Journal of critical care最新文献

{"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 , 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}

{"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":"Aishwarya Raparthi,&nbsp;Sharanya Kumar Bavurothu","doi":"10.1016/j.jcrc.2025.155240","DOIUrl":"10.1016/j.jcrc.2025.155240","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"91 ","pages":"Article 155240"},"PeriodicalIF":2.9,"publicationDate":"2025-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144892174","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":"Two paths to paralysis: A multicenter comparison of cisatracurium to atracurium in the management of acute respiratory distress syndrome","authors":"Paul Dobry ,&nbsp;Richard Lane ,&nbsp;Paige Whittaker ,&nbsp;Andrew Gwaltney ,&nbsp;Sloan Smith ,&nbsp;Brionna Hudson ,&nbsp;Shannon Carabetta ,&nbsp;Rochelle Brual ,&nbsp;Logan Sawyer ,&nbsp;Mary Perez ,&nbsp;Mimi Truong ,&nbsp;Margaret DeVier ,&nbsp;Katie Dalton ,&nbsp;Stephanie B. Edwin ,&nbsp;Christopher Giuliano ,&nbsp;Bradley J. Haan ,&nbsp;Mitchell Daley","doi":"10.1016/j.jcrc.2025.155227","DOIUrl":"10.1016/j.jcrc.2025.155227","url":null,"abstract":"<div><h3>Purpose</h3><div>Neuromuscular blocking agents (NMBAs) such as cisatracurium and atracurium are used to facilitate lung-protective ventilation in moderate-to-severe acute respiratory distress syndrome (ARDS). Although cisatracurium has been more extensively studied, data comparing these agents directly are limited. This study compares clinical outcomes between atracurium and cisatracurium in patients with moderate-to-severe ARDS.</div></div><div><h3>Materials and methods</h3><div>This multicenter, retrospective cohort study was conducted between January 2017 and December 2023 across 11 Ascension Health hospitals. Mechanically ventilated adults with a PaO₂/FiO₂ ratio &lt; 150 who received a continuous infusion of atracurium or cisatracurium for at least 12 h within 48 h of ARDS diagnosis were included. The primary endpoint was ventilator-free days at day 28.</div></div><div><h3>Results</h3><div>A total of 384 patients were included, with 192 in each group. Median 28-day ventilator-free days did not differ between groups in the unmatched (0 [IQR 0–16.7] vs. 0 [IQR 0–16.4], <em>p</em> = 0.72) or matched (0 [IQR 0–18.3] vs. 0 [IQR 0–14.4], <em>p</em> = 0.09) cohorts. These findings were further confirmed by multivariable analysis. After matching, there were no significant differences in 90-day inpatient mortality, length of stay, or duration of mechanical ventilation. While patients receiving cisatracurium showed greater improvements in PaO₂/FiO₂ ratio at 72 h (<em>p</em> &lt; 0.01), resolution of ARDS was similar between groups. Safety outcomes were comparable between agents.</div></div><div><h3>Conclusions</h3><div>Atracurium and cisatracurium demonstrated similar safety and effectiveness in patients with moderate-to-severe ARDS. These results suggest that atracurium is a viable alternative to cisatracurium for the treatment of ARDS.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"91 ","pages":"Article 155227"},"PeriodicalIF":2.9,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144886492","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":"Enhancing mechanical ventilation management with AI: Computer vision for automated detection of ventilatory modes, parameters and asynchrony","authors":"Diego de Carvalho ,&nbsp;Kleyton Hoffmann ,&nbsp;João Rogério Nunes Filho ,&nbsp;Antuani Rafael Baptistella","doi":"10.1016/j.jcrc.2025.155238","DOIUrl":"10.1016/j.jcrc.2025.155238","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the performance of an artificial intelligence (AI)-based decision support platform called <em>NexoVent,</em> which uses computer vision to automatically detect ventilator modes, parameters, and patient-ventilator asynchrony (PVA) from ventilator screen images in real time.</div></div><div><h3>Methods</h3><div>This observational study was conducted in the ICU of a tertiary care hospital. Images from Servo-i and Servo-s ventilators in PCV mode were acquired using standard mobile devices under various clinical conditions. The <em>NexoVent</em> platform used pre-processing filters, optical character recognition (OCR), and waveform analysis to extract alphanumeric and waveform data. Six types of PVA were evaluated: premature cycling, delayed cycling, ineffective effort, double triggering, flow starvation, and excessive flow. Performance was compared to expert consensus, which served as the reference standard.</div></div><div><h3>Results</h3><div>A total of 621 respiratory cycles were analyzed to evaluate the accuracy of <em>NexoVent</em> in detecting ventilator mode and alphanumeric ventilator parameters<em>. NexoVent</em> identified ventilator parameters with an overall accuracy of 95.4 % and detected ventilator modes with an accuracy of 94.0 %. The system accurately detected asynchronies with performance ranging from 81.6 % (delayed cycle) to 97.8 % (ineffective effort). All analyses were performed using images only, without any direct interface to the ventilator hardware or software.</div></div><div><h3>Conclusion</h3><div><em>NexoVent</em> accurately detects ventilatory data and multiple forms of PVA using non-invasive, image-based computer vision. These findings support the platform's potential to improve mechanical ventilation management and provide real-time clinical decision support in various ICU settings, especially where expertise or device interoperability is limited.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"91 ","pages":"Article 155238"},"PeriodicalIF":2.9,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144889936","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 clinical outcome of Montelukast versus co-enzyme Q10 in adult patients with sepsis: A randomized controlled clinical trial","authors":"Ghada Hussein Eladly ,&nbsp;Salwa Omar Elkhattab Amin ,&nbsp;Nagwa Ali Sabri ,&nbsp;May Ahmed Shawki","doi":"10.1016/j.jcrc.2025.155225","DOIUrl":"10.1016/j.jcrc.2025.155225","url":null,"abstract":"<div><h3>Background</h3><div>Oxidative stress and inflammatory cytokines are involved in sepsis pathogenesis with associated high rate of morbidity and mortality. This study aimed to evaluate the potential benefits of montelukast and co-enzyme Q10 (CoQ10) in septic patients as anti-inflammatory and antioxidant adjunctive therapies.</div></div><div><h3>Methods</h3><div>An open label randomized controlled trial was conducted at an intensive care unit (ICU). Ninety adult septic patients were randomized to receive the standard care alone (<em>n</em> = 30, control), or the standard care in addition to either montelukast sodium 10 mg/day (n = 30) or CoQ10 210 mg/day (n = 30). The 28-day mortality was the study primary outcome. Secondary outcomes included the duration of mechanical ventilation (MV) and vasopressor, SOFA score, tumor necrosis factor- α (TNF- α), and malondialdehyde (MDA).</div></div><div><h3>Results</h3><div>The 28- day mortality rate was 23.3 %, 33.3 %, and 56.7 % in the montelukast, CoQ10, and control with only significant difference being observed between the montelukast and the control groups (p- value = 0.024). The duration of vasopressor was significantly higher in the control group (mean ± SD = 9.8 ± 4.8 days) than the CoQ10 group (mean ± SD = 5.4 ± 2.7 days) and the montelukast group (mean ± SD = 2.9 ± 1.3 days) with <em>p</em>-values &lt;0.001, while the montelukast and CoQ10 groups showed comparable results. The same was observed regarding the duration of MV. Both montelukast and CoQ10 showed significant positive effect on SOFA score, procalcitonin, C-reactive protein (CRP), TNF- α and MDA. Montelukast didn't show any adverse effects. However, 20 % of CoQ10 patients experienced hypotension.</div></div><div><h3>Conclusion</h3><div>Montelukast and CoQ10 were tolerable and showed potential benefits as add on therapies in sepsis management.</div></div><div><h3>Trial registration</h3><div>The trial was registered at clinical <span><span>trial.gov</span><svg><path></path></svg></span> (<span><span>NCT05293132</span><svg><path></path></svg></span>). <span><span>https://clinicaltrials.gov/study/NCT05293132?cond=Sepsis&amp;term=Montelukast&amp;rank=1</span><svg><path></path></svg></span></div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"91 ","pages":"Article 155225"},"PeriodicalIF":2.9,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144886491","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":"When shortcuts fall short: The hidden danger of abbreviations in critical care","authors":"Sebastian Berger ,&nbsp;Pascale Grzonka ,&nbsp;Sabina Hunziker ,&nbsp;Anja I. Frei ,&nbsp;Raoul Sutter","doi":"10.1016/j.jcrc.2025.155236","DOIUrl":"10.1016/j.jcrc.2025.155236","url":null,"abstract":"<div><h3>Objectives</h3><div>Effective critical care communication is vital for patient safety, yet the risks of ambiguous abbreviations and acronyms or initialisms in clinical communication remain understudied. This narrative review aims to identify potentially ambiguous abbreviations and acronyms in critical care and evaluate their potential implications for clinical safety and communication quality. From this, educational interventions and standardized protocols could be devised to optimize communication.</div></div><div><h3>Methods</h3><div>PubMed and Embase databases were used to identify studies and reports on the use of abbreviations and acronyms in medical care and references of identified publications were screened. Additionally, the large language model “Chat Generative Pre-Trained Transformer-4omni” was used to generate a list of ambiguous terms used in critical care.</div></div><div><h3>Results</h3><div>We identified 52 ambiguous acronyms and initialisms, and 24 abbreviations used in critical care with multiple meanings, risking critical errors during communication and ward transfers. These ambiguities stem from specialty, context, or institutional differences. The literature discusses optimization of communication in critical care during hand-offs or more complex solutions including auto-expansion software or protocols. Only few studies discussed the dangers of medication errors or misunderstandings due to abbreviation use. Abbreviations contribute to as much as 13 % of medication errors. Strategies are proposed to reduce abbreviation-related errors including spelling out terms initially, using closed-loop communication, standardized unit-approved lists, regular education, and avoiding jargon.</div></div><div><h3>Conclusions</h3><div>Ambiguous abbreviations and acronyms pose a significant threat to safe and effective communication in critical care. Standardized terminology, education, and clear documentation practices are urgently needed to mitigate these risks and improve patient safety.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"91 ","pages":"Article 155236"},"PeriodicalIF":2.9,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144863533","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":"Portable handheld ultrasound for VExUS assessment in critical care: Reliability and time efficiency in resident-led examinations","authors":"Shan-shan Zhai ,&nbsp;Lin Shang ,&nbsp;De-zhi Ren ,&nbsp;Yong-yi Chen ,&nbsp;Hui Wang","doi":"10.1016/j.jcrc.2025.155224","DOIUrl":"10.1016/j.jcrc.2025.155224","url":null,"abstract":"<div><h3>Objectives</h3><div>Pathologic venous congestion significantly impacts outcomes yet remains underrecognized, necessitating practical bedside assessment. We evaluated the reliability and reproducibility of the venous excess ultrasound (VExUS) score using handheld ultrasound among resident trainees managing critically ill patients.</div></div><div><h3>Method</h3><div>Two blinded residents, trained in a short VExUS course, independently performed sequential VExUS scans on 80 critically ill patients using both handheld ultrasound and conventional ultrasound. Two ICU mentors then interpreted the anonymized images to establish gold-standard VExUS scores and assess image quality. We evaluated inter-rater reliability (IRR) and inter-user reproducibility (IUR) using Cohen's κ and intraclass correlation coefficient (ICC) for categorical outcomes. For continuous data, we used Spearman correlation, ICC, Deming regression, and Bland-Altman analysis. We also recorded the procedural time for each scan.</div></div><div><h3>Results</h3><div>In 80 ICU patients, handheld and conventional ultrasound showed strong agreement for most VExUS parameters (Bland-Altman/Deming), with IVC diameter demonstrating minimal bias (0.037 cm; rho = 0.92, ICC = 0.98) and hepatic velocities negligible differences (ICC &gt; 0.96). Both devices achieved high inter-rater VExUS grading reliability (handheld κ = 0.879/ICC = 0.912; conventional κ = 0.851/ICC = 0.865), though handheld showed reduced renal vein concordance (κ = 0.55 vs conventional 0.653). Image acquisition succeeded in &gt;91 % cases (hepatic/IVC 100 %). Handheld ultrasound halved procedural time (5 vs 8 min, <em>p</em> &lt; 0.0001) with comparable grading accuracy (<em>p</em> = 0.747).</div></div><div><h3>Conclusions</h3><div>Handheld ultrasound provides reliable VExUS assessment comparable to conventional systems (VExUS grade κ &gt; 0.85), with 40 % faster procedural time (5 vs 8 min, <em>p</em> &lt; 0.0001). Despite renal vein evaluation challenges (handheld κ = 0.55), high image acquisition (&gt;91 %) and inter-rater agreement support its utility for venous congestion monitoring in critical care.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"91 ","pages":"Article 155224"},"PeriodicalIF":2.9,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144863532","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 regarding:“Noninvasive ventilation failure in thoracic trauma: A retrospective study on predictive scores, ventilatory strategies and pain management”","authors":"Xiangfeng Tian,&nbsp;Feiye Zhu","doi":"10.1016/j.jcrc.2025.155220","DOIUrl":"10.1016/j.jcrc.2025.155220","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"91 ","pages":"Article 155220"},"PeriodicalIF":2.9,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144863720","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}