Journal of Intensive Care Medicine最新文献

{"title":"Systematic Ultrasound Screening for Lower Extremity Deep Vein Thrombosis in ICU Patients with Severe COVID-19: A Randomized Clinical Trial.","authors":"Carlos Ernesto Marrero Eligio De La Puente, David Flota Ruiz, Lluis Sánchez Besalduch, Xavier Faner Capó, Daniel Gil Sala, Clara Palmada Ibars, Ivan Bajaña Mindiolaza, Luis Silvestre Chiscano Camon, Adolfo Ruiz Sanmartin, Juan Carlos Ruiz-Rodríguez, Ricard Ferrer, Sergi Bellmunt Montoya","doi":"10.1177/08850666251313774","DOIUrl":"10.1177/08850666251313774","url":null,"abstract":"<p><p>BackgroundVenous thromboembolism (VTE), whether pulmonary embolism (PE) or deep vein thrombosis (DVT), is common in patients with COVID-19. Recommendations on systematic screening in the intensive care unit (ICU) are lacking.Research questionIs there any clinical benefit of systematic screening for DVT in critically ill patients with severe COVID-19?Study design and methodsSingle-center randomized clinical trial (RCT) of COVID-19 cases admitted to the ICU. Patients were randomized into two groups: a study group that underwent ultrasound (US) screening for DVT Mondays and Thursdays, and a control group that was treated according to the unit protocol. The primary outcome was the presence of DVT. Secondary outcomes were ICU total stay, death within 21-day follow-up and bleeding complications (minor or major). A composite outcome of poor prognosis variables was analyzed. We tested a superiority hypothesis with a confidence level of 95% and an equivalence limit of 20%.Results163 patients (84 screening group, 79 control group) were enrolled between April and July 2021. There were 90 men (55.2%) with a mean ± SD age of 49.8 ± 13.58 years. In screening group 16.7% developed DVT versus 3.8% in control group (p = .007), and 3.6% versus 5.1% developed PE, respectively (p = 0.7). Poor outcome variables were male sex, age, COVID-19 vaccination status, Fibrinogen, Urea, Creatinine and Interleukin 6 (IL6) levels; Acute Physiology and Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment (SOFA) scales. The superiority comparison, with a power of 95%, showed no statistically significant differences for a composite endpoint (p = .123). After adjusting by group, the OR for poor outcome is 1.966 (0.761-5.081) p = 0.163InterpretationAmong these patients, a strategy of systematic US screening for DVT was not associated with any significant improvements to clinical outcomes compared with usual care.Clinical Trial RegistrationClinicaltrials.org registration number: NCT05028244.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"739-748"},"PeriodicalIF":3.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006821","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 Number of Oral bacteria with Ventilator-Associated Pneumonia and Delirium in Patients in the Intensive Care Unit.","authors":"Chika Arimizu, Tomohiko Akahoshi, Teppei Jinno, Michiko Furuta, Ayako Ohashi, Shinnosuke Takamori, Naohisa Wada","doi":"10.1177/08850666251320924","DOIUrl":"10.1177/08850666251320924","url":null,"abstract":"<p><p>ObjectivesVentilator-associated pneumonia (VAP) and delirium are major complications among patients in the intensive care unit (ICU). The impact of oral bacterial count on these conditions is not well understood. This study aimed to explore the association between oral bacterial load and the incidence of VAP and delirium in ICU patients.MethodsIn this single-center longitudinal study, 130 patients admitted to the ICU from September 2022 to May 2023 were included. Oral bacteria counts on the tongue were quantified, and assessments of oral health using the Oral Health Assessment Tool (OHAT) and oral moisture levels were also conducted. We examined the associations between oral bacterial count, OHAT scores, and oral moisture with the incidence of VAP and delirium.ResultsThe incidence rates of VAP and delirium were 31.4% and 35.4%, respectively. Patients with a high oral bacterial load (≥5.0 × 10⁷ CFU/mL) at ICU admission had a higher likelihood of developing VAP (odds ratio [OR] 7.43, 95% confidence interval [CI] 1.68-32.87) and delirium (OR 3.30, 95% CI 1.04-10.44) compared with those with lower bacterial counts (<1.0 × 10⁷ CFU/mL). No significant associations were found between OHAT scores and oral moisture and the occurrence of VAP or delirium.ConclusionA higher oral bacterial count at ICU admission was associated with increased incidences of VAP and delirium.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"779-788"},"PeriodicalIF":3.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143523265","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":"When Our Best Friend Becomes Our Worst Enemy: The Mitochondrion in Trauma, Surgery, and Critical Illness.","authors":"May-Kristin Torp, Kåre-Olav Stensløkken, Jarle Vaage","doi":"10.1177/08850666241237715","DOIUrl":"10.1177/08850666241237715","url":null,"abstract":"<p><p>Common for major surgery, multitrauma, sepsis, and critical illness, is a whole-body inflammation. Tissue injury is able to trigger a generalized inflammatory reaction. Cell death causes release of endogenous structures termed damage associated molecular patterns (DAMPs) that initiate a sterile inflammation. Mitochondria are evolutionary endosymbionts originating from bacteria, containing molecular patterns similar to bacteria. These molecular patterns are termed mitochondrial DAMPs (mDAMPs). Mitochondrial debris released into the extracellular space or into the circulation is immunogenic and damaging secondary to activation of the innate immune system. In the circulation, released mDAMPS are either free or exist in extracellular vesicles, being able to act on every organ and cell in the body. However, the role of mDAMPs in trauma and critical care is not fully clarified. There is a complete lack of knowledge how they may be counteracted in patients. Among mDAMPs are mitochondrial DNA, cardiolipin, <i>N</i>-formyl peptides, cytochrome C, adenosine triphosphate, reactive oxygen species, succinate, and mitochondrial transcription factor A. In this overview, we present the different mDAMPs, their function, release, targets, and inflammatory potential. In light of present knowledge, the role of mDAMPs in the pathophysiology of major surgery and trauma as well as sepsis, and critical care is discussed.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"695-714"},"PeriodicalIF":3.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140174983","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":"Relationship Between the Prognostic Nutritional index and Short-Term Prognosis among Patients with Community-Acquired Bacterial Pneumonia: A Retrospective Analysis of the MIMIC-IV.","authors":"Qingsong Wu, Lianyi Liao, Qingjun Deng","doi":"10.1177/08850666251315718","DOIUrl":"10.1177/08850666251315718","url":null,"abstract":"<p><p>ObjectivesThe objective of this study was to investigate the association between the prognostic nutritional index (PNI) and the short-term outcomes in patients with community-acquired bacterial pneumonia (CABP).DesignThis study employed a retrospective design, utilizing data from the Medical Information Mart for Intensive Care (MIMIC)-IV database.Participants371 individuals from the MIMIC-IV database who were diagnosed with CABP.Primary and secondary outcomesThe primary endpoint was 28-day all-cause mortality. The secondary endpoint was the length of stay (LOS) in the intensive care unit (ICU) and in hospital.ResultsThe area under the curve of PNI for predicting 28-day all-cause mortality is 0.702 (95% CI 0.630 to 0.775; <i>p</i> < 0.001). Patients were divided into two groups based on their PNI at admission: the low PNI (<35.75) group and the high PNI group (≥35.75). CABP patients with higher PNI presented a lower 28-day all-cause mortality rate (adjusted HR: 0.53, 95% CI 0.28-0.98, <i>p</i> = 0.044). Moreover, a negative linear correlation was found between the PNI and short-term mortality rates via restricted cubic splines. Eventually, there was no difference in the LOS in the ICU or hospital between the two groups.ConclusionThese findings suggest a negative correlation between the PNI at admission and the short-term mortality rate of CABP. PNI is helpful for early identification of high-risk patients.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"769-778"},"PeriodicalIF":3.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189268","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":"Impact of Sepsis Onset Timing on All-Cause Mortality in Acute Pancreatitis: A Multicenter Retrospective Cohort Study.","authors":"Xiaodong Huang, Siyao Liu, Zhihong Xu, Xiong Liu, Jun Hu, Mandong Pan, Chengbin Yang, Jiyan Lin, Xianwei Huang","doi":"10.1177/08850666251319289","DOIUrl":"10.1177/08850666251319289","url":null,"abstract":"<p><p>BackgroundSepsis complicates acute pancreatitis (AP), increasing mortality risk. Few studies have examined how sepsis and its onset timing affect mortality in AP. This study evaluates the association between sepsis occurrence and all-cause mortality in AP, focusing specifically on the impact of sepsis onset timing.MethodsThis multicenter retrospective cohort study included 494 ICU-admitted AP patients from the MIMIC-IV database and 91 from our center. Patients were grouped by sepsis occurrence and onset timing. Clinical outcomes were in-hospital and 90-day all-cause mortality. Machine learning identified key variables associated with mortality. Multivariable regression analyzed the impact of sepsis and its onset timing on mortality. To reduce baseline differences, propensity score matching (PSM) based on time to sepsis was conducted. After PSM, Kaplan-Meier survival analyses incorporated data from our center for validation. Restricted cubic spline analysis examined any nonlinear relationship between sepsis onset timing and mortality.ResultsPatients with sepsis had significantly higher in-hospital and 90-day mortality rates than those without sepsis (<i>p</i> < 0.05). Sepsis was identified as a significant risk factor for in-hospital mortality and remained significantly associated after adjusting for key variables (<i>p</i> < 0.05). However, sepsis onset timing did not significantly impact in-hospital or 90-day mortality. These findings were validated after PSM and with our center's data. No nonlinear relationship between sepsis onset timing and mortality was found.ConclusionSepsis significantly increases all-cause mortality in AP patients, but the timing of its onset has limited impact. Continuous monitoring and intervention for sepsis during hospitalization are recommended to improve prognosis.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"759-768"},"PeriodicalIF":3.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143449318","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":"Takotsubo Cardiomyopathy After Subarachnoid Hemorrhage: Who Is At Risk?","authors":"Alejandro Pando, Roger Cheng, Caryn J Ha, Gaurav Gupta, Arevik Abramyan, Sourav Mukherjee, Jeffrey Pradeep Raj, James K Liu, Hai Sun, Kiwon Lee","doi":"10.1177/08850666251313759","DOIUrl":"10.1177/08850666251313759","url":null,"abstract":"<p><p>IntroductionTakotsubo Cardiomyopathy (TCM) is a rare but well recognized complication of subarachnoid hemorrhage associated with increased morbidity and poor clinical outcomes. There is a scarcity of literature describing the prevalence and risk factors associated with this complication. The aim of this study was to identify patients who are at risk of developing TCM in non-traumatic subarachnoid hemorrhage.MethodsThe 2016 to 2021 National Inpatient Sample (NIS) was used to identify adult inpatients with a primary diagnosis of non-traumatic subarachnoid hemorrhage. Univariate and multivariable analyses adjusting for patient demographics, comorbidity status, and hemorrhage etiology were used to characterize statistical associations with disease-related complications. Patients with TCM were further divided into those with \"good\" or \"poor\" functional outcomes and compared.ResultsA total of 42 141 patients were identified as having a subarachnoid hemorrhage from 2016 to 2021. Of these patients 486 patients (1.2%) were found to have TCM. TCM was associated with increased length of stay (19.15 ± 17.8 days vs 11.72 ± 14.4, <i>P</i> < .001), increased total costs ($451 502.59 ± 443 777.9 vs $242 327.92 ± 338 862.3, <i>P</i> < .001), increased number of days from admission to first procedure (1.74 ± 4.5 vs 1.94 ± 5.0, <i>P</i> < .001), and increased mortality (31.7% vs 22.8%, <i>P</i> < .001). After controlling for confounding factors, independent risk factors for TCM in patients with non-traumatic subarachnoid hemorrhage included: Female (Odds Ratio [OR]: 3.11, 95% Confidence Interval [CI]: 2.50-3.89, <i>P</i> < .001), Congestive Heart Failure (OR:4.60, CI:3.70-5.71, <i>P</i> < .001), and Fluid and Electrolyte Disorders (OR: 2.52, CI: 2.05-3.11, <i>P</i> < .001). Patients with good functional outcomes were found to have younger age (54.85 years ± 14.0 vs 58.14 ± 14.7, <i>P</i> < .001), decreased length of stay (17.11 ± 16.9 vs 19.83 ± 18.1, <i>P</i> < .001), decreased total charge ($370 245.94 ± 517 702.8 vs $477 366.55 ± 417 122.4, <i>P</i> < .001), and decreased mortality (<i>P</i> < .001) compared to those with poor functional outcomes.ConclusionTCM after subarachnoid hemorrhage is associated with increased mortality, length of stay, total cost, number of procedures in patients, and number of days to first procedure. Neurosurgeons and Neurocritical care medical professionals should be aware of the comorbidities and factors associated with increased TCM after subarachnoid hemorrhage in order to improve patient outcomes.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"749-758"},"PeriodicalIF":3.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006852","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":"Seasonal Patterns of Sepsis Incidence and Mortality in the United States: A Nationwide Analysis.","authors":"Ryota Sato, Daisuke Hasegawa, Siddharth Dugar","doi":"10.1177/08850666251353423","DOIUrl":"https://doi.org/10.1177/08850666251353423","url":null,"abstract":"<p><p>PurposeThe aim of this study was to describe seasonal variation in the incidence and outcomes of sepsis in the United States.MethodsThis is a retrospective study using National Inpatient Sample database from 2017-2019. Adult sepsis patients were identified based on the CMS SEP-1 measure codes. Monthly sepsis incidence, in-hospital mortality, and organ failure patterns were analyzed. Multivariable logistic regression was used to assess in-hospital mortality by month. We also analyzed the monthly variation in each type of organ failure to uncover patterns that could account for the observed differences in sepsis incidence and outcomes.Main ResultsThere were 57,019,369 hospitalizations due to sepsis during the study period. The incidence of sepsis hospitalizations was highest in January. January also had the highest in-hospital mortality rate (10.66%), while July had the lowest (8.66%). A multivariable logistic regression analysis showed that January had a significantly higher mortality rate compared to July (odds ratio of 1.22, p < 0.001). The relationship between month and in-hospital mortality for sepsis followed a U-shaped pattern (from January to December), both in raw and adjusted analysis. Respiratory failure similarly followed the U-shaped pattern, with January having the highest incidence, and July and August the lowest. Other organ failures showed consistent patterns throughout the year. The relationship between sepsis due to pneumonia was also U-shaped, especially in the Southern region.ConclusionsThis study revealed a U-shaped relationship between both incidence and in-hospital mortality of sepsis, and month throughout the year, with a peak during winter months. Respiratory failure significantly increased in winter, while other organ failures remained constant throughout the year. These data suggest that respiratory infection and respiratory failure appear to mediate the seasonal variation observed in sepsis incidence and mortality, respectively.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666251353423"},"PeriodicalIF":3.0,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144528371","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":"Impact of Veno-Venous Extracorporeal Membrane Oxygenation on Right Ventricular Impairment in Severe ARDS: A Prospective Observational Longitudinal Study.","authors":"Alice Marguerite Conrad, Daniel Duerschmied, Christoph Boesing, Manfred Thiel, Grietje Beck, Thomas Luecke, Patricia R M Rocco, Joerg Krebs, Gregor Loosen","doi":"10.1177/08850666251352445","DOIUrl":"https://doi.org/10.1177/08850666251352445","url":null,"abstract":"<p><p>PurposeRight ventricular impairment (RVI) can be alleviated by the initiation of veno-venous extracorporeal membrane oxygenation (V-V ECMO), which enhances gas exchange and allows for less invasive mechanical ventilation. However, the progression of RVI during V-V ECMO remains unclear. This study assesses echocardiographic changes in RVI over a five-day period in twenty acute respiratory distress syndrome (ARDS) patients with V-V ECMO support.Material and MethodsOver a five-day period of V-V ECMO support, we examined echocardiographic markers of RVI, including right and left ventricular end-diastolic area ratio (RVEDA/LVEDA), tricuspid annular plane systolic excursion (TAPSE), tricuspid valve lateral anulus peak systolic velocity (<i>S</i>'), right ventricular fractional area change (FAC), and right ventricular myocardial performance index. Secondary objectives included changes in mechanical power transmitted to the respiratory system, hemodynamics and gas-exchange.ResultsRVEDA/LVEDA ratio remained elevated (0.8 [0.7-0.8] vs 0.7 [0.7-0.9]; <i>p</i> = .986), TAPSE decreased (2.0[1.6-2.5] cm vs 1.7 [1.4-2.2] cm; <i>p</i> = .024) while no changes were observed in <i>S</i>' (16 [13-21] cm/s vs 15 [12-18] cm/s; <i>p</i> = .136) and FAC (38 [27-47] % vs 36 [29-43] %; <i>p</i> = .627). The right ventricular myocardial performance index improved (0.74 [0.45-1.00] vs 0.51 [0.42-0.80]; <i>p</i> = .004). Lung mechanical power was significantly reduced due to a decrease in lung elastic and resistive components.ConclusionsDespite preserved longitudinal function and improved global performance, RVI persisted in severe ARDS patients on V-V ECMO, as indicated by the RVEDA/LVEDA ratio. These findings suggest that mechanisms beyond hypoxemia, hypercapnia and the invasiveness of mechanical ventilation contribute to RVI in these patients.Trial registrationThis trial was registered with the German Clinical Trials Register (DRKS00028584) on March 28, 2022. https://drks.de/search/en/trial/DRKS00028584.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666251352445"},"PeriodicalIF":3.0,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144528370","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":"Weight Categories Have no Impact on Mortality in Patients Treated with Extracorporeal Membrane Oxygenation (ECMO).","authors":"Meredith Marefat, Mehrtash Hashemzadeh, Mohammad Reza Movahed","doi":"10.1177/08850666251351574","DOIUrl":"https://doi.org/10.1177/08850666251351574","url":null,"abstract":"<p><p>BackgroundExtracorporeal Membrane Oxygenation (ECMO) is a critical support system for patients with acute and severe cardiac and respiratory failure. This study investigates the impact of different patient body weight categories on the mortality rates of patients undergoing ECMO support.MethodsUsing the Nationwide Sample (NIS) database and ICD-10 codes for 2016 to 2020 in adults over age 18, we evaluated total mortality based on weight categories compared to normal weights using univariate and multivariate analyses.ResultsA total population of 47 990 patients underwent ECMO insertion with a mean age of 52.6 years. Total mortality was 45.7%. Patients with cachexia, overweight, and obesity had similar mortality to normal-weight patients. (Cachexia: 43.75%, normal weight: 46.30%, <i>p</i> = .60, OR = 0.90, 95% CI: 0.61-1.33, overweight 42.31%, <i>p</i> = .69, OR = 0.85, 95% CI: 0.38-1.89, and obesity 45.73%, <i>p</i> = .73, OR = 0.98, 95% CI: 0.85-1.12). However, morbid obesity had the lowest mortality in the univariate analysis (41.89%, <i>p</i> = .01, OR = 0.84, 95% CI: 0.73-0.96) but was not significant in the multivariate analysis (<i>p</i> = .66, OR: 0.97, CI: 0.83-1.12). Separating peripheral veno-arterial versus veno-venous ECMO showed similar results with similar mortalities based on weight categories.ConclusionsOur data suggest that the 'obesity paradox' does not exist in ECMO-treated patients, with no effect of weight on total mortality . Further research is necessary to understand the underlying factors contributing to these outcomes.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666251351574"},"PeriodicalIF":3.0,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144511995","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":"Adrenal Insufficiency After Glucocorticoid Use in the Pediatric Intensive Care Unit.","authors":"Ashley N Radig, Vanessa A Curtis, Erik Westlund, Christina L Cifra","doi":"10.1177/08850666251352447","DOIUrl":"https://doi.org/10.1177/08850666251352447","url":null,"abstract":"<p><p>IntroductionGlucocorticoids are commonly used in pediatric critical illness and may lead to subsequent adrenal insufficiency, causing morbidity among pediatric intensive care unit (PICU) survivors. We aimed to determine the prevalence of and risk factors for adrenal insufficiency among children who received glucocorticoids during PICU admission.MethodsWe conducted a retrospective cohort study using structured medical record review to determine the prevalence of adrenal insufficiency and clinical characteristics of PICU patients 0-18 years old who received enteral and/or parenteral glucocorticoids. Patients were consecutively admitted to an academic tertiary referral PICU over 2 years.ResultsAmong 530 patients who received glucocorticoids, 12 (2.3%) were diagnosed with adrenal insufficiency at a median of 55 (IQR 8-156) days after initial glucocorticoid exposure. Unadjusted analyses showed that patients with adrenal insufficiency were younger (median 0.5 vs 2 years, <i>p</i> = .020), had a longer PICU stay (79 vs 4 days, <i>p</i> < .001) and hospital stay (96 vs 6 days, <i>p</i> < .001), and had a lower survival rate at 1 year after PICU discharge (75% vs 94%, <i>p</i> = .033). There were no significant differences in sex, race/ethnicity, illness severity, or diagnostic categories. Patients with adrenal insufficiency were more likely to have received glucocorticoids for hyperinflammation (21% vs 8%) and less likely for reactive airway disease (10% vs 26%) (<i>p</i> = .036), had a higher median total hydrocortisone equivalent dose (2508 vs 480 mg, <i>p</i> = .007), and were more likely to have had a steroid taper (48% vs 24%, <i>p</i> = .003). Multivariable logistic regression showed no significant associations between clinical characteristics and the diagnosis of adrenal insufficiency.ConclusionsAmong PICU patients who received glucocorticoids, 2.3% were subsequently diagnosed with adrenal insufficiency. We identified potential risk factors for adrenal insufficiency after glucocorticoid use in the PICU, which warrant future study to better delineate and mitigate adrenal insufficiency's contribution to morbidity and mortality among critically ill children.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666251352447"},"PeriodicalIF":3.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144497356","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}