Journal of critical care最新文献

{"title":"The diagnostic accuracy of serum procalcitonin for sepsis in critically ill adults. A systematic review and diagnostic meta-analysis","authors":"Tanmoy Ghatak ,&nbsp;Akash Pal ,&nbsp;Bram Rochwerg ,&nbsp;Sukhen Samanta ,&nbsp;Anup Kumar ,&nbsp;Syed Ammar Sajjad ,&nbsp;Arnavjyoti Das ,&nbsp;Ratender k Singh","doi":"10.1016/j.jcrc.2025.155402","DOIUrl":"10.1016/j.jcrc.2025.155402","url":null,"abstract":"<div><h3>Introduction</h3><div>Procalcitonin (PCT) has been a blue-eyed-boy in diagnosing sepsis in previous years. The aim of this systematic review and meta-analysis was to assess the accuracy of PCT for the diagnosis of sepsis, according to the recent Sepsis-3 criteria, in adult patients admitted to the intensive care unit (ICU).</div></div><div><h3>Methods</h3><div>We searched several electronic databases, including PubMed, Science Direct, Wiley, Cochrane, and Google Scholar from the inception of the Sepsis-3 diagnostic criteria (January 1, 2016) until May 31, 2025, for randomized controlled trials, cohort, and case-control studies that assessed the diagnostic accuracy of PCT for sepsis using the Sepsis-3 criteria among critically ill adult patients with suspected infection. We performed a random effect diagnostic meta-analysis, evaluated the risk of bias of individual studies using the QUADAS tool, and assessed certainty of evidence using GRADE methodology.</div></div><div><h3>Results</h3><div>We included 10 studies comprising 1098 patients. Of these, 635 patients were diagnosed with sepsis based on Sepsis-3 criteria, including 89 patients with septic shock. The pooled sensitivity of PCT for diagnosing sepsis was 0.72 (95 % CI [confidence interval], 0.68–0.75, low certainty) and the pooled specificity was 0.65 (95 % CI, 0.61–0.69, low certainty). The pooled positive likelihood ratio was 2.45 (95 % CI [confidence interval], 1.62–3.68), The negative likelihood ratio was 0.38 (95 % CI, 0.28–0.53), and the pooled diagnostic odds ratio was 7.08 (95 % CI, 3.69–13.58). The area under the summary receiver operating characteristic curve of PCT was 0.79 (95 % CI 0.73–0.86).</div></div><div><h3>Conclusion</h3><div>Based on pooled analysis, PCT has a moderate sensitivity and specificity for diagnosis of sepsis in ICU patients with suspected infection. These results suggest clinicians should be cautious about using PCT to facilitate the diagnosis of sepsis in critically ill adults with suspected infection. Given the ongoing uncertainty, further high-quality data in this population is needed.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"92 ","pages":"Article 155402"},"PeriodicalIF":2.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145786898","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 “Is ketamine safe for traumatic brain injury? A systematic review and meta-analysis”","authors":"Wael Ghaly Elmasry ,&nbsp;Ahmed Mohammed Abdelbaky ,&nbsp;Ahmed Hossameldin Ahmed Awad","doi":"10.1016/j.jcrc.2025.155413","DOIUrl":"10.1016/j.jcrc.2025.155413","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"92 ","pages":"Article 155413"},"PeriodicalIF":2.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145880560","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":"Nationwide expert survey on transfusion and coagulation management strategies for bleeding critically ill patients in China","authors":"Siying Chen ,&nbsp;Lu Xu ,&nbsp;Shiyu Liu ,&nbsp;Bingkui Ren ,&nbsp;Yuping Zhang ,&nbsp;Junci Chong ,&nbsp;Lu Ke ,&nbsp;Jingchun Song ,&nbsp;Yun Fan ,&nbsp;Chuanbao Li ,&nbsp;Junhua Hu ,&nbsp;Huanzhang Shao ,&nbsp;Chao Deng ,&nbsp;Xiaojun Yang ,&nbsp;Haiyan Wu ,&nbsp;You Shang ,&nbsp;Yuanqi Gong ,&nbsp;Feng Guo ,&nbsp;Daozheng Huang ,&nbsp;Zhiyong Liu ,&nbsp;Zhigang Chang","doi":"10.1016/j.jcrc.2025.155352","DOIUrl":"10.1016/j.jcrc.2025.155352","url":null,"abstract":"<div><div>This study aimed to investigate coagulation management strategies by experienced critical care physicians across China. The questionnaire was independently designed referencing current guidelines and literature, and refined through five rounds of multidisciplinary review, covering basic information, blood product supply, clinical practices, and laboratory support. The survey recruited 473 senior physicians from 473 Intensive Care Units (ICUs) at 431 tertiary hospitals across China. Many hospitals reported a shortage of blood products. Most physicians preferred a strategy of fixed ratio for transfusion in traumatic (350/473, 74.0 %) and non-traumatic (271/473, 57.29 %) massive hemorrhage. For patients with hemorrhage and coagulopathy, fresh frozen plasma (FFP) (421/473, 89.0 %), prothrombin complex concentrate (PCC) (274/473, 57.9 %), and cryoprecipitate (Cryo) (213/473, 45.0 %) were commonly used. In cases of massive hemorrhage, 39.7 % (188/473) of physicians would empirically administer PCC, and 77.6 % (367/473) would rely on the results of traditional laboratory tests. Human fibrinogen (FIB) concentrate (373/473, 78.9 %) and Cryo (380/473, 80.3 %) were commonly used to replenish fibrinogen. To raise plasma FIB levels, 1–2 g of FIB (352/473, 74.4 %) and 5–15 units (U) of Cryo (402/473, 84.99 %) were usually administered empirically; a FIB level above 2.0 g/L was the most commonly used standard for treatment termination (234/473, 49.5 %). Tranexamic acid (TXA) was commonly used to treat traumatic (338/473, 71.5 %) or non-traumatic (326/473, 68.9 %) intracranial hemorrhage. Significant variation was observed in the use of FFP (351/473, 74.2 %) and PCC (171/473, 36.2 %) to treat hemorrhage caused by vitamin K antagonists. Significant differences have been observed in blood product supply and treatment strategies used by ICU physicians for massive hemorrhage in critically ill patients, suggesting the need for treatment protocol standardization and further research.</div></div><div><h3>Keypoints</h3><div>This nationwide expert survey provides a comprehensive understanding of current clinical practices in blood product transfusion and coagulation management for critically ill patients with hemorrhage. Most hospitals encounter a shortage of blood products while treating massive hemorrhage. Blood product transfusion ratios, plasma transfusion strategies, and PLT transfusion indications are notably different when treating critically ill patients with massive versus non-massive hemorrhage. Practical variations exist regarding the threshold indications and dosing of PCC, FIB, Cryo, and TXA in the setting of hemorrhage. Discrepancy and knowledge gaps still exist in antithrombotic reversal strategy for vitamin K antagonists, novel oral anticoagulant (NOAC), and antiplatelet drug-induced hemorrhage.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"92 ","pages":"Article 155352"},"PeriodicalIF":2.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145512877","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":"Identification of patient states in sepsis and septic shock","authors":"Ayush Ranjan ,&nbsp;Venkatesh Kareenhalli","doi":"10.1016/j.jcrc.2025.155369","DOIUrl":"10.1016/j.jcrc.2025.155369","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"92 ","pages":"Article 155369"},"PeriodicalIF":2.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146022464","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":"Effects on mortality of blood purification techniques in severe septic shock patients. An updated Bayesian network meta-analysis of randomized controlled trials","authors":"Massimo Meco ,&nbsp;Emiliano Agosteo ,&nbsp;Pierluigi Zulli ,&nbsp;Fulvio Nisi ,&nbsp;Enrico Giustiniano","doi":"10.1016/j.jcrc.2025.155330","DOIUrl":"10.1016/j.jcrc.2025.155330","url":null,"abstract":"<div><h3>Background</h3><div>Sepsis is a very severe condition that carries a high risk of death. Blood purification methods have been employed alongside conventional treatment to help decrease the death rate associated with severe sepsis.</div></div><div><h3>Research question</h3><div>The objective of our network meta-analysis (NMA) was to determine the most efficient blood purification device for decreasing mortality in individuals with severe septic shock.</div></div><div><h3>Study design and methods</h3><div>The network meta-analysis (NMA), which incorporated randomized clinical trials (RCTs), was performed by modeling the binary outcome “mortality” utilizing a Bayesian hierarchical model. We examined direct comparisons of blood purification methods employed for the immediate management of individuals experiencing severe septic shock. The studies' risk of bias was evaluated using the Cochrane Handbook for Systematic Reviews of Interventions. The main result was death rate. We calculated summary relative risks (RRs) through pairwise meta-analysis and NMA employing fixed effects. We utilized the surface beneath the cumulative ranking curve (SUCRA) to display the order of interventions.</div></div><div><h3>Results</h3><div>Out of 379 references, we incorporated 31 RCTs. We discovered 15 distinct treatment approaches. The overall count of patients was 2678. The forest plot, league heat table, and SUCRA plot indicated that the TORAYMYXIN™ filter (PMX) and HA 330™ were the sole devices that notably decreased mortality in comparison to standard treatment.</div></div><div><h3>Interpretation</h3><div>The PMX filter and HA 330 for blood purification greatly lower mortality rates in patients experiencing severe septic shock. All patients who received convection at any prescribed convective dose exhibited greater mortality compared to those receiving standard therapy.</div><div>PROSPERO (CRD42023486159).</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"92 ","pages":"Article 155330"},"PeriodicalIF":2.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145519386","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":"Fluid balance in COVID-19 patients supported with VV ECMO – A retrospective cohort study","authors":"Fabian Perschinka ,&nbsp;Lili Werlberger ,&nbsp;Paul Köglberger ,&nbsp;Timo Mayerhöfer ,&nbsp;Michael Joannidis","doi":"10.1016/j.jcrc.2025.155357","DOIUrl":"10.1016/j.jcrc.2025.155357","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"92 ","pages":"Article 155357"},"PeriodicalIF":2.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145604526","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":"Activities of daily living, physical activity, and care situation in chronic critical illness survivors one year after disease onset: A prospective cohort study","authors":"Marion Egger ,&nbsp;Melanie Finsterhölzl ,&nbsp;Franziska Wippenbeck ,&nbsp;Friedemann Müller ,&nbsp;Klaus Jahn ,&nbsp;Volker Huge ,&nbsp;Jeannine Bergmann","doi":"10.1016/j.jcrc.2025.155396","DOIUrl":"10.1016/j.jcrc.2025.155396","url":null,"abstract":"<div><h3>Background</h3><div>Survivors of critical illness frequently experience long-term impairments. Chronic critical illness (CCI) affects patients requiring prolonged ICU treatment and mechanical ventilation and is often complicated by critical illness polyneuropathy/myopathy (CIP/CIM). However, long-term data on CCI and CIP/CIM-particularly regarding activities of daily living (ADL), physical activity, and care situation-are limited.</div></div><div><h3>Methods</h3><div>We analyzed data from the prospective cohort study CINAMOPS, including patients with CCI and ≥ 5 days of mechanical ventilation. Participants underwent inpatient neurological rehabilitation and were followed for one year after onset of critical illness. We assessed functional independence in ADL (Barthel Index), instrumental ADL (IADL; Lawton&amp;Brody), physical activity (IPAQ-SF), overall disability (WHODAS-12), and the care situation via telephone and postal follow-up. Pre-hospitalization and follow-up conditions were compared, and health-related quality of life (HRQoL) correlations and differences between patients with and without CIP/CIM were analyzed.</div></div><div><h3>Results</h3><div>In our cohort (<em>n</em> = 204; 62 ± 13 years; 34 % women; 63 ± 42 ICU days), ADL, IADL, and physical activity were significantly reduced at one-year follow-up. The WHODAS-12 score was 39 ± 26 %, with 64 % exhibiting moderate to severe disability. Only 62 % were independent in personal care, and 36 % could manage household tasks. Disability and functional dependence correlate with HRQoL. Of those previously employed, nearly half remained on sick leave. CIP/CIM was associated with worse functional outcomes and greater therapy needs.</div></div><div><h3>Conclusions</h3><div>One year after CCI, most patients continued to exhibit functional impairment and substantial restrictions in independent living. The presence of CIP/CIM worsened outcomes. Intensive rehabilitation and individualized long-term support are essential to improve recovery in this population.</div><div><strong>Trial registration</strong>: German Clinical Trials Register, DRKS00021753. Registered 03 September 2020. <span><span>https://drks.de/search/en/trial/DRKS00021753</span><svg><path></path></svg></span>.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"92 ","pages":"Article 155396"},"PeriodicalIF":2.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145681143","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":"Subphenotyping aneurysmal subarachnoid Hemorrhage using clinical and biological data clustering","authors":"Manel Santafé ,&nbsp;Manuel Quintana ,&nbsp;Anna Sánchez ,&nbsp;Rosa-Maria Gràcia ,&nbsp;Daniel Campos-Fernandez ,&nbsp;Laura Abraira ,&nbsp;Estevo Santamarina","doi":"10.1016/j.jcrc.2025.155365","DOIUrl":"10.1016/j.jcrc.2025.155365","url":null,"abstract":"<div><h3>Background</h3><div>Aneurysmal subarachnoid hemorrhage (aSAH) is an heterogeneous disease with variable outcomes, even among patients with similar clinical and radiological severity. Additional research is needed to better stratify aSAH patients.</div></div><div><h3>Objectives</h3><div>To identify distinct clinical subphenotypes of aSAH, we applied clustering analysis using clinical, radiological, and laboratory data.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study of adult patients with aSAH admitted to the ICU between 2010 and 2021. K-means clustering was applied to standardized demographic, clinical, and laboratory variables collected at admission. Principal component analysis was used for dimensionality reduction and visualization. Additionally, we analyzed whether these clusters were associated with serum biomarkers (S100B, HMGB1, and TLR4) in a subset of patients.</div></div><div><h3>Results</h3><div>The study included 511 patients with aSAH. Two distinct subphenotypes were identified: a High-Risk Cluster (<em>n</em> = 301, 58.9 %) characterized by severe systemic complications, and higher mortality, and a Low-Risk Cluster (<em>n</em> = 210, 41.1 %) with less severe symptoms and better outcomes. Serum S100B levels were significantly elevated in the High-Risk Cluster (0.077 [0.056–0.179] vs. 0.055 [0.040–0.079] μg/L, <em>p</em> = 0.008) and showed moderate discriminatory power (AUC = 0.72).</div></div><div><h3>Conclusions</h3><div>Clustering analysis revealed two aSAH subphenotypes associated with DCI, mortality and functional. Integrating early clinical and biomarker data could enhance patient stratification.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"92 ","pages":"Article 155365"},"PeriodicalIF":2.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145615778","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":"Do machines, such as ECMO, save lives? Past, present, and perspectives","authors":"Benjamin Assouline ,&nbsp;Annemieke Oude Lansink-Hartgring ,&nbsp;Raphael Giraud ,&nbsp;Konstanty Szuldrzynski ,&nbsp;Matthieu Schmidt","doi":"10.1016/j.jcrc.2025.155356","DOIUrl":"10.1016/j.jcrc.2025.155356","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"92 ","pages":"Article 155356"},"PeriodicalIF":2.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145615779","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":"Gender equity and diversity in the intensive care medicine workforce: Insights from Türkiye and implications for the global scientific community","authors":"Francesca Rubulotta ,&nbsp;Sabrina Migliorelli ,&nbsp;Maria Vargas","doi":"10.1016/j.jcrc.2025.155362","DOIUrl":"10.1016/j.jcrc.2025.155362","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"92 ","pages":"Article 155362"},"PeriodicalIF":2.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145615781","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}