Journal of critical care最新文献

{"title":"Evaluating extreme temperature values and patient outcomes in aneurysmal subarachnoid hemorrhage: Post-hoc insights from the Earlydrain trial","authors":"David Wasilewski MD ,&nbsp;Peter Truckenmueller MD ,&nbsp;Anton Früh MD, MSc ,&nbsp;Peter Vajkoczy MD ,&nbsp;Stefan Wolf MD ,&nbsp;the Earlydrain Study Group","doi":"10.1016/j.jcrc.2025.155104","DOIUrl":"10.1016/j.jcrc.2025.155104","url":null,"abstract":"<div><h3>Purpose</h3><div>Dysregulation of temperature in aneurysmal subarachnoid hemorrhage (aSAH) patients may worsen neurological outcomes. Fever and hypothermia could be related to infection, inflammation, or loss of central temperature control. However, longitudinal studies on temperature extremes and outcomes are lacking. This post-hoc analysis of the Earlydrain trial examines the prognostic significance of body temperature during the first 8 days of neurocritical care.</div></div><div><h3>Methods</h3><div>We analyzed data from 287 patients, using Generalized Estimating Equations to investigate clinically used thresholds for intervention on body temperature. Statistical models were adjusted for hemorrhage severity, age, intracerebral and intraventricular hemorrhage, infection and the use of a lumbar drainage. We assessed the impact of different temperature thresholds on the modified Rankin Scale (mRS) at 180 days and the incidence of secondary infarctions.</div></div><div><h3>Results</h3><div>Extreme temperatures were associated with worse 180-day outcomes. In univariate analysis, all investigated temperature thresholds (&gt;38.0 °C, &gt;38.2 °C, &gt; 39.0 °C, as well as &lt;36.0 °C) were associated with worse outcome. In multivariate analysis, temperatures above 39 °C and below 36 °C increased the odds of an unfavorable mRS &gt;2 (OR_adj = 2.60, <em>p</em> = 0.002 and OR_adj = 3.82, <em>p</em> = 0.02, respectively). The development of secondary infarctions was not significantly related to temperature extremes.</div></div><div><h3>Conclusion</h3><div>Extreme temperature values significantly influence outcomes in aSAH. Maintaining normothermia may improve prognosis, warranting prospective studies for targeted temperature management.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"89 ","pages":"Article 155104"},"PeriodicalIF":3.2,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143912845","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":"Failure to achieve pharmacodynamic targets in critically Ill COVID-19 patients receiving antibiotics: A hypothesis-generating secondary analysis from the DOLPHIN study","authors":"Johanna M. de Jonge ,&nbsp;Wim J.R. Rietdijk ,&nbsp;Alan Abdulla ,&nbsp;Moska Hassanzai ,&nbsp;Chantal A. Boly ,&nbsp;Birgit C.P. Koch ,&nbsp;Henrik Endeman","doi":"10.1016/j.jcrc.2025.155102","DOIUrl":"10.1016/j.jcrc.2025.155102","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"89 ","pages":"Article 155102"},"PeriodicalIF":3.2,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143907477","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":"Sepsis on dementia risk: A population-based cohort study with dose-dependent analysis","authors":"Mingyang Sun ,&nbsp;Fangfang Li ,&nbsp;Yangyang Wang ,&nbsp;Mengrong Miao ,&nbsp;Zhongyuan Lu ,&nbsp;Wan-Ming Chen ,&nbsp;Szu-Yuan Wu ,&nbsp;Jiaqiang Zhang","doi":"10.1016/j.jcrc.2025.155100","DOIUrl":"10.1016/j.jcrc.2025.155100","url":null,"abstract":"<div><h3>Purpose</h3><div>Emerging evidence links sepsis-related inflammation to dementia risk, but the dose-dependent effects of recurrent sepsis episodes remain unclear. This study assessed whether sepsis increases dementia risk and explored a potential dose-response relationship between sepsis frequency and dementia.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study using Taiwan's National Health Insurance Research Database (2005–2022), enrolling patients aged ≥18 years hospitalized with sepsis. An index period (2008–2013) was used to identify patients without prior dementia. A fixed 12-month landmark period (calendar year 2014) was applied to assess the number of sepsis episodes. Patients who died during the landmark period were excluded. Propensity score matching was performed to generate well-balanced sepsis and non-sepsis groups. Follow-up for dementia and mortality began after the landmark period and continued for up to 64 months. Cox and Fine-Gray models were used to account for competing risks of death.</div></div><div><h3>Results</h3><div>Sepsis was associated with a significantly increased risk of all-cause dementia (HR 1.59; 95 % CI, 1.47–1.72; <em>P</em> &lt; 0.0001). A dose-response relationship was observed: patients with multiple sepsis episodes had the highest dementia risk (sHR 1.63; 95 % CI, 1.39–1.91). Vascular dementia showed the strongest association, with a higher incidence in the sepsis group (1.2 % vs. 0.6 %, <em>P</em> = 0.0003).</div></div><div><h3>Conclusions</h3><div>Our findings provide robust evidence of a dose-dependent association between sepsis and increased dementia risk, particularly vascular dementia, even after adjusting for competing mortality risks.</div></div><div><h3>Summary</h3><div>This study addresses the limitations of previous research by not only employing propensity score matching (PSM) to balance confounding factors between the sepsis and non-sepsis groups but also using an index period and landmark period design to better explore potential causal relationships. These periods ensure that dementia onset occurred after sepsis and allow for the examination of dose-response relationship between sepsis episode frequency and dementia. Furthermore, this is the largest study to date involving sepsis patients, providing more robust evidence than prior studies, which were often smaller and lacked adjustments for competing risks of death.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"89 ","pages":"Article 155100"},"PeriodicalIF":3.2,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143902233","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":"Moving beyond monitoring in critical care ultrasound","authors":"Michael J. Lanspa","doi":"10.1016/j.jcrc.2025.155098","DOIUrl":"10.1016/j.jcrc.2025.155098","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"88 ","pages":"Article 155098"},"PeriodicalIF":3.2,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143886952","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: \"Predicting a strongly positive fluid balance in critically ill patients with acute kidney injury: A multicentre, international study\"","authors":"Jiangan Guan,&nbsp;Yu Hu,&nbsp;Yao Huang,&nbsp;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 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":"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":"Letter to the Editor: “ Role of diaphragmatic dysfunction in extubation failure among patients at high risk of reintubation: A prospective cohort study”","authors":"Mina Adolf Helmy,&nbsp;Lydia Magdy Milad","doi":"10.1016/j.jcrc.2025.155095","DOIUrl":"10.1016/j.jcrc.2025.155095","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"88 ","pages":"Article 155095"},"PeriodicalIF":3.2,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143844846","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":"Lesson learnt from implementing a CRRT reimbursement program in a resource-limited setting","authors":"Prit Kusirisin ,&nbsp;Sadudee Peerapornratana ,&nbsp;Jiratorn Sutawong ,&nbsp;Yot Teerawattananon ,&nbsp;Nattachai Srisawat","doi":"10.1016/j.jcrc.2025.155089","DOIUrl":"10.1016/j.jcrc.2025.155089","url":null,"abstract":"<div><div>Acute kidney injury (AKI) poses significant risks, including high mortality and progression to chronic kidney disease. Effective treatment modalities include peritoneal dialysis (PD), intermittent hemodialysis (IHD), sustained low-efficiency dialysis (SLED), and continuous renal replacement therapy (CRRT). While each modality has specific advantages, CRRT is particularly vital for critically ill patients with severe AKI and contraindications for IHD. Despite its clinical benefits, the high cost of CRRT presents challenges, especially in resource-limited settings like Thailand.</div><div>This manuscript reviews the process of integrating CRRT into Thailand's Universal Coverage Scheme (UCS). Initial proposals in 2017 highlighted CRRT's importance, yet its high costs posed barriers to inclusion. A rigorous policy development process, emphasizing evidence-based and participatory decision-making, led to the proposal's acceptance in 2018. Key recommendations included optimizing reimbursement rates and increasing budget allocations.</div><div>By 2022, CRRT reimbursement was incorporated into the UCS, significantly improving access to treatment for patients with AKI. Specific outcomes from our 2-year policy implementation, including patient outcomes such as mortality, renal recovery, length of hospital stay, and complications, as well as cost-saving outcomes reflecting the need for intensive care resources, are ongoing. These cost-benefit analyses, along with policy adjustments, are necessary to ensure continued equitable and effective treatment. This case underscores the importance of aligning reimbursement strategies with clinical needs and financial realities to enhance both healthcare outcomes and system sustainability.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"88 ","pages":"Article 155089"},"PeriodicalIF":3.2,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143833972","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":"Profiles of the patients admitted to intermediate care units in France: Admission criteria appropriateness and potential outcome benefits (UNISURC project part 2)","authors":"Marc Beaussier ,&nbsp;Bertrand Guidet ,&nbsp;Philippe Aegerter ,&nbsp;Christophe Baillard ,&nbsp;Rym Boulkedid ,&nbsp;Mathieu Desmard ,&nbsp;Dominique Pateron ,&nbsp;Lionelle Nkam ,&nbsp;Benoît Misset ,&nbsp;UNISURC Investigators","doi":"10.1016/j.jcrc.2025.155078","DOIUrl":"10.1016/j.jcrc.2025.155078","url":null,"abstract":"<div><h3>Background</h3><div>The added value of Intermediate Care Units (IMCUs) remains controversial. This prospective, multicenter, observational cohort study aimed to: identify the characteristics of patients admitted and evaluate the appropriateness of IMCU stays according to criteria previously established in the UNISURC study; and describe the hospital trajectories and outcomes of patients admitted to IMCUs or not.</div></div><div><h3>Methods</h3><div>Data were collected from 12 IMCUs in seven French hospitals. All patients admitted to the IMCU from the emergency department, after intensive care unit discharge (post-ICU) or post-surgery were followed for 7 days following study inclusion. Primary and secondary outcome measures were: mortality rate over 7 days post-inclusion, demographic characteristics, IMCU-admission criteria, nursing workload assessed with the Nine Equivalents of nursing Manpower Score (NEMS).</div></div><div><h3>Results</h3><div>Among 437 enrolled patients, 398 were analyzed, 260 of whom were admitted to IMCUs. IMCU-admission criteria were in close accordance with previous Delphi-survey selection items (56/63 items used). For emergency department, post-ICU and post-operative trajectories, respectively, median [IQR] SAPS II at IMCU entry were: 17 [12–24], 32 [26–53] and 19 [13–25] (<em>p</em> &lt; 0.05), with respective NEMS of 16 [14–27], 15 [9–21] and 18 [15–21] (<em>p</em> = 0.071). Crude total 7-day mortality of patients with an IMCU stay was 13/260 (5 %), compared to 15/138 (10.8 %) of those without (<em>p</em> = 0.048).</div></div><div><h3>Conclusion</h3><div>These observations provide a rationale supporting the contribution of IMCU implementation in hospitals caring for patients requiring critical-care trajectories.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"88 ","pages":"Article 155078"},"PeriodicalIF":3.2,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143833974","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}