Journal of Intensive Care Medicine最新文献

{"title":"Association Between the Use of Long-Acting Insulin and Hypoglycemia in Critically Ill Patients with Diabetes.","authors":"Amina Ammar, Nataliya Sorochak, Renee Paxton, Melissa Lipari, Christopher Giuliano","doi":"10.1177/08850666251371709","DOIUrl":"https://doi.org/10.1177/08850666251371709","url":null,"abstract":"<p><p><b>Introduction</b>: Hypoglycemia in critically ill patients increases morbidity and mortality. Subcutaneous long-acting insulin (LAI) in patients without diabetes is associated with hypoglycemia in the SICU. However, limited evidence exists in patients with diabetes. <b>Methods:</b> This was a single-center, retrospective cohort study evaluating patients with T2DM who were admitted to the SICU for 24 h and received LAI in combination with sliding scale insulin (LAI + SSI) or sliding scale insulin (SSI) alone. The primary outcome was the incidence of hypoglycemia (BG < 70 mg/dL) in patients who received LAI + SSI or SSI. Secondary outcomes evaluated the number of glucose values across defined categories: hypoglycemia (54-70 mg/dL), severe hypoglycemia (<54 mg/dL), euglycemia (70-180 mg/dL), hyperglycemia (>180 mg/dL) and glycemic variability. <b>Results:</b> A total of 228 patients were included in the final analysis. The incidence of hypoglycemia occurred in 17.5% of patients in the LAI + SSI cohort and 18.4% in the SSI cohort (p = .86). After controlling for confounders, no differences were observed with LAI + SSI versus SSI for hypoglycemia (OR 1.09, 95% CI 0.46-2.6, p = .85). Secondary outcomes demonstrated no difference in total hypoglycemia (37 vs 31, p = .80), severe hypoglycemia (15 vs 34, p = .17) and euglycemia (1622 vs 1780, p = .22) in the LAI + SSI cohort compared to SSI alone. Hyperglycemia occurred more frequently with LAI + SSI. However, after adjusting for confounders there was no difference in hyperglycemia (OR 1.8, 95% CI 0.7-4.6, p = .22). No difference was observed in glycemic variability between LAI + SSI and SSI (26.5 vs 24.5, p = .21). <b>Conclusion and Relevance:</b> The addition of LAI to SSI in SICU patients with T2DM was not associated with an increased risk of hypoglycemia.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666251371709"},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957547","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":"Real-World Outcomes of Hemoadsorption with CytoSorb^® in Patients with Septic Shock: Insights from a Single-Center Study.","authors":"Giorgio Berlot, Paolo Carocci, Valentina Votrico, Barbara Iacoviello, Nicolò Taverna, Ugo Gerini, Vittorio di Maso, Ariella Tomasini","doi":"10.1177/08850666251331905","DOIUrl":"10.1177/08850666251331905","url":null,"abstract":"<p><p>BackgroundHemoadsorption is currently employed to treat septic shock and other clinical conditions involving massive inflammatory mediator release. CytoSorb^®, a device utilizing synthetic resin microbeads, provides a large adsorption surface for blood purification. This study aimed to review the clinical course of patients with septic shock treated with CytoSorb^® in our hospital's intensive care unit (ICU).Patients and MethodsThis study retrospectively analyzed the clinical course of patients with septic shock treated with CytoSorb^®, focusing on treatment timing and the volume of blood processed.ResultsBetween July 1, 2016, and December 31, 2023, 175 patients (106 men, 69 women; median age: 67 years, interquartile [IQR]: 58-85) received CytoSorb^® therapy. Survivors exhibited a significantly lower simplified acute physiology score at admission than nonsurvivors. CytoSorb^® was initiated within 24 h of shock onset in 102 patients (58%, early starters) and between 25 and 48 h in 73 patients (42%, late starters). Hemodynamic improvements elevated mean arterial pressure and reduced lactate, procalcitonin, C-reactive protein, sequential organ failure assessment scores, and noradrenaline doses in survivors. These effects were more pronounced in early starters receiving intensive treatment, who also demonstrated significantly lower lactate levels and higher mean arterial pressure at the end of therapy. Overall, 86 patients (49%) died in the ICU. Survivors underwent longer treatment durations and processed greater blood volumes than nonsurvivors.ConclusionsIn patients with septic shock treated with CytoSorb^® within 48 h of onset, treatment intensity-rather than timing-was associated with lower ICU mortality rates.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"993-1000"},"PeriodicalIF":3.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764129","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":"Strain in the Pediatric Intensive Care Unit and its Association with Patient Outcomes.","authors":"Matthew S Baker, Kristen R Miller, Jaime S LaVelle, Julia A Heneghan, Michele M Loi, Cameron F Gunville, Aline B Maddux","doi":"10.1177/08850666251329902","DOIUrl":"10.1177/08850666251329902","url":null,"abstract":"<p><p><b>Objective:</b> To characterize measures of pediatric intensive care unit (PICU) strain and test for associations between strain and patient outcomes. We hypothesized that periods of increased strain would be associated with increased odds of experiencing a post-ICU floor escalation event. <b>Design:</b> Retrospective cohort study. <b>Setting:</b> Quaternary care children's hospital PICU. <b>Study Population:</b> PICU admissions (2014-2023). <b>Interventions:</b> None. <b>Measurements and Main Results:</b> We measured PICU strain metrics daily including percent occupancy, percent turnover, and acuity. Percent occupancy and turnover were higher during annual peak viral season versus non-peak season (percent occupancy: median 84.4 [interquartile range (IQR) 72.9, 91.7] versus 68.8 [IQR 56.3, 82.1], <i>P</i> < .001; percent turnover: median 25.0 [IQR 20.0, 31.3] versus 21.9 [IQR 15.6, 28.1], <i>P</i> < .001). Acuity metrics did not differ during these periods. In patients admitted for respiratory or neurologic illness, we used multivariable logistic regression to test for associations between strain metrics on the day of transfer and odds of a floor escalation event defined as an unplanned PICU readmission or rapid response or code blue activation within 48 h of transfer. Of 12 832 patient transfers, 429 (3.3%) experienced a floor escalation event. After controlling for patient and clinical characteristics, percent occupancy and turnover were independently associated with an increase in floor escalation events. This risk was not linear for occupancy: above 87.5% (95% confidence interval (CI): 80.4, 94.6%), per 5% increase in occupancy patients experienced more floor escalation events (odds ratio [OR] 1.29 [95% CI: 1.07, 1.57]). For every 5% increase in turnover, patients experienced more floor escalation events (OR 1.06 [95% CI: 1.01, 1.12]). <b>Conclusions:</b> Occupancy and turnover characterized recognized periods of PICU strain. High occupancy and turnover were associated with more floor escalation events. Multicenter studies are needed to evaluate the generalizability of these findings across other PICUs.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"964-972"},"PeriodicalIF":3.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143976077","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":"The Impact of the COVID-19 Pandemic on Healthcare Associated Bloodstream Infections in Scottish Intensive Care Units: A Retrospective Cohort Study.","authors":"Jennifer Falconer, Mabel Balfour, Stephanie Walsh, Aynsley Milne, Jodie McCoubrey, Fiona Murdoch, Roselind Hall, Chris Robertson, Laura Imrie, Nazir Lone, Shona Cairns","doi":"10.1177/08850666251368802","DOIUrl":"https://doi.org/10.1177/08850666251368802","url":null,"abstract":"<p><p>BackgroundHealthcare associated blood stream infections (BSI) pose a significant risk of morbidity and mortality for patients admitted to intensive care units (ICUs). Recent evidence suggests that the COVID-19 pandemic may have impacted the risk of acquisition.AimThis retrospective cohort study explored risk factors, including patient COVID-19 admission status, associated with incidence rates of BSI in Scottish ICUs during the COVID-19 pandemic compared to a pre-pandemic period.MethodsThree national databases were linked to create a dataset of 38,081 ICU admissions across 41 ICUs during a comparator period of March 2018 to December 2019, and pandemic period of March 2020 to December 2021. Population demographics and clinical risk factors were described according to period of admission and COVID-19 admission status. Cox regression models investigated the influence of risk factors on time to BSI, using a competing risk approach to account for death as a competing event.FindingsIn non-COVID-19 patients, the first two waves of the pandemic significantly increased hazards of BSI (Wave 1 cause-specific hazard ratio (HR) 1.27, 95% Confidence Interval (CI) 1.02-1.59, wave 2a HR 1.39, 95% CI 1.14-1.70), but not mortality. COVID-19 status on admission did not significantly increase hazard of BSI in the pandemic, however there was a significant interaction between COVID-19 and the use of intubation in increasing hazard of BSI (HR 4.64, 95% CI 2.07-10.4) and COVID-19 was significant in increasing the hazard of mortality (HR 2.26, 95% CI 1.77-2.88).ConclusionWhile rates of ICU-acquired BSI were higher during the pandemic period, and in COVID-19 admissions, the reasons for this are multifactorial. Interpretation must consider the competing risk of mortality and how this is influenced by differences in patient population, along with changes that occurred during the pandemic in relation to infection prevention and control procedures, ICU pressures, and COVID-19 treatment and vaccination.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666251368802"},"PeriodicalIF":2.1,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957370","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 Whole Blood Cell-Derived Inflammatory Markers and All-Cause Mortality in Patients with Sepsis-Associated Acute Kidney Injury: A Retrospective Study Based on the MIMIC-IV Database.","authors":"Xinghe Shangguan, Ziwei Zhang, Xinyi Shangguan, Jike Wang, Yuanqi Gong","doi":"10.1177/08850666251363853","DOIUrl":"https://doi.org/10.1177/08850666251363853","url":null,"abstract":"<p><p>BackgroundSepsis-associated acute kidney injury (SA-AKI) is a serious condition with a high mortality rate. Whole blood-derived inflammatory markers like the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI), are emerging prognostic indicators for various diseases. This study endeavors to unravel the link of these markers to all-cause mortality(ACM) in the SA-AKI population utilizing the MIMIC-IV database.MethodsA retrospective cohort study was conducted on SA-AKI patients meeting the Sepsis-3 and KDIGO criteria. Cox regression analysis was performed to evaluate the association between inflammatory markers and mortality. Restricted cubic spline (RCS) analysis was employed to unveil the potential nonlinear relation of inflammatory markers to mortality. Survival differences across varying levels of inflammation were compared via Kaplan-Meier (KM) survival curves. Subgroup analyses were executed to examine the robustness of the relation and possible interactions between variables. The predictive performance of inflammatory markers was evaluated via receiver operating characteristic (ROC) curves, and the clinical utility of these markers was assessed through clinical decision curve analysis(DCA).Results3429 SA-AKI patients were encompassed (2785 survivors at 30 days and 644 non-survivors). Cox regression analysis revealed a significant link between risen NLR, PLR, MLR, SII, and SIRI to elevated ACM. KM survival analysis demonstrated that patients with higher levels of inflammatory markers had notably higher 30-day death rates. Subgroup analysis indicated an interaction between coronary artery disease (CHD) and inflammation in influencing mortality risk. Among the markers assessed, NLR exhibited the highest forecasting accuracy for 30-day death (AUC = 0.624). Propensity score matching (PSM) confirmed the robustness of these findings.ConclusionWhole blood-derived inflammatory markers, particularly NLR, are closely linked to mortality in patients with SA-AKI. These markers may serve as valuable prognostic tools for identifying high-risk patients and improving clinical outcomes.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666251363853"},"PeriodicalIF":2.1,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957580","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":"Reply to: Regarding \"Lumbar Puncture and Brain Herniation in Acute Bacterial Meningitis: An Updated Narrative Review\".","authors":"Ari R Joffe, Fernanda de Marzio Pestana Martins, Daniel Garros, Adrienne F Thompson","doi":"10.1177/08850666251370334","DOIUrl":"https://doi.org/10.1177/08850666251370334","url":null,"abstract":"","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666251370334"},"PeriodicalIF":2.1,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957288","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":"Corrigendum to \"Cognitive Health and Quality of Life After Surviving Sepsis: A Narrative Review\".","authors":"","doi":"10.1177/08850666251370162","DOIUrl":"10.1177/08850666251370162","url":null,"abstract":"","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666251370162"},"PeriodicalIF":2.1,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144882984","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":"\"Lumbar Puncture and Brain Herniation in Acute Bacterial Meningitis: An Updated Narrative Review\".","authors":"Victor Gabriel El-Hajj, Maria Gharios, Adrian Elmi-Terander","doi":"10.1177/08850666251370340","DOIUrl":"10.1177/08850666251370340","url":null,"abstract":"","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666251370340"},"PeriodicalIF":2.1,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144882982","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":"An Analytic Review of Neuropsychiatric Syndromes in the Intensive Care Unit.","authors":"Varsha Radhakrishnan, Kinza Tareen, Maureen Cassady, Chloe A Morgan, Alexander Martin","doi":"10.1177/08850666251368776","DOIUrl":"10.1177/08850666251368776","url":null,"abstract":"<p><p>Neuropsychiatric syndromes are characterized by disturbances in cognition, emotions, behavior, and represent the complex intersection between neurology and psychiatry, particularly in the critically ill. Despite this vulnerability in critically ill patients and the implications of the high level of care required in critical care settings, intensivists often face difficulty in the prompt recognition and management of neuropsychiatric syndromes. This in part may be reflective of the several overlapping and nonspecific clinical features (i.e. agitation, altered mentation, motor findings, autonomic instability, clonus), disparate definitions of encephalopathy within the literature, precipitating risk factors, lack of clearly defined diagnostic tests or laboratory findings, and shared secondary complications when diagnosis is delayed or missed. Agitation is often the most readily identifiable presenting symptom of neuropsychiatric syndromes in critically ill patients, largely due to its disruptive impact on patient care, both patient and staff safety, potential to delay in time to extubation, and risk of worsening patient outcomes.In this analytic review, neuropsychiatric syndromes that can present with agitation were identified and further appraised upon reviewing randomized controlled trials, meta-analyses, and systematic reviews from the PubMed database spanning from 1995 to 2024. In total 507 articles were identified using relevant search terminology, article titles were subsequently screened for relevance, followed by screening of abstracts. Neuropsychiatric syndromes included within this review were selected based upon diagnostic complexity, overlapping clinical features, and highlighted based upon prevalence within the literature: Serotonin syndrome, neuroleptic malignant syndrome, catatonia, and paroxysmal sympathetic hyperactivity. We highlight these distinct syndromes and propose a clinical heuristic-based decision tree to accompany clinical decision making for the intensivist from a psychiatrist's lens.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666251368776"},"PeriodicalIF":2.1,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144882983","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":"Diagnostic Accuracy of a Large Language Model (ChatGPT-4) for Patients Admitted to a Community Hospital Medical Intensive Care Unit: A Retrospective Case Study.","authors":"Jassimran Singh, Rhea Bohra, Vaibhavi Mukhtiar, Warren Fernandes, Charmi Bhanushali, Rajaeaswaran Chinnamuthu, Shihla Shireen Kanamgode, June Ellis, Eric Silverman","doi":"10.1177/08850666251368270","DOIUrl":"https://doi.org/10.1177/08850666251368270","url":null,"abstract":"<p><p>BackgroundThe future of artificial intelligence in medicine includes the use of machine learning and large language models to improve diagnostic accuracy, as a point-of-care tool, at the time of admission to an acute care hospital. The large language model, ChatGPT-4, has been shown to diagnose complex medical conditions with accuracies comparable to experienced clinicians, however, most published studies involved curated cases or examination-like questions and are not point-of-care. To test the hypothesis that ChatGPT-4 can make an accurate medical diagnosis using real-world medical cases and a convenient cut and paste strategy, we performed a retrospective case study involving critically ill patients admitted to a community hospital medical intensive care unit.MethodsA redacted H&P was essentially cut and pasted into ChatGPT-4 with uniform instructions to make a leading diagnosis and a list of 5 possibilities as a differential diagnosis. All features that could be used to identify patients were removed to ensure privacy and HIPAA compliance. The ChatGPT-4 diagnoses were compared with critical care physician diagnoses using a blinded longitudinal chart review as the ground truth diagnosis.ResultsA total of 120 randomly selected cases were included in the study. The diagnostic accuracy was 88.3% for physicians and 85.0% for ChatGPT-4, with no significant difference by McNemar testing (p-value of 0.249). The agreement between physician diagnosis and ChatGPT-4 diagnosis was moderate, 0.57 (95% CI: 0.35-0.79), based on Cohen's kappa statistic.ConclusionThese results suggest that ChatGTP-4 achieved diagnostic accuracy comparable to board certified physicians in the context of critically ill patients admitted to a community medical intensive care unit. Furthermore, the agreement was only moderate, suggesting that there may be complementary ways of combining the diagnostic acumen of physicians and ChatGPT-4 to improve overall accuracy. A prospective study would be necessary to determine if ChatGPT-4 could improve patient outcomes as a point-of-care tool at the time of admission.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666251368270"},"PeriodicalIF":2.1,"publicationDate":"2025-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144873593","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}