Journal of Intensive Care Medicine最新文献

{"title":"Systemic and Pulmonary Microcirculation, Double Microcirculation: From Basic Concepts to Treatment Key Points.","authors":"Guangjian Wang, Qingyu Deng, Jie Wang, Qian Zhang, Hui Lian, Xiaoting Wang","doi":"10.1177/08850666251321786","DOIUrl":"https://doi.org/10.1177/08850666251321786","url":null,"abstract":"<p><p>It seems logical to divide the macrocirculation into systemic and pulmonary circulation, but it is rare in clinical practice to further subdivide microcirculation into systemic and pulmonary microcirculation. Both systemic and pulmonary microcirculations play important roles in the development and progression of critical illness. Therefore, targeting the overall microcirculation status for clinical treatment may overlook the heterogeneity of different critically ill patients. It seems unavoidable to further subdivide the microcirculation, so this review explains the differences in structure, function, blood flow regulation, and other important aspects between systemic and pulmonary microcirculation, systematically presenting the concept of \"double microcirculation.\" At the same time, to refine the critical care treatment and even improve the prognosis of critically ill patients, we further propose and explain the treatment key points based on \"double microcirculation protection.\"</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666251321786"},"PeriodicalIF":3.0,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144022625","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":"Cerebral Venous Thrombosis in Traumatic Brain Injury: A Population-Based Cross-Sectional Study of 640 Patients.","authors":"Ankita Jain, Michael Fortunato, Bridget Nolan, Sahdev S Baweja, Galadu Subah, Sima Vazquez, Candice Dyce, Andy Jiang, Eris Spirollari, Ariel Sacknovitz, Chirag D Gandhi, Fawaz Al-Mufti","doi":"10.1177/08850666251331522","DOIUrl":"https://doi.org/10.1177/08850666251331522","url":null,"abstract":"<p><p>BackgroundCerebral venous thrombosis (CVT) is a rare but serious complication of traumatic brain injury (TBI), yet the implications of this association remain poorly understood. This study explores the demographics, risk factors, and clinical outcomes of patients with both TBI and CVT (CVT-TBI).MethodsThe National Inpatient Sample (NIS) was queried from 2016-2020 for adult patients with a primary diagnosis of TBI and concurrent CVT. Chi-squared tests and logistic regression were used to compare demographic, clinical, and outcome variables of CVT-TBI and TBI-only patients.ResultsOf the 1,583,915 TBI patients identified between 2016-2020, 640 (0.04%) had concurrent CVT. CVT-TBI patients were younger (47.94 vs 61.81; p < 0.001), more likely to have Medicaid (30.5% vs 14.1%; p < 0.001), less likely to be female (31.3% vs 39.0%; p < 0.001), and less likely to be Caucasian (60.9% vs 68.1%; p < 0.001). Multivariate analysis demonstrated age (OR = 0.98; p < 0.001), skull fracture (OR = 3.741; p < 0.001), epidural hematoma (OR = 1.407; p = 0.012), subdural hematoma (OR = 2.395; p < 0.001), and subarachnoid hemorrhage (OR = 1.415; p < 0.001) as CVT risk factors. CVT-TBI patients experienced more severe clinical courses involving mechanical ventilation (21.9% vs 10.4%; p < 0.001), cerebral herniation (6.3% vs 3.7%; p = 0.001), and being comatose (45.3% vs 30.7%; p < 0.001) and were more likely to undergo decompressive hemicraniectomy (4.7% vs 1.1%; p < 0.001), tracheostomy or percutaneous endoscopic gastrostomy tube placement (3.9% vs 1.5%; p < 0.001), and develop long-term sequelae, including seizures (10.9% vs 4.2%; p < 0.001) and hydrocephalus (7.0% vs 1.7%; p < 0.001). After matching, there was a significant difference in discharge home (OR = 1.806; p = 0.018), but no significant difference in discharge to a skilled nursing home (OR = 1.068; p = 0.449), short term rehabilitation facility (OR = 0.850; p = 0.500), or inpatient mortality (OR = 1.134; p = 0.500).ConclusionsThis population-based retrospective analysis unveils distinctive demographic and clinical features of CVT-TBI patients, emphasizing the need for tailored risk assessment and management strategies to improve outcomes for this subset of TBI patients.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666251331522"},"PeriodicalIF":3.0,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143969969","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":"Predicting Parental Post-Traumatic Stress Symptoms Following their Child's Stay in a Pediatric Intensive Care Unit, Prior to Discharge.","authors":"Mekela M Whyte-Nesfield, Eduardo A Trujillo Rivera, Daniel Kaplan, Simon Li, Pamela S Hinds, Murray M Pollack","doi":"10.1177/08850666241287442","DOIUrl":"10.1177/08850666241287442","url":null,"abstract":"<p><p><b>Objective:</b> Develop an inpatient predictive model of parental post-traumatic stress (PTS) following their child's care in the Pediatric Intensive Care Unit (PICU). <b>Design:</b> Prospective observational cohort. <b>Setting:</b> Two tertiary care children's hospitals with mixed medical/surgical/cardiac PICUs. <b>Subjects:</b> Parents of patients admitted to the PICU. <b>Interventions:</b> None. <b>Measurements and Main Results:</b> Preadmission and admission data from 169 parents of 129 children who completed follow up screening for parental post-traumatic stress symptoms at 3-9 months post PICU discharge were utilized to develop a predictive model estimating the risk of parental PTS 3-9 months after hospital discharge. The parent cohort was predominantly female (63%), partnered (75%), and working (70%). Child median age was 3 years (IQR 0.36-9.04), and more than half had chronic illnesses (56%) or previous ICU admissions (64%). Thirty-five percent (60/169) of parents met criteria for PTS (>9 on the Post-traumatic Stress Disorder Symptom Scale-Interview). The machine learning model (XGBoost) predicted subjects with parental PTS with 76.7% accuracy, had a sensitivity of 0.83 (95% CI 0.586, 0.964), a specificity of 0.72 (95% CI 0.506, 0.879), a precision of 0.682 (95% CI 0.451, 0.861) and number needed to evaluate of 1.47 (95% CI 1.16, 1.98). The area under the receiver operating curve was 0.78 (95% CI 0.64, 0.92). The most important predictive pre-admission and admission variables were determined using the Local Interpretable Model-Agnostic Explanation, which identified seven variables used 100% of the time. Composite variables of parental history of mental illness and traumatic experiences were most important. <b>Conclusion:</b> A machine learning model using parent risk factors predicted subsequent PTS at 3-9 months following their child's PICU discharge with an accuracy of 76.7% and number needed to evaluate of 1.47. This performance is sufficient to identify parents who are at risk during hospitalization, making inpatient and acute post admission mitigation initiatives possible.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"396-403"},"PeriodicalIF":3.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348273","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":"Assessing the Role of Blood Gas Analysis in COVID-19 Patients for Early Warning and Clinical Guidance.","authors":"Youji Wang, Tielian Liu, Hualongyue Du, Yongliang Wang, Gang Xiao, Xiaoming Lyu","doi":"10.1177/08850666241297081","DOIUrl":"10.1177/08850666241297081","url":null,"abstract":"<p><p>Objective: To assess the role of blood gas analysis as an auxiliary tool for detecting and predicting the progression of COVID-19 in patients. Research Methodology/Design: A consecutive cohort study was conducted of 106 patients diagnosed with the novel coronavirus. Patients were divided into two groups based on age and the course of the disease (mild to moderate and severe). Blood gas analysis parameters were measured for all participants and results were compared between groups. Setting: This study was conducted in the Department of Laboratory Medicine, The Third Affiliated Hospital, Southern Medical University, Guangzhou, China. Main Outcome Measures: Arterial/alveolar oxygen partial pressure ratio, reduced hemoglobin fraction, sodium ion, lactic acid, oxygen saturation, oxygen partial pressure, and oxyhemoglobin fraction. Results: Findings indicated statistically significant differences between the two groups in the measured parameters. Conclusion: Blood gas analysis has the potential to more accurately assess the progression of COVID-19 in elderly patients, specifically related to respiratory and acid-base balance issues. Implications for Clinical Practice: This study underscores the importance for bedside nurses to pay close attention to acid-base balance, lung ventilation/ventilation function, and hypoxia status in elderly critically ill patients with COVID-19, in order to more effectively diagnose and predict the progression of the disease.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"435-440"},"PeriodicalIF":3.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622290","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":"Telemedicine in Intensive Care Unit: Current Practice and Future Prospect.","authors":"Raffaele Merola, Annachiara Marra, Stefania De Simone, Maria Vargas","doi":"10.1177/08850666251325782","DOIUrl":"10.1177/08850666251325782","url":null,"abstract":"<p><p>Telemedicine in the intensive care unit (tele-ICU) is an increasingly significant field that leverages advanced technology to provide remote critical care services for patients in the ICU. The primary goal of tele-ICU is to enhance access to expert intensive care specialists, improve clinical outcomes, and optimize the management of critical care capacity and resources. Numerous studies have demonstrated that telemedicine can improve the efficiency of resource utilization, foster adherence to clinical best practices, and directly enhance both the quality of care and patient outcomes in the ICU setting. Moreover, telemedicine facilitates greater access to critical care knowledge, strengthens collaboration between healthcare providers across different institutions, and supports the development of specialized training programs for critical care professionals. Currently, the most widely adopted tele-ICU model is the centralized hub-and-spoke model, where a central monitoring station oversees multiple ICUs at geographically distant locations. While this model has proven effective in many contexts, there remains significant potential for further advancements in tele-ICU practices. In this article, we propose two novel theoretical models of tele-ICU that aim to address current limitations, improve quality of care, optimize personnel deployment, and maximize resource utilization. These proposed models are intended to offer a more flexible, scalable, and efficient approach to delivering critical care in diverse healthcare settings, ultimately contributing to better patient outcomes and more sustainable healthcare practices.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"456-463"},"PeriodicalIF":3.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692536","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":"POCUS in the PICU: A Narrative Review of Evidence-Based Bedside Ultrasound Techniques Ready for Prime-Time in Pediatric Critical Care.","authors":"Catherine E Naber, Michael D Salt","doi":"10.1177/08850666231224391","DOIUrl":"10.1177/08850666231224391","url":null,"abstract":"<p><p>Point-of-care ultrasound (POCUS) is an accessible technology that can identify and treat life-threatening pathology in real time without exposing children to ionizing radiation. We aim to review current evidence supporting the use of POCUS by pediatric intensivists with novice-level experience with bedside ultrasound. Current evidence supports the universal adoption of POCUS-guided internal jugular venous catheter placement and arterial line placement by pediatric critical care physicians. Focused cardiac ultrasound performed by PICU physicians who have completed appropriate training with quality assurance measures in place can identify life-threatening cardiac pathology in most children and important physiological changes in children with septic shock. POCUS of the lungs, pleural space, and diaphragm have great potential to provide valuable information at the bedside after validation of these techniques for use in the PICU with additional research. Based on currently available evidence, a generalizable and attainable POCUS educational platform for pediatric intensivists should include training in vascular access techniques and focused cardiac examination. A POCUS educational program should strive to establish credentialing and quality assurance programs that can be expanded when additional research validates the adoption of additional POCUS techniques by pediatric intensive care physicians.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"372-378"},"PeriodicalIF":3.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139403161","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":"Risk Stratification of QTc Prolongation in Critically Ill Patients Receiving Antipsychotics for the Management of Delirium Symptoms.","authors":"Monika Sadlonova, Scott R Beach, Margo C Funk, Jordan H Rosen, Andres F Ramirez Gamero, Rebecca A Karlson, Jeff C Huffman, Christopher M Celano","doi":"10.1177/08850666231222470","DOIUrl":"10.1177/08850666231222470","url":null,"abstract":"<p><p>BackgroundPatients experiencing significant agitation or perceptual disturbances related to delirium in an intensive care setting may benefit from short-term treatment with an antipsychotic medication. Some antipsychotic medications may prolong the QTc interval, which increases the risk of potentially fatal ventricular arrhythmias. In this targeted review, we describe the evidence regarding the relationships between antipsychotic medications and QTc prolongation and practical methods for monitoring the QTc interval and mitigating arrhythmia risk.MethodsSearches of PubMed and Cochrane Library were performed to identify studies, published before February 2023, investigating the relationships between antipsychotic medications and QTc prolongation or arrhythmias.ResultsMost antipsychotic medications commonly used for the management of delirium symptoms (eg, intravenous haloperidol, olanzapine, quetiapine) cause a moderate degree of QTc prolongation. Among other antipsychotics, those most likely to cause QTc prolongation are iloperidone and ziprasidone, while aripiprazole and lurasidone appear to have minimal risk for QTc prolongation. Genetic vulnerabilities, female sex, older age, pre-existing cardiovascular disease, electrolyte abnormalities, and non-psychiatric medications also increase the risk of QTc prolongation. For individuals at risk of QTc prolongation, it is essential to measure the QTc interval accurately and consistently and consider medication adjustments if needed.ConclusionsAntipsychotic medications are one of many risk factors for QTc prolongation. When managing agitation related to delirium, it is imperative to assess an individual patient's risk for QTc prolongation and to choose a medication and monitoring strategy commensurate to the risks. In intensive care settings, we recommend regular ECG monitoring, using a linear regression formula to correct for heart rate. If substantial QTc prolongation (eg, QTc > 500 msec) is present, a change in pharmacologic treatment can be considered, though a particular medication may still be warranted if the risks of discontinuation (eg, extreme agitation, removal of invasive monitoring devices) outweigh the risks of arrhythmias.AimsThis review aims to summarize the current literature on relationships between antipsychotic medications and QTc prolongation and to make practical clinical recommendations towards the approach of antipsychotic medication use for the management of delirium-related agitation and perceptual disturbances in intensive care settings.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"355-371"},"PeriodicalIF":3.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138830069","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 Associated with the use of High Dose Corticosteroids and IL-6 Inhibitors for the Treatment of Acute Respiratory Distress Syndrome Secondary to SARS COV-2.","authors":"Tessa Milic, Kieran Shah, Anish Mitra, Sarah Stabler","doi":"10.1177/08850666241287514","DOIUrl":"10.1177/08850666241287514","url":null,"abstract":"<p><p>Background: During the COVID-19 pandemic, treatment strategies evolved rapidly. The RECOVERY trial established corticosteroids as the standard care for reducing mortality in COVID-19 patients. However, some critical care clinicians began using doses higher than those recommended in RECOVERY. Objective: To characterize the use of high-dose corticosteroids and IL-6 inhibitors in critically ill COVID-19 patients and examine their association with adverse drug events (ADEs). Methods: A retrospective cohort study of 320 electronic health records (January 1, 2020 - June 30, 2022) was conducted on COVID-19 patients requiring high-flow oxygen or mechanical ventilation. Patients were categorized based on corticosteroid dose: \"high dose dexamethasone\" (daily dose greater than 12 mg and/or for longer than 10 days), \"low dose dexamethasone\" (daily dose 12 mg or less for 10 days or less), and \"no dexamethasone\" (no corticosteroid therapy). Subgroups were created based on IL-6 inhibitor use. Results: High-dose dexamethasone was associated with increased odds of ADEs compared to low dose (OR 2.55, 95% CI 1.45 to 4.49) and no dexamethasone (OR 6.29, 95% CI 2.08 to 19.03). No additional efficacy benefit was observed in patients receiving high dose corticosteroids when compared to low dose corticosteroids. Patients receiving both an IL-6 inhibitor and high-dose dexamethasone had further increased odds of ADEs. High-dose dexamethasone was also associated with increased mortality compared to low dose (OR 3.78, 95% CI 1.97-7.25) and no dexamethasone (OR 15.22, 95% CI 3.27-70.74). Conclusions: Acknowledging the risk for residual confounding, higher doses of dexamethasone were associated with increased ADEs and mortality. These findings highlight the need for careful consideration of the use of high-dose dexamethasone.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"388-395"},"PeriodicalIF":3.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142467753","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":"Cognitive and Functional Capacity Assessment of Individuals Who Were Admitted to the Intensive Care Unit Due to COVID-19: A Prospective Cohort Study.","authors":"Juliana Cristina Fogaça Carneiro, Mayco Biasibetti, Folly Rodrigues, Gustavo de Castro Barroso, Fernanda Cechetti","doi":"10.1177/08850666241291513","DOIUrl":"10.1177/08850666241291513","url":null,"abstract":"<p><p>Aim: The goal of this study was to identify changes in cognitive and functional capacity after hospital discharge in those infected with COVID-19 who were admitted to the ICU. Methods: This is a prospective cohort study carried out with individuals who were admitted to a hospital, from July 2021 to May 2022. The evaluations happened in three moments: at hospital discharge, 30 days after discharge and 90 days after discharge. The instruments applied are the following: handgrip dynamometer, Montreal Cognitive Assessment Basic questionnaire (MoCA-B), Barthel Index (BI), timed up and go test (TUG), hospital anxiety and depressive scale (HADS) and 36-Item Short Form Health Survey questionary (SF-36). Results: 74 individuals were eligible to participate in the study, 25 of which were followed for 90 days. Based on the results of the MoCA-b, there were no relevant cognitive changes after 3 months. According to the Barthel Index applied to each of the evaluations, the percentage of subjects that were classified as independent or minimally dependent was 48%, 92% then 96%, respectively, demonstrating that individuals can achieve a good degree of functional independence after 3 months. Despite that, the SF-36 demonstrated a score below the South Brazilian normal in some domains. Conclusion: The individuals studied did not present persistent cognitive changes after 3 months and functional capacity showed significant improvement during this period. However, when the assessment is about the self-perceived quality of life, the majority of domain values are still below expectations, deserving attention by the health professionals involved.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"427-434"},"PeriodicalIF":3.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142522128","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":"<i>Extubation Advisor</i>: Implementation and Evaluation of A Novel Extubation Clinical Decision Support Tool.","authors":"Brett N Hryciw, Natasha Hudek, Jamie C Brehaut, Christophe Herry, Nathan Scales, Emma Lee, Aimee J Sarti, Karen E A Burns, Andrew J E Seely","doi":"10.1177/08850666241291524","DOIUrl":"10.1177/08850666241291524","url":null,"abstract":"<p><p>Importance: Extubation Advisor (EA) is a novel software tool that generates a synoptic report for each Spontaneous Breathing Trial (SBT) conducted to inform extubation decision-making. Objectives: To assess bedside EA implementation, perceptions of utility, and identify barriers and facilitators of use. Design, Setting and Participants: We conducted a phase I mixed-methods interventional study in three mixed intensive care unit (ICUs) in two academic hospitals. We interviewed critical care physicians (MDs) and respiratory therapists (RTs) regarding user-centered design principles and usability. Analysis: We evaluated our ability to consent participants (feasibility threshold 50%), capture complete data (threshold 90%), generate and review EA reports in real-time (thresholds 75% and 80%, respectively), and MD perception of tool usefulness (6-point Likert scale). We analyzed interview transcripts using inductive coding to identify facilitators and barriers to EA implementation and perceived benefit of tool use. Results: We enrolled 31 patients who underwent 70 SBTs. Although consent rates [31/31 (100%], complete data capture [68/68 (100%)], and EA report generation [68/70 (97.1%)] exceeded feasibility thresholds, reports were reviewed by MDs for [55/70 (78.6%)] SBTs. Mean MD usefulness score was 4.0/6. Based on feedback obtained from 36 interviews (15 MDs, 21 RTs), we revised the EA report twice and identified facilitators (ability to track patient progress, enhance extubation decision-making, and provide support in resource-limited settings) and barriers (resource constraints, need for education) to tool implementation. Half of respondents (9 MDs, 9 RTs; combined 50%) perceived definite or potential benefit to EA tool use. Conclusion: This is the first study of a waveform-based variability-derived, predictive clinical decision support tool evaluated in adult ICUs. Our findings support the feasibility of integrating the EA tool into bedside workflow. Clinical trials are needed to assess the utility of the EA tool in practice and its impact on extubation decision-making and outcomes.Trial RegistrationNCT04708509.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"418-426"},"PeriodicalIF":3.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502203","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}