Journal of critical care最新文献

{"title":"Letter to the Editor: “Portal hypertension-like pattern in coronavirus disease 2019 acute respiratory distress syndrome”","authors":"Kashish Zehra Manjee, Aniqa Dejwani, Umaima Arif, Neeraj Kumar","doi":"10.1016/j.jcrc.2024.154941","DOIUrl":"10.1016/j.jcrc.2024.154941","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"85 ","pages":"Article 154941"},"PeriodicalIF":3.2,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142501228","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":"Protective effect of intravenous amino acid on kidney function: A systematic review and meta-analysis of randomized controlled trials","authors":"Wei Jiang ,&nbsp;Keran Shi ,&nbsp;Jun Shao ,&nbsp;Lin Song ,&nbsp;Ying Shi ,&nbsp;Haoran Wang ,&nbsp;Lulun Zhou ,&nbsp;Luanluan Li ,&nbsp;Yunfan Feng ,&nbsp;Jiangquan Yu ,&nbsp;Ruiqiang Zheng","doi":"10.1016/j.jcrc.2024.154937","DOIUrl":"10.1016/j.jcrc.2024.154937","url":null,"abstract":"<div><h3>Background</h3><div>Acute kidney injury (AKI) is a common complication in critically ill and cardiac surgery patients. Intravenous amino acids can increase renal perfusion and replenish renal functional reserves. However, the exact therapeutic efficacy of intravenous amino acids in reducing the incidence of AKI remains uncertain. Therefore, this study aims to comprehensively review the existing evidence to assess the potential of intravenous amino acids in kidney protection.</div></div><div><h3>Methods</h3><div>EMBASE, PubMed, MEDLINE, and the Cochrane Library were searched for randomized controlled trials published on or before July 2, 2024, that examined the relationship between Intravenous amino acids and renal function. We extracted population characteristics and outcome variables related to renal function from randomized controlled trials comparing intravenous amino acid supplementation with no supplementation. We assessed this evidence using the Risk of Bias 2 (RoB2) tool for randomized controlled trials. Data were synthesized using a random-effects model.</div></div><div><h3>Results</h3><div>This review included 7 randomized controlled trials with a total of 505 patients. The results showed that compared with the control group, intravenous amino acid administration significantly reduced the incidence of AKI (RR: 0.81, 95 % CI: 0.68–0.97, <em>P</em> = 0.02) and increased urine output (MD: 308.87, 95 % CI: 168.68–449.06, <em>P</em> &lt; 0.0001). However, intravenous amino acids did not reduce mortality or the incidence of kidney replacement therapy, with no statistical difference in 30-day mortality (RR: 0.93, 95 % CI: 0.65–1.34, <em>P</em> = 0.71), 90-day mortality (RR:1.00, 95 % CI: 0.77–1.29, <em>P</em> = 0.98), or need for kidney replacement therapy (RR: 0.92, 95 % CI: 0.41–2.06, <em>P</em> = 0.83). Subgroup analysis suggested that, regardless of sample size, intravenous amino acid administration reduced the incidence of AKI and was particularly significant in patients undergoing cardiac and major vascular surgery. Furthermore, intraoperative intravenous amino acid therapy demonstrated a significant reduction in the incidence of AKI compared to postoperative administration.</div></div><div><h3>Conclusions</h3><div>Intravenous amino acids protect renal function in patients at high risk of AKI, particularly after cardiac surgery. It reduces the incidence of AKI and increases urine output, but has no significant effect on KRT and mortality.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"85 ","pages":"Article 154937"},"PeriodicalIF":3.2,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142501229","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":"Impact of mild hypercapnia in critically ill patients with metabolic acidosis","authors":"Ary Serpa Neto ,&nbsp;Ahmad Nasser ,&nbsp;Prashanti Marella ,&nbsp;Tomoko Fujii ,&nbsp;Kazunari Takahashi ,&nbsp;Kevin Laupland ,&nbsp;Alexis Tabah ,&nbsp;Antony G. Attokaran ,&nbsp;Aashish Kumar ,&nbsp;James McCullough ,&nbsp;Kiran Shekar ,&nbsp;Peter Garrett ,&nbsp;Sebastiaan Blank ,&nbsp;Siva Senthuran ,&nbsp;Stephen Luke ,&nbsp;Mairead McNamara ,&nbsp;Rinaldo Bellomo ,&nbsp;Kyle White ,&nbsp;on behalf of the Queensland Critical Care Research Network (QCCRN) and the SODa-BIC investigators","doi":"10.1016/j.jcrc.2024.154936","DOIUrl":"10.1016/j.jcrc.2024.154936","url":null,"abstract":"<div><h3>Purpose</h3><div>Clinical trials focusing on critically ill patients with metabolic acidosis, a common exclusion criterion is the presence of a PaCO₂ &gt; 45 mmHg. The aim of this study was to assess the impact of mild hypercapnia on patient characteristics, severity, and clinical outcomes in critically ill patients with metabolic acidosis.</div></div><div><h3>Material and methods</h3><div>Multicentre, retrospective, observational study conducted in 12 intensive care units (ICUs) in Queensland, Australia. Patients with metabolic acidosis and concurrent vasopressor requirement were included and the exposure of interest was the PaCO₂ level at the time of meeting the eligibility criteria divided in two groups: PaCO₂ ≤ 45 mmHg and PaCO₂ 46–50 mmHg. Primary clinical outcome was major adverse kidney events within 30 days (MAKE30).</div></div><div><h3>Results</h3><div>We studied 5601 patients, with 3605 (64.4 %) in the PaCO₂ ≤ 45 mmHg group and 1996 (35.6 %) in the PaCO₂ 46–50 mmHg group. The incidence of MAKE30 was lower in the PaCO₂ 46–50 mmHg group (29 % vs. 34 %; OR, 0.79 [95 %CI, 0.69 to 0.90]; <em>p</em> &lt; 0.001) as was the use of renal replacement therapy, and the incidence of acute kidney injury. After adjustment for confounders, no outcome was different between the groups. The maximum fall of pH associated with an increase of 1 mmHg of PaCO₂ in the PaCO₂ 46–50 mmHg group was 0.006.</div></div><div><h3>Conclusion</h3><div>In patients with metabolic acidosis, after adjustment for potential confounders, mild hypercapnia does not increase the MAKE-30 rate and does not have a major impact on pH.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"85 ","pages":"Article 154936"},"PeriodicalIF":3.2,"publicationDate":"2024-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142466614","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":"Clinical phenotyping of septic shock with latent profile analysis: A retrospective multicenter study","authors":"Guanghao Liu ,&nbsp;Ruoqiong Wu ,&nbsp;Jun He ,&nbsp;Yichang Xu ,&nbsp;Li Han ,&nbsp;Yingying Yu ,&nbsp;Haibo Zhu ,&nbsp;Yehan Guo ,&nbsp;Hao Fu ,&nbsp;Ting Chen ,&nbsp;Shixiang Zheng ,&nbsp;Xiaopei Shen","doi":"10.1016/j.jcrc.2024.154932","DOIUrl":"10.1016/j.jcrc.2024.154932","url":null,"abstract":"<div><h3>Background</h3><div>Septic shock (SS) is a highly fatal and heterogeneous syndrome. Identifying distinct clinical phenotypes provides valuable insights into the underlying pathophysiological mechanisms and may help to propose precise clinical management strategies.</div></div><div><h3>Methods</h3><div>Latent profile analysis (LPA), a model-based unsupervised method, was used for phenotyping in the MIMIC cohort, and the model was externally independently validated in the eICU and AUMC cohorts.</div></div><div><h3>Results</h3><div>Three phenotypes, labeled phenotype I, II, and III, were derived. These phenotypes varied in demographics, clinical features, comorbidities, patterns of organ dysfunction, organ support, and prognosis. Phenotype I, characterized by the most severe organ dysfunction (especially liver), the youngest age, and the highest BMI, had the highest mortality (<em>p</em> &lt; 0.001). Phenotype II, with moderate mortality, was characterized by severe renal injury. In contrast, phenotype III, associated with the oldest age and the fewest comorbidities, exhibited significantly lower mortality. Phenotype I patients had the steepest survival curves and demonstrated an ultra-high risk of death, particularly within the first few days after SS onset.</div></div><div><h3>Conclusions</h3><div>The individualized identification of phenotypes is well suited to clinical practice. The three SS phenotypes differed significantly in pathophysiological and clinical outcomes, which are crucial for informing management decisions and prognosis.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"85 ","pages":"Article 154932"},"PeriodicalIF":3.2,"publicationDate":"2024-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142466613","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":"Vasopressor utilization in septic shock patients receiving propofol versus midazolam","authors":"Brittany R. Weger,&nbsp;Shannon Marie Carabetta,&nbsp;Lindsey Gignac,&nbsp;Sarah Hayes,&nbsp;J. Totty Johnson","doi":"10.1016/j.jcrc.2024.154935","DOIUrl":"10.1016/j.jcrc.2024.154935","url":null,"abstract":"<div><h3>Purpose</h3><div>The purpose of this study was to evaluate the effect of propofol versus midazolam on vasopressor requirements in patients with septic shock to better guide sedative selection.</div></div><div><h3>Methods</h3><div>This was a multicenter, retrospective, observational, IRB-approved, non-inferiority cohort study. Included individuals were ≥ 18 years of age, had a diagnosis of septic shock, and exclusive administration of propofol or midazolam for at least 12 h. The primary outcome was maximum increase in vasopressor requirements within the first 12 h following sedative initiation.</div></div><div><h3>Results</h3><div>For the primary outcome of maximum increase in norepinephrine equivalents (NEE) within 12 h, propofol was non-inferior to midazolam (0.09 vs. 0.129 μg/kg/min, <em>p</em> = 0.002). No difference was seen between the propofol and midazolam groups for the secondary outcome of maximum increase in NEE within 3 h (0.02 vs 0.04 μg/kg/min, <em>p</em> = 0.208), however, the propofol group had a significantly lower increase within 6 h (0.06 vs 0.086 μg/kg/min, <em>p</em> = 0.043) and 24 h (0.11 vs 0.25 μg/kg/min, <em>p</em> = 0.013).</div></div><div><h3>Conclusion</h3><div>In patients with septic shock, vasopressor requirement increases with propofol were non-inferior to midazolam within the first 12 h.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"85 ","pages":"Article 154935"},"PeriodicalIF":3.2,"publicationDate":"2024-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142466562","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":"Intensivists' ethical perceptions about decisions to withhold or withdraw treatment: A clinical ethics empirical investigation","authors":"Marta Spranzi PhD ,&nbsp;Sarah Morinet MD ,&nbsp;Nicolas Foureur MD","doi":"10.1016/j.jcrc.2024.154931","DOIUrl":"10.1016/j.jcrc.2024.154931","url":null,"abstract":"<div><h3>Background</h3><div>Intensive care professional societies have issued policy recommendations regarding decisions to withhold and/or withdraw treatment (Wh&amp;Wd) that consistently classify them as ethically equivalent and ethically neutral. However, on the ground they are often perceived as “active” and morally problematic. Moreover, recent studies have highlighted personal “variability” in the way such decisions are made. Therefore, it seemed necessary to explore intensivists' different ethical perceptions about Wh&amp;Wd decisions.</div></div><div><h3>Methods</h3><div>A qualitative retrospective and multicentered study was conducted in seven intensive care units belonging to the Paris Hospital Trust (AP-HP), which involved in-depth interviews with 44 intensivists of different ages and levels of professional experience. An inductive (“grounded theory”-inspired), multidisciplinary clinical ethics approach was used that aimed at eliciting and retrieving practitioners' ethical intuitions about different Wh&amp;Wd decisions. Interview transcripts were analyzed using a “thematic analysis” approach.</div></div><div><h3>Results</h3><div>Practitioners' perceptions of Wh&amp;Wd decisions vary along two continuous dimensions: active/passive and ethically problematic/unproblematic. Three groups have been identified: those who consider Wh&amp;Wd decisions 1) as passive and unproblematic, 2) as active and problematic, and 3) as active and unproblematic. More interestingly, these groups can be differently characterized with respect to three other ethically relevant considerations: the role of consensus during the collegial decision-making procedure, the difference between withholding and withdrawing decisions, and the definition of one's own overarching professional goal.</div></div><div><h3>Conclusion</h3><div>The study results allow for recognition of intensivists' moral distress about Wh&amp;Wd decisions and open new perspectives to deal with their deep-rooted variability, most notably by working on the rationale and format of the collegial decision-making procedure.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"85 ","pages":"Article 154931"},"PeriodicalIF":3.2,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142466615","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":"Ultrasound assessment of muscle mass in critically ill patients: A correlation with nutritional support and clinical outcomes","authors":"Maria Leonor Guia Lopes ,&nbsp;José Pedro Cidade ,&nbsp;David Sousa ,&nbsp;Marta Rebelo ,&nbsp;Carolina Antunes ,&nbsp;Eduarda Carmo ,&nbsp;Pedro Póvoa ,&nbsp;Pais Martins ,&nbsp;Clotilde Limbert ,&nbsp;João Sequeira Duarte","doi":"10.1016/j.jcrc.2024.154938","DOIUrl":"10.1016/j.jcrc.2024.154938","url":null,"abstract":"<div><h3>Background</h3><div>Critically ill patients are at high risk of Intensive Care Unit (ICU) Acquired weakness, which negatively impacts clinical outcomes. Traditional muscle mass and nutritional status assessments are often impractical in the ICU. Ultrasound offers a promising, non-invasive alternative. This study evaluates the relationship between ultrasound-based muscle assessments, patients' nutritional support, and clinical outcomes in the ICU.</div></div><div><h3>Methods</h3><div>A prospective cohort study was conducted in three ICUs of a tertiary center. Daily nutritional intake, ultrasound measurements of the quadriceps muscle (rectus femoris cross-sectional area – RFCSA – and quadriceps muscle layer thickness - QMLT), and clinical data were collected on days 1, 3, and 7 of ICU.</div></div><div><h3>Results</h3><div>A total of 128 patients were included in the analysis, with a mean age of 65.4 (±18.1) years and a median ICU stay of 6 (4–10) days. QMLT decreased by 5 % and 13 %, and RFCSA decreased by 10 % and 27 % on days 3 and 7, respectively. A significant correlation was found between lower caloric and protein intake and greater muscle mass loss within the initial 3 days of ICU admission. Multivariate logistic regression indicated that QMLT reduction significantly contributed to 28-day mortality (adjusted OR 1.088, 95 % CI: 1.018–1.113, <em>p</em> = 0.015). Lower daily caloric and protein intake was depicted in non-surviving patients (<em>p</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>Our study demonstrates that critically ill patients experience significant muscle mass loss within the first 72 h of ICU. QMLT reduction significantly impacts 28-day mortality, with an 8.8 % increase in the odds of death per 0.1 cm reduction.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"85 ","pages":"Article 154938"},"PeriodicalIF":3.2,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142466561","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":"Quadriceps Muscle Layer Thickness and its association with frailty in critically ill patients: A prospective observational study","authors":"Vijay Sundarsingh ,&nbsp;R. Manoj Kumar ,&nbsp;Manjunath Kulkarni ,&nbsp;Debasis Pradhan ,&nbsp;Pramela Renisha Rodrigues ,&nbsp;Nishanth Baliga ,&nbsp;Mamata Prasad ,&nbsp;Pooja Yadav ,&nbsp;Monish Thomas ,&nbsp;Tania Eltrida Pinto","doi":"10.1016/j.jcrc.2024.154930","DOIUrl":"10.1016/j.jcrc.2024.154930","url":null,"abstract":"<div><h3>Background</h3><div>Frailty is a well-recognized clinical entity known to influence the outcomes of critically ill patients. Muscle ultrasound, particularly Quadriceps Muscle Layer Thickness (QMLT), assesses muscle mass, which is a key component determining frailty. However, no studies have assessed the association between frailty and QMLT. This study aimed to determine the association between the QMLT and frailty in critically ill elderly patients.</div></div><div><h3>Method</h3><div>In this prospective, observational, single-center study conducted in an ICU in India, patients aged &gt;65 years were enrolled. Baseline frailty was assessed using the Clinical Frailty Scale (CFS). Quadriceps muscle thickness was measured via axial cross-section ultrasound at admission. Patients were categorized as non-frail (CFS 1–4) and frail (CFS ≥5), and their characteristics were compared. Multivariate regression analysis was used to identify factors associated with frailty.</div></div><div><h3>Results</h3><div>120 patients were included. The median APACHE II and SOFA scores were 19 [IQR 14.25–23] and 4.5 [IQR 3–6], respectively. The median age was 75 years [IQR 70–82]; 62.5 % were male. The most common comorbidities were diabetes mellitus (60 %) and hypertension (59 %). 65 % were mechanically ventilated. 65 % of patients were frail. Frail patients had higher mortality (37.17 % vs. 16.66 %, <em>p</em> = 0.022). QMLT was lesser in frail than non-frail (1.77 cm vs 2.21 cm, <em>p</em> &lt; 0.001). QMLT decreased with an increase in CFS (p &lt; 0.001). Frail and non-frail patients were further divided into four groups based on the median QMLT (1.96 cm). Frail patients with QMLT below the median had a higher 28-day mortality than non-frail and frail patients with QMLT above the median (48.97 % vs. 16.12 % vs. 18.18 % vs. 17.24 %, <em>p</em> = 0.003). Frailty was independently associated with increasing age (OR, 1.14; 95 % CI: 1.055–1.231, <em>p</em> = 0.001), higher APACHE II score (OR, 1.078; 95 % CI: 1.009–1.151, <em>p</em> = 0.025), and lower QMLT (OR, 0.205; 95 % CI: 0.083–0.509, p = 0.001).</div></div><div><h3>Conclusions</h3><div>We found an independent association between Quadriceps Muscle Layer Thickness (QMLT) and frailty. QMLT decreased progressively with CFS scores. Frail patients with lower QMLT had increased 28-day mortality. These findings highlight the role of incorporating QMLT measurements along with CFS in frailty evaluations to improve decision-making in critically ill elderly patients.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"85 ","pages":"Article 154930"},"PeriodicalIF":3.2,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142466560","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":"Association between the development of intensive care unit-acquired weakness and body composition at intensive care unit admission: A descriptive study","authors":"Yoshito Yabe ,&nbsp;Akira Komori ,&nbsp;Hiroki Iriyama ,&nbsp;Kazuto Ikezawa ,&nbsp;Toshikazu Abe","doi":"10.1016/j.jcrc.2024.154933","DOIUrl":"10.1016/j.jcrc.2024.154933","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate differences in body composition at intensive care unit (ICU) admission between patients with and without ICU-acquired weakness (ICU-AW).</div></div><div><h3>Materials and methods</h3><div>This single-center, retrospective cohort study was conducted at Tsukuba Memorial Hospital's mixed ICU in Japan. We included patients who could walk unassisted before admission, received rehabilitation post-admission, and survived for at least 48 h. Body composition was assessed using bioelectrical impedance analysis (BIA) at ICU admission. Patients were classified into ICU-AW and non-ICU-AW groups, and their characteristics, outcomes, and body compositions were compared.</div></div><div><h3>Results</h3><div>Of the 282 patients analyzed, 28 (9.9 %) developed ICU-AW. ICU-AW patients were older (79 [72–86] vs. 70 [61–77], <em>P</em> &lt; 0.01) and had higher SOFA scores (8 [5–13][ vs. 3 [2–6], <em>P</em> &lt; 0.01). BIA showed a higher extracellular water to total body water ratio (0.408 [0.391–0.414] vs. 0.388 [0.380–0.400], <em>P</em> &lt; 0.01) and a lower phase angle (3.7 [3.3–4.9] vs. 4.9 [4.2–5.7], <em>P</em> &lt; 0.01) in the ICU-AW group. Skeletal muscle mass was similar between groups (23.2 [18.9–26.0] vs. 24.8 [20.5–28.3], <em>P</em> = 0.07).</div></div><div><h3>Conclusions</h3><div>ICU-AW patients had poorer cellular nutritional status but similar skeletal muscle mass at ICU admission compared to non-ICU-AW patients.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"85 ","pages":"Article 154933"},"PeriodicalIF":3.2,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142466612","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":"Clinician assessment of kidney function from plasma creatinine values during critical illness: A scenario-based international multi-professional survey","authors":"Giada Azzopardi ,&nbsp;Ayah Mekhaimar ,&nbsp;Ryan W. Haines ,&nbsp;Timothy J. Stephens ,&nbsp;Zudin Puthucheary ,&nbsp;John R. Prowle","doi":"10.1016/j.jcrc.2024.154926","DOIUrl":"10.1016/j.jcrc.2024.154926","url":null,"abstract":"<div><h3>Purpose</h3><div>During critical illness interpretation of serum creatinine is affected by non-steady state conditions, reduced creatinine generation, and altered distribution. We evaluated healthcare professionals' ability to adjudicate underlying kidney function, based on simulated creatinine values.</div></div><div><h3>Methods</h3><div>We developed an online survey, incorporating 12 scenarios with simulated trajectories of creatinine based on profiles of muscle mass, GFR and fluid balance using bespoke kinetic modelling. Participants predicted true underlying GFR (&lt;5, 5–14, 15–29, 30–44, 45–59, 60–90, &gt;90 ml.min⁻¹.1.73 m⁻²) and AKI stage (stages 1–3, defined as 33 %, 50 %, 66 % decrease in GFR from baseline) during the first 7-days and at ICU discharge.</div></div><div><h3>Results</h3><div>100 of 103 respondents from 16 countries, 94 completed 1 or more scenarios. 43(43 %) were senior physicians, 74(74 %) critical care and 31(31 %) nephrology physicians. Over the first 7-days, true GFR was correctly estimated 43 % of the time and underlying AKI stage in 57 % of patient days. At ICU discharge GFR was predicted 35 % of the time. At all timepoints, over and under-estimation of GFR was observed.</div></div><div><h3>Conclusion</h3><div>Participants displayed marked variation in estimation of kidney function, suggesting difficulty in accounting for multiple confounders. There is need for alternative, unbiased measures of kidney function in critical illness to avoid misclassifying kidney disease.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"85 ","pages":"Article 154926"},"PeriodicalIF":3.2,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142444846","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}