Journal of critical care最新文献

{"title":"Letter to the Editor: \"Predicting a strongly positive fluid balance in critically ill patients with acute kidney injury: A multicentre, international study\"","authors":"Jiangan Guan, Yu Hu, Yao Huang, Chan Chen","doi":"10.1016/j.jcrc.2025.155081","DOIUrl":"10.1016/j.jcrc.2025.155081","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"88 ","pages":"Article 155081"},"PeriodicalIF":3.2,"publicationDate":"2025-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143877468","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":"The association between venous excess ultrasound grading system (VExUS) and major adverse kidney events after 30 days in critically ill patients: A prospective cohort study","authors":"P. Klompmaker ,&nbsp;A. Mousa ,&nbsp;D.J. Allard ,&nbsp;B.S.H. Hagen ,&nbsp;T. Bánki ,&nbsp;W. Vermeulen ,&nbsp;M. de Waal ,&nbsp;S. van Wolfswinkel ,&nbsp;H.J.S. De Grooth ,&nbsp;D.P. Veelo ,&nbsp;A.P.J. Vlaar ,&nbsp;P.R. Tuinman","doi":"10.1016/j.jcrc.2025.155097","DOIUrl":"10.1016/j.jcrc.2025.155097","url":null,"abstract":"<div><h3>Background</h3><div>The Venous Excess Ultrasound grading system (VExUS) can evaluate venous congestion at the bedside. There is conflicting evidence whether VExUS is associated with important clinical outcomes, such as acute kidney injury (AKI), in critically ill patients.</div><div>The primary aim is to evaluate prevalence of different VExUS grades and its association with AKI and 30 day mortality in critically ill patients. Secondary aims are to investigate the change of VExUS during admission and to assess the feasibility and agreement of VExUS examinations in critically ill patients.</div></div><div><h3>Method</h3><div>A single centre prospective cohort study in a tertiary hospital intensive care unit (ICU) in the Netherlands. Consecutive adult critically ill patients expected to be admitted to the ICU ≥ 24 h in whom ultrasound was feasible were included. VExUS was performed within 48 h of admission and repeated every other day with a maximum of three measurements per patient. Primary outcome was prevalence of VExUS grades and association with major adverse kidney events in the first 30 days after admission (MAKE-30) defined as a rise of ≥200 % in serum creatinine, use of renal replacement therapy or death.</div></div><div><h3>Results</h3><div>138 patients were included most of whom were male(67 %) with a median age of 67.5[56–75]. Prevalence of VExUS grade 2(8 %) and 3(4 %) was low and VExUS grades showed the most change within the first 72 h after ICU admission. VExUS grade ≥ 2 was strongly associated with MAKE-30 (OR 4.3 [95 % CI 1.2–20.7]), also when corrected for other variables. Lastly, VExUS showed moderate to excellent inter- and intra-rater agreement.</div></div><div><h3>Conclusions</h3><div>In critically ill patients the prevalence of VExUS 2 and 3 is low. VExUS is strongly associated with relevant patient outcomes and is a reliable tool in assessing venous congestion.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"88 ","pages":"Article 155097"},"PeriodicalIF":3.2,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143867821","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":"The prescribing patterns and effectiveness of sedatives and analgesics for severe traumatic brain injury patients in Taiwan","authors":"Sui-Sum Kung ,&nbsp;Shao-Yun Chien ,&nbsp;Fen-Fen Liao ,&nbsp;Yi-Hsin Yang ,&nbsp;Kun-Pin Hsieh","doi":"10.1016/j.jcrc.2025.155094","DOIUrl":"10.1016/j.jcrc.2025.155094","url":null,"abstract":"<div><h3>Background</h3><div>Traumatic brain injury (TBI) is a major global health challenge associated with high mortality and morbidity. Secondary brain injury caused by disrupted intracranial pressure (ICP) regulation often necessitates sedation; however, guidelines lack specificity for TBI management.</div></div><div><h3>Methods</h3><div>This study analyzed sedation and analgesia prescribing patterns and their outcomes in severe TBI patients in Taiwan using National Health Insurance Research Database data (2012–2019). Severe TBI patients intubated during intensive care unit (ICU) hospitalization were included. The primary outcome was 30-day all-cause mortality, with sensitivity analyses for 14-day mortality and 30-day all-cause mortality excluding deaths within 3 days. Inverse probability of treatment weighting (IPTW) was applied to balance patient characteristics across groups. Mortality rates across groups were evaluated using Kaplan-Meier survival analysis. At the same time, the Cox proportional hazards model simultaneously assessed the impact of various risk factors, such as age and comorbidities, on mortality.</div></div><div><h3>Results</h3><div>Among 6030 patients, sedation and analgesia patterns varied, with midazolam combined with opioids being the most common regimen. Compared to the reference group (sedatives with opioids), the risk of death was highest in the no-prescription group (HR = 2.73, 95 % CI = 2.60–2.86), followed by the sedation-only group (HR = 1.58, 95 % CI = 1.50–1.66) and the opioids-only group (HR = 1.49, 95 % CI = 1.42–1.57; all <em>p</em> &lt; 0.0001). Sensitivity analyses confirmed consistent trends.</div></div><div><h3>Conclusions</h3><div>These findings underscore the importance of optimizing sedation practices and enhancing awareness to improve outcomes for severe TBI patients.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"88 ","pages":"Article 155094"},"PeriodicalIF":3.2,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143874347","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: “Role of diaphragmatic dysfunction in extubation failure among patients at high risk of reintubation: A prospective cohort study”","authors":"Jie Zhang,&nbsp;Huiming Yao,&nbsp;All Authors","doi":"10.1016/j.jcrc.2025.155096","DOIUrl":"10.1016/j.jcrc.2025.155096","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"88 ","pages":"Article 155096"},"PeriodicalIF":3.2,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143864423","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":"Can extracorporeal CO2 removal facilitate ultraprotective ventilation in severe ARDS? A Latin American case series","authors":"Luis Alexander Peña-López ,&nbsp;Héctor Fabio Londoño Arcila ,&nbsp;Oscar Humberto Ruiz Serna ,&nbsp;Wilson Mauricio Lozano Franco ,&nbsp;Henry Mauricio Parada-Gereda ,&nbsp;David Ballesteros Castro","doi":"10.1016/j.jcrc.2025.155099","DOIUrl":"10.1016/j.jcrc.2025.155099","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"88 ","pages":"Article 155099"},"PeriodicalIF":3.2,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143867820","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":"Environmental sustainability in intensive care: An international survey of intensive care professionals‘views, practices and proposals to the European Society of Intensive Care Medicine","authors":"Katerina Iliopoulou ,&nbsp;Marc Leone ,&nbsp;Nicole Hunfeld ,&nbsp;Ricard Ferrer ,&nbsp;Heather Baid ,&nbsp;Marlies Ostermann ,&nbsp;Gaetano Scaramuzzo ,&nbsp;Hugo Touw ,&nbsp;Ana-Maria Ioan ,&nbsp;Maria Theodorakopoulou ,&nbsp;Guy Francois ,&nbsp;Jan J. De Waele","doi":"10.1016/j.jcrc.2025.155079","DOIUrl":"10.1016/j.jcrc.2025.155079","url":null,"abstract":"<div><h3>Background</h3><div>The intensive care unit (ICU) is a high-resource area, generating more waste and greenhouse gas (GHG) emissions than standard hospital wards. Environmental sustainability is important for healthcare professionals worldwide, prompting scientific societies to call for urgent action. To respond to this global need, the European Society of Intensive Care Medicine (ESICM) conducted an international survey assessing intensive care professionals' attitudes and practices towards environmental sustainability.</div></div><div><h3>Methods</h3><div>Intensive care professionals completed an online survey between 21 October 2023, and 5 January 2024. The survey, featuring 21 questions assessing attitudes and practices towards environmental sustainability and proposals for actions from ESICM, was disseminated during the 36th ESICM Congress via National Intensive Care Societies and ESICM's social media.</div></div><div><h3>Results</h3><div>We received 635 responses from 48 countries. Four hundred seventy (80 %) respondents acknowledged a responsibility to be aware of the environmental impact of intensive care practice, and 372 (63.5 %) disagreed or were uncertain about their knowledge level to guide practice. Four hundred thirty-seven (84 %) lacked formal training on making sustainable choices. Ninety-five per cent used non-sterile gloves in ICUs, and 63 % were willing to reduce use to support sustainable practices. Two proposed actions for ESICM to improve environmental sustainability were increasing knowledge on ecology (91/187, 49 %) and raising awareness in the field (36/187,20 %).</div></div><div><h3>Conclusion</h3><div>This survey highlighted the need for scientific societies, notably ESICM, to provide robust support and structured education on environmental sustainability. Intensive care professionals acknowledged the environmental impact of intensive care and seemed eager to invest in their education on this topic.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"88 ","pages":"Article 155079"},"PeriodicalIF":3.2,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143860029","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":"Low postoperative mitochondrial oxygen tension is an early marker of acute kidney injury after cardiac surgery: A prospective observational study","authors":"Bashar N. Hilderink ,&nbsp;Reinier F. Crane ,&nbsp;Sesmu M. Arbous ,&nbsp;Bas van den Bogaard ,&nbsp;Janesh Pillay ,&nbsp;Nicole P. Juffermans","doi":"10.1016/j.jcrc.2025.155088","DOIUrl":"10.1016/j.jcrc.2025.155088","url":null,"abstract":"<div><h3>Background</h3><div>Dissociation between the micro- and macrocirculation as well as the lack of specificity of current markers to signal impaired tissue oxygenation complicate the timely diagnosis and treatment of tissue hypoperfusion to prevent acute kidney injury (AKI) after cardiac surgery. The newly developed non-invasive technique to measure the mitochondrial oxygenation (mitoPO2) is currently the most downstream bedside marker of tissue oxygenation. The aim was to investigate mitoPO2 as an early marker of postoperative development of AKI.</div></div><div><h3>Methods</h3><div>In a prospective observational study, postoperative mitochondrial oxygen tension was measured to detect AKI (defined by KDIGO) in patients undergoing cardiac surgery.</div></div><div><h3>Results</h3><div>Of 50 included patients, 44 patients had analyzable mitoPO2 signal. 5 patients developed AKI. MitoPO2 at ICU admission was 16(13.8–24.6)mmHg in patients who developed AKI vs 63.4(37.5–77.9) mmHg in patients without AKI (<em>p</em> &lt; 0.001). MitoPO2 predicted AKI (ROC 0.95 (0.89–1.0) with an optimal cut-off value of 30 mmHg (OR 4.4, CI 2.8–6.0, p &lt; 0.001). Also, longer period of time under the mitoPO2 threshold predicted AKI with an AUROC of 0.91(0.80–1.00). In all patients, a decreased mitoPO2 occurred 4 h earlier than an clinically relevant increase in serum lactate. Other markers of tissue hypoperfusion, did not differ between patients with and without AKI.</div></div><div><h3>Conclusions</h3><div>A mitoPO2 value below 30 mmHg at ICU admission as well as the duration below this threshold indicate the development of AKI in cardiac surgery patients, occurring earlier than an increase in lactate above the normal range.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"88 ","pages":"Article 155088"},"PeriodicalIF":3.2,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143860030","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":"Early prediction of shock in intensive care unit patients by machine learning using discrete electronic health record data","authors":"Jacob C. Jentzer ,&nbsp;Shrinath Patel ,&nbsp;Ognjen Gajic ,&nbsp;Vitaly Herasevich ,&nbsp;Francisco Lopez-Jimenez ,&nbsp;Dennis H. Murphree ,&nbsp;Parag C. Patel ,&nbsp;Kianoush B. Kashani","doi":"10.1016/j.jcrc.2025.155093","DOIUrl":"10.1016/j.jcrc.2025.155093","url":null,"abstract":"<div><h3>Purpose</h3><div>To use machine learning to predict new-onset shock for at-risk intensive care unit (ICU) patients based on discrete vital sign data from the electronic health record.</div></div><div><h3>Methods and results</h3><div>We included 11,305 adult cardiac, medical, neurological, and surgical ICU patients who did not have shock within 4 h of ICU admission. We used routine vital sign data collected from the first 4 h of the ICU stay to predict new-onset shock within the subsequent 4 h. We compared logistic regression with machine learning models including elastic net, random forest, boosted trees and extreme gradient boosting (XGB). Median age was 64.0 years (44.5 % females). New-onset shock after 4 h developed in 483 (4.3 %) patients, and these patients had higher ICU (8.5 % vs. 1.9 %) and in-hospital (14.3 % vs. 5.0 %) mortality. Standard logistic regression had limited discrimination for new-onset shock, with the best single predictors being the maximum shock index and the minimum blood pressure during the second 2 h of the ICU stay. Discrimination in the validation cohort (<em>n</em> = 2826) was better for each ML model: elastic net, 0.76; boosted tree, 0.76; random forest, 0.79; XGB, 0.82; each model had ≥ 98 % negative predictive value. Accuracy was highest (81 %) with XGB, although positive predictive value was only 14 %. The XGB model also predicted in-hospital mortality with good discrimination.</div></div><div><h3>Conclusions</h3><div>Machine learning prediction models can achieve very good discrimination and accuracy for new-onset shock in ICU patients using vital sign data within 4 h after ICU admission.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"88 ","pages":"Article 155093"},"PeriodicalIF":3.2,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143854596","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":"Practice and ethical considerations surrounding donation after cardiac death from US and Europe","authors":"Shahla Siddiqui ,&nbsp;Valentin De Villiers de la Noue ,&nbsp;Olfa Hamzaoui ,&nbsp;Jan Bakker","doi":"10.1016/j.jcrc.2025.155092","DOIUrl":"10.1016/j.jcrc.2025.155092","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"88 ","pages":"Article 155092"},"PeriodicalIF":3.2,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143850505","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: “Reducing plastic waste in intensive care from longer use of intravenous administration and invasive monitoring sets: A before-and-after study”","authors":"Rupak Desai,&nbsp;Nirmala Manjappachar,&nbsp;Krishidhar Rao Nunna","doi":"10.1016/j.jcrc.2025.155084","DOIUrl":"10.1016/j.jcrc.2025.155084","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"88 ","pages":"Article 155084"},"PeriodicalIF":3.2,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143847478","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}