Journal of Intensive Care Medicine最新文献

{"title":"Integrated or Parallel Configurations for Renal Replacement Therapy in Patients on VenoArterial Extracorporeal Membrane Oxygenation, a Single Center Retrospective Study.","authors":"Floriane L'Her, Adel Maamar, Benoit Painvin, Yoann Launey, Alexandre Mansour, Nicolas Nesseler, Erwan Flecher, Jean-Marc Tadié, Mathieu Lesouhaitier","doi":"10.1177/08850666261443238","DOIUrl":"https://doi.org/10.1177/08850666261443238","url":null,"abstract":"<p><p>BackgroundAcute kidney injury (AKI) is frequent in patients supported with venoarterial extracorporeal membrane oxygenation (VA-ECMO), largely due to the severity of cardiogenic shock and multiorgan failure. Renal replacement therapy (RRT) can be delivered either via an indwelling catheter (parallel system, PS) or through direct connection to the ECMO circuit (integrated system, IS). Their respective safety profiles, particularly regarding infectious, hemorrhagic, and circuit-related complications, remain insufficiently characterized.MethodsWe conducted a single-center retrospective analysis of prospectively collected data from consecutive adults who received RRT for ≥24 h while on VA-ECMO between 2006 and 2019. Complications occurring during the concomitant ECMO-RRT period were compared between IS and PS configurations.ResultsEighty patients (84 procedures: 42 IS, 42 PS) were included. Infectious complications occurred in 31% of IS procedures and 45.2% of PS procedures, with earlier onset in the PS group (3 vs 5 days; p = 0.048). However, in multivariable analysis, IS was not independently associated with reduced infection risk (OR 0.67 [0.27-1.70]; p = 0.421). Hemorrhagic events (54.8% IS vs 59.5% PS) and circuit dysfunctions, including filter clotting, were comparable between groups.ConclusionIn VA-ECMO patients requiring RRT, integrated and parallel configurations demonstrate similar safety profiles with no significant differences in infectious, hemorrhagic, or circuit-related complications. These findings support selecting the RRT configuration based primarily on local expertise and technical feasibility rather than expected differences in complication risk.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666261443238"},"PeriodicalIF":2.1,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147773079","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 in Sepsis-Associated Respiratory Disease Mortality in the United States, 1999 to 2023.","authors":"Qais Bin Abdul Ghaffar, Khawaja Omar, Zoha Khan, Talha Adil, Mujtaba Azhar Siddiqui, Arbab Burhanuddin Kasi, Imran Khawaja","doi":"10.1177/08850666261443312","DOIUrl":"https://doi.org/10.1177/08850666261443312","url":null,"abstract":"<p><p>BackgroundSepsis-associated respiratory disease, often linked to conditions like pneumonia and acute respiratory distress syndrome (ARDS), is a major contributor to mortality in the United States. Despite its significant impact, national trends and demographic disparities in sepsis-related respiratory deaths, particularly with the influence of the COVID-19 pandemic, remain underexplored.Study Design and MethodsThis retrospective cohort study analyzed CDC WONDER mortality data (1999-2023) for adults aged ≥24 years with death records listing both respiratory disease (ICD-10: J00-J98) and sepsis (ICD-10: A02.1, A22.7, A26.7, A32.7, A40.0-A41.9, A42.7, B37.7) as causes. Age-adjusted mortality rates (AAMRs) per 100,000 were calculated using the 2000 U.S. standard population. Joinpoint regression estimated annual percent changes (APCs) and average annual percent changes (AAPCs) to identify temporal trends, stratified by sex, race/ethnicity, age, region, state, and place of death.ResultsOf 2,090,242 combined respiratory and sepsis deaths, 51.49% were male. AAMRs increased from 29.83 in 1999 to 41.12 in 2023 (AAPC=1.69%, 95% CI: 0.30-3.10; <i>P</i> = .017), with a rise from 1999-2018 (APC=1.86%), a surge from 2018-2021 (APC=11.47%), and a decline from 2021-2023 (APC=-12.82%). Males, American Indian or Alaska Native populations, middle-aged adults (45-64 years), and Western/Southern states showed the largest increases. Most deaths (88.16%) occurred in medical facilities.ConclusionSepsis-associated respiratory mortality rose over 25 years, with a pronounced COVID-19-driven surge (2018-2021) and partial post-2021 decline. Persistent disparities by sex, race, age, and region highlight the need for targeted interventions, improved screening, and equity-focused policies to address systemic vulnerabilities.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666261443312"},"PeriodicalIF":2.1,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147728975","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":"Artificial Nutrition Support in Acute Liver Failure in Intensive Care Unit: A Practical Approach.","authors":"Cristian Deana, Andrea De Gasperi, Francesco Alessandri, Giuseppe Cuttone, Vittorio Cherchi, Yaroslava Longhitano, Luigi Vetrugno","doi":"10.1177/08850666261443979","DOIUrl":"https://doi.org/10.1177/08850666261443979","url":null,"abstract":"<p><p>Acute liver failure (ALF) is a life-threatening clinical syndrome characterized by the rapid onset of severe hepatic dysfunction, coagulopathy, and hepatic encephalopathy in patients without preexisting chronic liver disease. ALF remains associated with high morbidity and mortality, largely driven by profound metabolic instability, systemic inflammation, and multiorgan dysfunction. The liver's central role in carbohydrate, protein, and lipid metabolism makes metabolic derangements an early and defining feature of ALF. Hypoglycemia, hyperlactatemia, and hyperammonemia reflect impaired hepatic bioenergetic and detoxifying capacity and directly contribute to cerebral edema, intracranial hypertension, and neurological deterioration. Simultaneously, a cytokine-mediated hypercatabolic state promotes accelerated skeletal muscle wasting and alters amino acid homeostasis, further complicating nutritional management. Lipid metabolism is also profoundly disrupted, with reduced lipoprotein synthesis, altered fatty acid profiles, and impaired innate immune functions. In parallel, intestinal barrier dysfunction and gut microbiota dysbiosis exacerbate systemic inflammation through bacterial translocation and endotoxemia, reinforcing the gut-liver axis as a key modulator of disease severity. Nutritional support therefore represents a cornerstone of intensive care management in ALF, extending beyond caloric provision to influence metabolic control, immune competence, and neurological safety. This review provides a practical, evidence-based framework for nutritional management of patients with ALF admitted to the intensive care unit. Key aspects discussed include assessment of energy expenditure, timing and route of nutritional support, macronutrient composition, and the management of micronutrient deficiencies. Particular attention is given to balancing protein delivery against the risk of hyperammonemia, optimizing glucose control to avoid neurological harm, and selecting lipid formulations that minimize proinflammatory effects. Nutritional therapy in ALF must be individualized, dynamically reassessed, and closely integrated with hemodynamic stabilization, renal replacement therapy, and neuroprotective strategies. A systematic and multidisciplinary approach to nutrition is essential to reduce metabolic and infectious complications and to improve outcomes in this critically ill population.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666261443979"},"PeriodicalIF":2.1,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147728494","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":"Practice Variation for Platelet Transfusion in Patients with Severe Refractory Thrombocytopenia: A Survey of Critical Care Practitioners.","authors":"Alina O Dulu, Sanjay Chawla, Neema Jayachamarajapura Onkaramurthy, Hao Zhang, Stephen M Pastores","doi":"10.1177/08850666261442460","DOIUrl":"https://doi.org/10.1177/08850666261442460","url":null,"abstract":"<p><p>BackgroundSevere thrombocytopenia refractory to platelet transfusion is an increasingly common issue and poses challenges for safely performing procedures in the intensive care unit (ICU).ObjectiveTo describe platelet transfusion thresholds and strategies ICU clinicians use when performing invasive procedures with general low bleeding risk in patients with severe refractory thrombocytopenia (below 5000/mm³), a scenario for which no current guideline recommendations exist.DesignCross-sectional web-based survey of ICU clinicians in adult oncologic ICUResultsOf 110 ICU clinicians 65 (59%) completed the survey (median IQR age: 36 years (31-43), 63% female). For placing a central venous catheter (CVC) majority (60%) chose a platelet transfusion threshold <20 000/mm³, while 40% chose a threshold ≥20 000/mm³. Lower thresholds were used frequently by Fellows, APPs, and clinicians with ≤5 years experience in ICU or < 50 CVC placements experience, whereas CCM attendings and more experienced clinicians favored higher thresholds (<i>P</i> = .015). Majority (74%) transfused one unit of platelets while performing the procedure under ultrasound guidance. The internal jugular vein was the preferred site (63%). Similar strategies and platelet thresholds were employed for hemodyalisis catheter (HD) placement. Desmopressin was administered by 55% before HD catheter placement. Thirty-seven percent reported patients with platelet counts below 20 000/mm³ undergoing line placement never required post-procedure transfusion for bleeding.ConclusionsThe survey shows that ICU clinicians are safely and comfortably performing procedures at platelet thresholds below 20,000, revealing a gap between guideline recommendations and real-world practice and a need for additional evidence to guide invasive procedures in this population.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666261442460"},"PeriodicalIF":2.1,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147773100","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 Bronchoscopy and Duration of Mechanical Ventilation after Out-of-Hospital Cardiac Arrest.","authors":"Andreas Kruger, Jan Naar, Marek Janotka, Katarina Koscova, Marcela Sumanova, Petr Neuzil","doi":"10.1177/08850666261442793","DOIUrl":"https://doi.org/10.1177/08850666261442793","url":null,"abstract":"<p><p>BackgroundProlonged invasive mechanical ventilation (IMV) following out-of-hospital cardiac arrest (OHCA) is associated with increased mortality, complications, and long-term functional impairment. Identification of early interventions that may reduce the duration of IMV is therefore clinically relevant.ObjectiveTo evaluate the association between the timing of bronchoscopy and the duration of IMV in patients successfully resuscitated after OHCA.MethodsWe performed a retrospective observational study of patients admitted to a cardiac intensive care unit after successful cardiopulmonary resuscitation for OHCA who required IMV for more than 24 h. Patients receiving mechanical circulatory support or those with poor neurological prognosis were excluded. The primary outcome was the total duration of IMV according to the timing of bronchoscopy. Secondary outcomes included associations between IMV duration and return of spontaneous circulation (ROSC) time, initial serum lactate levels, and the impact of bronchoscopy on antibiotic therapy.ResultsA total of 38 patients (29 men and 9 women; median age 53 years) were included. Bronchoscopy performed within 24 h of ICU admission was associated with a significantly shorter duration of IMV compared with delayed bronchoscopy (98 ± 15 vs 243 ± 49 h; p < .05). A moderate positive correlation was observed between ROSC duration and IMV duration (Pearson r = .44; p = .006). Initial serum lactate levels were not significantly correlated with IMV duration. Early bronchoscopy led to modification of antibiotic therapy in 56% of patients.ConclusionsEarly bronchoscopy after OHCA was associated with a substantial reduction in the duration of IMV. These findings suggest that early bronchoscopic evaluation may represent a readily available ICU intervention to reduce the risk of prolonged mechanical ventilation in selected post-cardiac arrest patients.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666261442793"},"PeriodicalIF":2.1,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147728618","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":"Prospective Multicenter Evaluation of a multiplex PCR Pneumonia Panel to Distinguish Infectious Pneumonia from Non-Infectious Mimics in ICU Respiratory Failure.","authors":"Lap Tin Ho, Alfred Lok Hang Lee, Chin Wing Yu, Eddie Chi Man Leung, Man Ting Yuk, Thomas Yuk Bun Lau, Ingrid Yu Ying Cheung, Viola Chi Ying Chow, Duncan Ka Hing Lam, Philip Koon Ngai Lam, Kwok Ming Ho","doi":"10.1177/08850666261442190","DOIUrl":"10.1177/08850666261442190","url":null,"abstract":"<p><p>BackgroundInfective pneumonia is a major cause of respiratory failure and ICU admission, but non-infectious mimics-such as autoimmune disease, malignancy, and organizing pneumonia-are also common. Multiplex PCR pneumonia panels may help differentiate these entities.MethodsWe conducted a prospective before-and-after study (1 Jan 2024-30 Jun 2025) evaluating the FilmArray Pneumonia plus panel (FAPN) in adults with respiratory failure admitted to two district general hospital ICUs. Consecutive patients undergoing FAPN testing (n = 116) were included. In the post-intervention cohort (n = 56), a consensus panel determined the cause of respiratory failure in patients with suspected pneumonia (PF ratio <300 mm Hg and ≥1 radiographic quadrant involvement). Agreement between FAPN and sputum culture-including the diagnostic value of a negative FAPN-was assessed.ResultsAmong post-intervention patients with suspected pneumonia (n = 45), the combined finding of \"negative FAPN and negative sputum culture\" identified non-infectious mimics with a sensitivity of 75% (95% CI 50-100%) and specificity of 91% (95% CI 81-100%). In multivariable analysis, negative FAPN results were associated with reduced antibiotic escalation (OR 0.70; <i>p</i> < .01). The positive predictive value of individual FAPN bacterial targets ranged from 0%-100% (median 35%). Culture confirmation increased with higher FAPN quantitative bins: 8% at 10⁴ CFU/mL, 7% at 10⁵ CFU/mL, 48% at 10⁶ CFU/mL, and 57% at 10⁷ CFU/mL.ConclusionsIn ICU patients with suspected pneumonia, a combined negative FAPN and sputum culture result should prompt evaluation for non-infectious mimics. Negative FAPN findings may help reduce unnecessary antibiotic escalation, although their positive predictive value for culture-confirmed bacterial infection is limited.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666261442190"},"PeriodicalIF":2.1,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147728585","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":"Ketamine Use in Critically Ill Patients: Insights into Depressive Symptoms and Hemodynamic Changes.","authors":"Vrutti Patel, Saurabh Sujanyal, Lekhya Raavi, Sophia G Blumenfeld, Faiz Saleem, Said Bateh, Abby Hanson, Anek Jena, Shahin Isha, Katie L Kunze, Patrick W Johnson, Katheleen A Rottman Pietrzak, Michelle M Ojard, Ivan A Huespe, Sadia Z Shah, Pablo Moreno Franco, Michael A Edwards, Mohit Chauhan, Devang Sanghavi, Shapiro Anna","doi":"10.1177/08850666261438474","DOIUrl":"https://doi.org/10.1177/08850666261438474","url":null,"abstract":"<p><p>BackgroundKetamine has demonstrated efficacy in treatment-resistant depression, primarily in psychiatric or outpatient populations. Its use in ICU patients remains underexplored, with limited data beyond case reports and small series. This study evaluated the association between subanesthetic ketamine infusions and improvement in depressive symptoms and hemodynamic changes in ICU patients.MethodsWe conducted a retrospective study of adults admitted to the ICU who received IV ketamine (0.3-0.75 mg/kg over 40 min on three consecutive days) for depressive symptoms. Changes in depressive symptoms were assessed using routine clinical documentation by physicians, nurses, and occupational and physical therapists. Hemodynamic parameters (blood pressure and heart rate) were recorded before and up to 120 min after infusion. The primary outcome was to evaluate depressive symptoms while the secondary outcome was to assess hemodynamic changes post transfusion.ResultsThirty-four patients met criteria, including 18 solid organ transplant recipients. Median age was 59 years; 61.8% were male. Ketamine was associated with improvement in apparent sadness (90.0% vs 52.2%, <i>P</i> < .05) and reported sadness (95.0% vs 59.1%, <i>P</i> < .05). In transplant recipients, improvement in apparent sadness remained significant (80.0% vs 41.7%, <i>P</i> < .05). Hemodynamic parameters remained stable; heart rate increased transiently at 15-30 min post-infusion, returning to baseline by 60-90 min. Adverse effects observed were anxiety (12.5%), restlessness and/or agitation (10.4%), and dissociation (8.16%).ConclusionSubanesthetic ketamine improved specific depressive symptoms in critically ill ICU patients without significant hemodynamic instability. These findings support its potential as a rapid-acting antidepressant in the ICU, warranting further prospective trials.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666261438474"},"PeriodicalIF":2.1,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147690585","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":"Dexmedetomidine Use and Reduced In-hospital Mortality in ICU Patients with Delirium: A Retrospective Study Based on Two Observational Cohorts.","authors":"Lizhi Fu, Sai Zhou, Huiping Liu, Wenming Song, Huan Chang, Gong Chen","doi":"10.1177/08850666261440805","DOIUrl":"https://doi.org/10.1177/08850666261440805","url":null,"abstract":"<p><p>ObjectiveDexmedetomidine has been reported to reduce the emergence and persistence of delirium among critically ill patients, but whether it has a survival benefit in these delirium patients remains unclear. The current study aimed to investigate the link between the use of dexmedetomidine during intensive care units (ICU) admission and mortality outcomes in critically ill individuals with delirium.Materials and MethodsData from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) and the eICU Collaborative Research Database (eICU-CRD) were used to conduct this retrospective cohort study. Adult ICU patients experiencing delirium were included. Exposure was defined as the use of dexmedetomidine during ICU stay. Covariates included demographics, clinical variables, illness severity scores, interventions in the first 24 h, and comorbidities. Associations between dexmedetomidine use and in-hospital mortality were analyzed using generalized linear models and propensity score methods.ResultsPatients receiving dexmedetomidine had significantly lower in-hospital mortality rates compared to those not treated, with 17.55% versus 32.67% in the MIMIC-IV cohort and 7.41% versus 7.81% in the eICU-CRD cohort. After adjustment, dexmedetomidine use was associated with reduced in-hospital mortality (MIMIC-IV: OR 0.40, 95% CI 0.28-0.58, <i>P</i> < 0.0001; eICU-CRD: OR 0.55, 95% CI 0.46-0.67, <i>P</i> < 0.0001). Propensity score analyses confirmed these findings. Furthermore, mortality at 90 days, 180 days, and 1 year was also significantly reduced in the dexmedetomidine group.ConclusionsDexmedetomidine administration during ICU stay correlates with a reduced mortality risk in critically ill patients suffering from delirium.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666261440805"},"PeriodicalIF":2.1,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147690574","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":"https://doi.org/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":"8850666261434483"},"PeriodicalIF":2.1,"publicationDate":"2026-04-15","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":"Tracheostomy Timing…It's Personal: Impact of Clinical Practice Variance and Patient-Specific Factors on Outcomes After Tracheostomy in a Community Hospital.","authors":"Pathik Patel, Bradley S Mankoff, Joud Fahed, Ujjawal Paudel, Mustafa Abdulmahdi, J Perren Cobb, Anthony Martinez","doi":"10.1177/08850666261438389","DOIUrl":"https://doi.org/10.1177/08850666261438389","url":null,"abstract":"<p><p>The inability to accurately predict PMV duration or determine the optimal timing of tracheostomy presents major barriers to progress in critical care. This was a single center, retrospective, observational study that included the years before, during, and after the COVID-19 pandemic. The purpose of our study was to assess the comparative effectiveness of \"early\" tracheostomy (performed within 10 days of intubation) for PMV based on 1) in-hospital mortality (including hospice transition), 2) patient-specific factors, and 3) discharge-to-home status. All 205 patients admitted to our adult mixed surgical and medical ICU who underwent bedside percutaneous tracheostomy were included from January 2018 to April 2023. During this study period, we observed a significant change in clinical practice over time, with tracheostomy rates increasing steadily from 1.8% to 5.6%. Based on the similarities of the APACHE II and SOFA scores, there were no discernable differences in the severity of illness. Early compared to late tracheostomy was associated with significantly fewer days on mechanical ventilation (p < 0.01) and ICU length of stay (p < 0.04). Time in the hospital was not different but a significantly higher percentage of patients with early tracheostomy were discharged home (p < 0.01). In a community hospital setting, the significant benefit of early tracheostomy was conditional upon certain patient characteristics. We recommend a personalized approach to tracheostomy timing based upon these patient factors.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666261438389"},"PeriodicalIF":2.1,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147690546","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}