Journal of critical care最新文献

{"title":"Association of age with extubation failure in neurocritical intensive care unit patients––Insight from an international prospective study named ENIO","authors":"Relin van Vliet ,&nbsp;David M.P. van Meenen ,&nbsp;Chiara Robba ,&nbsp;Raphaël Cinotti ,&nbsp;Karim Asehnoune ,&nbsp;Robert D. Stevens ,&nbsp;Denise Battaglini ,&nbsp;Shaurya Taran ,&nbsp;Mathieu van der Jagt ,&nbsp;Fabio Silvio Taccone ,&nbsp;Frederique Paulus ,&nbsp;Marcus J. Schultz","doi":"10.1016/j.jcrc.2025.155067","DOIUrl":"10.1016/j.jcrc.2025.155067","url":null,"abstract":"<div><h3>Objective</h3><div>To assess the association of age with extubation failure in neurocritical care patients.</div></div><div><h3>Design</h3><div>Posthoc analysis of the ‘Extubation strategies in Neuro–Intensive care unit patients and associations with Outcomes (ENIO) study’, an international prospective observational study.</div></div><div><h3>Setting</h3><div>ENIO was conducted in 73 centers in 18 countries from 2018 to 2020.</div></div><div><h3>Patients</h3><div>Neurocritical care patients with a Glasgow Coma Scale score ≤ 12 and receiving ventilation<!--> <!-->for at least 24 h were included. We categorized patients into four age groups based on age quartiles.</div></div><div><h3>Main results</h3><div>This analysis included 1095 patients with a median age of 53 [35 to 65] years. Younger patients were more likely to be admitted with traumatic brain injury, whereas older patients more often had cerebral hemorrhage, ischemic stroke, central nervous infection, or brain malignancies. Extubation failure occurred in 209 (19 %) patients. In the unadjusted analysis, older patients had a higher risk of extubation failure (odds ratio (OR), 1.012 [95 %–confidence interval (CI) 1.004 to 1.021]; <em>P</em> = 0.006). However, after adjusting for confounding factors, the effect of age on extubation failure was no longer significant (OR, 1.008 [0.997 to 1.019]; <em>P</em> = 0.172).</div></div><div><h3>Conclusions</h3><div>In this international cohort of intubated and ventilated neurocritical care patients, after adjusting for baseline covariates and for previously identified risk factors for extubation failure, age was not associated with extubation failure. Age may not be a factor to consider in extubation decisions for brain–injured patients.</div></div><div><h3>Registration</h3><div>ENIO is registered at <span><span>clinicaltrials.gov</span><svg><path></path></svg></span> (study identifier NCT 03400904).</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"88 ","pages":"Article 155067"},"PeriodicalIF":3.2,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143769331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Renal replacement therapy modalities and techniques in intensive care units: An international survey","authors":"Céline Monard ,&nbsp;Arnaud Marel ,&nbsp;Michael Joannidis ,&nbsp;Marlies Ostermann ,&nbsp;Zhiyong Peng ,&nbsp;Kent Doi ,&nbsp;Silvia De Rosa ,&nbsp;Ilona Bobek ,&nbsp;Dmitry Sokolov ,&nbsp;Vin-Cent Wu ,&nbsp;Vedran Premuzic ,&nbsp;Ravindra Mehta ,&nbsp;Rinaldo Bellomo ,&nbsp;Xaime Garcia ,&nbsp;Camilo Pizarro ,&nbsp;Alexander Zarbock ,&nbsp;Igor Milet ,&nbsp;Thiago Reis ,&nbsp;Marc Romain ,&nbsp;Bairbre Mc Nicholas ,&nbsp;Thomas Rimmelé","doi":"10.1016/j.jcrc.2025.155076","DOIUrl":"10.1016/j.jcrc.2025.155076","url":null,"abstract":"<div><h3>Background and hypothesis</h3><div>Up to 14 % of critically ill patients receive renal replacement therapy (RRT) during their ICU stay and are treated with intermittent hemodialysis (IHD) or one of the continuous renal replacement therapy (CRRT) techniques. The choice of a modality (IHD or CRRT) and technique (continuuous veno-venous -hemodialysis (CVVHD), −hemofiltration (CVVH), or - hemodiafiltration (CVVHDF)), and the way it is delivered, may have an impact on outcomes but only few studies addressed this question. We aimed to survey the availability, settings, and clinicians' preferences regarding RRT modalities and techniques in critically ill patients.</div></div><div><h3>Methods</h3><div>Between July 2021 and March 2022, we conducted an open online worldwide survey targeting ICU clinicians and consisting of 31 questions.</div></div><div><h3>Results</h3><div>Among the 1174 participants from 73 countries, 94 % indicated their ability to initiate RRT at any time. CRRT was more widely available than IHD (97 % vs 85 %). CVVHDF was the most frequently used CRRT technique (59 %), followed by CVVHD (26 %) and CVVH (16 %). Most participants (70 %) reported having access to at least two CRRT techniques in their unit. Preference for IHD or CRRT varied greatly, depending on the clinical situation. Among CRRT techniques, CVVHD was preferred for removal of small-sized molecules, better hemofilter lifespan and reduced nursing workload. The preferential indications for CVVH included septic shock, removal of middle-sized molecules and fluid overload. The technical settings for CVVH and CVVHDF were very heterogeneous.</div></div><div><h3>Conclusion</h3><div>This international survey underscores the large diversity in RRT practices wordlwide, as well as heterogeneity in beliefs and preferences among intensivists. These data highlight the need for robust comparative trials to identify the optimal RRT modality and technique to improve outcomes in specific clinical situations.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"88 ","pages":"Article 155076"},"PeriodicalIF":3.2,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143759684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A risk score to predict mechanical ventilation in patients with healthcare-associated ventriculitis and meningitis (HCAVM)","authors":"Rose Yeh,&nbsp;Rodrigo Hasbun","doi":"10.1016/j.jcrc.2025.155071","DOIUrl":"10.1016/j.jcrc.2025.155071","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"88 ","pages":"Article 155071"},"PeriodicalIF":3.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143739619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of right ventricle- pulmonary artery coupling during sepsis: A new way to detect occult right ventricle dysfunction at bedside?","authors":"Laurent Muller ,&nbsp;Laurent Zieleskiewicz","doi":"10.1016/j.jcrc.2025.155073","DOIUrl":"10.1016/j.jcrc.2025.155073","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"88 ","pages":"Article 155073"},"PeriodicalIF":3.2,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143724784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ICU-acquired weakness: Critical illness myopathy and polyneuropathy","authors":"Audrey Huang ,&nbsp;Marco Salazar ,&nbsp;Harli Weber ,&nbsp;Nimrod Gozum ,&nbsp;Jenny Yang ,&nbsp;Theresa Henson ,&nbsp;Neeraj Badjatia ,&nbsp;Taylor B. Harrison ,&nbsp;Stephan A. Mayer","doi":"10.1016/j.jcrc.2025.155074","DOIUrl":"10.1016/j.jcrc.2025.155074","url":null,"abstract":"<div><div>Critical illness myopathy (CIM) and critical illness polyneuropathy (CIP) are significant complications in intensive care unit (ICU) patients, first identified in the late 20th century. These conditions often present as flaccid paralysis and respiratory muscle weakness, making it challenging for patients to wean off ventilatory support. The incidence of ICU-acquired weakness, which includes CIM and CIP, ranges from 25 % to 84 % among long-term ventilated patients, with higher rates observed in those with sepsis or systemic inflammatory response syndrome. CIM is characterized by muscle wasting and can be confirmed using electromyography and muscle biopsy. The pathogenesis of CIM involves the loss of thick myosin filaments, while the proposed etiology of CIP centers around increased permeability of nerve axons, leading to axonal degeneration. Risk factors for developing these conditions include prolonged ICU length of stay, sepsis, multi-system organ dysfunction, hyperglycemia, as well as exposure to steroids and neuromuscular blocking agents. Emerging diagnostic tools including muscle ultrasound, magnetic resonance imaging (MRI), and biomarkers such as interleukin-6 (IL-6) and growth differentiation factor-15 (GDF-15) show promise in early detection and differentiation of CIM and CIP. Preventative and therapeutic treatment focuses on early mobilization, minimizing sedation, optimizing nutritional support, and use of intensive insulin therapy to prevent prolonged hyperglycemia. Despite these advancements, CIM and CIP continue to pose significant challenges, emphasizing the need for ongoing research to improve patient outcomes and develop effective treatments.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"88 ","pages":"Article 155074"},"PeriodicalIF":3.2,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143724663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship between echocardiography-estimated right ventricular-pulmonary artery coupling and mortality in septic shock","authors":"Yusuke Hirao ,&nbsp;Joshua Hu ,&nbsp;Brent Matsuda ,&nbsp;Ryota Sato","doi":"10.1016/j.jcrc.2025.155072","DOIUrl":"10.1016/j.jcrc.2025.155072","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"88 ","pages":"Article 155072"},"PeriodicalIF":3.2,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143715015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor: “Understanding ventilator-induced lung injury: The role of mechanical power”","authors":"R. Santa Cruz ,&nbsp;A.M. Esquinas","doi":"10.1016/j.jcrc.2025.155068","DOIUrl":"10.1016/j.jcrc.2025.155068","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"88 ","pages":"Article 155068"},"PeriodicalIF":3.2,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143697845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Establishment and validation of a critical care echocardiography-based predictive model for sepsis-induced cardiomyopathy: A prospective cohort study","authors":"Xiaojuan Yang ,&nbsp;Wanqi Sun ,&nbsp;Kai Chen ,&nbsp;Xiaohong Wang","doi":"10.1016/j.jcrc.2025.155066","DOIUrl":"10.1016/j.jcrc.2025.155066","url":null,"abstract":"<div><h3>Background</h3><div>Integrating echocardiographic parameters for a comprehensive and precise evaluation of sepsis-induced cardiomyopathy (SIC) presents a significant challenge.</div></div><div><h3>Research question</h3><div>To develop a nomogram for the echocardiographic diagnosis of SIC.</div></div><div><h3>Study design and methods</h3><div>A cohort of 181 septic patients was prospectively enrolled for critical care echocardiography assessments. The cohort was randomly divided into a training dataset (70 %, <em>n</em> = 126) and a validation dataset (30 %, <em>n</em> = 55). The LASSO regression analysis was used to identify key echocardiographic predictors, which were then analyzed using multivariate logistic regression to determine the final diagnostic predictors and establish an echocardiographic model for SIC. A nomogram was developed based on the model, which was evaluated and verified for discrimination, calibration, and clinical utility.</div></div><div><h3>Results</h3><div>Three key predictors, including left ventricular global longitudinal strain (GLS), early diastolic mitral flow velocity (E), and tricuspid annular plane systolic motion amplitude (TAPSE), were selected from 14 variables to develop a SIC echocardiographic predictive model. The model exhibited a strong discrimination with an area under the curve (AUC) value of 0.879 in the training dataset and 0.888 in the validation dataset. The results of the Hosmer-Lemeshow test further validated the consistency between predicted probabilities and actual outcomes in both datasets. Decision curve analysis (DCA) indicated a substantial net clinical benefit within risk threshold ranges of 5–100 % in the training dataset and 21–100 % in the validation dataset.</div></div><div><h3>Conclusion</h3><div>The nomogram, incorporating GLS, E, and TAPSE, emerged as a reliable non-invasive tool for assessing the risk of SIC.</div></div><div><h3>Clinical trial registration</h3><div>The study protocol was registered in the ChiCTR database (Registration No. ChiCTR2200066966; Date of Registration: December 22, 2022).</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"88 ","pages":"Article 155066"},"PeriodicalIF":3.2,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143680630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Authors reply: “Impact of initial jugular vein insertion site selection for central venous catheter placement on hemodialysis catheter complications”","authors":"Mohammad O. Abdelhafez ,&nbsp;Abdurrahman M. Hamadah ,&nbsp;Kamel A. Gharaibeh","doi":"10.1016/j.jcrc.2025.155070","DOIUrl":"10.1016/j.jcrc.2025.155070","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"88 ","pages":"Article 155070"},"PeriodicalIF":3.2,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143680632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accuracy between ICU admission and discharge diagnoses in non-survivors: A retrospective cohort study","authors":"Hannah H.M. Hulsewe ,&nbsp;Thom Wilbers ,&nbsp;Frank van Rosmalen ,&nbsp;Jasper van Bommel ,&nbsp;Sylvia Brinkman ,&nbsp;Bas C.T. van Bussel ,&nbsp;Iwan C.C. van der Horst ,&nbsp;Ronny M. Schnabel","doi":"10.1016/j.jcrc.2025.155065","DOIUrl":"10.1016/j.jcrc.2025.155065","url":null,"abstract":"<div><h3>Introduction</h3><div>Models predicting in-hospital mortality for intensive care unit (ICU) patients, like Acute Physiologic and Chronic Health Evaluation (APACHE) IV, depend on correct data about admission diagnoses. Incorrectly recording diagnoses or changes in diagnoses during admission may impact estimating mortality.</div></div><div><h3>Methods</h3><div>All deceased patients admitted to the ICU between Jan 1, 2018 and Dec 31, 2020 were included. Up to two discharge diagnoses were assigned using APACHE IV diagnostic codes. These were compared to the up to two diagnoses documented at admission. When differences occurred, these were classified as registration errors or diagnostic change. The APACHE IV predicted mortality was calculated using either admission or discharge diagnoses. The agreement between both methods was expressed as the mean difference and the intra-class correlation coefficient (ICC).</div></div><div><h3>Results</h3><div>886 (16 %) of 5633 patients died. In 363 (41 %) patients, there was no difference between admission and discharge diagnoses. Registration errors occurred in 138 (16 %) patients. 416 (47 %) patients had diagnostic change. The mean difference between predictions was 0.019 (95 % CI: 0.015–0.024). The ICC was 0.97 (95 % CI: 0.97–0.98).</div></div><div><h3>Discussion</h3><div>Differences between ICU admission and discharge diagnoses occur frequently, this leads to only a small discrepancy in the overall predicted mortality of deceased ICU patients.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"88 ","pages":"Article 155065"},"PeriodicalIF":3.2,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143680631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}