Critical Care最新文献

{"title":"Enhanced insights into immunity traits of elderly patients in the intensive care unit with infections: evidence from a multicenter, prospective observational study","authors":"Ju Zou, Yuanyuan Xiao, Lina Zhang, Zhihong Zuo, Xianwen Wang, Xuelian Liao, Na Cui, Jialin Jin, Zhaoxin Qian, Anhua Wu, Chunhui Li","doi":"10.1186/s13054-025-05616-z","DOIUrl":"https://doi.org/10.1186/s13054-025-05616-z","url":null,"abstract":"Infections, particularly sepsis, are a global health threat and a leading cause of mortality among elderly patients (≥ 60 years) in intensive care units (ICUs). The variable immune responses in this vulnerable population warrant deeper investigation. This multicenter prospective study included elderly patients with infections admitted to the ICUs of four hospitals between May 2023 and October 2024. Patients were classified into sepsis and non-sepsis infection groups based on a ≥2-point increase in Sequential Organ Failure Assessment (SOFA) score. Baseline immune and inflammatory markers were compared between groups. Logistic regression analyses were used to assess associations with mortality. Subgroup analyses were conducted by sex, age, infection site, and pathogen type. Among 1,152 elderly patients with infections in the ICUs, 640 with sepsis were older (70.0 vs.72.0 years), were predominantly male (55.3% vs. 68.1%), and had more comorbidities, all P < 0.001. Compared with the non-sepsis infection group, the septic group had higher rates of mechanical ventilation (3.12% vs. 40.80%), longer hospitalization (7.00 [4.00;10.0] vs. 11.8 [6.00;18.0] days), and increased mortality (0.98% vs. 9.51%), all P < 0.001. Distinct immune-mortality signatures were observed. In the fully adjusted model, non-septic infection was associated with reduced monocytes, lymphocytes, and TNFα (odds ratio [OR] < 1), elevated interleukin-12 (IL12) and INFγ (OR > 1, all P < 0.05), whereas sepsis was characterized by increased neutrophil and B-cell activation (OR > 1), decreased T cells (OR < 1, all P < 0.05), and no specific cytokine signature (all P > 0.05). Sex differences included higher levels of innate immune markers in males and elevated adaptive immune indicators in females. With age, patients showed reduced T cell counts and increased inflammatory markers (procalcitonin and C-reactive protein). Patients aged > 80 years exhibited marked lymphopenia, lower CD4+ T cell counts (β < 1, P < 0.05), and elevated IL6 and platelet levels (β > 1, P < 0.05). Immune profiles also varied by pathogen type: fungal infections were associated with increased lymphocyte and cytotoxic T lymphocyte counts (β > 1, P < 0.05) compared with bacterial infections, whereas viral infections showed reduced T cell subsets and cytokine levels (IL6, IL8, IL17; β < 1, P < 0.05). Elderly patients in the ICU, especially those with sepsis, exhibit immune imbalances of hyperinflammation and immunosuppression, varying with age, sex, pathogen type, and infection site. These findings highlight the potential role of immune phenotyping in guiding treatment decisions in this patient population.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"15 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144911002","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":"Impact of frailty on in-hospital outcomes in nonagenarian ICU patients: a binational multicenter analysis of 8,220 cases","authors":"Je Min Suh, Nattaya Raykateeraroj, Raelynn Tong, David Pilcher, Dong-Kyu Lee, Laurence Weinberg","doi":"10.1186/s13054-025-05612-3","DOIUrl":"https://doi.org/10.1186/s13054-025-05612-3","url":null,"abstract":"As global populations age, the number of nonagenarians admitted to intensive care units (ICUs) is rising. Frailty, a multidimensional syndrome marked by diminished physiological reserves, has been associated with adverse outcomes in older ICU patients. However, evidence remains limited regarding its prognostic significance in nonagenarians, who represent a unique and rapidly growing subset of critically ill patients. This study aimed to evaluate the impact of frailty on in-hospital mortality and length of stay among nonagenarian ICU patients in Australia and New Zealand. We conducted a retrospective cohort study using data from the ANZICS Adult Patient Database, including nonagenarians admitted to 211 ICUs between 2017 and 2023 with documented Clinical Frailty Scale (CFS) scores. Patients were classified as frail (CFS ≥ 5) or non-frail (CFS < 5). Propensity score matching (1:1) was applied to adjust for confounders including age, sex, illness severity, admission type, and comorbidities. Outcomes included ICU and hospital mortality, and ICU and hospital lengths of stay (LOS). Statistical analyses included multivariable Cox regression, log-transformed logistic regression, and Fine Gray competing risks models. Among 16,439 nonagenarians, 8220 patients were propensity matched. In the matched cohort, frailty was independently associated with increased hospital mortality (adjusted HR 1.352, 95% CI 1.192–1.534, p < 0.001) and ICU mortality (adjusted HR 1.242, 95% CI 1.044–1.440, p = 0.017). Each one-point increase in CFS score was associated with a 9% increase in the odds ratio of ICU mortality (OR 1.09, 95% CI 1.01–1.18, p = 0.026) and a 19% increase in the odds ratio of hospital mortality (OR 1.19, 95% CI 1.10–1.28, p < 0.001). Frailty was not associated with ICU LOS after adjustment (p = 0.739) but predicted prolonged hospital LOS (adjusted β = 1.051, 95% CI 1.033–1.070, p < 0.001). Frailty is a strong, independent predictor of hospital mortality and prolonged hospitalization in critically ill nonagenarians, even after adjusting for illness severity and comorbidities. These findings support the incorporation of frailty assessment into early risk stratification and clinical decision-making in ICU settings, to facilitate goal-concordant care and optimize resource allocation for the very elderly.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"9 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144906295","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":"Multiplex PCR panel dynamics: implications for therapy duration and methodological considerations","authors":"Tristan T. Timbrook, Benjamin Hommel, Andrea M. Prinzi, Tamara Krekel","doi":"10.1186/s13054-025-05631-0","DOIUrl":"https://doi.org/10.1186/s13054-025-05631-0","url":null,"abstract":"&lt;p&gt;Dear editor,&lt;/p&gt;&lt;p&gt;We read with great interest your recent article by Dessajan et al. [1], which evaluated the potential utility of syndromic multiplex PCR of lower respiratory tract samples for predicting clinical outcomes in patients with ventilated hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP). The authors conclude their findings suggest that multiplex PCR semi-quant values associated with detected pathogens did not predict clinical success.&lt;/p&gt;&lt;p&gt;This area of inquiry is particularly relevant given the ongoing controversies surrounding the optimal duration of therapy for non-lactose fermenting gram-negative bacilli (NLF GNB) such as &lt;i&gt;Pseudomonas aeruginosa&lt;/i&gt; and &lt;i&gt;Acinetobacter baumannii&lt;/i&gt; complex. Both IDSA and ERS/ESICM/ESCMID/ALAT HAP/VAP guidelines endorse 7-day antibiotic courses, including for NLF GNB, while acknowledging that longer durations may be needed in select individuals [2, 3]. While definitions of recurrence and relapse vary across studies (e.g., some require cessation of antibiotics before a new episode while others require documented clinical cure), these outcomes fundamentally represent patients who initially appeared to respond successfully to treatment but subsequently developed new pneumonia episodes. A 2023 systematic review and meta-analysis of randomized controlled trials comparing short- vs. long-course therapy in VAP reported no statistically significant difference in recurrence (OR 1.90, 95% CI 0.99–3.64) or relapse (OR 1.76, 95% CI 0.93–3.33) for NLF GNB [4]. Bayesian meta-analysis using established empirical priors (Turner et al. for heterogeneity [5], uninformative for overall effect) shows a 95% posterior probability of at least 10% increased odds of recurrence and 94.7% probability for relapse with 7-day therapy (Fig. 1). These findings suggest a tangible risk of clinical deterioration in subgroups that may be obscured by dichotomous significance thresholds for short-course therapy. Despite current guidelines favoring short-course therapy based on equivalent traditional endpoints (ventilator-free days, ICU length-of-stay, mortality), reducing recurrence through diagnostic-guided personalized duration could represent a clinically meaningful advance that is analogous to how differences in global cure rates have influenced treatment recommendations in other infectious syndromes [6].&lt;/p&gt;&lt;figure&gt;&lt;figcaption&gt;&lt;b data-test=\"figure-caption-text\"&gt;Fig. 1&lt;/b&gt;&lt;/figcaption&gt;&lt;picture&gt;&lt;img alt=\"figure 1\" aria-describedby=\"Fig1\" height=\"392\" loading=\"lazy\" src=\"//media.springernature.com/lw685/springer-static/image/art%3A10.1186%2Fs13054-025-05631-0/MediaObjects/13054_2025_5631_Fig1_HTML.png\" width=\"685\"/&gt;&lt;/picture&gt;&lt;p&gt;Bayesian meta-analysis posterior distributions showing probability of increased recurrence (&lt;b&gt;A&lt;/b&gt;) and relapse &lt;b&gt;(B&lt;/b&gt;) risk with short-course antibiotic therapy in VAP for NLF GNBs&lt;/p&gt;&lt;span&gt;Full size image&lt;/span&gt;&lt;svg aria-hidden=\"true\" focusable=\"false\" height=\"16\" role","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"27 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144899497","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":"Tipping the balance: early post-resuscitation fluid accumulation and outcome after cardiac arrest","authors":"Chiara Crivellari, Aurora Magliocca, Cristina Dulama, Giulia Merigo, Fabiana Madotto, Mauro Panigada, Giacomo Grasselli, Giuseppe Ristagno","doi":"10.1186/s13054-025-05633-y","DOIUrl":"https://doi.org/10.1186/s13054-025-05633-y","url":null,"abstract":"In a cohort of 109 adults resuscitated from out-of-hospital cardiac arrest and admitted to a tertiary intensive care unit (ICU), non-survivors showed higher mean fluid intake, reduced urine output, and greater cumulative positive fluid balance during the first 96 h after resuscitation. Daily increases in mean fluid balance were independently associated with ICU mortality after adjustment for confounding factors. These observations suggest that sustained positive fluid balance is linked to adverse outcomes, underscoring the potential value of more individualized or restrictive fluid management following cardiac arrest. ","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"14 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144899499","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":"Rethinking the clinical impact of timing in ICP monitoring initiation","authors":"Giuseppe Citerio","doi":"10.1186/s13054-025-05598-y","DOIUrl":"https://doi.org/10.1186/s13054-025-05598-y","url":null,"abstract":"&lt;p&gt;The decision to initiate intracranial pressure (ICP) monitoring is invariably a point of dialogue, and at times debate, between intensivists and neurosurgeons. In clinical practice, ICP monitor insertion by intensivists remains rare. As highlighted in the Synapse-ICU study, neurointensivists performed only 2% of insertions across the cohort [1].&lt;/p&gt;&lt;p&gt;In this context, the recent TIMING-ICP study by Mariani et al. [2] addresses a key operational question in neurocritical care: can intensivists safely and effectively initiate ICP monitoring more promptly than neurosurgeons? This prospective, multicenter investigation revealed a noteworthy 76-minute reduction in time from indication to device placement when the procedure was performed by intensivists at the ICU bedside. This shorter interval was expected: placing the probe directly in the ICU avoids the logistical delays associated with operating room transfer and coordination with on-call surgical teams, particularly during night shifts.&lt;/p&gt;&lt;p&gt;This reduction in procedural delay may be clinically meaningful. There is a well-established association between the “dose” of intracranial hypertension, encompassing both intensity and duration, and adverse neurological outcomes [3, 4]. Earlier identification and treatment of elevated ICP are thus fundamental pillars of secondary brain injury prevention.&lt;/p&gt;&lt;p&gt;Importantly, in the TIMING-ICP study, the decision to initiate monitoring was based on joint consultation between intensivists and neurosurgeons, aligned with international consensus recommendations, even if some indications remain blurry defined in the guidelines.&lt;/p&gt;&lt;p&gt;The study primarily assessed intraparenchymal catheters (IPCs), as these were the devices most commonly placed by intensivists at the bedside. Neurosurgeons, in contrast, inserted both IPCs and external ventricular drains (EVDs), the latter often in the operating room. It is essential to recognise that specific clinical scenarios, such as subarachnoid haemorrhage or acute hydrocephalus, may necessitate EVD placement not only for monitoring but also for therapeutic cerebrospinal fluid drainage [5]. The technical complexity of EVD insertion may limit its feasibility in non-surgical hands, highlighting the need for nuanced consideration of which invasive techniques should fall within the intensivist’s scope of practice.&lt;/p&gt;&lt;p&gt;Nonetheless, the clinical impact of reducing the time to monitor insertion remains uncertain. The study did not account for pre-procedural medical interventions that could transiently normalise ICP, and no data were presented on ICP burden during the early monitoring period (the 76-minute advantage) or on therapeutic decisions made in response to early monitoring. Notably, opening ICP values were similar in patients who underwent early versus delayed monitoring. This observation raises questions: did earlier monitoring result in a measurable reduction in the burden of elevated ICP, a known driver of secondary brai","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"22 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144899490","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":"Healthcare costs after sepsis: a systematic review","authors":"Victoria Chechulina, Fatima Sheikh, Meghan Lóser, Marina Englesakis, Kali Barrett","doi":"10.1186/s13054-025-05600-7","DOIUrl":"https://doi.org/10.1186/s13054-025-05600-7","url":null,"abstract":"Sepsis is a life-threatening syndrome associated with significant health resource utilization. Previous systematic reviews have demonstrated high healthcare costs during hospitalization with sepsis, but post-discharge health costs have not been characterized. Understanding these costs allows health system decision-makers to identify targets for reducing preventable spending and strain on healthcare resources. This systematic review aims to describe the post-hospitalization healthcare costs among adults living in developed nations who survived an episode of sepsis. We searched MEDLINE, Embase, CINAHL, and the Cochrane Central Register of Controlled Trials and Database of Systematic Reviews from the year 2000 to February 4, 2025. The search strategy was developed by combining concepts of sepsis, costs, study types, and developed countries. Two reviewers independently screened titles and abstracts, followed by full-text review and data extraction. Conflicts were resolved by a third reviewer. Study quality was assessed using the Newcastle-Ottawa scale for non-randomized studies. Narrative synthesis was used to summarize findings. We identified 23 observational studies that met the inclusion criteria. The methods used to calculate and report healthcare costs varied widely across studies, including the types of costs incurred (readmissions, physician visits, medication costs, and others) and the period over which costs were calculated. Across studies, the median total healthcare cost among sepsis survivors in year one after discharge was $28,719 (IQR $21,715) and the median total healthcare cost in year two after discharge was $22,460 (IQR $14,407). The median cost of a readmission for sepsis survivors was $20,320 (IQR $4,889). Six of seven studies that included a non-sepsis comparator group reported that sepsis survivors accrue higher healthcare costs post-discharge compared to individuals without sepsis. Our systematic review demonstrates that sepsis survivors incur high healthcare costs that can persist for years after discharge from initial hospitalization. These findings underscore the long-term health economic burden of sepsis, highlighting sepsis as an important target for policy and practice interventions that could improve health outcomes and reduce costs. CRD42023456850.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"38 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144899581","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":"Correction to: High rates of Cefiderocol plasma target attainment: results of a retrospective cohort study in 31 critically ill ICU patients","authors":"Hans Theodor Naumann, Rainer Höhl, Martina Kinzig, Sophie Salat, Vanessa Bartsch, Fritz Sörgel, Ralph Bertram, Joerg Steinmann","doi":"10.1186/s13054-025-05583-5","DOIUrl":"https://doi.org/10.1186/s13054-025-05583-5","url":null,"abstract":"&lt;p&gt;&lt;b&gt;Correction: Crit Care (2024) 28:438 &lt;/b&gt;&lt;b&gt;https://doi.org/10.1186/s13054-024-05214-5&lt;/b&gt;.&lt;/p&gt;&lt;p&gt;Following the publication of the original article [1], the author reported that due to an error the Competing Interests section was incomplete and that affiliations 6-8 were incorrectly included.&lt;/p&gt;&lt;p&gt;The section currently reads:&lt;/p&gt;&lt;br/&gt;&lt;p&gt;&lt;b&gt;Competing interests&lt;/b&gt;&lt;/p&gt;&lt;p&gt;RH was active in the Advisory Board of Shionogi, the supplier of cefiderocol. JS received speaker’s honorarium from Gilead, Pfizer and bioMérieux.&lt;/p&gt;&lt;p&gt;The section should instead read:&lt;/p&gt;&lt;br/&gt;&lt;p&gt;&lt;b&gt;Competing interests&lt;/b&gt;&lt;/p&gt;&lt;p&gt;RH was active in the Advisory Board of Shionogi, the supplier of cefiderocol. JS received speaker’s honorarium from Gilead, Pfizer and bioMérieux. Financial compensation for cefiderocol analytics was provided by Shionogi&lt;/p&gt;&lt;p&gt;The Competing Interests section has been updated in this correction article and the original article [1] has been corrected. &lt;/p&gt;&lt;ol data-track-component=\"outbound reference\" data-track-context=\"references section\"&gt;&lt;li data-counter=\"1.\"&gt;&lt;p&gt;Naumann HT, Höhl R, Kinzig M, et al. High rates of Cefiderocol plasma target attainment: results of a retrospective cohort study in 31 critically ill ICU patients. Crit Care. 2024;28:438. https://doi.org/10.1186/s13054-024-05214-5.&lt;/p&gt;&lt;p&gt;Article PubMed PubMed Central Google Scholar &lt;/p&gt;&lt;/li&gt;&lt;/ol&gt;&lt;p&gt;Download references&lt;svg aria-hidden=\"true\" focusable=\"false\" height=\"16\" role=\"img\" width=\"16\"&gt;&lt;use xlink:href=\"#icon-eds-i-download-medium\" xmlns:xlink=\"http://www.w3.org/1999/xlink\"&gt;&lt;/use&gt;&lt;/svg&gt;&lt;/p&gt;&lt;span&gt;Author notes&lt;/span&gt;&lt;ol&gt;&lt;li&gt;&lt;p&gt;Hans Theodor Naumann and Rainer Höhl have contributed equally to this work.&lt;/p&gt;&lt;/li&gt;&lt;/ol&gt;&lt;h3&gt;Authors and Affiliations&lt;/h3&gt;&lt;ol&gt;&lt;li&gt;&lt;p&gt;Institute of Clinical Microbiology, Infectious Diseases and Infection Control, Nuremberg General Hospital, Paracelsus Medical University, Nuremberg, Germany&lt;/p&gt;&lt;p&gt;Hans Theodor Naumann, Rainer Höhl, Ralph Bertram &amp; Joerg Steinmann&lt;/p&gt;&lt;/li&gt;&lt;li&gt;&lt;p&gt;Intensive Care Unit, Department of Medicine 1, University Hospital Carl Gustav Carus, TU, Dresden, Dresden, Germany&lt;/p&gt;&lt;p&gt;Hans Theodor Naumann&lt;/p&gt;&lt;/li&gt;&lt;li&gt;&lt;p&gt;Institute for Biomedical and Pharmaceutical Research, Nuremberg-Heroldsberg, Germany&lt;/p&gt;&lt;p&gt;Martina Kinzig &amp; Fritz Sörgel&lt;/p&gt;&lt;/li&gt;&lt;li&gt;&lt;p&gt;Study Program in Human Medicine, Paracelsus Medical University, Nuremberg, Germany&lt;/p&gt;&lt;p&gt;Sophie Salat &amp; Vanessa Bartsch&lt;/p&gt;&lt;/li&gt;&lt;li&gt;&lt;p&gt;Institute of Pharmacology, West German Heart and Vascular Centre, University of Duisburg-Essen, Essen, Germany&lt;/p&gt;&lt;p&gt;Fritz Sörgel&lt;/p&gt;&lt;/li&gt;&lt;/ol&gt;&lt;span&gt;Authors&lt;/span&gt;&lt;ol&gt;&lt;li&gt;&lt;span&gt;Hans Theodor Naumann&lt;/span&gt;View author publications&lt;p&gt;&lt;span&gt;Search author on:&lt;/span&gt;&lt;span&gt;PubMed&lt;span&gt; &lt;/span&gt;Google Scholar&lt;/span&gt;&lt;/p&gt;&lt;/li&gt;&lt;li&gt;&lt;span&gt;Rainer Höhl&lt;/span&gt;View author publications&lt;p&gt;&lt;span&gt;Search author on:&lt;/span&gt;&lt;span&gt;PubMed&lt;span&gt; &lt;/span&gt;Google Scholar&lt;/span&gt;&lt;/p&gt;&lt;/li&gt;&lt;li&gt;&lt;span&gt;Martina Kinzig&lt;/span&gt;View author publications&lt;p&gt;&lt;span&gt;Search author on:&lt;/span&gt;&lt;span&gt;PubMed&lt;span&gt; &lt;/spa","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"16 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144899583","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":"Impact of syndromic molecular diagnostics on antimicrobial adequacy and time to therapy in critically ill patients with pneumonia: a systematic review and meta-analysis of randomized trials","authors":"Yuri de Albuquerque Pessoa dos Santos, Bruno Martins Tomazini, Maurício Henrique Claro dos Santos, Eduardo Lyra de Queiroz, Laerte Pastore Júnior, Eduardo Leite Vieira Costa, Fernando José da Silva Ramos","doi":"10.1186/s13054-025-05623-0","DOIUrl":"https://doi.org/10.1186/s13054-025-05623-0","url":null,"abstract":"Pneumonia is a leading cause of ICU admission and mortality, requiring prompt and adequate antimicrobial therapy to improve outcomes. Conventional cultures are slow and often insensitive, delaying targeted treatment. Syndromic PCR panels offer rapid identification of pathogens and resistance genes directly from respiratory samples, potentially improving early antibiotic optimization. However, the true clinical benefit of these diagnostics in critically ill patients remains uncertain. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing PCR-based molecular diagnostics with standard culture techniques in predominantly adult ICU patients with severe community-acquired, hospital-acquired, or ventilator-associated pneumonia. Literature searches were performed in PubMed, Embase, and Cochrane CENTRAL from inception to July 16, 2025. The primary outcome was in-hospital mortality. Secondary outcomes included adequacy of initial antimicrobial therapy and time to effective antibiotic administration. Data were synthesized using random-effects models. We included five randomized controlled trials comprising 2,466 patients. Syndromic PCR testing did not significantly reduce in-hospital mortality, the primary outcome (RR 1.04; 95% CI: 0.90–1.21; p = 0.57; I² = 0%). However, PCR testing was associated with a higher rate of adequate initial antimicrobial therapy (RR 1.82; 95% CI: 1.10–3.00; p = 0.02; I² = 97%) and a reduction in time to effective antibiotic administration (mean difference − 27.98 h; 95% CI: − 46.07 to − 9.89; p = 0.002; I² = 94%). Syndromic PCR diagnostics did not reduce in-hospital mortality in critically ill patients with pneumonia but were associated with improved adequacy of initial antimicrobial therapy and faster initiation of effective treatment. These findings support their role as a complementary tool in ICU-based antimicrobial stewardship. PROSPERO CRD420251006301.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"11 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144899582","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":"Molecular diagnostic technology: beyond analytical accuracy","authors":"Xiangquan Li, Juan Liu","doi":"10.1186/s13054-025-05620-3","DOIUrl":"https://doi.org/10.1186/s13054-025-05620-3","url":null,"abstract":"Infectious diseases cause high morbidity and mortality, and early, effective antimicrobial therapy improves outcomes. However, conventional microbiology methods like culture are slow and insensitive. Emerging molecular diagnostics—such as multiplex PCR (mPCR), droplet digital PCR (ddPCR), and metagenomic next-generation sequencing (mNGS)—offer rapid, accurate pathogen identification. Challenges persist in result interpretation (e.g., setting positivity thresholds, low positive predictive value) and clinician trust. While molecular diagnostics excel in sensitivity, their real-world impact on specificity and patient prognosis - clinical accuracy -remains limited. Key hurdles include patient selection, timing, result interpretation, and pathogen relevance. Addressing these gaps is critical for standardizing these technologies and maximizing their clinical benefit. ","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"27 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144899580","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":"Evaluating the o1 reasoning large language model for cognitive bias: a vignette study","authors":"Or Degany, Sahar Laros, Daphna Idan, Sharon Einav","doi":"10.1186/s13054-025-05591-5","DOIUrl":"https://doi.org/10.1186/s13054-025-05591-5","url":null,"abstract":"Cognitive biases, systematic deviations from logical judgment, are well documented in clinical decision-making, particularly in clinical settings characterized by high decision load, limited time, and diagnostic uncertainty-such as critical care. Prior work demonstrated that large language models, particularly GPT-4, reproduce many of these biases, sometimes to a greater extent than human clinicians. We tested whether the o1 model (o1-2024–12-17), a newly released AI system with enhanced reasoning capabilities, is susceptible to cognitive biases that commonly affect medical decision-making. Following the methodology established by Wang and Redelmeier [15], we used ten pairs of clinical scenarios, each designed to test a specific cognitive bias known to influence clinicians. Each scenario had two versions, differed by subtle modifications designed to trigger the bias (such as presenting mortality rates versus survival rates). The o1 model generated 90 independent clinical recommendations for each scenario version, totalling 1,800 responses. We measured cognitive bias as systematic differences in recommendation rates between the paired scenarios, which should not occur with unbiased reasoning. The o1 model's performance was compared against previously published results from both the GPT-4 model and historical human clinician studies. The o1 model showed no measurable cognitive bias in seven of the ten vignettes. In two vignettes, the o1 model showed significant bias, but its absolute magnitude was lower than values previously reported for GPT-4 and human clinicians. In a single vignette, Occam’s razor, the o1 model exhibited consistent bias. Therefore, although overall bias appears less frequent overall with the reasoning model than with GPT-4, it was worse in one vignette. The model was more prone to bias in vignettes that included a gap-closing cue, seemingly resolving the clinical uncertainty. Across eight vignette versions, intra‑scenario agreement exceeded 94%, indicating lower decision variability than previously described with GPT‑4 and human clinicians. Reasoning models may reduce cognitive bias and random variation in judgment (i.e., “noise”). However, our findings caution that reasoning models are still not entirely immune to cognitive bias. These findings suggest that reasoning models may impart some benefits as decision-support tools in medicine, but they also imply a need to explore further the circumstances in which these tools may fail.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"53 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144899446","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}