Critical Care最新文献

{"title":"Relationship between SARS-CoV-2 infection and ICU-acquired candidemia in critically ill medical patients: a multicenter prospective cohort study","authors":"Florian Reizine, Nicolas Massart, Alexandre Mansour, Yannick Fedun, Anaïs Machut, Charles-Hervé Vacheron, Anne Savey, Arnaud Friggeri, Alain Lepape","doi":"10.1186/s13054-024-05104-w","DOIUrl":"https://doi.org/10.1186/s13054-024-05104-w","url":null,"abstract":"While SARS-CoV2 infection has been shown to be a significant risk-factor for several secondary bacterial, viral and Aspergillus infections, its impact on intensive care unit (ICU)-acquired candidemia (ICAC) remains poorly explored. Using the REA-REZO network (French surveillance network of ICU-acquired infections), we included all adult patients hospitalized for a medical reason of admission in participating ICUs for at least 48 h from January 2020 to January 2023. To account for confounders, a non-parsimonious propensity score matching was performed. Rates of ICAC according to SARS-CoV2 status were compared in matched patients. Factors associated with ICAC in COVID-19 patients were also assessed using a Fine-Gray model. A total of 55,268 patients hospitalized at least 48 h for a medical reason in 101 ICUs were included along the study period. Of those, 13,472 were tested positive for a SARS-CoV2 infection while 284 patients developed an ICAC. ICAC rate was higher in COVID-19 patients in both the overall population and the matched patients’ cohort (0.8% (107/13,472) versus 0.4% (173/41,796); p < 0.001 and 0.8% (93/12,241) versus 0.5% (57/12,241); p = 0.004, respectively). ICAC incidence rate was also higher in those patients (incidence rate 0.51 per 1000 patients-days in COVID-19 patients versus 0.32 per 1000 patients-days; incidence rate ratio: 1.58 [95% CI:1.08–2.35]; p = 0.018). Finally, patients with ICAC had a higher ICU mortality rate (49.6% versus 20.2%; p < 0.001). In this large multicenter cohort of ICU patients, although remaining low, the rate of ICAC was higher among COVID-19 patients.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":null,"pages":null},"PeriodicalIF":15.1,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142325484","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 INTOXICATE study: methodology and preliminary results of a prospective observational study","authors":"Samanta M. Zwaag, Irma S. van den Hengel-Koot, Stuart Baker, Patrick Druwé, Muhammed Elhadi, Ana Ferrer Dufol, Sune Forsberg, Burcin Halacli, Christian Jung, Gabija Laubner Sakalauskienė, Elin Lindqvist, Rui Moreno, Christian Rabe, Nanna Reiter, Richard Rezar, Radu Țincu, Arzu Topeli, David M. Wood, Dylan W. de Lange, Claudine C. Hunault","doi":"10.1186/s13054-024-05096-7","DOIUrl":"https://doi.org/10.1186/s13054-024-05096-7","url":null,"abstract":"There is currently no practice-based, multicenter database of poisoned patients admitted to intensive care units (ICUs). The INTOXICATE study, endorsed by the ESICM and EAPCCT, aimed to determine the rate of eventful admissions among acutely intoxicated adult ICU patients. Ethical approval was obtained for this multicenter, prospective observational study, and data-sharing agreements were signed with each participating center. An electronic case report form was used to collect data on patient demographics, exposure, clinical characteristics, investigations, treatment, and in-hospital mortality data. The primary outcome, ‘eventful admission’, was a composite outcome defined as the rate of patients who received any of the following treatments in the first 24 h after the ICU admission: oxygen supplementation with a FiO2 > 40%, mechanical ventilation, vasopressors, renal replacement therapy (RRT), cardiopulmonary resuscitation, antidotes, active cooling, fluid resuscitation (> 1.5 L of intravenous fluid of any kind), sedation, or who died in the hospital. Seventy-eight ICUs, mainly from Europe, but also from Australia and the Eastern Mediterranean, participated. A total of 2,273 patients were enrolled between November 2020 and June 2023. The median age of the patients was 41 years, 72% were exposed to intoxicating drugs. The observed rate of patients with an eventful ICU admission was 68% (n = 1546/2273 patients). The hospital mortality was 4.5% (n = 103/2273). The vast majority of patients survive, and approximately one third of patients do not receive any ICU-specific interventions after admission in an intensive care unit for acute intoxication. High-quality detailed clinical data have been collected from a large cohort of acutely intoxicated ICU patients, providing information on the pattern of severe acute poisoning requiring intensive care admission and the outcomes of these patients. Trial registration: OSF registration ID: osf.io/7e5uy.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":null,"pages":null},"PeriodicalIF":15.1,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142325630","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":"Prognostic role of early blood gas variables in critically ill patients with Pneumocystis jirovecii pneumonia: a retrospective analysis","authors":"Anouk Voutaz, Jean Bonnemain, Zied Ltaief, Oriol Manuel, Lucas Liaudet","doi":"10.1186/s13054-024-05087-8","DOIUrl":"https://doi.org/10.1186/s13054-024-05087-8","url":null,"abstract":"&lt;p&gt;&lt;i&gt;Pneumocystis jirovecii&lt;/i&gt; pneumonia (PJP) is a severe fungal opportunistic infection occurring in immunocompromised patients, commonly associated with Human Immunodeficiency Virus (HIV) in the past and nowadays increasingly diagnosed in non-HIV patients with immune suppression. Severe PJP requiring admission to the intensive care unit is associated with mortality rates &gt; 50%, and several factors have been associated with reduced survival including age, a non-HIV status, invasive mechanical ventilation and the admission SOFA score [1, 2]. Whether additional prognostic factors might help identify high-risk patients at an early stage of ICU stay remains undefined. To address this issue, we retrospectively analyzed (study protocol approved by our ethical committee, CER-VD Nr 2020-00201) the clinical and early (admission—day 0- and day 1) arterial blood gas (ABG) variables, including values of methemoglobin (MetHb) and carboxyhemoglobin (HbCO), in a cohort of PJP patients admitted to our multidisciplinary ICU between 2006 and 2019. The primary outcome was mortality at day 60. Data were compared between survivors and non survivors using the Wilcoxon’s rank sum test and the Pearson’s chi-squared test, and univariate logistic regression analyses were done to evaluate associations between variables and 60-day mortality. We also performed a multivariable analysis incorporating invasive mechanical ventilation at day 1 as a possible confounder, with blood gas data at day 1 (PaCO&lt;sub&gt;2&lt;/sub&gt;, HbCO and MetHb) as explanatory co-variables. The impact of blood gas variables on 60-day survival was further assessed using Kaplan–Meier plots and log-rank test analysis.&lt;/p&gt;&lt;p&gt;A total of 37 patients with confirmed &lt;i&gt;Pneumocystis jirovecii&lt;/i&gt; infection (except in one patient in whom no sample could be obtained, but with typical clinical/radiological presentation and a positive beta-glucan test) were included. Underlying diagnoses were malignancy (n = 21), chronic immune-mediated inflammatory disease (n = 8), HIV (n = 5), solid organ (n = 4) or bone marrow transplantation (n = 5), with more than 1 condition present in 6 patients. Most patients had been treated prior to admission with one or more immune suppressive therapies. The 60-day mortality was 51% (19/37 patients). Non-survivors were significantly older but did not differ from survivors with respect to gender and underlying diagnoses. All patients received non-invasive and/or invasive respiratory support, and non-survivors required significantly more often invasive mechanical ventilation (79 vs. 39%, &lt;i&gt;p&lt;/i&gt; &lt; 0.05). ABG analyses showed that non-survivors had higher PaCO&lt;sub&gt;2&lt;/sub&gt; (day 1), lower pHa and higher MetHb as well as a trend for higher HbCO (day 0 and day 1). In contrast, P/F O&lt;sub&gt;2&lt;/sub&gt; was comparable in survivors and non-survivors at the two time-points. In univariate analyses, day 0 HbCO and MetHb, and day 1 PaCO&lt;sub&gt;2&lt;/sub&gt;, pHa and MetHb were significantly associated with 60-day m","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":null,"pages":null},"PeriodicalIF":15.1,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142325486","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":"Lymphopenia in sepsis: a narrative review","authors":"Zhibin Wang, Wenzhao Zhang, Linlin Chen, Xin Lu, Ye Tu","doi":"10.1186/s13054-024-05099-4","DOIUrl":"https://doi.org/10.1186/s13054-024-05099-4","url":null,"abstract":"This narrative review provides an overview of the evolving significance of lymphopenia in sepsis, emphasizing its critical function in this complex and heterogeneous disease. We describe the causal relationship of lymphopenia with clinical outcomes, sustained immunosuppression, and its correlation with sepsis prediction markers and therapeutic targets. The primary mechanisms of septic lymphopenia are highlighted. In addition, the paper summarizes various attempts to treat lymphopenia and highlights the practical significance of promoting lymphocyte proliferation as the next research direction. ","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":null,"pages":null},"PeriodicalIF":15.1,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142276053","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":"Infusion of sodium DL-3-ß-hydroxybutyrate decreases cerebral injury biomarkers after resuscitation in experimental cardiac arrest","authors":"Filippo Annoni, Fuhong Su, Lorenzo Peluso, Ilaria Lisi, Enrico Caruso, Francesca Pischiutta, Elisa Gouvea Bogossian, Bruno Garcia, Hassane Njimi, Jean-Louis Vincent, Nicolas Gaspard, Lorenzo Ferlini, Jacques Creteur, Elisa R. Zanier, Fabio Silvio Taccone","doi":"10.1186/s13054-024-05106-8","DOIUrl":"https://doi.org/10.1186/s13054-024-05106-8","url":null,"abstract":"Cerebral complications after cardiac arrest (CA) remain a major problem worldwide. The aim was to test the effects of sodium-ß-hydroxybutyrate (SBHB) infusion on brain injury in a clinically relevant swine model of CA. CA was electrically induced in 20 adult swine. After 10 min, cardiopulmonary resuscitation was performed for 5 min. After return of spontaneous circulation (ROSC), the animals were randomly assigned to receive an infusion of balanced crystalloid (controls, n = 11) or SBHB (theoretical osmolarity 1189 mOsm/l, n = 8) for 12 h. Multimodal neurological and cardiovascular monitoring were implemented in all animals. Nineteen of the 20 animals achieved ROSC. Blood sodium concentrations, osmolarity and circulating KBs were higher in the treated animals than in the controls. SBHB infusion was associated with significantly lower plasma biomarkers of brain injury at 6 (glial fibrillary acid protein, GFAP and neuron specific enolase, NSE) and 12 h (neurofilament light chain, NFL, GFAP and NSE) compared to controls. The amplitude of the stereoelectroencephalograph (sEEG) increased in treated animals after ROSC compared to controls. Cerebral glucose uptake was lower in treated animals. In this experimental model, SBHB infusion after resuscitated CA was associated with reduced circulating markers of cerebral injury and increased sEEG amplitude.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":null,"pages":null},"PeriodicalIF":15.1,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142276044","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":"High flow nasal cannula versus non-invasive ventilation in the treatment of acute exacerbations of COPD with acute-moderate hypercapnic respiratory failure","authors":"Rongpeng Xu, Ziqiang Shao","doi":"10.1186/s13054-024-05094-9","DOIUrl":"https://doi.org/10.1186/s13054-024-05094-9","url":null,"abstract":"&lt;p&gt;Dear Editor,&lt;/p&gt;&lt;p&gt;Recently, we read with great interest the article by Tan et al. [1], in which the authors demonstrated that compared to high-flow nasal cannula oxygen (HFNC), non-invasive ventilation (NIV) is a better choice for initial respiratory support in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) complicated by acute-moderate hypercapnic respiratory failure. Although this result highlights the efficacy of NIV in the treatment of AECOPD patients, we believe that there are still certain issues that need to be clarified in the study conducted by Tan et al.&lt;/p&gt;&lt;p&gt;First, the gas flow rate of HFNC during treatment needs to be noticed. Mechanically, the high gas flow rate of HFNC can wash out the dead space of chronic obstructive pulmonary disease (COPD) patients, and effectively decreases pressure of arterial carbon dioxide (PaCO&lt;sub&gt;2&lt;/sub&gt;). Studies have shown that HFNC as initial respiratory support is non-inferior to NIV in decreasing PaCO&lt;sub&gt;2&lt;/sub&gt; after 2 h of treatment in patients with mild-to-moderate AECOPD [2]. However, carbon dioxide retention was the most common reason for treatment failure in the HFNC group in this study. Therefore, whether raising the initial gas flow rate from 40 L/min to 60 L/min could improve the treatment success rate of HFNC. It is worth noting that study has shown that higher gas flow rate than 30 L/min not only fails to lower PaCO&lt;sub&gt;2&lt;/sub&gt; but also increases inspiratory effort [3]. In short, the initial gas flow rate of 40 L/min does not seem to be an optimal setting. In addition, HFNC has the advantage of comfort and is usually used continuously after obtaining the optimal gas flow rate required by the patient. In this study, intermittent downregulation of gas flow rate or even discontinuation of HFNC was adopted in the HFNC group, which may be a key factor leading to the failure of HFNC treatment.&lt;/p&gt;&lt;p&gt;Additionally, the baseline data lacks of information on the frequency of acute exacerbations in patients. The 2017 Global Strategy for the Diagnosis, Management and Prevention of COPD report noted that that the frequency of previous hospitalizations for acute exacerbations of COPD and concurrent cardiovascular disease comorbidities are associated with poor outcomes in patients [4]. Therefore, it is necessary to list the frequency of acute exacerbations and to describe the cardiovascular comorbidities such as heart failure, hypertension, and arrhythmia in the baseline data, which may significantly affect the success of respiratory therapy in each group of patients.&lt;/p&gt;&lt;p&gt;Furthermore, Oxygen therapy and ventilatory support are only one part of AECOPD treatment [4]. It is well known that the use of bronchodilators is critical in the treatment of AECOPD. Through dilating the bronchi and bronchioles, bronchodilators not only improve the exchange of oxygen and carbon dioxide, but also facilitate the expulsion of sputum, which is closely related to the success of o","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":null,"pages":null},"PeriodicalIF":15.1,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142245195","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 procalcitonin trajectory as an effective tool for identifying sepsis patients at high risk of mortality","authors":"Xu Wang, Shilong Lin, Ming Zhong, Jieqiong Song","doi":"10.1186/s13054-024-05100-0","DOIUrl":"https://doi.org/10.1186/s13054-024-05100-0","url":null,"abstract":"&lt;p&gt;Sepsis is a critical condition that significantly burdens healthcare systems globally. Given the heterogeneity among sepsis patients, identifying high-risk mortality groups is crucial [1]. Procalcitonin (PCT) is a well-established biomarker for evaluating sepsis severity and guiding antibiotic therapy [2]. In practice, PCT is usually measured repeatedly during the hospital stay. While single PCT values are helpful, dynamic trends through repeated measurements offer deeper insights into patient prognosis. Traditional analysis methods often fail to fully capture the complexity of these data [3]. By employing a hierarchical linear mixed-effects (HLME) model [4], this study aims to explore distinct PCT trajectories in sepsis patients and their association with mortality, providing a refined approach to risk stratification.&lt;/p&gt;&lt;p&gt;We here report our main findings in this study. The medical ethics committee of Zhongshan Hospital Fudan University reviewed and approved this study (B2021-501R). Informed consent was waived because of the retrospective nature of the study and the analysis used anonymous clinical data. Between Jan 2019 and March 2024, 537 patients (167 females, 370 males; median age 69 years old [IQR 59–77]) were included. The proportion of patients with septic shock is 47.5%. Abdomen (274/51.0%) and respiratory (202/37.6%) were the two main sites of infection. The median length of stay (LOS) was 10 days [IQR 4–20] in ICU and 15 days [IQR 10–25] in hospital. One hundred sixty-five in-hospital deaths were observed.&lt;/p&gt;&lt;p&gt;A total of 2492 PCT measurements were available for trajectory modeling analyses. Three classes were identified using the HLME model (Fig. 1A). Class 1, also known as the “high-value-slow-decrease” class, included 43 patients (8%) and was characterized by initially high PCT values that remained stable for the first three days before gradually declining. Class 2, the “consistent-low” class, included 354 patients (66%) and displayed low initial PCT values that remained consistently low over the first 7 days in the ICU. Class 3, the “high-value-fast-decrease” class, included 140 patients (26%) and was marked by high initial PCT values that declined rapidly over time. Baseline characteristics differed significantly between the three PCT classes (Table 1). Patients in Class 1 and Class 3 had higher baseline SOFA scores and required more norepinephrine to maintain blood pressure compared to Class 2. In-hospital mortality was highest in Class 1 (42%) compared to Class 2 (32%) and Class 3 (24%) (&lt;i&gt;P&lt;/i&gt; = 0.044). Baseline variables (age, sex, baseline SOFA, baseline lactate, presence of septic shock, surgical intervention, infection sites) and PCT classes were included in the Cox proportional hazards model for in-hospital mortality. With Class 1 as the reference level, Class 2 (HR: 0.507 [95% CI 0.287–0.895], &lt;i&gt;P&lt;/i&gt; = 0.020) and Class 3 (HR 0.449 [95% CI 0.244–0.827], &lt;i&gt;P&lt;/i&gt; = 0.011) were independent protective factors for in-","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":null,"pages":null},"PeriodicalIF":15.1,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142245196","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":"Post-insufflation diaphragm contractions in patients receiving various modes of mechanical ventilation","authors":"Antenor Rodrigues, Fernando Vieira, Michael C. Sklar, L. Felipe Damiani, Thomas Piraino, Irene Telias, Ewan C. Goligher, W. Darlene Reid, Laurent Brochard","doi":"10.1186/s13054-024-05091-y","DOIUrl":"https://doi.org/10.1186/s13054-024-05091-y","url":null,"abstract":"During mechanical ventilation, post-insufflation diaphragm contractions (PIDCs) are non-physiologic and could be injurious. PIDCs could be frequent during reverse-triggering, where diaphragm contractions follow the ventilator rhythm. Whether PIDCs happens with different modes of assisted ventilation is unknown. In mechanically ventilated patients with hypoxemic respiratory failure, we aimed to examine whether PIDCs are associated with ventilator settings, patients’ characteristics or both. One-hour recordings of diaphragm electromyography (EAdi), airway pressure and flow were collected once per day for up to five days from intubation until full recovery of diaphragm activity or death. Each breath was classified as mandatory (without-reverse-triggering), reverse-triggering, or patient triggered. Reverse triggering was further subclassified according to EAdi timing relative to ventilator cycle or reverse triggering leading to breath-stacking. EAdi timing (onset, offset), peak and neural inspiratory time (Tineuro) were measured breath-by-breath and compared to the ventilator expiratory time. A multivariable logistic regression model was used to investigate factors independently associated with PIDCs, including EAdi timing, amplitude, Tineuro, ventilator settings and APACHE II. Forty-seven patients (median[25%-75%IQR] age: 63[52–77] years, BMI: 24.9[22.9–33.7] kg/m2, 49% male, APACHE II: 21[19–28]) contributed 2 ± 1 recordings each, totaling 183,962 breaths. PIDCs occurred in 74% of reverse-triggering, 27% of pressure support breaths, 21% of assist-control breaths, 5% of Neurally Adjusted Ventilatory Assist (NAVA) breaths. PIDCs were associated with higher EAdi peak (odds ratio [OR][95%CI] 1.01[1.01;1.01], longer Tineuro (OR 37.59[34.50;40.98]), shorter ventilator inspiratory time (OR 0.27[0.24;0.30]), high peak inspiratory flow (OR 0.22[0.20;0.26]), and small tidal volumes (OR 0.31[0.25;0.37]) (all P ≤ 0.008). NAVA was associated with absence of PIDCs (OR 0.03[0.02;0.03]; P < 0.001). Reverse triggering was characterized by lower EAdi peak than breaths triggered under pressure support and associated with small tidal volume and shorter set inspiratory time than breaths triggered under assist-control (all P < 0.05). Reverse triggering leading to breath stacking was characterized by higher peak EAdi and longer Tineuro and associated with small tidal volumes compared to all other reverse-triggering phenotypes (all P < 0.05). In critically ill mechanically ventilated patients, PIDCs and reverse triggering phenotypes were associated with potentially modifiable factors, including ventilator settings. Proportional modes like NAVA represent a solution abolishing PIDCs.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":null,"pages":null},"PeriodicalIF":15.1,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142236435","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":"Further support for the intracranial compartmental syndrome concept","authors":"Daniel Agustin Godoy, Sergio Brasil, Andres M. Rubiano","doi":"10.1186/s13054-024-04974-4","DOIUrl":"https://doi.org/10.1186/s13054-024-04974-4","url":null,"abstract":"&lt;p&gt;The current approach to severe neuro-injury monitoring, especially traumatic brain injury (TBI), has experienced paradigm shifts that open a broad outlook for the future [1]. On one hand, advances in pathophysiological knowledge have made possible establishing today that intracranial pressure (ICP) control is just one more epiphenomenon within other serious events that occur simultaneously such as tissue hypoxia, metabolic crises and cerebral energy dysfunction [1]. On the other hand, the advent of new monitoring techniques (invasive and noninvasive) have allowed a deeper analysis in real time of what is happening in the injured brain [1]. One of the most important advancements in neuromonitoring was the recent popularization of the analysis of the ICP wave (ICPw) morphology. Current studies pointed the changes in ICPw as reliable markers of cerebrospinal compliance and to be followed in clinical environments. In this regard, ICPw was considered the pillar of the intracranial compartmental syndrome (ICCS) concept [2]. So, &lt;i&gt;“ICCS occurs when the compliance of the intracranial system is compromised as a result of the exhaustion of the compensating mechanisms that try to keep it within normal limits’’&lt;/i&gt;. ‘&lt;i&gt;’Perfusion, oxygenation and energy utilization compromise are its consequences’’&lt;/i&gt; [2]&lt;i&gt;.&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Further enlightenments raised from the recent study of Kazimierska et al., which evaluated a series of 130 patients who were victims of severe TBI from the CENTER-TBI database. Those authors analyzed the relationship between parameters obtained from the neuroimaging Computed Tomography (CT) scan upon admission and variables collected from invasive ICP monitoring [3]. Injury mass volume, degree of midline shift, Marshall’s and Rotterdam classifications were the data provided by the CT scans, while mean ICP values, wave amplitude and indices derived from the analysis of ICP recordings. A neural network model (previously tested with 93% accuracy) was applied in order to automatically group ICP waveforms into 4 classes [3]. As a main finding, the pulse shape index—PSI was strongly correlated with the analyzed tomographic parameters (&lt;i&gt;p&lt;/i&gt; = 0.001), while mean ICP was correlated with ICPw amplitude, indicating that the morphology of the ICP pulse wave reflects a decrease in the cerebrospinal compensatory reserve therefore of cerebral compliance [3].&lt;/p&gt;&lt;p&gt;ICP waveform is a result of complex interaction between volumes (blood, brain and cerebrospinal fluid) restrained by meninges and the bony skull box, interacting with dynamic phenomena as blood viscosity, cardiac and respiratory cycles per example [1]. Therefore, several are the ways of exploring and translating ICPw into parameters readable at the bedside to assess compensatory reserve status. Prior to PSI, the compensatory reserve index (RAP) was described by Czosnyka et al. as the moving correlation between ICP values and ICP pulse amplitude variation [4]. Both the PSI and RAP can be a","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":null,"pages":null},"PeriodicalIF":15.1,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142236434","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":"Lung ultrasound and ARDS: global collaboration is the way to go","authors":"Marry R. Smit, Maud Boumans, William Aerts, Pieter R. Tuinman","doi":"10.1186/s13054-024-05075-y","DOIUrl":"https://doi.org/10.1186/s13054-024-05075-y","url":null,"abstract":"We would like to extend our gratitude to Dr. da Hora Passos et al. for their interest in our recently published review and meta-analysis in Critical Care. In this response, we will elaborate on the points raised by the authors. We agree with the authors that LUS, like any other diagnostic technique, is valuable and safe only when utilized by trained operators. The authors expressed uncertainty regarding the sensitivity of LUS in detecting mild ARDS or ARDS at an early stage. This variance in sensitivity is more likely due to diversity in diagnostic thresholds. We advocate for global collaboration among LUS experts to align LUS methodologies and strengthen the evidence supporting LUS in the diagnosis of ARDS and its morphological subphenotypes.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":null,"pages":null},"PeriodicalIF":15.1,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142235009","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}