Critical Care最新文献

{"title":"Polymyxin-containing regimens for treating of pneumonia caused by multidrug-resistant gram-negative bacteria: Mind the breakpoints and the standardization of nebulization therapy","authors":"Lihui Wang, Chunhui Xu, Lining Si, Guifen Gan, Bin Lin, Yuetian Yu","doi":"10.1186/s13054-024-05111-x","DOIUrl":"https://doi.org/10.1186/s13054-024-05111-x","url":null,"abstract":"<p>With great interest we read the recent network meta-analysis by Zhou et al. which found that the intravenous plus inhaled polymyxin-containing regimen could reduce the all-cause mortality of patients with pneumonia caused by multidrug-resistant gram-negative bacterial (MDRGNB) [1]. This is undoubtedly an encouraging result and provides evidence for the subsequent clinical implementation of such regimens. However, there are still some issues that need further attention.</p><p>Pneumonia caused by MDRGNB remains a huge challenge in the intensive care unit (ICU). Currently, the available effective antibiotics are limited, and polymyxins are still the cornerstones for treatment. However, with the introduction of new antibiotics into clinical practice (especially new beta-lactam and beta-lactamase inhibitor combination) and the potential renal toxicity of polymyxins, since 2020, the performance standards for antimicrobial susceptibility testing of the Clinical and Laboratory Standards Institute (CLSI) have canceled the susceptibility breakpoints of polymyxins for <i>Enterobacteriaceae, Pseudomonas aeruginosa, and Acinetobacter baumannii</i>. It defines a minimal inhibitory concentration (MIC) of ≤ 2 ug/mL as intermediate (https://clsi.org). At present, the newly available antibiotics for the treatment of MDRGNB pneumonia in China is limited. Therefore, Chinese Medical Association (CMA) still define MIC ≤ 2 ug/mL as susceptible according to the previous versions of CLSI before 2020 or the 10th version of European Committee on Antimicrobial Susceptibility Testing (EUCAST), to guide clinical treatment. The international approved and recognized method for susceptibility testing of polymyxins is broth microdilution (BMD), but its manual operation is complex and time-consuming, making it difficult for laboratories to routinely carry out. Thus, most laboratories still use automated or semi-automated instruments nowadays to detect the susceptibility, and the accuracy of the results still needs further evaluation.</p><p>In addition, the clinical pharmacokinetic/pharmacodynamic (PK/PD) target of polymyxins for efficacy is unclear [2]. Some guidelines recommended that for polymyxin B the AUC<sub>ss,24h</sub> should be about 50 mg h/L and possibly 50–100 mg h/L, with the latter corresponding to an average steady-state concentration across 24 h (C<sub>ss,avg</sub>) of 2–4 ug/mL for pathogens with MIC of ≤ 2 ug/mL [3]. Therefore, careful interpretation is needed for the susceptible judgment of polymyxins, the optimal PK/PD index, and the effectiveness of antibiotic therapy.</p><p>The presence of the blood-alveolar barrier prevents satisfactory concentrations of antibiotics in the epithelial lining fluid (ELF) when antibiotics are administered intravenously, and increasing the dosage of intravenous administration may lead to high rate of side effects such as acute kidney injury. Nebulization therapy can convert liquid antibiotic preparations into particles of 3–5 ","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"205 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142374095","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":"What criteria for neuropronostication: consciousness or ability? The neuro-intensivist’s dilemma","authors":"Nicolas Engrand, Armelle Nicolas-Robin, Pierre Trouiller, Stéphane Welschbillig","doi":"10.1186/s13054-024-05098-5","DOIUrl":"https://doi.org/10.1186/s13054-024-05098-5","url":null,"abstract":"<p>Rohaut et al. published the results of a remarkable 12-year evolutionary project, showing a positive association between substantial improvement in consciousness 1 month after brain injury and a favorable outcome (Glasgow Outcome Scale-Extended [GOS-E] score ≥ 4) 1 year later, with an odds ratio of 14.6 [1]. This is a major new finding on neuropronostication, a fundamental issue in neurocritical care.</p><p>The multimodal assessment (MMA) based on seven objective criteria, combined with a critical reading by a panel of experts (the “DoC team”) comprising neuro-intensivists, neurologists, neurophysiologists, neuroradiologists and neuroscientists, allowed for predicting GOS-E score 1–3 at 1 year with 100% accuracy in the group with predicted poor prognosis. Assuming that the aim of the MMA is to give a chance for neurological recovery to every patient with a capacity for recovery, these results are highly effective. This also means that at 1 month after brain injury, when the MMA and DoC team predicted a poor 1-year prognosis, they were right. So, the first important lesson for neuro-intensivists is that they can withhold or even withdraw life-sustaining therapies according to this result, without compromising a significant chance of neurological recovery, sparing the patient 1 year of invasive care and rehabilitation.</p><p>However, only 39% of the group with predicted good prognosis achieved a GOS-E score ≥ 4 (excluding withdrawal of life-sustaining therapies and unknown decisions). Similarly, only 24% of patients in the group with an uncertain prognosis achieved this good result. Therefore, the MMA’s prediction of an uncertain or favorable outcome exposed the patient to the risk of continuing treatment inappropriately, thus leading to a large number of disabilities and dependencies. In other words, there were very few early “good-prognosis patients,” and even after the MMA, 83% of the 277 patients had a GOS-E score < 4. So, although increasing the number of modalities improved accuracy, the MMA still remained not able to reliably detect long-term ability.</p><p>These results raise the question of the goal of neurocritical care.</p><p>Although it is known that all patients ultimately recover wakefulness after severe brain injury [2] and many even recover substantial consciousness [3], some will never regain the ability to interact with their environment. These latter conditions, classified as unresponsive wakefulness syndrome or vegetative state without consciousness, are widely considered failure of care. However, what about a conscious but highly dependent patient with modified Rankin Scale (mRS) score 4 or 5 or GOS-E score 4 or 3? In neurovascular studies, an mRS score of 4 (often even 3) is considered failure. For example, this score is considered an outcome to be avoided in decompressive craniectomy studies [4] (with the exception of the recent Switch study [5]) but considered a success in studies of consciousness recovery [6].</p><p>A","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"191 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142369448","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":"Consensus statements for the establishment of medical intensive care in low-resource settings: international study using modified Delphi methodology.","authors":"Pedja Kovacevic, Jadranka Vidovic, Boris Tomic, Jihad Mallat, Ali Ait Hssain, Muyiwa Rotimi, Owoniya Temitope Akindele, Kent Doi, Rajesh Mishra, F Joachim Meyer, Ivan Palibrk, Ranko Skrbic, Enrique Boloña, Oguz Kilickaya, Ognjen Gajic","doi":"10.1186/s13054-024-05113-9","DOIUrl":"10.1186/s13054-024-05113-9","url":null,"abstract":"<p><strong>Background: </strong>The inadequacy of intensive care medicine in low-resource settings (LRS) has become significantly more visible after the COVID-19 pandemic. Recommendations for establishing medical critical care are scarce and rarely include expert clinicians from LRS.</p><p><strong>Methods: </strong>In December 2023, the National Association of Intensivists from Bosnia and Herzegovina organized a hybrid international conference on the topic of organizational structure of medical critical care in LRS. The conference proceedings and literature review informed expert statements across several domains. Following the conference, the statements were distributed via an online survey to conference participants and their wider professional network using a modified Delphi methodology. An agreement of ≥ 80% was required to reach a consensus on a statement.</p><p><strong>Results: </strong>Out of the 48 invited clinicians, 43 agreed to participate. The study participants came from 20 countries and included clinician representatives from different base specialties and health authorities. After the two rounds, consensus was reached for 13 out of 16 statements across 3 domains: organizational structure, staffing, and education. The participants favored multispecialty medical intensive care units run by a medical team with formal intensive care training. Recognition and support by health care authorities was deemed critical and the panel underscored the important roles of professional organizations, clinician educators trained in high-income countries, and novel technologies such as tele-medicine and tele-education.</p><p><strong>Conclusion: </strong>Delphi process identified a set of consensus-based statements on how to create a sustainable patient-centered medical intensive care in LRS.</p>","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"28 1","pages":"323"},"PeriodicalIF":8.8,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11451122/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142371201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Derivation and validation of generalized sepsis-induced acute respiratory failure phenotypes among critically ill patients: a retrospective study.","authors":"Tilendra Choudhary, Pulakesh Upadhyaya, Carolyn M Davis, Philip Yang, Simon Tallowin, Felipe A Lisboa, Seth A Schobel, Craig M Coopersmith, Eric A Elster, Timothy G Buchman, Christopher J Dente, Rishikesan Kamaleswaran","doi":"10.1186/s13054-024-05061-4","DOIUrl":"10.1186/s13054-024-05061-4","url":null,"abstract":"<p><strong>Background: </strong>Septic patients who develop acute respiratory failure (ARF) requiring mechanical ventilation represent a heterogenous subgroup of critically ill patients with widely variable clinical characteristics. Identifying distinct phenotypes of these patients may reveal insights about the broader heterogeneity in the clinical course of sepsis, considering multi-organ dynamics. We aimed to derive novel phenotypes of sepsis-induced ARF using observational clinical data and investigate the generalizability of the derived phenotypes.</p><p><strong>Methods: </strong>We performed a multi-center retrospective study of ICU patients with sepsis who required mechanical ventilation for ≥ 24 h. Data from two different high-volume academic hospital centers were used, where all phenotypes were derived in MICU of Hospital-I (N = 3225). The derived phenotypes were validated in MICU of Hospital-II (N = 848), SICU of Hospital-I (N = 1112), and SICU of Hospital-II (N = 465). Clinical data from 24 h preceding intubation was used to derive distinct phenotypes using an explainable machine learning-based clustering model interpreted by clinical experts.</p><p><strong>Results: </strong>Four distinct ARF phenotypes were identified: A (severe multi-organ dysfunction (MOD) with a high likelihood of kidney injury and heart failure), B (severe hypoxemic respiratory failure [median P/F = 123]), C (mild hypoxia [median P/F = 240]), and D (severe MOD with a high likelihood of hepatic injury, coagulopathy, and lactic acidosis). Patients in each phenotype showed differences in clinical course and mortality rates despite similarities in demographics and admission co-morbidities. The phenotypes were reproduced in external validation utilizing the MICU of Hospital-II and SICUs from Hospital-I and -II. Kaplan-Meier analysis showed significant difference in 28-day mortality across the phenotypes (p < 0.01) and consistent across MICU and SICU of both Hospital-I and -II. The phenotypes demonstrated differences in treatment effects associated with high positive end-expiratory pressure (PEEP) strategy.</p><p><strong>Conclusion: </strong>The phenotypes demonstrated unique patterns of organ injury and differences in clinical outcomes, which may help inform future research and clinical trial design for tailored management strategies.</p>","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"28 1","pages":"321"},"PeriodicalIF":8.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11445942/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142361276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of mechanical versus manual cardiopulmonary resuscitation in cardiac arrest","authors":"Yang Zhao, Da Chen, Qian Wang","doi":"10.1186/s13054-024-05088-7","DOIUrl":"https://doi.org/10.1186/s13054-024-05088-7","url":null,"abstract":"&lt;p&gt;To the editor&lt;/p&gt;&lt;p&gt;We read with great interest the article by El-Menyar et al., titled “Mechanical versus manual cardiopulmonary resuscitation (CPR): an umbrella review of contemporary systematic reviews and more”, recently published in &lt;i&gt;Critical Care&lt;/i&gt; [1]. The findings from the umbrella review and the new systematic review in this study suggest that mechanical CPR is not superior to manual CPR in achieving return of spontaneous circulation (ROSC).&lt;/p&gt;&lt;p&gt;Although this article offers valuable insights, several issues warrant further discussion and clarification. In Fig. 2’s Forest plot for ROSC from El-Menyar et al.’s article, we observed some issues with the study selection. The umbrella meta-analysis included duplicated studies [2, 3] and studies with no ROSC-related data upon our detailed review [4, 5]. Additionally, the inclusion of just the abstracts from three studies [6, 7, 8] could potentially limit the robustness of the findings. Moreover, when replicating the authors’ search strategy, we identified a missing randomized controlled trial (RCT) comparing mechanical and manual CPR in in-hospital cardiac arrest (IHCA) settings [9].&lt;/p&gt;&lt;p&gt;We consolidated studies from the umbrella review and the new systematic review, excluding improperly included studies and adding the newly identified RCT. Using Stata Version 16.0 (StataCorp, College Station, TX), we conducted subgroup analyses for out-of-hospital cardiac arrest (OHCA) and IHCA patients across RCTs and non-RCTs. For OHCA patients, mechanical CPR did not improve ROSC rates in either study type. However, the IHCA outcomes varied by study type: RCTs showed a higher probability of ROSC with mechanical CPR, whereas non-RCTs indicated a reduced likelihood of achieving ROSC (Figs. 1 and 2)&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%2Fs13054-024-05088-7/MediaObjects/13054_2024_5088_Fig1_HTML.png?as=webp\" type=\"image/webp\"/&gt;&lt;img alt=\"figure 1\" aria-describedby=\"Fig1\" height=\"631\" loading=\"lazy\" src=\"//media.springernature.com/lw685/springer-static/image/art%3A10.1186%2Fs13054-024-05088-7/MediaObjects/13054_2024_5088_Fig1_HTML.png\" width=\"685\"/&gt;&lt;/picture&gt;&lt;p&gt;Forest plot of ROSC in mechanical CPR versus manual CPR in RCTs. ROSC, return of spontaneous circulation; CPR, cardiopulmonary resuscitation; OHCA, out-of-hospital cardiac arrest; IHCA, in-hospital cardiac arrest; RCT, randomized controlled trial; CI, confidence interval&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;figure&gt;&lt;figcaption&gt;&lt;b data-test=\"figure-caption-text\"&gt;Fig. 2&lt;/b&gt;&lt;/figcaption&gt;&lt;picture&gt;&lt;source srcset=\"//media.springernature.com/lw685/springer-static/image/art%3A10.1186%2Fs13054-024-05088-7/MediaObjects/13054_2024_5088_Fig2_","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"36 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142325485","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":"Exploring the effectiveness of eHealth interventions in treating Post Intensive Care Syndrome (PICS) outcomes: a systematic review","authors":"Daniel Jie Lai, Zhao Liu, Elaine Johnston, Lisa Dikomitis, Teresa D’Oliveira, Sukhi Shergill","doi":"10.1186/s13054-024-05089-6","DOIUrl":"https://doi.org/10.1186/s13054-024-05089-6","url":null,"abstract":"It remains unclear how to optimise critical care rehabilitation to reduce the constellation of long-term physical, psychological and cognitive impairments known as Post Intensive Care Syndrome (PICS). Possible reasons for poor recovery include access to care and delayed treatment. eHealth could potentially aid in increasing access and providing consistent care remotely. Our review aimed to evaluate the effectiveness of eHealth interventions on PICS outcomes. Studies reporting eHealth interventions targeting Post Intensive Care Syndrome outcomes, published in Medline, CINAHL, PsycINFO, Embase, and Scopus from 30th January 2010 to 12th February 2024, were included in the review. Study eligibility was assessed by two reviewers with any disagreements discussed between them or resolved by a third reviewer. Study quality and risk of bias were assessed using the Mixed Method Appraisal Tool. Further to the identification of effective strategies, our review also aimed to clarify the timeline of recovery considered and the outcomes or domains targeted by the interventions. Thirteen studies were included in our review. Study duration, eHealth intervention delivery format, and outcome measures varied considerably. No studies reported a theory of behavioural change and only one study was co-produced with patients or carers. Most studies were conducted in the early post-discharge phase (i.e., < 3 months) and had feasibility as a primary outcome. The cognitive domain was the least targeted and no intervention targeted all three domains. Interventions targeting the psychological domain suggest generally positive effects. However, results were underpowered and preliminary. Though all studies were concluded to be feasible, most studies did not assess acceptability. In studies that did assess acceptability, the main facilitators of acceptability were usability and perceived usefulness, and the main barrier was sensitivity to mental health and cognitive issues. Our systematic review highlighted the promising contributions of eHealth with preliminary support for the feasibility of interventions in the early stages of post-critical care rehabilitation. Future research should focus on demonstrating effectiveness, acceptability, the cognitive domain, and multi-component interventions.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"31 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142325488","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":"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":"4 1","pages":""},"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":"25 1","pages":""},"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":"41 1","pages":""},"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":"190 1","pages":"315"},"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}