Journal of critical care最新文献

{"title":"Current perspectives in cardiogenic shock","authors":"Ounci Es-saad ,&nbsp;Wincy Ng ,&nbsp;Antonio Messina ,&nbsp;Michelle S. Chew","doi":"10.1016/j.jcrc.2026.155471","DOIUrl":"10.1016/j.jcrc.2026.155471","url":null,"abstract":"<div><div>Cardiogenic shock (CS) remains a leading cause of death in intensive cardiac care. Outcomes are limited by delayed recognition of hypoperfusion, heterogeneous phenotypes, and late escalation of therapies.</div><div>Diagnosis and risk stratification have progressed with the introduction of the SCAI staging system, which provides a common language for clinical severity and guides escalation of care. Echocardiography and invasive hemodynamics remain central for defining ventricular phenotype, detecting mechanical complications, and tailoring therapy. Early activation of multidisciplinary shock teams is increasingly adopted to coordinate rapid assessment and structured management.</div><div>Treatment focuses on restoring perfusion, correcting the underlying cause, and preventing further organ injury. Norepinephrine is generally preferred as first-line vasopressor, while inotropes, including dobutamine and milrinone, are selected according to physiologic profile rather than theoretical advantages.</div><div>Mechanical circulatory support (MCS) should be considered early in refractory hypoperfusion, using integrated clinical, metabolic, echocardiographic, and PAC-derived triggers when feasible. Multiorgan support (ventilation, renal replacement therapy, and ECMO-related strategies such as LV unloading/venting) should be aligned with shock trajectory and goals of care.</div><div>CS management should shift from a “one-size-fits-all” model to an early, phenotype-driven strategy with explicit perfusion targets and timely MCS escalation, supported by shock teams and networks. Emerging biomarkers and machine-learning tools may further improve risk stratification and treatment timing.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"93 ","pages":"Article 155471"},"PeriodicalIF":2.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146142524","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: \"Restrictive transfusion in acute brain injury: A meta-analysis of randomized clinical trials\"","authors":"Marina F. Machado ,&nbsp;Victor A. Gomez Galeano ,&nbsp;Silvana E. Ribeiro Papp ,&nbsp;Caroline de Oliveira Fischer ,&nbsp;Marcelo Vier Gambetta ,&nbsp;Beatriz Araújo ,&nbsp;Luciana Gioli-Pereira","doi":"10.1016/j.jcrc.2026.155453","DOIUrl":"10.1016/j.jcrc.2026.155453","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"93 ","pages":"Article 155453"},"PeriodicalIF":2.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146118945","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":"Patterns of opioid and sedative use in adult ICUs: Insights from the ALERT-ICU study on iatrogenic withdrawal syndrome","authors":"Scott Bolesta ,&nbsp;Kathryn E. Smith ,&nbsp;Céline Gélinas ,&nbsp;Marc M. Perreault ,&nbsp;Lisa Burry ,&nbsp;Rebekah Eadie ,&nbsp;Federico C. Carini ,&nbsp;Jamie Harpel ,&nbsp;Ryan Stewart ,&nbsp;Richard R. Riker ,&nbsp;Brian L. Erstad ,&nbsp;on behalf of the ALERT-ICU study investigators","doi":"10.1016/j.jcrc.2026.155444","DOIUrl":"10.1016/j.jcrc.2026.155444","url":null,"abstract":"<div><h3>Background</h3><div>Iatrogenic withdrawal syndrome (IWS) can develop due to prolonged use of opioids and sedatives. This study aimed to evaluate the current usage patterns of these medications in adult ICUs and their potential link to IWS risk, hypothesizing that cumulative doses would increase with longer ICU stays.</div></div><div><h3>Methods</h3><div>This international, multicenter, observational, point-prevalence study included all patients aged 18 and older in adult ICUs who received parenteral opioids or sedatives in the previous 24 h. Data were collected on a selected day between June 1 and September 30, 2021, focusing on medication use over the preceding 24 h. The main outcome measure was the proportion of patients receiving regularly dosed parenteral opioids or sedatives for ≥72 h.</div></div><div><h3>Results</h3><div>A total of 1506 patients from 229 ICUs across 87 hospitals in 11 countries were analyzed. Among those on opioids or sedatives for ≥72 h, 52.4% received regularly dosed opioids, and 56.4% received sedatives. Continuous IV infusion was observed in 63.6% for opioids and 59.1% for sedatives. Median 24-h total doses were significantly higher in patients on opioids-sedatives for ≥72 h (<em>p</em> &lt; 0.030). Additionally, significantly more patients on &lt;72 h received &gt;50% dose reductions (61% vs. 38%; <em>p</em> &lt; 0.001) and initiated enteral medication (24% vs. 15%; p &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>Over half of adult ICU patients are administered regularly dosed parenteral opioids-sedatives for ≥72 h, often at higher doses, potentially increasing the risk of IWS.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"93 ","pages":"Article 155444"},"PeriodicalIF":2.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146024692","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":"Infection-related hospital readmissions after surviving sepsis: A retrospective population level study of adult sepsis survivors in Australia","authors":"Khalia Ackermann,&nbsp;Nanda Aryal,&nbsp;Johanna Westbrook,&nbsp;Ling Li","doi":"10.1016/j.jcrc.2026.155443","DOIUrl":"10.1016/j.jcrc.2026.155443","url":null,"abstract":"<div><h3>Objectives</h3><div>Among adult sepsis survivors we aimed to: (i) assess the rate of all-cause, sepsis or infection hospital readmissions, and (ii) identify associated risk factors.</div></div><div><h3>Methods</h3><div>Retrospective cohort study of adult sepsis survivors with an index hospital admission between Jan 1, 2015, and Jan 31, 2021, in any hospital in New South Wales, Australia. The primary outcome was all-cause, sepsis or infection readmission through the emergency department (ED) within 30 days. Secondary outcomes were 7- and 90-day readmissions. Risk factors were investigated using multivariable logistic regression modelling.</div></div><div><h3>Results</h3><div>Within 30 days, 18,731 (14.9%) of the 125,370 adult sepsis survivors had an all-cause readmission through the ED. Of these readmissions, 1910 (10.2%) had a sepsis diagnosis and 4790 (25.6%) had an infection diagnosis. Factors associated with a higher risk of sepsis or infection-related readmission within 30 days were male sex, not being married, and chronic pulmonary disease, liver disease, diabetes, renal disease, malignancies, or malignant tumour comorbidities. In contrast, factors associated with a lower risk of sepsis or infection-related readmission were being aged 16–44 years (compared to survivors aged &gt;85 years), living in inner regional areas (compared to major cities), or living in the least socioeconomically disadvantaged area (compared to the most), and myocardial infarction, cerebrovascular disease, or peptic ulcer disease comorbidities.</div></div><div><h3>Conclusion</h3><div>Early and unexpected hospital readmissions are common in Australian sepsis survivors with almost 15% returning to hospital through the ED within 30 days, a third of which were for another sepsis or infection event.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"93 ","pages":"Article 155443"},"PeriodicalIF":2.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146024690","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 “Associations of positive end-expiratory pressure (PEEP) with extubation failure and clinical outcomes in invasively ventilated patients with acute brain injury: A secondary analysis of the ENIO study”","authors":"Congrui Wang,&nbsp;Wenkai Zhang","doi":"10.1016/j.jcrc.2026.155462","DOIUrl":"10.1016/j.jcrc.2026.155462","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"93 ","pages":"Article 155462"},"PeriodicalIF":2.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146024077","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: Derivation and validation of a prediction rule for sedative-associated delirium during acute respiratory failure requiring mechanical ventilation","authors":"Yujia Lai","doi":"10.1016/j.jcrc.2026.155463","DOIUrl":"10.1016/j.jcrc.2026.155463","url":null,"abstract":"<div><div>Prendergast and colleagues developed a prediction rule for sedative-associated delirium in mechanically ventilated patients, with good discriminatory ability (AUROC 0.83 in derivation, 0.70 in validation). However, we suggest three improvements: First, the model should specify the decision timepoint, as sedation is frequently adjusted after intubation. Second, using cumulative doses alone may not fully reflect sedation strategies, and incorporating sedation depth (e.g., Richmond Agitation-Sedation Scale) could enhance its relevance. Third, the tool's transportability depends on the delirium assessment method. Recalibration methods, such as adjusting intercepts and slopes, should be considered to ensure consistent performance across settings. Incorporating sedation regimen choices, such as dexmedetomidine versus lorazepam, would also improve clinical applicability. These refinements could strengthen the model's role as a decision-support tool for individualized sedation management.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"93 ","pages":"Article 155463"},"PeriodicalIF":2.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146024266","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 “effects on mortality of blood purification techniques in severe septic shock patients. An updated Bayesian network meta-analysis of randomized controlled trials”","authors":"Amit Kumar Mishra ,&nbsp;Prateek Pandey ,&nbsp;Shubham Singh","doi":"10.1016/j.jcrc.2026.155465","DOIUrl":"10.1016/j.jcrc.2026.155465","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"93 ","pages":"Article 155465"},"PeriodicalIF":2.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146137606","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: “Different microcirculatory patterns in patients with COVID-19 and non-COVID-19 ARDS: A multicenter cross-sectional study”","authors":"Yaojun Zhou,&nbsp;Hongling Zhu,&nbsp;Yanyuan Zhang,&nbsp;Shunsheng Wang","doi":"10.1016/j.jcrc.2026.155454","DOIUrl":"10.1016/j.jcrc.2026.155454","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"93 ","pages":"Article 155454"},"PeriodicalIF":2.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146022763","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":"Peripherally administered vasopressin initiated in the emergency department","authors":"Kyle McCurry ,&nbsp;Kyle DeWitt ,&nbsp;Cameron P. Upchurch ,&nbsp;Rebecca Nashett Wren","doi":"10.1016/j.jcrc.2025.155363","DOIUrl":"10.1016/j.jcrc.2025.155363","url":null,"abstract":"<div><h3>Context</h3><div>Vasopressors are frequently administered in the emergency department (ED) to improve hemodynamic stability in critically ill patients. Due to their potent vasoconstrictive properties, these medications are typically delivered through a central venous catheter (CVC) to minimize the risk of extravasation or infiltration. The use of peripheral venous access for administering vasopressors has grown as more safety data has been published; however, the majority of data does not include vasopressin.</div></div><div><h3>Objective</h3><div>The purpose of this study was to evaluate the incidence of reported infiltrations or extravasations following the administration of peripheral vasopressin.</div></div><div><h3>Design</h3><div>A single-center, retrospective study between 2014 and 2024.</div></div><div><h3>Setting</h3><div>Seventy-nine-bed ED in a 620-bed academic tertiary medical center.</div></div><div><h3>Patients</h3><div>A total of 80 patients received vasopressin via peripheral administration in the ED.</div></div><div><h3>Results</h3><div>The median duration of peripheral vasopressin administration was 444 min [IQR 196, 1314]. The documented minimum and maximum rates of vasopressin were 0.01 units/min and 0.08 units/min, respectively, with a median rate of 0.03 units/min [IQR 0.03, 0.04]. There were no reports or incidents of infiltration or extravasation related to the administration of peripheral vasopressin. Although patients initially received peripheral vasopressin, 26 patients (32.5 %) were later transitioned to CVC administration.</div></div><div><h3>Conclusions</h3><div>With no observed instances of infiltration, extravasation, or other related complications, peripheral administration of vasopressin initiated in the ED for select, hemodynamically compromised patients may represent a feasible approach to initiate early vasopressor therapy while allowing clinicians to more carefully weigh the risks and benefits of CVC placement. Future research should focus on prospective, multicenter studies to validate these findings in larger and more diverse patient populations.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"92 ","pages":"Article 155363"},"PeriodicalIF":2.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145615776","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 clinical outcome of Montelukast versus co-enzyme Q10 in adult patients with sepsis: A randomized controlled clinical trial”","authors":"Ying Han","doi":"10.1016/j.jcrc.2025.155317","DOIUrl":"10.1016/j.jcrc.2025.155317","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"92 ","pages":"Article 155317"},"PeriodicalIF":2.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145615780","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}