Journal of Intensive Care Medicine最新文献

{"title":"Kinetics of Renin Concentrations in Infants Undergoing Congenital Cardiac Surgery.","authors":"Michael E Kim, Katja M Gist, Katie Brandewie, Huaiyu Zang, David Lehenbauer, David S Winlaw, David L S Morales, Jeffrey A Alten, Stuart L Goldstein, David S Cooper","doi":"10.1177/08850666241268655","DOIUrl":"10.1177/08850666241268655","url":null,"abstract":"<p><strong>Background: </strong>Elevated renin has been shown to predict poor response to standard vasoactive therapies and is associated with poor outcomes in adults. Similarly, elevated renin was associated with mortality in children with septic shock. Renin concentration profiles after pediatric cardiac surgery are unknown. The purpose of this study was to characterize renin kinetics after pediatric cardiac surgery.</p><p><strong>Methods: </strong>Single-center retrospective study of infants who underwent cardiac surgery with cardiopulmonary bypass (CPB) utilizing serum samples obtained in the perioperative period to measure plasma renin concentrations (pg/mL). Time points included pre-bypass and 1, 4, and 24 h after initiation of CPB.</p><p><strong>Results: </strong>Fifty patients (65% male) with a median age 5 months (interquartile range (IQR) 3.5, 6.5) were included. Renin concentrations peaked 4 h after CPB. There was a significant difference in preoperative and 4 h post-CPB renin concentration (4 h post-CPB vs preoperative: mean difference 100.6, 95% confidence interval (CI) 48.9-152.4, <i>P</i> < .001). Median renin concentration at 24 h after CPB was lower than the preoperative baseline.</p><p><strong>Conclusions: </strong>We describe renin kinetics in infants after CPB. Future studies based on these data can now be performed to evaluate the associations of elevated renin concentrations with adverse outcomes.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"172-177"},"PeriodicalIF":3.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11639413/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141878886","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":"Urine Output and Development of Acute Kidney Injury in Sepsis: A Multicenter Observational Study.","authors":"Ryo Yamamoto, Kazuma Yamakawa, Jo Yoshizawa, Daiki Kaito, Yutaka Umemura, Koichiro Homma, Junichi Sasaki","doi":"10.1177/08850666241268390","DOIUrl":"10.1177/08850666241268390","url":null,"abstract":"<p><strong>Background: </strong>Acute kidney injury (AKI) is common in sepsis and a urine output <0.5 mL/kg/h associated with increased mortality is incorporated into AKI diagnosis. We aimed to identify the urine-output threshold associated with increased AKI incidence and hypothesized that a higher urine output than a specified threshold, which differs from the predominantly used 0.5 mL/kg/h threshold, would be associated with an increased AKI incidence.</p><p><strong>Methods: </strong>This was a post-hoc analysis of a nationwide prospective observational study. This study included adult patients newly diagnosed with sepsis and requiring intensive care. Urine output on the day of sepsis diagnosis was categorized as low, moderate, or high (<0.5, 0.5-1.0, and >1.0 mL/kg/h, respectively), and we compared AKI incidence, renal replacement therapy (RRT) requirement, and 28-day survival by category. Estimated probabilities for these outcomes were also compared after adjusting for patient background and hourly fluid administration.</p><p><strong>Results: </strong>Among 172 eligible patients, AKI occurred in 46.3%, 48.3%, and 53.1% of those with high, moderate, and low urine output, respectively. The probability of AKI was lower in patients with high urine output than in those with low output (43.6% vs 56.5%; <i>P </i>= .028), whereas RRT requirement was lower in patients with high and moderate urine output (11.7% and 12.8% vs 49.1%; <i>P </i>< .001). Patients with low urine output demonstrated significantly lower survival (87.7% vs 82.8% and 67.8%; <i>P </i>= .018). Cubic spline curves for AKI, RRT, and survival prediction indicated different urine-output thresholds, including <1.2 to 1.3 mL/kg/h for AKI and <0.6 to 0.8 mL/kg/h for RRT and mortality risk.</p><p><strong>Conclusions: </strong>Urine output >1.0 mL/kg/h on the day of sepsis diagnosis was associated with lower AKI incidence. The urine-output threshold was higher for developing AKI than for RRT requirement or mortality.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"191-199"},"PeriodicalIF":3.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141878888","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":"Comparison of Tenecteplase Versus Alteplase for the Treatment of Pulmonary Embolism and Cardiac Arrest with Suspected Pulmonary Embolism.","authors":"Jessica M Daniell, Jack Mccormick, Iram Nasreen, Todd M Conner, Ginger Rouse, Diana Gritsenko, Akhil Khosla","doi":"10.1177/08850666241268539","DOIUrl":"10.1177/08850666241268539","url":null,"abstract":"<p><p>High-risk pulmonary embolism (PE) is a life-threatening disease state with current guidelines recommending reperfusion therapy with systemic thrombolytics in addition to anticoagulation. This was a prospective observational cohort study with a historical control group comparing tenecteplase to alteplase for the treatment of PE or cardiac arrest with suspected PE. The primary outcome was the incidence of institutional protocol deviations defined as incorrect thrombolytic dose administered or the incorrect product compounded. Secondary outcomes included any bleeding event, major bleeding event, all-cause mortality, and for patients with a cardiac arrest, successful return of spontaneous circulation (ROSC). Fifty-four patients were included in the study. Protocol deviations occurred in one patient receiving tenecteplase and one patient receiving alteplase (4.0% vs 3.4%; <i>P</i> = 1.0). There was no difference in all-cause mortality (80% vs 86.2%; <i>P</i> = .72), any bleed (12% vs 13.8%; <i>P</i> = 1.0), major bleed (8.0% vs 6.9%; <i>P</i> = 1.0), or ROSC achievement (22.2% vs 28.6%; <i>P</i> = .73) when comparing tenecteplase to alteplase. Our study demonstrates that tenecteplase may be an alternative thrombolytic to alteplase for treatment of PE or cardiac arrest with suspected PE. Further studies comparing the different systemic thrombolytic agents for PE or cardiac arrest with suspected PE are needed.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"200-206"},"PeriodicalIF":3.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141906815","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":"Evaluating the Appropriateness, Consistency, and Readability of ChatGPT in Critical Care Recommendations.","authors":"Kaan Y Balta, Arshia P Javidan, Eric Walser, Robert Arntfield, Ross Prager","doi":"10.1177/08850666241267871","DOIUrl":"10.1177/08850666241267871","url":null,"abstract":"<p><p><b>Background:</b> We assessed 2 versions of the large language model (LLM) ChatGPT-versions 3.5 and 4.0-in generating appropriate, consistent, and readable recommendations on core critical care topics. <b>Research Question:</b> How do successive large language models compare in terms of generating appropriate, consistent, and readable recommendations on core critical care topics? <b>Design and Methods:</b> A set of 50 LLM-generated responses to clinical questions were evaluated by 2 independent intensivists based on a 5-point Likert scale for appropriateness, consistency, and readability. <b>Results:</b> ChatGPT 4.0 showed significantly higher median appropriateness scores compared to ChatGPT 3.5 (4.0 vs 3.0, <i>P</i> < .001). However, there was no significant difference in consistency between the 2 versions (40% vs 28%, <i>P</i> = 0.291). Readability, assessed by the Flesch-Kincaid Grade Level, was also not significantly different between the 2 models (14.3 vs 14.4, <i>P</i> = 0.93). <b>Interpretation:</b> Both models produced \"hallucinations\"-misinformation delivered with high confidence-which highlights the risk of relying on these tools without domain expertise. Despite potential for clinical application, both models lacked consistency producing different results when asked the same question multiple times. The study underscores the need for clinicians to understand the strengths and limitations of LLMs for safe and effective implementation in critical care settings. <b>Registration:</b> https://osf.io/8chj7/.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"184-190"},"PeriodicalIF":3.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11639400/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141906786","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":"Survival of Patients with Solid Tumours and Sepsis Admitted to Intensive Care in a Tertiary Oncology Centre: A Retrospective Analysis.","authors":"Sam S Smith, Luke Edwards, Timothy Wigmore, Shaman Jhanji, David B Antcliffe, Kate C Tatham","doi":"10.1177/08850666241312621","DOIUrl":"https://doi.org/10.1177/08850666241312621","url":null,"abstract":"<p><strong>Introduction: </strong>Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. Patients with cancer are at risk of developing sepsis and requiring intensive care unit (ICU) admission. We aimed to assess survival of patients with a solid tumour admitted to ICU as an emergency with sepsis, and to identify predictors of 90-day survival at admission.</p><p><strong>Materials and methods: </strong>We conducted a retrospective cohort survival analysis. We identified adults with a solid tumour admitted to ICU with sepsis between 01/01/2011 and 31/12/2020 at a tertiary oncology centre with two hospitals (London and Surrey, UK). We defined sepsis using the Sepsis-3 definition. The primary outcome was 90-day survival. We used the parametric accelerated failure time model for multivariate analysis to generate acceleration factors (AF).</p><p><strong>Results: </strong>625 patients were identified and the 90-day survival rate was 59.5%(353/593).Multivariate analysis identified the presence of localized (AF 0.13, 95% CI 0.06-0.25) or regionalized disease (AF 0.21, 95% CI 0.12-0.36) compared to distant metastatic disease, unplanned surgery on the day of admission (AF 0.15, 95% CI 0.07-0.31), lactate (AF 1.25 95% CI 1.15-1.35), Sequential Organ Failure Assessment Score (AF 1.19, 95% CI 1.12-1.27), previous radiotherapy (AF 1.89, 95% CI 1.14-3.125), previous systemic anti-cancer treatment (excluding hormonal therapy) (AF 1.49, 95% CI 0.93-2.38), bacteraemia (AF 0.47, 95% CI 0.27-0.81) and serum albumin (AF 0.94, 95% CI 0.91-0.98) as independent predictors of 90-day survival.</p><p><strong>Conclusions: </strong>This study of solid tumour patients admitted to ICU is one of the largest providing survival data to inform clinicians and patients. This data provides information on factors that should be considered when deliberating the possible outcome of ICU admission for a patient with solid malignancy and sepsis and highlights that the presence of cancer itself should not limit ICU admission for sepsis.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666241312621"},"PeriodicalIF":3.0,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143052821","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":"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":"https://doi.org/10.1177/08850666251313774","url":null,"abstract":"<p><strong>Background: </strong>Venous 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.</p><p><strong>Research question: </strong>Is there any clinical benefit of systematic screening for DVT in critically ill patients with severe COVID-19?</p><p><strong>Study design and methods: </strong>Single-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%.</p><p><strong>Results: </strong>163 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 = 0.163.</p><p><strong>Interpretation: </strong>Among these patients, a strategy of systematic US screening for DVT was not associated with any significant improvements to clinical outcomes compared with usual care.</p><p><strong>Clinical trial registration: </strong>Clinicaltrials.org registration number: NCT05028244.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666251313774"},"PeriodicalIF":3.0,"publicationDate":"2025-01-22","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":"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":"https://doi.org/10.1177/08850666251313759","url":null,"abstract":"<p><strong>Introduction: </strong>Takotsubo 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.</p><p><strong>Methods: </strong>The 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.</p><p><strong>Results: </strong>A 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.</p><p><strong>Conclusion: </strong>TCM 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":"8850666251313759"},"PeriodicalIF":3.0,"publicationDate":"2025-01-19","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":"Cardiac Critical Care of the Cardio-Obstetric Patient.","authors":"Amrin Kharawala, Sanjana Nagraj, Gayatri Setia, Deborah Reynolds, Rosy Thachil","doi":"10.1177/08850666241308207","DOIUrl":"https://doi.org/10.1177/08850666241308207","url":null,"abstract":"<p><p>Cardiovascular disease (CVD) is the leading cause of pregnancy-related mortality in the United States, with an incidence that has increased from 7.2 to 32.9 fatalities per 100,000 live births in the last 3 decades. This trend underscores the potential for an increase in the volume of admissions to cardiac intensive care units (CICUs) in the peripartum period. While congestive heart failure remains at the forefront of maternal morbidity, other life-threatening conditions include myocardial infarction (MI), hypertensive emergencies, fatal arrhythmias such as ventricular fibrillation, venous thromboembolism, aortopathies, valvular dysfunction, cardiac arrest, and cardiogenic shock. The lack of standardized guidelines to facilitate management of these conditions highlights the significant gap in medical knowledge while caring for acutely ill pregnant women. Through this comprehensive review, we highlight the most common cardiac pathologies encountered in the obstetric population and their diagnosis and contemporary management in the cardiac intensive care unit.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666241308207"},"PeriodicalIF":3.0,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006811","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":"Factors Associated with the Initiation of Renal Replacement Therapy in Patients on VV-ECMO: A Case-Control Study.","authors":"Robayo-Amortegui Henry, Quecano-Rosas Cesar, Perez-Garzon Michel, Muñoz-Claros Conny, Poveda-Henao Claudia","doi":"10.1177/08850666241309852","DOIUrl":"https://doi.org/10.1177/08850666241309852","url":null,"abstract":"<p><p><b></b> Acute Kidney Injury (AKI) is a common complication in patients with Acute Respiratory Distress Syndrome (ARDS) receiving VV-ECMO support, carrying a high risk of progression to Renal Replacement Therapy (RRT). Both AKI and RRT are linked to an increased risk of mortality. This study aims to evaluate the risk factors associated with the need for RRT in patients undergoing VV-ECMO. <b>Methods:</b> This is a retrospective case-control study involving patients on VV-ECMO therapy admitted to the intensive care unit (ICU) between 2019 and 2023. Patients on VV ECMO support, with or without RRT, were included and their severity scores and associated mortality were calculated. A multivariate logistic regression analysis was performed to assess the variable RRT using odds ratios (OR) with their corresponding confidence intervals (CI) for the outcome variables. <b>Results:</b> A total of 192 subjects were included, with a mortality rate of 39.6%. Of these, 68.7% were male, with an average ICU stay of 25.1 days and a need for RRT in 19.7% of cases. The multivariate analysis independently associated the use of vasopressors with RRT norepinephrine OR 5.61 (95% CI, 1.64-19.1) and vasopressin OR 4.64 (95% CI, 2.15-10.0)). An increase in creatinine levels before ECMO support is associated with an increased risk OR 2.21 (95% CI 1.54-3.18), and 24 h after ECMO support, the risk rises further adjusted odds ratio (AOR) 3.32 (95% IC 1.55-7.09). The accuracy of severity scores presented weak discrimination and similar behavior, except for DEOx for the primary outcome, with an AUC of 0.79 (95% CI, 0.72-0.87), and APACHE II with an AUC of 0.68 (95% CI, 0.59-0.78). <b>Conclusions:</b> The prediction of RRT in patients on VV-ECMO support was superior for DEOx, which is influenced by the use of vasopressors, creatinine levels, and platelet transfusion prior to cannulation. This could be useful for predicting early interventions in this patient population.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666241309852"},"PeriodicalIF":3.0,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006818","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":"Validation of Pediatric Sequential Organ Failure Assessment (pSOFA) Scores to Predict Critical Events in the Pediatric Intensive Care Unit.","authors":"Colleen M Badke, Austin Wang, Latasha A Daniels, L Nelson Sanchez-Pinto","doi":"10.1177/08850666241307630","DOIUrl":"https://doi.org/10.1177/08850666241307630","url":null,"abstract":"<p><strong>Objective: </strong>To determine the prognostic value of the Pediatric Sequential Organ Failure Assessment (pSOFA) to discriminate critical events, including code events and intubations, in the pediatric intensive care unit (PICU).</p><p><strong>Methods: </strong>We performed an observational cohort study of all critical events in a quaternary care PICU between 5/2020 and 4/2023. Critical events were extracted from our hospital communications platform and from the electronic health record (EHR). The pediatric sequential organ failure assessment (pSOFA) scores were prospectively calculated in real-time in our EHR every 15 min during the study period for data-driven situational awareness and were retrospectively analyzed for this study. Each encounter was divided into 6-h time blocks and we assessed the performance of the highest pSOFA score in each block at discriminating the occurrence of a critical event in the subsequent block.</p><p><strong>Results: </strong>There were 5687 unique patient encounters included in the analysis. Critical events were identified in 578 out of 169 486 time blocks (prevalence 0.3%), which included 103 code events and 498 intubation events, in 392 unique PICU encounters. The total pSOFA score in a 6-h time block was significantly associated with a subsequent code event (odds ratio [OR] 1.19, 95% CI 1.13-1.24) or intubation (OR 1.13, 95% CI 1.10-1.15). Several organ-specific pSOFA subscores were also significantly associated with the outcomes. Area under the receiver operating characteristic curve (AUROC) for the total pSOFA score was 0.67 for a code event and 0.65 for intubation. Using a pSOFA score cutoff of ≥8, the positive predictive value was 0.8% and the negative predictive value was 99.7% for any critical event.</p><p><strong>Conclusions: </strong>The pSOFA score is significantly associated with critical events in the PICU, however, it does not have adequate performance to be used for situational awareness by itself.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666241307630"},"PeriodicalIF":3.0,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950173","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}