Journal of Intensive Care Medicine最新文献

{"title":"The Use of Direct Current Cardioversion for Unstable Atrial Fibrillation with Rapid Ventricular Response in Critically ill Patients - a Propensity Score Analysis.","authors":"Hong Hieu Truong, Aysun Tekin, Lucrezia Rovati, Claudia Castillo Zambrano, Faysal K Al-Ghoula, Jacob C Jentzer, Ognjen Gajic","doi":"10.1177/08850666251315332","DOIUrl":"10.1177/08850666251315332","url":null,"abstract":"<p><p>ObjectivesThere is substantial practice variation in the management strategies for atrial fibrillation (AF) with rapid ventricular rate (RVR) and hemodynamic instability in critically ill patients. This study aimed to evaluate the use and effectiveness of direct current cardioversion (DCCV) for unstable AF RVR in the intensive care unit (ICU).DesignMulticenter retrospective cohort study.SettingNon-cardiac/cardiovascular surgery ICUs of the Mayo Clinic Hospitals in Minnesota, Wisconsin, Florida, and Arizona.PatientsAdult patients who developed paroxysmal AF RVR with hemodynamic instability (heart rate ≥ 130 beats per minute and a documented SBP ≤ 90 mmHg or the need for vasopressors) during ICU stay.InterventionsEmergency DCCV.Measurements and Main ResultsPrimary outcomes were in-hospital mortality, hospital-, ICU-, and organ support-free days. Secondary outcomes were return to sinus rhythm rate before and after discharge. Among 691 patients eligible for inclusion, 47 (6.8%) received emergent DCCV in the ICU. The frequency of DCCV was higher for patients located in surgical ICUs (14.5% vs 6.1%, <i>P</i> = .04). Patients were 1:2 propensity-score matched. The comparative analyses were conducted on 141 patients. Those who underwent DCCV were more likely to restore sinus rhythm (odds ratio [95% confidence interval], 5.2 [1.30 20.8]). However, DCCV was not associated with increased odds of having sinus rhythm at discharge, lower mortality, or higher number of ICU-, or hospital-free days. The number of organ support-free days was significantly lower in the DCCV group (estimate ± standard error, -5.0 ± 2.0, <i>P</i> = .012).ConclusionsEmergency DCCV is rarely used to treat unstable AF in non-cardiac ICUs. Despite increased likelihood of immediate sinus rhythm restoration, DCCV was not associated with improvement in patient-centered outcomes. Prospective studies are warranted to evaluate harms and benefits of DCCV in non-cardiac critically ill patients with unstable AF where the driver of hemodynamic instability is often an underlying condition rather than arrhythmia per se.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"677-685"},"PeriodicalIF":3.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143523308","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":"Implementation of a Checklist Tool to Improve Understanding of Rapid Response Team Protocols.","authors":"Maria C Pliakas, Erin F Carlton, Sarah Brennan, Diane Brown, Laura Getchell, Debra O'Neal, Kayla B Phelps, Rebekah Shaw, Courtney Strohacker, Anisha K Coughlin","doi":"10.1177/08850666241309860","DOIUrl":"10.1177/08850666241309860","url":null,"abstract":"<p><p>Background and ObjectivesRapid response teams (RRT) are multidisciplinary teams activated to assess patients outside of the Intensive Care Unit (ICU) and require a shared framework for approaching a deteriorating patient. In this project, we aimed to improve the understanding of RRT protocols through the development and implementation of the RRT Huddle Checklist.MethodsThis quality improvement project took place from 2019 to 2022. A multidisciplinary workgroup conducted a current state analysis and defined the ideal RRT process. To improve the RRT process, we developed and implemented an RRT Huddle Checklist based on the SBAR framework, standardized education, and created a process for regular feedback. The primary aim was to improve understanding of RRT protocols among participants. RRT duration was used as a balancing measure.ResultsA total of 301 stakeholders completed surveys, including 127 nurses, 101 residents, 45 RRT nurses, 10 Hospital Medicine faculty and fellows, and 18 PICU fellows. After implementation of the RRT Huddle Checklist, the proportion of respondents who agreed with knowing RRT protocols increased from 69% in 2020 to 75% in 2022, with no increase in RRT duration.ConclusionsThe implementation of the RRT Huddle Checklist resulted in an increased proportion of key stakeholders that understood RRT protocols without increasing the duration of RRTs. The RRT Huddle Checklist tool utilizes a widely known, validated framework that can be adapted at other institutions to standardize the RRT process and promote ongoing just-in-time education.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"611-622"},"PeriodicalIF":3.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950233","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 Febrile Encephalopathy with Rigidity.","authors":"Dearbhla M Kelly, Eoin M Kelleher","doi":"10.1177/08850666251345448","DOIUrl":"https://doi.org/10.1177/08850666251345448","url":null,"abstract":"<p><p>Febrile encephalopathy with rigidity can be the presenting feature of several life-threatening neurological emergencies such as neuroleptic malignant syndrome (NMS) and serotonin syndrome. Although the pathogenesis of these conditions is poorly understood, we review advances in our understanding of underlying genetic and other biological mechanisms. We also discuss the complex and expanding differential diagnoses which include other drug-induced hyperpyrexia or rigidity syndromes (eg malignant hyperthermia, parkinsonism-hyperpyrexia syndrome, malignant catatonia) as well as autoimmune syndromes. Finally, we consider potential predictive and preventative approaches along with best practice management strategies.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666251345448"},"PeriodicalIF":3.0,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144191931","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":"Advancing Microcirculatory Therapies in Pediatric Sepsis: Current Opportunities and Future Directions.","authors":"Carolina Casas, Jaime Fernández-Sarmiento, Mauricio Sarta-Mantilla, Hernando Mulett, Lorena Acevedo, Briam Beltrán, Juanita Medina, Clarisel Del Carmen Compres, Piera Nathalie Serrano, María Elvira Sarta-Mantilla, Valentina Pérez, Maria Camila Gomez, Maria Carolina Niño, Cielo Cuadros, Maria José Barrera, Natalia Pedraza-López, Joseph A Carcillo","doi":"10.1177/08850666251340601","DOIUrl":"https://doi.org/10.1177/08850666251340601","url":null,"abstract":"<p><p>Microcirculatory dysfunction in pediatric sepsis is a key factor in the development of tissue hypoperfusion and multiple organ failure. Endothelial glycocalyx alteration, increased capillary permeability, and blood flow heterogeneity are common findings in these patients, suggesting that a microcirculation-targeted approach could improve clinical outcomes. In this context, strategies such as resuscitation with balanced solutions have been shown to minimize hyperchloremia and metabolic acidosis, reducing endothelial dysfunction and inflammatory activation. Likewise, correcting hypoalbuminemia has been associated with reduced glycocalyx degradation and improved vascular stability. The use of inotropes and inodilators has shown favorable effects on capillary perfusion and modulation of the inflammatory response, suggesting their potential to optimize tissue oxygenation in septic shock patients. Additionally, fresh frozen plasma may play a role in glycocalyx restoration and endothelial homeostasis regulation, although its impact on pediatric sepsis still requires further clinical evidence. Despite these advances, questions remain regarding the best strategy to evaluate and treat microcirculatory dysfunction in children with sepsis. Identifying specific biomarkers and developing tools for real-time perfusion assessment could allow for more personalized therapies. Further clinical studies are needed to validate the impact of these interventions on pediatric mortality and morbidity. Integrating a microcirculation-targeted approach into pediatric septic shock management protocols represents an opportunity to improve care and outcomes in this vulnerable population.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666251340601"},"PeriodicalIF":3.0,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144180899","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":"Cognitive Health and Quality of Life After Surviving Sepsis: A Narrative Review.","authors":"Khalia Ackermann, Nanda Aryal, Johanna Westbrook, Ling Li","doi":"10.1177/08850666251340631","DOIUrl":"10.1177/08850666251340631","url":null,"abstract":"<p><p>Purpose of the researchSepsis is a leading cause of disease and affects approximately a third of ICU patients worldwide. Despite the rising number of sepsis survivors, the burden of cognitive and quality of life related post-sepsis morbidities remains understudied. This narrative review aimed to summarize and discuss current research investigating the quality of life and the burden of cognitive, mental, and functional health morbidities in sepsis survivors at different stages of life.Major findingsSepsis survivors of all ages were affected by cognitive dysfunction, with very preterm neonatal sepsis survivors reporting higher odds of neurodevelopmental disabilities, childhood sepsis survivors reporting delayed development, and adult sepsis survivors reporting cognitive decline, including a higher risk of dementia. Mental health concerns were reported in both survivors and family members, with limited mixed evidence for post-traumatic stress disorder, depression, suicide, and anxiety. Survivor functional status is frequently impacted in diverse ways, with both physical and mental changes often inhibiting daily life. Lastly, the impact of sepsis on survivor quality of life is mixed. While sepsis survivors frequently report poorer quality of life compared to the general population, studies have reported no difference in quality of life when comparing sepsis survivors with other critical illness survivors.ConclusionsSepsis impacts the quality of life and cognitive, mental, and functional health in numerous diverse ways across the lifespan. Future research should focus on sepsis survivorship in children, and the mental health burden of sepsis across all age groups.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666251340631"},"PeriodicalIF":3.0,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078508","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":"Propofol-associated Hypertriglyceridemia: Development and Multicenter Validation of a Machine-Learning-Based Prediction Tool.","authors":"Jiawen Deng, Kiyan Heybati, Keshav Poudel, Guozhen Xie, Eric Zuberi, Vinaya Simha, Hemang Yadav","doi":"10.1177/08850666251342559","DOIUrl":"https://doi.org/10.1177/08850666251342559","url":null,"abstract":"<p><strong>Purpose: </strong>To develop and validate an explainable machine learning (ML) tool to help clinicians predict the risk of propofol-associated hypertriglyceridemia in critically ill patients receiving propofol sedation. <b>Methods:</b> Patients from 11 intensive care units (ICUs) across five Mayo Clinic hospitals were included if they met the following criteria: a) ≥ 18 years of age, b) received propofol infusion while on invasive mechanical ventilation for ≥24 h, and c) had a triglyceride level measured. The primary outcome was hypertriglyceridemia (triglyceride >400 mg/dL) onset within 10 days of propofol initiation. Both COVID-inclusive and COVID-independent modeling pipelines were developed to ensure applicability post-pandemic. Decision thresholds were chosen to maintain model sensitivity >80%. Nested leave-one-site-out cross-validation (LOSO-CV) was used to externally evaluate pipeline performance. Model explainability was assessed using permutation importance and SHapley Additive exPlanations (SHAP). <b>Results:</b> Among 3922 included patients, 769 (19.6%) developed propofol-associated hypertriglyceridemia, and 879 (22.4%) had COVID-19 at ICU admission. During nested LOSO-CV, the COVID-inclusive pipeline achieved an average AUC-ROC of 0.71 (95% confidence interval [CI] 0.70-0.72), while the COVID-independent pipeline achieved an average AUC-ROC of 0.69 (95% CI 0.68-0.70). Age, initial propofol dose, and BMI were the top three most important features in both models. <b>Conclusion:</b> We developed an explainable ML-based tool with acceptable predictive performance for assessing the risk of propofol-associated hypertriglyceridemia in ICU patients. This tool can aid clinicians in identifying at-risk patients to guide triglyceride monitoring and optimize sedative selection.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666251342559"},"PeriodicalIF":3.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078513","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":"Prognosis of Patients with Lung Cancer Admitted to the Intensive Care Unit: A Systematic Review and Meta-Analysis.","authors":"Ahmed Elkhapery, Hazem Taifour, Chengu Niu, Ayman O Soubani","doi":"10.1177/08850666251339451","DOIUrl":"https://doi.org/10.1177/08850666251339451","url":null,"abstract":"<p><p>IntroductionDespite recent advances in the care of critically ill patients with cancer, studies show that lung cancer is associated with higher Intensive Care Unit (ICU) mortality than other types of cancer. This systematic review and meta-analysis aim to investigate the ICU outcomes and predictors of mortality in critically ill patients with lung cancer.MethodsPubMed, OVID MEDLINE, Cochrane and Embase were searched to identify relevant studies. The primary outcome was ICU mortality. The secondary outcomes were hospital mortality and predictors of mortality. Abstracts, case reports and case series were excluded.ResultsThirty-three studies met inclusion criteria, including 28 cohort studies (n = 4123) and five population-based studies (n = 82,475). The pooled ICU mortality was 46.4% (95% CI 41.0-51.8; n = 16,772). The pooled hospital mortality was 51.9% (95% CI 46.9-56.9; n = 72,215). The pooled long-term mortality (6-12 months) was 73.5%, (95% CI 68.2- 78.2; n = 84,008). Predictors of mortality included the presence of metastatic disease (RR 1.30, 95% CI 1.06-1.59), poor performance status (RR 1.33, 95% CI 1.12-1.57), requirement for mechanical ventilation (RR 2.25, 95% CI 1.58-3.21), requirement for vasopressors (RR 1.95, 95% CI 1.54-2.46), higher APACHE or SAPS score (standardized mean difference 0.63, 95% CI 0.45-0.80), and higher SOFA score (mean difference 1.95, 95% CI 1.21-2.70).ConclusionCritically ill patients with lung cancer have reasonable short term but poor long-term outcome. Focused and early goals of care discussions are crucial part of ICU care in this patient population.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666251339451"},"PeriodicalIF":3.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078511","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":"Outcomes of Sedative Hypnotic Agents Used for Endotracheal Intubation in Critically Ill Adults: A Systematic Review with Exploratory Meta-Analysis.","authors":"Nathan J Smischney, George Williams, Craig S Jabaley, Ashish K Khanna, Bethany Bouldin, Andrew R Petrilli, Hao Deng, Elissa A Kinzelman-Vesely, Ronald G Pearl","doi":"10.1177/08850666251337702","DOIUrl":"https://doi.org/10.1177/08850666251337702","url":null,"abstract":"<p><p>ObjectiveSpecific sedative hypnotic agents, administered to facilitate endotracheal intubation (ETI) in critically ill adults, may lead to adverse outcomes such as peri-intubation cardiovascular collapse. However, little is known from systematic investigations of the impact these individual agents have on cardiovascular function or other clinical outcomes.Data sourcesMEDLINE, Embase, CENTRAL, ClinicalTrials.gov, Scopus and Web of science databases.Study selectionWe conducted a systematic search for randomized and non-randomized studies that evaluated adult (≥18 years) critically ill patients who were sedated to facilitate ETI with ketamine, propofol, ketamine/propofol, etomidate, or a benzodiazepine and who had data on peri-intubation hemodynamics and at least one other outcome involving acute kidney injury, delirium, opioid use, intubation difficulty, sequential organ failure assessment, length of stay, or mortality. Eighty-five studies were identified for eligibility assessment with 23 included in the analysis.Data extractionTwo reviewers independently screened articles, extracted data from selected articles, and assessed risk of bias using ROBINS-I for observational studies and revised Cochrane Risk of Bias tool for randomized controlled trials.Data synthesisAcute cardiovascular dysfunction (peri-intubation hemodynamic instability and/or cardiac arrest) was similar between etomidate and ketamine with more events seen when propofol versus non-propofol sedation was administered. However, exploratory meta-analysis demonstrated no difference between etomidate and ketamine (OR 1.05 [95%CI 0.60-1.84]) or between etomidate and propofol (OR 0.91 [95%CI 0.33-2.46]). Compared to ketamine, etomidate demonstrated lower survival to hospital discharge in the included studies in exploratory meta-analysis OR 0.76 (95%CI 0.62-0.92). Limited data existed for other outcomes with no discernible differences between sedative agents.ConclusionsAcute cardiovascular dysfunction was more common when propofol, as compared to non-propofol sedation, was administered, although not statistically significant in exploratory meta-analysis. In addition, etomidate conferred lower survival to hospital discharge versus non-etomidate sedation, which was confirmed in exploratory meta-analysis of etomidate versus ketamine.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666251337702"},"PeriodicalIF":3.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078510","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":"Beyond the Basics: Recommended Approach to Severe Acute Pancreatitis Management in the Critical Care Setting.","authors":"Zaid Alkaissy, Kelli Kosako Yost, Megan B Ghai, Khaled Malkawi, Mustafa Nawaz, Wahid Wassef","doi":"10.1177/08850666251338044","DOIUrl":"https://doi.org/10.1177/08850666251338044","url":null,"abstract":"<p><p>Acute Pancreatitis (AP) poses a significant healthcare burden globally. While most cases present with a mild course, approximately one-fifth progress to severe forms characterized by severe pancreatitis and systemic complications, leading to a mortality rate of up to 40%. Effective management of severe acute pancreatitis necessitates a multidisciplinary approach involving gastroenterologists, interventional radiologists, intensive care teams, and surgeons. The advances in treatment modalities, including early hydration, nutrition, and pain control, have led to a decrease in the morbidity and long-term complications associated with severe acute pancreatitis down to 20%. In this review, we focus on the management challenges and outcomes associated with the difficult condition of severe acute pancreatitis.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666251338044"},"PeriodicalIF":3.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143996523","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":"Developmental Care in the Early Years in Pediatric Intensive Care Patients as a Strategy to Mitigate Pediatric Post-Intensive-Care Syndrome: A Narrative Review.","authors":"Ari R Joffe, Charlene M T Robertson","doi":"10.1177/08850666251340646","DOIUrl":"https://doi.org/10.1177/08850666251340646","url":null,"abstract":"<p><p>Survivors after pediatric critical care often have adverse sequelae in domains of cognition, executive function, attention, memory, visual-spatial skills, language, motor function, behavior, and emotional functioning, the post-intensive-care syndrome pediatric (PICS-p). The time from birth to approximately age 2 years is a period of rapid structural and functional brain development. The fundamental structural and functional architecture of the brain is in place by the second year of life. This narrative review focuses on how we, in the pediatric intensive care unit (PICU), can work towards maximizing each patient's full potential despite adverse experiences during hospitalization. In part I, concepts relevant to understanding the effects of hospitalization in PICU on brain development are clarified, including concepts of toxic stress and trauma, sensitive periods and cascades, experience-expectant neural plasticity in the early years, and resilience and buffering of adversity focused on relational care. In part II, evidence is presented that these concepts are important because they describe the effects of early childhood adversity that are pervasive on physical health, cognitive, and emotional outcomes throughout the lifespan. Evidence is presented to show that intervention to improve these outcomes can be effective. In part III, the concepts and evidence are synthesized by focusing on the opportunity before us, what we must and can do better while patients are in the PICU, in order to improve their long-term lifelong outcomes. We present evidence to argue that we in pediatric critical care must take a public-health approach to address the key environmental conditions necessary for optimal early childhood development and hence facilitate children's ability to thrive. Future research must aim to determine what works best and what does not work in the PICU. Early childhood investments to improve lifelong outcomes have great potential to help patients and reduce the growing burden of healthcare costs.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666251340646"},"PeriodicalIF":3.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144024526","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}