Intensive Care Medicine最新文献_第9页

Association of hospital-level continuous kidney replacement therapy use and mortality in critically ill patients with acute kidney injury. 急性肾损伤危重患者持续肾替代治疗与死亡率的关系

IF 38.9 1区医学

Intensive Care Medicine Pub Date : 2025-06-30 DOI: 10.1007/s00134-025-07993-z

Javier A Neyra,Jorge Echeverri,Daniel Bronson-Lowe,Caio Plopper,Kai Harenski,Raghavan Murugan

{"title":"Association of hospital-level continuous kidney replacement therapy use and mortality in critically ill patients with acute kidney injury.","authors":"Javier A Neyra,Jorge Echeverri,Daniel Bronson-Lowe,Caio Plopper,Kai Harenski,Raghavan Murugan","doi":"10.1007/s00134-025-07993-z","DOIUrl":"https://doi.org/10.1007/s00134-025-07993-z","url":null,"abstract":"PURPOSEIn numerous high-risk medical and surgical conditions, an increased volume of patients and procedures is associated with improved processes and survival. This study examined the association of hospital-level continuous kidney replacement therapy (CKRT) utilization rates with all-cause hospital mortality in critically ill patients with acute kidney injury (AKI).METHODSThis multicenter cohort study used data from patients admitted to the intensive care unit (ICU) within the Premier Incorporated AI (PINC-AI) database. Patients were critically ill adults with AKI receiving kidney replacement therapy (KRT) in U.S. hospitals that offered both CKRT and intermittent hemodialysis. Hospitals were characterized according to their CKRT utilization in the ICU, and risk-adjusted association with all-cause hospital mortality by day 90 was estimated.RESULTSAmong 49,685 patients with AKI admitted to 426 acute care U.S. hospitals and treated with KRT in the ICU, a higher hospital-level CKRT utilization rate was associated with lower patient-level risk-adjusted hospital mortality. Hospitals with higher CKRT utilization rates (CKRT use in ≥ 31.5% of KRT patients per year) had a 15% lower adjusted probability of death compared with hospitals with lower CKRT utilization rates (CKRT use in < 8% of KRT patients per year). When compared with the first quartile of hospital-level CKRT use, the third (adjusted hazard ratio [aHR], 0.93, 95%CI: 0.89-0.98) and fourth (aHR, 0.85, 95%CI: 0.81-0.89) quartiles were associated with lower risk-adjusted hospital mortality. Findings were consistent in several sensitivity analyses.CONCLUSIONSAmong critically ill adults with AKI requiring KRT, treatment in hospitals with higher CKRT utilization rates was associated with reduced hospital mortality.","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"19 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144521224","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}

引用次数: 0

Self-reported symptoms in ICU patients and their impact on long-term outcomes-a prospective multicenter study. ICU患者自我报告的症状及其对长期预后的影响——一项前瞻性多中心研究

IF 38.9 1区医学

Intensive Care Medicine Pub Date : 2025-06-30 DOI: 10.1007/s00134-025-07995-x

Christin Saltnes-Lillegård,Tone Rustøen,Sigrid Beitland,Kathleen Puntillo,Milada Hagen,Kristin Hofsø

{"title":"Self-reported symptoms in ICU patients and their impact on long-term outcomes-a prospective multicenter study.","authors":"Christin Saltnes-Lillegård,Tone Rustøen,Sigrid Beitland,Kathleen Puntillo,Milada Hagen,Kristin Hofsø","doi":"10.1007/s00134-025-07995-x","DOIUrl":"https://doi.org/10.1007/s00134-025-07995-x","url":null,"abstract":"PURPOSEThe aim was to identify possible associations between patient symptom subgroups, identified while in the ICU, adjusted for clinical and demographic variables and PICS outcomes, three months after ICU admission.METHODSA prospective multi-center cohort study. Based on reported symptom prevalence in the ICU, patients were categorized into a Low, Middle or High symptom subgroup. PICS outcomes were measured using validated questionnaires (i.e., Katz Index; Cognitive Failure questionnaire, The Hospital Anxiety and Depression Scale, Impact of Event Scale) three months after ICU admission. Possible associations between ICU symptom subgroups and dichotomized PICS outcomes were modeled using conditional backward logistic regression.RESULTSWe included 175 patients with a median age of 62 years (interquartile range 49-70) and 65.1% were males. Three months after ICU admission, 23.5% had physical disability, 12.1% cognitive failure, 18.3% anxiety, 16.6% depression, and 16.7% post-traumatic stress. In multivariate analyses, patients in the High symptom subgroup compared to Low/Middle symptom subgroups had higher odds for worse outcomes in all PICS domains. The odds ratios (95%CI) were 3.31 (1.25-8.78) for physical disability, 3.56 (1.20-10.60) for cognitive failure, 3.70 (1.41-9.67) for anxiety, 4.74 (1.79-12.58) for depression and 4.38 (1.49-12.84) for post-traumatic stress, respectively.CONCLUSIONA subgroup of patients with high symptom burden during ICU stay had worse physical, cognitive and mental health outcomes three months after ICU admission compared to patients with medium/low symptom burden. Future studies are needed to evaluate if early interventions in the ICU can reduce long-time burden in the PICS domains in ICU survivors.","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"64 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144521222","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}

引用次数: 0

The dawn of target trials in intensive care: time to move beyond association is not causation. 重症监护目标试验的曙光：是时候超越关联并不是因果关系。

IF 38.9 1区医学

Intensive Care Medicine Pub Date : 2025-06-30 DOI: 10.1007/s00134-025-08013-w

Bruno Adler Maccagnan Pinheiro Besen

引用次数: 0

Corticosteroids for non-viral community-acquired pneumonia: strengthened evidence amid persistent clinical uncertainties. 皮质类固醇治疗非病毒性社区获得性肺炎：持续临床不确定性的强化证据

IF 38.9 1区医学

Intensive Care Medicine Pub Date : 2025-06-30 DOI: 10.1007/s00134-025-07963-5

Mohan Giri,Anju Puri,Yi Chen,Shuliang Guo

引用次数: 0

High mean arterial pressure (MAP) targets in septic shock: one size does not fit all. Authors' reply. 脓毒性休克的高平均动脉压（MAP）指标：一种大小不适合所有。作者的回答。