Critical Care最新文献

{"title":"Liberal versus restrictive transfusion strategies in subarachnoid hemorrhage: a secondary analysis of the TRAIN study","authors":"Chahnez Taleb, Elisa Gouvea Bogossian, Carla Bittencour Rynkowski, Kirsten Møller, Piet Lormans, Manuel Quintana Diaz, Anselmo Caricato, Luigi Zattera, Pedro Kurtz, Geert Meyfroidt, Herve Quintard, Maria Celeste Dias, Angelo Giacomucci, Charlotte Castelain, Russell Chabanne, Pilar Marcos-Neira, Stepani Bendel, Ahmed Subhy Alsheikhly, Mohamed Elbahnasawy, Samuel Gay, Maximilian D’Onofrio, Konstantin A. Popugaev, Nikolaos Markou, Pierre Bouzat, Jean-Louis Vincent, Fabio Silvio Taccone","doi":"10.1186/s13054-025-05270-5","DOIUrl":"https://doi.org/10.1186/s13054-025-05270-5","url":null,"abstract":"The optimal hemoglobin (Hb) threshold to trigger red blood cell transfusions (RBCT) in subarachnoid hemorrhage (SAH) patients is unclear. This study evaluated the impact of liberal versus restrictive transfusion strategies on neurological outcome in patients with SAH. This is a pre-planned secondary analysis of the “TRansfusion Strategies in Acute brain INjured Patients” (TRAIN) study. We included all SAH patients from the original study that were randomized to receive RBCT when Hb levels dropped below 9 g/dL (liberal group) or 7 g/dL (restrictive group). The primary outcome was an unfavorable neurological outcome at 180 days, defined by a Glasgow Outcome Scale Extended score of 1–5. Of the 190 SAH patients in the trial, 188 (98.9%) had data available for the primary outcome, with 86 (45.3%) in the liberal group and 102 (53.6%) in the restrictive group. Patients in the liberal group were older than in the restrictive group, but otherwise had similar baseline characteristics. Patients in the liberal group received more RBCT and showed higher Hb levels over time. At 180 days, 57 (66.3%) patients in the liberal group and 78 (76.4%) in the restrictive group had unfavorable outcomes (risk ratio, RR 0.87; 95% confidence intervals, 95% CI 0.71–1.04). Patients in the liberal group had a significantly lower risk of cerebral ischemia (RR 0.63; 95% CI 0.41–0.97). In a multivariate analysis, randomization to the liberal group was associated with a lower risk of unfavorable outcome (RR 0.83, 95% CI 0.70–0.99). A liberal transfusion strategy was not associated with a lower incidence of unfavorable outcome after SAH when compared to a restrictive strategy. However, in a multivariable analysis adjusted for confounders randomization to the liberal group was associated with lower risk of unfavorable outcome. The occurrence of cerebral ischemia was significantly lower in the liberal transfusion strategy group. ClinicalTrials.gov number—NCT02968654 registered on November 16th, 2016.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"32 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143258452","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":"Postoperative sepsis and its sequential impact on dementia","authors":"Mingyang Sun, Fangfang Li, Yangyang Wang, Mengrong Miao, Zhongyuan Lu, Wan-Ming Chen, Szu-Yuan Wu, Jiaqiang Zhang","doi":"10.1186/s13054-025-05276-z","DOIUrl":"https://doi.org/10.1186/s13054-025-05276-z","url":null,"abstract":"Postoperative sepsis is a severe complication associated with increased mortality and potential long-term cognitive decline, including dementia. However, the relationship between postoperative sepsis and dementia remains poorly understood. This retrospective cohort study used data from the National Database in Taiwan, covering the period from January 1, 2005, to December 31, 2022. The index period for surgeries was set between January 1, 2008, and December 31, 2013, allowing the identification of patients without prior dementia. A landmark period of 12 months following surgery was defined to capture the number of postoperative sepsis events, which were then analyzed for their impact on dementia risk. After 1:4 propensity score matching (PSM), dementia and mortality were evaluated using Cox proportional hazards and Fine-Gray competing risk models. Following PSM, 778 patients were in the postoperative sepsis group and 3,112 in the non-postoperative sepsis group. Dementia incidence was higher in the postoperative sepsis group (26%) compared to the non- postoperative sepsis group (13.6%), with a hazard ratio (HR) of 1.25 (95% CI, 1.03–1.52). A dose–response relationship was observed, with dementia rates of 24.5% for one postoperative sepsis event and 34.9% for two or more events, the latter showing an HR of 1.77 (95% CI, 1.17–2.66). Mortality was also elevated in the postoperative sepsis group (40.5% vs. 31.6%; HR 1.45, 95% CI, 1.28–1.65). Postoperative sepsis is significantly associated with increased dementia risk in a dose-dependent manner. These findings highlight the importance of enhancing perioperative infection control to reduce both immediate and long-term cognitive complications.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"50 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143192524","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":"Potent P2Y12 inhibitors in patients with acute myocardial infarction and cardiogenic shock","authors":"Jinhwan Jo, Seung Hun Lee, Hyun Sung Joh, Hyun Kuk Kim, Ju Han Kim, Young Joon Hong, Young Keun Ahn, Myung Ho Jeong, Seung Ho Hur, Doo-Il Kim, Kiyuk Chang, Hun Sik Park, Jang-Whan Bae, Jin-Ok Jeong, Yong Hwan Park, Kyeong Ho Yun, Chang-Hwan Yoon, Yisik Kim, Jin-Yong Hwang, Hyo-Soo Kim, Woochan Kwon, Doosup Shin, Junho Ha, Chang Hoon Kim, Ki Hong Choi, Taek Kyu Park, Jeong Hoon Yang, Young Bin Song, Joo-Yong Hahn, Seung-Hyuk Choi, Hyeon-Cheol Gwon, Joo Myung Lee","doi":"10.1186/s13054-025-05277-y","DOIUrl":"https://doi.org/10.1186/s13054-025-05277-y","url":null,"abstract":"Although potent P2Y12 inhibitors, such as ticagrelor and prasugrel, are standard treatment in patients with acute myocardial infarction (AMI), evidence for their efficacy and safety compared with clopidogrel is limited in patients with AMI complicated by cardiogenic shock. Among 28,949 patients from the nationwide pooled registry of KAMIR-NIH and KAMIR-V, a total of 1482 patients (5.1%) with AMI and cardiogenic shock who underwent percutaneous coronary intervention of the culprit vessel were selected. Primary outcome was major adverse cardiovascular event (MACE, a composite of cardiac death, MI, repeat revascularization and definite stent thrombosis) and major secondary outcome was Bleeding Academic Research Consortium (BARC) type 2 or greater bleeding at 2 years. Among the study population, 537 patients (36.2%) received potent P2Y12 inhibitors and 945 patients (63.8%) received clopidogrel after index procedure. The risk of MACE was significantly lower in the potent P2Y12 inhibitors group than in the clopidogrel group (16.6% versus 24.7%; adjusted hazard ratio [HR], 0.76 [95% CI 0.59–0.99]; P = 0.046). Regarding BARC type 2 or greater bleeding, there was no significant difference between the potent P2Y12 inhibitors group and the clopidogrel group (12.5% versus 10.7%; adjusted HR, 1.36 [95% CI 0.98–1.88]; P = 0.064). Significant interaction was observed in patients aged ≥ 75 years (interaction P = 0.021) or venoarterial extracorporeal membrane oxygenator (VA-ECMO) use (interaction P = 0.015) for significantly increased risk of BARC type 2 or greater bleeding following the use of potent P2Y12 inhibitors. In patients with AMI complicated by cardiogenic shock, the use of potent P2Y12 inhibitors was associated with a lower risk of MACE compared with clopidogrel, without an increased risk of BARC type 2 or greater bleeding. The current data supports the use of potent P2Y12 inhibitors in patients with AMI and cardiogenic shock, except in patients aged ≥ 75 years or receiving VA-ECMO support. ","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"20 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143192500","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":"Assessment of recruitment from CT to the bedside: challenges and future directions","authors":"Stefano Giovanazzi, Domenico Nocera, Giulia Catozzi, Francesca Collino, Massimo Cressoni, Lorenzo Ball, Onnen Moerer, Michael Quintel, Luigi Camporota, Luciano Gattinoni","doi":"10.1186/s13054-025-05263-4","DOIUrl":"https://doi.org/10.1186/s13054-025-05263-4","url":null,"abstract":"Assessing and quantifying recruitability are important for characterizing ARDS severity and for reducing or preventing the atelectrauma caused by the cyclic opening and closing of pulmonary units. Over the years, several methods for recruitment assessment have been developed, grouped into three main approaches: 1) Quantitative CT Scanning: This method accurately measures the amount of atelectatic lung tissue that regains aeration; 2) Regional Gas Volume Measurement: Based on anatomical markers, this approach assesses gas volume within a specified lung region; 3) Compliance-Based Gas Volume Measurement: This technique compares actual gas volume at a given pressure to expected values, assuming respiratory system compliance is constant within the explored pressure range. Additional methods, such as lung ultrasonography and electrical impedance variation, have also been explored. This paper details the distribution of opening and closing pressures throughout the lung parenchyma, which underpin the concept of recruitability. The distribution of recruitable regions corresponds to atelectasis distribution, with the pressure needed for recruitment varying according to whether the atelectasis is “loose” or “sticky.” We also discuss the effects of different PEEP levels on preventing atelectrauma, the importance of keeping some lung areas closed throughout the respiratory cycle, and briefly cover the roles of sigh ventilation, prone positioning, and the closed lung approach.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"138 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143192501","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":"Time to positivity as a predictor of catheter-related bacteremia and mortality in adults with Pseudomonas aeruginosa bloodstream infection","authors":"Daniel N. Marco, Maria Brey, Sergi Anguera, Cristina Pitart, Ignacio Grafia, Marta Bodro, Jose Antonio Martínez, Ana del Río, Carolina Garcia-Vidal, Abiu Sempere, Celia Cardozo, Pedro Puerta-Alcalde, Mariana Chumbita, Marta Hernández-Meneses, Guillermo Cuervo, Patricia Monzo-Gallo, Miguel Ángel Verdejo, Tommaso Francesco Aiello, Mateu Espasa, Climent Casals-Pascual, Laura Morata, Felipe García, Josep Mensa, Àlex Soriano, Sabina Herrera","doi":"10.1186/s13054-025-05292-z","DOIUrl":"https://doi.org/10.1186/s13054-025-05292-z","url":null,"abstract":"Time to positivity (TTP) and differential TTP (DTP) emerge as diagnostic and prognostic tools for bloodstream infections (BSI) though specific cut-off values need to be determined for each pathogen. Pseudomonas aeruginosa BSI (PAE-BSI) is of critical concern, particularly in immunocompromised patients, due to high mortality rates. Catheter-related infections are a common cause, necessitating rapid and accurate diagnostic tools for effective management (source-control). Unicentric retrospective observational study analyzing the diagnostic utility and best cut-off values of time to positivity (TTP) and differential time to positivity (DTP) to identify catheter-related PAE-BSI and the association of TTP with 30-day mortality. 1177 PAE-BSI cases TTP were included in the study. TTP was available in all episodes whereas DTP was available in 355 episodes. Breakthrough bacteremia disregarding the TTP, more than one positive blood culture or > 7 days with a catheter in place and both a TTP < 13h and a DTP > 2h were independently associated to catheter-related PAE-BSI. Secondly, lower TTP were significantly associated with higher 30-day mortality rates in both catheter-related and non-catheter-related PAE-BSI. For catheter-related infections, TTP < 14h exacerbated mortality among patients among patients in whom the catheter was not removed within 48h (OR 2.9[1.04–8]); whereas for other sources TTP < 16h increased mortality (OR 1.6[1.1–2.4]) particularly when the empiric antibiotic therapy was not active (OR 3.8[1.5–10]). These findings advocate for the routine use of TTP over DTP as a diagnostic tool to guide timely interventions such as catheter removal, thereby potentially improving patient outcomes in PAE-BSI. Moreover, lower TTP have also prognostic implications in both catheter-related and non-catheter-related infections.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"15 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143192502","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":"Effect of an intensive care unit virtual reality intervention on relatives´ mental health distress: a multicenter, randomized controlled trial","authors":"Denzel L. Q. Drop, Johan H. Vlake, Evert-Jan Wils, Jasper Van Bommel, Christian Jung, Denise E. Hilling, O. Joseph Bienvenu, Tim I. M. Korevaar, Anna F. C. Schut, Margo M. C. van Mol, Diederik Gommers, Michel E. van Genderen","doi":"10.1186/s13054-025-05281-2","DOIUrl":"https://doi.org/10.1186/s13054-025-05281-2","url":null,"abstract":"Relatives of intensive care unit (ICU) patients often endure symptoms of post-traumatic stress, anxiety, and depression during and after treatment of a family member’s hospitalization. The aim of this study was to evaluate the effect of ICU-specific virtual reality (ICU-VR) on mental health among relatives, 6 months after patient’s ICU discharge. This multicenter, randomized controlled trial included relatives of ICU patients who were assigned to receive either standard care or standard care plus ICU-VR, by randomizing the ICU patients. Relatives were assessed up to 6 months after patient discharge from the ICU for post-traumatic stress, anxiety, depression, quality of life, relatives’ understanding of ICU care, and appreciation of ICU-VR. One hundred relatives of 81 patients and 89 relatives of 80 patients were randomized to the intervention and control groups, respectively. Relatives’ median age was 48 years and 53% were female. Compared to the control group, relatives who received ICU-VR did not experience a decrease in post-traumatic stress (23% vs. 18%; p = 0.99), anxiety (22% vs. 30%; p = 0.35), or depression (17% vs. 23%; p = 0.44). There was no significant difference between median mental quality of life (50.2 vs. 52.6; p = 0.51), physical quality of life (56.1 vs. 54.3; p = 0.16), or understanding of ICU care between groups. Patients in the intervention group highly endorsed ICU-VR (90%), favoring it over traditional informational brochures and the majority (82%) stated it improved their understanding of ICU treatment. ICU-VR did not significantly improve mental health distress symptoms among relatives 6-months after a patient’s discharge. Relatives highly endorsed ICU-VR and self-reported that it improved their understanding of ICU treatment.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"40 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143125074","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":"Enhancing depression risk assessment in critical care nurses: a call for quantitative modeling","authors":"Amir Vahedian-Azimi","doi":"10.1186/s13054-025-05303-z","DOIUrl":"https://doi.org/10.1186/s13054-025-05303-z","url":null,"abstract":"&lt;p&gt;I am writing this letter in reference to a recent study published in Critical Care entitled “Network of job demands-resources and depressive symptoms in critical care nurses: a nationwide cross-sectional study” [1]. I would like to commend the authors for their interesting study of this important topic that explain the non-linear and multi-directional relationships between job demands-resources and depressive symptoms in critical care nurses. Despite the comprehensive and robust methodology employed by the researchers in this study, along with the intriguing results that hold significant clinical implications for nurses in critical care, it is important to note that the effectiveness and performance of the findings may be enhanced by their objectivity and higher efficiency as critical care nurses are at a heightened risk for experiencing depression, a condition that can have far-reaching consequences [2]. Not only does depression negatively impact their overall well-being, but it also significantly increases their intention to leave their positions [3]. This mental health challenge can further impair their job performance and diminish organizational productivity [4]. It is crucial to recognize that various work-related factors play a significant role in the development of depressive symptoms among these healthcare professionals. Addressing these factors is essential for the mental health of nurses, as well as for the effectiveness and efficiency of healthcare delivery in critical care settings.&lt;/p&gt;&lt;p&gt;The study failed to quantify the risk factors associated with the onset of depression among nurses working in critical care. Such quantification could have served as a predictive model for depression within this population to identify the variables influencing the onset of depression through multivariate analysis utilizing logistic regression. This approach would allow for the determination of the weight of each risk factor as an individual variable, ultimately leading to the development of a model capable of predicting the onset of depression in this vulnerable group. The attached article present a methodology aimed at developing the aforementioned model [5].&lt;/p&gt;&lt;p&gt;Although the researchers articulated that nursing managers play a crucial role in supporting critical care nurses by facilitating the identification of their sense of purpose in their work, implementing resilience-building programs, fostering meaningful relationships, and establishing a collaborative work environment that encourages mutual assistance among colleagues [1]. However, the factors discussed are predominantly qualitative and subjective, which limits their practical and objective application in clinical settings. Consequently, they provide minimal capacity for predicting the onset of depression and for implementing individualized interventions tailored to the diverse characteristics of nurses working in critical care. The proposed modeling approach allows researchers to ident","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"207 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143125189","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":"Clinical subtypes in critically ill patients with sepsis: validation and parsimonious classifier model development","authors":"Rombout B. E. van Amstel, Emma Rademaker, Jason N. Kennedy, Lieuwe D. J. Bos, Hessel Peters-Sengers, Joe M. Butler, Niklas Bruse, Dave A. Dongelmans, Matthijs Kox, Alexander P. J. Vlaar, Tom van der Poll, Olaf L. Cremer, Christopher W. Seymour, Lonneke A. van Vught","doi":"10.1186/s13054-025-05256-3","DOIUrl":"https://doi.org/10.1186/s13054-025-05256-3","url":null,"abstract":"The application of sepsis subtypes to enhance personalized medicine in critically ill patients is hindered by the lack of validation across diverse cohorts and the absence of a simple classification model. We aimed to validate the previously identified SENECA clinical sepsis subtypes in multiple large ICU cohorts, and to develop parsimonious classifier models for δ-type adjudication in clinical practice. Data from four cohorts between 2008 and 2023 were used to assign α, β, γ and δ-type in patients fulfilling the Sepsis-3 criteria using clinical variables: (I) The Molecular diAgnosis and Risk stratification of Sepsis (MARS, n = 2449), (II) a contemporary continuation of the MARS study (MARS2, n = 2445) (III) the Dutch National Intensive Care Evaluation registry (NICE, n = 28,621) and (IV) the Medical Information Mart for Intensive Care including (MIMIC-IV, n = 18,661). K-means clustering using clinical variables was conducted to assess the optimal number of classes and compared to the SENECA subtypes. Parsimonious models were built in the SENECA derivation cohort to predict subtype membership using logistic regression, and validated in MARS and MIMIC-IV. Among 52.226 patients with sepsis, the subtype distribution in MARS, MARS2 and NICE was 2–6% for the α-type, 1–5% for the β-type, 49–65% for the γ-type and 26–48% for the δ-type compared to 33%, 27%, 27% and 13% in the original SENECA derivation cohort, whereas subtype distribution in MIMIC-IV was more similar at 25%, 24%, 27% and 25%, respectively. In-hospital mortality rates were significantly different between the four cohorts for α, γ and δ-type (p < 0.001). Method-based validation showed moderate overlap with the original subtypes in both MARS and MIMIC-IV. A parsimonious model for all four subtypes had moderate to low accuracy (accuracy 62.2%), while a parsimonious classifier model with 3 variables (aspartate aminotransferase, serum lactate, and bicarbonate) had excellent accuracy in predicting the δ-type patients from all other types in the derivation cohort and moderate accuracy in the validation cohorts (MARS: area under the receiver operator characteristic curve (AUC) 0.93, 95% CI [0.92–0.94], accuracy 85.5% [84.0–86.8%]; MIMIC-IV: AUC 0.86 [0.85–0.87], accuracy 82.9% [82.4–83.4%]). The distribution and mortality rates of clinical sepsis subtypes varied between US and European cohorts. A three-variable model could accurately identify the δ-type sepsis patients.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"61 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143083825","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":"Trendelenburg position is a reasonable alternative to passive leg raising for predicting volume responsiveness in mechanically ventilated patients in the ICU","authors":"Zhiyong Wang, Jie Zhang, Jing Zhao, Yaxuan Wu, Shiya Zhang, Chengfen Yin, Xinjing Gao, Lei Xu","doi":"10.1186/s13054-025-05301-1","DOIUrl":"https://doi.org/10.1186/s13054-025-05301-1","url":null,"abstract":"Passive leg raising (PLR) is a well-recognized method for assessing volume responsiveness in the intensive care unit (ICU); however, it has some limitations. The physiology of the cardiac preload induced by the Trendelenburg position and PLR is similar. The Trendelenburg position can be initiated from the supine position and then tilted downward (TRENDSUPINE) or from the reverse Trendelenburg position and then tilted further downward (TRENDrTREND). Therefore, this study aimed to compare the predictive performance of the percentage change in stroke volume index (ΔSVI) induced by TRENDSUPINE, TRENDrTREND, and PLR for volume responsiveness in mechanically ventilated patients in the ICU. The study was a prospective single-center cohort study conducted in a comprehensive ICU. The study consisted of the following sequential steps: (1) baseline-1: supine position with a 0° bed angulation; (2) Trendelenburg position: 15° downward bed angulation; (3) baseline-2: the same position as baseline-1; (4) reverse Trendelenburg position: 15° upward bed angulation; (5) Trendelenburg position: 15° downward bed angulation; (6) baseline-3: the same position as baseline-1; (7) semi-recumbent position: trunk elevated at 45°; (8) PLR: lower limbs elevated at 45° and trunk in the supine position; (9) baseline-4: the same position as baseline-1; (10) volume loading test: 250 ml of 4% albumin was infused over 10 min. At each time point, hemodynamic parameters were monitored using pulse contour analysis. A positive volume response was defined as an increase of at least 15% in SVI on pulse contour monitoring from baseline-4 after the volume loading test. The receiver operating characteristic curves were performed for ΔSVI. In this study, 36 patients were included for analysis, and of these, 15 patients (42%) were volume-responsive. TRENDSUPINE-induced ΔSVI (ΔSVISUPINE-TREND), TRENDrTREND-induced ΔSVI (ΔSVIrTREND-TREND) and PLR-induced ΔSVI (ΔSVIPLR) were 6%, 16%, and 11%, respectively (ΔSVISUPINE-TREND vs. ΔSVIrSUPINE-TREND, p &lt; 0.001; ΔSVISUPINE-TREND vs. ΔSVIPLR, p &lt; 0.05). The R2 values of the linear regression between ΔSVISUPINE-TREND, ΔSVIrTREND-TREND, ΔSVIPLR and volume loading test-induced ΔSVI were 0.14, 0.32, and 0.43, respectively (all p &lt; 0.001). Furthermore, the area under the receiver operating characteristic curve for predicting volume responsiveness was 0.78 [95% confidence interval (CI), 0.59–0.92], 0.88 (95%CI, 0.75–0.96), and 0.83 (95%CI, 0.61–0.95) for TRENDSUPINE, TRENDrTREND, and PLR-induced ΔSVI, respectively, with no statistically significant difference among them. The sensitivity and specificity for predicting volume responsiveness were 93% and 67% for ΔSVISUPINE-TREND at 4% cutoff, 87% and 76% for ΔSVIrTREND-TREND at 13% cutoff, and 73% and 86% for ΔSVIPLR at 11% cutoff. The Trendelenburg position (TRENDSUPINE and TRENDrTREND)-induced and PLR-induced percentage changes in SVI were similar in their ability to predict volume responsiveness in mechanica","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"47 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143125308","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 skin microvascular blood flow and capillary refill time in critically ill patients","authors":"Alexandra Morin, Louai Missri, Tomas Urbina, Vincent Bonny, Maxime Gasperment, Juliette Bernier, Jean-Luc Baudel, Eduardo Kattan, Eric Maury, Jérémie Joffre, Hafid Ait-Oufella","doi":"10.1186/s13054-025-05285-y","DOIUrl":"https://doi.org/10.1186/s13054-025-05285-y","url":null,"abstract":"Capillary refill time (CRT) and skin blood flow (SBF) have been reported to be strong predictors of mortality in critically ill patients. However, the relationship between both parameters remains unclear. We conducted a prospective observational study in a tertiary teaching hospital. All patients older than 18 years admitted in the intensive care unit (ICU) with circulatory failure and a measurable CRT were included. We assessed index SBF by laser doppler flowmetry and CRT on the fingertip, at T0 (Within the first 48 h from admission) and T1 (4 to 6 h later). Correlation was computed using Spearman or Pearson’s formula. During a 2-month period, 50 patients were included, 54% were admitted for sepsis. At baseline median CRT was 2.0 [1.1–3.9] seconds and median SBF was 46 [20–184] PU. At baseline SBF strongly correlated with CRT (R2 = 0.89; p < 0.0001, curvilinear relationship), this correlation was maintained whether patients were septic or not (R2 = 0.94; p = 0.0013; R2 = 0.87; p < 0.0001, respectively), and whether they received norepinephrine or not (R2 = 0.97; p = 0.0035; R2 = 0.92; p < 0.0001, respectively). Between T0 and T1, changes in SBF also significantly correlated with changes in CRT (R2 = 0.34; p < 0.0001). SBF was related to tissue perfusion parameters such as arterial lactate level (p = 0.02), whilst no correlation was found with cardiac output. In addition, only survivors significantly improved their SBF between T0 and T1. SBF was a powerful predictor of day-28 mortality as the AUROC at T0 was 85% [95% IC [76–91]] and at T1 90% [95% IC [78–100]]. We have shown that index CRT and SBF were correlated, providing evidence that CRT is a reliable marker of microvascular blood flow. Trial registration Comité de protection des personnes Ouest II N° 2023-A02046-39.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"10 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143083826","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}