Journal of critical care最新文献

{"title":"Machine learning to assess correlated sociodemographic and socioeconomic community-level data and association with sepsis incidence","authors":"Zahra Aghababa , Jason N. Kennedy , RuoFei Yin , Christina F. Mair , Kristina E. Rudd","doi":"10.1016/j.jcrc.2025.155421","DOIUrl":"10.1016/j.jcrc.2025.155421","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"93 ","pages":"Article 155421"},"PeriodicalIF":2.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145966076","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":"Between a nightmare and a miracle: A qualitative study of patient experience during and after intensive care unit admission in pregnancy or postpartum","authors":"Yarden Zerem ,&nbsp;Sharon Einav ,&nbsp;Carolyn F. Weiniger ,&nbsp;Reut Schvartz ,&nbsp;Hen Y. Sela ,&nbsp;Adi Finkelstein","doi":"10.1016/j.jcrc.2026.155472","DOIUrl":"10.1016/j.jcrc.2026.155472","url":null,"abstract":"<div><h3>Background</h3><div>Intensive care unit (ICU) admission of obstetric patients during pregnancy or postpartum is not uncommon. The long-term physical and emotional implications of such admissions require elucidation.</div></div><div><h3>Aim</h3><div>To describe obstetric patients' long-term perspectives on ICU admission and recovery.</div></div><div><h3>Methods</h3><div>A phenomenological approach was undertaken. All consecutive obstetric patients admitted to the ICU during 2016–2021 were invited to participate in a semi-structured interview after hospital discharge. Interviews were conducted from 12/2020 to 06/2022, and the transcripts were analyzed using Braun and Clarke's six-phase approach to reflexive thematic analysis.</div></div><div><h3>Results</h3><div>A total of 59 women aged 20–34 years admitted to an ICU during pregnancy or postpartum were interviewed. Qualitative inductive analysis of the interview transcripts generated three themes: the illness experience, an atypical patient, and recovery. Repetitive topics were a sense of disorientation, feeling distressed and scared, the importance of remaining in contact with and informed on the neonate, the importance of partner and family support, the challenges of being an atypical ICU patient, the difficulties in returning to normal life, and coping strategies.</div></div><div><h3>Conclusions</h3><div>This study sheds new light on the experiences of obstetric patients admitted to an ICU. It highlights missed opportunities for maternal‑neonatal bonding, the importance of family support, unique needs that often remain unmet, the need for effective communication with the ICU staff, and the physical and emotional long-term adverse effects of the experience. The patient's narrative can contribute to our understanding of the ICU experience as a whole and its outcomes.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"93 ","pages":"Article 155472"},"PeriodicalIF":2.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146100271","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 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}