Journal of the Intensive Care Society最新文献

{"title":"Characteristics and outcomes of auto-intoxicated patients admitted to the ICU: A retrospective cohort study.","authors":"Lotte Van Nylen, Sander Swennen, Ina Callebaut, Laurien Geebelen, Jasperina Dubois, Jeroen Herbots, Marijke Nulens, Jeroen Vandenbrande, Michiel Vantornout, Björn Stessel","doi":"10.1177/17511437241311102","DOIUrl":"10.1177/17511437241311102","url":null,"abstract":"<p><strong>Introduction: </strong>Auto-intoxication represents a considerable number of Intensive care unit (ICU) admissions. Literature focusing on characteristics and outcomes of ICU-admitted auto-intoxicated patients is limited.</p><p><strong>Objectives: </strong>We aimed to identify the quantity of intensive care admissions attributable to auto-intoxication in a Belgian tertiary center, to examine characteristics and outcomes of these patients, and to assess the impact of the covid-19 pandemic on these variables.</p><p><strong>Methods: </strong>In this retrospective cohort study, all patients admitted to the ICU of JESSA hospital, Hasselt, Belgium with a diagnosis of auto-intoxication between January 1st 2017 and December 31st 2022, were included in the study. We collected data on patient characteristics, comorbidities, type of intoxication and outcomes including the length of ICU and hospital stay and mortality.</p><p><strong>Results: </strong>In total, 342 patients were included in the dataset, covering 2.44% of all ICU admissions from January 1st 2017 to December 31st 2022. Although auto-intoxication occurred in all age-categories, the age group from 18 to 29 years old, showed the highest prevalence (24%). More woman (57.6%) than man (42.4%) were included in the study. Of all included patients, 21.6% had a history of previous suicide attempt and 36.5% of previous auto-intoxication. The most common substances ingested were sedatives (44.4%), illicit drugs (20.2%), analgesics (17.8%), and antidepressants (16.7%) whereas in 54.1% of the cases, a combination of substances was ingested. Type of intoxication was separated into four groups: suicide attempt, accidental, iatrogenic and recreational use with suicide attempt accounting for 71.3% of all auto-intoxications. The prevalence of ICU-admitted auto-intoxicated patients remained stable over the 5-year study period. An impact of the Covid-19 pandemic on this prevalence could not be established. Overall mortality was low with an ICU- and hospital mortality of 1.75% and 2.6% respectively. Total mortality at time of dataset closure, on the other hand, was 7.2%.</p><p><strong>Conclusions: </strong>The impact of auto-intoxication on ICU resource utilization is relatively high and the risk of recidivism is substantial. ICU- and in-hospital mortality after auto-intoxication is low, although these patients have a substantial risk for death in years to come after hospital discharge.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"17511437241311102"},"PeriodicalIF":2.1,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11881095/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Levetiracetam dosing in continuous renal replacement therapy: A systematic review and development of a novel pharmacokinetic model to optimise dosing in critically ill patients. Do recommended doses achieve therapeutic drug concentrations?","authors":"James Sweatman, Sarraa Al-Mahdi, Dagan O Lonsdale, Susannah Leaver, Andrew Rhodes","doi":"10.1177/17511437251320557","DOIUrl":"10.1177/17511437251320557","url":null,"abstract":"<p><strong>Aim: </strong>Levetiracetam is a widely used anti-epileptic in the critical care setting that is almost exclusively (>90%) renally excreted. The altered pharmacokinetics of levetiracetam have been widely studied in intermittent haemodialysis but the evidence and guidance on dosage in continuous renal replacement therapy is varied and poorly defined. Understanding this is critical as a significant number of critically unwell patients develop renal failure requiring continuous renal replacement therapy. The aim of this systematic review is to investigate the pharmacokinetics of levetiracetam in such patients and to understand the implications on dosing strategies.</p><p><strong>Methods: </strong>A systematic review of the available literature from 2000 to November 2022 was conducted. Seven articles were identified for inclusion from 54 records. A novel hybrid model was developed to evaluate the quality of pharmacokinetic and haemofiltration data. This data was used to develop a one-compartment model that simulated dosing strategies in 10,000 patients based on an assumed steady state of 72 hr and target trough concentrations of 12-46 mcg/mL.</p><p><strong>Results: </strong>From the seven articles included, pharmacokinetic data was retrieved for 24 individual patients. Total clearance was 3.49-4.63 L/hr (mean 3.55, S.D. 0.52). Elimination half-life was 5.66-12.88 hr (mean 9.41, S.D. 2.86). Volume of distribution was 0.45-0.73 L/kg. The proportion of total clearance attributable to continuous renal replacement therapy was 52%-73% (mean 54.7%, S.D. 13.5). Our simulations demonstrate that more than half of patients who received twice daily doses of 750 mg or greater without a loading dose achieved therapeutic drug concentrations. The time to achievement of therapeutic drug concentrations was greatly reduced by the addition of a 60 mg/kg loading dose (up to a maximum of 4.5 g). The use of a reduced loading dose or twice daily doses of 500 mg or less without loading were more likely to result in prolonged sub-therapeutic drug concentrations.</p><p><strong>Conclusion: </strong>Levetiracetam clearance in haemofiltration is similar to healthy adults with normal renal function (GFR > 90 mL/min). The use of reduced doses due to renal failure in critically ill patients may result in sub-therapeutic drug concentrations in a high number of patients. A twice daily dosing of 750-1000 mg with an initial loading dose of 60 mg/kg should be considered in such patients alongside therapeutic drug monitoring.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"17511437251320557"},"PeriodicalIF":2.1,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11851601/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143516833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The MRC CRASH trial at 20: Time to reappraise corticosteroids for traumatic brain injury?","authors":"Matt Thomas, Charis Banks, Andy Ray","doi":"10.1177/17511437251323087","DOIUrl":"10.1177/17511437251323087","url":null,"abstract":"","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"17511437251323087"},"PeriodicalIF":2.1,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11847313/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143494018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of pre-hospital hypertonic saline on neutrophil to lymphocyte ratio in traumatic brain injury: A retrospective analysis.","authors":"Adam Jr Watson, Ryan Riordan, Julian Hannah, Tim Nicholson Roberts, James Plumb","doi":"10.1177/17511437251320553","DOIUrl":"10.1177/17511437251320553","url":null,"abstract":"<p><p>Hypertonic saline (HTS) may have anti-inflammatory properties. We aimed to investigate the effect of pre-hospital HTS on neutrophil to lymphocyte ratio (NLR), a simple marker of systematic inflammation, in patients with severe traumatic brain injury (TBIs). We included 110 adults with blunt TBIs requiring pre-hospital anaesthesia (median age 57.1 years, 67% male). On hospital admission, median NLR was lower in patients who received pre-hospital HTS (7.9 vs 11.9, <i>p</i> = 0.021), and in multivariable analysis, HTS use remained associated with NLR (<i>p</i> = 0.048). We believe our findings highlight the neuroinflammatory properties of HTS as an area for future research.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"17511437251320553"},"PeriodicalIF":2.1,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11846088/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trace elements: Clinical perspectives in the critically ill.","authors":"Varshan Karunakaran, Keri Harding, Alexander Sarnowski, Edward Walter","doi":"10.1177/17511437241305269","DOIUrl":"10.1177/17511437241305269","url":null,"abstract":"<p><p>Trace elements are required in minute quantities in the diet but play a vital role in a wide variety of functions, such as co-factors in antioxidant reactions and normal immune function to DNA and protein synthesis and skeletal and tissue remodelling and repair. Critically ill patients are at risk of trace element deficiency or excess, due to changes in intake, absorption, metabolism or excretion. Deficiency or excess can lead to a wide range of cellular and organ dysfunction that may be seen in patients with an acute or critical illness, including cardiomyopathy, impaired glucose tolerance and reduced oxygen delivery. In addition, various diseases, such as systemic inflammation and renal and intestinal failure, and intensive care treatments, such as parenteral nutrition, renal replacement therapy and diuretics, can increase the likelihood of deficient or excessive amounts of micronutrient levels. This narrative review discusses sources and normal physiology of trace element handling and how this may be impaired in critically ill patients. It then discusses various conditions seen in critically ill patients that may be caused or exacerbated by abnormal trace element status and the current evidence around whether supplementation is of benefit in particular critical illnesses.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"17511437241305269"},"PeriodicalIF":2.1,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11800230/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143382918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improved intensive care lighting and staff wellbeing: A pilot feasibility service evaluation.","authors":"Sampath Weerakkody, Jemima Unwin Teji, Edward Barrett, Margarita Kousteni, Lorna Flores-Villa, Emma Jenkins, Hugh Montgomery","doi":"10.1177/17511437251315570","DOIUrl":"10.1177/17511437251315570","url":null,"abstract":"<p><strong>Background: </strong>The lighting environment in intensive care units (ICUs) is markedly different from natural light, potentially disrupting patients' circadian rhythms and impacting staff wellbeing. New lighting technologies may mitigate these effects.</p><p><strong>Methods: </strong>A mixed methods service evaluation was conducted in a London ICU using Dyson Lightcycle™ luminaires (DLs) to evaluate staff wellbeing. Wellbeing assessments and user perceptions of the built environment were conducted using validated questionnaires before, during, and after DL deployment. Existing ambient light usage was measured using HOBO devices installed on the ceiling. Additionally, data on DL usage (including spectral data) were collected continuously using Raspberry Pi™ sensors.</p><p><strong>Results: </strong>DL usage was high (>70% per 24 h), primarily as supplementary lighting. Users found DLs easy to control and beneficial for clinical and administrative tasks. Participants assigned a 12.5% higher satisfaction score rated from 0 to 8 of lighting overall during deployment compared to pre-deployment (6.06 ± 0.29 and 5.06 ± 0.60, respectively; <i>p</i> = 0.20). Control variables for the built environment (noise, temperature and air quality) remained unchanged. Staff reported improvements in mood (38%, <i>p</i> < 0.001), fatigue (17.7%, <i>p</i> < 0.001), and sleep quality (21.2%, <i>p</i> = 0.01) during DL use.</p><p><strong>Discussion: </strong>In the first pilot feasibility service evaluation of its kind, the relationship between ICU lighting quality and staff wellbeing was investigated using DLs. We show that it is feasible to equip an ICU with a novel mode of lighting to evaluate both illuminance and user-centred outcomes. The study suggests a positive association between DL use and staff wellbeing, with notable improvements in mood, fatigue and sleep quality. The nature of the emitted light may enhance the space rather than simply illuminate, thus further adding to a feeling of wellbeing. These findings support data from studies which report effects of light brightness and colour on mood. Additionally, there appears to be a signal towards benefit to the user when additional lighting is provided, compared to the current overhead fluorescent luminaires prevalent in most ICUs. In this service evaluation these benefits were demonstrated in ICU staff operating the device. However, it is conceivable that effects such as improved mood and reduced sleep disturbance may have patient benefits too.</p><p><strong>Conclusion: </strong>Local lighting systems like DLs show promise in enhancing ICU staff wellbeing. Their impact on patient outcomes and the potential for broader implementation deserve further investigation in appropriately designed and powered larger-scale trials.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"17511437251315570"},"PeriodicalIF":2.1,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11800227/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The use of machine learning based models to predict the severity of community acquired pneumonia in hospitalised patients: A systematic review.","authors":"Caitlin Lythgoe, David Oliver Hamilton, Brian W Johnston, Sandra Ortega-Martorell, Ivan Olier, Ingeborg Welters","doi":"10.1177/17511437251315319","DOIUrl":"10.1177/17511437251315319","url":null,"abstract":"<p><strong>Background: </strong>Community acquired pneumonia (CAP) is a common cause of hospital admission. CAP carries significant risk of adverse outcomes including organ dysfunction, intensive care unit (ICU) admission and death. Earlier admission to ICU for those with severe CAP is associated with better outcomes. Traditional prediction models are used in clinical practice to predict the severity of CAP. However, accuracy of predicting severity may be improved by using machine learning (ML) based models with added advantages of automation and speed. This systematic review evaluates the evidence base of ML-prediction tools in predicting CAP severity.</p><p><strong>Methods: </strong>MEDLINE, EMBASE and PubMed were systematically searched for studies that used ML-based models to predict mortality and/or ICU admission in CAP patients, where a performance metric was reported.</p><p><strong>Results: </strong>11 papers including a total of 351,365 CAP patients were included. All papers predicted severity and four predicted ICU admission. Most papers applied multiple ML algorithms to datasets and derived area under the receiver operator characteristic curve (AUROC) of 0.98 at best performance and 0.57 at worst, with a mixed performance against traditional prediction tools.</p><p><strong>Conclusion: </strong>Although ML models showed good performance at predicting CAP severity, the variables selected for inclusion in each model varied significantly which limited comparisons between models and there was a lack of reproducible data, limiting validity. Future research should focus on validating ML predication models in multiple cohorts to derive robust, reproducible performance measures, and to demonstrate a benefit in terms of patient outcomes and resource use.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"17511437251315319"},"PeriodicalIF":2.1,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11791961/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143255981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antiplatelet and anticoagulation use and risk of bleeding from percutaneous dilatational tracheostomy insertion: Systematic review and meta-analysis.","authors":"Mark Brown, Fayez Elsawy, Benjamin Allison, Brendan McGrath","doi":"10.1177/17511437251314298","DOIUrl":"10.1177/17511437251314298","url":null,"abstract":"<p><strong>Introduction: </strong>Antiplatelet and anticoagulation therapies are frequently required in acutely unwell patients and confer an increased propensity for procedural bleeding. During percutaneous tracheostomy insertion, the decision to stop these therapies is left to clinical decision-makers. This meta-analysis summarises the risk of bleeding associated with antiplatelet and anticoagulation therapy during percutaneous tracheostomy insertion.</p><p><strong>Method: </strong>We conducted a systematic review and meta-analysis of studies which reported intraoperative bleeding during percutaneous tracheostomy while on single antiplatelet therapy (SAPT) or dual antiplatelet therapy (DAPT), as well as therapeutic anticoagulation (TAC). Groups were compared against those with prophylactic or no anticoagulation. Studies were pooled using random effects via the inverse variance method.</p><p><strong>Results: </strong>Four databases found 22 eligible studies, of which 14 studies presented data for meta-analysis representing 3,485 percutaneous tracheostomy insertion procedures. These included six studies that reported intraoperative bleeding outcome SAPT, six for DAPT and five for TAC. Overall, methodological quality was poor. No significant association was found for SAPT (Odds ratio 1.58; 95% confidence interval 0.72-4.41); <i>P</i> = 0.25; <i>I</i> ² = 81%) and TAC (OR 1.79; 95% CI 0.58-5.56; <i>P</i> = 0.35; I² = 35%). The DAPT group was associated with increased bleeding with an OR of 2.05 (95% CI 1.18-3.56; <i>P</i> = 0.01; <i>I</i> ² = 0%).</p><p><strong>Conclusion: </strong>Our study supports temporarily withholding DAPT or TAC (if clinically feasible) to minimize bleeding risks associated with percutaneous dilatational tracheostomy.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"17511437251314298"},"PeriodicalIF":2.1,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11791969/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143255964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting risk of maternal critical care admission in Scotland: Development of a risk prediction model.","authors":"Lorna M Cowan, Imad Adamestam, John A Masterson, Monika Beatty, James P Boardman, Louis Chislett, Pamela Johnston, Judith Joss, Heather Lawrence, Kerry Litchfield, Nicholas Plummer, Stella Rhode, Timothy S Walsh, Arlene Wise, Rachael Wood, Christopher J Weir, Nazir I Lone","doi":"10.1177/17511437251313700","DOIUrl":"10.1177/17511437251313700","url":null,"abstract":"<p><strong>Background: </strong>Identifying women at highest or lowest risk of perinatal intensive care unit (ICU) admission may enable clinicians to risk stratify women antenatally so that enhanced care or elective admission to ICU may be considered or excluded in birthing plans. We aimed to develop a statistical model to predict the risk of maternal ICU admission.</p><p><strong>Methods: </strong>We studied 762,918 pregnancies between 2005 and 2018. Predictive models were constructed using multivariable logistic regression. The primary outcome was ICU admission. Additional analyses were performed to allow inclusion of delivery-related factors. Predictors were selected following expert consultation and reviewing literature, resulting in 13 variables being included in the primary analysis: demographics, prior health status, obstetric history and pregnancy-related factors. A complete case analysis was performed. <i>K</i>-fold cross validation was used to mitigate against overfitting.</p><p><strong>Results: </strong>Complete data were available for 578,310 pregnancies, of whom 1087 were admitted to ICU (0.19%). Model performance was fair (area under the ROC curve = 0.66). A comparatively high cut-point of ⩾0.6% for ICU admission risk resulted in a negative predictive value (NPV) of 99.8% (specificity 97.8%) but positive predictive value (PPV) of 0.8% (sensitivity 9.1%). Models including delivery-related factors demonstrated superior discriminative performance.</p><p><strong>Conclusions: </strong>Our model for maternal ICU admission has an acceptable discriminative performance. The low frequency of ICU admission and resulting low PPV indicates that the model would be unlikely to be useful as a 'rule-in' test for pre-emptive consideration of ICU admission. Its potential for improving efficiency in screening as a 'rule-out' test remains uncertain.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"17511437251313700"},"PeriodicalIF":2.1,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11758435/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of traumatic brain injury and acute respiratory distress syndrome-What evidence exists? A scoping review.","authors":"Margot Kelly-Hedrick, Sunny Liu, Jordan Hatfield, Alexandria L Soto, Alyssa M Bartlett, Helen J Heo, Ellen O'Callaghan, Evangeline Arulraja, Samantha Kaplan, Tetsu Ohnuma, Vijay Krishnamoorthy, Katherine Colton, Jordan Komisarow","doi":"10.1177/17511437241311398","DOIUrl":"10.1177/17511437241311398","url":null,"abstract":"<p><strong>Introduction: </strong>Up to 20% of patients with traumatic brain injury (TBI) develop acute respiratory distress syndrome (ARDS), which is associated with increased odds of mortality. Guideline-based treatment for ARDS includes \"lung protective\" ventilation strategies, some of which are in opposition to \"brain protective\" strategies used for ventilation with patients with TBI. We conducted a scoping review of ventilation management strategies with clinical outcomes among patients with TBI and ARDS.</p><p><strong>Methods: </strong>We searched three databases (MEDLINE, Embase, Web of Science) using a systematic search strategy. We included any studies of patients with TBI and ARDS with ventilation strategies including PEEP, oxygenation, prone positioning, recruitment maneuvers, pulmonary vasodilators (e.g., nitric oxide), high frequency oscillatory ventilation (HFOV), and extracorporeal membrane oxygenation (ECMO). All clinical outcomes were included. Extracted data included details about sample (age, gender), study design, inclusion/exclusion criteria, intervention details, and outcomes.</p><p><strong>Results: </strong>The search returned 10,514 articles, 35 of which met final inclusion criteria. Interventions studied included ECMO (<i>n</i> = 13 articles), HFOV (<i>n</i> = 4), PEEP interventions (<i>n</i> = 3), prone positioning (<i>n</i> = 3), vasodilators (<i>n</i> = 4), and other lung recruitment maneuvers (<i>n</i> = 9). No randomized controlled trials were identified; studies were mostly case reports (<i>n</i> = 18/35, 51%) and series (<i>n</i> = 7/35, 20%), with some cohort studies (<i>n</i> = 5/35, 14%) and non-randomized experimental trials (<i>n</i> = 5/35, 14%), all at single institutions. Outcomes included physiologic changes (e.g., change in cerebrodynamics or hemodynamics with intervention) and clinical outcomes such as mortality, complications, or neurologic recovery. Five studies (14%) included pediatric patients.</p><p><strong>Discussion: </strong>In this scoping review of ventilatory strategies for patients with concurrent TBI and ARDS, we found variation in heterogeneity of study design, interventions, and outcomes. Studies were mostly case report/series and observational studies, seriously limiting our ability to draw conclusions about effectiveness of interventions. Targeted areas of further research are discussed.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"17511437241311398"},"PeriodicalIF":2.1,"publicationDate":"2025-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11742134/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}