Journal of critical care最新文献

{"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}

{"title":"Comment on “Machine learning survival analysis for predicting kidney disease progression in patients with acute kidney injury undergoing continuous kidney replacement therapy: An analysis of the LINKA database”","authors":"Mohammed Anas Mohiuddin ,&nbsp;Mohammed Misbah Ul Haq ,&nbsp;S.R.V. Prasad Reddy","doi":"10.1016/j.jcrc.2026.155457","DOIUrl":"10.1016/j.jcrc.2026.155457","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"93 ","pages":"Article 155457"},"PeriodicalIF":2.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146137577","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":"Comment on Machine learning survival analysis for predicting kidney disease progression in patients with acute kidney injury undergoing continuous kidney replacement therapy: An analysis of the LINKA database","authors":"Bo Song ,&nbsp;Guoying Wang ,&nbsp;Song Zhou","doi":"10.1016/j.jcrc.2026.155456","DOIUrl":"10.1016/j.jcrc.2026.155456","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"93 ","pages":"Article 155456"},"PeriodicalIF":2.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146024078","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":"ICU transfer delay and mortality after ward-onset shock","authors":"Tongjuan Zou ,&nbsp;Chansokhon Ngan ,&nbsp;Wanhong Yin","doi":"10.1016/j.jcrc.2026.155423","DOIUrl":"10.1016/j.jcrc.2026.155423","url":null,"abstract":"<div><h3>Purpose</h3><div>To assess whether intensive care unit (ICU) transfer delay after ward-onset shock is associated with mortality, and whether early point-of-care ultrasound (POCUS) is associated with outcomes.</div></div><div><h3>Materials and methods</h3><div>Retrospective cohort study using an ICU registry linked to electronic health records at West China Hospital (Jan 1, 2019–Jan 31, 2024). Adults with ward-onset shock requiring first ICU transfer were included. Transfer delay was grouped as &lt;3 h, 3–6 h, or &gt; 6 h. Multivariable logistic regression adjusted for age, APACHE II, and SOFA. Early POCUS was defined as ultrasound within 6 h of shock onset.</div></div><div><h3>Results</h3><div>Among 3535 patients, in-hospital mortality was 24.0%. Mortality increased across delay groups: 18.0% (&lt;3 h; <em>n</em> = 2849), 40.7% (3–6 h; <em>n</em> = 150), and 51.5% (&gt;6 h; <em>n</em> = 536). Versus &lt;3 h, adjusted odds of in-hospital death were higher for 3–6 h (OR 2.34, 95% CI 1.62–3.38) and &gt; 6 h (OR 3.27, 95% CI 2.65–4.03) (both <em>P</em> &lt; 0.001). Early POCUS (<em>n</em> = 251, 7.1%) was associated with lower in-hospital mortality (adjusted OR 0.57, 95% CI 0.37–0.84; <em>P</em> = 0.005) and lower 28-day mortality (adjusted OR 0.47, 95% CI 0.30–0.72; <em>P</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>ICU transfer delay after ward-onset shock was independently associated with increased mortality, whereas early POCUS was associated with lower mortality.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"93 ","pages":"Article 155423"},"PeriodicalIF":2.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924194","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: “The impact of ketamine on ICU mortality in patients with sepsis: A retrospective cohort study”","authors":"Mengdi Zhang","doi":"10.1016/j.jcrc.2026.155467","DOIUrl":"10.1016/j.jcrc.2026.155467","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"93 ","pages":"Article 155467"},"PeriodicalIF":2.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146024272","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":"Family engagement in the cardiac ICU: Insights from the FAME study","authors":"Vanessa Debay ,&nbsp;Jillian Kifell ,&nbsp;Joseph Somech ,&nbsp;Michael Goldfarb","doi":"10.1016/j.jcrc.2026.155481","DOIUrl":"10.1016/j.jcrc.2026.155481","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"93 ","pages":"Article 155481"},"PeriodicalIF":2.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146170383","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":"Factors associated with oropharyngeal dysphagia 3 months after ICU discharge in patients undergoing invasive mechanical ventilation: A post-hoc analysis of a Brazilian multicenter prospective cohort study","authors":"Laura Przybylski ,&nbsp;Rafaela Rech ,&nbsp;Duane Mocellin ,&nbsp;Gabriela Soares Rech ,&nbsp;Aline Paula Miozzo ,&nbsp;Jennifer de Souza Menna Barreto ,&nbsp;Emelyn de Souza Roldão ,&nbsp;Rosa da Rosa Minho dos Santos ,&nbsp;Marciane Maria Rover ,&nbsp;Gabriel Pozza Estivalete ,&nbsp;Raíne Fogliati de Carli Schardosin ,&nbsp;Christian Moraes Soares ,&nbsp;Hellen Luiza Moreira dos Santos ,&nbsp;Geraldine Trott ,&nbsp;Gabrielle Nunes da Silva ,&nbsp;Denise de Souza ,&nbsp;Carolina Rothmann Itaqui ,&nbsp;Vanessa Maziero Oliveira ,&nbsp;Rafael de Souza ,&nbsp;Cesar Eduardo Pimentel Ferreira ,&nbsp;Regis Goulart Rosa","doi":"10.1016/j.jcrc.2026.155437","DOIUrl":"10.1016/j.jcrc.2026.155437","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the incidence and factors associated with oropharyngeal dysphagia (OD) three months after intensive care unit (ICU) discharge in patients who underwent invasive mechanical ventilation (IMV).</div></div><div><h3>Methods</h3><div>This was a post-hoc analysis of a prospective multicenter cohort study conducted across ten clinical–surgical ICUs in Brazil. Adult survivors (age &gt; 18 years) with ICU stays ≥72 h and who needed IMV were included. The primary outcome was the incidence of OD, assessed by the Functional Oral Intake Scale (FOIS) during structured telephone interviews. Secondary outcomes included quality of life, measured by the Short Form Health Survey version 2, and rehospitalization.</div></div><div><h3>Results</h3><div>Among 360 patients, the incidence of OD 3 months after ICU discharge was 24.17%. Educational attainment (adjusted risk ratio [aRR] per 1 year increase, 0.95; 95% confidence interval [CI] 0.92–0.99), risk of death at ICU admission (aRR per 1% increase, 1.99; 95% CI, 1.06–3.77), acute respiratory distress syndrome [ARDS] diagnosis at ICU admission (aRR, 0.21; 95% CI, 0.06–0.71), and length of mechanical ventilation (aRR per 1 day increase, 1.02; 95%CI, 1.01–1.03) were associated with OD. Patients with OD reported significantly worse physical and mental quality-of-life scores. The incidence of rehospitalization did not differ significantly between patients with and without OD.</div></div><div><h3>Conclusions</h3><div>OD 3 months after ICU discharge is a common condition among ICU survivors who required IMV. Educational level, severity of illness at ICU admission, ARDS diagnosis at ICU admission, and length of mechanical ventilation are key associated variables.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"93 ","pages":"Article 155437"},"PeriodicalIF":2.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146024689","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":"Dipeptidyl peptidase-3 to predict respiratory outcomes in patients hospitalized with COVID-19: A secondary analysis of a multicenter randomized trial","authors":"J. Pedro Teixeira ,&nbsp;Christopher L. Schaich ,&nbsp;Caitlin C. ten Lohuis ,&nbsp;Nathan D. Nielsen ,&nbsp;Peter Chen ,&nbsp;Adit A. Ginde ,&nbsp;David N. Hager ,&nbsp;Akram Khan ,&nbsp;Lisa H. Merck ,&nbsp;Basmah Safdar ,&nbsp;Jeffrey M. Sturek ,&nbsp;Marjolein de Wit ,&nbsp;Michelle S. Harkins ,&nbsp;Wesley H. Self ,&nbsp;Sean P. Collins ,&nbsp;Laurence W. Busse ,&nbsp;for the ACTIV-4 Host Tissue Investigators","doi":"10.1016/j.jcrc.2026.155478","DOIUrl":"10.1016/j.jcrc.2026.155478","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"93 ","pages":"Article 155478"},"PeriodicalIF":2.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146137527","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: \"What every intensivist should know about…Methylene blue in septic shock\"","authors":"Shannon M. Fernando ,&nbsp;Karim Soliman ,&nbsp;Alexandre Tran ,&nbsp;Salmaan Kanji ,&nbsp;Bram Rochwerg","doi":"10.1016/j.jcrc.2026.155451","DOIUrl":"10.1016/j.jcrc.2026.155451","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"93 ","pages":"Article 155451"},"PeriodicalIF":2.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146046611","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}