Journal of Intensive Care Medicine最新文献

{"title":"Pulse Oximetry Discrepancies and Occult Hypoxemia in ICU Patients: Predictors and Clinical Outcomes.","authors":"Saikou Saidy, Ali Iqbal, Saqib H Baig","doi":"10.1177/08850666251351594","DOIUrl":"https://doi.org/10.1177/08850666251351594","url":null,"abstract":"<p><p>BackgroundPulse oximeters sometimes fail to accurately reflect arterial oxygen saturation (SaO₂), particularly in darker-skinned patients resulting in undiagnosed hypoxemia, potentially delaying recognition and appropriate interventions.Research QuestionWe aimed to evaluate the prevalence and predictors of SpO₂-SaO₂ discrepancies, particularly occult hypoxemia, and to assess their association with clinical outcomes in ICU patients.Study Design and MethodsWe conducted a retrospective cohort analysis using the Blood-gas and Oximetry Linked Dataset (BOLD), analyzing critically ill patients from the eICU-CRD database (2014-2015). Patients with paired SpO₂-SaO₂ measurements within five minutes were included. We identified SpO₂-SaO₂ discrepancies as a difference of >2.99% and defined occult hypoxemia as an arterial partial pressure of oxygen (PaO₂) < 60 mm Hg or SaO₂ < 89% with an SpO₂ > 88%. The primary outcomes included ICU length of stay (LOS), Sequential Organ Failure Assessment (SOFA) score, and in-hospital mortality.ResultsAmong 36,280 ICU patients, 23.6% had SpO₂-SaO₂ discrepancies, and 4.7% had occult hypoxemia. Black patients were overrepresented in both groups, with an adjusted odds ratio (aOR) of 1.35 (95% CI: 1.25-1.47) for discrepancy and 1.22 (95% CI: 1.04-1.47) for occult hypoxemia. Higher BMI, lower pH, elevated creatinine, and higher Charlson Comorbidity Index scores were also significant predictors. Patients with discrepancies had worse clinical outcomes, including increased SOFA scores in the following 24 h (β = 0.31; <i>p</i> < .0001) and higher in-hospital mortality (aOR 1.15; <i>p</i> < .0001). Occult hypoxemia was associated with even worse outcomes, including a longer ICU LOS (IRR 1.12; <i>p</i> < .0001) and significantly increased mortality (aOR 1.73; <i>p</i> < .0001).InterpretationOne in four critically ill patient in our cohort experienced SpO₂-SaO₂ discrepancy which is associated with adverse clinical outcomes. Black race, obesity, and higher comorbidity burden were significant predictors of these discrepancies. Our findings emphasize the need for more rigorous clinician oversight in the use of this technology.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666251351594"},"PeriodicalIF":3.0,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144642788","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":"Aftercare of Solid Abdominal Organ Transplant Recipients.","authors":"Jawad Ahmad","doi":"10.1177/08850666251358768","DOIUrl":"https://doi.org/10.1177/08850666251358768","url":null,"abstract":"<p><p>Abdominal organ transplantation has successfully transformed the lives of patients with end stage kidney, liver, intestinal, and pancreatic disease. Patients awaiting abdominal organ transplant have complex, inter-related organ dysfunction and often have multiple comorbidities. This is further complicated after transplant by the effects of immunosuppression. The intensive care team in conjunction with the transplant team, plays an important role in the management of transplant recipients, particularly in the immediate post-operative period. The focus of this review is the management of the common issues that are seen in the intensive care unit in patients undergoing solid abdominal organ transplant.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666251358768"},"PeriodicalIF":3.0,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144637262","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":"Identifying Opportunities for Fluid Balance Optimization in Critically Ill Children.","authors":"Denise C Hasson, Ami Shah, Chloe G Braun, Ulka Kothari, Steve Drury, Heda Dapul, Julie C Fitzgerald, Celeste Dixon, Andrew Barbera, James Odum, Nina Terry, Scott L Weiss, Susan D Martin, Adam C Dziorny","doi":"10.1177/08850666251359543","DOIUrl":"https://doi.org/10.1177/08850666251359543","url":null,"abstract":"<p><p>IntroductionFluid overload (FO), a state of pathologic positive cumulative fluid balance (CFB), is common in Pediatric Intensive Care Units (PICU) and associated with morbidity and mortality. Because different PICUs may have unique needs, barriers, and limitations to accurately report fluid balance (FB) and reduce FO, understanding the drivers of positive FB is needed. We hypothesize CFB >5% and >10% is common on ICU days 1 and 2, but that reasons for high %CFB will vary across sites, as will barriers to accurate FB recording and opportunities to improve FB recording/management.MethodsConcurrent mixed methods study utilizing a retrospective observational cohort design and prospective interview and survey design performed at four tertiary pediatric ICUs. FB data were extracted from the electronic health record. A federated data collection framework allowed for rapid data aggregation. The primary outcome was %CFB on ICU days 1 and 2, defined as total intake minus total output divided by ICU admission weight. Chi-square test and Wilcoxon rank sum tests compared results across and within sites.ResultsAmongst 3,071 ICU encounters, day 2 CFB >5% varied from 39% to 54% (p = 0.03) and day 2 CFB >10% varied from 16% to 25% (p = 0.04) across sites. Urine occurrence recordings and patients receiving >100% Holliday-Segar fluids on Day 1 differed across sites (p < 0.001). Sites discussed overall FB and specific FB goals on rounds with differing frequency (42-73% and 19-39%, respectively), but they reported similar barriers to accurate FB reporting and achievable opportunities to improve FB measurements, including patients/families not saving urine/stool, patients not tracking oral intake, and lack of standardized charting of flushes.ConclusionDay 2 CFB >5% and >10% was common among pediatric ICU encounters but proportion of patients varied significantly across ICUs. Individual ICUs have different drivers of FO that must be targeted to improve FB management.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666251359543"},"PeriodicalIF":3.0,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144642786","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":"Caring for Heart and Lung Transplant Patients.","authors":"Brigitte Hollander, Antonio Rubino, Jasvir Pamar, Florian Falter","doi":"10.1177/08850666251351592","DOIUrl":"https://doi.org/10.1177/08850666251351592","url":null,"abstract":"<p><p>Heart and lung transplantation are the definitive, and often the only, therapeutic option for patients with end stage cardiac or respiratory failure. Their journey through the intensive care unit often begins before the transplant operation when the global shortage of suitable donor organs makes bridging with mechanical circulatory support necessary. Once transplanted, recipients are vulnerable to a large number of complications ranging from issues arising from the operation to secondary organ failure and infection and to primary graft failure. Clinicians managing these patients need to be able to recognize these issues early and they need to have the tools to initiate treatment in a timely manner. There is no such discipline as a cardiothoracic transplant intensivist. Managing these complex patients requires a highly skilled team of individuals from different backgrounds - intensivists, surgeons, cardiologists and chest physicians as well as nurses, physiotherapists, ECMO specialists, pharmacists, dieticians and many more. They all contribute vital knowledge and skills. In order to put these to good use, however, they need to share the willingness and ability to efficiently communicate with each other. This review aims to give the general intensivist an overview over the peri-operative care of heart and lung transplant patients while also providing general principles should these patients need treatment outside a specialist intensive care unit.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666251351592"},"PeriodicalIF":3.0,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144637263","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":"Inflammation and Neurological Outcomes in Cardiac Arrest - a Narrative Review of Serum Biomarker Investigations.","authors":"Sergio L Angulo, Thomas W Johnson, Lilly Hutchinson, Bhagyashri Bhende, Yama Akbari, Sung-Min Cho, Imad R Khan","doi":"10.1177/08850666251357536","DOIUrl":"https://doi.org/10.1177/08850666251357536","url":null,"abstract":"<p><strong>Background: </strong>Hypoxic-ischemic brain injury (HIBI) is a significant cause of disability following cardiac arrest (CA). Activation of the inflammatory cascade is central to HIBI pathophysiology and drives post-cardiac arrest syndrome (PCAS), which can induce further secondary brain injury. Although numerous studies have described this mechanism in preclinical models, translating this knowledge to therapeutic targets and neurological outcomes in humans is variable and incomplete. The impact of inflammation on the neurovascular unit, comprising neurons, astroglia, and capillary endothelium, may play a significant role in outcomes but is poorly understood in humans.</p><p><strong>Objective: </strong>This narrative review explores studies examining PCAS, inflammation, and neurological outcomes in adult CA and classifies them into interrelated pathomechanisms.</p><p><strong>Methods: </strong>We searched multiple databases using a search string constructed from core concepts, including inflammation, CA, neurovascular unit components, and neurologic outcomes. We screened abstracts published from database conception until July 2024 and excluded animal/in-vitro studies, unrelated topics, duplicates, foreign language articles, reviews/commentaries, studies without neurological outcomes, and case studies.</p><p><strong>Results: </strong>The biomarkers studied fit into three general domains: reperfusion-induced oxidative stress, local and systemic inflammatory response, and coagulopathy associated with endothelial injury. Numerous markers were associated with neurological outcomes after CA, but few demonstrated a strong association in multivariate analysis. Few clinical trials of therapies for CA have studied impacts on the inflammatory cascade or have targeted inflammatory components. Associations between inflammation reduction and neurological outcomes are variable. However, various limitations reduce the applicability of these trials.</p><p><strong>Conclusions: </strong>Inflammatory mechanisms in PCAS may hold the key to secondary brain injury and warrant larger, more systematic studies to establish therapeutic targets to improve neurological outcomes.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666251357536"},"PeriodicalIF":3.0,"publicationDate":"2025-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144626517","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":"Ludwig's Angina and a Complicated Course of <i>Streptococcus constellatus</i> Management.","authors":"Kyle Distler, Awad Hammad, Elizabeth Ryder, Shradha Pokharel","doi":"10.1177/08850666251357488","DOIUrl":"https://doi.org/10.1177/08850666251357488","url":null,"abstract":"<p><p>IntroductionLudwig's angina is a rapidly progressive and life-threatening cellulitis of the soft tissue of the floor of the mouth and neck. <i>Streptococcal</i> and <i>Staphylococcal</i> infections are the most common causes, arising from poor dentition, oral procedures, alcoholism, diabetes or vascular disease, immunocompromised states such as malignancy, or malnutrition. Treatment involves securing the airway, broad spectrum antibiotic coverage, and surgical drainage for any abscess or drainable collection of fluid.CaseA 22-year-old transgender woman with a history of pre-diabetes, hypertension, asthma, hyperlipidemia, and alcohol use disorder reported poor dentition with dysphagia, drooling, and pain in ears and throat for about 1 week. She was taking amoxicillin after being seen at an urgent care 4 days prior for cough, fever, chills, and suspected pharyngitis and tonsillitis. Her oropharynx and tonsils were erythematous with tongue protrusion, dysphonia, poor dentition, diffuse swelling and induration in the submandibular area with tenderness to palpation, and limited neck range of motion. She was placed on mechanical ventilation and broad spectrum antibiotics. She was then taken for an incision and drainage (I & D) of submental and submandibular abscesses followed by removal of 5 teeth with dental carry debridement. Subsequent chest tube insertions into the pleura and mediastinum were performed for fluid collection as well as repeated I & D procedures. We found bilateral otomastoiditis with an abscess on the right extending to the sternocleidomastoid, drained abscesses on the right mastoid, and performed a tympanostomy on the left. Infection spread to the cerebellum necessitated initiation of high dose ceftriaxone. Her condition improved after a 45-day stay and she was sent to a long-term acute care hospital.ConclusionThis Ludwig angina case illustrates the tendency of <i>S. constellatus</i> to form abscesses elsewhere. The steroid hormone treatments, elevated cortisol state of Cushing's Syndrome, and severe metabolic syndrome provided ample opportunity for this infection to persist and spread to the mediastinum, pleura, and central nervous system. Source control is critical, as well as early and frequent evaluations by Otolaryngology and Oromaxillofacial surgery to provide extraction, drainage, and additional measures if needed.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666251357488"},"PeriodicalIF":3.0,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144584148","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":"Early Rehabilitation for Patients with Septic Shock Associated with Mobilization During Their Intensive Care Unit Stay Without Worsening Mortality: A Multicenter, Prospective, Cohort Study.","authors":"Tasuku Hanajima, Yu Kawazoe, Takeshi Morimoto, Hitoshi Yamamura, Kyohei Miyamoto, Noriko Miyagawa, Yoshinori Ohta, Hideki Kanai, Tetsuya Kobayashi, Yoshiaki Tanabe, Tomonari Masuda, Yuichi Kataoka, Yasushi Asari","doi":"10.1177/08850666251355211","DOIUrl":"https://doi.org/10.1177/08850666251355211","url":null,"abstract":"<p><strong>Objectives: </strong>Early rehabilitation of critically ill patients has been reported to have benefits such as recovery of physical function at the time of discharge and increasing ventilator-free days, but there is also a risk of increasing the mortality rate. Whether early rehabilitation for patients with septic shock is associated with mobilization during their intensive care unit (ICU) stay without worsening the survival rate was investigated.</p><p><strong>Design: </strong>The Best Available Treatment for septic SHOCK (BEAT-SHOCK) registry was a multicenter, prospective, cohort study.</p><p><strong>Setting: </strong>Twenty ICUs in Japan.</p><p><strong>Patients: </strong>Patients with septic shock requiring high-dose norepinephrine (≥0.2 µg/kg/min) who were admitted to participating ICUs for more than 5 days from 2020 to 2022.</p><p><strong>Interventions: </strong>Early rehabilitation within 48 h after ICU admission for patients with septic shock.</p><p><strong>Measurements: </strong>The primary outcomes were sitting on the edge of the bed and standing within 14 days during the ICU stay, with secondary outcomes including 28-day mortality and 90-day mortality.</p><p><strong>Main results: </strong>Of 268 patients, 156 underwent early rehabilitation. The early rehabilitation and no early rehabilitation groups had similar median ages (72 vs 73 years) and Acute Physiology And Chronic Health Evaluation II scores (28 vs 26). Early rehabilitation had a significant effect on sitting on the edge of the bed within 14 days after ICU admission (adjusted hazard ratio [aHR] 1.66; 95% confidence interval [CI] 1.15-2.39). It also had a significant effect on standing within 14 days after ICU admission (aHR 2.20; 95%CI 1.29-3.77). The 90-day mortality rate was similar between the groups (early rehabilitation group: 28%, no early rehabilitation group: 23%, <i>P</i>=0.51), with an aHR of 1.27 (95%CI 0.78-2.08).</p><p><strong>Conclusion: </strong>Early rehabilitation for patients with septic shock was associated with mobilization during their ICU stay without worsening the survival rate.<b>[</b>Trial registration: UMIN clinical trial registry, UMIN000038302. Registered November 1, 2019, https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000043641<b>]</b>.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666251355211"},"PeriodicalIF":3.0,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144560396","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":"Effectiveness of Corticosteroids on Persistent Inflammation, Immunosuppression, and Catabolism Syndrome in Patients with Septic Shock: A Retrospective Claims Database Study.","authors":"Hayabusa Takano, Naoki Kanda, Hiroyuki Ohbe, Minoru Yoshida, Kensuke Nakamura","doi":"10.1177/08850666251353723","DOIUrl":"https://doi.org/10.1177/08850666251353723","url":null,"abstract":"<p><p>BackgroundPersistent inflammation, immunosuppression, and catabolism syndrome (PICS) that develops following critical illness is one of the most challenging issues in critical care medicine. While corticosteroids are widely used in septic shock, their impact on PICS remains unclear. While corticosteroids may reduce inflammation, they potentially increase infection risk and affect muscle function.MethodsThis retrospective cohort study analyzed 3186 patients with septic shock from a Japanese administrative claims database, which was supplied by Medical Data Vision Co., Ltd (Tokyo, Japan). Using propensity score matching, we compared outcomes between patients who received corticosteroids within the first two days of admission (steroid group) and those who did not (control group). The primary outcome was the incidence of PICS on day 28, defined as meeting at least two of the following criteria: C-reactive protein >2.0 mg/dL, albumin <3.0 g/dL, and lymphocyte count <800/μL.ResultsA total of 4054 patients were enrolled in this retrospective cohort study. After the exclusion of 868 patients, 3186 eligible patients (906 in the steroid group and 2280 in the control group) were included in the propensity score analysis. After matching, there was no significant difference in the incidence of PICS on day 28 between the steroid and control groups (16.7% vs 13.6%; risk difference, 2.22%; 95% CI, -1.89% to 6.34%; P = 0.095). Additionally, no significant differences were observed in 28-day mortality (15.2% vs 15.2%), in-hospital mortality, PICS on day 14, the Barthel Index at discharge or the percentage of patients meeting PICS criteria for each component on day 14 and day 28.ConclusionsThe administration of corticosteroids in patients with septic shock was not associated with the incidence of PICS.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666251353723"},"PeriodicalIF":3.0,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144553759","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 Case Series Study of Airway Pressure Release Ventilation in Patients with Intracranial Pathologies and Acute Respiratory Failure.","authors":"Leon Schmidt, Keith Lamb, Dragan Jankovic, Darius Kalasauskas, Michael Kosterhon, Florian Ringel, Thomas Kerz","doi":"10.1177/08850666251320550","DOIUrl":"10.1177/08850666251320550","url":null,"abstract":"<p><p><b>Background:</b> Airway Pressure Release Ventilation (APRV) is an alternate mode of ventilation in acute respiratory failure (ARF), but there is inconsistent data to support its use over other modes of ventilation. Because of increased intrathoracic pressure for most of the respiratory cycle, a negative impact of APRV on intracranial pressure (ICP) and cerebral perfusion pressure (CPP) has been hypothesized. We evaluated the effects of APRV ventilation, with particular attention to ICP, CPP and ICP-directed therapy, in a real-world cohort of neuro-ICU patients. <b>Methods:</b> Retrospective single-center analysis from January 2021 to December 2023 of neurosurgical ICU patients with ICP monitoring. APRV was used as a rescue mode at the physician's discretion when the Horovitz index (PaO₂/FIO₂ ratio) fell below 150 despite optimized conventional ventilation. <b>Results:</b> Between 2021 and 2023, APRV was utilized in 29 patients undergoing a total of 60 episodes. Forty patients (66.7%) were female, median age was 49.5 (Q1 34; Q3 61.25) years.After transition to APRV, mean FiO2 decreased by 4.3% (t = 3.5, p < .001) and mean PaO2 increased by 22.7 mm Hg (t = 4.2, p < .001). The Horovitz index improved by 44.6 mm Hg (t = 4.9, p < .001). Mean compliance did not differ after transition to APRV (-1.5 ml/mbar, t = -0.9, p = .4).During the APRV episode, mean ICP was 1.2 mm Hg lower (t = 2.6, p = .01), while mean CPP was 1.6 mm Hg higher (t = -0.9, p = .4) and the intensity of ICP-directed therapy (TIL) was significantly lower (X²= 92.771, p < .001). <b>Conclusion:</b> APRV was hemodynamically tolerated in 29 out of 33 patients, and was safe with regard to ICP, CPP, and the intensity of ICP-directed therapy. Oxygenation was increased by APRV. 4 out of 33 patients would not tolerate APRV for hemodynamic reasons, APRV therefore was stopped immediately.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"789-797"},"PeriodicalIF":3.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143523111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"Unlocking Airway Predictability: The Role of Ultrasound in Assessing Cormack-Lehane Grade Through Anterior Neck Soft Tissue Thickness at the Level of Vocal Cords and Hyoid Bone\".","authors":"D G S R Krishnamoorthy, K J Devendra Prasad, K Rajesh, Y Nikhil Reddy, S R Aravind","doi":"10.1177/08850666251323257","DOIUrl":"10.1177/08850666251323257","url":null,"abstract":"<p><p><b>Introduction:</b> Endotracheal intubation in the emergency department can be challenging due to difficult airways. The Cormack-Lehane score helps assess intubation difficulty based on laryngoscopic views, with higher scores indicating poorer visibility. This study examines whether point-of-care ultrasound measurements of anterior neck soft tissue thickness at the vocal cords and hyoid bone can predict difficult intubations with Macintosh blade. <b>Methodology:</b> Prospective observational study included 100 patients over 18 years old who required rapid sequence intubation in emergency department at a tertiary care hospital in India, from March to December 2023. Patients with cervical spine pathology and pregnant women were excluded. Ultrasound measurements of anterior neck soft tissue thickness were taken at the vocal cords and hyoid bone. Direct laryngoscopy with a Macintosh blade was then performed, and the CL grade was recorded. Intubation difficulty was categorized based on CL grades 1-2 (easy) and 3-4 (difficult). Diagnostic performance metrics, including sensitivity, specificity, and Area under the Receiver Operating Characteristic Curve (AUROC), were calculated. <b>Results:</b> The study found that increased anterior neck soft tissue thickness at both the hyoid bone and vocal cords was significantly associated with higher CL grades (<i>P</i> < .001). The AUROC values were 0.961 for hyoid bone measurements and 0.970 for vocal cords measurements, indicating high diagnostic accuracy. The sensitivity and specificity of these measurements suggest they are effective predictors of difficult intubation. Notably, higher ANS measurements correlated with a higher likelihood of requiring multiple intubation attempts. <b>Conclusion:</b> This study supports the use of ultrasound-measured anterior neck soft tissue thickness at the hyoid bone and vocal cords as effective predictors of difficult intubation. The high accuracy and statistical significance of these measurements suggest they can improve pre-intubation assessments and guide clinical decisions. Using these ultrasound measurements in routine practice could help better predict intubation challenges and improve patient outcome.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"798-806"},"PeriodicalIF":3.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700474","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}