Critical Care最新文献

{"title":"Subphenotyping prone position responders with machine learning","authors":"Maxime Fosset, Dario von Wedel, Simone Redaelli, Daniel Talmor, Nicolas Molinari, Julie Josse, Elias N. Baedorf-Kassis, Maximilian S. Schaefer, Boris Jung","doi":"10.1186/s13054-025-05340-8","DOIUrl":"https://doi.org/10.1186/s13054-025-05340-8","url":null,"abstract":"Acute respiratory distress syndrome (ARDS) is a heterogeneous condition with varying response to prone positioning. We aimed to identify subphenotypes of ARDS patients undergoing prone positioning using machine learning and assess their association with mortality and response to prone positioning. In this retrospective observational study, we enrolled 353 mechanically ventilated ARDS patients who underwent at least one prone positioning cycle. Unsupervised machine learning was used to identify subphenotypes based on respiratory mechanics, oxygenation parameters, and demographic variables collected in supine position. The primary outcome was 28-day mortality. Secondary outcomes included response to prone positioning in terms of respiratory system compliance, driving pressure, PaO2/FiO2 ratio, ventilatory ratio, and mechanical power. Three distinct subphenotypes were identified. Cluster 1 (22.9% of whole cohort) had a higher PaO2/FiO2 ratio and lower Positive End-Expiratory Pressure (PEEP). Cluster 2 (51.3%) had a higher proportion of COVID-19 patients, lower driving pressure, higher PEEP, and higher respiratory system compliance. Cluster 3 (25.8%) had a lower pH, higher PaCO2, and higher ventilatory ratio. Mortality differed significantly across clusters (p = 0.03), with Cluster 3 having the highest mortality (56%). There were no significant differences in the proportions of responders to prone positioning for any of the studied parameters. Transpulmonary pressure measurements in a subcohort did not improve subphenotype characterization. Distinct ARDS subphenotypes with varying mortality were identified in patients undergoing prone positioning; however, predicting which patients benefited from this intervention based on available data was not possible. These findings underscore the need for continued efforts in phenotyping ARDS through multimodal data to better understand the heterogeneity of this population.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"9 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143627460","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":"Social media insights on sepsis management using advanced natural language processing techniques","authors":"Ravi Shankar, Amartya Mukhopadhyay","doi":"10.1186/s13054-025-05344-4","DOIUrl":"https://doi.org/10.1186/s13054-025-05344-4","url":null,"abstract":"<p>Early recognition and prompt initiation of appropriate treatment are critical for improving sepsis outcomes [1]. However, public insight of sepsis remains suboptimal, contributing to delays in care-seeking and worse prognoses [2]. To gain insights into public perceptions of sepsis, we analyzed 4,080 sepsis-related posts on the social media platform X.com (formerly Twitter) from January 2020 to January 2024 with advanced natural language processing (NLP) techniques.</p><p>Our multi-method approach encompassed sentiment analysis, topic modeling, aspect-based sentiment analysis, engagement analysis, and inductive thematic analysis. Our data collection utilized X.com's Academic Research Application Programming Interface (API) to gather tweets containing sepsis-related keywords in English. We preprocessed the data by removing duplicates, retweets, and non-English content. For sentiment analysis, we employed the VADER (Valence Aware Dictionary and sEntiment Reasoner) sentiment analyzer [3], specifically tuned for social media content. Topic modeling was conducted using Latent Dirichlet Allocation (LDA) [4] with optimal topic numbers determined through coherence score analysis. Our aspect-based sentiment analysis combined dependency parsing with domain-specific lexicons to identify sentiment-aspect pairs [5]. Engagement analysis incorporated retweet counts, likes, and reply metrics, while thematic analysis followed Braun and Clarke's six-phase framework [6] with two independent coders achieving strong inter-rater reliability.</p><p>Sentiment analysis revealed a complex emotional landscape with predominantly neutral (46.3%) and negative (36.1%) perceptions, highlighting the interplay between factual information-sharing and emotionally charged personal narratives. Topic modeling identified six key themes, with limited sepsis awareness (24.6% of posts) and personal experiences with sepsis (21.3%) emerging as the most prevalent (Table 1A). The dominance of these themes suggests that public understanding of sepsis is often only triggered by direct encounters with the condition, either through one's own or a loved one’s illness, underscoring the urgent need for more widespread and accessible sepsis education initiatives.</p><figure><figcaption><b data-test=\"table-caption\">Table 1 Analysis of Sepsis-Related Social Media Content</b></figcaption><span>Full size table</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>Aspect-based sentiment analysis (− 1 to + 1) yielded further nuance, uncovering strong negative associations with severe clinical outcomes like \"shock\" (sentiment score: − 0.82) and \"organ failure\" (score: − 0.75), while terms like \"survivors\" (score: 0.62) and \"awareness\" (score: 0.55) were linked to positive sentiment. This duality reflects the public's recognition of both the profound threat posed ","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"183 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143618418","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":"Lactate infusion improves cardiac function in a porcine model of ischemic cardiogenic shock","authors":"Oskar Kjærgaard Hørsdal, Mark Stoltenberg Ellegaard, Alexander Møller Larsen, Halvor Guldbrandsen, Niels Moeslund, Jacob Eifer Møller, Ole Kristian Lerche Helgestad, Hanne Berg Ravn, Henrik Wiggers, Roni Nielsen, Nigopan Gopalasingam, Kristoffer Berg-Hansen","doi":"10.1186/s13054-025-05346-2","DOIUrl":"https://doi.org/10.1186/s13054-025-05346-2","url":null,"abstract":"Cardiogenic shock (CS) is associated with high mortality and medical therapies have failed to improve survival. Treatment with lactate is associated with improved cardiac function which may benefit this condition. Comprehensive hemodynamic assessment of lactate administration in CS is lacking, and the mechanisms underlying the cardiovascular effects of lactate in CS have not yet been elucidated. In this study we aimed to study the cardiovascular and cardiometabolic effects of treatment with lactate in experimental ischemic CS. In a randomized, blinded design, 20 female pigs (60 kg) were studied. Left main coronary artery microsphere injections were used to cause CS, defined as a 30% reduction in CO or mixed venous saturation (SvO2). Subjects were randomized to receive either intravenous exogenous lactate or euvolemic, equimolar saline (control) for 180 min. Positive inotropic control with dobutamine was administered on top of ongoing treatment after 180 min. Extensive hemodynamic measurements were obtained from pulmonary artery and left ventricular (LV) pressure–volume catheterization. Furthermore, endomyocardial biopsies were analyzed for mitochondrial function and arterial, renal vein, and coronary sinus blood samples were collected. The primary endpoint was change in CO during 180 min of treatment. Arterial lactate levels increased from 2.4 ± 1.1 to 7.7 ± 1.1 mmol/L (P < 0.001) during lactate infusion. CO increased by 0.7 L/min (P < 0.001) compared with control, due to increased stroke volume (P = 0.003). Notably, heart rate and mean arterial pressure did not differ significantly between treatments. End-systolic elastance (load independent contractility) was enhanced during lactate infusion (P = 0.048), together with LV ejection fraction (P = 0.009) and dP/dt(max) (P = 0.041). Arterial elastance (afterload) did not differ significantly (P = 0.12). This resulted in improved ventriculo-arterial coupling efficiency (P = 0.012). Cardiac mechanical efficiency (P = 0.003), diuresis (P = 0.016), and SvO2 (P = 0.018) were increased during lactate infusion. Myocardial mitochondrial complex I respiration was enhanced during lactate infusion compared with control (P = 0.04). Concomitant administration of dobutamine on top of lactate resulted in further hemodynamic improvements compared with control. Lactate infusion improved cardiac function and myocardial mitochondrial respiration in a porcine model of CS. The hemodynamic effects included increased CO mediated through stroke volume increase. These favorable cardiovascular effects may benefit patients with CS.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"87 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143618437","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":"Characteristics, outcomes, and complications among nonagenarian and centenarian patients admitted to the intensive care unit: a scoping review","authors":"Je Min Suh, Nattaya Raykageeraroj, Boris Waldman, Nuanprae Kitisin, Cilla Haywood, Rinaldo Bellomo, Anoop N. Koshy, David Pilcher, Dong-Kyu Lee, Laurence Weinberg","doi":"10.1186/s13054-025-05349-z","DOIUrl":"https://doi.org/10.1186/s13054-025-05349-z","url":null,"abstract":"Nonagenarians and centenarians are a growing and vulnerable groups of patients admitted to ICU. There is limited information on their characteristics, outcomes, and complications. We performed a scoping review of studies focused on nonagenarians and centenarians admitted to ICU. We assessed their characteristics, the presence of frailty, the presence of comorbidities, their complications, their ICU and hospital length of stay and mortality and their long-term outcomes. We assessed 36 studies, mostly retrospective, with one classified as a National Quality Registry study and another as a prospective analysis of two large multinational cohorts. The studies involved 16,859 patients with a mean age of 92.4 years and a male prevalence of 39.3%. Multiple comorbidities were present in the majority of patients. Overall, 40.7% of patients received mechanical ventilation, with a median of 36% (range: 0%–100%; IQR: 23.8%–50%). Mean duration of mechanical ventilation was 90.4 h, with a median of 84 h (range: 10–221 h; IQR: 12.25–146.5 h). Cardiovascular and renal complications were common. Mean ICU stay across studies was 5.4 days, with a median of 5 days (range: 0.9–13 days; IQR: 2.55–7.03 days). The median length of hospital stay was 12.4 days (range: 5.7–31 days; IQR: 11–17.6 days). The median hospital mortality was 25.55% (range: 0%–62.5%; IQR: 15%–35.5%). The mean six-month and 1-year mortality rates were 38.6% and 45.6%, respectively. Nonagenarians and centenarians admitted to ICU are a highly comorbid and vulnerable population who experience prolonged hospital stays and complications. However four out of five survive to hospital discharge and half are alive at one year after admission. Therefore, through judicious patient selection, ICU care can be both meaningful and beneficial. Our findings underscore the need for a standardized reporting structure for nonagenarians and centenarians admitted to the ICU to allow comparability across studies, enhanced data quality and reliability, greater research efficiency, and better identification of the unique health needs in this vulnerable patient cohort.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"9 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143608078","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":"Short and long-term complications of prehospital arterial catheterisation performed by a Helicopter Emergency Medical Service in the United Kingdom","authors":"Edwin Li Ping Wah-Pun Sin, Owen Hibberd, James Price, Kate Lachowycz, Rob Major, Paul Rees, Ed Barnard","doi":"10.1186/s13054-025-05348-0","DOIUrl":"https://doi.org/10.1186/s13054-025-05348-0","url":null,"abstract":"&lt;p&gt;In patients with life-threatening physiological derangement, non-invasive blood pressure measurements are often inaccurate and are affected by logistical factors associated with the transfer to the hospital [1]. Prehospital arterial catheterisation and invasive blood pressure monitoring is increasingly being performed by Helicopter Emergency Medical Services (HEMS), however, due to the clinical urgency of device insertion coupled with possibly compromised asepsis, procedures performed in this environment may be at higher risk of complication than those delivered in-hospital [2]. The objective of this study was to report the complication rate of prehospital arterial catheterisation from admission to hospital discharge in patients attended by HEMS in the UK.&lt;/p&gt;&lt;p&gt;The East Anglian Air Ambulance (EAAA) is one of the largest providers of physician-paramedic prehospital critical care in the East of England. Prehospital arterial catheterisation has been performed by EAAA for over ten years, using a 20G arterial catheter (BD Arterial Cannula with Flow Switch, Sandy, UT, USA) for peripheral catheterisation and a 5Fr sheath introducer (MERIT Prelude, MERIT Medical, South Jordan, UT, USA) for femoral artery catheterisation.&lt;/p&gt;&lt;p&gt;This retrospective observational study included adult (≥ 18-years-old) patients who underwent prehospital arterial catheterisation and were conveyed to the regional major trauma centre (MTC); 01/02/2015–17/04/2023. The primary outcome was to report the complication rate of prehospital arterial catheterisation from admission to discharge. Complications were categorised as infective, vascular, or neurological and were sub-classified as major or minor [3, 4]. The secondary outcome was to report the duration of arterial catheter placement and the association between duration of placement and incidence of complication.&lt;/p&gt;&lt;p&gt;The following data were retrieved from both the EAAA electronic medical record (HEMSbase, Medic One Systems Ltd, UK) and the hospital electronic medical record (Epic Hyperspace Production®, Epic Systems Corporation, Verona, WI, USA): sex; age in years; aetiology (medical or trauma); insertion site; insertion time and date; complications; removal time and date. Notes were reviewed until the date of hospital discharge or death if in-hospital. Characteristics of the sample were described as number (percentage) for categorical variables and median [interquartile range (IQR)] for continuous variables. Categorical variables were analysed using Fisher’s exact test reported with a Baptista-Pike calculated odds ratio (OR) with 95%CI, and a &lt;i&gt;p&lt;/i&gt;-value; significance was pre-defined at &lt; 0.05.&lt;/p&gt;&lt;p&gt;During the study period 353 patients were eligible for inclusion. 31 (8.8%) patients were excluded; 322 patients were included in the analysis per-protocol, Fig. 1. The median age was 55 [37–70] years, &lt;i&gt;n&lt;/i&gt; = 218 (67.7%) were male, and &lt;i&gt;n&lt;/i&gt; = 198 (61.5%) presented with trauma. The radial artery was the most preval","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"92 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143608089","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 comorbidities on management and outcomes of patients weaning from invasive mechanical ventilation: insights from the WEAN SAFE study","authors":"Omid Khazaei, Caoimhe M. Laffey, Rionach Sheerin, Bairbre A. McNicholas, Tài Pham, Leo Heunks, Giacomo Bellani, Laurent Brochard, Andrew J. Simpkin, John G. Laffey","doi":"10.1186/s13054-025-05341-7","DOIUrl":"https://doi.org/10.1186/s13054-025-05341-7","url":null,"abstract":"The impact of comorbidities on patients weaning from invasive ventilation is incompletely understood. We wished to understand the impact of the number and type of comorbidities on patients’ weaning from invasive mechanical ventilation enrolled in the ‘WorldwidE AssessmeNt of Separation of pAtients From ventilatory assistancE (WEAN SAFE) study. The study population consisted of patients enrolled in the WEAN SAFE study that commenced the weaning process. We categorized patients by the number of comorbidities (none, 1, 2, or 3 plus), and by specific comorbidity type. The primary outcome was the impact of comorbidities on delayed weaning and failed weaning from invasive MV. Secondary outcomes included the impact of comorbidities on ICU and hospital survival, and decisions to limit life-sustaining interventions. Of 4523 patients in the study population, 1614 (35.7%) had one comorbidity, 889 (19.7%) had two comorbidities, 432 (9.6%) had three or more comorbidities, while 1562 (34.5%) had no comorbidities. The most frequently occurring comorbid conditions were respiratory (22%) and cardiovascular (11%). Patients with comorbidities were more likely to fail a separation attempt, more likely to receive an extubation attempt, and to require more than 1 extubation attempt. The proportion of patients with failed weaning from invasive MV increased progressively with increasing comorbidities. Neuromuscular comorbidities were associated with increased weaning duration. Weaning failure was increased with respiratory, hepatic, renal, neuromuscular, and immune dysfunction comorbidities. Hospital mortality rates increased progressively from 16% with no comorbidity to 34% with ≥ 3 comorbidities. Each specific comorbidity was independently associated with increased hospital mortality. The presence of comorbidities was associated with decisions to limit life sustaining interventions. Most patients weaning from invasive ventilation have comorbidities, which are associated with higher weaning failure risk and worse outcomes. The adverse impact of comorbidities on the weaning outcomes and of the process are not explained by a less aggressive approach to weaning.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"16 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143618420","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 promise of transcranial focused ultrasound in disorders of consciousness: a narrative review","authors":"Dongdong Yang, Shengqi Fu, Meng Zhao, Yu Shi","doi":"10.1186/s13054-025-05338-2","DOIUrl":"https://doi.org/10.1186/s13054-025-05338-2","url":null,"abstract":"Transcranial focused ultrasound (tFUS) has emerged as a promising non-invasive neuromodulation technique for disorders of consciousness (DOC). This work critically evaluates tFUS's potential, highlighting its unique ability to precisely modulate deep brain structures, particularly the thalamus, while maintaining non-invasiveness. The mechanisms of action span multiple levels, from membrane-level ion channel modulation to network-wide changes in neural connectivity. Preclinical and early clinical studies have demonstrated tFUS's potential to improve DOC outcomes. Preliminary clinical trials in both acute and chronic DOC patients have shown encouraging results, including diagnostic category shifts, improvements in behavioral responsiveness, and alterations in thalamo-cortical connectivity. However, significant challenges remain. These include optimizing stimulation parameters, addressing variability in patient responses, and ensuring long-term safety. The current evidence base is limited, necessitating larger, more rigorous investigations. Future research should focus on multicenter randomized controlled trials to comprehensively evaluate tFUS across different DOC etiologies and chronicity. Key priorities include identifying predictive biomarkers, exploring combination therapies, and addressing ethical considerations. While tFUS shows significant promise in DOC management, further investigation is crucial to refine its application and establish its definitive clinical role.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"56 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143608082","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":"Advancements in imaging techniques for monitoring the respiratory muscles","authors":"Martin Dres, Jonne Doorduin, Samia Boussouar, Damien Bachasson","doi":"10.1186/s13054-025-05339-1","DOIUrl":"https://doi.org/10.1186/s13054-025-05339-1","url":null,"abstract":"This review highlights the latest advancements in imaging techniques for monitoring respiratory muscles in critically ill patients. At the bedside, conventional ultrasound has been widely adopted to measure diaphragm thickness, thickening and excursion. It has also been used to assess extradiaphragmatic respiratory muscles, including parasternal intercostal and abdominal muscles. Advanced ultrasound-derived techniques have expanded its applications, enabling the evaluation of tissue velocity (tissue Doppler imaging), stiffness (shear wave elastography), and local tissue displacement (speckle tracking). Facility-based imaging modalities such as magnetic resonance imaging and chest tomography provide complementary insights into respiratory muscles structure and function, offering valuable information for evaluating the effects of therapeutic interventions. Finally, imaging techniques have emerged as valuable tools for evaluating the metabolic demands of respiratory muscles, with advanced methods such as positron emission tomography and contrast-enhanced ultrasound showing significant potential.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"124 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143608084","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":"Efficacy and safety of gastrodin in preventing postoperative delirium following cardiac surgery: a randomized placebo controlled clinical trial","authors":"Yun-Xiao Bai, Hui-Liang Wu, Wan-Li Xie, Xia Li, Jing-Jing Han, Jie Liu, Shi-Qiang Chen, Ping Yin, Nian-Guo Dong, Qing-Ping Wu","doi":"10.1186/s13054-025-05331-9","DOIUrl":"https://doi.org/10.1186/s13054-025-05331-9","url":null,"abstract":"Delirium and postoperative cognitive dysfunction (POCD) are common complications post-cardiac surgery, yet no specific medical intervention is currently recommended for prevention. This study aimed to evaluate the efficacy of gastrodin infusion in preventing delirium and POCD in critically ill patients following cardiac surgery. A double-blind, randomized, placebo-controlled trial was conducted on patients aged 18–75, scheduled for coronary artery bypass grafting (CABG) surgery, with or without valve replacement. Participants were randomized in a 1:1 ratio to receive gastrodin infusion 600 mg twice daily or placebo from the day of surgery until the postoperative day (POD) 6. The co-primary outcomes were the incidences of delirium and POCD, assessed from ICU admission until POD 7 and at 1 and 3 months postoperatively. This study was registered with the Chinese Clinical Trials Registry (ChiCTR1800020414). Of 160 randomized participants, 155 were analyzed (77 gastrodin, 78 placebo) according to a modified intention to treat principle. The incidence of postoperative delirium was 19.5% in the gastrodin group and 35.9% in the placebo group, with a significant relative risk of 0.54 (95% CI 0.32–0.93, p = 0.022). The incidence of in-hospital POCD was 2.9% and 4.0% in the placebo and gastrodin groups, respectively. The odds of hospital discharge were significantly greater in the gastrodin group (subhazard ratio, 1.20; 95% CI 1.00–1.84; p = 0.049). Adverse events occurred in 9.1% (7/77) of patients administered gastrodin and 14.1% (11/78) of patients administered the placebo, with none being drug-related. Gastrodin infusion significantly reduced postoperative delirium and improved discharge outcomes in patients undergoing CABG, but larger studies are needed to confirm its efficacy in preventing delirium.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"19 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143589710","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":"Individualized PEEP can improve both pulmonary hemodynamics and lung function in acute lung injury","authors":"Mayson L. A. Sousa, Luca S. Menga, Annia Schreiber, Mattia Docci, Fernando Vieira, Bhushan H. Katira, Mariangela Pellegrini, Sebastian Dubo, Ghislaine Douflé, Eduardo L. V. Costa, Martin Post, Marcelo B. P. Amato, Laurent Brochard","doi":"10.1186/s13054-025-05325-7","DOIUrl":"https://doi.org/10.1186/s13054-025-05325-7","url":null,"abstract":"There are several approaches to select the optimal positive end-expiratory pressure (PEEP), resulting in different PEEP levels. The impact of different PEEP settings may extend beyond respiratory mechanics, affecting pulmonary hemodynamics. To compare PEEP levels obtained with three titration strategies—(i) highest respiratory system compliance (CRS), (ii) electrical impedance tomography (EIT) crossing point; (iii) positive end-expiratory transpulmonary pressure (PL)—in terms of regional respiratory mechanics and pulmonary hemodynamics. Experimental studies in two porcine models of acute lung injury: (I) bilateral injury induced in both lungs, generating a highly recruitable model (n = 37); (II) asymmetrical injury, generating a poorly recruitable model (n = 13). In all experiments, a decremental PEEP titration was performed monitoring PL, EIT (collapse, overdistention, and regional ventilation), respiratory mechanics, and pulmonary and systemic hemodynamics. PEEP titration methods resulted in different levels of median optimal PEEP in bilateral lung injury: 14(12–14) cmH2O for CRS, 11(10–12) cmH2O for EIT, and 8(8–10) cmH2O for PL, p < 0.001. Differences were less pronounced in asymmetrical lung injury. PEEP had a quadratic U-shape relationship with pulmonary artery pressure (R2 = 0.94, p < 0.001), right-ventricular systolic transmural pressure, and pulmonary vascular resistance. Minimum values of pulmonary vascular resistance were found around individualized PEEP, when ventilation distribution and pulmonary circulation were simultaneously optimized. In porcine models of acute lung injury with variable lung recruitability, both low and high levels of PEEP can impair pulmonary hemodynamics. Optimized ventilation and hemodynamics can be obtained simultaneously at PEEP levels individualized based on respiratory mechanics, especially by EIT and esophageal pressure.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"34 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143582816","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}