Journal of Intensive Care Medicine最新文献

{"title":"Cognitive Health and Quality of Life After Surviving Sepsis: A Narrative Review.","authors":"Khalia Ackermann, Nanda Aryal, Johanna Westbrook, Ling Li","doi":"10.1177/08850666251340631","DOIUrl":"https://doi.org/10.1177/08850666251340631","url":null,"abstract":"<p><strong>Purpose of the research: </strong>Sepsis is a leading cause of disease and affects approximately a third of ICU patients worldwide. Despite the rising number of sepsis survivors, the burden of cognitive and quality of life related post-sepsis morbidities remains understudied. This narrative review aimed to summarize and discuss current research investigating the quality of life and the burden of cognitive, mental, and functional health morbidities in sepsis survivors at different stages of life.</p><p><strong>Major findings: </strong>Sepsis survivors of all ages were affected by cognitive dysfunction, with very preterm neonatal sepsis survivors reporting higher odds of neurodevelopmental disabilities, childhood sepsis survivors reporting delayed development, and adult sepsis survivors reporting cognitive decline, including a higher risk of dementia. Mental health concerns were reported in both survivors and family members, with limited mixed evidence for post-traumatic stress disorder, depression, suicide, and anxiety. Survivor functional status is frequently impacted in diverse ways, with both physical and mental changes often inhibiting daily life. Lastly, the impact of sepsis on survivor quality of life is mixed. While sepsis survivors frequently report poorer quality of life compared to the general population, studies have reported no difference in quality of life when comparing sepsis survivors with other critical illness survivors.</p><p><strong>Conclusions: </strong>Sepsis impacts the quality of life and cognitive, mental, and functional health in numerous diverse ways across the lifespan. Future research should focus on sepsis survivorship in children, and the mental health burden of sepsis across all age groups.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666251340631"},"PeriodicalIF":3.0,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078508","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":"Acute Esophageal Necrosis Associated with Alcoholic Ketoacidosis A Case Report.","authors":"Laurin Egli, Alexa Hollinger, Anne Leuppi-Taegtmeyer, Martin Siegemund","doi":"10.1177/08850666251341813","DOIUrl":"https://doi.org/10.1177/08850666251341813","url":null,"abstract":"<p><p>Acute esophageal necrosis (AEN) is a rare condition associated with ischemia of the esophagus, corrosive injury by gastric fluids and reduced mucosal defense. It is also referred to as \"Black Esophagus\" or \"Gurvit's syndrome\". Its clinical presentation is most notable for upper gastrointestinal bleeding with signs and symptoms such as abdominal or epigastric pain, nausea, vomiting, dysphagia and fever. AEN is diagnosed via esophagogastroduodenoscopy, where the cardinal finding is a circumferential black discoloration of the esophagus, usually most pronounced in the distal esophagus. The lesion usually stops abruptly at the gastroesophageal junction. AEN is usually seen in older men with multiple comorbidities (eg, cardiovascular disease, diabetes mellitus) and follows a triggering event (eg, sepsis, diabetic ketoacidosis). We describe the case of a 28-year-old man presenting with acute esophageal necrosis associated with alcoholic ketoacidosis after excessive alcohol consumption, prolonged starvation and self-reported increased intake of venlafaxine and quetiapine.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666251341813"},"PeriodicalIF":3.0,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078505","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":"Propofol-associated Hypertriglyceridemia: Development and Multicenter Validation of a Machine-Learning-Based Prediction Tool.","authors":"Jiawen Deng, Kiyan Heybati, Keshav Poudel, Guozhen Xie, Eric Zuberi, Vinaya Simha, Hemang Yadav","doi":"10.1177/08850666251342559","DOIUrl":"https://doi.org/10.1177/08850666251342559","url":null,"abstract":"<p><strong>Purpose: </strong>To develop and validate an explainable machine learning (ML) tool to help clinicians predict the risk of propofol-associated hypertriglyceridemia in critically ill patients receiving propofol sedation. <b>Methods:</b> Patients from 11 intensive care units (ICUs) across five Mayo Clinic hospitals were included if they met the following criteria: a) ≥ 18 years of age, b) received propofol infusion while on invasive mechanical ventilation for ≥24 h, and c) had a triglyceride level measured. The primary outcome was hypertriglyceridemia (triglyceride >400 mg/dL) onset within 10 days of propofol initiation. Both COVID-inclusive and COVID-independent modeling pipelines were developed to ensure applicability post-pandemic. Decision thresholds were chosen to maintain model sensitivity >80%. Nested leave-one-site-out cross-validation (LOSO-CV) was used to externally evaluate pipeline performance. Model explainability was assessed using permutation importance and SHapley Additive exPlanations (SHAP). <b>Results:</b> Among 3922 included patients, 769 (19.6%) developed propofol-associated hypertriglyceridemia, and 879 (22.4%) had COVID-19 at ICU admission. During nested LOSO-CV, the COVID-inclusive pipeline achieved an average AUC-ROC of 0.71 (95% confidence interval [CI] 0.70-0.72), while the COVID-independent pipeline achieved an average AUC-ROC of 0.69 (95% CI 0.68-0.70). Age, initial propofol dose, and BMI were the top three most important features in both models. <b>Conclusion:</b> We developed an explainable ML-based tool with acceptable predictive performance for assessing the risk of propofol-associated hypertriglyceridemia in ICU patients. This tool can aid clinicians in identifying at-risk patients to guide triglyceride monitoring and optimize sedative selection.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666251342559"},"PeriodicalIF":3.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078513","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":"Addressing Data Misinterpretation in Recent Meta-Analysis.","authors":"Kristin Alm-Kruse, Jo Kramer-Johansen","doi":"10.1177/08850666251341255","DOIUrl":"https://doi.org/10.1177/08850666251341255","url":null,"abstract":"","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666251341255"},"PeriodicalIF":3.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078506","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":"Prognosis of Patients with Lung Cancer Admitted to the Intensive Care Unit: A Systematic Review and Meta-Analysis.","authors":"Ahmed Elkhapery, Hazem Taifour, Chengu Niu, Ayman O Soubani","doi":"10.1177/08850666251339451","DOIUrl":"https://doi.org/10.1177/08850666251339451","url":null,"abstract":"<p><p>IntroductionDespite recent advances in the care of critically ill patients with cancer, studies show that lung cancer is associated with higher Intensive Care Unit (ICU) mortality than other types of cancer. This systematic review and meta-analysis aim to investigate the ICU outcomes and predictors of mortality in critically ill patients with lung cancer.MethodsPubMed, OVID MEDLINE, Cochrane and Embase were searched to identify relevant studies. The primary outcome was ICU mortality. The secondary outcomes were hospital mortality and predictors of mortality. Abstracts, case reports and case series were excluded.ResultsThirty-three studies met inclusion criteria, including 28 cohort studies (n = 4123) and five population-based studies (n = 82,475). The pooled ICU mortality was 46.4% (95% CI 41.0-51.8; n = 16,772). The pooled hospital mortality was 51.9% (95% CI 46.9-56.9; n = 72,215). The pooled long-term mortality (6-12 months) was 73.5%, (95% CI 68.2- 78.2; n = 84,008). Predictors of mortality included the presence of metastatic disease (RR 1.30, 95% CI 1.06-1.59), poor performance status (RR 1.33, 95% CI 1.12-1.57), requirement for mechanical ventilation (RR 2.25, 95% CI 1.58-3.21), requirement for vasopressors (RR 1.95, 95% CI 1.54-2.46), higher APACHE or SAPS score (standardized mean difference 0.63, 95% CI 0.45-0.80), and higher SOFA score (mean difference 1.95, 95% CI 1.21-2.70).ConclusionCritically ill patients with lung cancer have reasonable short term but poor long-term outcome. Focused and early goals of care discussions are crucial part of ICU care in this patient population.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666251339451"},"PeriodicalIF":3.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078511","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":"Outcomes of Sedative Hypnotic Agents Used for Endotracheal Intubation in Critically Ill Adults: A Systematic Review with Exploratory Meta-Analysis.","authors":"Nathan J Smischney, George Williams, Craig S Jabaley, Ashish K Khanna, Bethany Bouldin, Andrew R Petrilli, Hao Deng, Elissa A Kinzelman-Vesely, Ronald G Pearl","doi":"10.1177/08850666251337702","DOIUrl":"https://doi.org/10.1177/08850666251337702","url":null,"abstract":"<p><p>ObjectiveSpecific sedative hypnotic agents, administered to facilitate endotracheal intubation (ETI) in critically ill adults, may lead to adverse outcomes such as peri-intubation cardiovascular collapse. However, little is known from systematic investigations of the impact these individual agents have on cardiovascular function or other clinical outcomes.Data sourcesMEDLINE, Embase, CENTRAL, ClinicalTrials.gov, Scopus and Web of science databases.Study selectionWe conducted a systematic search for randomized and non-randomized studies that evaluated adult (≥18 years) critically ill patients who were sedated to facilitate ETI with ketamine, propofol, ketamine/propofol, etomidate, or a benzodiazepine and who had data on peri-intubation hemodynamics and at least one other outcome involving acute kidney injury, delirium, opioid use, intubation difficulty, sequential organ failure assessment, length of stay, or mortality. Eighty-five studies were identified for eligibility assessment with 23 included in the analysis.Data extractionTwo reviewers independently screened articles, extracted data from selected articles, and assessed risk of bias using ROBINS-I for observational studies and revised Cochrane Risk of Bias tool for randomized controlled trials.Data synthesisAcute cardiovascular dysfunction (peri-intubation hemodynamic instability and/or cardiac arrest) was similar between etomidate and ketamine with more events seen when propofol versus non-propofol sedation was administered. However, exploratory meta-analysis demonstrated no difference between etomidate and ketamine (OR 1.05 [95%CI 0.60-1.84]) or between etomidate and propofol (OR 0.91 [95%CI 0.33-2.46]). Compared to ketamine, etomidate demonstrated lower survival to hospital discharge in the included studies in exploratory meta-analysis OR 0.76 (95%CI 0.62-0.92). Limited data existed for other outcomes with no discernible differences between sedative agents.ConclusionsAcute cardiovascular dysfunction was more common when propofol, as compared to non-propofol sedation, was administered, although not statistically significant in exploratory meta-analysis. In addition, etomidate conferred lower survival to hospital discharge versus non-etomidate sedation, which was confirmed in exploratory meta-analysis of etomidate versus ketamine.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666251337702"},"PeriodicalIF":3.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078510","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":"Beyond the Basics: Recommended Approach to Severe Acute Pancreatitis Management in the Critical Care Setting.","authors":"Zaid Alkaissy, Kelli Kosako Yost, Megan B Ghai, Khaled Malkawi, Mustafa Nawaz, Wahid Wassef","doi":"10.1177/08850666251338044","DOIUrl":"https://doi.org/10.1177/08850666251338044","url":null,"abstract":"<p><p>Acute Pancreatitis (AP) poses a significant healthcare burden globally. While most cases present with a mild course, approximately one-fifth progress to severe forms characterized by severe pancreatitis and systemic complications, leading to a mortality rate of up to 40%. Effective management of severe acute pancreatitis necessitates a multidisciplinary approach involving gastroenterologists, interventional radiologists, intensive care teams, and surgeons. The advances in treatment modalities, including early hydration, nutrition, and pain control, have led to a decrease in the morbidity and long-term complications associated with severe acute pancreatitis down to 20%. In this review, we focus on the management challenges and outcomes associated with the difficult condition of severe acute pancreatitis.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666251338044"},"PeriodicalIF":3.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143996523","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":"Developmental Care in the Early Years in Pediatric Intensive Care Patients as a Strategy to Mitigate Pediatric Post-Intensive-Care Syndrome: A Narrative Review.","authors":"Ari R Joffe, Charlene M T Robertson","doi":"10.1177/08850666251340646","DOIUrl":"https://doi.org/10.1177/08850666251340646","url":null,"abstract":"<p><p>Survivors after pediatric critical care often have adverse sequelae in domains of cognition, executive function, attention, memory, visual-spatial skills, language, motor function, behavior, and emotional functioning, the post-intensive-care syndrome pediatric (PICS-p). The time from birth to approximately age 2 years is a period of rapid structural and functional brain development. The fundamental structural and functional architecture of the brain is in place by the second year of life. This narrative review focuses on how we, in the pediatric intensive care unit (PICU), can work towards maximizing each patient's full potential despite adverse experiences during hospitalization. In part I, concepts relevant to understanding the effects of hospitalization in PICU on brain development are clarified, including concepts of toxic stress and trauma, sensitive periods and cascades, experience-expectant neural plasticity in the early years, and resilience and buffering of adversity focused on relational care. In part II, evidence is presented that these concepts are important because they describe the effects of early childhood adversity that are pervasive on physical health, cognitive, and emotional outcomes throughout the lifespan. Evidence is presented to show that intervention to improve these outcomes can be effective. In part III, the concepts and evidence are synthesized by focusing on the opportunity before us, what we must and can do better while patients are in the PICU, in order to improve their long-term lifelong outcomes. We present evidence to argue that we in pediatric critical care must take a public-health approach to address the key environmental conditions necessary for optimal early childhood development and hence facilitate children's ability to thrive. Future research must aim to determine what works best and what does not work in the PICU. Early childhood investments to improve lifelong outcomes have great potential to help patients and reduce the growing burden of healthcare costs.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666251340646"},"PeriodicalIF":3.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144024526","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":"Documenting Pediatric Delirium During Transitions of Care: A Single Site Observational Study.","authors":"Matthew S Hazle, Gabrielle Horner, Melissa Ross, Harlan McCaffery, Nasuh Malas, Erin F Carlton, Emily Jacobson","doi":"10.1177/08850666251339457","DOIUrl":"https://doi.org/10.1177/08850666251339457","url":null,"abstract":"<p><p>BackgroundDelirium is a common complication of illness. Patients who experience delirium are at risk for worse outcomes during and after hospitalization. This study aims to describe rates of, and factors associated with, delirium documentation during care transitions for patients who screened positive for delirium in the pediatric intensive care unit (PICU) at transfer to the pediatric hospital medicine (PHM) service and discharge.MethodsDemographic and clinical characteristics were collected retrospectively on patients ages 0-21 years, without developmental delay, who screened positive via Cornell Assessment of Pediatric Delirium (CAPD) before transferring from PICU to PHM service of a tertiary-care children's hospital from 2016-2022. Primary outcomes were documentation of \"delirium\" at PICU transfer and hospital discharge. Statistical analysis included bivariate analysis and multivariate logistic regression.ResultsOf 337 encounters, 66 transfer (20%) and 62 discharge notes (18%) documented delirium. On bivariate analysis, older age, female sex, Hispanic ethnicity, prolonged and elevated CAPD scoring, longer PICU and hospital length of stay, mechanical ventilation (MV), and psychiatry consultation were associated with documentation at transfer. On logistic regression, Black race decreased odds (OR 0.275, 95% CI 0.08-0.84) while psychiatry consultation (OR 66.82, 24.45-212.25) and invasive MV (OR 6.495, 2.13-22.34) increased odds of documentation. Discharge documentation demonstrated similar associations, except sex and ethnicity were not associated, while neurology consultation was positively associated with documentation. On logistic regression, psychiatry consultation (OR 36.01, 14.51-100.71) and invasive MV (OR 2.96, 1.09-8.83) increased odds of documentation at discharge.ConclusionsDespite a validated screening tool, pediatric providers often fail to document delirium at PICU transfer and hospital discharge. Lack of documentation may leave patients and families at risk for worse outcomes.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666251339457"},"PeriodicalIF":3.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143970290","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":"Lumbar Puncture and Brain Herniation in Acute Bacterial Meningitis: An Updated Narrative Review.","authors":"Ari R Joffe, Fernanda de Marzio Pestana Martins, Daniel Garros, Adrienne F Thompson","doi":"10.1177/08850666251337684","DOIUrl":"https://doi.org/10.1177/08850666251337684","url":null,"abstract":"<p><p>The risk of lumbar puncture (LP) to precipitate brain herniation in acute bacterial meningitis (ABM) was reviewed in this journal in 2007. We report the case of an infant with ABM who had acute apnea requiring intubation and tonic posturing (mistaken for seizure), and then had brain herniation within four hours of an LP. The case prompted this updated narrative review, from 2007 to 2024, focused on the twelve points made in 2007. The review included 14 case reports of brain herniation shortly after LP in ABM, 23 observational studies or systematic reviews, 28 narrative reviews, and 9 guidelines, each with evidence, advice, or recommendations important for the decision to perform LP in ABM. We found evidence to support, and did not find convincing evidence to refute, the twelve points. We found five additional claims made that were meant to refute some of the original points; however, these were based upon data that did not support the claims made. Limitation of the evidence reviewed was the absence of randomized trials to prove whether those patients who herniated may have been destined to herniate regardless of whether they had an LP. Reasons why ABM may be a unique circumstance where normal CT scan cannot determine the risk of herniation after an LP were discussed. We argue that the preponderance of evidence supported the conclusion that, in a patient with strongly suspected ABM who is clinically considered at high risk for herniation, interventions to control ICP and antibiotics administration should be the priority, followed secondarily by an urgent CT scan and, even with a normal CT, not an LP. The case report emphasized that respiratory arrest or suspected tonic seizure can be due to early herniation, and indicate CT scan, and prolonged LP deferral (for 3-4 days) even with a normal CT.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666251337684"},"PeriodicalIF":3.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144014530","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}