Critical Care最新文献

{"title":"Labour market attachment before and after hospitalisation for sepsis: a Danish cohort study","authors":"Camilla Schade Skov, Mikkel Brabrand, Christian Backer Mogensen, Helene Skjøt-Arkil, Flemming Schønning Rosenvinge, Isik Somuncu Johansen, Annmarie Lassen","doi":"10.1186/s13054-025-05446-z","DOIUrl":"https://doi.org/10.1186/s13054-025-05446-z","url":null,"abstract":"Sepsis survivors often experience cognitive, physiological, and functional impairments that may limit return to work (RTW). We aimed to describe changes in workforce attachment among working-age patients with sepsis, both overall and stratified by treatment in general wards versus the intensive care unit (ICU). Additionally, we aimed to evaluate the impact of educational level and to identify factors associated with RTW. A register-based cohort study including all patients aged 20–63 years with incident community-acquired sepsis admitted to a hospital in the Region of Southern Denmark between 1 January 2016 and 20 March 2018. Labour market attachment was illustrated using area charts, overall and stratified by treatment in general wards versus the ICU. Further, the overall area chart was stratified by educational level. Patients were classified as part of the workforce or non-workforce. A subgroup of the workforce comprised those working. RTW was estimated for the workforce and those working after 12, 52, 104, and 156 weeks. Factors associated with RTW were identified using cause-specific hazards. Of the 1610 patients with sepsis included, 651 were part of the workforce, with 488 working. After 12 weeks, 69.0% of workforce patients (excluding those censored) had returned to work. This proportion increased to 81.6%, 87.5%, and 90.4% after 52, 104, and 156 weeks, respectively. Among patients working before sepsis, RTW proportions were higher. Several baseline variables and in-hospital measures were associated with RTW among the workforce including younger age (20–39 years), HR = 1.33 (95% CI, 1.05–1.68), no ICU admission, HR = 2.64 (95% CI, 1.81–3.86), lactate < 4 mmol/L, HR = 2.19 (1.13–4.24), and single organ failure, HR = 2.33 (95% CI, 1.16–4.69). While ICU admission had impact on RTW in both the workforce and those working, educational level was unrelated to RTW among those working. Most working-age patients with sepsis were outside the workforce. Working before sepsis was the strongest predictor of RTW. While educational level influenced whether patients were part of the workforce, it was not associated with RTW among those working. No ICU admission was associated with RTW.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"40 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144088252","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":"Reliability of pre-admission patient-reported outcome measures postoperatively assessed via proxies: a prospective, multicenter observational study","authors":"Julius J. Grunow, Leonie Hartmann, Bernhard Ulm, Mathilde Maechler, Manfred Blobner, Katharina Seidenspinner, Lukas Schoennagel, Steffen Weber-Carstens, Kristina Fuest, Tobias Wollersheim, Stefan J. Schaller","doi":"10.1186/s13054-025-05431-6","DOIUrl":"https://doi.org/10.1186/s13054-025-05431-6","url":null,"abstract":"Pre-admission status obtained through patient-reported outcome measures is an essential metric in both clinical and research settings for prognostication and treatment decisions. It is frequently collected by proxies, although its reliability has yet to be thoroughly investigated. The objective was to determine the reliability of proxy assessments regarding pre-ICU admission status via patient-reported outcome measures and to explore the impact of the ICU setting on these assessments. Prospective multicentre observational study in two tertiary care university hospitals in Germany, including surgical adult patients able to independently answer the patient-reported outcome measures (SF-36, EQ-5D-5L, WHODAS 2.0, IADL, and Barthel Index) with a proxy available. Patients were interviewed pre-operatively, while proxies were interviewed post-operatively in the ICU or normal ward, depending on the patient's location. The reliability of patient-reported outcome measures was analyzed using Bland–Altman plots and Cohen’s kappa. Of 204 patient-proxy pairs, 102 were admitted to an ICU. The median patient and proxy age were 69 and 64 years, with 41% and 68% female, respectively. Bland–Altman plots demonstrated insufficient reliability of proxy ratings, as the 95% limits of agreement fell outside the minimal clinically important difference (MCID) for all questionnaires. However, a significant bias was evident only among ICU patients, showing worse ratings from proxies for the WHODAS 2.0, IADL, and subsets of the SF-36. For the EQ-5D, bias appeared in both the ICU and non-ICU cohorts. The dichotomous analysis of the within-pairs-difference supported the findings, revealing a high proportion of pairs with differences outside the MCID (n (%)—SF-36 PCS normal ward: 47 (46%), ICU: 58 (57%); SF-36 MCS normal ward: 59 (58%), ICU: 62 (61%); WHODAS 2.0 normal ward: 58 (57%), ICU: 78 (77%); EQ-5D-5L normal ward: 40 (39%), ICU: 46 (45%); Barthel-Index normal ward: 22 (22%), ICU: 21 (21%)). Cohen’s kappa indicated moderate reliability for the IADL. The reliability of proxy assessment with the instruments used was insufficient, exhibiting a significant bias in the pre-admission status of ICU patients; therefore, it should be applied with caution. Trial registration: ClinicalTrials.gov (NCT03785444—28th of December 2018). ","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"35 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144088260","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":"Plasma H3.1 nucleosomes as biomarkers of infection, inflammation and organ failure","authors":"Daan F. L. Filippini, Michael Jiang, Lina Kramer, Tom van der Poll, Olaf Cremer, Teddy Tun Win Hla, Andrew Retter, Lieuwe D. J. Bos","doi":"10.1186/s13054-025-05415-6","DOIUrl":"https://doi.org/10.1186/s13054-025-05415-6","url":null,"abstract":"Neutrophil extracellular traps (NETs) are a vital part of the innate immune response, while excessive NET formation can cause tissue damage. H3.1 nucleosomes, a component of NETs, have emerged as a potential biomarker. This study aimed to evaluate H3.1 nucleosomes in critical illness, assessing their relationship with sepsis, organ failure, inflammatory subphenotypes and outcomes. The MARS cohort was used, comprising of consecutive Intensive Care Unit patients, with plasma samples collected on days 0, 2 and 4. H3.1 nucleosome concentrations were measured using the Nu.Q® NETs Immunoassay. H3.1 nucleosome concentrations were compared across sepsis presence and organ failure, both at baseline and longitudinally. The relationship between H3.1 nucleosome concentrations and clinical outcomes was investigated. 1713 critically ill patients were included, with a total of 3671 plasma samples. Baseline H3.1 nucleosome concentrations differed between sepsis confirmed by clinical adjudication (740 ng/mL), sepsis unconfirmed by clinical adjudication (416 ng/mL) and non-sepsis (463 ng/mL, P < 0.001). H3.1 concentrations were associated with SOFA score (r = 0.40) and were higher in patients with disseminated intravascular coagulation, acute kidney injury and hyperinflammatory sepsis. H3.1 concentration was highly predictive for the need of renal replacement therapy (hazard ratio 2.00 per log10 increase), correcting for mortality. Sepsis and organ failure were closely associated with plasma H3.1 nucleosome concentrations. While individual diagnostic performance for sepsis and organ failure remained low, H3.1 levels predicted the need for renal replacement therapy and disseminated intravascular coagulation, revealing unique insights into the innate immune response. Trial registration: ClinicalTrials.gov identifier NCT01905033; IRB number 10-056C, registered June 16, 2010.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"4 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144088253","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":"Severe listeriosis in intensive care units: insights from a retrospective multicentric study","authors":"Antoine Villa, Martin Cour, Nicolas De Prost, Antoine Guillon, Benjamine Sarton, Nicolas Terzi, Kada Klouche, Florence Boissier, Paul Nedelec, Sibylle Cunat, Julien Le Marec, Pierre Godard, Thibault Vieille, Mathieu Jozwiak, Damien Contou, Vincent Castelain, Eliott le Basnier, Marie Lecronier, Frédéric Pène, Simon Bourcier, Fabrice Uhel, David Schnell, Guillaume Dumas, Hafid Ait-Oufella","doi":"10.1186/s13054-025-05421-8","DOIUrl":"https://doi.org/10.1186/s13054-025-05421-8","url":null,"abstract":"Listeriosis is a rare but severe foodborne infection, particularly affecting immunocompromised individuals and older adults. Severe cases may lead to neurolisteriosis and sepsis, necessitating intensive care unit (ICU) admission. This study aims to analyze the demographic characteristics, clinical presentation, microbiological findings, treatments, and outcomes of critically ill patients with Listeria infections in the ICU. A retrospective multicenter study was conducted across 23 French hospitals over a 10-year period, including ICU patients with culture-confirmed Listeria monocytogenes infections. Data on demographics, comorbidities, ICU admission characteristics, biological and microbiological parameters, treatments, and outcomes were collected. The primary outcome was ICU mortality. A multivariable logistic regression model was used to identify factors associated with mortality in patients with neurological manifestations. A total of 110 patients were included, with a median age of 68 years; 61% were male, and 71% were immunocompromised. Neurological involvement was present in most cases. Invasive mechanical ventilation was required in 58% of patients, and vasopressor support in 44%. ICU and in-hospital mortality rates were 25% and 32%, respectively. Among patients with neurolisteriosis, each 1-point decrease in Glasgow Coma Scale score at admission was associated with increased mortality (OR, 1.22; 95% CI 1.05–1.45; p = 0.009), as were higher cerebrospinal fluid (CSF) protein levels (OR, 1.56; 95% CI 1.15–2.41; p = 0.028). Steroid use was not significantly associated with reduced mortality (OR, 0.30; 95% CI 0.07–1.05; p = 0.076). Listeriosis requiring ICU admission is associated with high morbidity and mortality, particularly in older and immunocompromised patients. The severity of these infections is reflected by the frequent need for organ support. Further research is needed to clarify the potential role of steroids in neurolisteriosis.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"10 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144088251","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 “mechanical paradox” unveiled: a physiological study","authors":"Giorgia Pacchiarini, Tommaso Pettenuzzo, Francesco Zarantonello, Nicolò Sella, Gianluca Lumetti, Annalisa Boscolo, Alessandro De Cassai, Gianmaria Cammarota, Paolo Persona, Paolo Navalesi","doi":"10.1186/s13054-025-05385-9","DOIUrl":"https://doi.org/10.1186/s13054-025-05385-9","url":null,"abstract":"Recent studies report that chest wall loading may reduce airway pressures and increase respiratory system compliance, contrary to the anticipated effect of this maneuver (“mechanical paradox”). Aim of this physiological study is to clarify the mechanism underlying this phenomenon. Twenty patients receiving invasive mechanical ventilation for acute hypoxemic respiratory failure were studied during a decremental PEEP trial. Variable weights were placed on the patients’ abdomen to achieve a 5-mmHg increase in intra-abdominal pressure. Three consecutive phases for each PEEP level were performed: weight-off, weight-on, and weight-off. Esophageal pressure measurement and electrical impedance tomography (EIT) were used. The abdominal weight decreased end-expiratory lung impedance (EELI) and overdistention and increased collapse for all PEEP values (all p-values < 0.001). For PEEP values higher than the EIT-based optimal PEEP, the abdominal weight reduced respiratory system and lung plateau pressures (coefficient [standard error] − 1.26 [0.21] and − 5.51 [0.28], respectively, both p-values < 0.001) and driving pressures (− 1.47 [0.22] and − 1.62 [0.22], respectively, both p-values < 0.001). For PEEP values lower than the optimal, the effect of the application of the abdominal weight was the opposite (all p-values < 0.001). The improvement in respiratory system and lung mechanics following abdominal loading is consequent to the reduction of end-expiratory lung volume. This effect, however, only occurs at PEEP levels associated with prevalent overdistention. This simple and safe maneuver could be applied at the bedside to identify lung overdistension and titrate PEEP. ClinicalTrials.gov (NCT06174636, July 9th 2023).","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"30 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144066213","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":"Optimum electrical impedance tomography-based PEEP and recruitment-to-inflation ratio in patients with severe ARDS on venovenous ECMO","authors":"Alexandre Coppens, Sarah Aissi James, Hadrien Roze, Charles Juvin, Benjamin Repusseau, Guillaume Lebreton, Charles-Edouard Luyt, Guillaume Hékimian, Juliette Chommeloux, Marc Pineton de Chambrun, Alain Combes, Guillaume Franchineau, Matthieu Schmidt","doi":"10.1186/s13054-025-05437-0","DOIUrl":"https://doi.org/10.1186/s13054-025-05437-0","url":null,"abstract":"The significance of the Recruitment to Inflation (R/I) ratio in identifying PEEP recruiters in patients undergoing ultra-protective lung ventilation during venovenous ECMO is not well established. To compare the concordance of the R/I ratio and Electrical Impedance Tomography (EIT) in determining optimum PEEP settings in severe ARDS patients on ECMO and ventilated with very low tidal volumes. Initially, a low-flow insufflation was performed to detect and measure the airway opening pressure (AOP). Subsequently, the R/I ratio was calculated from PEEP 15–5 cmH2O, followed by a decremental PEEP trial (20–6 cmH2O in 2 cmH2O steps) monitored by EIT. The optimum EIT-based PEEP was defined as the intersection of the collapse and overdistension curves. Among 54 ECMO patients (tidal volume: 4.8 [3.0–6.0] mL/kg), 13 (24%) exhibited an airway opening pressure (AOP) of 11 (8–14) cmH2O. The cohort’s median R/I ratio was 0.43 (0.28–0.61). A tertile-based analysis of the R/I ratio (≤ 0.34; 0.34–0.54; > 0.54) revealed median optimum EIT-based PEEP of 8 [8–10], 10 [8–14], and 14 [12–16] cmH2O, respectively. The R/I ratio demonstrated weak inverse correlations with lung overdistension (R2 = 0.19) and positive correlations with lung collapse (R2 = 0.26) measured by EIT (p < 0.01). The R/I ratio is feasible during ultra-protective ventilation and provides valuable indications for guiding PEEP titration. Specifically, an R/I ratio > 0.34 may help identify patients likely to benefit from further individualized PEEP optimization using EIT. In contrast, when the R/I ratio is ≤ 0.34, a moderate PEEP level (8–10 cmH₂O) may suffice.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"96 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144066207","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 mean arterial pressure targets in critically ill patients guided by non-invasive cerebral-autoregulation: a scoping review","authors":"Jiale Xie, Adam Renato Carbonara, Al-Waleed Al-Battashi, Amanda Ross-White, J. Gordon Boyd","doi":"10.1186/s13054-025-05432-5","DOIUrl":"https://doi.org/10.1186/s13054-025-05432-5","url":null,"abstract":"Current guidelines recommend a uniform mean arterial pressure (MAP) target for resuscitating critically ill patients; for example, 65 mmHg for patients with sepsis and post-cardiac arrest. However, since cerebral autoregulation capacity likely varies widely in patients, uniform target may be insufficient in maintaining cerebral perfusion. Personalized MAP targets, based on a non-invasive determination of cerebral autoregulation, may optimize perfusion and reduce complications. This scoping review summarizes the numerical values, feasibility, and clinical data on personalized MAP targets in critically ill patients. The focus is on non-invasive monitoring, such as near-infrared spectroscopy and transcranial doppler ultrasound, due to their safety, practicality and applicability to patients with- and without brain injury. Following PRISMA-ScR guidelines, a systematic search of Ovid MedLine, Embase (Ovid), and the Cochrane Library (Wiley) was conducted on September 28, 2023. Two independent reviewers screened titles, abstracts, and full texts for eligibility and manually reviewed references. Of 7,738 studies were identified, 49 met the inclusion criteria. Of these, 45 (92%) were observational and 4 (8%) were interventional. Patient populations included cardiac surgery (26, 53%), non-cardiac major surgery (4, 8%), cardiac arrest (8, 16%), brain injury (7, 14%), respiratory failure and shock (3, 6%), and sepsis (3, 6%). Optimal MAP was reported in 24 (49%), lower limit of autoregulation in 23 (47%), and upper limit of autoregulation in 10 studies (20%). Thirty-four studies reported partial data loss due to software failures, anomalous data, insufficient natural MAP fluctuation, and workflow barriers. Available randomized controlled trials (RCT) identified challenges with maintaining patients within their target range. Studies explored the associations between personalized MAP targets and a wide range of neurological and non-neurological outcomes, with the most significant and consistent associations identified for acute kidney injury and major morbidity and mortality. Ten studies investigated demographic predictors identifying only few predictors of personalized targets. Preliminary investigations suggest considerable variability in personalized MAP targets, which may explain differences in clinical outcomes among critically ill populations. Key gaps remain, including a lack of observational studies in critically ill subpopulations other than cardiac surgery and well-designed RCTs. Resolving identified feasibility barriers might be crucial to successfully carrying out future studies. ","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"33 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144066204","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":"Traditional Chinese medicine for sepsis: advancing from evidence to innovative drug discovery","authors":"Yun Ji, Hongyun Song, Libin Li","doi":"10.1186/s13054-025-05441-4","DOIUrl":"https://doi.org/10.1186/s13054-025-05441-4","url":null,"abstract":"The global health burden of sepsis is immense, characterized by significant loss of life and high healthcare costs. Traditional Chinese medicine (TCM), with its over two millennia of clinical practice in China, has gained attention as a potential adjunctive approach for sepsis. Here, we evaluated TCM applications in sepsis management, highlighting both potential benefits and methodological limitations of existing clinical evidence. Although various TCM preparations have been evaluated for sepsis treatment, the vast majority lack robust clinical evidence. Xuebijing Injection represents a rare example that has demonstrated efficacy in a large-scale, multicenter, randomized, double-blind, placebo-controlled trial. In contrast, the evidence supporting other preparations such as Shenfu and Shenmai Injections comes primarily from smaller, single-center studies with significant methodological limitations. There is a clear need for more high-quality, multicenter randomized controlled trials to rigorously evaluate these potentially beneficial but currently insufficiently validated TCM preparations. The pharmacological effects and underlying mechanisms of some bioactive compounds derived from TCM medications have been elucidated, shedding light on the potential of TCM-based anti-sepsis drug discovery. We underscore the importance of continued research to better integrate TCM with modern sepsis management, paving the way for the development of evidence-based TCM treatments for this challenging condition.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"29 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143979462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peri-intubation complications in critically ill obese patients: a secondary analysis of the international INTUBE cohort","authors":"Vincenzo Russotto, John G. Laffey, Elena Tassistro, Sheila N. Myatra, Emanuele Rezoagli, Giuseppe Foti, Laura Antolini, Maria Grazia Valsecchi, Philippe R. Bauer, Konstanty Szułdrzyński, Luigi Camporota, Robert Greif, Andy Higgs, Matteo Parotto, Roberto Fumagalli, Massimiliano Sorbello, Chiara Robba, Giacomo Grasselli, Giacomo Bellani, Pietro Caironi, Jean Baptiste Lascarrou","doi":"10.1186/s13054-025-05419-2","DOIUrl":"https://doi.org/10.1186/s13054-025-05419-2","url":null,"abstract":"Airway management in critically ill obese patients is potentially associated with a higher risk of adverse events due to a constellation of physiological and anatomical challenges. Data from international prospective studies on peri-intubation adverse events in obese critically ill patients are lacking. INTUBE (International Observational Study to Understand the Impact and Best Practices of Airway Management In Critically Ill Patients) was an international multicentre prospective cohort study enrolling critically ill adult patients undergoing in-hospital tracheal intubation in 197 sites from 29 countries worldwide from October 1, 2018, to July 31, 2019. This secondary analysis compares airway management practices and outcomes between obese (body mass index–BMI $$ge$$ 30 kg/m2) and non-obese patients (BMI $$<$$ 30 kg/m2). A total of 2946 patients met inclusion criteria for this secondary analysis, 639 (21.7%) obese and 2307 (78.3%) non-obese. Severe peri-intubation hypoxemia was more frequently reported in obese compared to non-obese patients (12.1% vs 8.6% respectively, p = 0.01). Variables independently associated with a higher risk of peri-intubation hypoxemia were baseline SpO2/FiO2 (OR 0.996, 95% CI 0.994–0.997), 30–45° head-up position (OR 1.53, 95% CI 1.04–2.26) and first-pass intubation failure (OR for first-pass success 0.21, 95% CI 0.15–0.29). Obesity (OR 0.71, 95% CI 0.56–0.91) and 20° head-up position (OR 0.67, 95% CI 0.47–0.95) were independently associated with higher likelihood of first-pass intubation failure. In contrast, intubation by staff physician/consultant (OR 1.70, 95% CI 1.30–2.21) or anesthesiologists (OR 1.98, 95% CI 1.55–2.53) were associated with higher first-pass success. Compared to non-obese patients, obese critically ill exhibit a higher incidence of peri-intubation severe hypoxemia. In this population, worse baseline oxygenation and first-pass intubation failure significantly increase the risk of peri-intubation severe hypoxemia. As obesity is linked to a higher likelihood of first-pass intubation failure, likely driven by more challenging airway features, in this high-risk population first attempt should be performed by an expert operator to minimize peri-intubation complications. Trial registration: Clinicaltrials.gov NCT03616054 . Registered 3 August 2018.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"3 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143939773","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":"Predicting in-hospital mortality in severe traumatic brain injury patients using admission CT perfusion","authors":"Nila Salimi, Ehsan Alimohammadi","doi":"10.1186/s13054-025-05455-y","DOIUrl":"https://doi.org/10.1186/s13054-025-05455-y","url":null,"abstract":"&lt;p&gt;Dear Editor,&lt;/p&gt;&lt;p&gt;We read with great interest the recent article by Shankar et al. on the use of admission CT perfusion (CTP) to diagnose in-hospital mortality in patients with severe traumatic brain injury (TBI) [1]. The study presents a compelling case for CTP as an early prognostic tool. However, we have a few questions and concerns that we believe warrant further discussion [2,3,4].&lt;/p&gt;&lt;ol&gt;\u0000&lt;li&gt;\u0000&lt;span&gt;1.&lt;/span&gt;\u0000&lt;p&gt;The study defines non-survivable brain injury as a matched decrease in cerebral blood flow (CBF) and cerebral blood volume (CBV) in the brainstem. While this definition is clearly stated, the authors do not provide detailed information on the specific quantitative thresholds used to define \"decrease\" in CBF and CBV. Could the authors elaborate on how these thresholds were determined and whether any specific software or algorithms were used for CTP image analysis?&lt;/p&gt;\u0000&lt;/li&gt;\u0000&lt;li&gt;\u0000&lt;span&gt;2.&lt;/span&gt;\u0000&lt;p&gt;The interpretation of CTP images was performed by two independent neuroradiologists, which is a strength of the study. However, the article does not report the level of agreement between the two readers. Could the authors provide data on inter-observer variability (e.g., kappa statistic) for the assessment of decreased CBF and CBV in the brainstem? This would help to further validate the reliability of the CTP findings.&lt;/p&gt;\u0000&lt;/li&gt;\u0000&lt;li&gt;\u0000&lt;span&gt;3.&lt;/span&gt;\u0000&lt;p&gt;The study mentions that the results of CTP were not used for clinical decision-making. While this approach minimizes potential bias, it also raises questions about the clinical utility of CTP in this context. If CTP findings of non-survivable brain injury are not acted upon, what is the potential benefit of this information? Could the authors discuss the potential implications of their findings for future clinical practice and whether CTP might be used to guide treatment strategies or inform prognosis in the future?&lt;/p&gt;\u0000&lt;/li&gt;\u0000&lt;li&gt;\u0000&lt;span&gt;4.&lt;/span&gt;\u0000&lt;p&gt;The authors acknowledge that their study focused on in-hospital mortality. It would be valuable to know if the CTP findings of non-survivable brain injury were also associated with other important outcomes, such as long-term functional status or neurological recovery. Did the authors explore any correlations between CTP results and other clinical outcomes, and are there plans to investigate these associations in future research?&lt;/p&gt;\u0000&lt;/li&gt;\u0000&lt;li&gt;\u0000&lt;span&gt;5.&lt;/span&gt;\u0000&lt;p&gt;The study population consisted of adult patients with severe TBI. Could the authors comment on the generalizability of these findings to other populations, such as pediatric patients or patients with different types of brain injury?&lt;/p&gt;\u0000&lt;/li&gt;\u0000&lt;/ol&gt;&lt;p&gt;Addressing these questions would provide a more comprehensive understanding of the role of CTP in predicting mortality in severe TBI patients and its potential clinical implications.&lt;/p&gt;&lt;p&gt;No datasets were generated or analysed during the current study.&lt;/p&gt;&lt;ol data-track-component=\"outbound reference\" data-track-context=\"references sectio","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"112 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143939775","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}