Journal of Intensive Care Medicine最新文献

{"title":"BRAIN-SIM: Leveraging Simulation for Neurocritical Care Education with an Innovative Multidisciplinary Approach.","authors":"Brett DerGarabedian, Lauren Lacovara, Justin Delic, Swarna Rajagopalan","doi":"10.1177/08850666251327156","DOIUrl":"10.1177/08850666251327156","url":null,"abstract":"<p><p>Background and ObjectivesEarly recognition and response are paramount in the treatment of neurologic emergencies. Due to its complexity, neurocritical care continues to provoke unease for practitioners and trainees. Simulation provides a realistic opportunity for learners to detect an acutely deteriorating neurologic patient and make rapid-fire treatment decisions. A multidisciplinary simulation-based learning environment may improve trainee confidence when caring for the neurocritical care patient population.MethodsNine simulation lab sessions were performed with a multidisciplinary team including medical students, residents, critical care medicine fellows, advanced practice providers (APP), critical care pharmacy residents, and neuroscience unit nurses. High fidelity manikins capable of reproducing acute neurologic and physiologic emergencies were used. After the simulation, participants completed a survey utilizing Likert scale responses regarding simulation logistics, faculty competence, and pre- and post-simulation confidence levels managing specific acute neurologic emergencies and performing neurocritical care procedural skills.ResultsNine simulation lab sessions were conducted, and thirty-eight surveys were completed. Mean learner confidence levels in managing patients improved from pre- to post-simulation in patients with coma [3.18 ± 0.51 versus 4.32 ± 0.25 (<i>P </i>< .001)], status epilepticus [3.23 ± 0.55 versus 4.36 ± 0.29 (<i>P </i>< .001)], acute ischemic stroke [3.75 ± 0.59 versus 4.63 ± 0.43 (<i>P </i>< .001)], intracerebral hemorrhage [3.25 ± 0.74 versus 4.63 ± 0.43 (<i>P </i>< .001)], intracranial hypertension [3.25 ± 0.74 versus 4.63 ± 0.43 (<i>P </i>< .001)], respiratory failure [3.5 ± 0.77 versus 4.63 ± 0.43 (<i>P </i>= .0016)], and procedures such as central lines [2.2 ± 0.56 versus 3.8 ± 0.56 (<i>P </i>= .003)], intubations [2.25 ± 0.39 versus 3.63 ± 0.62 (<i>P </i>< .001)], and bronchoscopies [2 ± 0 versus 3.2 ± 0.56 (<i>P </i>= .004). Consistently, learners strongly agreed that faculty were knowledgeable, well-informed, and thorough. Learners commented that the simulation experiences were realistic and allowed them to identify areas for improvement.DiscussionSimulation training can be an effective method to improve neurocritical care education by increasing clinician confidence in managing neurologic emergencies and procedures while providing opportunities for multidisciplinary collaboration. Further evaluation of the effectiveness of simulation education in this patient care setting is warranted.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"876-884"},"PeriodicalIF":3.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12177193/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144008540","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":"Necrotising Lung Infections and Respiratory ECMO-Incidence and Outcome A Retrospective Cohort Study in Adult Patients.","authors":"Jernej Berden, Milica Lukić, Rok Zbačnik, Alenka Goličnik","doi":"10.1177/08850666251363944","DOIUrl":"https://doi.org/10.1177/08850666251363944","url":null,"abstract":"<p><p>BackgroundNecrotizing lung infections (NLI) are rare yet severe complications of lower respiratory tract infections with high mortality. Due to their scarcity and varying severity, there are no specific guidelines on managing these entities. Incidence and outcomes of NLI in patients on VV-ECMO remains largely unknown.MethodsThis observational cohort study retrospectively analyzed data from a prospective ECMO registry at University Medical Centre Ljubljana. Consecutive adult VV-ECMO patients hospitalized between 2010 and 2023 were screened. Patients with NLI, defined as computed tomography (CT) documented necrotising pneumonia, lung abscess or necrotizing cavitation were identified and included in the analysis.ResultsOut of 125 VV-ECMO patients with severe respiratory failure due to lung infections, 38 (30.4%) had NLI. Majority of patients (71%) initially presented with viral pneumonia with secondary bacterial superinfection and most had multi-lobar involvement (73.7%). There was considerable overlap of all necrotizing entities. Duration of hospitalization prior to ECMO initiation was the only significant factor determining patient outcome (2 days in survivors vs 8 days in non-survivors, <i>p</i> = 0.04), while duration of mechanical ventilation prior to cannulation had no significant effect on patient outcome. Although not statistically significant, survival rates were considerably higher in patients who primarily presented with community-aquired pneumonia compared to those with hospital-aquired pneumonia (38% vs 14%). Patients with additional complications like empyema or bronchopulmonary fistula had poor outcomes, with only 5% survival. Surgical lobectomy was performed in 5 (13%) patients, all patients died. Nine (24%) patients survived to ICU and hospital discharge and were still alive at 1-year follow-up.ConclusionsIncidence of NLI in VV ECMO patients is higher than reported in non-ECMO population. Surgical interventions were not successful in this cohort. Considering the combination of severe respiratory failure and necrotising complications, overall survival rate of respiratory ECMO patients with NLI is still reasonable.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666251363944"},"PeriodicalIF":2.1,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144753577","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":"Vitamin C Versus Placebo in Pediatric Septic Shock (VITACiPS) - A Randomised Controlled Trial.","authors":"Jhuma Sankar, Aravindhan Manoharan, Rakesh Lodha, H P Sharma, S K Kabra","doi":"10.1177/08850666251362121","DOIUrl":"https://doi.org/10.1177/08850666251362121","url":null,"abstract":"<p><strong>Background: </strong>Intravenous vitamin C has been evaluated as an adjunctive therapy in adults with septic shock, with mixed results. In pediatric patients, evidence remains limited and its role is yet to be defined.MethodsIn this randomized, double-blind, placebo-controlled trial conducted in the pediatric intensive care unit (PICU) of a tertiary care hospital from February 2022 to March 2024, children <17 years-old with septic shock were randomly assigned to receive either intravenous Vitamin C at 25 mg/kg every 6 h for 72 h or equal volumes of 5% dextrose as placebo. The primary outcome was change in pediatric sequential organ failure assessment (pSOFA) score at 72 h from baseline. Secondary outcome was shock resolution and 28-day mortality.</p><p><strong>Results: </strong>Of 262 children with septic shock, 218 were randomized [median (IQR) age: 96 months (36.5, 133); 128 male]. The adjusted mean difference for change in pSOFA score at 72 h between the Vitamin C and placebo groups was -0.51 [95% CI: (-1.76, 0.75)] (<i>p</i> = 0.43)] (reduction in the Vitamin C group as compared to the placebo group). The 28-day mortality was comparable [Vitamin C, 21.6% versus placebo, 22.5%, RR: 0.96 (0.58-1.58), <i>p</i> = 0.88]. There was no difference in shock resolution or any other outcomes. The incidence of prespecified adverse events (acute kidney injury) was similar in both groups.ConclusionIntravenous Vitamin C administration as adjunctive therapy in pediatric septic shock did not significantly impact organ dysfunction at 72 h. Our findings do not support the routine use of Vitamin C as adjunctive therapy in septic shock in children.</p><p><strong>Trial registration: </strong>Clinical trial registry India (CTRI/2020/01/022886).</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666251362121"},"PeriodicalIF":3.0,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144707738","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":"Integration of Respiratory Care Experts and Emerging Technologies in Critical Care Simulation.","authors":"Michelle S Rausen, Stephanie J Holst, Samantha P Davis","doi":"10.1177/08850666251361064","DOIUrl":"https://doi.org/10.1177/08850666251361064","url":null,"abstract":"<p><p>Respiratory Therapists (RTs) are indispensable members of the critical care team, yet their participation in the design and facilitation simulation-based training (SBT) remains significantly underrepresented. SBT provides healthcare professionals a risk-free environment to develop and maintain clinical and team skills, prepare for uncommon, high-risk scenarios and receive real-time feedback. This review examines critical contributions of RTs, encompassing their expertise in invasive procedures, mechanical ventilation management, and the burgeoning role of Advanced Practice Respiratory Therapists (APRTs). We explore the professional evolution of critical care and the parallel advancements in simulation technology, creating opportunities to enhance the training of all healthcare professionals. RTs possess unique clinical and technical skills ideally suited for the design and facilitation of critical care simulations. Their inclusion offers a powerful means to improve team training and patient outcomes. Integrating RTs into simulation programs has proven challenging. Resource limitations and staffing constraints require a multifaceted solution including dedicated full-time equivalents (FTEs) in simulation programs, specialized training in simulation pedagogy, and fostering robust interprofessional collaboration opportunities for RTs. Research demonstrating the return on investment (ROI) of integrating RTs into simulation is lacking, but remains crucial to securing the necessary resources and support. Research should focus on quantifiable improvements in trainee performance, team dynamics, and patient safety metrics. By fully integrating RTs into SBT, healthcare institutions can significantly enhance the quality of critical care training, fostering improved interprofessional teamwork, leading to better patient outcomes. This strategic investment in RT participation in SBT will yield substantial returns in improved healthcare delivery.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666251361064"},"PeriodicalIF":3.0,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144690533","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":"Optimizing Blood Culture Draws Through Use of an Algorithm Can Reduce Utilization in a Community ICU.","authors":"Nitin Mehdiratta, Erin Gettler, Vijay Krishnamoorthy, Kathleen Claus, Jessica Seidelman","doi":"10.1177/08850666251357494","DOIUrl":"https://doi.org/10.1177/08850666251357494","url":null,"abstract":"<p><p>ObjectiveTo evaluate the implementation of a blood culture algorithm in a mixed medical-surgical ICU at a community hospital, and examine the association with blood culture utilization rate and patient outcomes.DesignA quasi-experimental study examining pre- and post-implementation periods.SettingA 22-bed mixed medical-surgical ICU at a community hospital.PatientsAdult ICU patients were admitted between February 2022 and October 2024, excluding those with neutropenia (<500 cells/μL) or solid organ transplants.InterventionIntroduction of a multidisciplinary-developed blood culture algorithm designed to standardize ordering practices for new clinical events and clearance of bacteremia.Measurements and Main ResultsPrimary outcomes included blood culture event rates. Secondary outcomes were antibiotic days of therapy, mortality, and readmissions. Interrupted time series analysis using Poisson regression models were used to examine associations between the intervention and clinical outcomes. The intervention reduced blood culture event rates by 39% (IRR 0.61, 95% 0.49, 0.75) without significantly decreasing adverse events such as 90-day death incidence (5.7% vs 7.2%, p-value 0.44) and 30-day hospital readmission (11.0% vs 8.0%, p-value 0.11). Inappropriate blood culture rates also decreased.ConclusionsImplementation of a blood culture algorithm in a community ICU setting was associated with reduced blood culture utilization without compromising patient safety. The intervention may substantially reduce unnecessary blood cultures, addressing a key gap in diagnostic stewardship in non-academic settings.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666251357494"},"PeriodicalIF":3.0,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649697","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":"Mechanisms and Impact of Sleep Disturbance in Critical Illness: A Review.","authors":"Shanshan Meng, Xiaoqing Li, Yixuan Chen, Jianfeng Xie, Yi Yang, Fengmei Guo","doi":"10.1177/08850666251359203","DOIUrl":"https://doi.org/10.1177/08850666251359203","url":null,"abstract":"<p><p>Sleep disturbances should not be overlooked in the management of critically ill patients. Critically ill patients frequently encounter sleep deprivation and circadian rhythm disruptions due to various factors, such as underlying diseases, environmental influences, frequent medical interventions, immobility, and delirium. This manuscript aims to review the research progress regarding the mechanisms and impact of sleep disturbances in critically ill patients, thereby enhancing sleep quality and stabilizing circadian rhythms. The synaptic homeostasis hypothesis, neural synchronization and desynchronization processes, memory consolidation mechanisms, metabolic and energy dynamics, immune system modulation, organ functional interactions, disruption of the light-dark cycle, and pharmacological agents utilized are all implicated in the pathophysiology of sleep disorders and circadian rhythm disturbances of critically ill patients. These conditions can exacerbate organ dysfunction, delay recovery, prolong hospital stays, and negatively impact both short-term and long-term outcomes. Understanding the pathogenesis of sleep disorders in critically ill patients effectively is of paramount importance.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666251359203"},"PeriodicalIF":3.0,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144642787","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":"Cerebral Tissue Oximetry Monitoring for Severe Brain Injury.","authors":"Sebastián Vásquez-García, Andrés M Rubiano, Kiwon Lee","doi":"10.1177/08850666251357487","DOIUrl":"https://doi.org/10.1177/08850666251357487","url":null,"abstract":"<p><p>Neurocritical care management for severe brain injuries (SBI) has traditionally focused on intracranial pressure (ICP) and cerebral perfusion pressure (CPP) monitoring and treatment to prevent brain herniation and ischemia. However, the complex pathophysiology of secondary brain injury in SBI patients involves various mechanisms, including oxygen metabolism and transport disturbances, mitochondrial dysfunction, and signaling cascade disruption. Multimodal neuromonitoring (MMN) techniques and modern high-technology resources are being utilized to detect these detrimental phenomena and guide individualized clinical management strategies. Recent and ongoing clinical trials, mainly in traumatic brain injury (TBI), aim to assess the potential benefits, safety, reproducibility, and feasibility of adding cerebral tissue oximetry monitoring (CTOM) to the common practice of ICP monitoring. This state-of-the-art review highlights the essential concepts behind CTOM in patients with SBI, particularly in TBI, and provides practice-oriented analysis and considerations for healthcare providers managing these complex patients.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666251357487"},"PeriodicalIF":3.0,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144642785","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":"Pulse Oximetry Discrepancies and Occult Hypoxemia in ICU Patients: Predictors and Clinical Outcomes.","authors":"Saikou Saidy, Ali Iqbal, Saqib H Baig","doi":"10.1177/08850666251351594","DOIUrl":"https://doi.org/10.1177/08850666251351594","url":null,"abstract":"<p><p>BackgroundPulse oximeters sometimes fail to accurately reflect arterial oxygen saturation (SaO₂), particularly in darker-skinned patients resulting in undiagnosed hypoxemia, potentially delaying recognition and appropriate interventions.Research QuestionWe aimed to evaluate the prevalence and predictors of SpO₂-SaO₂ discrepancies, particularly occult hypoxemia, and to assess their association with clinical outcomes in ICU patients.Study Design and MethodsWe conducted a retrospective cohort analysis using the Blood-gas and Oximetry Linked Dataset (BOLD), analyzing critically ill patients from the eICU-CRD database (2014-2015). Patients with paired SpO₂-SaO₂ measurements within five minutes were included. We identified SpO₂-SaO₂ discrepancies as a difference of >2.99% and defined occult hypoxemia as an arterial partial pressure of oxygen (PaO₂) < 60 mm Hg or SaO₂ < 89% with an SpO₂ > 88%. The primary outcomes included ICU length of stay (LOS), Sequential Organ Failure Assessment (SOFA) score, and in-hospital mortality.ResultsAmong 36,280 ICU patients, 23.6% had SpO₂-SaO₂ discrepancies, and 4.7% had occult hypoxemia. Black patients were overrepresented in both groups, with an adjusted odds ratio (aOR) of 1.35 (95% CI: 1.25-1.47) for discrepancy and 1.22 (95% CI: 1.04-1.47) for occult hypoxemia. Higher BMI, lower pH, elevated creatinine, and higher Charlson Comorbidity Index scores were also significant predictors. Patients with discrepancies had worse clinical outcomes, including increased SOFA scores in the following 24 h (β = 0.31; <i>p</i> < .0001) and higher in-hospital mortality (aOR 1.15; <i>p</i> < .0001). Occult hypoxemia was associated with even worse outcomes, including a longer ICU LOS (IRR 1.12; <i>p</i> < .0001) and significantly increased mortality (aOR 1.73; <i>p</i> < .0001).InterpretationOne in four critically ill patient in our cohort experienced SpO₂-SaO₂ discrepancy which is associated with adverse clinical outcomes. Black race, obesity, and higher comorbidity burden were significant predictors of these discrepancies. Our findings emphasize the need for more rigorous clinician oversight in the use of this technology.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666251351594"},"PeriodicalIF":3.0,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144642788","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":"Aftercare of Solid Abdominal Organ Transplant Recipients.","authors":"Jawad Ahmad","doi":"10.1177/08850666251358768","DOIUrl":"https://doi.org/10.1177/08850666251358768","url":null,"abstract":"<p><p>Abdominal organ transplantation has successfully transformed the lives of patients with end stage kidney, liver, intestinal, and pancreatic disease. Patients awaiting abdominal organ transplant have complex, inter-related organ dysfunction and often have multiple comorbidities. This is further complicated after transplant by the effects of immunosuppression. The intensive care team in conjunction with the transplant team, plays an important role in the management of transplant recipients, particularly in the immediate post-operative period. The focus of this review is the management of the common issues that are seen in the intensive care unit in patients undergoing solid abdominal organ transplant.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666251358768"},"PeriodicalIF":3.0,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144637262","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":"Identifying Opportunities for Fluid Balance Optimization in Critically Ill Children.","authors":"Denise C Hasson, Ami Shah, Chloe G Braun, Ulka Kothari, Steve Drury, Heda Dapul, Julie C Fitzgerald, Celeste Dixon, Andrew Barbera, James Odum, Nina Terry, Scott L Weiss, Susan D Martin, Adam C Dziorny","doi":"10.1177/08850666251359543","DOIUrl":"10.1177/08850666251359543","url":null,"abstract":"<p><p>IntroductionFluid overload (FO), a state of pathologic positive cumulative fluid balance (CFB), is common in Pediatric Intensive Care Units (PICU) and associated with morbidity and mortality. Because different PICUs may have unique needs, barriers, and limitations to accurately report fluid balance (FB) and reduce FO, understanding the drivers of positive FB is needed. We hypothesize CFB >5% and >10% is common on ICU days 1 and 2, but that reasons for high %CFB will vary across sites, as will barriers to accurate FB recording and opportunities to improve FB recording/management.MethodsConcurrent mixed methods study utilizing a retrospective observational cohort design and prospective interview and survey design performed at four tertiary pediatric ICUs. FB data were extracted from the electronic health record. A federated data collection framework allowed for rapid data aggregation. The primary outcome was %CFB on ICU days 1 and 2, defined as total intake minus total output divided by ICU admission weight. Chi-square test and Wilcoxon rank sum tests compared results across and within sites.ResultsAmongst 3,071 ICU encounters, day 2 CFB >5% varied from 39% to 54% (p = 0.03) and day 2 CFB >10% varied from 16% to 25% (p = 0.04) across sites. Urine occurrence recordings and patients receiving >100% Holliday-Segar fluids on Day 1 differed across sites (p < 0.001). Sites discussed overall FB and specific FB goals on rounds with differing frequency (42-73% and 19-39%, respectively), but they reported similar barriers to accurate FB reporting and achievable opportunities to improve FB measurements, including patients/families not saving urine/stool, patients not tracking oral intake, and lack of standardized charting of flushes.ConclusionDay 2 CFB >5% and >10% was common among pediatric ICU encounters but proportion of patients varied significantly across ICUs. Individual ICUs have different drivers of FO that must be targeted to improve FB management.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666251359543"},"PeriodicalIF":3.0,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144642786","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}