Journal of critical care最新文献

{"title":"The impact of coagulopathy on prognosis in critically ill patients with sepsis: A nationwide cohort study","authors":"Heonyeong Ha ,&nbsp;Dong-gon Hyun ,&nbsp;Jee Hwan Ahn,&nbsp;Jin Won Huh,&nbsp;Sang-Bum Hong,&nbsp;Younsuck Koh,&nbsp;Dong Kyu Oh,&nbsp;Su Yeon Lee,&nbsp;Mi Hyeon Park,&nbsp;Chae-Man Lim,&nbsp;on behalf of the Korean Sepsis Alliance (KSA) Investigators","doi":"10.1016/j.jcrc.2026.155436","DOIUrl":"10.1016/j.jcrc.2026.155436","url":null,"abstract":"<div><h3>Introduction</h3><div>Coagulation impairment is frequently observed in patients with sepsis. However, the relationship between coagulopathy and outcomes in Korean sepsis patients remains poorly defined.</div></div><div><h3>Methods</h3><div>We analyzed a nationwide cohort of 13,827 sepsis patients from 15 hospitals in South Korea between September 2019 and December 2022. Patients were classified into three groups according to sepsis-induced coagulopathy (SIC) and disseminated intravascular coagulation (DIC) scores: SIC (−), SIC (+), and DIC (+). The primary outcome was 28-day mortality; the secondary outcome was the incidence of major bleeding events.</div></div><div><h3>Results</h3><div>Among 3217 patients, 1696 (52.7%) were in the SIC (−) group, 932 (29.0%) in the SIC (+) group, and 589 (18.3%) in the DIC (+) group. After adjustment for covariates, both the SIC (+) group (adjusted hazard ratio [aHR] 1.35, 95% confidence interval [CI] 1.16–1.58, <em>p</em> &lt; 0.001) and the DIC (+) group (aHR 1.59, 95% CI 1.33–1.90, p &lt; 0.001) showed significantly increased 28-day mortality. Major bleeding events, although infrequent across all groups, increased in the DIC (+) group (adjusted odds ratio [aOR] 2.02, 95% CI 1.03–3.88, <em>p</em> = 0.036); however, no significant increase was observed in the SIC (+) group (aOR 1.20, 95% CI 0.60–2.33, <em>p</em> = 0.600) compared with the SIC (−) group.</div></div><div><h3>Conclusions</h3><div>In this nationwide cohort, sepsis-induced coagulopathy was associated with higher 28-day mortality but not with a significantly increased risk of major bleeding.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"93 ","pages":"Article 155436"},"PeriodicalIF":2.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146024691","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":"Physiological rationale and clinical use of lateral positioning in ARDS","authors":"Marie-Thérèse Al-Andary ,&nbsp;Martin Benites ,&nbsp;Jaime Retamal ,&nbsp;Laurent Papazian","doi":"10.1016/j.jcrc.2026.155480","DOIUrl":"10.1016/j.jcrc.2026.155480","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"93 ","pages":"Article 155480"},"PeriodicalIF":2.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146170382","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: “External validation of eight different models to predict sepsis mortality in intensive care units”","authors":"Wing-Sum Chan ,&nbsp;Yu-Chang Yeh","doi":"10.1016/j.jcrc.2026.155460","DOIUrl":"10.1016/j.jcrc.2026.155460","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"93 ","pages":"Article 155460"},"PeriodicalIF":2.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146024268","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":"Sex differences in venoarterial extracorporeal membrane oxygenation utilisation and clinical outcomes in Australia","authors":"Riley J. Batchelor ,&nbsp;Carol L. Hodgson ,&nbsp;Malanka Lankaputhra ,&nbsp;Aidan Burrell ,&nbsp;Judit Orosz ,&nbsp;Julia Coull ,&nbsp;Vincent Pellegrino ,&nbsp;James Antsey ,&nbsp;Jeffrey Lefkovits ,&nbsp;Andrew J. Taylor ,&nbsp;David M. Kaye ,&nbsp;Dion Stub ,&nbsp;on behalf of EXCEL coinvestigators","doi":"10.1016/j.jcrc.2026.155473","DOIUrl":"10.1016/j.jcrc.2026.155473","url":null,"abstract":"<div><h3>Background</h3><div>Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly utilised in critically ill patients with severe cardiac failure and cardiac arrest, yet sex-specific differences in presentation, utilisation, and clinical outcomes are not well understood.</div></div><div><h3>Methods</h3><div>The EXCEL registry is a binational registry capturing data on patients requiring ECMO in Australia and New Zealand. Data were collected on adult patients supported with VA-ECMO in Australia from February 2019 to December 2024. Patients were stratified by sex to assess differences in demographics, clinical characteristics, ECMO indications, complications, and outcomes. Multivariable logistic regression analyses conditional on several baseline covariates assessed associations between sex, in-hospital mortality, and major bleeding.</div></div><div><h3>Results</h3><div>Among 1443 patients undergoing VA-ECMO, 32.7% female and 67.3% were male. Females were younger, had lower APACHE IV scores, and more commonly required ECMO for myocarditis, pulmonary embolism, and advanced pulmonary hypertension. Conversely, males predominantly presented with acute myocardial infarction and more frequently had cardiac arrest with a shockable rhythm. Unadjusted in-hospital mortality was comparable between sexes; however, following adjustment, female sex independently predicted higher in-hospital mortality (OR 1.41, 95% CI 1.07–1.87; <em>p</em> = 0.015) and major bleeding (OR 1.40, 95% CI 1.03–1.91; <em>p</em> = 0.033).</div></div><div><h3>Conclusion</h3><div>Female patients represent one third of the VA-ECMO population and are a distinct cohort to male patients. Despite younger age and fewer traditional risk factors, female sex is associated with increased adjusted risk of in-hospital mortality and bleeding in VA-ECMO patients. These findings should be interpreted as an adjusted association that is contingent on the completeness of covariate adjustment.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"93 ","pages":"Article 155473"},"PeriodicalIF":2.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146074306","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":"Subphenotypes in acute respiratory distress syndrome: A scoping review across clinical, biological, computational, imaging, omics, and artificial intelligence approaches","authors":"Javier Muñoz ,&nbsp;Jamil Antonio Cedeño ,&nbsp;Galo Francisco Castañeda","doi":"10.1016/j.jcrc.2026.155441","DOIUrl":"10.1016/j.jcrc.2026.155441","url":null,"abstract":"<div><h3>Background</h3><div>Acute respiratory distress syndrome (ARDS) is a heterogeneous syndrome with high mortality. Subphenotyping may identify more homogeneous groups for prognostic enrichment and precision therapies.</div></div><div><h3>Methods</h3><div>We conducted a scoping review (January 2013–December 31, 2025) in PubMed, Embase, and the Cochrane Library, complemented by reference screening. We included original adult studies deriving, applying, or validating ARDS phenotypes/subphenotypes and excluded pediatric, preclinical, review/editorial, and abstract-only reports.</div></div><div><h3>Results</h3><div>Sixty studies met eligibility criteria. Subphenotypes were reported across clinical, biological, computational, imaging, omics, and artificial intelligence (AI) domains, with uneven evidence maturity; reproducibility and validation were strongest in biological and computational frameworks, whereas imaging and omics evidence was more heterogeneous and less frequently externally validated. The most robust distinction separated hyperinflammatory and hypoinflammatory groups, differing in mortality, ventilator-free days, and organ failure, and showing heterogeneity of treatment effect in secondary analyses of randomized trials (fluid management, statins, corticosteroids, and recruitment manoeuvres). Clinical and computational approaches provided parsimonious classifiers for near real-time assignment, while biological studies implicated inflammatory, epithelial, and endothelial injury markers. AI models integrated multimodal data and reproduced known phenotypes, but external validation and interpretability were inconsistent.</div></div><div><h3>Conclusions</h3><div>ARDS subphenotypes—particularly hyperinflammatory and hypoinflammatory classes—are prognostically meaningful and associated with heterogeneity of treatment effect. Parsimonious clinical and computational classifiers appear closest to bedside translation. Future research should prioritise prospective phenotype-stratified/adaptive trials using standardized, transparent algorithms in diverse international cohorts.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"93 ","pages":"Article 155441"},"PeriodicalIF":2.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146074307","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: “Recovery of motor functions and cognitive functions in patients with intensive care unit–acquired weakness”","authors":"Sandhya Anil Harihar ,&nbsp;Anant Sidhappa Kurhade","doi":"10.1016/j.jcrc.2026.155477","DOIUrl":"10.1016/j.jcrc.2026.155477","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"93 ","pages":"Article 155477"},"PeriodicalIF":2.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146074308","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":"Response to the letter: Effects of levosimendan on weaning from mechanical ventilation","authors":"Cang Li,&nbsp;Fei Guo,&nbsp;Zengfeng Wang,&nbsp;Liang Shan","doi":"10.1016/j.jcrc.2026.155450","DOIUrl":"10.1016/j.jcrc.2026.155450","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"93 ","pages":"Article 155450"},"PeriodicalIF":2.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146074309","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":"Cardiac surgery-associated acute kidney injury requiring haemofiltration: The immediate postoperative phase is critical to achieve equivalent long-term survival","authors":"Sambhavi Sneha Kumar ,&nbsp;Ujjawal Kumar ,&nbsp;Jayenthan Karunanantham ,&nbsp;Daniel Sitaranjan ,&nbsp;Shakil Farid","doi":"10.1016/j.jcrc.2026.155474","DOIUrl":"10.1016/j.jcrc.2026.155474","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the clinical impact of cardiac surgery-associated acute kidney injury requiring continuous venovenous haemofiltration by assessing its impact on short- and long-term outcomes.</div></div><div><h3>Methods</h3><div>Data for all adult cardiac surgeries performed between 2015 and 2024 were retrieved from our institutional database. 1:2 propensity-score matching of patients requiring postoperative haemofiltration and those not requiring haemofiltration was performed based on the EuroSCORE II covariates. In-hospital outcomes (mortality, postoperative complications, postoperative hospitalisation duration) and long-term survival were evaluated.</div></div><div><h3>Results</h3><div>After excluding patients requiring renal replacement therapy preoperatively, 16,681 patients were included. Propensity matching yielded Group H (postoperative haemofiltration, <em>n</em> = 510) and Group C (controls, <em>n</em> = 1020). Groups had generally similar demographics and preoperative clinical characteristics. Group H exhibited worse in-hospital outcomes compared to Group C. Hospital mortality was significantly higher in Group H (23.1% vs 6.2%, <em>p</em> &lt; 0.001), with higher mortality up to five years and poorer long-term survival (HR =1.81 (95% CI: 1.50–2.18), <em>p</em> &lt; 0.001). Conditional survival analyses demonstrated that among patients who survived past hospital discharge, long-term survival was comparable between groups (HR 1.23, 95% CI 0.95–1.58, <em>p</em> = 0.115).</div></div><div><h3>Conclusions</h3><div>Postoperative AKI requiring haemofiltration is associated with poor outcomes following cardiac surgery. However, in patients surviving the acute postoperative phase, there was no significant difference in long-term survival compared to those who did not require haemofiltration. These findings underscore the importance of early recognition and management of acute kidney injury after cardiac surgery whilst offering a more nuanced understanding of long-term prognosis.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"93 ","pages":"Article 155474"},"PeriodicalIF":2.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146105819","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":"Lung ultrasound-guided decongestion in heart failure patients: A systematic review and meta-analysis of randomized controlled trials","authors":"Alhareth Al-Sagban ,&nbsp;Marwah Algodi ,&nbsp;Omar Saab ,&nbsp;Hasan Al-Obaidi ,&nbsp;Howard Graham ,&nbsp;Mohamed T. Abuelazm ,&nbsp;Amita Krishnan ,&nbsp;Tijana Tuhy ,&nbsp;Matthew Lammi","doi":"10.1016/j.jcrc.2026.155435","DOIUrl":"10.1016/j.jcrc.2026.155435","url":null,"abstract":"<div><h3>Background</h3><div>Pulmonary congestion is a prognostic marker for heart failure (HF) morbidity and mortality; however, the current congestion evaluation depends on traditional physical examination, which lacks adequate sensitivity. Lung ultrasound (LUS) has been investigated as a more sensitive method to guide decongestion in decompensated HF.</div></div><div><h3>Methods</h3><div>A systematic review and meta-analysis synthesizing evidence from randomized controlled trials (RCTs) obtained from PubMed, CENTRAL, Scopus, and Web of Science until March 2025. Using Stata MP v. 17, we used the fixed-effects model to report dichotomous outcomes using the risk ratio (RR) and continuous outcomes using the standardized mean difference with a 95% confidence interval (CI). PROSPERO ID: CRD42024620337.</div></div><div><h3>Results</h3><div>Nine RCTs with 1095 patients were included. LUS-guided management significantly decreased the risk of HF hospitalization/all-cause mortality (RR: 0.72, [95% CI 0.56, 0.93], <em>p</em> = 0.01), HF hospitalization (RR: 0.65, [95% CI 0.48, 0.88], p = 0.01), and HF urgent visits (RR: 0.38, [95% CI 0.22, 0.66], <em>p</em> &lt; 0.0001). There was no significant difference between LUS-guided management and standard of care regarding the incidence of hypotension (RR: 1.87, [95% CI 0.56, 6.20], <em>p</em> = 0.31), hypokalemia (RR: 0.93, [95% CI 0.48, 1.82], <em>p</em> = 0.83), hyperkalemia (RR: 0.98, [95% CI 0.62, 1.53], <em>p</em> = 0.91), and acute kidney injury/impaired renal function (RR: 1.08, [95% CI 0.66, 1.77], <em>p</em> = 0.75).</div></div><div><h3>Conclusion</h3><div>LUS-guided decongestion was associated with a significant decrease in the risk of HF re-hospitalization and HF urgent visits, with a tolerable safety profile, compared to standard care, with similar rates of hypotension, hypokalemia, hyperkalemia, and AKI.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"93 ","pages":"Article 155435"},"PeriodicalIF":2.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146125001","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":"Proportionality and the process of decision-making around ICU admission: A narrative review of the ethical complexities of navigating from “can” to “ought”","authors":"Timothy Haydon ,&nbsp;Alastair Brown","doi":"10.1016/j.jcrc.2026.155434","DOIUrl":"10.1016/j.jcrc.2026.155434","url":null,"abstract":"<div><h3>Purpose</h3><div>To identify sources of ethical tension emerging around ICU admission decision-making. To assess the potential role for clinical ethics applications in building clinician capacity to identify and navigate these tensions along with an appropriate core principle for framing ethical considerations.</div></div><div><h3>Methods</h3><div>We performed a search of Ovid Medline, CINAHL and PubMed databases. Keywords and MeSH headings included “intensive care admission”, “decision-making”, “conflict” and “clinical ethics” for the period January 1, 2005 to January 1, 2025. Additional papers were identified from reference lists and formulated into a narrative synthesis of themes describing shared ethical tensions. We then undertook further review of the bioethics literature to identify practical solutions based on clinical ethics consultation and an appropriate normative lens to apply to balancing considerations.</div></div><div><h3>Results</h3><div>Clinical ethics approaches have been employed to understand sources of ethical tension and improve the process of decision-making around ICU admission. Clinicians' difficulty weighing benefits and burdens of treatments emerged as a potentially modifiable deficit. Proportionality emerged as a more appropriate way than futility or rescue imperatives to frame the value of ICU admission. Uncertainty emerged as an important modifiable contributor to decision-making challenges.</div></div><div><h3>Conclusions</h3><div>Moral case deliberation as an example of a clinical ethics approach shows promise as an education tool and a way to build decision-making capacity and trust between ICU and other clinicians. Proportionality is a suitable approach to framing benefit and weighing competing tensions. Further research is required to explore the impact of these elements on navigating shared ethical tensions.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"93 ","pages":"Article 155434"},"PeriodicalIF":2.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146009945","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}