Critical Care最新文献

{"title":"Advancements in imaging techniques for monitoring the respiratory muscles","authors":"Martin Dres, Jonne Doorduin, Samia Boussouar, Damien Bachasson","doi":"10.1186/s13054-025-05339-1","DOIUrl":"https://doi.org/10.1186/s13054-025-05339-1","url":null,"abstract":"This review highlights the latest advancements in imaging techniques for monitoring respiratory muscles in critically ill patients. At the bedside, conventional ultrasound has been widely adopted to measure diaphragm thickness, thickening and excursion. It has also been used to assess extradiaphragmatic respiratory muscles, including parasternal intercostal and abdominal muscles. Advanced ultrasound-derived techniques have expanded its applications, enabling the evaluation of tissue velocity (tissue Doppler imaging), stiffness (shear wave elastography), and local tissue displacement (speckle tracking). Facility-based imaging modalities such as magnetic resonance imaging and chest tomography provide complementary insights into respiratory muscles structure and function, offering valuable information for evaluating the effects of therapeutic interventions. Finally, imaging techniques have emerged as valuable tools for evaluating the metabolic demands of respiratory muscles, with advanced methods such as positron emission tomography and contrast-enhanced ultrasound showing significant potential.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"124 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143608084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of gastrodin in preventing postoperative delirium following cardiac surgery: a randomized placebo controlled clinical trial","authors":"Yun-Xiao Bai, Hui-Liang Wu, Wan-Li Xie, Xia Li, Jing-Jing Han, Jie Liu, Shi-Qiang Chen, Ping Yin, Nian-Guo Dong, Qing-Ping Wu","doi":"10.1186/s13054-025-05331-9","DOIUrl":"https://doi.org/10.1186/s13054-025-05331-9","url":null,"abstract":"Delirium and postoperative cognitive dysfunction (POCD) are common complications post-cardiac surgery, yet no specific medical intervention is currently recommended for prevention. This study aimed to evaluate the efficacy of gastrodin infusion in preventing delirium and POCD in critically ill patients following cardiac surgery. A double-blind, randomized, placebo-controlled trial was conducted on patients aged 18–75, scheduled for coronary artery bypass grafting (CABG) surgery, with or without valve replacement. Participants were randomized in a 1:1 ratio to receive gastrodin infusion 600 mg twice daily or placebo from the day of surgery until the postoperative day (POD) 6. The co-primary outcomes were the incidences of delirium and POCD, assessed from ICU admission until POD 7 and at 1 and 3 months postoperatively. This study was registered with the Chinese Clinical Trials Registry (ChiCTR1800020414). Of 160 randomized participants, 155 were analyzed (77 gastrodin, 78 placebo) according to a modified intention to treat principle. The incidence of postoperative delirium was 19.5% in the gastrodin group and 35.9% in the placebo group, with a significant relative risk of 0.54 (95% CI 0.32–0.93, p = 0.022). The incidence of in-hospital POCD was 2.9% and 4.0% in the placebo and gastrodin groups, respectively. The odds of hospital discharge were significantly greater in the gastrodin group (subhazard ratio, 1.20; 95% CI 1.00–1.84; p = 0.049). Adverse events occurred in 9.1% (7/77) of patients administered gastrodin and 14.1% (11/78) of patients administered the placebo, with none being drug-related. Gastrodin infusion significantly reduced postoperative delirium and improved discharge outcomes in patients undergoing CABG, but larger studies are needed to confirm its efficacy in preventing delirium.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"19 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143589710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Individualized PEEP can improve both pulmonary hemodynamics and lung function in acute lung injury","authors":"Mayson L. A. Sousa, Luca S. Menga, Annia Schreiber, Mattia Docci, Fernando Vieira, Bhushan H. Katira, Mariangela Pellegrini, Sebastian Dubo, Ghislaine Douflé, Eduardo L. V. Costa, Martin Post, Marcelo B. P. Amato, Laurent Brochard","doi":"10.1186/s13054-025-05325-7","DOIUrl":"https://doi.org/10.1186/s13054-025-05325-7","url":null,"abstract":"There are several approaches to select the optimal positive end-expiratory pressure (PEEP), resulting in different PEEP levels. The impact of different PEEP settings may extend beyond respiratory mechanics, affecting pulmonary hemodynamics. To compare PEEP levels obtained with three titration strategies—(i) highest respiratory system compliance (CRS), (ii) electrical impedance tomography (EIT) crossing point; (iii) positive end-expiratory transpulmonary pressure (PL)—in terms of regional respiratory mechanics and pulmonary hemodynamics. Experimental studies in two porcine models of acute lung injury: (I) bilateral injury induced in both lungs, generating a highly recruitable model (n = 37); (II) asymmetrical injury, generating a poorly recruitable model (n = 13). In all experiments, a decremental PEEP titration was performed monitoring PL, EIT (collapse, overdistention, and regional ventilation), respiratory mechanics, and pulmonary and systemic hemodynamics. PEEP titration methods resulted in different levels of median optimal PEEP in bilateral lung injury: 14(12–14) cmH2O for CRS, 11(10–12) cmH2O for EIT, and 8(8–10) cmH2O for PL, p < 0.001. Differences were less pronounced in asymmetrical lung injury. PEEP had a quadratic U-shape relationship with pulmonary artery pressure (R2 = 0.94, p < 0.001), right-ventricular systolic transmural pressure, and pulmonary vascular resistance. Minimum values of pulmonary vascular resistance were found around individualized PEEP, when ventilation distribution and pulmonary circulation were simultaneously optimized. In porcine models of acute lung injury with variable lung recruitability, both low and high levels of PEEP can impair pulmonary hemodynamics. Optimized ventilation and hemodynamics can be obtained simultaneously at PEEP levels individualized based on respiratory mechanics, especially by EIT and esophageal pressure.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"34 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143582816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Net albumin leakage in patients in the ICU with suspected sepsis. A prospective analysis using mass balance calculations","authors":"Dag Seldén, Nicolas Tardif, Jan Wernerman, Olav Rooyackers, Åke Norberg","doi":"10.1186/s13054-025-05323-9","DOIUrl":"https://doi.org/10.1186/s13054-025-05323-9","url":null,"abstract":"Albumin kinetics in septic shock have been extensively studied, but clinical recommendations remain weak. An increased transcapillary escape rate (TER) of albumin has been demonstrated, though TER does not account for lymphatic return. Mass balance calculations, considering lymphatic return, have been used to assess net albumin leakage (NAL) in major surgery but not in sepsis. This study aimed to evaluate NAL in ten ICU patients with suspected sepsis, hypothesizing a net positive leakage. Secondary aims included investigating associations between NAL and fluid overload, glycocalyx shedding products, and cytokines, as well as identifying factors associated with it. This prospective, observational study included ten patients within twelve hours of ICU admission for suspected sepsis at Karolinska University Hospital Huddinge. Albumin, hematocrit, and hemoglobin levels were sampled at 0, 1, 2, 4, 8, and 24 h. NAL was estimated using mass balance calculations, comparing proportional changes in albumin and hemoglobin concentrations over time, adjusted for albumin and hemoglobin infusions and losses. A proportionally greater decrease or smaller increase in albumin compared to hemoglobin indicated NAL, representing the net leakage from the circulation to the interstitium minus lymphatic return. Over 24 h, patients exhibited a net positive albumin leakage to the interstitium of 8 ± 10 g (p = 0.029). NAL showed no correlation with glycocalyx shedding products or fluid overload but had a weak correlation with interleukin-6 and interleukin-8 in the first 4 h. Albumin infusions appeared to increase net leakage. This study demonstrated a net positive albumin leakage of 8 ± 10 g over 24 h in ICU patients with suspected sepsis, with a weak early correlation to pro-inflammatory cytokines but no significant link to fluid balance or glycocalyx shedding. Notably, albumin infusions were associated with increased net leakage.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"54 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143576302","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":"Being an observer of one’s own life—a meta-synthesis on the experience of mechanically ventilated patients in intensive care units","authors":"Fritz Sterr, Mareike Hechinger, Lydia Bauernfeind, Christian Rester, Rebecca Palm, Sabine Metzing","doi":"10.1186/s13054-025-05326-6","DOIUrl":"https://doi.org/10.1186/s13054-025-05326-6","url":null,"abstract":"The experience of patients under mechanical ventilation in the intensive care unit is described as complex and multifaceted, but an overarching and in-depth understanding of the experience is still missing. To provide an in-depth analysis and synthesis of patients’ experience when being mechanically ventilated in intensive care units. We conducted a meta-synthesis according to the methodological recommendations of Sandelowski and Barroso. Our systematic literature search in Medline, CINAHL, and Cochrane was complemented by hand and citation searches. We included only qualitative studies with a rich description of conscious patients’ experience under mechanical ventilation. Studies on children, step-down units, noninvasive ventilation and non-scientific journal articles were excluded. After the title, abstract and full-text screening by three reviewers, we performed initial, axial and selective coding and in-depth analysis in MAXQDA. The synthesis was supported by multiple discussion rounds. Of the 2,563 records identified, 20 studies were included in our synthesis. This revealed the central phenomenon of patients being observers of their own lives. They are yearning for a stable picture of reality and developing various situation-specific needs. Finally, patients are finding ways to deal with the situation. These concepts are interwoven in time and are experienced repeatedly in different dimensions. Patients under mechanical ventilation are highly perceptive. Healthcare professionals are particularly responsible for patients. They should reflect on their role in intensive care and must be sensitized to patients’ differentiated experience. Registration, Protocol: https://doi.org/10.17605/OSF.IO/G8Q6X ","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"10 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575187","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":"Machine learning models compared with current clinical indices to predict the outcome of high flow nasal cannula therapy in acute hypoxemic respiratory failure","authors":"Hang Yu, Sina Saffaran, Roberto Tonelli, John G. Laffey, Antonio M. Esquinas, Lucas Martins de Lima, Letícia Kawano-Dourado, Israel S. Maia, Alexandre Biasi Cavalcanti, Enrico Clini, Declan G. Bates","doi":"10.1186/s13054-025-05336-4","DOIUrl":"https://doi.org/10.1186/s13054-025-05336-4","url":null,"abstract":"Early identification of patients with acute hypoxemic respiratory failure (AHRF) who are at risk of failing high-flow nasal cannula (HFNC) therapy could facilitate closer monitoring, and timely adjustment/escalation of treatment. We aimed to establish whether machine learning (ML) models could predict HFNC outcome, early in the course of treatment, with greater accuracy than currently used clinical indices. We developed ML models trained using measurements made within the first 2 h of treatment from 184 AHRF patients (37% HFNC failures) treated at the respiratory ICU of the University Hospital of Modena between 2018 and 2023. For external validation, we used a dataset on 567 AHRF patients (22% failures) comprising 510 patients from the recent RENOVATE trial in Brazil and 57 from the MIMIC-IV and eICU databases in the US. Predictive performance of the ML models was benchmarked against optimized thresholds of the following clinical indices: respiratory rate oxygenation index (ROX) and variants, heart rate to saturation of pulse oxygen (SpO2) ratio, SpO2/FiO2 ratio, PaO2/FiO2 ratio, sequential organ failure assessment and heart rate, acidosis, consciousness, oxygenation and respiratory rate scores. Internal and external predictive performance of a Support Vector Machine (SVM) ML model was superior to all clinical indices across all scenarios tested. In external validation on the 567-patient dataset, a SVM model trained on non-invasive measurements had an accuracy of 73%, sensitivity of 73%, specificity of 73%, and AUC of 0.79. The ROX index had an accuracy of 64%, sensitivity of 79%, specificity of 60%, and AUC of 0.74. When arterial blood gasses (ABG’s) were also used for model training, the SVM model had an accuracy of 83%, sensitivity of 84%, specificity of 82%, and AUC of 0.82 in external validation on the MIMIC-IV/eICU dataset. The modified ROX index, which requires PaO2, achieved 70% accuracy, 63% sensitivity, 74% specificity, and AUC of 0.65. Decision support tools based on SVM models could provide clinicians with more accurate early predictions of HFNC outcome than currently available clinical indices. If available, ABG measurements could improve the capability to accurately identify patients at risk of failing HFNC therapy.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"17 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143569463","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":"Sodium azide (NaN3) intoxication, “the man who lived”: potential effective antidote and treatment strategy","authors":"Jasper X. Geerdink, Greetje van der Wal, Lutea A. A. de Jong, Erik J. H. Olyslager, Thomas W. van den Goorbergh, Leo A. J. Kluijtmans, Peter E. Spronk","doi":"10.1186/s13054-025-05330-w","DOIUrl":"https://doi.org/10.1186/s13054-025-05330-w","url":null,"abstract":"This case report describes the successful treatment of a suicide attempt involving the ingestion of a supralethal dose of sodium azide (NaN3), presenting a prospective novel antidote and therapeutic approach. Treatment encompassed the implementation of high-volume continuous veno-venous hemofiltration (HV-CVVH) alongside the administration of levocarnitine. The latter demonstrated a substantial mitigation of lactate concentration. Comprehensive analyses of serum, ultrafiltrate, and urine revealed the efficacy of HV-CVVH in elimination of NaN3. Our case report presents a potential therapeutic approach for managing otherwise fatal NaN3 intoxications.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"11 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143570343","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":"Standardizing persistent and chronic critical illness: impact of definitions variability on prevalence and mortality","authors":"Toshinobu Nakai, Yuki Kotani, Yoshiro Hayashi","doi":"10.1186/s13054-025-05335-5","DOIUrl":"https://doi.org/10.1186/s13054-025-05335-5","url":null,"abstract":"&lt;p&gt;Standardization of terminology and definitions is essential for scientific communication. Without such standardization, some studies may use different terms to express similar conditions, and other studies may use the same term with different definitions. Such diversities in medical language creates inconsistencies in scientific reporting, thereby hindering us from properly understanding the condition.&lt;/p&gt;&lt;p&gt;In this regard, persistent critical illness (PerCI) and chronic critical illness (CCI) are two terms used to describe prolonged critical conditions beyond the acute phase [1, 2]. However, the absence of standardized definitions leads to substantial variability in their clinical implications. Recently, &lt;i&gt;Critical Care&lt;/i&gt; published a systematic scoping review highlighting the heterogeneity in definitions, epidemiology, and outcomes of PerCI and CCI [3]. We commend the authors for their comprehensive analysis, which synthesizes data obtained from numerous studies, performs a meta-analysis on specific patient populations (e.g., overall populations, sepsis, trauma, and COVID-19), and offers valuable recommendations for future research.&lt;/p&gt;&lt;p&gt;To further expand on the insights provided by Ohbe et al., we conducted an exploratory analysis to illustrate how different PerCI/CCI definitions impact reported prevalence and in-hospital mortality. From the 99 studies included in Ohbe et al.’s scoping review [3], we selected those explicitly reporting PerCI/CCI definitions, prevalence, and in-hospital mortality. We then created a scatter plot, where each dot represents a study, with PerCI/CCI prevalence on the x-axis and in-hospital mortality on the y-axis (Fig. 1), using Excel version 16.94. Dots were color-coded according to the PerCI/CCI definition applied in each study. This visualization underscores the substantial variability in prevalence and mortality based on the chosen definition.&lt;/p&gt;&lt;figure&gt;&lt;figcaption&gt;&lt;b data-test=\"figure-caption-text\"&gt;Fig. 1&lt;/b&gt;&lt;/figcaption&gt;&lt;picture&gt;&lt;source srcset=\"//media.springernature.com/lw685/springer-static/image/art%3A10.1186%2Fs13054-025-05335-5/MediaObjects/13054_2025_5335_Fig1_HTML.png?as=webp\" type=\"image/webp\"/&gt;&lt;img alt=\"figure 1\" aria-describedby=\"Fig1\" height=\"400\" loading=\"lazy\" src=\"//media.springernature.com/lw685/springer-static/image/art%3A10.1186%2Fs13054-025-05335-5/MediaObjects/13054_2025_5335_Fig1_HTML.png\" width=\"685\"/&gt;&lt;/picture&gt;&lt;p&gt;Prevalence and hospital mortality according to the different persistent/chronic critical illness definitions&lt;/p&gt;&lt;span&gt;Full size image&lt;/span&gt;&lt;svg aria-hidden=\"true\" focusable=\"false\" height=\"16\" role=\"img\" width=\"16\"&gt;&lt;use xlink:href=\"#icon-eds-i-chevron-right-small\" xmlns:xlink=\"http://www.w3.org/1999/xlink\"&gt;&lt;/use&gt;&lt;/svg&gt;&lt;/figure&gt;&lt;p&gt;Studies defining PerCI/CCI as “ICU stay ≥ 14 days with persistent organ dysfunction” (orange) reported higher prevalence compared to other definitions. This trend may be attributed to the study populations, which predominantly consisted of septic","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"12 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143569478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: An updated “norepinephrine equivalent” score in intensive care as a marker of shock severity","authors":"Yuki Kotani, Annamaria Di Gioia, Giovanni Landoni, Alessandro Belletti, Ashish K. Khanna","doi":"10.1186/s13054-025-05250-9","DOIUrl":"https://doi.org/10.1186/s13054-025-05250-9","url":null,"abstract":"&lt;p&gt;&lt;b&gt;Correction: Critical Care (2023) 27:29 &lt;/b&gt;&lt;b&gt;https://doi.org/10.1186/s13054-023-04322-y&lt;/b&gt;&lt;/p&gt;&lt;p&gt;Following publication of the original article [1], the authors would like to correct the correction rate for metaraminol which is 1/8 under the heading Proposed updated norepinephrine equivalent score, Figure 1 and Table 1.&lt;/p&gt;&lt;p&gt;The sentences currently reads:&lt;/p&gt;&lt;br/&gt;&lt;p&gt;A randomized trial compared metaraminol and norepinephrine in septic shock [38]. Based on the findings of this trial suggesting 2.5 μg/kg/min of metaraminol corresponded to 0.3 μg/kg/min of norepinephrine, we defined a correction factor of 8 to metaraminol dose in μg/kg/min.&lt;/p&gt;&lt;br/&gt;&lt;p&gt;The sentences should read:&lt;/p&gt;&lt;br/&gt;&lt;p&gt;A randomized trial compared metaraminol and norepinephrine in septic shock [38]. Based on the findings of this trial suggesting 2.5 μg/kg/min of metaraminol corresponded to 0.3 μg/kg/min of norepinephrine, we defined a correction factor of 1/8 to metaraminol dose in μg/kg/min.&lt;/p&gt;&lt;p&gt;The incorrect Figure 1:&lt;/p&gt;&lt;figure&gt;&lt;figcaption&gt;&lt;b data-test=\"figure-caption-text\"&gt;Fig. 1&lt;/b&gt;&lt;/figcaption&gt;&lt;picture&gt;&lt;source srcset=\"//media.springernature.com/lw685/springer-static/image/art%3A10.1186%2Fs13054-025-05250-9/MediaObjects/13054_2025_5250_Fig1_HTML.png?as=webp\" type=\"image/webp\"/&gt;&lt;img alt=\"figure 1\" aria-describedby=\"Fig1\" height=\"315\" loading=\"lazy\" src=\"//media.springernature.com/lw685/springer-static/image/art%3A10.1186%2Fs13054-025-05250-9/MediaObjects/13054_2025_5250_Fig1_HTML.png\" width=\"685\"/&gt;&lt;/picture&gt;&lt;p&gt;Visual summary of an updated norepinephrine equivalent score and need for using norepinephrine equivalence&lt;/p&gt;&lt;span&gt;Full size image&lt;/span&gt;&lt;svg aria-hidden=\"true\" focusable=\"false\" height=\"16\" role=\"img\" width=\"16\"&gt;&lt;use xlink:href=\"#icon-eds-i-chevron-right-small\" xmlns:xlink=\"http://www.w3.org/1999/xlink\"&gt;&lt;/use&gt;&lt;/svg&gt;&lt;/figure&gt;&lt;p&gt;The correct Figure 1:&lt;/p&gt;&lt;figure&gt;&lt;figcaption&gt;&lt;b data-test=\"figure-caption-text\"&gt;Fig. 1&lt;/b&gt;&lt;/figcaption&gt;&lt;picture&gt;&lt;source srcset=\"//media.springernature.com/lw685/springer-static/image/art%3A10.1186%2Fs13054-025-05250-9/MediaObjects/13054_2025_5250_Fig2_HTML.png?as=webp\" type=\"image/webp\"/&gt;&lt;img alt=\"figure 2\" aria-describedby=\"Fig2\" height=\"321\" loading=\"lazy\" src=\"//media.springernature.com/lw685/springer-static/image/art%3A10.1186%2Fs13054-025-05250-9/MediaObjects/13054_2025_5250_Fig2_HTML.png\" width=\"685\"/&gt;&lt;/picture&gt;&lt;p&gt;Visual summary of an updated norepinephrine equivalent score and need for using norepinephrine equivalence&lt;/p&gt;&lt;span&gt;Full size image&lt;/span&gt;&lt;svg aria-hidden=\"true\" focusable=\"false\" height=\"16\" role=\"img\" width=\"16\"&gt;&lt;use xlink:href=\"#icon-eds-i-chevron-right-small\" xmlns:xlink=\"http://www.w3.org/1999/xlink\"&gt;&lt;/use&gt;&lt;/svg&gt;&lt;/figure&gt;&lt;p&gt;The incorrect Table 1:&lt;/p&gt;&lt;figure&gt;&lt;figcaption&gt;&lt;b data-test=\"table-caption\"&gt;Table 1 Summary of norepinephrine equivalent formulas&lt;/b&gt;&lt;/figcaption&gt;&lt;span&gt;Full size table&lt;/span&gt;&lt;svg aria-hidden=\"true\" focusable=\"false\" height=\"16\" role=\"img\" width=\"16\"&gt;&lt;use xlink:href=\"#icon-eds-i-chevron-right-small\"","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"8 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143569458","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":"Development and validation of intracranial hypertension prediction models based on radiomic features in patients with traumatic brain injury: an exploratory study based on CENTER-TBI data","authors":"Yingchi Shan, Yajun Xue, Jun Zhu, Thijs Vande Vyvere, Dana Pisică, Andrew Maas, Shuo Zhang, Guoyi Gao","doi":"10.1186/s13054-025-05328-4","DOIUrl":"https://doi.org/10.1186/s13054-025-05328-4","url":null,"abstract":"Head computed tomography (CT) is a routinely performed examination to assess the intracranial condition of patients with traumatic brain injury (TBI), and radiological findings can help to indicate the presence of intracranial hypertension. At present, the prediction of intracranial hypertension is mainly based on manual discrimination of imaging characteristics. The aim of our study was to establish a model to predict intracranial hypertension via fully automatic CT image segmentation, rigorous radiomic feature extraction and reliable model development and validation. Patients admitted to the intensive care unit (ICU) who underwent intracranial pressure (ICP) monitoring were included in our study. For the development cohort, we extracted data from the CENTER-TBI database and randomly divided the data into a training group and a test group. For the validation cohort, we extracted data from patients admitted to the Shanghai General Hospital. Patients whose initial recorded ICP value was greater than or equal to 20 mmHg were defined as having intracranial hypertension. Radiological features, including imaging characteristics and three categories of radiomic features, were extracted from the head CT. Feature selection was performed for all radiological findings. A morphological model was built on the basis of selected imaging characteristics. First-order, second-order and third-order models were built on the basis of selected radiomic features. A comprehensive model was built on the basis of all selected radiological findings. The performances of these five models were assessed by four classifiers, including logistic regression (LR), random forest (RF), multilayer perceptron (MLP), and extreme gradient boosting (XGB), from which the best classifier was selected. After the process of model training and external validation, we ultimately used the optimal classifier to generate a prediction model with greater predictive power and stability. Five models were built, including a morphological model, first-order model, second-order model, third-order model and comprehensive model. The optimal classifier was the logistic regression (LR) classifier, with which the morphological, first-order, second-order, third-order and comprehensive models had AUCs of 0.75, 0.77, 0.76, 0.86, and 0.83 and F1 scores of 0.54, 0.73, 0.63, 0.72, and 0.75, respectively, in the external validation group. We successfully established a model for predicting intracranial hypertension on the basis of radiomic features. This model may serve as an approach for intracranial hypertension prediction in TBI patients. ","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"85 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143569471","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}