Journal of critical care最新文献

{"title":"Letter to the Editor: “Evaluating extreme temperature values and patient outcomes in aneurysmal subarachnoid hemorrhage: Post-hoc insights from the Earlydrain trial”","authors":"Ghazaleh Homaghostar , Ehsan Alimohammadi","doi":"10.1016/j.jcrc.2025.155143","DOIUrl":"10.1016/j.jcrc.2025.155143","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"89 ","pages":"Article 155143"},"PeriodicalIF":3.2,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144263394","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: “A pilot feasibility study of continuous cardiac output and blood pressure monitoring during intermittent hemodialysis in patients recovering from severe acute kidney injury”","authors":"Sofia Spano , Emily See","doi":"10.1016/j.jcrc.2025.155141","DOIUrl":"10.1016/j.jcrc.2025.155141","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"89 ","pages":"Article 155141"},"PeriodicalIF":3.2,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144240765","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":"Strategic analysis of apnea testing to determine brain death with PaCO2 and pH targets in China: A multi-center retrospective study","authors":"Xintong Zhang ,&nbsp;Chen Chen ,&nbsp;Chao Sun ,&nbsp;Yuying Su ,&nbsp;Ju Qiu ,&nbsp;Min Du ,&nbsp;Man Xia ,&nbsp;Yajuan Hu","doi":"10.1016/j.jcrc.2025.155136","DOIUrl":"10.1016/j.jcrc.2025.155136","url":null,"abstract":"<div><h3>Background</h3><div>Brain death (BD) means the irreversible loss of whole brain function. Apnea testing (AT) is crucial when determining BD. AT criteria has been updated to combine PaCO₂ and pH rather than an individual PaCO₂ target. In this study, we aimed to explore the influencing factors of AT under the new standard to reduce non-diagnostic results and complications.</div></div><div><h3>Method</h3><div>Data were retrieved from five hospitals from 2018 to 2023 in China. Samples were grouped based on AT duration, temperature, pre-PaCO₂, oxygenation index (OI, PaO₂/FiO₂) respectively to compare. Multivariate linear regression analysis analysis was used to identify related clinical indicators.</div></div><div><h3>Results</h3><div>We included 620 BD patients that underwent AT. Diagnostic rate for dual AT targets was 92.4 %, which is 3.4 % lower than that under conventional criteria. Diagnostic rate no longer improved for AT duration (time disconnected from the ventilator) that lasted longer than 9 min (χ² = 0.049, <em>p</em> = 0.826), but the incidence of severe hypercapnia (PaCO₂ &gt; 80 mmHg) and severe acidosis (pH &lt; 7.10) increased. The pre-PaCO₂ ≥ 40 mmHg group had shorter required durations (<em>p</em> = 0.029), and higher diagnostic rate (<em>p</em> = 0.041) than pre-PaCO₂ &lt; 40 mmHg group. The duration could last significantly longer in OI ≥200 than OI &lt; 200 group (8.675 ± 0.077 min vs. 8.063 ± 0.165 min; <em>p</em> &lt; 0.001). Weight, heart rate baseline, pre-pH, pre-PaCO₂ and duration were related to the final PaCO₂ and pH.</div></div><div><h3>Conclusion</h3><div>For most patients, 7–9 min of AT duration is appropriate to reach dual diagnostic targets. Modulating the baseline level of PaCO₂ (≥40 mmHg), pH and OI (≥200) can help reduce non-diagnostic results and improve the safety of AT implementation.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"89 ","pages":"Article 155136"},"PeriodicalIF":3.2,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144230989","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":"Effect of music intervention on anxiety in critically ill patients, a meta-analysis of randomized controlled trials","authors":"Muhammad Saqib ,&nbsp;Asia Batool ,&nbsp;Qurat Ul Ain Iftikhar ,&nbsp;Makhzan Ali Akbar ,&nbsp;Faiza Hayat Qadri ,&nbsp;Kanz Ul Eman Maryam ,&nbsp;Syeda Alishba Zahra Naqvi ,&nbsp;Asiya Najam Ul Haq ,&nbsp;Fareeha Hasan","doi":"10.1016/j.jcrc.2025.155133","DOIUrl":"10.1016/j.jcrc.2025.155133","url":null,"abstract":"<div><div>Music therapy has been explored as a non-pharmacological intervention for anxiety in critically ill patients, but its effectiveness remains unclear. This meta-analysis synthesized evidence from five randomized controlled trials (RCTs) involving 325 participants. A comprehensive literature search across PubMed, Embase, and Cochrane databases ensured the inclusion of high-quality studies published between 2010 and 2025. Music therapy sessions ranged from 15 to 30 min. Anxiety was assessed using validated measures, and data were analyzed with a random-effects model to calculate the mean difference (MD) in anxiety scores with 95 % confidence intervals (CI). Heterogeneity was evaluated using the I2 statistic, and sensitivity analyses were conducted to address potential bias.</div><div>The pooled analysis found an MD of −1.11 (95 % CI: −12.97 to 10.75, <em>p</em> = 0.85; I2 = 99 %), showing no significant anxiety reduction. Heterogeneity was substantial. A sensitivity analysis, excluding two influential studies, reduced heterogeneity (I2 = 30 %) but still showed no significant effect (MD = 0.69, 95 % CI: −2.15 to 3.53, <em>p</em> = 0.63). A funnel plot suggested possible publication bias, but the limited number of studies hindered formal assessment.</div><div>Overall, current evidence does not support music therapy as an effective stand-alone intervention for anxiety reduction in critically ill patients. Further research with standardized protocols and larger sample sizes is necessary to clarify its role in critical care settings.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"89 ","pages":"Article 155133"},"PeriodicalIF":3.2,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144230863","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: “What every intensivist should know about type D hyperlactatemia”","authors":"Julien Moury ,&nbsp;Thibault Gennart ,&nbsp;Sydney Blackman ,&nbsp;Nathan De Lissnyder ,&nbsp;Oumayma Errais ,&nbsp;Patrick M. Honore","doi":"10.1016/j.jcrc.2025.155138","DOIUrl":"10.1016/j.jcrc.2025.155138","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"89 ","pages":"Article 155138"},"PeriodicalIF":3.2,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144230864","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":"Mapping the landscape of post-intensive care recovery interventions and their barriers: A nationwide cross-sectional survey","authors":"Carola M.A. Schol ,&nbsp;Elke Berger ,&nbsp;Simone P. Rauh ,&nbsp;Ashley De Bie Dekker ,&nbsp;Peter E. Spronk ,&nbsp;Laurens L.A. Bisschops ,&nbsp;Marianne Brackel ,&nbsp;Margo M.C. van Mol ,&nbsp;Dorien Kiers","doi":"10.1016/j.jcrc.2025.155132","DOIUrl":"10.1016/j.jcrc.2025.155132","url":null,"abstract":"<div><h3>Background</h3><div>Recovery interventions initiated in the intensive care unit (ICU) or after discharge are essential for supporting ICU survivors and their families. Despite national guidelines aimed at standardizing and improving post-ICU care, implementation varies due to systemic and operational barriers.</div></div><div><h3>Aim</h3><div>This study evaluates the organization of post-ICU care in the Netherlands, assesses whether national guideline recommendations are appropriated in practice, and explores barriers to implementation from healthcare professionals' perspectives.</div></div><div><h3>Methods</h3><div>A nationwide cross-sectional study was conducted (November 2023– February 2024) across all Dutch hospitals with adult ICUs. A structured, telephone-administered questionnaire collected data on ICU characteristics, post-ICU care coordination, early and late recovery interventions, and implementation barriers. The data were compared with a similar 2018 study.</div></div><div><h3>Results</h3><div>All 72 ICUs (100 %) participated. While 97.2 % provided at least one early and one late post-ICU recovery intervention—such as ICU diaries (97.2 %), ward follow-ups (93.1 %), and aftercare consultations (93.1 %)— only 27.8 % reported appropriating the full range of the national guideline strategies. Reported barriers included limited time, staff shortages, and financial constraints. While overall post-ICU care provision remained stable compared to 2018, notable improvements were observed in protocol use, nurse involvement in ICU diaries, and family engagement.</div></div><div><h3>Conclusion</h3><div>Despite the widespread post-ICU care provision, full appropriation of national guideline recommendations remains limited. Addressing practical barriers is essential for fostering consistent, high-quality post-ICU care. Targeted interventions are needed to bridge gaps and support equitable, patient-centered recovery pathways.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"89 ","pages":"Article 155132"},"PeriodicalIF":3.2,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144223510","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":"What every intensivist should know about exertional heat stroke","authors":"Niccolò Stomeo ,&nbsp;Laura Leuci ,&nbsp;Paolo Emilio Adami ,&nbsp;Maurizio Cecconi ,&nbsp;Luca Carenzo","doi":"10.1016/j.jcrc.2025.155134","DOIUrl":"10.1016/j.jcrc.2025.155134","url":null,"abstract":"<div><div>Exertional heat stroke (EHS) is a life-threatening condition caused by strenuous physical activity, leading to severe hyperthermia and central nervous system dysfunction. Unlike classic heat stroke, EHS can occur in young, healthy individuals and in temperate climates, when heat production exceeds the body's ability to dissipate heat. Rising global temperatures and increased participation in endurance events are contributing to a growing incidence of EHS. Early recognition and rapid cooling are essential to prevent multi-organ failure and death. Whole-body cold-water immersion is the gold standard treatment, and the principle of “cool first, transport second” is key to improving survival. In-hospital care focuses on continued cooling when necessary and managing complications such as acute kidney injury, coagulopathy, liver dysfunction, and neurological impairment. This review provides intensivists with practical guidance on the pathophysiology, diagnosis, and management of EHS. Given their expertise in critical illness and involvement in prehospital and emergency care, intensivists play a pivotal role in early intervention and reducing morbidity and mortality. As EHS incidence rises, increased awareness and preparedness are essential to ensure timely, effective treatment and improve patient outcomes.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"89 ","pages":"Article 155134"},"PeriodicalIF":3.2,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144195741","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":"Post-extubation polyuria: characterization of an underrecognized phenomenon in a proof-of-concept study.","authors":"Mateo Orgoroso ,&nbsp;Federico Verga ,&nbsp;Martín Angulo","doi":"10.1016/j.jcrc.2025.155131","DOIUrl":"10.1016/j.jcrc.2025.155131","url":null,"abstract":"<div><h3>Introduction</h3><div>The transition from invasive mechanical ventilation (MV) to unassisted breathing involves significant physiological changes for patients admitted to Intensive Care Units (ICUs). Discontinuation of MV impacts not only the respiratory system, but also affects hemodynamics and fluid balance. We aimed to assess whether urine output changes following extubation.</div></div><div><h3>Methods</h3><div>A prospective study was conducted at CASMU Medical Center (Uruguay). We included adult patients who required invasive MV for 1 to 15 days in the ICU and were subsequently extubated and placed on conventional oxygen therapy. Urine output was documented for the 48 h before and after extubation.</div></div><div><h3>Results</h3><div>The study included 60 patients, with a median age of 58 (32–70) years, that received invasive MV for 3 (2–4) days. Following extubation, diuresis increased from 2.1 (1.4–3.1) L/day to 3.2 (2.3–4.6) L/day (<em>P</em> &lt; 0.001). Polyuria (diuresis &gt;3 L in 24 h) was present in 16 (27 %) patients during MV, compared to 34 (57 %) patients after extubation (<em>P</em> &lt; 0.001). Urine output (relative to pre-extubation values) persisted significantly elevated for up to 30 h after discontinuation of MV. The increase in diuresis following extubation was correlated with the level of positive end-expiratory pressure administered during MV (r_s = 0.368; <em>P</em> = 0.004). Increased diuresis was not associated with hemodynamic or renal function impairment.</div></div><div><h3>Conclusion</h3><div>Discontinuation of MV was associated with a significant increase in urine output. This observed post-extubation polyuria may represent a physiological response to changes in intrathoracic pressure and fluid redistribution, and warrants further research to explore underlying mechanisms.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"89 ","pages":"Article 155131"},"PeriodicalIF":3.2,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144195742","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":"Does inspiratory muscle training affect expiratory muscle thickness in respiratory intensive care patients? A pilot randomized controlled study","authors":"Reyhan Kaygusuz Benli ,&nbsp;Barış Yılmaz ,&nbsp;S. Ufuk Yurdalan ,&nbsp;Nalan Adıgüzel","doi":"10.1016/j.jcrc.2025.155125","DOIUrl":"10.1016/j.jcrc.2025.155125","url":null,"abstract":"<div><h3>Background</h3><div>This randomized controlled trial aimed to compare abdominal muscle thickness between intensive care patients and healthy controls, and to evaluate the impact of IMT on expiratory muscle thickness using ultrasound.</div></div><div><h3>Methods</h3><div>In this single-blind randomized controlled trial, 20 post-extubation intensive care patients were randomly assigned to either an a conventional physiotherapy (CP) group or IMT + CP group. Both interventions were applied for five days. An additional 10 healthy individuals served as controls for comparison. Abdominal muscle thicknesses—including external oblique (EOA), internal oblique (IOA), transversus abdominis (TRA), and rectus abdominis (RA)—were measured using ultrasound. Maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP) were also recorded.</div></div><div><h3>Results</h3><div>At baseline, healthy controls had significantly higher MIP, MIP% predicted, MEP, MEP% predicted, and RA muscle thickness compared to both patient groups (<em>p</em> &lt; 0.05). Following intervention, both IMT and CP groups showed significant improvements in MIP (p &lt; 0.05), but only the IMT group demonstrated significant increases in MEP, MEP% predicted, IOA, and RA muscle thickness (<em>p</em> &lt; 0.05). The IMT group showed significantly greater improvements in MIP, MEP, IOA, and RA muscle thickness compared to the CP group (<em>p</em> &lt; 0.05).</div></div><div><h3>Conclusion</h3><div>Post-extubation IMT may improve not only inspiratory but also expiratory muscle strength and abdominal wall thickness. These findings suggest that IMT could support weaning processes in intensive care, although larger studies are needed.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"89 ","pages":"Article 155125"},"PeriodicalIF":3.2,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144167678","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":"Stratifying risk in ACLF-3 patients: The impact of circulatory and respiratory failure on one-year post-transplant outcomes","authors":"Hannah Wozniak ,&nbsp;Xun Zhao ,&nbsp;Shiyi Chen ,&nbsp;Margaret S. Herridge ,&nbsp;Mamatha Bhat","doi":"10.1016/j.jcrc.2025.155129","DOIUrl":"10.1016/j.jcrc.2025.155129","url":null,"abstract":"<div><h3>Background</h3><div>In patients with Acute-on-Chronic Liver Failure grade 3 (ACLF-3), the number of organ failures (OF) before liver transplant (LT) is associated with poorer outcomes following LT. We hypothesized that ACLF-3 patients with circulatory and/or respiratory failure before LT would experience worse prognosis after LT.</div></div><div><h3>Methods</h3><div>We analyzed ACLF-3 patients from the U.S. Scientific Registry of Transplant Recipients, categorized by OF combinations at the time of LT: 1) circulatory failure with other non-respiratory OF, 2) both circulatory and respiratory failures with other OF, 3) all other OF combinations excluding (1) and (2). Cox regression models assessed one-year mortality, and logistic regression examined one-year functional status.</div></div><div><h3>Results</h3><div>Of 5054 ACLF-3 patients, 14 %(728/5054) died within one-year post-LT. The distribution was: 427 patients had circulatory failure with other OF, 1042 had circulatory and respiratory failure with other OF, and 3357 had all other possible combinations of OFs. Patients with both circulatory and respiratory failures experienced higher post-LT mortality than those with circulatory failure plus other OF (one-year Hazard Ratio (HR) for death: 1.32, 95 %CI: 1.08–1.62, <em>p</em> &lt; 0.01). No differences were found between those with circulatory failure plus other OF and those with OF other than circulatory or respiratory. Patients with OF other than circulatory and respiratory failures had better one-year functional status compared to those with circulatory OF (OR for poor functional status: 0.73, 95 %CI: 0.54–0.98, <em>p</em> &lt; 0.01).</div></div><div><h3>Conclusion</h3><div>Specific OF combinations affect post-LT outcomes in ACLF-3 patients. Combined respiratory and circulatory failure at LT time was associated with poorer outcomes, regardless of the number of OF.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"89 ","pages":"Article 155129"},"PeriodicalIF":3.2,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144178431","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}