Journal of Intensive Care Medicine最新文献

{"title":"Clinical Significance of <i>Aspergillus</i> sp Found in Respiratory Fungal Cultures of ICU Patients.","authors":"Katriina Pihlajamaa, Maija Halme, Miia Valkonen, Veli-Jukka Anttila","doi":"10.1177/08850666251340043","DOIUrl":"10.1177/08850666251340043","url":null,"abstract":"<p><strong>Background: </strong>Invasive pulmonary aspergillosis (IPA) is a very severe manifestation of <i>Aspergillus</i> disease. Besides well-known risk groups of deeply neutropenic hematologic and solid organ transplant recipients other risk groups among patients treated in ICUs have been recognized. The prevalence of IPA among ICU-patients is not known and it is not known how well IPA is recognized in ICU-settings. The diagnosis of IPA is often difficult to make and non-invasive ways to diagnose IPA reliably are needed. <b>Objectives:</b> In this study we studied the clinical significance of <i>Aspergillus</i>-positive respiratory samples in ICU-patients. <b>Methods:</b> We retrospectively evaluated the ICU-patients (N = 205) who provided <i>Aspergillus</i>-positive respiratory samples in 2007-2020 and classified patients to groups of \"colonization\", \"putative IPA\", \"proven IPA \", as in AspICU algorithm. Data were collected from laboratory registry and Helsinki University Hospital medical records. Underlying conditions, reasons leading to treatment in ICU, immunosuppression, known risk factors of IA in ICU, signs of infection, results of <i>Aspergillus</i>-specific laboratory testing, use of antifungal treatment, survival, and reason of death were assessed. <b>Results:</b> Majority of the findings (63%) were colonization, 11 (5%) patients had proven IPA, and \"putative IPA\" 59 (29%) of the patients. All patients with proven IPA died within one year, whereas mortality in putative and colonization groups was 39% and 33% respectively. Difference in mortality during one year between \"colonization\" and \"putative IPA\" groups was not statistically significant (p = .244), but when both \"proven\" and \"putative\" IPA were included, the difference was statistically significant, p = .019. Overall hospital mortality in the study group was 38%. Mortality in all the groups is higher than overall ICU-patient mortality of non-selected patients in Finland. <b>Conclusions:</b> The overall incidence of <i>Aspergillus</i>-findings in our ICUs was low. Isolation of <i>Aspergillus</i> in critically ill is associated with high mortality irrespective of invasion or colonization.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666251340043"},"PeriodicalIF":3.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144064085","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 Review of Tracheal Intubation of Obstetrical Patients, Incidence and Associated Factors.","authors":"Ryan J Keneally, Laura M Roland, Eric R Heinz, Jonathan M Wainblat, Andrew B Canonico, Marshall Lawler, Bhiken I Naik, Mohamed Tiouririne, Michael A Mazzeffi","doi":"10.1177/08850666251339467","DOIUrl":"https://doi.org/10.1177/08850666251339467","url":null,"abstract":"<p><strong>Introduction: </strong>Tracheal intubation (TI) of an obstetrical patient around the time of delivery can be an upsetting event for involved providers. It can also cause an unpredictable use of intensive care resources. Its incidence is currently poorly characterized in the literature. We analyzed the 2019 National Inpatient Sample (NIS) to assess the incidence rate and associated risk factors. <b>Methods:</b> Patients were identified by International Classification of Diseases, 10th edition codes for delivery of a child. Measured endpoints were the incidence of TI and factors associated. Categorical variables were compared using Chi squared or Fisher's Exact. Continuous variables were compared using the Student T-test or the Mann Whitney rank sum U-test. A logistic regression model was created to determine the odds for each variable contributing to TI. A P value of 0.05 was considered the minimum standard for significance. <b>Results:</b> There was a low rate of TI (0.03%). Mortality was rare (0.004%) and there was a higher rate of mortality among patients who underwent tracheal intubation (5.5% vs 0.003% among patients not intubated, <i>P</i> < .001). The majority of intubations occurred among patients who delivered via CD. Pneumonia, cardiomyopathy, eclampsia, and postpartum hemorrhage were all independently associated with increased odds for TI. <b>Conclusions:</b> There are risk factors which may increase the likelihood for tracheal intubation. The diagnosis of a cardiomyopathy was strongly associated with an increased odds for TI and may result from acute respiratory failure. PPH and eclampsia were also associated with a greater odds for intubation.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666251339467"},"PeriodicalIF":3.0,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143985976","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 Factors for Mortality in Patients with Pulmonary Embolism-A Meta-Analysis.","authors":"Wei You, Xiao-Yu Fan, Yao Chen, Xue-Lian Wang, Juan Song, Chen-Cong Nie, Qin Dong","doi":"10.1177/08850666251326539","DOIUrl":"https://doi.org/10.1177/08850666251326539","url":null,"abstract":"<p><p>BackgroundIn recent years, although there have been many domestic and international reports on risk factors for pulmonary embolism (PE), there has not yet been a comprehensive and systematic analysis of risk factors for death from PE In this study, we conducted a meta-analysis of the research literature on PE published from June 2012 to January 2024.AimThe aim of this study was to systematically and comprehensively assess the risk factors, association strength, and quality of evidence for death in patients with pulmonary embolism.MethodsThe search strategy was developed in accordance with the PICOS principles (P: Participant, ie, study subject; I: Intervention, ie, intervention; C: Comparison, ie, control group; O: ie, Outcome study endpoints; S: Study design, ie, study design), and the search strategy was developed through computerized searches of English databases (including PubMed, Web of Science, Cochrane Library,EMbase) and Chinese databases, including China Biomedical Literature Database (CBM), Wanfang Data Medical Journals Repository, Wipo Database and China Knowledge Network. The search period was from the construction of the database to January 2024.ResultsTwenty-four papers met the nadir criteria, and the total number of cases and controls were 8769 and 8,830, respectively. Meta-analysis showed that the Odds ratio (OR) for the risk of death from PE were: age >70 years (1.65, 95% confidence interval 1.62 to 1.68), hyponatremia (2.68, 2.25 to 3.19), D-dimer(1.51, 1.38 to 1.67), Troponin I (3.56, 1.83 to 6.90), Malignancy (3.67, 3.01 to 4.48), Diabetes mellitus (1.58, 1.33 to 1.88), and S protein factor activity (0.72, 0.65 to 0.81). (See Table 3).ConclusionThe results of this study showed that age over 70, hyponatremia, D-dimer, troponin I, malignancy, diabetes, and decreased protein S activity are independent risk factors for acute death in patients with pulmonary embolism. However, controlling certain risk factors alone may not reduce the mortality of PE. First, many of the risk factors for PE death are not modifiable (age, diabetes, malignancy). Secondly, the association between a risk factor and mortality is not always causal. Efforts to address a risk factor may not result in improved outcomes if there is no causal link. Therefore, these risk factors can be tracked in future randomized controlled trial studies.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666251326539"},"PeriodicalIF":3.0,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143971681","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":"Validation of Pediatric Sequential Organ Failure Assessment (pSOFA) Scores to Predict Critical Events in the Pediatric Intensive Care Unit.","authors":"Colleen M Badke, Austin Wang, Latasha A Daniels, L Nelson Sanchez-Pinto","doi":"10.1177/08850666241307630","DOIUrl":"10.1177/08850666241307630","url":null,"abstract":"<p><p>Objective: To determine the prognostic value of the Pediatric Sequential Organ Failure Assessment (pSOFA) to discriminate critical events, including code events and intubations, in the pediatric intensive care unit (PICU). Methods: We performed an observational cohort study of all critical events in a quaternary care PICU between 5/2020 and 4/2023. Critical events were extracted from our hospital communications platform and from the electronic health record (EHR). The pediatric sequential organ failure assessment (pSOFA) scores were prospectively calculated in real-time in our EHR every 15 min during the study period for data-driven situational awareness and were retrospectively analyzed for this study. Each encounter was divided into 6-h time blocks and we assessed the performance of the highest pSOFA score in each block at discriminating the occurrence of a critical event in the subsequent block. Results:There were 5687 unique patient encounters included in the analysis. Critical events were identified in 578 out of 169 486 time blocks (prevalence 0.3%), which included 103 code events and 498 intubation events, in 392 unique PICU encounters. The total pSOFA score in a 6-h time block was significantly associated with a subsequent code event (odds ratio [OR] 1.19, 95% CI 1.13-1.24) or intubation (OR 1.13, 95% CI 1.10-1.15). Several organ-specific pSOFA subscores were also significantly associated with the outcomes. Area under the receiver operating characteristic curve (AUROC) for the total pSOFA score was 0.67 for a code event and 0.65 for intubation. Using a pSOFA score cutoff of ≥8, the positive predictive value was 0.8% and the negative predictive value was 99.7% for any critical event. Conclusions: The pSOFA score is significantly associated with critical events in the PICU, however, it does not have adequate performance to be used for situational awareness by itself.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"565-570"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950173","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":"Pathogenic Burden, Antimicrobial Resistance Pattern and Clinical Outcome of Nosocomial Bloodstream Infections in Intensive Care Unit.","authors":"Deepak Kumar, Monika Chaudhary, Naresh Kumar Midha, Gopal Krishana Bohra, Durga Shankar Meena, Vibhor Tak, Hembala Rathore, Vishavjeet Rathore, Meruvu Hari Vaishnavi, Neetha Tr, Sadik Mohammed, Nikhil Kothari, Pradeep Bhatia","doi":"10.1177/08850666241305043","DOIUrl":"10.1177/08850666241305043","url":null,"abstract":"<p><p><b>Purpose:</b> Nosocomial bloodstream infections with multidrug-resistant microorganisms have become a common health threat in intensive care settings worldwide. Understanding antimicrobial resistance and the outcomes of these infections is crucial for addressing this issue. This study aimed to investigate the burden, antimicrobial resistance, and 28-day outcomes of nosocomial bloodstream infections in the intensive care unit. <b>Materials and Methods:</b> This retrospective study was conducted in a multispecialty intensive care unit at a tertiary care hospital in western India. Adult patients aged ≥18 years with bloodstream infections acquired after 48 h of admission were included in the analysis. <b>Results:</b> A total of 245 patients suspected of having nosocomial infections in the intensive care unit were evaluated, and 179 were included in the study. Gram-negative bacteremia was identified in the majority of cases, affecting 111 (62%) patients. Carbapenem-resistant <i>Acinetobacter baumannii</i> was the most prevalent pathogen, found in 21.2% (38/179) of patients. <i>Candida</i> species were detected in 37 (20.6%) cases, and gram-positive cocci were identified in 31 (17.3%) patients, with vancomycin-sensitive <i>Enterococci</i> being the most common gram-positive cocci isolated from blood. The central venous catheter was the most frequent source of bloodstream infection, identified in 66 (36.9%) patients. Among all patients, 28-day mortality was observed in 102 (57%) patients. Higher quick sepsis-related organ failure (qSOFA) scores at the onset of bloodstream infection, central venous catheters as a source of infection, inability to initiate early appropriate therapy and septic shock at the onset of bloodstream infection were identified as independent predictors of mortality in patients with nosocomial bloodstream infections. <b>Conclusion:</b> An increased burden of gram-negative bacilli and <i>Candida</i> was found to cause nosocomial bloodstream infections, with very high rates of antimicrobial resistance. Early appropriate diagnosis and treatment play a critical role in improving survival. Additionally, enhanced infection prevention and control practices are necessary to mitigate the heavy burden of infections caused by multidrug-resistant organisms in critical care settings.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"556-564"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142877174","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":"Ig-M and Ig-A Enriched Ig-G Infusion as Adjuvant Therapy in the Critically ill Patients Experiencing SARS-CoV-2 Severe Infection.","authors":"Alberto Corona, Sara Simoncini, Giuseppe Richini, Ivan Gatti, Clemente Santorsola, Andrea Patroni, Giacomina Tomasini, Alice Capone, Elena Zendra, Myriam Shuman","doi":"10.1177/08850666241301689","DOIUrl":"10.1177/08850666241301689","url":null,"abstract":"<p><p>Introduction: SARS-CoV-2 in patients who need Intensive Care (ICU) is associated with a mortality rate ranging from 10 to 40%-45%, with an increase in morbidity and mortality in presence of sepsis. Methods: We assumed that immunoglobulin (Ig) M and IgA enriched IgG (IGAM) therapy may support SARS COV-2 sepsis-related phase improving patient outcome. We conducted a retrospective case-control study on all the patients admitted to our ICU during the three pandemic waves between February 2020 and April 2021. Upon ICU admission, patients received anticoagulants with the standard supportive treatment (ST) ± IGAM therapy. After matching for the baseline characteristics and treatments, the patients receiving IGAM therapy too (group A), were compared with those undergoing ST (group B) only. Results: 85 patients were enrolled in group A, whereas 111 in group B. The mortality resulted lower in group A [37.6% versus 55.8%, OR: 0.7 (02-08), <i>P</i> = .01)]. A logistic regression analysis identified IGAM treatment as a survival predictor [OR: 0.35 (95%CI, 0.2-0.8)], whereas experiencing a super-infection [OR: 1.88 (95%CI, 1.5-4.9)] and a septic shock [OR: 1.92 (95%CI, 1.4-4.3)] as predictors of death. On day 7, the probability of dying was 3 times higher in patients treated with ST only. Variable life adjustment display (VLAD) was equal to 2.4 in group A, while - 2.2 group B (in terms of lives saved in relation with those expected, in according with Simplified Acute Physiology Score II (SAPS II) score. Conclusion: The treatment based on IGAM infusion seems to give an advantage chance of survival in SARS-CoV-2 severe infection. Further prospective studies are warranted.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"536-546"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142794924","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":"Exploring the Potential Role of the Cholinergic Anti-Inflammatory Pathway from the Perspective of Sepsis Pathophysiology.","authors":"Ziyi Zhu, Lixia Liu","doi":"10.1177/08850666251334342","DOIUrl":"10.1177/08850666251334342","url":null,"abstract":"<p><p>Sepsis is one of the most prevalent conditions in critical care medicine and is characterized by a high incidence, mortality, and poor prognosis, with no specific treatment currently available. The pathogenesis of sepsis is complex with a dysregulated inflammatory response at its core. If the initial inflammatory response is not promptly controlled, patients often develop multiple organ dysfunction syndrome or die, whereas survivors may experience post-sepsis syndrome. Regulation by the central and autonomic nervous systems is essential for maintaining inflammatory homeostasis. Among these, the cholinergic anti-inflammatory pathway (CAP) has been extensively studied in sepsis owing to its significant role in modulating inflammatory responses. Recent advancements in CAP-related interventions include minimally invasive vagus nerve stimulation, novel α7nAchR-targeting drugs, serum choline acetyltransferase and cholinesterase, acupuncture, and focused ultrasound stimulation therapy. This review primarily discusses the advantages, limitations, and therapeutic prospects of these approaches. Additionally, heart rate variability, which reflects changes in autonomic nervous system function, can serve as an indicator for assessing the functional status of the vagus nerve. In summary, modulation of inflammatory responses through the vagus nerve-mediated CAP represents a potential strategy for achieving precision medicine for sepsis. Future research should focus on conducting high-quality clinical studies on CAP-based therapies in the context of sepsis-induced inflammatory dysregulation. Incorporating indicators to evaluate the autonomic nervous system function may further elucidate the impact of inflammatory dysregulation in the body.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":"40 5","pages":"571-580"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144028545","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":"Examination of Risk Factors Affecting the Development of BSI and Mortality in Critically Ill COVID-19 Patients Hospitalized in Intensive Care Unit (ICU): A Single-Center Retrospective Study.","authors":"Çağla Keskin Sarıtaş, Halit Özsüt, Aysun Benli, Seniha Başaran","doi":"10.1177/08850666241305347","DOIUrl":"10.1177/08850666241305347","url":null,"abstract":"<p><p>Background: Various studies have shown that the incidence of BSI is greater in COVID-19 patients hospitalized in the intensive care unit (ICU). Aims: Our study aimed to determine the risk factors for BSI, mortality rates, and factors affecting mortality in adult COVID-19 patients hospitalized in the ICU. Methods: All COVID-19 patients who met the study criteria and stayed in intensive care for more than 2 days at a tertiary university hospital during the two-year pandemic period were included in the study. Logistic regression analysis was used to determine the risk factors for BSI and mortality. Results: We found that respiratory rate (RR) ≥ 30 breaths per minute at the time of admission [OR: 2.342 (95% CI: 1.12-4.897)] and antibiotic use in the month before admission ICU [OR: 3.137 (95% CI: 1.321-7.451)] were independent risk factors for BSI in COVID-19 patients. Subanalysis was also performed according to the doses of immunomodulators such as anakinra, tocilizumab, and corticosteroids, and it was found that they had no effect on the BSI (<i>P</i> > .05). The predominant causative pathogens were <i>K. pneumoniae</i>, <i>A. baumannii</i> and enterococci. The multidrug resistant rate among bacteria was 78%. Although their comorbidities and disease severity at the time of ICU admission were similar, patients with BSIs had a higher mortality rate (58.1 to 81.9%, <i>P</i> = .000). The SAPS-2 score at ICU admission [OR: 3.095 (95% CI: 1.969-4.865)] and mechanical ventilation requirement throughout the ICU admission [OR: 9.314 (95% CI: 3.878-22.37)] were found to be independent risk factors for mortality by multivariate analysis. BSI was not found to be a risk factor for mortality (> .05). Conclusions: Antibiotic use in patients with severe COVID-19 significantly increases the risk of BSI; unnecessary antibiotic use should be avoided.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"547-555"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142864604","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":"Palliative Care Outcomes for Critically ill Children After Rapid Whole Genome Sequencing.","authors":"Katherine Perofsky, Ami Doshi, Zaineb Boulil, Julia Beauchamp Walters, Euyhyun Lee, David Dimmock, Stephen Kingsmore, Nicole G Coufal","doi":"10.1177/08850666241304320","DOIUrl":"10.1177/08850666241304320","url":null,"abstract":"<p><p>Objectives: Clinical utility of rapid whole genome sequencing (rWGS) has been reported in 30-70% of pediatric ICU patients who receive a molecular diagnosis. Rapid molecular diagnostic techniques have been increasingly integrated into critical care, yet the influence of genetic test results on palliative care related decision making is largely unknown. This study evaluates palliative care related outcomes after rWGS. Design: Retrospective chart review Setting: Tertiary children's hospital Patients: Acutely ill children <math><mo>≤</mo></math> 18 years of age who received rWGS due to suspected genetic disease between July 2016 and November 2019 Interventions: rWGS with associated precision medicine Measurements and Main Results: 536 patients underwent rWGS, of whom 152 (28.4%) received a molecular diagnosis. Diagnostic rWGS was associated with more code status modifications, an increase in palliative care inpatient consultations, and greater enrollment in home-based palliative services. A comparison of diagnostic and nondiagnostic rWGS groups where palliative decisions were made prior to reporting of genomic testing results did not identify differences between the groups. In the subset of patients who had palliative care interventions (<i>n </i>= 57, 53% with diagnostic rWGS), time to palliative care consultation and time to compassionate extubation were shorter for patients with rWGS-based diagnoses (Kaplan-Meier method, <i>P </i>= .008; <i>P </i>= .015). Significantly more patients in this subgroup with diagnostic rWGS received home-based palliative care (Chi-squared, <i>P = </i>.025, 95% CI [-0.47, -0.05]). Univariate Poisson regression indicated that diagnostic rWGS is associated with significantly fewer emergency visits, PICU admissions, and unplanned intubations. Conclusions: Diagnostic rWGS correlates with more rapid engagement of pediatric palliative care services, higher enrollment rates in home-based palliative care, and shorter time to compassionate extubation. Further studies are needed with larger cohort sizes and validated pediatric palliative care outcome measurement tools to accurately determine if this change in care is driven by the underlying condition or knowledge of a molecular diagnosis.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"509-518"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142794941","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":"High-dose Intravenous N-Acetylcysteine in Mechanically Ventilated Patients with COVID-19 Pneumonia: A Propensity-Score Matched Cohort Study.","authors":"Ka Man Fong, George Wing Yiu Ng, Anne Kit Hung Leung, Kang Yiu Lai","doi":"10.1177/08850666241299391","DOIUrl":"10.1177/08850666241299391","url":null,"abstract":"<p><p>Background: Current therapies for severe COVID-19, such as steroids and immunomodulators are associated with various side effects. N-acetylcysteine (NAC) has emerged as a potential adjunctive therapy with minimal side effects for patients with cytokine storm due to COVID-19. However, evidence supporting high-dose intravenous NAC in severe COVID-19 pneumonia requiring mechanical ventilation is limited. Methods: We conducted a retrospective analysis of consecutive patients aged ≥ 18 who were admitted for acute respiratory failure (PaO2/FiO2 ratio <300) with SARS-CoV-2 infection to the Intensive Care Unit (ICU) of Queen Elizabeth Hospital from fifth July 2020 to 31^st October 2022. Inclusion was limited to patients who required mechanical ventilation. High-dose NAC refers to a dosage of 10 g per day. The primary outcome was all-cause mortality within 28 days. Propensity-score matched analysis using logistic regression was performed. Results: Among the 136 patients analyzed, 42 (40.3%) patients received NAC. The unmatched NAC patients displayed a higher day-28 mortality (12 (28.6%) versus 4 (6.5%), p = 0.005) and fewer ventilator-free days (18.5 (0-23.0) versus 22.0 (18.3-24.0), p = 0.015). No significant differences were observed in ICU and hospital length of stays among survivors. In patients who were not treated with tocilizumab, those receiving NAC exhibited a trend toward a quicker reduction in C-reactive protein compared to those who did not receive NAC.After propensity score matching which included 64 patients with 33 (51.6%) receiving NAC, no significant differences were found in 28-day mortality, ventilator-free days, or ICU and hospital length of stay. After adjusting for potential confounders, logistic regression of the propensity score-matched population did not demonstrate that the use of NAC independently affected 28-day mortality. Conclusions: In patients with COVID-19 pneumonia requiring mechanical ventilation and receiving standard COVID-19 treatment, the addition of high-dose NAC did not lead to improved clinical outcomes.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"476-485"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142687160","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}