Journal of critical care最新文献

{"title":"Letter to the editor: “Association of opioid utilization in the intensive care unit and opioid prescriptions at hospital discharge in opioid-naïve non-surgical patients who received enhanced oxygen therapy”","authors":"Eric J. Charles, Faisal A. Shaikh, Jana K. Elsawwah, Zoltan H. Nemeth","doi":"10.1016/j.jcrc.2025.155120","DOIUrl":"10.1016/j.jcrc.2025.155120","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"89 ","pages":"Article 155120"},"PeriodicalIF":3.2,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144069937","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: Heliox ventilation in elderly, hypertensive ICU patients improves microcirculation: A randomized controlled study","authors":"Aurelien Gonze , Thibault Gennart , Emily Perriens , Sydney Blackman , Nathan De Lissnyder , Patrick M. Honore","doi":"10.1016/j.jcrc.2025.155118","DOIUrl":"10.1016/j.jcrc.2025.155118","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"89 ","pages":"Article 155118"},"PeriodicalIF":3.2,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143949020","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":"Cystatin C-derived measures of renal function as risk factors for mortality and renal replacement therapy in the critically ill – An analysis of the SWECRIT cohort","authors":"Erik Linné ,&nbsp;Anna Åkesson ,&nbsp;Maria Lengquist ,&nbsp;Hans Friberg ,&nbsp;Attila Frigyesi ,&nbsp;Anders O. Larsson ,&nbsp;Anders Grubb ,&nbsp;Peter Bentzer","doi":"10.1016/j.jcrc.2025.155116","DOIUrl":"10.1016/j.jcrc.2025.155116","url":null,"abstract":"<div><h3>Purpose</h3><div>Assess if cystatin C-derived measures of kidney function are associated with mortality in septic- and non-septic intensive care unit (ICU) patients.</div></div><div><h3>Methods</h3><div>Data from adult patients staying &gt;24 h in four ICUs in Sweden from November 2015–December 2018 included. Outcomes were mortality and need for renal replacement therapy (RRT) due to acute kidney injury. Associations between cystatin C-estimated glomerular filtration rate (eGFRcys) and shrunken pore syndrome (SPS) and outcomes were assessed with Cox-regression in unadjusted and analyses adjusted for sex, age, illness severity, chronic kidney disease and creatinine. SPS was defined as a ratio between eGFRcys and eGFRcreatinine &lt;0.6.</div></div><div><h3>Results</h3><div>In total, 4455 patients were included in the analysis, of which 32 % had sepsis. SPS was present in 7.4 % of the cohort, and 90-day mortality was 30.8 %. In sepsis- and non-sepsis patients, SPS and eGFRcys were associated with 90-day-, 1-year mortality and RRT in unadjusted analyses. In an adjusted analysis, SPS was associated with 1-year mortality in sepsis patients (hazard ratio [HR] 1.4, 95 % CI 1.1–1.9, <em>p</em> = 0.021), and eGFRcys was associated with RRT in both sepsis and non-sepsis patients (HR 3.1, 95 % CI 1.6–6.0, <em>p</em> &lt; 0.001, eGFRcys &lt;20 vs ≥60 ml/min/1.73m²). No other associations between eGFRcys, SPS and mortality were detected in adjusted analyses.</div></div><div><h3>Conclusion</h3><div>Our finding that SPS is more robustly associated with mortality in sepsis patients than in non-sepsis patients suggests that the association between SPS and mortality may depend on underlying pathophysiology. A cystatin C-based estimate of GFR is independently associated with RRT in sepsis and non-sepsis.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"89 ","pages":"Article 155116"},"PeriodicalIF":3.2,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143949019","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: “Accuracy between ICU admission and discharge diagnoses in non-survivors: A retrospective cohort study”","authors":"Hao Xu,&nbsp;Sai Xiang","doi":"10.1016/j.jcrc.2025.155117","DOIUrl":"10.1016/j.jcrc.2025.155117","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"89 ","pages":"Article 155117"},"PeriodicalIF":3.2,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143928975","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":"Evaluating extreme temperature values and patient outcomes in aneurysmal subarachnoid hemorrhage: Post-hoc insights from the Earlydrain trial","authors":"David Wasilewski MD ,&nbsp;Peter Truckenmueller MD ,&nbsp;Anton Früh MD, MSc ,&nbsp;Peter Vajkoczy MD ,&nbsp;Stefan Wolf MD ,&nbsp;the Earlydrain Study Group","doi":"10.1016/j.jcrc.2025.155104","DOIUrl":"10.1016/j.jcrc.2025.155104","url":null,"abstract":"<div><h3>Purpose</h3><div>Dysregulation of temperature in aneurysmal subarachnoid hemorrhage (aSAH) patients may worsen neurological outcomes. Fever and hypothermia could be related to infection, inflammation, or loss of central temperature control. However, longitudinal studies on temperature extremes and outcomes are lacking. This post-hoc analysis of the Earlydrain trial examines the prognostic significance of body temperature during the first 8 days of neurocritical care.</div></div><div><h3>Methods</h3><div>We analyzed data from 287 patients, using Generalized Estimating Equations to investigate clinically used thresholds for intervention on body temperature. Statistical models were adjusted for hemorrhage severity, age, intracerebral and intraventricular hemorrhage, infection and the use of a lumbar drainage. We assessed the impact of different temperature thresholds on the modified Rankin Scale (mRS) at 180 days and the incidence of secondary infarctions.</div></div><div><h3>Results</h3><div>Extreme temperatures were associated with worse 180-day outcomes. In univariate analysis, all investigated temperature thresholds (&gt;38.0 °C, &gt;38.2 °C, &gt; 39.0 °C, as well as &lt;36.0 °C) were associated with worse outcome. In multivariate analysis, temperatures above 39 °C and below 36 °C increased the odds of an unfavorable mRS &gt;2 (OR_adj = 2.60, <em>p</em> = 0.002 and OR_adj = 3.82, <em>p</em> = 0.02, respectively). The development of secondary infarctions was not significantly related to temperature extremes.</div></div><div><h3>Conclusion</h3><div>Extreme temperature values significantly influence outcomes in aSAH. Maintaining normothermia may improve prognosis, warranting prospective studies for targeted temperature management.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"89 ","pages":"Article 155104"},"PeriodicalIF":3.2,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143912845","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":"Association of vasopressor use during renal replacement therapy and mortality","authors":"Javier A. Neyra ,&nbsp;Jorge Echeverri ,&nbsp;Daniel Bronson-Lowe ,&nbsp;Caio Plopper ,&nbsp;Kai Harenski ,&nbsp;Raghavan Murugan","doi":"10.1016/j.jcrc.2025.155103","DOIUrl":"10.1016/j.jcrc.2025.155103","url":null,"abstract":"<div><div>Among critically ill patients with acute kidney injury (AKI) requiring renal replacement therapy (RRT) whether vasopressor use is associated with outcomes is unclear. We examined the association of vasopressor use following RRT initiation with in-hospital mortality in critically ill adults with AKI requiring different modalities of RRT. This observational study was conducted using the Premier Inc. (PINC) AI Healthcare Database of patients (<em>n</em> = 20,882) in U.S. hospitals with AKI requiring continuous RRT (<em>n</em> = 7660) and intermittent hemodialysis ([IHD], <em>n</em> = 13,222) with discharge from January 1, 2018, to June 30, 2021. Data on vasopressor use 3 days before and 3 days after RRT initiation were extracted. Exposure to vasopressors post-RRT initiation was significantly associated with risk-adjusted in-hospital mortality among patients treated with CRRT (risk-adjusted hazard ratio [aHR], 1.69 95 %CI: 1.55–1.85) and IHD (aHR, 1.72, 95 %CI: 1.61–1.84). There was an incremental risk of death associated with the number of vasopressors. Among CRRT patients, the risk of death were: 1 vasopressor (aHR, 1.50; 95 % CI: 1.36–1.65), 2 vasopressors (aHR, 1.94; 95 % CI: 1.76–2.14), and 3 vasopressors (aHR, 2.06; 95 % CI: 1.72–2.46). Similarly, for IHD patients, the aHRs were: 1 vasopressor (aHR, 1.57; 95 % CI: 1.47–1.68), 2 vasopressors (aHR, 2.20; 95 % CI: 2.02–2.40), and 3 vasopressors (aHR, 2.32; 95 % CI: 1.82–2.96). In summary, vasopressor use during the 3 days post-RRT initiation was independently and incrementally associated with higher in-hospital mortality in patients receiving either CRRT or IHD as the first modality.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"89 ","pages":"Article 155103"},"PeriodicalIF":3.2,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143918416","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":"Failure to achieve pharmacodynamic targets in critically Ill COVID-19 patients receiving antibiotics: A hypothesis-generating secondary analysis from the DOLPHIN study","authors":"Johanna M. de Jonge ,&nbsp;Wim J.R. Rietdijk ,&nbsp;Alan Abdulla ,&nbsp;Moska Hassanzai ,&nbsp;Chantal A. Boly ,&nbsp;Birgit C.P. Koch ,&nbsp;Henrik Endeman","doi":"10.1016/j.jcrc.2025.155102","DOIUrl":"10.1016/j.jcrc.2025.155102","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"89 ","pages":"Article 155102"},"PeriodicalIF":3.2,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143907477","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":"Reversal of antithrombotics in the critically ill: An international online survey","authors":"Stefan F. van Wonderen ,&nbsp;Maite M.T. van Haeren ,&nbsp;Joanna C. Dionne ,&nbsp;Simon J.W. Oczkowski ,&nbsp;Cécile Aubron ,&nbsp;Nathan D. Nielsen ,&nbsp;Daniele Poole ,&nbsp;Johannes Gratz ,&nbsp;Beverley J. Hunt ,&nbsp;Jens Meier ,&nbsp;Riccardo G. Abbasciano ,&nbsp;Maurizio Cecconi ,&nbsp;Gavin J. Murphy ,&nbsp;Nicole P. Juffermans ,&nbsp;Alexander P.J. Vlaar ,&nbsp;Marcella C.A. Müller","doi":"10.1016/j.jcrc.2025.155101","DOIUrl":"10.1016/j.jcrc.2025.155101","url":null,"abstract":"<div><h3>Purpose</h3><div>Critically ill patients face an increased risk of both thrombotic and bleeding complications, necessitating careful administration of antithrombotic agents such as platelet aggregation inhibitors (PAI), anticoagulants and fibrinolytics for prophylactic and therapeutic purposes, but also posing challenges for reversal strategies. This survey aims to assess the current clinical practice of reversal of antithrombotics in the intensive care unit (ICU).</div></div><div><h3>Methods</h3><div>An international online 79-item survey was performed among critical care physicians. The survey was disseminated via multiple intensive care societies. Reversal practices for PAI, vitamin K antagonists (VKA), heparins, factor Xa inhibitors, direct thrombin inhibitors (DTI) and fibrinolytics were surveyed.</div></div><div><h3>Results</h3><div>From June 2023 to January 2024, 477 participants started the survey, with 208 completed surveys from 49 countries. The majority (79 %) of respondents practiced ICU medicine in Europe. Only 17 % of the included participants indicated the presence of an ICU-specific antithrombotic reversal protocol in their hospital. Of those, specific protocols were present for 92 % for reversal of VKA, 75 % for unfractioned heparin, 58 % for low-molecular-weight heparin, 53 % for factor Xa inhibitors, 50 % for PAI, 44 % for DTI and 31 % for fibrinolytics. There was heterogeneity in reported reversal practice for different antithrombotics in specific scenarios and between continents. However, dosing strategies of applicable reversal agents were similar.</div></div><div><h3>Conclusion</h3><div>This survey shows variability in the reported clinical approaches to reverse antithrombotic agents in the ICU. The majority of hospitals included do not have a specific protocol for antithrombotic agents reversal emphasizing the need for ICU specific guidelines.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"89 ","pages":"Article 155101"},"PeriodicalIF":3.2,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143907476","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":"Sepsis on dementia risk: A population-based cohort study with dose-dependent analysis","authors":"Mingyang Sun ,&nbsp;Fangfang Li ,&nbsp;Yangyang Wang ,&nbsp;Mengrong Miao ,&nbsp;Zhongyuan Lu ,&nbsp;Wan-Ming Chen ,&nbsp;Szu-Yuan Wu ,&nbsp;Jiaqiang Zhang","doi":"10.1016/j.jcrc.2025.155100","DOIUrl":"10.1016/j.jcrc.2025.155100","url":null,"abstract":"<div><h3>Purpose</h3><div>Emerging evidence links sepsis-related inflammation to dementia risk, but the dose-dependent effects of recurrent sepsis episodes remain unclear. This study assessed whether sepsis increases dementia risk and explored a potential dose-response relationship between sepsis frequency and dementia.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study using Taiwan's National Health Insurance Research Database (2005–2022), enrolling patients aged ≥18 years hospitalized with sepsis. An index period (2008–2013) was used to identify patients without prior dementia. A fixed 12-month landmark period (calendar year 2014) was applied to assess the number of sepsis episodes. Patients who died during the landmark period were excluded. Propensity score matching was performed to generate well-balanced sepsis and non-sepsis groups. Follow-up for dementia and mortality began after the landmark period and continued for up to 64 months. Cox and Fine-Gray models were used to account for competing risks of death.</div></div><div><h3>Results</h3><div>Sepsis was associated with a significantly increased risk of all-cause dementia (HR 1.59; 95 % CI, 1.47–1.72; <em>P</em> &lt; 0.0001). A dose-response relationship was observed: patients with multiple sepsis episodes had the highest dementia risk (sHR 1.63; 95 % CI, 1.39–1.91). Vascular dementia showed the strongest association, with a higher incidence in the sepsis group (1.2 % vs. 0.6 %, <em>P</em> = 0.0003).</div></div><div><h3>Conclusions</h3><div>Our findings provide robust evidence of a dose-dependent association between sepsis and increased dementia risk, particularly vascular dementia, even after adjusting for competing mortality risks.</div></div><div><h3>Summary</h3><div>This study addresses the limitations of previous research by not only employing propensity score matching (PSM) to balance confounding factors between the sepsis and non-sepsis groups but also using an index period and landmark period design to better explore potential causal relationships. These periods ensure that dementia onset occurred after sepsis and allow for the examination of dose-response relationship between sepsis episode frequency and dementia. Furthermore, this is the largest study to date involving sepsis patients, providing more robust evidence than prior studies, which were often smaller and lacked adjustments for competing risks of death.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"89 ","pages":"Article 155100"},"PeriodicalIF":3.2,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143902233","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":"Moving beyond monitoring in critical care ultrasound","authors":"Michael J. Lanspa","doi":"10.1016/j.jcrc.2025.155098","DOIUrl":"10.1016/j.jcrc.2025.155098","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"88 ","pages":"Article 155098"},"PeriodicalIF":3.2,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143886952","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}