Journal of Intensive Care Medicine最新文献

{"title":"Specific Therapies For ALF: Viral, Autoimmune and Wilson Disease.","authors":"Margherita Saracco, Silvia Strona, Chiara Manuli, Silvia Martini","doi":"10.1177/08850666261432156","DOIUrl":"https://doi.org/10.1177/08850666261432156","url":null,"abstract":"<p><p>The aim of this review is to provide an updated overview of targeted treatments in ALF due to autoimmune hepatitis, viral infections, and Wilson's disease, emphasizing prognostic assessment and therapeutic decision-making. A structured literature search was performed in PubMed/MEDLINE and Embase for studies published between January 2000 and December 2025 using the terms \"acute liver failure,\" \"autoimmune hepatitis,\" \"viral hepatitis,\" \"herpes simplex virus,\" \"Wilson's disease,\" and \"therapeutic plasma exchange.\" Original articles, meta-analyses, and clinical guidelines in English were selected based on relevance to treatment strategies and outcomes. Acute severe autoimmune hepatitis carries high mortality. Corticosteroids remain first-line therapy, with response rates of 70%-80%. Early identification of non-responders using prognostic models (eg, SURFASA score or composite indices including bilirubin, INR, encephalopathy grade, and platelets) is essential to avoid delaying LT evaluation. Optimal steroid dosing remains debated, as moderate regimens may balance efficacy and infection risk. Viral hepatitis is a major global cause of ALF. In hepatitis B-related ALF or severe reactivation, early nucleos(t)ide analogue therapy improves transplant-free survival. Hepatitis A and E rarely progress to ALF but may cause severe disease in vulnerable individuals. Non-hepatotropic viruses-including HSV, CMV, EBV, VZV, and dengue-can lead to fulminant hepatitis; prompt empirical antivirals, particularly acyclovir for suspected HSV, are critical. Wilson's disease-related ALF is rapidly fatal without LT. Early recognition and validated prognostic indices support urgent transplant referral. Therapeutic plasma exchange may provide temporary stabilization and serve as a bridge to recovery or LT, although high-quality evidence is limited. Once grade 3-4 encephalopathy develops, aetiology-specific therapies often lose effectiveness, and emergency LT-accounting for 2%-8% of annual procedures-remains the only definitive treatment.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666261432156"},"PeriodicalIF":2.1,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147690577","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 of a Chlorhexidine-Based Oral Prevention Protocol in Reducing Ventilator-Associated Pneumonia in Pediatrics: A Controlled Before-After Study.","authors":"Ivonne Portaccio, Orazio Genovese, Federico De Leonardis, Ilaria Vitali, Enzo Picconi, Tony Christian Morena, Federica Tosi, Audrey Marie Orr, Artiom Noto, Giorgia Spinazzola, Rita Murri, Giorgio Conti, Marco Piastra","doi":"10.1177/08850666261440187","DOIUrl":"https://doi.org/10.1177/08850666261440187","url":null,"abstract":"<p><p>BackgroundVentilator-associated pneumonia (VAP) remains the second most common nosocomial infection in pediatric intensive care units, yet evidence-based prevention strategies specific to children remain limited.ObjectiveTo evaluate the efficacy of a multimodal VAP prevention bundle incorporating 0.12% chlorhexidine oral care in reducing VAP incidence among mechanically ventilated pediatric patients.MethodsControlled before-after study in the Gemelli PICU (January 2016-May 2019) including 162 patients aged <18 years requiring mechanical ventilation ≥48 h: 80 historical controls (2016-2017) and 82 in the intervention group (2018-2019). The bundle comprised age-stratified oral hygiene (0.12% chlorhexidine for age >2 years, saline for younger children), head-of-bed elevation 30°-40°, biweekly microbiological surveillance, and daily weaning assessment. Primary outcome was VAP incidence using CDC/NHSN criteria.ResultsBundle implementation was associated with a 69.5% reduction in VAP incidence (20% to 6.1%, <i>P</i> = .01), decreasing from 3.3 to 1.0 VAP/100 ventilator-days. The number needed to treat was 7.2 patients. Protocol implementation reduced VAP risk (adjusted OR 0.23; 95% CI 0.07-0.81; <i>P</i> = .022). VAP-associated mortality was lower in the intervention group (0% vs 3.8% in controls). Duration of mechanical ventilation remained the strongest risk factor (OR 1.18 per day; 95% CI 1.08-1.29; <i>P</i> < .001). Pseudomonas aeruginosa was identified in 57.1% of VAP cases, with polymicrobial infections in 52.4%. All isolates remained antibiotic-susceptible.ConclusionsStructured implementation of an evidence-based VAP bundle may contribute to significant reductions in preventable VAP in pediatric intensive care. While findings are promising, the modest sample size necessitates cautious interpretation and validation through larger multicenter studies.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666261440187"},"PeriodicalIF":2.1,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147645650","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":"Characterizing Bronchoscopy in Pediatric Critical Care: A Cohort Analysis of Practice and Outcomes.","authors":"Melany Gaetani, Thitima Sirimontakan, Karthi Nallasamy, Norbert Chin, Katherine Reise, Briseida Mema","doi":"10.1177/08850666261438400","DOIUrl":"https://doi.org/10.1177/08850666261438400","url":null,"abstract":"<p><p>BackgroundFlexible bronchoscopy (FB) has become an essential diagnostic and therapeutic tool in pediatric intensive care units (PICUs). Despite increasing adoption, comprehensive data on FB's current use, clinical impact and safety in critically ill children, particularly those supported by extracorporeal membrane oxygenation (ECMO), remain limited. We aimed to describe the utilization, findings, microbiological yield and complications of FB in critically ill pediatric patients, including its diagnostic and therapeutic applications and associated physiologic effects.MethodsThis retrospective cohort study included all children aged 0-18 years who underwent FB in a quaternary PICU between January 2019 and December 2024. Data were abstracted from the electronic medical record and analyzed descriptively. Physiologic variables before and after bronchoscopy were compared using paired differences (Δ = post - pre).ResultsA total of 179 patients underwent 246 bronchoscopies. The median age was 61 months (IQR 17-172), and the median time from PICU admission to bronchoscopy was 4 days (IQR 1-11). All patients were mechanically ventilated, and 26% were supported with ECMO. The most frequent indications were evaluation of infection (30.3%), focal imaging abnormalities (25.0%), and surveillance bronchoscopy (15.4%). Increased airway secretions were observed in 50% of procedures. Airway plug removal (22.8%), bronchoalveolar lavage (20.7%), and Dornase alfa instillation (7.7%) were the most common interventions. Multiple findings and interventions often occurred during a single procedure. Concordance between bronchoscopic and non-bronchoscopic lavage cultures was moderate, with highest agreement for <i>Pseudomonas aeruginosa</i> (67%) and <i>Candida</i> (100%). Complications were infrequent: minor bleeding (4.9%) and transient desaturation (4.5%) were most common; no pneumothorax or mortality occurred. Physiologic parameters showed minimal change post-procedure.ConclusionsFlexible bronchoscopy is a safe and versatile diagnostic and therapeutic procedure in the PICU, including among ECMO-supported patients. The stable physiologic profile and low complication rate support its continued integration into multidisciplinary critical care practice.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666261438400"},"PeriodicalIF":2.1,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147638901","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":"Acute Kidney Injury and Outcomes in the Cardiac Intensive Care Unit: Insights from the Critical Care Cardiology Trials Network.","authors":"Narayana Sarma V Singam, Mitchell Padkins, Alexander I Papolos, Benjamin B Kenigsberg, David Berg, Jason N Katz, Sean van Diepen, Alexandra K Steverson, Scott W Rose, Jeffrey Wang, Erin A Bohula, Jeong-Gun Park, David A Morrow, Gregory W Barsness, Jacob Colin Jentzer","doi":"10.1177/08850666261440201","DOIUrl":"https://doi.org/10.1177/08850666261440201","url":null,"abstract":"<p><p>BackgroundAcute kidney injury (AKI) is associated with high morbidity and mortality in critically ill patients. Multicenter analyses describing the epidemiology of AKI in the cardiac intensive care unit (CICU) are scarce. Here, we describe the prevalence, predictors, and outcomes associated with AKI in a contemporary multicenter CICU population.MethodsThe Critical Care Cardiology Trials Network (CCCTN) is a collaboration of CICUs in North America coordinated by the TIMI Study Group (Boston, MA). We evaluated patient and hospital-level outcomes as a function of creatinine-only Kidney Disease: Improving Global Outcomes (KDIGO) AKI stage within the CCCTN registry. Logistic regression was used to assess associations with in-hospital mortality.ResultsAmong 21 603 admissions, the overall prevalence of AKI was 23.7%, which was composed of KDIGO stage 1: 12.7%, stage 2: 1.7%, and stage 3: 9.2%. A higher prevalence and severity of AKI were seen in patients with baseline kidney disease, hypertension, or diabetes and in admissions with heart failure, cardiogenic shock, and cardiac arrest (<i>P</i> < .001 for all). There was a stepwise increase in hospital mortality across AKI stages (stage 1: 23%, stage 2: 39%, stage 3: 42%; <i>P</i> < .0001). The increased risk of death associated with progressive AKI stage persisted after multivariate adjustment (adjusted OR: stage 1: 2.1, stage 2: 3.7, stage 3: 3.4).ConclusionsAKI occurs in 1 in 4 admissions to the CICU, and a higher AKI stage is incrementally associated with in-hospital mortality, highlighting a need to develop strategies to mitigate AKI and its complications.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666261440201"},"PeriodicalIF":2.1,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147638948","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":"Post-intensive Care Unit (ICU) Symptom Experiences in ICU Survivors: A Scoping Review.","authors":"Yoonsoo Eo, Rachel Hawn, Jennifer M Stevens, Kristen E Pecanac, Kristine L Kwekkeboom","doi":"10.1177/08850666261438672","DOIUrl":"https://doi.org/10.1177/08850666261438672","url":null,"abstract":"<p><p>ObjectivesA growing number of intensive care unit (ICU) survivors experience persistent physical, cognitive, or mental health symptoms or impairments post-ICU discharge, collectively known as post-intensive care syndrome (PICS). Characterizing post-ICU symptom experiences is essential for understanding PICS from a patient-centered perspective and for designing effective interventions to improve long-term health outcomes. However, there is limited collation of existing literature on this topic. This scoping review aimed to map, collate, and synthesize existing knowledge about PICS symptom experiences (types and dimensions) in adult ICU survivors, including co-occurring symptoms, symptom relationships, and symptom clusters (co-occurring and related symptoms).MethodsWe conducted a systematic search of PubMed, CINAHL, PsycINFO, and SCOPUS for studies published in English that collected data between January 2020 and December 2023. Eligible studies were conducted in the United States, included adult (≥18 years) ICU survivors, and described two or more subjective, self-reported symptoms within one year of ICU discharge.ResultsOf 1278 articles screened, 13 studies met the inclusion criteria. Mental health symptoms, such as depression and anxiety, were the most commonly reported, appearing in 11 and 9 studies, respectively. Nine studies reported symptom prevalence, eight reported symptom intensity, and none reported symptom frequency, distress, or meaning. Among 13 studies reporting co-occurring symptoms, two studies reported symptom relationships, with one suggesting potential symptom clusters.ConclusionSignificant gaps remain in the literature regarding a comprehensive, patient-centered understanding of PICS symptom experiences. Future research should address symptom frequency, distress, meaning, as well as symptom relationships and clusters, to inform effective post-discharge symptom management interventions for ICU survivors.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666261438672"},"PeriodicalIF":2.1,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147633696","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":"Comparative Analysis of the Predictive Utility of Gastric Mucosal PH and Lactate in Septic Shock.","authors":"Zhang Yining, Tang Sha, Zhai Jianhua","doi":"10.1177/08850666261434931","DOIUrl":"https://doi.org/10.1177/08850666261434931","url":null,"abstract":"&lt;p&gt;&lt;p&gt;ObjectiveTo provide novel insights for the diagnosis and management of patients with septic shock, this study analyzed the clinical characteristics of these patients and compared the predictive and combined value of blood lactate levels and gastric intramucosal pH (PHi) for in-hospital mortality.MethodsComparisons between groups were performed using independent sample &lt;i&gt;t&lt;/i&gt;-tests. Logistic regression analyses were conducted using Firth's penalized likelihood method to calculate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for gastric mucosal PH and lactate levels. A variance inflation factor (VIF) test was performed to rule out potential issues of multicollinearity. Receiver operating characteristic (ROC) curves were generated to assess predictive performance, and the area under the curve (AUC) was calculated.ResultsPatients with septic shock who were admitted to Tianjin Medical University General Hospital's Emergency Intensive Care Unit between November 2022 and March 2024 were recruited for a prospective case-control study. There were 72 patients in all. Within 24 h of admission, baseline data, blood lactate levels, PH values of the stomach mucosa, and Sequential Organ Failure Assessment (SOFA) scores were documented. Patients were divided into two groups based on their 28-day in-hospital mortality: the death group (&lt;i&gt;n&lt;/i&gt; = 18) and the survival group (&lt;i&gt;n&lt;/i&gt; = 54). Among the 72 patients, 54 (75.0%) survived and 18 (25.0%) died. Independent &lt;i&gt;t&lt;/i&gt;-test results showed a significant difference in gastric mucosal PH between the two outcome groups (&lt;i&gt;t&lt;/i&gt; = 4.558, &lt;i&gt;p&lt;/i&gt; &lt; 0.001), with lower PH levels observed in the death group. Lactate levels also differed significantly between groups (&lt;i&gt;t&lt;/i&gt; = -3.782, &lt;i&gt;p&lt;/i&gt; &lt; 0.001), being higher in the death group. In the univariate Firth logistic regression model, gastric mucosal PH (OR = 3.40, &lt;i&gt;p&lt;/i&gt; &lt; 0.0001) was significantly associated with poor prognosis, whereas lactate (OR = 1.69, &lt;i&gt;p&lt;/i&gt; &gt; 0.05) did not reach statistical significance, as its 95% CI included 1.With ORs of 3.94 and 2.29, respectively, both variables remained significant in the bivariate model that included both, indicating a possible mutual attenuation effect and improved predictive power in comparison to univariate models. Lactate lost statistical significance (OR = 0.80, &lt;i&gt;p&lt;/i&gt; = 0.782), whereas stomach mucosal PHi remained a independent predictor of death (OR = 10.03, &lt;i&gt;p&lt;/i&gt; &lt; 0.05) after controlling for covariates in the multivariate model. These results suggest that while lactate's predictive significance may be muddled, gastric mucosal PH offers reliable and independent prognostic information. The variance inflation factor (VIF) test showed that all included variables had VIF values less than 5 (specifically, 1.15 for lactate and 1.22 for the SOFA score), indicating no severe multicollinearity in the model. ROC curve analysis further confirmed these results. The AUC for gastric mucosa","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666261434931"},"PeriodicalIF":2.1,"publicationDate":"2026-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147623343","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":"Characteristics of <i>Serratia marcescens</i> Bacteremia in Comparison to Other Gram-Negative Bacteremia in Infants in the Pediatric Cardiac Intensive Care Unit A Case-Control Study (2012-2022).","authors":"Eran Shostak, Eliana Fanous, Ofer Schiller, Yael Feinstein, Magda Zomer, Tzippy Shochat, Gilat Livni","doi":"10.1177/08850666261424210","DOIUrl":"https://doi.org/10.1177/08850666261424210","url":null,"abstract":"<p><p>Purpose<i>Serratia marcescens</i> is a well-recognized hospital-acquired pathogen frequently implicated in outbreaks in neonatal and pediatric intensive care units. We compared clinical characteristics of infants with <i>Serratia</i> bloodstream infections (BSI) to those with non-<i>Serratia</i> gram-negative BSI.MethodsA retrospective case-control study comparing infants (0-2 y/o) hospitalized at our referral pediatric cardiac intensive care unit (PCICU), who acquired gram-negative blood cultures, during 2012-2022. Patients were categorized into two groups: <i>S. marcescens</i> BSI versus non-<i>Serratia</i> gram-negative BSI. Demographic and clinical data were extracted from our medical databases.ResultsOf 112 patients meeting inclusion criteria, 40 (36%) had <i>Serratia</i> BSI and 72 (64%) non-<i>Serratia</i> gram-negative BSI. Blood stream infection with <i>Serratia</i> occurred later postoperatively (median 15 vs 7 days, <i>p</i> < .01), were associated with less pre-infection inotropic support (median VIS 0 vs 5, <i>p</i> < .01) and higher rates of multisite involvement (35% vs 18%, <i>p</i> = .04). Duration of indwelling vascular catheters at time of infection was longer in the <i>Serratia</i> group (median 10 vs 7 days, <i>p</i> = .03). No associated mortality was attributed to <i>Serratia</i> BSI, as compared to a 5.6% mortality rate in the non-<i>Serratia</i> group.Conclusions<i>Serratia</i> BSI in the PCICU tends to develop later during hospitalization, involves more multiple infection sites, and is associated with longer vascular catheters dwell durations at the time of infection. <i>Serratia</i> infections appeared sporadically throughout the year without seasonal clustering. This supports the importance of stringent infection control practices and warrants prospective studies on prevention strategies.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666261424210"},"PeriodicalIF":2.1,"publicationDate":"2026-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147616118","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":"Do ICU Admissions Following Rapid Response Events Differ by Patient Demographics?","authors":"Shahla Siddiqui, Ryan Gould, Jennifer Stevens","doi":"10.1177/08850666251415523","DOIUrl":"https://doi.org/10.1177/08850666251415523","url":null,"abstract":"<p><p>BackgroundRapid response systems (RRS) have been developed to identify and manage clinical deterioration on hospital floors. However, disparities in downstream care decisions, particularly ICU triage, remain poorly understood. This study investigated the role of demographic variables in ICU admission decisions following rapid response activation.MethodsWe conducted a retrospective analysis of 37,400 RRS activations at a tertiary academic medical center (2013-2023). Data included demographics, primary service at time of trigger trigger reasons, and code status. The RRS comprises an ICU nurse, respiratory therapist, and on-call ICU physician; however, the attending physician of record determines final disposition. Multivariable logistic regression estimated odds of ICU transfer, adjusted for age, sex, marital status, race, ethnicity, primary service, code status, and trigger reason; 95% CIs are reported.ResultsOf 13,799 patients, 1126 (8.2%) were transferred to the ICU after a trigger. Female sex was associated with 13.5% lower odds of ICU admission (OR 0.865; p < 0.05), and married status was associated with 18.6% higher odds of admission (OR 1.186; p < 0.05). Race and age were not significantly associated with ICU transfer. Interaction terms between race and activation reason were nonsignificant.ConclusionDespite similar clinical criteria for activation, female patients were less likely to be transferred to the ICU than male patients following a rapid response activation. This suggests a potential difference in acute care decision-making. Further research using a combination of prospective and mixed methods approaches would be beneficial to examine how healthcare providers make decisions and to explore strategies to reduce potential unintentional influences.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666251415523"},"PeriodicalIF":2.1,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147616076","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":"Machine Learning in the ICU: Predicting Mortality in Patients with Carbapenem-Resistant Gram-Negative Bacilli Bloodstream Infections.","authors":"Özlem Güler, Volkan Alparslan, Burak İnner, Sibel Balcı, Ahmet Düzgün, Nur Baykara, Alparslan Kuş","doi":"10.1177/08850666261423499","DOIUrl":"10.1177/08850666261423499","url":null,"abstract":"<p><p>Background and ObjectiveMultidrug and carbapenem resistant gram-negative bacilli bloodstream infections cause high mortality in intensive care units (ICUs). Predicting mortality can improve treatment and support end-of-life decisions. This study aimed to develop a machine learning model to predict mortality in ICU patients with these infections.MethodsThis retrospective cohort study was conducted at a tertiary care medical center between 2017 and 2023. Adult ICU patients with bloodstream infections caused by multidrug and carbapenem resistant Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii were included. Demographic, clinical, and laboratory data were collected. Mann-Whitney U and Chi-square tests were used to compare the groups. Multivariable analysis with binary logistic regression was used to identify mortality risk factors. Ten machine learning classifiers were evaluated using stratified 5-fold cross-validation, and model predictions were interpreted with SHapley Additive exPlanations (SHAP).Results197 patients were included, with a 15-day mortality rate of 48%. The Light Gradient Boosting Machine (LightGBM) classifier showed the best performance, with an AUROC of 0.94, AUPRC of 0.952, accuracy of 0.868, precision of 0.906, recall of 0.822, F1 score of 0.855, Matthews Correlation Coefficient (MCC) of 0.744, and Brier score of 0.131. SHAP analysis revealed coagulopathy, rapid access to antibiotics, septic shock, SOFA score, platelet count, C-reactive protein (CRP) level, and time-related parameters as the most important predictive features.ConclusionThe LightGBM model showed promising results in predicting mortality in ICU patients. This model may support early intervention and assist in complex end-of-life decisions. This study was registered at ClinicalTrials.gov(https://clinicaltrials.gov/ct2/show/NCT06167083).</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"309-319"},"PeriodicalIF":2.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13004843/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147468224","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":"Comparison of Early Versus Delayed Initiation of Vasopressin in Post-Cardiothoracic Surgery Vasoplegic Shock and the Effect on Post-Operative Atrial Fibrillation.","authors":"Kinsey Smith, Roberto Montealegre, Britton Blough, Vivek Kataria","doi":"10.1177/08850666251364773","DOIUrl":"10.1177/08850666251364773","url":null,"abstract":"<p><p>Post-operative complications of cardiothoracic surgery include vasoplegic shock and post-operative atrial fibrillation (POAF). Use of catecholamines for vasoplegic shock may enhance the risk of POAF; thus, use of non-catecholamine vasopressors is reasonable. This retrospective, single-center cohort study compared early to delayed initiation of vasopressin in vasoplegic shock and assessed the association with POAF. Patients were included if they were ≥ 18 years of age, underwent cardiothoracic surgery, and were diagnosed with vasoplegic shock requiring norepinephrine and vasopressin post-operatively. Early vasopressin use was defined as vasopressin initiated within six hours of ICU admission and delayed vasopressin use was defined as vasopressin initiated greater than six hours and up to 24 hafter ICU admission. In total, 126 patients were included. Patients were primarily male (83.3%) and Caucasian (80.1%). Most patients received coronary artery bypass grafting (77.8%). Post-operative hemodynamics were similar between groups, although patients in the early vasopressin group were more likely to receive earlier initiation of norepinephrine (17 vs 62 min, <i>P</i> < .001). Post-operative atrial fibrillation occurred in 21.8% of patients in the early vasopressin group compared to 28% of patients in the late vasopressin group during ICU admission (<i>P</i> = .508), with most patients on vasopressors at time of POAF onset (72.4%). Observations in patients who received early vasopressin were shorter duration of vasoplegic shock (39 vs 60 h, <i>P</i> < .001), shorter ICU length of stay (2.2 vs 3 days, <i>P</i> = .009) and shorter hospital length of stay (7.1 vs 9.8 days, <i>P</i> = .005). Multivariate logistic regression with variables including intraoperative vasopressin use and the POAF score did not impact the primary outcome. Early initiation of vasopressin was not significantly associated with a decreased rate of POAF in the management of vasoplegic shock after cardiothoracic surgery. Further investigation into early vasopressin use in this patient population is warranted.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"320-328"},"PeriodicalIF":2.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957495","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}