Journal of critical care最新文献

{"title":"Explainable machine learning for discontinuation of therapeutic antibiotics in intensive care patients","authors":"Tariq A. Dam ,&nbsp;Rogier P. Schade ,&nbsp;Jurriaan E.M. de Steenwinkel ,&nbsp;Martijn Otten ,&nbsp;Luca F. Roggeveen ,&nbsp;Mark Hoogendoorn ,&nbsp;Armand R.J. Girbes ,&nbsp;Lucas M. Fleuren ,&nbsp;Paul W.G. Elbers","doi":"10.1016/j.jcrc.2025.155247","DOIUrl":"10.1016/j.jcrc.2025.155247","url":null,"abstract":"<div><h3>Introduction</h3><div>The threshold for initiating lifesaving antibiotics for intensive care patients is low while determining when to stop remains challenging: prolonged administration increases antibiotic resistance and occurrence of side effects, while premature discontinuation may lead to resurgence of infection. Explainable machine learning may predict for which ICU patients antibiotics will be reinitiated.</div></div><div><h3>Methods</h3><div>We retrospectively collected data on all adult ICU patients treated with antibiotics in two tertiary academic hospitals in the Netherlands. We included monitor data, laboratory data, selective decontamination strategy, medication, and culture results as predictors. We trained logistic regression, lightGBM and AutoPrognosis models to predict the primary outcome of restarting antibiotics within 72 h.</div></div><div><h3>Results</h3><div>We included data on 2,486 patients receiving 3,645 therapeutic antibiotic courses between October 2015 and January 2022. The primary outcome occurred 708 (19.4 %) times, of which the same subgroup was restarted in 468 (66.10 %) cases and the exact same combination in 278 (39.27 %). Cultures were collected in 80.4 % and positive in 43.3 % of cases. 90-day mortality was higher in the reinitiation group (39.8 % vs. 25.0 %). The best performing model was logistic regression (AUROC 0.675). The most important predictors were the use of penicillins and the treatment duration of the last started antibiotic.</div></div><div><h3>Conclusion</h3><div>Although prediction of reinitiation remained challenging, the most important and consistent predictor for reinitiation of antibiotics was a shorter duration of the last started antibiotic. The same antibiotic was restarted frequently, and 90-day mortality was higher in the reinitiation group, illustrating potential for data-driven decision support on when to discontinue antibiotics.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"91 ","pages":"Article 155247"},"PeriodicalIF":2.9,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144904129","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":"Measuring alarm fatigue in intensive care units: translation and validation of the Charité Alarm Fatigue Questionnaire: a multi-centre study","authors":"Verona C.A. Gerardu ,&nbsp;Lina Katharina Mosch ,&nbsp;Carla Kloeze ,&nbsp;Jip W.T.M. de Kok ,&nbsp;Ingeborg H.F. Herold ,&nbsp;Ashley J.R. De Bie ,&nbsp;Ronny M. Schnabel ,&nbsp;Ulrich Strauch ,&nbsp;Tom Dormans ,&nbsp;Maximilian M. Wunderlich ,&nbsp;R. Arthur Bouwman ,&nbsp;Felix Balzer ,&nbsp;Iwan C.C. van der Horst ,&nbsp;Bas C.T. van Bussel ,&nbsp;Akira-Sebastian Poncette ,&nbsp;Rob G.H. Driessen","doi":"10.1016/j.jcrc.2025.155223","DOIUrl":"10.1016/j.jcrc.2025.155223","url":null,"abstract":"<div><h3>Background</h3><div>Alarm fatigue can negatively impact patient safety and quality of health care, particularly in Intensive Care Units (ICUs). The Charité Alarm Fatigue Questionnaire (CAFQa) is a German questionnaire measuring alarm fatigue in two scales (alarm stress and alarm coping) in nurses and physicians. Its hypothesized dimensionality has not been investigated in non-German-speaking countries. This multi-centre study aimed to translate and validate CAFQa in Dutch-speaking ICUs.</div></div><div><h3>Methods</h3><div>Forward and backward translation of CAFQa by two bilingual staff members, evaluation by an expert panel, cognitive interviews and a pilot test were performed to obtain the final Dutch questionnaire. Confirmatory factor analysis was performed, Cronbach's alpha (internal homogeneity) and correlation between self-reported alarm fatigue and item scores (convergent validity) were calculated.</div></div><div><h3>Results</h3><div>CAFQa was translated into Dutch, approved by the expert panel and cognitive interviews showed good face validity. Responses from 418 healthcare professionals from 11 centres (10 Dutch, 1 Belgian) were used. Cronbach's alpha was 0.69 (overall), 0.74 (alarm stress scale) and 0.46 (alarm coping scale). Strong correlations of item scores with self-reported alarm fatigue were found (overall: <em>r</em> = 0.51, alarm stress: <em>r</em> = 0.48, alarm coping: <em>r</em> = 0.30), supporting convergent validity. Confirmatory factor analysis indicated an adequate model fit (CFI = 0.961, TLI = 0.946, RMSEA = 0.052), and all factor loadings (0.20–0.74) proved statistically significant, albeit being higher for alarm stress (0.60–0.74) than alarm coping (0.21–0.70).</div></div><div><h3>Conclusions</h3><div>CAFQa was translated and validated in a Dutch speaking population for the first time. This instrument can benchmark, measure and compare alarm fatigue of nurses and physicians.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"91 ","pages":"Article 155223"},"PeriodicalIF":2.9,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144908608","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: “Pulse oximetry beyond oxygen saturation: early waveform characteristics in sepsis patients with adverse outcomes”","authors":"Sanne Ter Horst ,&nbsp;Raymond J. van Wijk ,&nbsp;Anna D. Schoonhoven ,&nbsp;Anouk de Lange ,&nbsp;Jan C. ter Maaten ,&nbsp;Hjalmar R. Bouma","doi":"10.1016/j.jcrc.2025.155241","DOIUrl":"10.1016/j.jcrc.2025.155241","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"91 ","pages":"Article 155241"},"PeriodicalIF":2.9,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144904379","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: “Anti-infective management in brain-dead organ donors – A retrospective analysis at two centers reveals need for improvement”","authors":"Parth Aphale ,&nbsp;Shashank Dokania ,&nbsp;Himanshu Shekhar","doi":"10.1016/j.jcrc.2025.155244","DOIUrl":"10.1016/j.jcrc.2025.155244","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"91 ","pages":"Article 155244"},"PeriodicalIF":2.9,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144904377","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: “Systematic review: The impact of virtual reality interventions on stress and anxiety in intensive care units”","authors":"Yuanqi Li ,&nbsp;Shijun Tong ,&nbsp;Lang Gao ,&nbsp;Jinbao Tian ,&nbsp;Zheng Chen ,&nbsp;Yanli Bao ,&nbsp;Ying Fu","doi":"10.1016/j.jcrc.2025.155242","DOIUrl":"10.1016/j.jcrc.2025.155242","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"91 ","pages":"Article 155242"},"PeriodicalIF":2.9,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144904378","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":"Systematic review: The impact of virtual reality interventions on stress and anxiety in intensive care units","authors":"Tjasa Savoric ,&nbsp;Ryan Ruiyang Ling ,&nbsp;Safwan Aziz ,&nbsp;Kaja Antlej ,&nbsp;Sylvester Arnab ,&nbsp;Ashwin Subramaniam","doi":"10.1016/j.jcrc.2025.155243","DOIUrl":"10.1016/j.jcrc.2025.155243","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"91 ","pages":"Article 155243"},"PeriodicalIF":2.9,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144892853","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":"Virtual family participation in adult intensive care unit rounds: A multicenter pilot feasibility cohort study","authors":"Sarah A. Beydoun ,&nbsp;Sahar Bahrami ,&nbsp;Karen E.A. Burns ,&nbsp;Sylvie Debigaré ,&nbsp;Julia Duong ,&nbsp;Catherine Gagné ,&nbsp;Jillian Kifell ,&nbsp;Chella Price ,&nbsp;Francesca Rubulotta ,&nbsp;Amelia Stephenson ,&nbsp;Shreya Udupa ,&nbsp;Han Ting Wang ,&nbsp;Michael Goldfarb","doi":"10.1016/j.jcrc.2025.155245","DOIUrl":"10.1016/j.jcrc.2025.155245","url":null,"abstract":"<div><h3>Introduction</h3><div>Family participation in intensive care unit (ICU) rounds is a recommended care practice by critical care professional societies. However, system and individual-level barriers may prevent families from attending rounds in person. This study aimed to assess the feasibility of virtual family participation in ICU rounds.</div></div><div><h3>Methods</h3><div>This multicenter prospective cohort study included family members of ICU patients who participated via videoconference in daily multidisciplinary team rounds in five adult ICUs in Montreal, Canada, between June 2023 and August 2024. Feasibility metrics included recruitment rate, intervention uptake, technical issues, and follow-up rate. Family-centered outcomes included care engagement (FAMily Engagement; FAME), satisfaction (Family Satisfaction in the ICU-24R), and mental health (Hospital Anxiety and Depression Scale).</div></div><div><h3>Results</h3><div>A total of 72 family members participated in at least one virtual round (out of 84 enrolled; 85.7 % uptake). No technical issues were experienced in 113/132 (85.7 %) virtual rounds. Follow-up data were available for 56/72 (77.7 %) participants. From baseline to post-intervention, overall family engagement scores (FAME) increased (64.5 ± 20.5 to 69.8 ± 15.2; <em>p</em> = 0.045) with improvements in the perception of engagement (63.0 ± 22.3 to 70.8 ± 16.5; <em>p</em> = 0.04) and family-centered care (75.7 ± 16.9 to 82.1 ± 14.0; p = 0.04) domains. Overall mean family satisfaction was high (75.8 ± 17.2). Anxiety and depression symptoms were reported by 42.8 % and 23.2 % of participants, respectively.</div></div><div><h3>Conclusion</h3><div>Virtual participation by family members in ICU rounds was feasible and was associated with improved family engagement scores and high satisfaction scores. These results support the need for a multicenter trial to evaluate the effectiveness of virtual rounds in improving process and experience-related outcomes.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"91 ","pages":"Article 155245"},"PeriodicalIF":2.9,"publicationDate":"2025-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144892172","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: “Pulse oximetry beyond oxygen saturation: Early waveform characteristics in sepsis patients with adverse outcomes - a proof-of-concept study”","authors":"Jiacheng Shen ,&nbsp;Li Li","doi":"10.1016/j.jcrc.2025.155239","DOIUrl":"10.1016/j.jcrc.2025.155239","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"91 ","pages":"Article 155239"},"PeriodicalIF":2.9,"publicationDate":"2025-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144892173","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":"Endothelial dysfunction in critically ill patients with sepsis and COVID-19 using the albumin transudation rate: A pilot study","authors":"Ricardo Castro ,&nbsp;Ashish K. Khanna ,&nbsp;Martin Schreiber ,&nbsp;Jan Bakker","doi":"10.1016/j.jcrc.2025.155237","DOIUrl":"10.1016/j.jcrc.2025.155237","url":null,"abstract":"<div><h3>Background</h3><div>COVID-19, sepsis, and septic shock are associated with significant endothelial dysfunction and capillary leakage, posing diagnostic and management challenges in critically ill patients. Capillary leakage, as reflected by the albumin transudation rate (ATR), may have implications for fluid dynamics and patient outcomes in these conditions. We sought to describe and compare ATR in these two related pathologies, but clinically distinct conditions.</div></div><div><h3>Methods</h3><div>This study was conducted in 2022 across three ICUs and included 36 patients (18 with COVID-19 and 18 with sepsis). The local ethical committees approved the study. ATR, total blood volume (TBV), red blood cell volume (RBCV), and plasma volume (PV) were measured at multiple time points (Days 1, 2, 3, 7, and 10) using a ¹³¹I-albumin tracer. Data were analyzed using the non-parametric Wilcoxon rank-sum test and multivariate linear regression to identify predictors of ATR.</div></div><div><h3>Results</h3><div>ATR was significantly higher in patients with sepsis compared to those with COVID-19 throughout the ICU stay, despite lower admission severity scores in the sepsis group. Clinical assessments of the volume status frequently misclassify TBV in patients with COVID-19 or sepsis. Patients were often deemed hypervolemic when, by objective measures, they were hypovolemic under both conditions.</div></div><div><h3>Conclusion</h3><div>ATR was persistently elevated in critically ill patients with sepsis and COVID-19. Sepsis exhibited significantly higher ATR values, suggesting a more pronounced endothelial dysfunction. There is a frequent inaccuracy in clinical fluid status assessment, which demands more reliable diagnostic tools to better guide fluid therapy in critically ill patients.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"91 ","pages":"Article 155237"},"PeriodicalIF":2.9,"publicationDate":"2025-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144889935","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":"Levetiracetam dosing in critically ill patients receiving prolonged intermittent renal replacement therapy","authors":"Sirichai Chusiri ,&nbsp;Jirapat Vamananda ,&nbsp;Dhakrit Rungkitwattanakul ,&nbsp;Taniya Charoensareerat ,&nbsp;Sutthiporn Pattharachayakul ,&nbsp;Tatta Sriboonruang ,&nbsp;Nattachai Srisawat ,&nbsp;Chusak Limotai ,&nbsp;Thanompong Sathienluckana ,&nbsp;Weerachai Chaijamorn","doi":"10.1016/j.jcrc.2025.155246","DOIUrl":"10.1016/j.jcrc.2025.155246","url":null,"abstract":"<div><h3>Objective</h3><div>Levetiracetam can be significantly removed by prolonged intermittent renal replacement therapy (PIRRT) due to its pharmacokinetic properties. However, dosing guidance for this population is limited. This study aimed to evaluate the probability of target attainment (PTA) for various levetiracetam regimens in critically ill adults receiving PIRRT, using Monte Carlo simulation (MCS).</div></div><div><h3>Methods</h3><div>A one-compartment model with first-order elimination was developed using published pharmacokinetic data. Simulations incorporated PIRRT modalities (hemodialysis and hemofiltration), with an effluent rate of 18 L/h and varying durations (4, 6, 8, and 10 h). PIRRT was modeled as occurring early (at drug administration) or late (14–20 h post-dose). MCS was conducted in 10,000 virtual patients per regimen over 48 h. The pharmacodynamic target was an area under the concentration-time curve (AUC) of 222–666 mg·h/L. Regimens achieving ≥90 % PTA were considered optimal.</div></div><div><h3>Results</h3><div>Several commonly used regimens failed to achieve adequate PTA. For alternate-day PIRRT with hemofiltration, 500 mg every 12 h or 1000 mg every 24 h were optimal. For alternate-day PIRRT with hemodialysis, 750 mg every 12 h or 1250 mg every 24 h were preferred. For daily PIRRT with either modality, 750 mg every 12 h consistently met PTA targets.</div></div><div><h3>Conclusions</h3><div>Standard dosing regimens may be inadequate for achieving therapeutic exposure in PIRRT. Optimal dosing varies by PIRRT modality, frequency, and timing<strong>.</strong> These findings support individualized dosing and highlight the need for clinical validation.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"91 ","pages":"Article 155246"},"PeriodicalIF":2.9,"publicationDate":"2025-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144889934","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}