Critical Care最新文献

{"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}

{"title":"The effects between andexanet alpha and four-factor prothrombin complex concentrate on DOACs anticoagulation reversal","authors":"Tengfei Yang, Bo Zhao","doi":"10.1186/s13054-024-05157-x","DOIUrl":"https://doi.org/10.1186/s13054-024-05157-x","url":null,"abstract":"<p>To the Editor,</p><p>The publication by Daniele Orsc et al. [1] in Critical Care, titled \"Andexanet alpha versus four-factor prothrombin complex concentrate in DOACs anticoagulation reversal: an updated systematic review and meta-analysis,\" has significant clinical implications. This present study obtained two key findings that may complement their conclusions.</p><p>The primary outcome of this meta-analysis revealed a higher thromboembolic event risk associated with Andexanet alpha when analyzing controlled (RCT and PSM) studies. However, the authors did not perform trial sequential analysis (TSA), potentially leading to type I and type II errors and premature conclusions. To address this, TSA Viewer version 0.9.5.10 Beta was utilized to determine if published studies provided sufficient evidence for reliable conclusions. The two-sided type I error was set at 5%, and 80% power was selected to calculate the required information size (RIS). The control group incidence was determined through meta-analysis. Results from the TSA showed that the blue Z-curve crossed the conventional boundary but not the TSA boundary (Fig. 1). Moreover, the data failed to meet the required information size (RIS = 1717). Consequently, conventional meta-analysis may yield false-positive results. Additional trials are necessary to confirm the difference in thromboembolic events between the groups.</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%2Fs13054-024-05157-x/MediaObjects/13054_2024_5157_Fig1_HTML.png?as=webp\" type=\"image/webp\"/><img alt=\"figure 1\" aria-describedby=\"Fig1\" height=\"451\" loading=\"lazy\" src=\"//media.springernature.com/lw685/springer-static/image/art%3A10.1186%2Fs13054-024-05157-x/MediaObjects/13054_2024_5157_Fig1_HTML.png\" width=\"685\"/></picture><p>Trial sequential analysis (TSA) for the rate of thromboembolic events. Blue Z curve stands for Z-values accumulated from the meta-analysis (combined relative risk). Pink dotted lines are indicative of conventional boundaries, whereas red solid lines stand for TSA boundaries. RIS, required information size</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:xlink=\"http://www.w3.org/1999/xlink\"></use></svg></figure><p>In the analysis of all-cause short-term mortality in retrospective studies, the authors included the studies with varying follow-up periods, ranging from 7-day, 28-day, 30-day, and in-hospital mortality. This variability may introduce inaccuracies in meta-analysis results due to factors such as persistent treatment effects and disease deterioration, potentially leading to heterogeneity and compromising result interpretation and conclusion reliability. To address this, a subgroup analysis using Revman5.3 software was conducted on six studies [2,3,4,5,6,7] that r","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"1 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142670818","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":"Electrical impedance tomography monitoring in adult ICU patients: state-of-the-art, recommendations for standardized acquisition, processing, and clinical use, and future directions","authors":"Gaetano Scaramuzzo, Bertrand Pavlovsky, Andy Adler, Walter Baccinelli, Dani L. Bodor, L. Felipe Damiani, Guillaume Franchineau, Juliette Francovich, Inéz Frerichs, Juan A. Sánchez Giralt, Bartłomiej Grychtol, Huaiwu He, Bhushan H. Katira, Alette A. Koopman, Steffen Leonhardt, Luca S. Menga, Amne Mousa, Mariangela Pellegrini, Thomas Piraino, Paolo Priani, Peter Somhorst, Elena Spinelli, Claas Händel, Fernando Suárez-Sipmann, Jantine J. Wisse, Tobias Becher, Annemijn H. Jonkman","doi":"10.1186/s13054-024-05173-x","DOIUrl":"https://doi.org/10.1186/s13054-024-05173-x","url":null,"abstract":"Electrical impedance tomography (EIT) is an emerging technology for the non-invasive monitoring of regional distribution of ventilation and perfusion, offering real-time and continuous data that can greatly enhance our understanding and management of various respiratory conditions and lung perfusion. Its application may be especially beneficial for critically ill mechanically ventilated patients. Despite its potential, clear evidence of clinical benefits is still lacking, in part due to a lack of standardization and transparent reporting, which is essential for ensuring reproducible research and enhancing the use of EIT for personalized mechanical ventilation. This report is the result of a four-day expert meeting where we aimed to promote the consistent and reliable use of EIT, facilitating its integration into both clinical practice and research, focusing on the adult intensive care patient. We discuss the state-of-the-art regarding EIT acquisition and processing, applications during controlled ventilation and spontaneous breathing, ventilation-perfusion assessment, and novel future directions.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"13 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142673909","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":"Inhalation NO in the HFNC group may result in a meaningless extension of survival time.","authors":"Lin Zhong, Lingtong Huang","doi":"10.1186/s13054-024-05154-0","DOIUrl":"10.1186/s13054-024-05154-0","url":null,"abstract":"","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"28 1","pages":"370"},"PeriodicalIF":8.8,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11571993/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142667269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Volatile anaesthetics for ICU sedation: beyond hypnosis?","authors":"José Manuel Añón, Fernando Suarez-Sipmann, María Paz Escuela, Aris Perez-Lucendo, Andoni García-Muñoz","doi":"10.1186/s13054-024-05163-z","DOIUrl":"https://doi.org/10.1186/s13054-024-05163-z","url":null,"abstract":"<p>We read the review by Müller-Wirtz [1] et al., recently published in this journal with interest. It addresses the advantages of using volatile anaesthetics for lung and diaphragm-protective sedation. As the authors point out in their methodology, it is a narrative review based on expert opinion to which we wanted to contribute with some comments we believe are important.</p><p>The authors affirm that volatile anaesthetics reduce tidal volume and simultaneously increase respiratory rate in a dose-dependent fashion, thus potentially contributing to reduce lung stress and strain in spontaneously breathing patients. In addition, volatile anaesthetics better preserve respiratory drive than do common intravenous alternatives. The combination of these two effects lead them to conclude that volatile anaesthetics may contribute to a lung-diaphragmatic protective ventilation. Attributing a lung-diaphragmatic protective effect to the use of one specific type of sedation based mainly on pre-clinical studies [2,3,4,5,6] and small studies on healthy volunteers [7,8,9,10,11] with little data on critically ill patients, is a hypothesis that warrants to be tested and confirmed in well-designed clinical trials. We agree on the importance of adequate sedation and the potential protective benefits of volatile anaesthetics, but the role of factors such as the underlying lung condition, the effective control of respiratory drive and the dosage needed for it, the synergistic effects with opioids and other hypnotics, among others are yet to be established. The best balance between a preserved or excessive respiratory drive is difficult and depends on the individual patient and may vary along the evolution. For instance, in the presence of a high respiratory drive, such as seen in patients with acute respiratory distress syndrome (ARDS), sedation should rather contribute to modulate the intensity of the spontaneous inspiratory effort than to enhance it. Nevertheless, volatile anaesthetics are a welcome new addition to the clinical arsenal to improve sedation strategies in the always complicated transition from controlled to spontaneous mechanical ventilation.</p><p>All reflectors increase dead space ventilation due to their internal volume and partial carbon dioxide reflection. The two devices clinically available for inhaled sedation have made an effort to reduce their instrumental dead space volume, on average from 100 ml in the first-generation devices to around 50 ml of the currently used ones. However, it is important to pay special attention to avoid unnecessary increases in dead space particularly in patients ventilated with lower tidal volumes, where instrumental dead-space can add up to a 15–30% to the dead-space fraction. In this respect, the graphical abstract used to illustrate the clinical setup is rather unfortunate showing a large straight connector adding an additional instrumental dead space volume of at least 50–70 ml something that should be strictl","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"45 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142642702","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 long-term conditional mortality rate in older ICU patients compared to the general population.","authors":"Anna Aronsson Dannewitz, Bodil Svennblad, Karl Michaëlsson, Miklos Lipcsey, Rolf Gedeborg","doi":"10.1186/s13054-024-05147-z","DOIUrl":"10.1186/s13054-024-05147-z","url":null,"abstract":"<p><strong>Background: </strong>Understanding how preexisting comorbidities may interact with a critical illness is important for the assessment of long-term survival probability of older patients admitted to the ICU.</p><p><strong>Material and methods: </strong>The mortality after a first ICU admission in patients ≥ 55 years old registered in the Swedish Intensive Care Registry was compared to age- and sex-matched individuals from the general population with a landmark after 1 year. The comparison was adjusted for age, sex, and baseline comorbidity using Cox regression.</p><p><strong>Results: </strong>The 7-year study period included 140 008 patients, of whom 23% were 80 years or older. Patients surviving the first year remained at an increased risk compared to the general population, but much of this difference was attenuated after adjustment for baseline comorbidity (HR, 1.03; 95% CI 1.02-1.04). Excluding cardio-thoracic ICU admissions, the increased risk remained slightly elevated (adjusted HR, 1.15; 95% CI 1.13-1.16). Also, the subgroup ≥ 75 years old surviving the first year returned to a mortality rate comparable to the general population (HR, 0.98; 95% CI 0.96-0.99). Stratified by admission diagnosis an increased mortality rate remained beyond the first year for acute-on-chronic respiratory failure (adjusted HR, 1.47; 95% CI 1.36-1.58) but not for other respiratory causes (adjusted HR, 1.03; 95% CI 0.99-1.07) or admission for septic shock (adjusted HR, 1.04; 95% CI 0.95-1.13). No substantial increased mortality rate was notable beyond the first year for other admission diagnoses.</p><p><strong>Conclusion: </strong>Older ICU patients that survive the first year after an ICU admission return to a mortality rate close to that of the general population having similar baseline comorbidity, but variability is seen depending on the ICU admission diagnosis. Trial registration ClinicalTrials.gov ID: NCT06234709, date 02/01/2024.</p>","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"28 1","pages":"368"},"PeriodicalIF":8.8,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11566578/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142616234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of fever on the outcome non-anoxic acute brain injury patients: a systematic review and meta-analysis","authors":"Elisa Gouvêa Bogossian, Michele Salvagno, Marco Fiore, Marta Talamonti, Chiara Prezioso, Federica Montanaro, Sara Fratino, Sophie Schuind, Fabio Silvio Taccone","doi":"10.1186/s13054-024-05132-6","DOIUrl":"https://doi.org/10.1186/s13054-024-05132-6","url":null,"abstract":"Fever is a common condition in intensive care unit (ICU) patients, with an incidence between 30 and 50% in non-neurological ICU patients and up to 70–90% in neurological ICU patients. We aim to perform systematic review and meta-analysis of current literature to assess impact of fever on neurological outcomes and mortality of acute brain injury patients. We searched PubMed/Medline, Scopus and Embase databases following the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, and we included both retrospective and prospective observational studies, interventional studies, and randomized clinical trials that had data on body temperature and fever during ICU admission. The primary endpoints were neurological outcome and mortality at any time. Secondary outcomes included: early neurological deterioration, delayed cerebral ischemia (DCI, only for patients with subarachnoid hemorrhage), large infarct or hemorrhage size, hemorrhagic transformation (only for patients with ischemic stroke). This study was registered in PROSPERO (CRD42020155903). 180 studies from 14692 records identified after the initial search were included in the final analysis, for a total of 460,825 patients. Fever was associated with an increased probability of unfavorable neurological outcome (pooled OR 2.37 [95% CI 2.08–2.71], I2:92%), death (pooled OR 1.31 [95% CI 1.28–1.34], I2:93%), neurological deterioration (pooled OR 1.10 [95% CI 1.05–1.15]), risk of DCI (pooled OR 1.96 [95% CI 1.73–2.22]), large infarct size (pooled OR 2.94 [95% CI 2.90–2.98]) and hemorrhagic transformation (pooled OR 1.63 [95% CI 1.34–1.97]) and large hemorrhagic volume (pooled OR 2.38 [95% CI 1.94–2.93]). Fever was associated with poor neurological outcomes and mortality in patients with acute brain injury. Whether normothermia should be targeted in the management of all neuro critically ill patients warrants specific research.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"7 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142601243","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":"Based -evidence, an intervention study to improve sleep quality in awake adult ICU patients: a prospective, single-blind, clustered controlled trial","authors":"Yanting Zhang, Yihua Yang, Chong Cheng, Gui Hou, Xinbo Ding, Jing Ma","doi":"10.1186/s13054-024-05161-1","DOIUrl":"https://doi.org/10.1186/s13054-024-05161-1","url":null,"abstract":"Evidence-based guidelines advocate promoting sleep in intensive care unit (ICU) patients, yet many patients experience poor sleep quality. We sought to develop a collaborative evidence-based intervention with healthcare providers and assess whether evidence-based sleep interventions could improve sleep quality in awake adult ICU patients. We conducted a prospective, nonrandomized cluster control trial in two intensive care units (ICUs) at a tertiary general teaching hospital in China. Patients aged 18 years or older who stayed in the ICU for one night or more and were conscious were eligible for enrollment. We only blinded the patients, not the outcome assessors. On the basis of evidence-based practice and clinical reality, we developed intervention measures for the intervention group, which mainly included four aspects: reducing environmental noise in the ICU, adjusting nursing actions, modifying nighttime lighting, and other measures. The assessment tools used were wearable actigraphy sleep monitoring devices and the Richards-Campbell Sleep Questionnaire (RCSQ). The primary outcomes were patient sleep quality, including total sleep time, deep sleep time, light sleep time, rapid eye movement (REM) time, number of awakenings, overall sleep score, and patients' self-assessment of their sleep quality that night. The data collected were analyzed via SPSS and Mplus statistical software for between-group analysis, pre-post comparison, profile analysis, and calculation of the intervention effect size. From September 1, 2023, to January 31, 2024, 713 patients underwent eligibility assessment, and ultimately 246 patients were included in the analysis, with 125 in the intervention group and 121 in the control group. Comparative analysis revealed no statistically significant differences in sleep quality between the two groups when the duration in the ICU = 1 night (P > 0.05), with a small intervention effect size. However, the intervention group had higher sleep quality scores (sleep monitoring wristband: 57.74 ± 22.55 > 57.72 ± 19.39; RCSQ questionnaire: 60.58 ± 22.14 > 57.61 ± 24.4) and total sleep time (440.42 ± 262.11 > 420.31 ± 236.89), a lower awakening frequency (3.98 ± 2.69 < 6.09 ± 4.66) and a lower awakening frequency (3.976 ± 2.693 < 6.09 ± 4.664) than did the control group. The sleep quality of patients who stayed in the ICU for > 1 night significantly improved in all the parameters except rapid eye movement time (min) according to the pre-post-test analyses (P < 0.05), with a medium to large intervention effect size and favorable intervention effects. Evidence-based interventions significantly improve sleep quality in ICU patients hospitalized for more than one day. However, our results do not support the improvement of sleep quality in patients admitted to the ICU for one day. Clinical trial registration: ChiCTR2300075763, Registered 14 September 2023—Retrospectively registered, https://www.chictr.org.cn/bin/userProject ","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"127 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142599740","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":"Predictors of weaning failure in ventilated intensive care patients: a systematic evidence map","authors":"Fritz Sterr, Michael Reintke, Lydia Bauernfeind, Volkan Senyol, Christian Rester, Sabine Metzing, Rebecca Palm","doi":"10.1186/s13054-024-05135-3","DOIUrl":"https://doi.org/10.1186/s13054-024-05135-3","url":null,"abstract":"Ventilator weaning is of great importance for intensive care patients in order to avoid complications caused by prolonged ventilation. However, not all patients succeed in weaning immediately. Their spontaneous breathing may be insufficient, resulting in extubation failure and the subsequent need for reintubation. To identify patients at high risk for weaning failure, a variety of potential predictors has already been examined in individual studies and meta-analyses over the last decades. However, an overview of all the predictors investigated is missing. To provide an overview of empirically investigated predictors for weaning failure. A systematic evidence map was developed. To this end, we conducted a systematic search in the Medline, Cochrane, and CINAHL databases in December 2023 and added a citation search and a manual search in June 2024. Studies on predictors for weaning failure in adults ventilated in the intensive care unit were included. Studies on children, outpatients, non-invasive ventilation, or explanatory factors of weaning failure were excluded. Two reviewers performed the screening and data extraction independently. Data synthesis followed an inductive approach in which the predictors were thematically analyzed, sorted, and clustered. Of the 1388 records obtained, 140 studies were included in the analysis. The 112 prospective and 28 retrospective studies investigated a total of 145 predictors. These were assigned to the four central clusters ‘Imaging procedures’ (n = 22), ‘Physiological parameters’ (n = 61), ‘Scores and indices’ (n = 53), and ‘Machine learning models’ (n = 9). The most frequently investigated predictors are the rapid shallow breathing index, the diaphragm thickening fraction, the respiratory rate, the P/F ratio, and the diaphragm excursion. Predictors for weaning failure are widely researched. To date, 145 predictors have been investigated with varying intensity in 140 studies that are in line with the current weaning definition. It is no longer just individual predictors that are investigated, but more comprehensive assessments, indices and machine learning models in the last decade. Future research should be conducted in line with international weaning definitions and further investigate poorly researched predictors. Registration, Protocol: https://doi.org/10.17605/OSF.IO/2KDYU ","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"50 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142599739","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":"Representation of intensivists’ race/ethnicity, sex, and age by artificial intelligence: a cross-sectional study of two text-to-image models","authors":"Mia Gisselbaek, Mélanie Suppan, Laurens Minsart, Ekin Köselerli, Sheila Nainan Myatra, Idit Matot, Odmara L. Barreto Chang, Sarah Saxena, Joana Berger-Estilita","doi":"10.1186/s13054-024-05134-4","DOIUrl":"https://doi.org/10.1186/s13054-024-05134-4","url":null,"abstract":"Integrating artificial intelligence (AI) into intensive care practices can enhance patient care by providing real-time predictions and aiding clinical decisions. However, biases in AI models can undermine diversity, equity, and inclusion (DEI) efforts, particularly in visual representations of healthcare professionals. This work aims to examine the demographic representation of two AI text-to-image models, Midjourney and ChatGPT DALL-E 2, and assess their accuracy in depicting the demographic characteristics of intensivists. This cross-sectional study, conducted from May to July 2024, used demographic data from the USA workforce report (2022) and intensive care trainees (2021) to compare real-world intensivist demographics with images generated by two AI models, Midjourney v6.0 and ChatGPT 4.0 DALL-E 2. A total of 1,400 images were generated across ICU subspecialties, with outcomes being the comparison of sex, race/ethnicity, and age representation in AI-generated images to the actual workforce demographics. The AI models demonstrated noticeable biases when compared to the actual U.S. intensive care workforce data, notably overrepresenting White and young doctors. ChatGPT-DALL-E2 produced less female (17.3% vs 32.2%, p < 0.0001), more White (61% vs 55.1%, p = 0.002) and younger (53.3% vs 23.9%, p < 0.001) individuals. While Midjourney depicted more female (47.6% vs 32.2%, p < 0.001), more White (60.9% vs 55.1%, p = 0.003) and younger intensivist (49.3% vs 23.9%, p < 0.001). Substantial differences between the specialties within both models were observed. Finally when compared together, both models showed significant differences in the Portrayal of intensivists. Significant biases in AI images of intensivists generated by ChatGPT DALL-E 2 and Midjourney reflect broader cultural issues, potentially perpetuating stereotypes of healthcare worker within the society. This study highlights the need for an approach that ensures fairness, accountability, transparency, and ethics in AI applications for healthcare.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"13 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142598287","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}