink:href=\"#icon-eds-i-chevron-right-small\" xmlns:xlin","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"52 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142670817","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":"Pitfall of lung ultrasound in the quantification of pneumothorax","authors":"Haotian Zhao, Kai Liu, Li Li, Heling Zhao","doi":"10.1186/s13054-024-05169-7","DOIUrl":"https://doi.org/10.1186/s13054-024-05169-7","url":null,"abstract":"<p>We read with interest the article by Michael Beshara et al. [1] entitled “Nuts and bolts of lung ultrasound: utility, scanning techniques, protocols, and findings in common pathologies”. In this review, the author provides a complete and accurate description of the latest applications of pulmonary ultrasound. For the part of pneumothorax, only the diagnostic methods and ultrasound signs were described. However, the application of pneumothorax in pulmonary imaging tools should include qualitative diagnosis, quantification, and localization.</p><p>Numerous studies have demonstrated the value of lung ultrasound in diagnosing pneumothorax. Lung ultrasound can preliminarily diagnose pneumothorax by identifying four key signs: absence of pleural sliding, lung pulse, B-lines, and lung consolidation [2, 3]. Additionally, scanning for the “lung point” and/or “stratosphere sign” aids in diagnosing and localizing pneumothorax [4]. However, for intensivists, quantitative assessment is crucial for making informed decisions regarding treatment strategies for pneumothorax. This assessment helps determine whether to adopt conservative management, such as watchful waiting, or to proceed with interventional options like chest tube placement. In this context, the diagnostic accuracy of lung ultrasound is superior to that of supine chest X-ray (CXR); however, this evaluation may have significant limitations [5].</p><p>It is suggested that when lung ultrasound shows a complete \"stratosphere sign\" (absence of the lung point sign) on one side, it indicates that the lung lobe has been fully compressed by intrapleural gas, resulting in a complete loss of pleural apposition, potentially indicating a large pneumothorax. However, the actual volume of pneumothorax in patients with a complete stratosphere sign can vary widely. In three patients with a complete stratosphere sign on one side, chest CT scans revealed varying degrees of lung compression by pneumothorax, resulting in significant differences in pneumothorax volume and subsequent treatment choices (Fig. 1A–C). Thus, the complete stratosphere sign only indicates a large surface area of pneumothorax but cannot quantify its volume.</p><figure><figcaption><b data-test=\"figure-caption-text\">Fig. 1</b></figcaption><picture><source srcset=\"//media.springernature.com/lw685/springer-static/image/art%3A10.1186%2Fs13054-024-05169-7/MediaObjects/13054_2024_5169_Fig1_HTML.png?as=webp\" type=\"image/webp\"/><img alt=\"figure 1\" aria-describedby=\"Fig1\" height=\"694\" loading=\"lazy\" src=\"//media.springernature.com/lw685/springer-static/image/art%3A10.1186%2Fs13054-024-05169-7/MediaObjects/13054_2024_5169_Fig1_HTML.png\" width=\"685\"/></picture><p>Three patients with pneumothorax all showed the stratosphere sign on lung ultrasound, but the pneumothorax volume could not be quantified: <b>a</b> Lung compression was approximately 20%. <b>b</b> Lung compression was approximately 50%. <b>c</b> Lung compression was more than 90%</p><span>Full ","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"40 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142670821","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":"A multicentre prospective registry of one thousand sepsis patients admitted in Indian ICUs: (SEPSIS INDIA) study","authors":"Subhash Todi, Yatin Mehta, Kapil Zirpe, Subhal Dixit, Atul P. Kulkarni, Sushma Gurav, Shweta Ram Chandankhede, Deepak Govil, Amitabha Saha, Arpit Kumar Saha, Sumalatha Arunachala, Kapil Borawake, Shilpushp Bhosale, Sumit Ray, Ruchi Gupta, Swarna Deepak Kuragayala, Srinivas Samavedam, Mehul Shah, Ashit Hegde, Palepu Gopal, Abdul Samad Ansari, Ajoy Krishna Sarkar, Rahul Pandit","doi":"10.1186/s13054-024-05176-8","DOIUrl":"https://doi.org/10.1186/s13054-024-05176-8","url":null,"abstract":"Sepsis is a global health problem with high morbidity and mortality. Low- and middle-income countries have a higher incidence and poorer outcome with sepsis. Large epidemiological studies in sepsis using Sepsis-3 criteria, addressing the process of care and deriving predictors of mortality are scarce in India. A multicentre, prospective sepsis registry was conducted using Sepsis 3 criteria of suspected or confirmed infection and SOFA score of 2 or more in 19 ICUs in India over a period of one year (August 2022–July 2023). All adult patients admitted to the Intensive Care Unit who fulfilled the Sepsis 3 criteria for sepsis and septic shock were included. Patient infected with Covid 19 were excluded. Patients demographics, severity, admission details, initial resuscitation, laboratory and microbiological data and clinical outcome were recorded. Performance improvement programs as recommended by the Surviving Sepsis guideline were noted from the participating centers. Patients were followed till discharge or death while in hospital. Registry Data of 1172 patients with sepsis (including 500 patients with septic shock) were analysed. The average age of the study cohort was 65 years, and 61% were male. The average APACHE II and SOFA score was 21 and 6.7 respectively. The majority of patients had community-acquired infections, and lung infections were the most common source. Of all culture positive results, 65% were gram negative organism. Carbapenem-resistance was identified in 50% of the gram negative blood culture isolates. The predominant gram negative organisms were Klebsiella spp (25%), Escherechia coli (24%) and Acinetobacter Spp (11%). Tropical infections (Dengue, Malaria, Typhus) constituted minority (n = 32, 2.2%) of sepsis patients. The observed hospital mortality for the entire cohort (n = 1172) was 36.3%, for those without shock (n = 672) it was 25.6% and for those with shock (n = 500) it was 50.8%. The average length of ICU and hospital stay for the study cohort was 8.64 and 11.9 respectively. In multivariate analysis adequate source control, correct choice of empiric antibiotic and the use of intravenous thiamine were protective. The general demographics of the sepsis population in the Indian Sepsis Registry is comparable to Western population. The mortality of sepsis cohort was higher (36.3%) but septic shock mortality (50.8%) was comparable to Western reports. Gram negative infection was the predominant cause of sepsis with a high incidence of carbapenem resistance. Eschericia coli, Klebsiella Spp and Acinetobacter Spp were the predominant causative organism. Tropical infection constituted a minority of sepsis population with low hospital mortality. The SOFA score on admission was a comparatively better predictor of poor outcome. Sepsis secondary to nosocomial infections had the worst outcomes, while source control, correct empirical antibiotic selection, and intravenous thiamine were protective. CTRI Registration CTRI:2022/07/044516.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"54 47 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142673908","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}