Journal of Intensive Care Medicine最新文献

{"title":"Flexible Fiberoptic Bronchoscopy During Pediatric ECMO: Balancing Risk and Clinical Benefit.","authors":"Esin Gizem Olgun, Nazan Çobanoğlu, Tanıl Kendirli","doi":"10.1177/08850666261469111","DOIUrl":"10.1177/08850666261469111","url":null,"abstract":"","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"1194-1195"},"PeriodicalIF":2.3,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148430531","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":"Neuromuscular Blockade for Intracranial Hypertension: Quantifying Real-World Effectiveness on Intracranial Pressure.","authors":"Noam Goder, Gordon D Rubenfeld, Andre C K B Amaral","doi":"10.1177/08850666261432119","DOIUrl":"10.1177/08850666261432119","url":null,"abstract":"<p><p>BackgroundContemporary intracranial hypertension guidelines, including SIBICC (2019) and the 2024 ACS Best Practices, list neuromuscular blockade as a Tier Two, short-duration option for refractory ICP elevation. Despite its physiologic rationale, the real-world effect of initiating continuous paralysis on ICP has not been quantified using large-scale intra-patient physiologic data.MethodsWe performed a retrospective intra-patient before-after study at a Level 1 trauma and neurocritical care center (2016-2021). Among 9373 ICU admissions, 106 patients receiving a Rocuronium infusion with continuous invasive ICP monitoring met inclusion criteria. ICP values were compared using symmetric pre/post windows (-165-0 min; +15-180 min). A generalized additive model (GAM) evaluated time-dependent ICP changes adjusting for sedatives and hypertonic saline.ResultsMedian ICP decreased from 20.7 to 18.6 mm Hg (within-patient Δ -0.9 mm Hg; <i>P</i> = .017). Cerebral perfusion pressure increased from 71.1 ± 10.5 to 75.2 ± 12.5 mm Hg (<i>P</i> < .001). In patients with pre-treatment ICP > 20 mm Hg, median ΔICP was -2.0 mm Hg (<i>P</i> < .001). Adjusted GAM modeling demonstrated reductions of -1.66 mm Hg at 3 h and -2.23 mm Hg at 6 h.ConclusionsContinuous Rocuronium infusion was associated with modest (approximately 1-2 mm Hg) reductions in ICP and improved CPP. Although these physiologic changes are small and may have limited clinical significance, this study provides the largest real-world evaluation and quantification of the effect of continuous neuromuscular blockade on ICP control and directly informs a major evidence gap highlighted in contemporary guidelines.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"1105-1112"},"PeriodicalIF":2.3,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13672926/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147463482","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":"Subtracting Lactate From the Anion Gap: From Association to Diagnosis.","authors":"Dilek Kuzukıran Kocataş","doi":"10.1177/08850666261489209","DOIUrl":"10.1177/08850666261489209","url":null,"abstract":"","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"1196-1197"},"PeriodicalIF":2.3,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149008452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Targeted Temperature Management and New-Onset Brain Disability in in-Hospital Cardiac Arrest Survivors: A Nationwide Cohort Study.","authors":"Tak Kyu Oh, In-Ae Song","doi":"10.1177/08850666261434483","DOIUrl":"10.1177/08850666261434483","url":null,"abstract":"<p><p>ObjectivesTargeted temperature management (TTM) is the standard of care for comatose cardiac arrest survivors. However, evidence regarding its long-term neurological impact specifically on in-hospital cardiac arrest (IHCA) survivors remains limited. This study investigated the association between TTM and the risk of new-onset brain disability in adult IHCA survivors using a \"hard\" endpoint derived from a national registry.DesignThis nationwide retrospective cohort study utilized the South Korean National Health Insurance Service database (2013-2022). Adult IHCA survivors were categorized into TTM and non-TTM groups. The primary endpoint was newly diagnosed brain disability registered in the Korea National Disability Registration System. This endpoint requires stringent certification by board-certified specialists after at least six months of active treatment to confirm irreversibility. We performed 1:5 propensity score matching and used stratified Cox proportional hazards models to estimate hazard ratios (HR).ResultsAmong 95 337 eligible survivors, 31 592 patients were included in the matched cohort (5633 TTM vs 25 959 non-TTM). The TTM group showed a significantly lower incidence of new-onset brain disability compared with the non-TTM group (5.0% vs 5.2%). In the PS-matched analysis, TTM was independently associated with a reduced risk of new-onset brain disability (HR, 0.85; 95% confidence interval [CI], 0.75-0.96; <i>P</i> = .012). Multivariable sensitivity analysis in the entire cohort confirmed this protective association (adjusted HR, 0.80; 95% CI, 0.70-0.90; <i>P</i> < .001).ConclusionIn this large-scale nationwide cohort of IHCA survivors, TTM implementation was associated with a decreased risk of legally certified, permanent brain disability. These findings provide real-world evidence supporting the continued use of TTM as a neuroprotective strategy to improve long-term quality of survivorship in the IHCA population.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"1135-1143"},"PeriodicalIF":2.3,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147690560","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":"Trends of Standardized Mortality Ratio and its Correlation with Admission Patient Volume in Different Intensive Care Units.","authors":"Yu Qiu, Zhuang Liu, Jing Bai, Mengya Zhao, Haizhou Zhuang, Xiaojun Ji, Jingfeng Liu, Xiuming Xi, Jin Lin, Meili Duan","doi":"10.1177/08850666261434471","DOIUrl":"10.1177/08850666261434471","url":null,"abstract":"<p><p>BackgroundHealthcare quality impacts patient prognosis in the intensive care unit (ICU). The healthcare quality can be indicated by the standardized mortality ratio (SMR) and is influenced by the volume of admitted patients. However, the correlation between the admission patient volume and SMR in ICUs remains unclear. This study examined SMR trends and their influencing factors and assessed the correlation between SMR and the admission patient volume across various ICU types.MethodsWe analyzed data retrospectively gathered from 75 ICUs from a Quality Improvement Project from January 2011 to December 2022. It examined the correlations between SMR, admission patient volume, and other quality control indicators. We further compared SMR trends between two groups of ICUs with high or low admission volumes. The study also evaluated inter- and intra-group SMR disparities across hospital levels (secondary vs tertiary) and ICU types (general vs specialty).ResultsThe study encompassed 425,534 patients. A significant decline in SMR (<i>P</i> < 0.001) was observed over the 12 years, alongside a notable negative correlation between admission patient volume and SMR (<i>P</i> < 0.001). The low-admission group had a higher SMR than the high-admission group (<i>P</i> = 0.010). Both the low (<i>P</i> = 0.004) and high admission groups (<i>P</i> = 0.001) showed a significant decreasing trend in SMR, with no significant inter-group difference (<i>P</i> = 0.267). Moreover, the study identified distinct SMR trends between general ICUs (<i>P</i> = 0.018) and secondary hospital ICUs (<i>P</i> = 0.048) but not between specialty ICUs (<i>P</i> = 0.511) and tertiary hospital ICUs (<i>P</i> = 0.276). Sensitivity analysis confirmed that this negative association between patient volume and SMR remained robust after adjusting for structural indicators.ConclusionAn inverse association was identified between ICU admission patient volume and SMR, with SMR exhibiting considerable variation across different ICU types. These findings underscore the importance of tailored quality improvement strategies, such as prioritizing infection control and care bundle adherence in lower-volume ICUs and secondary hospitals.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"1124-1134"},"PeriodicalIF":2.3,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147529882","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 Differences in Clinical Characteristics, Incidence, and Prognosis of Acute Kidney Injury Between Patients with Severe Pneumonia of COVID-19 and non-COVID-19 During the Omicron.","authors":"Weijuan Deng, Xia Du, Huiping Kong, Ziyi Qiu, Zhuo Zhen, Mengqing Ma","doi":"10.1177/08850666261434538","DOIUrl":"10.1177/08850666261434538","url":null,"abstract":"<p><p>BackgroundThe clinical characteristics and prognosis of acute kidney injury (AKI) in severe COVID-19 patients infected with the Omicron variant compared to patients with classic severe pneumonia remain unclear. This study aims to evaluate these differences following the adjustment of the \"zero-COVID\" policy.MethodsA retrospective cohort study was conducted using propensity score matching (PSM). We enrolled adult patients with non-COVID-19 severe pneumonia (2016-2021) and severe/critical COVID-19 (Omicron wave, 2022-2023). AKI was defined according to KDIGO criteria based on serum creatinine (SCr). The primary outcome was AKI incidence; secondary outcomes included severe AKI, continuous renal replacement therapy (CRRT) use, and in-hospital mortality.ResultsA total of 845 non-COVID-19 and 396 severe COVID-19 patients were screened. After 1:1 matching, 300 pairs were analyzed. The incidence of AKI was similar between groups (49.0% in non-COVID-19 vs 51.3% in COVID-19, <i>P</i> = 0.603). However, severe COVID-19 patients had significantly higher rates of severe AKI (34.0% vs 25.7%, <i>P</i> = 0.034), CRRT use (8.7% vs 3.7%, <i>P</i> = 0.017), and in-hospital mortality (29.3% vs 19.3%, <i>P</i> = 0.006). Multivariate analysis showed that Omicron infection was an independent risk factor for in-hospital death (OR = 2.096, 95% CI: 1.231-3.567, <i>P</i> = 0.006) and CRRT use (OR = 5.907, 95% CI: 1.662-20.997, <i>P</i> = 0.006).ConclusionsAlthough the overall incidence of AKI was similar after matching, severe COVID-19 (Omicron) patients suffered from more severe kidney injury and worse clinical outcomes compared to non-COVID-19 severe pneumonia patients.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"1113-1123"},"PeriodicalIF":2.3,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148436842","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":"Comments on \"Intensive Care Unit and Hospital Mortality for non-COVID Critically ill Patients Before, and During the COVID-19 Pandemic in Alberta Hospitals: Retrospective, Observational Cohort Study\".","authors":"Bakhtawar Shaikh, Syeda Ukasha Mati, Abdul Mannan Shaikh","doi":"10.1177/08850666261478599","DOIUrl":"10.1177/08850666261478599","url":null,"abstract":"","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"1198"},"PeriodicalIF":2.3,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148989681","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":"Using Serum Lactate Concentration to Correct for the Anion Gap.","authors":"Ramin Sam","doi":"10.1177/08850666261489207","DOIUrl":"10.1177/08850666261489207","url":null,"abstract":"","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"1201"},"PeriodicalIF":2.3,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13672911/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149008437","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":"Association Between Albumin-Bilirubin Index and Clinical Outcomes in Septic Acute Kidney Injury Patients.","authors":"Caihong Liu, Dongmei Wu, Liyao Yang, Wei Wei, Yongxiu Huang, Fanlin Zhou, Binyu Yang, Jinglei Ren, Fang Wang, Jian Li, Letian Yang, Bo Wang, Liang Ma, Ping Fu, Ling Zhang, Yuliang Zhao","doi":"10.1177/08850666261498162","DOIUrl":"https://doi.org/10.1177/08850666261498162","url":null,"abstract":"<p><p>BackgroundThe albumin-bilirubin index (ALBI) has been reported as a prognostic marker in various clinical conditions; however, its value in patients with septic acute kidney injury (AKI) has not been clearly evaluated. This study aimed to investigate the association between ALBI and clinical outcomes in this population.MethodsThis retrospective cohort study used data from the Medical Information Mart for Intensive Care IV database. ALBI was analyzed as both a continuous variable in the primary analysis and a categorical variable according to tertiles in sensitivity analysis. The primary outcomes were 28-day, 60-day, 90-day, and 1-year all-cause mortality. Secondary outcomes included intensive care unit (ICU) transfer, septic shock, and disease severity. Cox proportional hazards models were used to evaluate the association between ALBI and mortality, and restricted cubic spline analyses were performed to assess potential nonlinearity. Subgroup analyses were further conducted to examine the consistency across different sub-group populations.ResultsOverall, 6700 patients with septic AKI were included. In adjusted Cox models, each 1-standard deviation increase in ALBI was associated with higher risks of 28-day mortality (HR 1.16, 95% confidence interval [CI] 1.10-1.22), 60-day mortality (HR 1.14, 95% CI 1.10-1.19), 90-day mortality (HR 1.13, 95% CI 1.08-1.18), and 1-year mortality (HR 1.10, 95% CI 1.06-1.14). The association between ALBI and mortality was generally consistent across most prespecified subgroups. Higher ALBI was also linked with septic shock (odds ratio [OR] 1.15, 95%CI 1.08-1.21, P < .001), ICU transfer (OR 1.09, 95%CI 1.02-1.16), and greater disease severity. RCS curves showed a nonlinear increase in mortality risk with ascending ALBI. Sensitivity analyses based on ALBI tertiles yielded broadly consistent findings.ConclusionHigher ALBI was independently associated with increased short- and long-term mortality and adverse clinical outcomes in septic AKI patients.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666261498162"},"PeriodicalIF":2.3,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Pediatric Critical Illness With Household Income Trajectories.","authors":"Tak Kyu Oh, In-Ae Song","doi":"10.1177/08850666261500002","DOIUrl":"https://doi.org/10.1177/08850666261500002","url":null,"abstract":"<p><p>BackgroundWe aimed to quantify longitudinal changes in household income among families of pediatric survivors of critical illness and to identify factors associated with catastrophic household income decline.MethodsThis nationwide retrospective cohort study used data from the National Health Insurance Service of South Korea. We included 10 590 pediatric patients aged 1 month to 17 years who were admitted to intensive care units (ICUs) between January 1, 2020, and December 31, 2022, and survived for at least 365 days after ICU admission. The primary outcome was the longitudinal change in household income level (ordinal scale, 0-20) between the pre-ICU baseline and the subsequent calendar-year assessment, analyzed using generalized estimating equation (GEE) models. A sensitivity analysis assessed income two calendar years after ICU admission in the 2020-2021 cohort.ResultsAmong 10 590 pediatric survivors, 2837 (26.8%) experienced a decline in household income, and 797 (7.5%) experienced catastrophic household income decline. In the primary GEE model, household income did not significantly differ between the pre-ICU and post-ICU assessments (ratio of means [RoM], 0.99; 95% CI, 0.99-1.00; <i>P</i> = .631). The 2-calendar-year sensitivity analysis yielded a consistent result (RoM, 0.99; 95% CI, 0.96-1.01; <i>P</i> = .299). In subgroup analyses, higher-income households showed decreases in income level, including Q4 (RoM, 0.96; 95% CI, 0.95-0.97; <i>P</i> < .001), whereas Q1 households showed a relative increase (RoM, 2.05; 95% CI, 1.94-2.16; <i>P</i> < .001).ConclusionsPediatric critical illness was not associated with a statistically significant change in household income at the population level. However, subgroup analyses suggested differing patterns of income change across baseline socioeconomic strata, including declines among higher-income households. These findings highlight potential socioeconomic heterogeneity in the financial consequences experienced by families following pediatric critical illness.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666261500002"},"PeriodicalIF":2.3,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224330","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}