Critical Care最新文献

{"title":"Early exercise therapy in patients with severe traumatic spinal cord injury: is it feasible in the ICU?","authors":"Antoine Dionne, David Magnuson, Andréane Richard-Denis, Yvan Petit, Dorothy Barthélémy, Francis Bernard, Jean-Marc Mac-Thiong","doi":"10.1186/s13054-025-05297-8","DOIUrl":"https://doi.org/10.1186/s13054-025-05297-8","url":null,"abstract":"<p>Following traumatic spinal cord injury (SCI), patients remain immobilized in the intensive care unit (ICU) and the wards for several weeks before they are transferred to rehabilitation [1]. Unfortunately, this places them at high risk for deconditioning and developing immobility-associated complications [2]. In addition, immobility during the acute stages after TSCI could potentially hinder adaptive neuroplasticity and limit long-term neurological recovery, while early mobilization/exercise could improve outcomes [3]. Until now, early exercise therapy (EET) had never been attempted in humans due to practical obstacles for bedridden patients and potential concerns for safety, especially for patients in the ICU. In this context, the PROMPT-SCI trial is the first trial designed to evaluate the safety and feasibility of EET in patients with acute severe TSCI (ClinicalTrials.gov: NCT04699474) [4]. In this Correspondence, we aim to report specifically on our patients who were hospitalized in the ICU.</p><p>As part of the PROMPT-SCI trial, 45 adult patients were recruited from a single Level-1 trauma center in Montreal, Canada, between April 2021 and August 2023. All had sustained a severe TSCI leading to an American Spinal Injury Association Impairment Scale (AIS) grade A, B or C injury. After immediate medical stabilization and resuscitation, MAP therapy was instituted (target MAP≈ 85 mmHg) and surgery was performed within 48 h to decompress the spinal cord and stabilize the spine. The intervention consisted of daily 30-min sessions of continuous passive in-bed leg cycling for 14 consecutive days, starting within 48 h of surgery based on the initiation criteria described in Table 1. During cycling, MAP, heart rate (HR), respiratory rate (RR) and blood oxygen saturation (SpO2) were monitored, and adverse events were noted. Sessions were stopped if patients requested termination, if vital signs fluctuated outside of the following ranges in a sustained fashion: MAP: 60–110 mmHg; HR: 40–140 bpm; SpO2: ≥ 90%, or if there were other signs of medical instability (e.g.hypo/hypertension, cardiac anomaly, etc.). Vasopressors were titrated to achieve a MAP≈ 85 mmHg and maintained at stable levels during sessions. After each session, complete neurological exams were performed to ensure safety.</p><figure><figcaption><b data-test=\"table-caption\">Table 1 Baseline characteristics of the 40 ICU patients who participated in the PROMPT-SCI trial</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>Forty participants initiated the 14-day protocol in the ICU within 3 days of the SCI. Of these 40 participants, 33 (82.5%) managed to complete their first full session of cycling < 48 h after spine surgery, while the 7 remaining patients managed to do so the next day (< 72 h of surgery)","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"33 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143653331","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":"Streamlining data recording through optical character recognition: a prospective multi-center study in intensive care units","authors":"Prompak Nitayavardhana, Keibun Liu, Kiyomitsu Fukaguchi, Mineto Fujisawa, Itaru Koike, Aina Tominaga, Yuta Iwamoto, Tadahiro Goto, Jacky Y. Suen, John F. Fraser, Pauline Yeung Ng","doi":"10.1186/s13054-025-05347-1","DOIUrl":"https://doi.org/10.1186/s13054-025-05347-1","url":null,"abstract":"The manual entry of data into large patient databases requires significant resources and time. It is possible that a system that is enhanced with the technology of optical character recognition (OCR) can facilitate data entry, reduce data entry errors, and decrease the burden on healthcare personnel. This was a prospective multi-center observational study across intensive care units (ICU) in 3 countries. Subjects were critically-ill and required invasive mechanical ventilation and extracorporeal life support. Clinical photos from various medical devices were uploaded using an OCR-enhanced case record form. The degree of data completeness, data accuracy, and time saved in entering data were compared with conventional manual data entry. The OCR-based system was developed with 868 photos and validated with 469 photos. In independent validation by 8 untrained personnel involving 1018 data points, the overall data completeness was 98.5% (range 98.2–100%), while the overall data accuracy was 96.9% (range 95.3–100%). It significantly reduced data entry time compared to manual entry (mean reduction 43.9% [range 27.0–1.1%]). The average data entry time needed per patient were 3.4 (range 1.2–5.9) minutes with the OCR-based system, compared with 6.0 (range 2.2–8.1) minutes with manual data entry. Users reported high satisfaction with the tool, with an overall recommendation rate of 4.25 ± 1.04 (maximum of 5). An OCR-based data entry system can effectively and efficiently facilitate data entry into clinical databases, making it a promising tool for future clinical data management. Wider uptake of these systems should be encouraged to better understand their strengths and limitations in both clinical and research settings.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"24 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143640145","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":"44th International Symposium on Intensive Care & Emergency Medicine","authors":"","doi":"10.1186/s13054-025-05304-y","DOIUrl":"https://doi.org/10.1186/s13054-025-05304-y","url":null,"abstract":"<h3>KS Yum</h3><h4>Chungbuk National University Hospital, Neurology, Cheongju, South Korea</h4><p><i>Critical Care</i> 2025, <b>29(S1)</b>:P001</p><br/><p><b>Introduction:</b> Predicting early stroke recurrence after transient ischemic attack (TIA) is crucial in emergency settings, where rapid intervention for high-risk patients is essential. While the ABCD2 score is traditionally used for recurrence risk assessment, adding imaging markers may improve predictive accuracy. This study integrates perfusion, hemorrhage after reperfusion marker (HARM), diffusion-weighted imaging (DWI), and stenosis with the ABCD2 score in a machine learning model to enhance 7-day stroke recurrence predictions.</p><br/><p><b>Methods:</b> Data were collected from TIA patients who presented to the ED between 2010 and 2023. Variables analyzed included the ABCD2 score and imaging markers: perfusion, HARM, DWI, and stenosis. After evaluating the association of these variables with recurrence risk, they were integrated into the final model. A random Forest model was developed, with random oversampling applied to enhance the learning of stroke recurrence in the minority class. Model performance was evaluated using accuracy, precision, recall, and F1-score.</p><br/><p><b>Results:</b> The random Forest model combining imaging markers with the ABCD2 score achieved an accuracy of 80.7%, with a precision of 52.8% and a recall of 81.0%. In contrast, the model using only the ABCD2 score demonstrated a lower accuracy of 64.3%, with comparatively reduced precision and recall for recurrence prediction. The imaging markers were identified as significant contributors to short-term stroke recurrence predictions in ED patients with TIA, enhancing the model's predictive capability.</p><br/><p><b>Conclusions:</b> This study suggests that a machine learning model integrating the ABCD2 score with imaging markers effectively predicts early stroke recurrence in TIA patients. With an 81.0% recall, the model enables rapid identification of high-risk patients, supporting timely intervention and clinical decision-making in emergency settings. This approach may contribute to improved management and preventive strategies for high-risk patients in the ED.</p><h3>SH Park<sup>1</sup>, TJ Kim<sup>2</sup>, HK Park<sup>3</sup>, SB Ko<sup>4</sup>, KB Lee<sup>1</sup>\u0000</h3><h4>\u0000<sup>1</sup>Soonchunhyang University Hospital, Department of Neurology, Seoul, South Korea, <sup>2</sup>Seoul National University Hospital, Department of Neurology, Seoul, South Korea, <sup>3</sup>Inha University Hospital, Incheon, South Korea, <sup>4</sup>Seoul National University Hospital, Seoul, South Korea</h4><p><i>Critical Care</i> 2025, <b>29(S1)</b>:P002</p><br/><p><b>Introduction:</b> Blood viscosity (BV) plays a critical role in blood rheology and has been linked to microvascular perfusion, contributing to the development of cerebrovascular diseases. However, its influence on the lateralization of brain lesions has not been fu","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"69 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143640150","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":"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}