Journal of Intensive Care Medicine最新文献

{"title":"Antibiotic Stewardship in the Neonatal Intensive Care Unit.","authors":"Dustin D Flannery, Sarah A Coggins, Alexandra K Medoro","doi":"10.1177/08850666241258386","DOIUrl":"10.1177/08850666241258386","url":null,"abstract":"<p><p>Antibiotic stewardship is a multidisciplinary, evidence-based approach to optimize antibiotic use and mitigate development of antibiotic resistance. Neonates have high rates of antibiotic exposure, particularly those born preterm and admitted to the NICU, and mounting evidence describes the adverse consequences of such exposures in the absence of infection. Here, we review the general principles of antibiotic stewardship and how they can be applied in NICUs. The unique characteristics of NICUs and patients cared for in this setting, which warrant unique implementation strategies and special considerations are discussed. We summarize current antibiotic use metrics for assessment of responses to stewardship interventions and changes over time, and review evidence-based infection prevention practices in the NICU. Current recommendations for empiric antibiotic use in the NICU and the utility of infection biomarkers are summarized. Lastly, given the growing global threat of increasing antibiotic resistance, specific threats in the NICU are highlighted.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"862-875"},"PeriodicalIF":3.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141247335","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":"In-hospital Mortality is Lower in Brain-Injured Patients After Admission to a Neuroscience Intensive Care Unit: A Multi-Center Cohort Study.","authors":"Angel J Cadena-Tejada, Shaista Alam, Varoon Thavapalan, Sara Habib, Fred Rincon","doi":"10.1177/08850666251325778","DOIUrl":"10.1177/08850666251325778","url":null,"abstract":"<p><p>ObjectiveTo study the impact of dedicated Neuroscience Intensive Care Units (NSU) on clinical outcomes in patients with acute brain injury.DesignRetrospective, multicenter cohort study.Setting172 intensive care units within the United States.PatientsProspectively compiled and maintained a registry of a total of 32,047 brain-injured patients (stroke = AIS, aneurysmal-bleed = SAH, intra-cerebral-hemorrhage = ICH, and traumatic brain injury = TBI) from 2008-2013.MeasurementsExposure of interest was the type of intensive care unit (ICU), divided into NSU and non-NSU (medical = MICU, non-neurosurgical = SICU, trauma = TICU, cardiac = CCU, or mixed). Outcomes of interest were the actual and predicted in-hospital mortality, ICU mortality, ICU length of stay, and ventilator-free days. We calculated the actual and predicted in-hospital mortality using the Cerner Corporation Acute Physiology and Chronic Health Evaluation IV (APACHE Clinical Information System, CIS). We then compared the actual in-hospital mortality against the mortality prediction of the APACHE-IV model based on ICU designation (NSU v. non-NSU). The multivariable model was adjusted for within-hospital effects and known predictors of poor outcomes after brain injury.Main ResultsNational APACHE-IV predicted that in-hospital mortality was higher for NSU admissions than non-NSU admissions (21% v. 19%, p < .0001). However, the actual ICU mortality (10% vs 11%, p < 0.01) and in-hospital mortality (15% vs 16%, p = 0.06) were lower in patients admitted to a NSU as compared to non-NSU. We observed lower ventilator-free days (22 vs 24, p < 0.001) in NSU v. non-NSU. In the multivariable regression analysis adjusted for within-hospital effects, known variables of poor outcome, and the severity of illness APACHE-III score, the in-hospital mortality was lower for NSU admissions (OR, 0.8; 95%CI, 0.7-0.9, p = 0.02) as compared to non-NSU.ConclusionAdmission of critically ill brain-injured patients to dedicated NSUs is associated with lower actual in-hospital mortality. Future iterations of APACHE-IV modeling may need to incorporate NSU designations for calculations of expected mortality among brain-injured patients.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"902-906"},"PeriodicalIF":3.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12177187/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144022475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Healthcare-associated infections in Iranian pediatric and adult intensive care units: A comprehensive review of risk factors, etiology, molecular epidemiology, antimicrobial sensitivity, and prevention strategies during the COVID-19 pandemic.","authors":"Mehdi Safarabadi, Tahereh Motallebirad, Davood Azadi, Ali Jadidi","doi":"10.1177/08850666241249162","DOIUrl":"10.1177/08850666241249162","url":null,"abstract":"<p><p>The current review article provides a comprehensive analysis of nosocomial infections in pediatric and adult intensive care units (ICUs) in Iran. We examine the risk factors and etiology of nosocomial infections, with a particular focus on molecular epidemiology and antimicrobial sensitivity. In this article, we explore a range of prevention strategies, including hand hygiene, personal protective equipment, environmental cleaning, antibiotic stewardship, education, and training. Moreover, we discuss the impact of the COVID-19 pandemic on infection control measures in ICUs and provide valuable insights for healthcare professionals and policymakers seeking to address this critical public health issue. In conclusion, this review article can serve as a valuable resource for those interested in understanding and improving infection control in ICUs and beyond.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"839-848"},"PeriodicalIF":3.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140853321","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 as a Potential Risk Factor for Upper Gastrointestinal Bleeding in Critically Ill Patients: A Systematic Review and Meta-analysis.","authors":"Yanfen Yao, Tejin Ba, Bagenna Bao, Shuanglin Zhang, Li Kong","doi":"10.1177/08850666241252048","DOIUrl":"10.1177/08850666241252048","url":null,"abstract":"<p><p><b>Purpose:</b> Sepsis is a common and critical condition in intensive care units (ICUs) known to complicate patient outcomes. Previous studies have indicated an association between sepsis and various ICU morbidities, including upper gastrointestinal bleeding (UGIB). However, the extent of this relationship and its implications in ICU settings remain inadequately quantified. This study aims to elucidate the association between sepsis and the risk of UGIB in ICU patients. <b>Methods:</b> A comprehensive meta-analysis was conducted, encompassing nine studies with a total of nearly 9000 participants. These studies reported events for both sepsis and nonsepsis patients separately. Pooled odds ratios (ORs) were calculated to assess the risk of UGIB in septic versus nonseptic ICU patients. Subgroup analyses were conducted based on age and study design, and both unadjusted and adjusted ORs were examined. <b>Results:</b> The pooled OR indicated a significant association between sepsis and UGIB (OR = 3.276, 95% CI: 1.931 to 5.557). Moderate heterogeneity was observed (I² = 43.9%). The association was significant in adults (pooled OR = 4.083) but not in children. No difference in association was found based on the study design. Unadjusted and adjusted ORs differed slightly, indicating the influence of confounding factors. <b>Conclusion:</b> This meta-analysis reveals a significant association between sepsis and an increased risk of UGIB in ICU patients, particularly in adults. These findings highlight the need for vigilant monitoring and proactive management of septic ICU patients to mitigate the risk of UGIB. Future research should focus on understanding the underlying mechanisms and developing tailored preventive strategies.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"849-859"},"PeriodicalIF":3.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141175759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Cleveland Clinic Post-ICU Recovery Clinic: Early Experience During the COVID-19 Pandemic.","authors":"Kavya Kommaraju, Heather Torbic, Joshua Veith, Xiaofeng Wang, Michelle Biehl","doi":"10.1177/08850666251326551","DOIUrl":"10.1177/08850666251326551","url":null,"abstract":"<p><p>BackgroundOver half of ICU survivors experience post intensive care syndrome (PICS). Few PICS clinics were operational in the United States at the onset of the COVID-19 pandemic. Here we describe early experience of such a clinic at a large academic medical center. Our objective was to describe the (a) model of care (b) clinic interventions (c) short-term cognitive, psychiatric, and functional outcomes (d) one-year outcomes of COVID-19 ICU survivors at the Cleveland Clinic post-ICU recovery clinic (PIRC).MethodsWe conducted a retrospective cohort study through a chart review of all patients seen in PIRC from April 2020 - December 2020. A total of 59 patients completed the visit with 49% being virtual, and 51% being in-person. The cohort was predominantly white (50.8%), and male (57.6%) with a median age of 58.2 years. We screened for cognitive and psychiatric impairments using several different validated questionnaires. Functional impairments were self-reported and detected after assessment by a physical therapist. Quantifiable clinic interventions were referrals, pharmacy medication reconciliation, and vaccine administration. One-year outcomes were health care utilization, and death.ResultsIn our cohort, 36%, 39.6%, and 17% of patients screened positive for cognitive impairment, anxiety and/or depression, and PTSD respectively. 42.3% of patients had lower extremity mobility impairment. 57.6% of patients required at least one referral after clinic. Of the 67.9% of patients who were working and 93.9% driving prior to hospitalization, only 24.6% and 73.2% had returned to those activities, respectively. The most common pharmacy intervention was discontinuation of a medication no longer in use. By one year, 34% of patients had hospital re-admissions with 5% requiring the ICU. There were no deaths.ConclusionsAdult survivors of COVID-19 critical illness have impairments in all PICS domains as well as high health care utilization in the first year after hospital discharge.MeSH TermsPost intensive care syndrome, COVID-19Key Points/SummaryAdult survivors of COVID-19 critical illness have impairments in all PICS domains as well as high health care utilization in the first year after hospital discharge. Post-ICU recovery clinics can help survivors with recovery.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"893-901"},"PeriodicalIF":3.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Methylene Blue and Cyanocobalamin for Vasoplegic Syndrome in Liver Transplantation.","authors":"Yaroslava Longhitano, Ezeldeen Albuelkasem, Antonio Voza, Luigi La Via, Christian Zanza, Raymond M Planinsic","doi":"10.1177/08850666251347951","DOIUrl":"10.1177/08850666251347951","url":null,"abstract":"<p><p>Vasoplegic syndrome is a complication that may occur during liver transplantation, most often after donor graft reperfusion. Multiple factors in end-stage liver disease (ESLD) may contribute to this vasodilation which may be exacerbated during reperfusion in liver transplantation. Two cases of vasoplegia during living donor liver transplantation are reported along with a systematic review of current literature. These patients were successfully treated with methylene blue and cyanocobalamin. All publications between January 1992 to september 2024 that assessed the use of methylene blue and/or cyanocobalamin in vasoplegia during liver transplantation in humans were included. Seven case reports and one case series were found and reviewed. These consisted of 4 case reports of vasoplegic syndrome during liver transplantation treated with methylene blue and other four describing the use of cyanocobalamin. A total of twenty-four patients were treated with methylene blue and eight patients with cyanocobalamin in the reviewed articles and all patients had a beneficial impact on blood pressure after administration of the medications. Patients affected by vasoplegia during liver transplantation show encouraging results when treated with methylene blue and cyanocobalamin, but these data have to be confirmed by additional studies.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"907-914"},"PeriodicalIF":3.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144234358","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":"A Retrospective Cohort Study of the Role of Palliative Care Consultation for Patients on Extracorporeal Membrane Oxygenation.","authors":"Samira Teeri, Pooja Singh, Ritika Gadodia, Shikha Kapil, Maxwell Hockstein, Keki Balsara, Akram M Zaaqoq, Anirudh Rao","doi":"10.1177/08850666251327105","DOIUrl":"10.1177/08850666251327105","url":null,"abstract":"<p><p>BackgroundExtracorporeal membrane oxygenation (ECMO) serves as a critical intervention for patients with severe cardiac and pulmonary dysfunction. Given the high rates of mortality and morbidity, as well as the impact on families, palliative care (PC) integration is recommended. We aimed to examine the indications and outcomes of ECMO patients at a tertiary care hospital and evaluate the impact of PC consultation on patient outcomes.MethodsWe conducted a retrospective cohort study of 306 patients cannulated for venovenous (VV) or venoarterial (VA) ECMO from January 2020 to December 2022. We analyzed demographics, ECMO indications, and outcomes, comparing those who received PC consultations with those who did not.ResultsOf the 306 patients analyzed, 220 were on VA-ECMO and 86 on VV-ECMO. The overall in-hospital mortality rate was 49%. Patients on VV-ECMO had longer ECMO durations (8 vs 4 days) and hospital stays (31 vs 16 days, P < 0.001) than patients on VA-ECMO. PC consultations were associated with increased ECMO duration and hospital stay in both groups (P < 0.001). Mortality among patients who received PC consultations was not statistically different from those who did not (P = 0.68). Notably, patients with obesity on VA-ECMO had 2.3 times higher odds of in-hospital death (P = 0.027).ConclusionPC consultation is integral in managing patients on ECMO, focusing on holistic support for patients and their families. Further prospective studies are warranted to explore the psychosocial benefits of PC for patients on ECMO and their family members.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"885-892"},"PeriodicalIF":3.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692438","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":"BRAIN-SIM: Leveraging Simulation for Neurocritical Care Education with an Innovative Multidisciplinary Approach.","authors":"Brett DerGarabedian, Lauren Lacovara, Justin Delic, Swarna Rajagopalan","doi":"10.1177/08850666251327156","DOIUrl":"10.1177/08850666251327156","url":null,"abstract":"<p><p>Background and ObjectivesEarly recognition and response are paramount in the treatment of neurologic emergencies. Due to its complexity, neurocritical care continues to provoke unease for practitioners and trainees. Simulation provides a realistic opportunity for learners to detect an acutely deteriorating neurologic patient and make rapid-fire treatment decisions. A multidisciplinary simulation-based learning environment may improve trainee confidence when caring for the neurocritical care patient population.MethodsNine simulation lab sessions were performed with a multidisciplinary team including medical students, residents, critical care medicine fellows, advanced practice providers (APP), critical care pharmacy residents, and neuroscience unit nurses. High fidelity manikins capable of reproducing acute neurologic and physiologic emergencies were used. After the simulation, participants completed a survey utilizing Likert scale responses regarding simulation logistics, faculty competence, and pre- and post-simulation confidence levels managing specific acute neurologic emergencies and performing neurocritical care procedural skills.ResultsNine simulation lab sessions were conducted, and thirty-eight surveys were completed. Mean learner confidence levels in managing patients improved from pre- to post-simulation in patients with coma [3.18 ± 0.51 versus 4.32 ± 0.25 (<i>P </i>< .001)], status epilepticus [3.23 ± 0.55 versus 4.36 ± 0.29 (<i>P </i>< .001)], acute ischemic stroke [3.75 ± 0.59 versus 4.63 ± 0.43 (<i>P </i>< .001)], intracerebral hemorrhage [3.25 ± 0.74 versus 4.63 ± 0.43 (<i>P </i>< .001)], intracranial hypertension [3.25 ± 0.74 versus 4.63 ± 0.43 (<i>P </i>< .001)], respiratory failure [3.5 ± 0.77 versus 4.63 ± 0.43 (<i>P </i>= .0016)], and procedures such as central lines [2.2 ± 0.56 versus 3.8 ± 0.56 (<i>P </i>= .003)], intubations [2.25 ± 0.39 versus 3.63 ± 0.62 (<i>P </i>< .001)], and bronchoscopies [2 ± 0 versus 3.2 ± 0.56 (<i>P </i>= .004). Consistently, learners strongly agreed that faculty were knowledgeable, well-informed, and thorough. Learners commented that the simulation experiences were realistic and allowed them to identify areas for improvement.DiscussionSimulation training can be an effective method to improve neurocritical care education by increasing clinician confidence in managing neurologic emergencies and procedures while providing opportunities for multidisciplinary collaboration. Further evaluation of the effectiveness of simulation education in this patient care setting is warranted.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"876-884"},"PeriodicalIF":3.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12177193/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144008540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case Series Study of Airway Pressure Release Ventilation in Patients with Intracranial Pathologies and Acute Respiratory Failure.","authors":"Leon Schmidt, Keith Lamb, Dragan Jankovic, Darius Kalasauskas, Michael Kosterhon, Florian Ringel, Thomas Kerz","doi":"10.1177/08850666251320550","DOIUrl":"10.1177/08850666251320550","url":null,"abstract":"<p><p><b>Background:</b> Airway Pressure Release Ventilation (APRV) is an alternate mode of ventilation in acute respiratory failure (ARF), but there is inconsistent data to support its use over other modes of ventilation. Because of increased intrathoracic pressure for most of the respiratory cycle, a negative impact of APRV on intracranial pressure (ICP) and cerebral perfusion pressure (CPP) has been hypothesized. We evaluated the effects of APRV ventilation, with particular attention to ICP, CPP and ICP-directed therapy, in a real-world cohort of neuro-ICU patients. <b>Methods:</b> Retrospective single-center analysis from January 2021 to December 2023 of neurosurgical ICU patients with ICP monitoring. APRV was used as a rescue mode at the physician's discretion when the Horovitz index (PaO₂/FIO₂ ratio) fell below 150 despite optimized conventional ventilation. <b>Results:</b> Between 2021 and 2023, APRV was utilized in 29 patients undergoing a total of 60 episodes. Forty patients (66.7%) were female, median age was 49.5 (Q1 34; Q3 61.25) years.After transition to APRV, mean FiO2 decreased by 4.3% (t = 3.5, p < .001) and mean PaO2 increased by 22.7 mm Hg (t = 4.2, p < .001). The Horovitz index improved by 44.6 mm Hg (t = 4.9, p < .001). Mean compliance did not differ after transition to APRV (-1.5 ml/mbar, t = -0.9, p = .4).During the APRV episode, mean ICP was 1.2 mm Hg lower (t = 2.6, p = .01), while mean CPP was 1.6 mm Hg higher (t = -0.9, p = .4) and the intensity of ICP-directed therapy (TIL) was significantly lower (X²= 92.771, p < .001). <b>Conclusion:</b> APRV was hemodynamically tolerated in 29 out of 33 patients, and was safe with regard to ICP, CPP, and the intensity of ICP-directed therapy. Oxygenation was increased by APRV. 4 out of 33 patients would not tolerate APRV for hemodynamic reasons, APRV therefore was stopped immediately.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"789-797"},"PeriodicalIF":3.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143523111","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":"Systematic Ultrasound Screening for Lower Extremity Deep Vein Thrombosis in ICU Patients with Severe COVID-19: A Randomized Clinical Trial.","authors":"Carlos Ernesto Marrero Eligio De La Puente, David Flota Ruiz, Lluis Sánchez Besalduch, Xavier Faner Capó, Daniel Gil Sala, Clara Palmada Ibars, Ivan Bajaña Mindiolaza, Luis Silvestre Chiscano Camon, Adolfo Ruiz Sanmartin, Juan Carlos Ruiz-Rodríguez, Ricard Ferrer, Sergi Bellmunt Montoya","doi":"10.1177/08850666251313774","DOIUrl":"10.1177/08850666251313774","url":null,"abstract":"<p><p>BackgroundVenous thromboembolism (VTE), whether pulmonary embolism (PE) or deep vein thrombosis (DVT), is common in patients with COVID-19. Recommendations on systematic screening in the intensive care unit (ICU) are lacking.Research questionIs there any clinical benefit of systematic screening for DVT in critically ill patients with severe COVID-19?Study design and methodsSingle-center randomized clinical trial (RCT) of COVID-19 cases admitted to the ICU. Patients were randomized into two groups: a study group that underwent ultrasound (US) screening for DVT Mondays and Thursdays, and a control group that was treated according to the unit protocol. The primary outcome was the presence of DVT. Secondary outcomes were ICU total stay, death within 21-day follow-up and bleeding complications (minor or major). A composite outcome of poor prognosis variables was analyzed. We tested a superiority hypothesis with a confidence level of 95% and an equivalence limit of 20%.Results163 patients (84 screening group, 79 control group) were enrolled between April and July 2021. There were 90 men (55.2%) with a mean ± SD age of 49.8 ± 13.58 years. In screening group 16.7% developed DVT versus 3.8% in control group (p = .007), and 3.6% versus 5.1% developed PE, respectively (p = 0.7). Poor outcome variables were male sex, age, COVID-19 vaccination status, Fibrinogen, Urea, Creatinine and Interleukin 6 (IL6) levels; Acute Physiology and Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment (SOFA) scales. The superiority comparison, with a power of 95%, showed no statistically significant differences for a composite endpoint (p = .123). After adjusting by group, the OR for poor outcome is 1.966 (0.761-5.081) p = 0.163InterpretationAmong these patients, a strategy of systematic US screening for DVT was not associated with any significant improvements to clinical outcomes compared with usual care.Clinical Trial RegistrationClinicaltrials.org registration number: NCT05028244.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"739-748"},"PeriodicalIF":3.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006821","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}