Journal of Intensive Care最新文献

{"title":"Limitation of life sustaining measures in neurocritical care: sex, timing, and advance directive.","authors":"Stefan Yu Bögli, Federica Stretti, Didar Utebay, Ladina Hitz, Caroline Hertler, Giovanna Brandi","doi":"10.1186/s40560-023-00714-y","DOIUrl":"10.1186/s40560-023-00714-y","url":null,"abstract":"<p><strong>Background: </strong>The limitation of life sustaining treatments (LLST) causes ethical dilemmas even in patients faced with poor prognosis, which applies to many patients admitted to a Neurocritical Care Unit (NCCU). The effects of social and cultural aspects on LLST in an NCCU population remain poorly studied.</p><p><strong>Methods: </strong>All NCCU patients between 01.2018 and 08.2021 were included. Medical records were reviewed for: demographics, diagnosis, severity of disease, and outcome. Advance directives (AD) and LLST discussions were reviewed evaluating timing, degree, and reason for LLST. Social/cultural factors (nationality, language spoken, religion, marital status, relationship to/sex of legal representative) were noted. Associations between these factors and the patients' sex, LLST timing, and presence of AD were evaluated.</p><p><strong>Results: </strong>Out of 2975 patients, 12% of men and 10.5% of women underwent LLST (p = 0.30). Women, compared to men, more commonly received withdrawal instead of withholding of life sustaining treatments (57.5 vs. 45.1%, p = 0.028) despite comparable disease severity. Women receiving LLST were older (73 ± 11.7 vs. 69 ± 14.9 years, p = 0.005) and often without a partner (43.8 vs. 25.8%, p = 0.001) compared to men. AD were associated with female sex and early LLST, but not with an increased in-hospital mortality (57.1 vs. 75.2% of patients with and without AD respectively).</p><p><strong>Conclusions: </strong>In patients receiving LLST, the presence of an AD was associated with an increase of early LLST, but not with an increased in-hospital mortality. This supports the notion that the presence of an AD is primarily an expression of the patients' will but does not per se predestine the patient for an unfavorable outcome.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"12 1","pages":"3"},"PeriodicalIF":7.1,"publicationDate":"2024-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10790395/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139472328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-intensive care syndrome follow-up system after hospital discharge: a narrative review.","authors":"Nobuto Nakanishi, Keibun Liu, Junji Hatakeyama, Akira Kawauchi, Minoru Yoshida, Hidenori Sumita, Kyohei Miyamoto, Kensuke Nakamura","doi":"10.1186/s40560-023-00716-w","DOIUrl":"10.1186/s40560-023-00716-w","url":null,"abstract":"<p><strong>Background: </strong>Post-intensive care syndrome (PICS) is the long-lasting impairment of physical functions, cognitive functions, and mental health after intensive care. Although a long-term follow-up is essential for the successful management of PICS, few reviews have summarized evidence for the efficacy and management of the PICS follow-up system.</p><p><strong>Main text: </strong>The PICS follow-up system includes a PICS follow-up clinic, home visitations, telephone or mail follow-ups, and telemedicine. The first PICS follow-up clinic was established in the U.K. in 1993 and its use spread thereafter. There are currently no consistent findings on the efficacy of PICS follow-up clinics. Under recent evidence and recommendations, attendance at a PICS follow-up clinic needs to start within three months after hospital discharge. A multidisciplinary team approach is important for the treatment of PICS from various aspects of impairments, including the nutritional status. We classified face-to-face and telephone-based assessments for a PICS follow-up from recent recommendations. Recent findings on medications, rehabilitation, and nutrition for the treatment of PICS were summarized.</p><p><strong>Conclusions: </strong>This narrative review aimed to summarize the PICS follow-up system after hospital discharge and provide a comprehensive approach for the prevention and treatment of PICS.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"12 1","pages":"2"},"PeriodicalIF":7.1,"publicationDate":"2024-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10785368/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139432658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of quality indicators for palliative care in intensive care units and pilot testing them via electronic medical record review.","authors":"Yuta Tanaka, Kento Masukawa, Hideaki Sakuramoto, Akane Kato, Yuichiro Ishigami, Junko Tatsuno, Kaori Ito, Yoshiyuki Kizawa, Mitsunori Miyashita","doi":"10.1186/s40560-023-00713-z","DOIUrl":"10.1186/s40560-023-00713-z","url":null,"abstract":"<p><strong>Background: </strong>Patients in intensive care units (ICUs) often require quality palliative care for relief from various types of suffering. To achieve quality palliative care, specific goals need to be identified, measured, and reported. The present study aimed to develop quality indicators (QIs) for palliative care in ICUs, based on a systematic review and modified Delphi method, and test their feasibility by reviewing electronic medical record (EMR) data.</p><p><strong>Methods: </strong>The current study was performed in two phases: the development of QIs using the modified Delphi method, and pilot-testing the quality of palliative care in ICUs based on EMR review. The pilot test included 262 patients admitted to the general or emergency ICU at a university hospital from January 1, 2019, to June 30, 2019.</p><p><strong>Results: </strong>A 28-item QI set for palliative care in ICUs was developed based on the consensus of 16 experts. The Delphi process resulted in low measurability ratings for two items: \"Assessment of the patient's psychological distress\" and \"Assessment of the patient's spiritual and cultural practices.\" However, these items were determined to be important for quality care from the perspective of holistic assessment of distress and were adopted in the final version of the QI set. While the pilot test results indicated the feasibility of the developed QIs, they suggested that the frequency of care performance varied, and certain aspects of palliative care in ICUs needed to be improved, namely (1) regular pain assessment, (2) identification of the patient's advance directive and advance care planning for treatment, (3) conducting an interdisciplinary family conference on palliative care, and (4) assessment of psychological distress of family members.</p><p><strong>Conclusions: </strong>The QI set, developed using the modified Delphi method and tested using EMR data, provided a tool for assessing the quality of palliative care in ICUs. In the two ICUs considered in this study, aspects of the palliative care process with a low performance frequency were identified, and further national surveys were recommended. It is necessary to conduct ongoing surveys at more facilities to improve the quality of palliative care in ICUs.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"12 1","pages":"1"},"PeriodicalIF":7.1,"publicationDate":"2024-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10775577/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139403187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mechanical circulatory support in cardiogenic shock","authors":"Jun Nakata, Takeshi Yamamoto, Keita Saku, Yuki Ikeda, Takashi Unoki, Kuniya Asai","doi":"10.1186/s40560-023-00710-2","DOIUrl":"https://doi.org/10.1186/s40560-023-00710-2","url":null,"abstract":"Cardiogenic shock is a complex and diverse pathological condition characterized by reduced myocardial contractility. The goal of treatment of cardiogenic shock is to improve abnormal hemodynamics and maintain adequate tissue perfusion in organs. If hypotension and insufficient tissue perfusion persist despite initial therapy, temporary mechanical circulatory support (t-MCS) should be initiated. This decade sees the beginning of a new era of cardiogenic shock management using t-MCS through the accumulated experience with use of intra-aortic balloon pump (IABP) and venoarterial extracorporeal membrane oxygenation (VA-ECMO), as well as new revolutionary devices or systems such as transvalvular axial flow pump (Impella) and a combination of VA-ECMO and Impella (ECPELLA) based on the knowledge of circulatory physiology. In this transitional period, we outline the approach to the management of cardiogenic shock by t-MCS. The management strategy involves carefully selecting one or a combination of the t-MCS devices, taking into account the characteristics of each device and the specific pathological condition. This selection is guided by monitoring of hemodynamics, classification of shock stage, risk stratification, and coordinated management by the multidisciplinary shock team.","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"1 1","pages":""},"PeriodicalIF":7.1,"publicationDate":"2023-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138742376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Higher levels of circulating desphospho-uncarboxylated matrix Gla protein over time are associated with worse survival: the prospective Maastricht Intensive Care COVID cohort","authors":"Mark M. G. Mulder, Joep Schellens, Jan-Willem E. M. Sels, Frank van Rosmalen, Anne-Marije Hulshof, Femke de Vries, Ruud Segers, Casper Mihl, Walther N. K. A. van Mook, Aalt Bast, Henri M. H. Spronk, Yvonne M. C. Henskens, Iwan C. C. van der Horst, Hugo ten Cate, Leon J. Schurgers, Marjolein Drent, Bas C. T. van Bussel","doi":"10.1186/s40560-023-00712-0","DOIUrl":"https://doi.org/10.1186/s40560-023-00712-0","url":null,"abstract":"Extra-hepatic vitamin K-status, measured by dephosphorylated uncarboxylated matrix Gla protein (dp-ucMGP), maintains vascular health, with high levels reflecting poor vitamin K status. The occurrence of extra-hepatic vitamin K deficiency throughout the disease of COVID-19 and possible associations with pulmonary embolism (PE), and mortality in intensive care unit (ICU) patients has not been studied. The aim of this study was to investigated the association between dp-ucMGP, at endotracheal intubation (ETI) and both ICU and six months mortality. Furthermore, we studied the associations between serially measured dp-ucMGP and both PE and mortality. We included 112 ICU patients with confirmed COVID-19. Over the course of 4 weeks after ETI, dp-ucMGP was measured serially. All patients underwent computed tomography pulmonary angiography (CTPA) to rule out PE. Results were adjusted for patient characteristics, disease severity scores, inflammation, renal function, history of coumarin use, and coronary artery calcification (CAC) scores. Per 100 pmol/L dp-ucMGP, at ETI, the odds ratio (OR) was 1.056 (95% CI: 0.977 to 1.141, p = 0.172) for ICU mortality and 1.059 (95% CI: 0.976 to 1.059, p = 0.170) for six months mortality. After adjustments for age, gender, and APACHE II score, the mean difference in plasma dp-ucMGP over time of ICU admission was 167 pmol/L (95% CI: 4 to 332, p = 0.047). After additional adjustments for c-reactive protein, creatinine, and history of coumarin use, the difference was 199 pmol/L (95% CI: 50 to 346, p = 0.010). After additional adjustment for CAC score the difference was 213 pmol/L (95% CI: 3 to 422, p = 0.051) higher in ICU non-survivors compared to the ICU survivors. The regression slope, indicating changes over time, did not differ. Moreover, dp-ucMGP was not associated with PE. ICU mortality in COVID-19 patients was associated with higher dp-ucMGP levels over 4 weeks, independent of age, gender, and APACHE II score, and not explained by inflammation, renal function, history of coumarin use, and CAC score. No association with PE was observed. At ETI, higher levels of dp-ucMGP were associated with higher OR for both ICU and six month mortality in crude and adjusted modes, although not statistically significantly.","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"29 1","pages":""},"PeriodicalIF":7.1,"publicationDate":"2023-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138715635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Functional intervention following cardiac surgery to prevent postoperative delirium in older patients (FEEL WELL study)","authors":"Tuğce Dinç Dogan, Vera Guttenthaler, Alexa Zimmermann, Andrea Kunsorg, Merve Özlem Dinç, Niko Knuelle, Jens-Christian Schewe, Maria Wittmann","doi":"10.1186/s40560-023-00711-1","DOIUrl":"https://doi.org/10.1186/s40560-023-00711-1","url":null,"abstract":"Postoperative delirium is a common complication in patients after cardiac surgery, especially in older patients, and can manifest as a disturbance of attention and consciousness. It can lead to increased postoperative morbidity, prolonged need for care, and mortality. The presented study investigates whether the occurrence of postoperative delirium after cardiac surgery can be prevented by a multisensory stimulation. It was conducted as a prospective, randomized, controlled, non-pharmacological intervention study in the years 2021 and 2022 at the University Hospital Bonn in Germany. A total of 186 patients over 65 years with elective cardiac surgery were enrolled. Patients were randomized either to the intervention or control group. In both groups, postoperative delirium was assessed with the 3-min diagnostic interview for confusion assessment method on the first 5 days after surgery and pain was assessed using the Numeric Rating Scale. Multisensory stimulation was performed 20 min a day for the first three postoperative days in the intervention group. The incidence of postoperative delirium was 22.6% in the intervention group and 49.5% in the control group (p < 0.001). Duration of postoperative delirium was significantly shorter in the intervention group (p < 0.001). Stay in the intensive care unit was significantly longer in the control group (p = 0.006). In the regression model non-intervention, high pain scores, advanced age, and prolonged mechanical ventilation were associated with postoperative delirium (p = 0.007; p = 0.032; p = 0.006; p = 0.006, respectively). Results of the study imply that a multisensory stimulation done on the first 3 days after planned cardiac surgery can reduce the incidence and duration of postoperative delirium in older patients. Influence of the treatment on the incidence of delirium in other patient groups, the length of stay in the intensive care unit, and patients´ postoperative pain should be confirmed in further clinical studies. Trial registration: DRKS, DRKS00026909. Registered 28 October 2021, Retrospectively registered, https://drks.de/search/de/trial/DRKS00026909 .","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"105 1","pages":""},"PeriodicalIF":7.1,"publicationDate":"2023-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138581806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Light and dark sides of evidence-based and supportive ICU care for patients undergoing extracorporeal membrane oxygenation","authors":"Keibun Liu, Mohan Gurjar, Ricardo Kenji Nawa, Chi Ryang Chung, Kensuke Nakamura","doi":"10.1186/s40560-023-00704-0","DOIUrl":"https://doi.org/10.1186/s40560-023-00704-0","url":null,"abstract":"&lt;p&gt;Dear Editor,&lt;/p&gt;&lt;p&gt;Battles against a critical illness never end even after survivorship, or rather the beginning of long-term hardship patients and families face to restore previous lives. The functional disabilities after ICU stay, or post-intensive care syndrome (PICS), is a physically, cognitively, and mentally devastating state that significantly reduces patient quality of life […] [1]. As prevention, evidence-based and supportive ICU care, such as the ‘ABCDEF’ bundle and nutrition therapy, is strongly recommended in daily clinical practice for all ICU patients, regardless of disease. PICS may get worse depending on the severity. Therefore, patients requiring extracorporeal membrane oxygenation (ECMO) to sustain their lives are at high risk of PICS development [2]. The benefits of ECMO have been well described and its cases have considerably increased [3]. However, the implementation of evidence-based and supportive ICU care for ECMO patients has not been adequately exposed.&lt;/p&gt;&lt;p&gt;We conducted a secondary analysis of previously published point prevalence studies on 3 dates (June 3, July 1, 2020, and January 27, 2021) with the aim of investigating the implementation of the ‘ABCDEF’ bundle and nutrition therapy (defined in Additional file 2: Table S1) for ECMO patients with mechanical ventilation (MV) patients as reference. A total of 60 ECMO patients and 778 MV patients were enrolled in 110 ICUs across 35 countries (Additional file 1: Figure S1 and Additional file 3: Table S2). Implementation of an entire ABCDEF bundle was extremely low in both groups. Compared to MV patients, ECMO patients, with longer ICU days, younger, and more use of renal replacement and vasopressors (Additional file 4: Table S3) demonstrated the higher implementation of Element ‘A’: pain assessments (75%), ‘C’: sedation assessments (90%), and ‘D’: delirium assessments (73%), while only one of the ten in the ECMO group received Element ‘B’: Spontaneous Awakening Trials and ‘E’: Early mobility and exercise, and one of the four received Element ‘F’: Family engagement and empowerment. More than half of both groups received 1500 kcal/day or 20 kcal/kg/day or more of energy, whereas protein provision of 1.2 g/kg/day or more was achieved for only 40%.&lt;/p&gt;&lt;p&gt;Large potentials to improve ICU care during ECMO were implied, though studies only captured performances on three days in the COVID-19 pandemic under high pressure on ICUs. The importance of pain, sedation, and delirium during ECMO might be relatively acknowledged, reflecting the higher requirements of analgesia and sedation than MV. However, we found an obvious opposite trend against the current recommendations of establishing whole-bundle care. Although no consensus on the optimal timings was set, light sedation, or ‘awake ECMO’, and early mobilization, which showed significant physiological benefits, were also rarely performed despite the relatively long stay in the ICU [4]. Considering high risk of new psychiatric sym","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"81 1","pages":""},"PeriodicalIF":7.1,"publicationDate":"2023-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138546023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intensive care unit mortality and cost-effectiveness associated with intensivist staffing: a Japanese nationwide observational study.","authors":"Saori Ikumi, Takuya Shiga, Takuya Ueda, Eichi Takaya, Yudai Iwasaki, Yu Kaiho, Kunio Tarasawa, Kiyohide Fushimi, Yukiko Ito, Kenji Fujimori, Masanori Yamauchi","doi":"10.1186/s40560-023-00708-w","DOIUrl":"10.1186/s40560-023-00708-w","url":null,"abstract":"<p><strong>Background: </strong>Japan has four types of intensive care units (ICUs) that are divided into two categories according to the management fee charged per day: ICU management fees 1 and 2 (ICU1/2) (equivalent to high-intensity staffing) and 3 and 4 (ICU3/4) (equivalent to low-intensity staffing). Although ICU1/2 charges a higher rate than ICU3/4, no cost-effectiveness analysis has been performed for ICU1/2. This study evaluated the clinical outcomes and cost-effectiveness of ICU1/2 compared with those of ICU3/4.</p><p><strong>Methods: </strong>This retrospective observational study used a nationwide Japanese administrative database to identify patients admitted to ICUs between April 2020 and March 2021 and divided them into the ICU1/2 and ICU3/4 groups. The ICU mortality rates and in-hospital mortality rates were determined, and the incremental cost-effectiveness ratio (ICER) (Japanese Yen (JPY)/QALY), defined as the difference between quality-adjusted life year (QALY) and medical costs, was compared between ICU1/2 and ICU3/4. Data analysis was performed using the Chi-squared test; an ICER of < 5 million JPY/QALY was considered cost-effective.</p><p><strong>Results: </strong>The ICU1/2 group (n = 71,412; 60.7%) had lower ICU mortality rates (ICU 1/2: 2.6% vs. ICU 3/4: 4.3%, p < 0.001) and lower in-hospital mortality rates (ICU 1/2: 6.1% vs. ICU 3/4: 8.9%, p < 0.001) than the ICU3/4 group (n = 46,330; 39.3%). The average cost per patient of ICU1/2 and ICU3/4 was 2,249,270 ± 1,955,953 JPY and 1,682,546 ± 1,588,928 JPY, respectively, with a difference of 566,724. The ICER was 718,659 JPY/QALY, which was below the cost-effectiveness threshold.</p><p><strong>Conclusions: </strong>ICU1/2 is associated with lower ICU patient mortality than ICU3/4. Treatments under ICU1/2 are more cost-effective than those under ICU3/4, with an ICER of < 5 million JPY/QALY.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"11 1","pages":"60"},"PeriodicalIF":7.1,"publicationDate":"2023-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10694900/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138482455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Visualizing the dynamic mechanical power and time burden of mechanical ventilation patients: an analysis of the MIMIC-IV database.","authors":"Han Chen, Zhi-Zhong Chen, Shu-Rong Gong, Rong-Guo Yu","doi":"10.1186/s40560-023-00709-9","DOIUrl":"10.1186/s40560-023-00709-9","url":null,"abstract":"<p><strong>Background: </strong>Limiting driving pressure and mechanical power is associated with reduced mortality risk in both patients with and without acute respiratory distress syndrome. However, it is still poorly understood how the intensity of mechanical ventilation and its corresponding duration impact the risk of mortality.</p><p><strong>Methods: </strong>Critically ill patients who received mechanical ventilation were identified from the Medical Information Mart for Intensive Care (MIMIC)-IV database. A visualization method was developed by calculating the odds ratio of survival for all combinations of ventilation duration and intensity to assess the relationship between the intensity and duration of mechanical ventilation and the mortality risk.</p><p><strong>Results: </strong>A total of 6251 patients were included. The color-coded plot demonstrates the intuitive concept that episodes of higher dynamic mechanical power can only be tolerated for shorter durations. The three fitting contour lines represent 0%, 10%, and 20% increments in the mortality risk, respectively, and exhibit an exponential pattern: higher dynamic mechanical power is associated with an increased mortality risk with shorter exposure durations.</p><p><strong>Conclusions: </strong>Cumulative exposure to higher intensities and/or longer duration of mechanical ventilation is associated with worse outcomes. Considering both the intensity and duration of mechanical ventilation may help evaluate patient outcomes and guide adjustments in mechanical ventilation to minimize harmful exposure.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"11 1","pages":"58"},"PeriodicalIF":7.1,"publicationDate":"2023-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10685677/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138460293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic value of oxygen saturation index trajectory phenotypes on ICU mortality in mechanically ventilated patients: a multi-database retrospective cohort study.","authors":"Xiawei Shi, Yangyang Shi, Liming Fan, Jia Yang, Hao Chen, Kaiwen Ni, Junchao Yang","doi":"10.1186/s40560-023-00707-x","DOIUrl":"https://doi.org/10.1186/s40560-023-00707-x","url":null,"abstract":"<p><strong>Background: </strong>Heterogeneity among critically ill patients undergoing invasive mechanical ventilation (IMV) treatment could result in high mortality rates. Currently, there are no well-established indicators to help identify patients with a poor prognosis in advance, which limits physicians' ability to provide personalized treatment. This study aimed to investigate the association of oxygen saturation index (OSI) trajectory phenotypes with intensive care unit (ICU) mortality and ventilation-free days (VFDs) from a dynamic and longitudinal perspective.</p><p><strong>Methods: </strong>A group-based trajectory model was used to identify the OSI-trajectory phenotypes. Associations between the OSI-trajectory phenotypes and ICU mortality were analyzed using doubly robust analyses. Then, a predictive model was constructed to distinguish patients with poor prognosis phenotypes.</p><p><strong>Results: </strong>Four OSI-trajectory phenotypes were identified in 3378 patients: low-level stable, ascending, descending, and high-level stable. Patients with the high-level stable phenotype had the highest mortality and fewest VFDs. The doubly robust estimation, after adjusting for unbalanced covariates in a model using the XGBoost method for generating propensity scores, revealed that both high-level stable and ascending phenotypes were associated with higher mortality rates (odds ratio [OR]: 1.422, 95% confidence interval [CI] 1.246-1.623; OR: 1.097, 95% CI 1.027-1.172, respectively), while the descending phenotype showed similar ICU mortality rates to the low-level stable phenotype (odds ratio [OR] 0.986, 95% confidence interval [CI] 0.940-1.035). The predictive model could help identify patients with ascending or high-level stable phenotypes at an early stage (area under the curve [AUC] in the training dataset: 0.851 [0.827-0.875]; AUC in the validation dataset: 0.743 [0.709-0.777]).</p><p><strong>Conclusions: </strong>Dynamic OSI-trajectory phenotypes were closely related to the mortality of ICU patients requiring IMV treatment and might be a useful prognostic indicator in critically ill patients.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"11 1","pages":"59"},"PeriodicalIF":7.1,"publicationDate":"2023-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10685672/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138460292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}