Critical Care最新文献

{"title":"Fluid management for sepsis-induced hypotension in patients with advanced chronic kidney disease: a secondary analysis of the CLOVERS trial","authors":"Anselm Jorda, Ivor S. Douglas, Thomas Staudinger, Gottfried Heinz, Felix Bergmann, Rainer Oberbauer, Gürkan Sengölge, Markus Zeitlinger, Bernd Jilma, Nathan I. Shapiro, Georg Gelbenegger","doi":"10.1186/s13054-024-05019-6","DOIUrl":"https://doi.org/10.1186/s13054-024-05019-6","url":null,"abstract":"Early fluid management in patients with advanced chronic kidney disease (CKD) and sepsis-induced hypotension is challenging with limited evidence to support treatment recommendations. We aimed to compare an early restrictive versus liberal fluid management for sepsis-induced hypotension in patients with advanced CKD. This post-hoc analysis included patients with advanced CKD (eGFR of less than 30 mL/min/1.73 m2 or history of end-stage renal disease on chronic dialysis) from the crystalloid liberal or vasopressor early resuscitation in sepsis (CLOVERS) trial. The primary endpoint was death from any cause before discharge home by day 90. Of 1563 participants enrolled in the CLOVERS trial, 196 participants had advanced CKD (45% on chronic dialysis), with 92 participants randomly assigned to the restrictive treatment group and 104 assigned to the liberal fluid group. Death from any cause before discharge home by day 90 occurred significantly less often in the restrictive fluid group compared with the liberal fluid group (20 [21.7%] vs. 41 [39.4%], HR 0.5, 95% CI 0.29–0.85). Participants in the restrictive fluid group had more vasopressor-free days (19.7 ± 10.4 days vs. 15.4 ± 12.6 days; mean difference 4.3 days, 95% CI, 1.0–7.5) and ventilator-free days by day 28 (21.0 ± 11.8 vs. 16.5 ± 13.6 days; mean difference 4.5 days, 95% CI, 0.9–8.1). In patients with advanced CKD and sepsis-induced hypotension, an early restrictive fluid strategy, prioritizing vasopressor use, was associated with a lower risk of death from any cause before discharge home by day 90 as compared with an early liberal fluid strategy. NCT03434028 (2018-02-09), BioLINCC 14149.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":null,"pages":null},"PeriodicalIF":15.1,"publicationDate":"2024-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141584403","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 paradox of workplace violence in the intensive care unit: a focus group study","authors":"Fredric Sjöberg, Martin Salzmann-Erikson, Eva Åkerman, Eva Joelsson-Alm, Anna Schandl","doi":"10.1186/s13054-024-05028-5","DOIUrl":"https://doi.org/10.1186/s13054-024-05028-5","url":null,"abstract":"Conflicts with patients and relatives occur frequently in intensive care units (ICUs), driven by factors that are intensified by critical illness and its treatments. A majority of ICU healthcare professionals have experienced verbal and/or physical violence. There is a need to understand how healthcare professionals in ICUs experience and manage this workplace violence. A qualitative descriptive analysis of four hospitals in Sweden was conducted using semi-structured focus-group interviews with ICU healthcare professionals. A total of 34 participants (14 nurses, 6 physicians and 14 other staff) were interviewed across the four hospitals. The overarching theme: “The paradox of violence in healthcare” illustrated a normalisation of violence in ICU care and indicated a complex association between healthcare professionals regarding violence as an integral aspect of caregiving, while simultaneously identifying themselves as victims of this violence. The healthcare professionals described being poorly prepared and lacking appropriate tools to manage violent situations. The management of violence was therefore mostly based on self-taught skills. This study contributes to understanding the normalisation of violence in ICU care and gives a possible explanation for its origins. The paradox involves a multifaceted approach that acknowledges and confronts the structural and cultural dimensions of violence in healthcare. Such an approach will lay the foundations for a more sustainable healthcare system.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":null,"pages":null},"PeriodicalIF":15.1,"publicationDate":"2024-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141584405","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":"Unveiling the hidden burden: the impact of undiagnosed comorbidities on health-related quality of life in ICU survivors","authors":"Jill Moser, Roos Mensink, Marisa Onrust, Fredrike Blokzijl, Jacqueline Koeze","doi":"10.1186/s13054-024-05025-8","DOIUrl":"https://doi.org/10.1186/s13054-024-05025-8","url":null,"abstract":"<p>With great interest we read the recent article by Orwelius et al. [1] on the impact of comorbidities on health-related quality of life (HRQoL) in ICU survivors. We commend the authors for their work on addressing this challenging topic and for providing an insightful review. While we agree with the key issues highlighted by the authors, we believe that several points warrant further discussion.</p><p>One of the major challenges in assessing the impact of comorbidities on HRQoL among ICU survivors is obtaining accurate comorbidity prevalence data, both at ICU admission and during post-ICU follow-up. ICU physicians rely on medical records to identify patient comorbidities; however, conditions such as hypertension, diabetes, and chronic kidney disease (CKD) frequently remain undiagnosed until they reach advanced stages. For instance, elevated glucose levels are commonly found in patients admitted to the ICU, despite having no medical history of diabetes. While this is typically attributed to critical illness, it may also be partly due to underlying diabetes or prediabetes. Similarly, baseline serum creatinine levels are often unknown upon ICU admission. As a result, elevated creatinine levels may be misinterpreted as acute kidney injury when it could partly stem from pre-existing CKD. Our recent findings underscore this issue, revealing that while 17% of hospitalized COVID-19 patients had a medical history of CKD, 93% exhibited renal histopathological features consistent with the disease [2]. Hence, the underdiagnosis of chronic conditions can lead to an underestimation of the true burden and severity of comorbidities in patients admitted to the ICU. Consequently, the impact of these conditions on HRQoL might be inaccurately attributed solely to ICU stay when, in reality, pre-existing but undiagnosed conditions play a substantial role.</p><p>In addition, there are notable sex differences in the reporting and management of chronic health issues. Men and women may experience and report comorbidities differently and may also have different health-seeking behaviors [3]. Women, for instance, are more likely to seek medical care and thus may have their chronic conditions diagnosed earlier and managed more effectively than men. This disparity can lead to biased data regarding the prevalence and impact of comorbidities on HRQoL.</p><p>Similar to the observations of Orwelius et al., we emphasize that using age adjustment in HRQoL studies to account for comorbidities is insufficient. In recent years, there has been a noticeable shift in the age at which comorbidities are being diagnosed, with younger populations increasingly exhibiting chronic diseases traditionally associated with older adults. This trend is largely due to unhealthy lifestyle choices prevalent in modern society, such as poor dietary habits, physical inactivity, and elevated stress levels. Consequently, conditions such as hypertension, type 2 diabetes, and liver disease are now being diagn","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":null,"pages":null},"PeriodicalIF":15.1,"publicationDate":"2024-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141566231","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":"A proof of concept for microcirculation monitoring using machine learning based hyperspectral imaging in critically ill patients: a monocentric observational study.","authors":"Judith Kohnke, Kevin Pattberg, Felix Nensa, Henning Kuhlmann, Thorsten Brenner, Karsten Schmidt, René Hosch, Florian Espeter","doi":"10.1186/s13054-024-05023-w","DOIUrl":"10.1186/s13054-024-05023-w","url":null,"abstract":"<p><strong>Background: </strong>Impaired microcirculation is a cornerstone of sepsis development and leads to reduced tissue oxygenation, influenced by fluid and catecholamine administration during treatment. Hyperspectral imaging (HSI) is a non-invasive bedside technology for visualizing physicochemical tissue characteristics. Machine learning (ML) for skin HSI might offer an automated approach for bedside microcirculation assessment, providing an individualized tissue fingerprint of critically ill patients in intensive care. The study aimed to determine if machine learning could be utilized to automatically identify regions of interest (ROIs) in the hand, thereby distinguishing between healthy individuals and critically ill patients with sepsis using HSI.</p><p><strong>Methods: </strong>HSI raw data from 75 critically ill sepsis patients and from 30 healthy controls were recorded using TIVITA® Tissue System and analyzed using an automated ML approach. Additionally, patients were divided into two groups based on their SOFA scores for further subanalysis: less severely ill (SOFA ≤ 5) and severely ill (SOFA > 5). The analysis of the HSI raw data was fully-automated using MediaPipe for ROI detection (palm and fingertips) and feature extraction. HSI Features were statistically analyzed to highlight relevant wavelength combinations using Mann-Whitney-U test and Benjamini, Krieger, and Yekutieli (BKY) correction. In addition, Random Forest models were trained using bootstrapping, and feature importances were determined to gain insights regarding the wavelength importance for a model decision.</p><p><strong>Results: </strong>An automated pipeline for generating ROIs and HSI feature extraction was successfully established. HSI raw data analysis accurately distinguished healthy controls from sepsis patients. Wavelengths at the fingertips differed in the ranges of 575-695 nm and 840-1000 nm. For the palm, significant differences were observed in the range of 925-1000 nm. Feature importance plots indicated relevant information in the same wavelength ranges. Combining palm and fingertip analysis provided the highest reliability, with an AUC of 0.92 to distinguish between sepsis patients and healthy controls.</p><p><strong>Conclusion: </strong>Based on this proof of concept, the integration of automated and standardized ROIs along with automated skin HSI analyzes, was able to differentiate between healthy individuals and patients with sepsis. This approach offers a reliable and objective assessment of skin microcirculation, facilitating the rapid identification of critically ill patients.</p>","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":null,"pages":null},"PeriodicalIF":8.8,"publicationDate":"2024-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11238485/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141579223","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":"Physiological and clinical effects of trunk inclination adjustment in patients with respiratory failure: a scoping review and narrative synthesis","authors":"Martín H. Benites, Marcelo Zapata-Canivilo, Fabian Poblete, Francisco Labbe, Romina Battiato, Andrés Ferre, Jorge Dreyse, Guillermo Bugedo, Alejandro Bruhn, Eduardo L. V. Costa, Jaime Retamal","doi":"10.1186/s13054-024-05010-1","DOIUrl":"https://doi.org/10.1186/s13054-024-05010-1","url":null,"abstract":"Adjusting trunk inclination from a semi-recumbent position to a supine-flat position or vice versa in patients with respiratory failure significantly affects numerous aspects of respiratory physiology including respiratory mechanics, oxygenation, end-expiratory lung volume, and ventilatory efficiency. Despite these observed effects, the current clinical evidence regarding this positioning manoeuvre is limited. This study undertakes a scoping review of patients with respiratory failure undergoing mechanical ventilation to assess the effect of trunk inclination on physiological lung parameters. The PubMed, Cochrane, and Scopus databases were systematically searched from 2003 to 2023. Interventions: Changes in trunk inclination. Measurements: Four domains were evaluated in this study: 1) respiratory mechanics, 2) ventilation distribution, 3) oxygenation, and 4) ventilatory efficiency. After searching the three databases and removing duplicates, 220 studies were screened. Of these, 37 were assessed in detail, and 13 were included in the final analysis, comprising 274 patients. All selected studies were experimental, and assessed respiratory mechanics, ventilation distribution, oxygenation, and ventilatory efficiency, primarily within 60 min post postural change. In patients with acute respiratory failure, transitioning from a supine to a semi-recumbent position leads to decreased respiratory system compliance and increased airway driving pressure. Additionally, C-ARDS patients experienced an improvement in ventilatory efficiency, which resulted in lower PaCO2 levels. Improvements in oxygenation were observed in a few patients and only in those who exhibited an increase in EELV upon moving to a semi-recumbent position. Therefore, the trunk inclination angle must be accurately reported in patients with respiratory failure under mechanical ventilation.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":null,"pages":null},"PeriodicalIF":15.1,"publicationDate":"2024-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141561502","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":"Diagnostic accuracy of lung ultrasound in diagnosis of ARDS and identification of focal or non-focal ARDS subphenotypes: a systematic review and meta-analysis.","authors":"Maud M A Boumans, William Aerts, Luigi Pisani, Lieuwe D J Bos, Marry R Smit, Pieter R Tuinman","doi":"10.1186/s13054-024-04985-1","DOIUrl":"10.1186/s13054-024-04985-1","url":null,"abstract":"<p><strong>Background: </strong>Acute respiratory distress syndrome (ARDS) is a life-threatening respiratory condition with high mortality rates, accounting for 10% of all intensive care unit admissions. Lung ultrasound (LUS) as diagnostic tool for acute respiratory failure has garnered widespread recognition and was recently incorporated into the updated definitions of ARDS. This raised the hypothesis that LUS is a reliable method for diagnosing ARDS.</p><p><strong>Objectives: </strong>We aimed to establish the accuracy of LUS for ARDS diagnosis and classification of focal versus non-focal ARDS subphenotypes.</p><p><strong>Methods: </strong>This systematic review and meta-analysis used a systematic search strategy, which was applied to PubMed, EMBASE and cochrane databases. Studies investigating the diagnostic accuracy of LUS compared to thoracic CT or chest radiography (CXR) in ARDS diagnosis or focal versus non-focal subphenotypes in adult patients were included. Quality of studies was evaluated using the QUADAS-2 tool. Statistical analyses were performed using \"Mada\" in Rstudio, version 4.0.3. Sensitivity and specificity with 95% confidence interval of each separate study were summarized in a Forest plot.</p><p><strong>Results: </strong>The search resulted in 2648 unique records. After selection, 11 reports were included, involving 2075 patients and 598 ARDS cases (29%). Nine studies reported on ARDS diagnosis and two reported on focal versus non-focal ARDS subphenotypes classification. Meta-analysis showed a pooled sensitivity of 0.631 (95% CI 0.450-0.782) and pooled specificity of 0.942 (95% CI 0.856-0.978) of LUS for ARDS diagnosis. In two studies, LUS could accurately differentiate between focal versus non-focal ARDS subphenotypes. Insufficient data was available to perform a meta-analysis.</p><p><strong>Conclusion: </strong>This review confirms the hypothesis that LUS is a reliable method for diagnosing ARDS in adult patients. For the classification of focal or non-focal subphenotypes, LUS showed promising results, but more research is needed.</p>","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":null,"pages":null},"PeriodicalIF":8.8,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11232316/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141558304","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":"Clinical application of targeted next-generation sequencing in severe pneumonia: a retrospective review.","authors":"Peng Zhang, Baoyi Liu, Shuang Zhang, Xuefei Chang, Lihe Zhang, Dejian Gu, Xin Zheng, Jiaqing Chen, Saiyin Xiao, Zhentao Wu, Xuemin Cai, Mingfa Long, Wenjie Lu, Mingzhu Zheng, Rongrong Chen, Rui Gao, Yan Zheng, Jinhua Wu, Qiujuan Feng, Gang He, Yantang Chen, Weihao Zheng, Wanli Zuo, Yanming Huang, Xin Zhang","doi":"10.1186/s13054-024-05009-8","DOIUrl":"10.1186/s13054-024-05009-8","url":null,"abstract":"<p><strong>Background: </strong>The precise identification of the underlying causes of infectious diseases, such as severe pneumonia, is essential, and the development of next-generation sequencing (NGS) has enhanced the effectiveness of pathogen detection. However, there is limited information on the systematic assessment of the clinical use of targeted next-generation sequencing (tNGS) in cases of severe pneumonia.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 130 patients with severe pneumonia treated in the ICU from June 2022 to June 2023. The consistency of the results of tNGS, metagenomics next-generation sequencing (mNGS), and culture with the clinical diagnosis was evaluated. Additionally, the results for pathogens detected by tNGS were compared with those of culture, mNGS, and quantitative reverse transcription PCR (RT-qPCR). To evaluate the efficacy of monitoring severe pneumonia, five patients with complicated infections were selected for tNGS microbiological surveillance. The tNGS and culture drug sensitisation results were then compared.</p><p><strong>Results: </strong>The tNGS results for the analysis of the 130 patients showed a concordance rate of over 70% with clinical diagnostic results. The detection of pathogenic microorganisms using tNGS was in agreement with the results of culture, mNGS, and RT-qPCR. Furthermore, the tNGS results for pathogens in the five patients monitored for complicated infections of severe pneumonia were consistent with the culture and imaging test results during treatment. The tNGS drug resistance results were in line with the drug sensitivity results in approximately 65% of the cases.</p><p><strong>Conclusions: </strong>The application of tNGS highlights its promise and significance in assessing the effectiveness of clinical interventions and providing guidance for anti-infection therapies for severe pneumonia.</p>","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":null,"pages":null},"PeriodicalIF":8.8,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11232260/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141558303","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":"Immune profiling of critically ill patients with acute kidney injury during the first week after various types of injuries: the REALAKI study.","authors":"Frank Bidar, Louis Peillon, Maxime Bodinier, Fabienne Venet, Guillaume Monneret, Anne-Claire Lukaszewicz, Jean-François Llitjos, Julien Textoris, Thomas Rimmelé","doi":"10.1186/s13054-024-04998-w","DOIUrl":"10.1186/s13054-024-04998-w","url":null,"abstract":"<p><strong>Background: </strong>Acute kidney injury (AKI) is common in hospitalized patients and results in significant morbidity and mortality. The objective of the study was to explore the systemic immune response of intensive care unit patients presenting with AKI, especially the association between immune profiles and persistent AKI during the first week after admission following various types of injuries (sepsis, trauma, surgery, and burns).</p><p><strong>Methods: </strong>REALAKI is an ancillary analysis of the REAnimation Low Immune Status Marker (REALISM) cohort study, in which 359 critically ill patients were enrolled in three different intensive care units. Patients with end-stage renal disease were excluded from the REALAKI study. Clinical samples and data were collected three times after admission: at day 1 or 2 (D1-2), day 3 or 4 (D3-4) and day 5, 6 or 7 (D5-7). Immune profiles were compared between patients presenting with or without AKI. Patients with AKI at both D1-2 and D5-7 were defined as persistent AKI. A multivariable logistic regression model was performed to determine the independent association between AKI and patients' immunological parameters.</p><p><strong>Results: </strong>Three hundred and fifty-nine patients were included in this analysis. Among them, 137 (38%) were trauma patients, 103 (29%) post-surgery patients, 95 (26%) sepsis patients, and 24 (7%) were burn patients. One hundred and thirty-nine (39%) patients presented with AKI at D1-2 and 61 (20%) at D5-7. Overall, 94% presented with persistent AKI at D5-7. Patients with AKI presented with increased pro and anti-inflammatory cytokines and altered innate and adaptive immune responses. The modifications observed in the immune profiles tended to be more pronounced with increasing KDIGO stages. In the logistic regression model, a statistically significant association was observed at D1-2 between AKI and CD10^lowCD16^low immature neutrophils (OR 3.03 [1.7-5.5]-p < 0.001). At D5-7, increased interleukin-10 (IL-10) levels and reduced ex vivo TNF-α production after LPS stimulation were significantly associated with the presence of AKI (OR 1.38 [1.12-1.71]-p = 0.001 and 0.51 [0.27-0.91]-p = 0.03, respectively). Patients who recovered from AKI between D1-2 and D5-7 compared to patients with persistent AKI at D5-7, tended to correct these alterations.</p><p><strong>Conclusion: </strong>Following various types of severe injuries, early AKI is associated with the initial inflammatory response. Presence of AKI at the end of the first week after injury is associated with injury-induced immunosuppression.</p>","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":null,"pages":null},"PeriodicalIF":8.8,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11232205/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141558305","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":"Trials and the importance of usual care","authors":"Kyle C. White, Kevin B. Laupland, Rinaldo Bellomo","doi":"10.1186/s13054-024-04977-1","DOIUrl":"https://doi.org/10.1186/s13054-024-04977-1","url":null,"abstract":"<p>Dear Editor,</p><p>We read with great interest the REDUSE trial paper by Linden and colleagues [1] and particularly commend the comprehensive protocol that recognised the importance of nutrition to fluid accumulation [2] and detailed instructions on concentrating drug administration.</p><p>However, we are concerned about the external validity of fluid input with the usual care arm of the REDUSE trial. Such patients received a median fluid input of 9.76 L in the first three days of ICU stay.</p><p>In 6412 patients with septic shock, from a previously described cohort [3], admitted to 12 participating ICUs in Australia we found a median fluid input over the first 3 days, D0–D3, of 5.99 L. The overall fluid input over the first three days of ICU admission, together with the single-day breakdown is presented in Fig. 1. The median fluid input of under 6 L was the same as the 6.01 L reported in the intervention arm of the REDUSE trial, demonstrating different baseline practices.</p><figure><figcaption><b data-test=\"figure-caption-text\">Fig. 1</b></figcaption><picture><source srcset=\"//media.springernature.com/lw685/springer-static/image/art%3A10.1186%2Fs13054-024-04977-1/MediaObjects/13054_2024_4977_Fig1_HTML.png?as=webp\" type=\"image/webp\"/><img alt=\"figure 1\" aria-describedby=\"Fig1\" height=\"261\" loading=\"lazy\" src=\"//media.springernature.com/lw685/springer-static/image/art%3A10.1186%2Fs13054-024-04977-1/MediaObjects/13054_2024_4977_Fig1_HTML.png\" width=\"685\"/></picture><p>Fluid Administration in patients admitted to ICU with septic shock all sources of fluid input included (crystalloids, colloids, blood products nutrition, and oral sources</p><span>Full size image</span><svg aria-hidden=\"true\" focusable=\"false\" height=\"16\" role=\"img\" width=\"16\"><use xlink:href=\"#icon-eds-i-chevron-right-small\" xmlns:xlink=\"http://www.w3.org/1999/xlink\"></use></svg></figure><p>Furthermore, recent evidence in renal replacement therapy has demonstrated profound geographical variation in fluid management practices [4]. The assumption that the results of the trial can applied to different jurisdictions may be inaccurate and could have consequences on future, multinational interventional trials, and, ultimately, patient care.</p><p>Second, we would like to stress that the REDUSE trial intervention did not highlight the impact on fluid balance, as this information is relegated to the supplemental material. Recent work in critically ill patients with acute kidney injury has demonstrated the importance of urine output and diuretic therapy to the multi-factor development of fluid accumulation [2]. In the REDUSE trial cumulative fluid balance at day 3 was + 2317 mL in the usual care arm, whereas, in our cohort of &gt; 6000 patients, the median cumulative FB was + 544 mL, D0–D3.</p><p>We believe that addressing these concerns will contribute to a more comprehensive understanding of fluid management in critically ill patients and guide future research in this important area.</p","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":null,"pages":null},"PeriodicalIF":15.1,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141557169","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":"Thiamine supplementation in septic shock patients: still looking for the target population.","authors":"Amanda Gomes Pereira, Nara A Costa, Mariana B de Moraes, Marina P Okoshi, Leonardo A M Zornoff, Paula S Azevedo, Marcos F Minicucci, Sérgio A R de Paiva, Bertha F Polegato","doi":"10.1186/s13054-024-05012-z","DOIUrl":"10.1186/s13054-024-05012-z","url":null,"abstract":"","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":null,"pages":null},"PeriodicalIF":8.8,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11232252/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141558306","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}