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><p><b>Background:</b> 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":"1089-1095"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12402517/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fluid Resuscitation Dilemma in End-stage Renal Disease Patients Presenting with Sepsis: A Systematic Review and Meta-analysis.","authors":"Georges Khattar, Khalil El Gharib, Ngowari Pokima, Juliet Kotys, Vineeth Kandala, Jonathan Mina, Fadi Haddadin, Saif Abu Baker, Samer Asmar, Taqi Rizvi, Matthew Flamenbaum, Dany Elsayegh, Michel Chalhoub, Halim El Hage, Suzanne El Sayegh","doi":"10.1177/08850666241261673","DOIUrl":"10.1177/08850666241261673","url":null,"abstract":"<p><p><b>Background:</b> This study aims to investigate the safety and efficacy of guideline-directed fluid resuscitation (GDFR) compared with conservative fluid management in end-stage renal disease (ESRD) patients with sepsis by evaluating 90-day mortality and intubation rate. <b>Methods:</b> Following PRISMA guidelines, a systematic review was conducted across multiple databases using specific keywords and controlled vocabulary. The search strategy, implemented until October 1, 2023, aimed to identify studies examining fluid resuscitation in ESRD patients with sepsis. The review process was streamlined using Covidence software. A fourth reviewer resolved discrepancies in study inclusion. A random-effects model with the generic Mantel-Haenszel method was preferred for integrating odds ratios (ORs). Sensitivity analysis and publication bias analysis were performed. <b>Results:</b> Of the 1274 identified studies, 10 were selected for inclusion, examining 1184 patients, 593 of whom received GDFR. Four studies were selected to investigate the intubation rate, including 304 patients. No significant mortality or intubation rate difference was spotted between both groups [OR = 1.23; confidence interval (CI) = 0.92-1.65; <i>I</i>² = 0% and OR = 1.91; CI = 0.91-4.04]. In most studies, sensitivity analysis using the leave-one-out approach revealed higher mortality and intubation rates. The Egger test results indicated no statistically significant publication bias across the included studies. <b>Conclusion:</b> Our research contradicts the common assumption about the effectiveness of GDFR for sepsis patients with ESRD. It suggests that this approach, while not superior to the conservative strategy, may potentially be harmful.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"1013-1022"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141759262","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":"Approaches to Cholecystitis: Surgical, Endoscopic, and Percutaneous Management.","authors":"Nicole Cherng, Ikechukwu Achebe, Mason Winkie, Julie Thomann, Eric Then, Neil B Marya","doi":"10.1177/08850666241267262","DOIUrl":"10.1177/08850666241267262","url":null,"abstract":"<p><p>Acute cholecystitis (AC) is associated with significant morbidity and mortality. Minimally invasive laparoscopic cholecystectomy remains the gold standard of treatment. Therapeutic endoscopy for management of AC continues to emerge as a favorable alternative to percutaneous gallbladder drainage in patients with prohibitive operative risk. Endoscopic management of AC includes transpapillary and transmural stenting. When patient-specific factors prevent both surgical and endoscopic treatment, percutaneous cholecystostomy tube (PCT) placement is an option. Early studies show PCT to have worse outcomes when compared against all other described treatment options for the management of AC.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"1033-1041"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141878884","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 Race, Ethnicity, and Outcomes Following Pediatric Firearm Injury: A United States Population Study.","authors":"Austin L Du, Alvaro A Macias, Brittany N Burton, Rodney A Gabriel","doi":"10.1177/08850666251337399","DOIUrl":"10.1177/08850666251337399","url":null,"abstract":"<p><p>PurposeAs of 2019, firearm injury is the leading cause of death among children and adolescents. This study aims to investigate the association of race and ethnicity on the outcomes of pediatric firearm injury patients.MethodsFirearm injuries among patients ages 0-17 years in 2016 and 2019 were identified using the Kids' Inpatient Database, the largest database for the United States inpatient pediatric population representing 70-80% of all pediatric hospitalizations nationwide. Race and ethnicity were the primary independent variables, and the primary outcome was a composite variable of in-hospital morbidities, including outcomes such as postoperative infection, iatrogenic hypotension, and postoperative aspiration pneumonia. All outcomes except for length of stay were analyzed using multivariable logistic regression. Fine-Gray competing risks regression was used to analyze hospital length of stay. Subgroup analyses of patients under 15 years old, ZIP codes below median household income, urban counties, high severity injury, and each injury intent were used to identify effect modification.ResultsAmong the 6173 firearm injury patients, no association was found between race and ethnicity and composite morbidity. Compared to non-Hispanic White patients, Black patients had decreased odds of inpatient mortality overall (OR 0.53 [95% CI 0.35-0.8], p = 0.003), although this association was not found in subgroups specific to assault, self-harm, populations >250,000, or age under 15 years. Overall, non-routine disposition and length of stay were not associated with race and ethnicity.ConclusionsRace and ethnicity are not associated with morbidity following firearm injury in younger pediatric patients. Intent of injury, young age, and urban environment may act as effect modifiers for firearm mortality. Policy interventions can limit disparities in outcomes by targeting suicide and assault in specific racial and ethnic groups.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"1067-1076"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143996517","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":"Is Clinical Outcome Pathogen Related? Characteristics and Outcomes of ICU Patients with Severe Acute Respiratory Infections: Focusing on Respiratory Syncytial Virus, Human Metapneumovirus, Influenza Virus, and Parainfluenza Virus.","authors":"S van der Bie, R C Fluit, T Neijzen, S M Euser, E C M van Gorp, J Kalpoe, D Souverein, D Snijders, J Du Toit, A D M E Osterhaus, D Gommers, S F L van Lelyveld, M Goeijenbier","doi":"10.1177/08850666251375938","DOIUrl":"https://doi.org/10.1177/08850666251375938","url":null,"abstract":"<p><p>IntroductionViral severe acute respiratory infections (SARI) are a major cause of intensive care unit (ICU) admission, with a significant burden and mortality. Comparative clinical data of patients admitted to the ICU with virus infections other than SARS-CoV-2 or influenza virus (IV) infection are limited. Therefore, this study investigates patient characteristics, clinical outcomes, and ventilation parameters of ICU patients admitted with SARI caused by Respiratory syncytial virus (RSV), Human metapneumovirus (HMPV), IV, or Parainfluenza virus (PIV).MethodsA retrospective cohort study was conducted of patients with SARI admitted to the ICU of the Spaarne Gasthuis, a Dutch secondary teaching hospital, between 2017 and 2023.Results277 patients were included, with RSV (n = 51), HMPV (n = 40), IV (n = 142), and PIV (n = 44) infections respectively. Pre-existing hematological malignancies were more common in RSV patients. No significant differences were found in length of hospital stay or ventilation parameters across the respective virus groups. Median duration of ICU stay was four days (IQR 2-7). Bacterial co-infections, pulmonary infiltrates and a higher ROX-index were more common in patients with noninvasive ventilation (NIV) failure. Hospital mortality rates were not different between the groups; RSV (25.5%), HMPV (15%), IV (24.6%), and PIV (20.5%).ConclusionThis study analyzed ICU patients with SARI caused by HMPV, RSV, IV, or PIV, revealing four key findings: high ICU, hospital and 1 year mortality rates with no differences and similar mechanical ventilation parameters between the groups, risk factors for NIV failure linked to prolonged ventilation, and co-morbidities associated with severe disease.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666251375938"},"PeriodicalIF":2.1,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145199584","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":"Neurological Outcome Beyond the ICU in Patients with Severe Acute Brain Injury: A Knowledge gap for ICU Teams.","authors":"Wolmet E Haksteen, Ruben J Bax, Daan C Velseboer, Janneke Horn","doi":"10.1177/08850666251375411","DOIUrl":"https://doi.org/10.1177/08850666251375411","url":null,"abstract":"<p><p>BackgroundIn patients with severe acute brain injury (SABI) admitted to the Intensive Care Unit (ICU) outcome is often uncertain. Physicians have to decide on continuation or withdrawal of life-sustaining therapy (WLST) in the first weeks. However, long-term neurological outcomes rarely reach the ICU team, limiting the opportunity to learn from decisions. This study aimed to assess the availability of long-term neurological outcome data and from which sources this could be retrieved.MethodsThis single-center retrospective observational study included all ICU survivors with SABI between January first and December 31^st 2022. Patient characteristics and neurological outcome data were extracted from the patient records. Neurological outcome was assessed using the Glasgow Outcome Scale Extended (GOSE) within 6 months after admission.ResultsA total of 65 patients were included, the median Glasgow Coma Scale (GCS) score at admission was 6 [IQR 4-7], the most common admission diagnosis was subarachnoid hemorrhage (34%). The mean ICU stay was 8 days (SD 8) and hospital stay 38 days (SD 29). Outcome data could be retrieved from neurology or neurosurgery outpatient clinic notes in 54% of patients, in 12% from the post-ICU clinic and in 2% from other hospitals, rehabilitation facilities and nursing homes. Mortality within 6 months was 26%. A favorable GOSE score (≥ 5) was found in 18 patients (28%), an unfavorable score in 42 patients (64%), and in 5 patients (8%) no outcome could be determined.ConclusionsFunctional recovery outcomes could be extracted from the patient records in nearly all ICU survivors with SABI. However, these outcomes were mostly identified from outpatient clinic notes from the neurology and neurosurgery department and it is uncertain whether these outcomes reach ICU physicians. A clear feedback loop is needed, to ensure ICU teams can learn from long-term patient trajectories and improve future patient care.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666251375411"},"PeriodicalIF":2.1,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145054134","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":"Efficacy Analysis of Sodium Bicarbonate in the Treatment of Shock Patients: A Systematic Review and Meta-Analysis.","authors":"Aizhen Tang, A-Ling Tang, Wenjie Li, Jiulong Hu","doi":"10.1177/08850666251377036","DOIUrl":"https://doi.org/10.1177/08850666251377036","url":null,"abstract":"<p><p>BackgroundFluid resuscitation represents conventional therapy for shock; however, the optimal fluid choice remains controversial. Sodium bicarbonate administration during resuscitation has shown potential benefits in modulating acidosis and hemodynamic parameters. This study aims to evaluate the clinical effects of sodium bicarbonate compared to conventional resuscitation fluids in patients with shock. We conducted a comprehensive literature search across the PubMed, Embase, Web of Science, and China National Knowledge Infrastructure (CNKI) databases, encompassing studies published in both Chinese and English. Publication bias was assessed using funnel plots and Egger's test. Sensitivity analyses were performed to evaluate the robustness of the findings. For studies exhibiting substantial heterogeneity, meta-regression was applied to explore potential sources of variability. Subgroup analyses examined the influence of shock type, control interventions, and temporal factors. A total of 4137 articles were reviewed. Ultimately, 18 studies meeting the predefined inclusion criteria were selected for analysis, comprising data from 1411 participants. Analysis of the included studies indicated that Sodium bicarbonate administration was associated with a reduction in the duration of intensive care unit (ICU) stay (MD = -1.42 days, 95% CI: -1.87 to -0.97) and total hospitalization length (MD = -2.78 days, 95% CI: -4.33 to -1.23). Sodium bicarbonate treatment lowered lactic acid levels (MD = -0.97 mmol/L, 95% CI: -1.28 to -0.67) and decreased the incidence of complications, including multiple organ dysfunction syndrome (MODS), acute respiratory distress syndrome (ARDS), and disseminated intravascular coagulation (DIC). Furthermore, improvements were observed in coagulation parameters, Including thrombin time (TT), activated partial thromboplastin time (APTT), and prothrombin time (PT). The inflammatory response was also attenuated, as evidenced by reduced circulating levels of interleukin-6 (IL-6), interleukin-10 (IL-10), and tumor necrosis factor-alpha (TNF-α).ConclusionThis study suggests that Sodium bicarbonate may confer potential therapeutic effects in patients with shock compared to alternative interventions. Further research is required to investigate its efficacy across diverse shock etiologies and therapeutic approaches.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666251377036"},"PeriodicalIF":2.1,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145040388","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":"Evaluation of the Impact of Statin Therapy Intensity on the Risk of Delirium in Critically Ill Patients Admitted to ICUs: A Multicenter Cohort Study.","authors":"Khalid Al Sulaiman, Renad Bin Naheet, Esraa Badawi, Ghazwa B Korayem, Fatimah M Abudayah, Ali F Altebainawi, Mohamed A Albekery, Ohud H Bahari, Lulwah Al Turki, Ashjan Hadadi, Dalia A Alzomaie, Raghad M Alanazi, Nouf H Alzahrani, Tahani J Almalki, Alanod Alsurykh, Hussam Al Shahrani, Ghada Alqannam, Abdullah Alhatlani, Amal Kahlil Alissa, Maha Maoud Altuwayr, Hamzah Nazeeh Alothmany, Norah Abdulrahman Alenezi, Haya Abdullah Alazaima, Hanan Fahad Alanazi, Ohoud Aljuhani","doi":"10.1177/08850666251362784","DOIUrl":"https://doi.org/10.1177/08850666251362784","url":null,"abstract":"<p><p>BackgroundStatins have well-established pleiotropic effects by interrupting delirium pathogenesis through their anti-inflammatory, immunomodulatory, and antithrombotic properties. The literature presents conflicting findings regarding the effects of statins on critically ill patients. It remains unclear whether the pleiotropic properties of statins and their influence on delirium are influenced by their lipophilicity, agent-specific, or statin intensity. This study aims to evaluate the impact of statin intensity on the risk of delirium in critically ill patients.MethodThis is a multicenter, retrospective cohort study that included adult patients aged 18 years and older who received statin therapy and were admitted to the intensive care units (ICUs). Patients were categorized into high-intensity versus low-moderate intensity groups. The primary endpoint was the occurrence of delirium. The secondary endpoints were delirium recurrence during the same ICU admission, delirium-free days (DFDs) within 60 days, mortality, hospital and ICU length of stay. A propensity score (PS) matching procedure (SAS, Cary, NC) was used at a 1:1 ratio. Multivariable logistic regression was used to determine the adjusted p-value and odds ratio for outcomes.ResultsAfter PS matching, a total of 1054 patients were included, 527 patients in each statin group. The odds of delirium and delirium recurrence were not significantly different between the two groups (OR: 1.10, 95% CI: 0.77, 1.57, P = 0.59 and OR: 0.92, 95% CI: 0.44,1.94, P = 0.84, respectively). Moreover, there was no statistically significant difference between the two groups in terms of delirium-free days (DFDs), mortality, and ICU length of stay. In contrast, patients who received the high-intensity statin had a significantly shorter duration of hospital length of stay than the low-intermediate group (beta coefficient: -0.12, 95% CI: (-0.23, -0.01), P = 0.04).ConclusionThe use of high-intensity statins in critically ill patients admitted to ICUs was not associated with a lower risk of delirium compared to low-moderate intensity statins. Further studies are required to confirm and explore various hypotheses and deepen the understanding of this correlation.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666251362784"},"PeriodicalIF":2.1,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145040404","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 Ventilatory Ratio with Acute Cor Pulmonale and Mortality in COVID-19 ARDS: A Cohort Study.","authors":"Martín H Benites, Romina Battiato, Pablo Mercado, Ronald Pairumani, Juan Nicolás Medel, Edward Petruska, Diego Ugalde, Felipe Morales, Daniela Eisen, Carla Araya, Jorge Montoya, Jaime Retamal, Eduardo Kattan, Roque Basoalto, Guillermo Bugedo, Emilio Daniel Valenzuela","doi":"10.1177/08850666251359548","DOIUrl":"https://doi.org/10.1177/08850666251359548","url":null,"abstract":"<p><p>PurposeAn elevated ventilatory ratio (VR) and acute cor pulmonale (ACP) are associated with mortality in ARDS patients. The primary aim of this study was to assess the association between VR and ACP in patients with COVID-19-related ARDS (C-ARDS). The secondary objectives were to analyze the association between VR and ICU mortality, describe VR temporal behavior in survivors and non-survivors, and evaluate the association between VR and pulmonary embolism.Materials and MethodsWe studied a cohort of patients with C-ARDS. The VR was calculated using a validated formula. Echocardiography was used to diagnose ACP, and CT pulmonary angiography was performed to identify PE. To evaluate the associations between VR and ACP, mortality, and PE, a generalized logistic regression model was used.ResultsOf the 140 subjects, 60 (43%) had a VR < 2, while 80 (57%) had a VR ≥ 2. Patients with a VR ≥2 had a higher risk of developing ACP than those with a VR <2 (Odds Ratio (OR), 3.77; 95% CI: 1.30 - 8.72). The ICU mortality rate was 29%. Of the 40 patients who died, 30 (75%) had a VR ≥ 2. Mortality was significantly associated with VR ≥ 2 and driving pressure ≥ 15 cm H₂O. In non-survivor patients with a VR < 2 at ICU admission, a significant increase in VR was observed over the 7-day observation period. No significant association was observed between PE and VR (p = .118).ConclusionElevated VR was associated with ACP in patients with C-ARDS. VR ≥ 2 combined with driving pressure ≥ 15 cm H₂O significantly improved the ability to identify patients at risk for ACP. Additionally, at ICU admission, elevated VR values and initially low values that increased over the first week were associated with higher ICU mortality.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666251359548"},"PeriodicalIF":2.1,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145015598","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":"Extracorporeal Membrane Oxygenation Cannulation by Intensivists: A Systematic Review and Meta-Analysis.","authors":"Ryota Sato, Natsumi Hamahata, Daisuke Hasegawa, Jonathan Paladino, Erick Itoman","doi":"10.1177/08850666251375418","DOIUrl":"https://doi.org/10.1177/08850666251375418","url":null,"abstract":"<p><p>PurposeTo summarize the currently available evidence regarding the effectiveness and safety of extracorporeal membrane oxygenation (ECMO) cannulation performed by intensivists.MethodsWe conducted a systematic search of MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials for studies of any design in which patients underwent ECMO cannulation by intensivists. The search was updated on Dec 15, 2024. Two independent authors screened titles and abstracts for general applicability, followed by full-text review to determine whether studies met the following criteria: (1) adult patients and (2) ECMO cannulation performed by intensivists. Two independent authors extracted study characteristics and outcomes of interest. The Freeman-Tukey double arcsine transformation was used to stabilize variance. A random-effects model was used to calculate the pooled complication rates.ResultsA total of 209 studies were screened, and 12 retrospective, single-center studies were included. The pooled complication rate of ECMO cannulations performed by intensivists was 2% per cannula and 5% per patient. In the subgroup of VA ECMO cannulations, the complication rate was 9% per patient, whereas for VV ECMO cannulations, it was 4% per patient.ConclusionsECMO cannulation by intensivists appears to be safe and feasible when supported by adequate training, credentialing processes, and backup support from surgeons in the event of complications such as vascular injury.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666251375418"},"PeriodicalIF":2.1,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145015575","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}