Acute and Critical Care最新文献

{"title":"Duration of antibiotic therapy: with or without biomarkers?","authors":"Gonçalo Sequeira Guerreiro, João Fustiga, Pedro Póvoa","doi":"10.4266/acc.002525","DOIUrl":"10.4266/acc.002525","url":null,"abstract":"<p><p>Antimicrobial resistance has emerged as a critical global health challenge. Significant variability in antibiotic prescribing practices underscores the urgent need for high-quality evidence to inform optimal antibiotic prescribing policies. The ideal duration of antimicrobial therapy remains uncertain, and a one-size-fits-all approach is far from ideal. In this review, we examine bacterial growth kinetics and antibiotic pharmacodynamics and explore various strategies for determining the duration of antibiotic therapy: fixed duration, biomarker-guided, clinical course-based, and the more recent double-trigger approach.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":"1-11"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12989933/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145851091","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":"Blinding in critical care trials with subjective outcomes: a note of caution.","authors":"William Jack McIver","doi":"10.4266/acc.005525","DOIUrl":"10.4266/acc.005525","url":null,"abstract":"","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":"41 1","pages":"186-188"},"PeriodicalIF":2.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12989925/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147463499","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 standard- versus high-protein enteral feeding on rectus femoris muscle mass in mechanically ventilated traumatic brain injury: prospective randomized study.","authors":"Hanan Elkalawy, Pavan Sekhar, Mona Fayad, Mohamed Barrima, Mohammad Abdullah","doi":"10.4266/acc.001025","DOIUrl":"10.4266/acc.001025","url":null,"abstract":"<p><strong>Background: </strong>Critically ill patients with muscle wasting experience prolonged intensive care unit (ICU) stays, delayed weaning, and higher mortality. Trauma-induced stress disrupts protein metabolism, leading to immunosuppression and muscle loss. This study evaluates whether high-protein intake through enteral nutrition preserves muscle mass and improves clinical outcomes compared to standard protein intake.</p><p><strong>Methods: </strong>In our multicenter research, 102 critically ill, mechanically ventilated patients (age, 39±7; female, 52; body mass index, 23.8±2.7 kg/m2) were assigned randomly to receive either a high-protein (2.2 g/kg BW/day) or standard (1.5 g/kg BW/day) diet. Enteral nutrition was individualized based on energy expenditure. Ultrasound measured whether the rectus femoris muscle cross-sectional area (RFM-9 CSA) and pennation angle correlated with dietary intake. The data are presented as mean±standard deviation.</p><p><strong>Results: </strong>Protein intake was 1.8±0.2 vs. 1.2±0.4 g/kg/day in high-protein and standard groups, respectively. In the intervention and standard groups, the baseline RFM-CSA and Pennation angle were 11.43±0.87 mm vs. 11.3±0.91 mm and 9.1±0.58 mm vs. 8.91±1.04 mm (P>0.05). Days 5, 10, and 20 showed significant variations in RFM-CSA and pennation angle (P<0.001). The intervention group experienced a shorter ICU length of stay (47±19.5 vs. 56.3±26.9 days, P=0.001) and a shorter period of mechanical ventilation (33±2.3 vs. 30±3.5 days, P=0.001).</p><p><strong>Conclusions: </strong>Early high protein intake significantly preserves muscle mass, reducing the duration of stay in the ICU and the need for mechanical ventilation.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12989931/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145851029","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":"Thoracic fluid content by electrical cardiometry versus diaphragmatic excursion by ultrasound for the prediction of weaning success in patients with lung congestion.","authors":"Shawky Meselhy Elshaer, Ahmed Mostafa Abdelhamid, Enas Wageh Mahdy, Samar Rafik Amin","doi":"10.4266/acc.003984","DOIUrl":"10.4266/acc.003984","url":null,"abstract":"<p><strong>Background: </strong>Predicting the weaning outcomes is critical, since premature or delayed extubation is associated with an increased risk of mortality. This study aimed to compare two physiological indices, thoracic fluid content (TFC) and diaphragmatic excursion (DE), for predicting weaning success in mechanically ventilated patients.</p><p><strong>Methods: </strong>This observational cohort study involved 100 mechanically ventilated patients with congested lungs who were eligible for weaning. Patients' TFC and DE were measured using electrical cardiometry and ultrasonography, respectively, before starting the spontaneous breathing trial. Following extubation, patients were grouped into successful and failed-weaning groups, with failure defined as reintubation or a need for non-invasive ventilation within 48 hours. Respiratory and cardiovascular variables were compared. The receiver operating characteristic (ROC) curve was used to assess the ability of TFC and DE to predict weaning success.</p><p><strong>Results: </strong>Successful weaning occurred in 73 patients (73%) and failed weaning occurred in 27 patients (27%). The two groups' baseline characteristics were comparable; however, TFC and DE were significantly different between the failed- and successful-weaning groups (P<0.001). The area under the ROC curve (AUC) exhibited moderate predictive abilities of both the TFC and DE in predicting weaning success (AUC, 0.805, cutoff <40 kΩ-1 and AUC, 0.774, cutoff >1.45 cm). In the cardiac patient subgroup, TFC exhibited high predictive ability (AUC, 0.861), but DE did not achieve comparable results (AUC, 0.750).</p><p><strong>Conclusions: </strong>Both TFC and DE are significant predictors for successful weaning from mechanical ventilators. In particular, a TFC of <40 kΩ-1 demonstrated an excellent ability to predict weaning success in patients with low ejection fraction.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":"40 4","pages":"557-566"},"PeriodicalIF":2.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12696564/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145726187","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":"Association between emergency department-to-intensive care unit transfer time and mortality in patients with septic shock: a target trial emulation with septic shock in South Korea.","authors":"Ji Hyun Cha, Danbee Kang, Ryoung-Eun Ko, Won Young Kim, Dong-Gon Hyun, Yeon Joo Lee, Woo Hyun Cho, Sunghoon Park, Juhee Cho, Gee Young Suh","doi":"10.4266/acc.003575","DOIUrl":"10.4266/acc.003575","url":null,"abstract":"<p><strong>Background: </strong>Emergency department (ED) overcrowding poses a global challenge, particularly for critically ill patients requiring intensive care unit (ICU) admission. Although delays in ICU transfer increase mortality in critically ill populations, the optimal timing for septic shock remains uncertain.</p><p><strong>Methods: </strong>We conducted a target trial emulation using a prospective cohort of 815 septic shock patients from 19 Korean hospitals. Delayed ICU transfer was defined using restricted cubic splines. The primary outcome was in-hospital mortality. Multivariable logistic regression and inverse probability treatment weighting were used to adjust for confounders of age, sex, comorbidities, severity of illness, and mechanical ventilation use. Subgroup analyses were performed to assess the effect across patient characteristics.</p><p><strong>Results: </strong>The median time of ED-to-ICU transfer was 6.7 hours (interquartile range, 4.7-11.4), and only 7% of patients were transferred within 3 hours. ICU transfer within 3 hours was associated with significantly lower in-hospital mortality (odds ratio, 0.48; 95% CI, 0.24-0.94) compared to later transfers. Mortality risk increased with elapsing time up to 6 hours and then plateaued. The benefit of early ICU transfer was consistent across subgroups but was particularly pronounced in patients requiring extracorporeal membrane oxygenation or continuous renal replacement therapy (P for interaction=0.02).</p><p><strong>Conclusions: </strong>Early ICU transfer within 3 hours significantly reduces mortality in patients with septic shock, with the greatest benefit observed in those requiring advanced organ support. These findings highlight the need for system-wide strategies to reduce ED boarding time and prioritize timely ICU admission for septic shock management.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":"40 4","pages":"548-556"},"PeriodicalIF":2.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12696553/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145726720","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":"Comment on \"Excessive fluid resuscitation is associated with intensive care unit mortality in Pakistani patients with dengue shock syndrome\".","authors":"Hinpetch Daungsupawong, Viroj Wiwanitkit","doi":"10.4266/acc.002875","DOIUrl":"10.4266/acc.002875","url":null,"abstract":"","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":"40 4","pages":"630-631"},"PeriodicalIF":2.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12696556/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145726776","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":"Weight variability at pediatric intensive care unit admission and adverse outcomes in critically ill children.","authors":"Jae Hwa Jung, Yoon Hee Kim, Min Jung Kim, Mireu Park, Hamin Kim, Kyung Won Kim, Myung Hyun Sohn, Soo Yeon Kim","doi":"10.4266/acc.001550","DOIUrl":"10.4266/acc.001550","url":null,"abstract":"<p><strong>Background: </strong>Body weight can fluctuate during critical illness due to factors such as fluid shifts, nutritional status, the type of acute illness, and underlying comorbidities. We investigated the association between acute body weight variability (WV) and clinical outcomes in critically ill pediatric patients.</p><p><strong>Methods: </strong>We retrospectively analyzed data from patients aged 1 month to 18 years who were admitted to the pediatric intensive care unit (PICU) of a university-affiliated tertiary hospital between August 2017 and July 2021. WV was defined as the percentage difference between the measured body weight at PICU admission and the usual body weight, obtained either from recent hospital records or caregiver reports. Associations between WV and clinical outcomes, including PICU mortality and ventilator-free days (VFDs), were assessed.</p><p><strong>Results: </strong>Of the 926 patients, 74 (8.0%) died. Median WV was significantly higher in non-survivors than in survivors (8.7% vs. 0.0%; P<0.001). Increased WV was independently associated with higher mortality (hazard ratio [HR], 1.102; 95% CI, 1.073-1.131) and fewer VFDs (odds ratio [OR], 0.599; 95% CI, 0.524-0.684). Combining WV with Pediatric Index of Mortality 3 score significantly improved mortality prediction over either parameter alone (area under the curve, 0.888; P=0.047).</p><p><strong>Conclusions: </strong>Higher WV at PICU admission is independently associated with adverse clinical outcomes, including increased mortality and fewer VFDs. WV could complement existing mortality prediction models in pediatric critical care.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":"40 4","pages":"605-613"},"PeriodicalIF":2.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12696563/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145726558","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":"Response to \"Correction and clarification on reported percentage error of estimated continuous cardiac output\".","authors":"Antonio Romanelli, Alessandro Calicchio, Salvatore Palmese, Sabato Pascarella, Bruna Pisapia, Renato Gammaldi","doi":"10.4266/acc.005425","DOIUrl":"10.4266/acc.005425","url":null,"abstract":"","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":"40 4","pages":"640-641"},"PeriodicalIF":2.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12696569/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145726695","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":"A case of suspected 2, 4-D ethyl ester poisoning mimicking organophosphate toxicity: a diagnostic and therapeutic challenge.","authors":"Jyothi Koteswara Rao, Sireesha Chilakapati","doi":"10.4266/acc.001250","DOIUrl":"10.4266/acc.001250","url":null,"abstract":"","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":"40 4","pages":"632-634"},"PeriodicalIF":2.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12696557/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145726769","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":"Role of serum magnesium in post-aneurysmal subarachnoid hemorrhagic hydrocephalus.","authors":"Moinay Kim, Hyunchul Jung, Seung Bin Kim, Jun Ha Hwang, Hanwool Jeon, Yeongu Chung, Youngbo Shim, Jae Hyun Kim, Joonho Byun, Aiden Cousins, Wonhyoung Park, Jung Cheol Park, Jae Sung Ahn, Seungjoo Lee","doi":"10.4266/acc.003550","DOIUrl":"10.4266/acc.003550","url":null,"abstract":"<p><strong>Background: </strong>Post-hemorrhagic hydrocephalus (PHH) is a frequent complication of aneurysmal subarachnoid hemorrhage (aSAH), yet the relationship between serum magnesium (Mg) level and PHH remains unclear. To our knowledge, this is the first prospective study to specifically examine the association between admission serum Mg level and PHH in aSAH patients.</p><p><strong>Methods: </strong>In this prospective, multicenter study (October 2019-October 2024), 131 patients with confirmed aSAH were enrolled from four neuro-intensive care units. Patients were stratified by admission serum Mg level as <2.2 mg/dL or ≥2.2 mg/dL. The primary outcome was PHH incidence; secondary outcomes were cerebral vasospasm (CV), delayed cerebral ischemia (DCI), and 30-day modified Rankin Scale (mRS) score.</p><p><strong>Results: </strong>Baseline characteristics were similar between groups. Serum Mg ≥2.2 mg/dL was not significantly associated with reduced vasospasm, DCI, or poor functional outcome. However, serum Mg >2.5 mg/dL correlated with lower PHH incidence in univariate analysis (odds ratio, 0.36; P=0.027) but not in multivariate analysis (P=0.136). Independent predictors of PHH were posterior circulation aneurysm, high Fisher grade, and high Hunt and Hess grade. Poor 30-day mRS was independently associated with high Fisher and Hunt and Hess grades.</p><p><strong>Conclusions: </strong>Admission serum Mg level was not independently associated with PHH, although a potential protective trend was noted at higher levels (>2.5 mg/dL). These findings suggest a possible role of Mg in PHH prevention. Further prospective trials are warranted to clarify the therapeutic potential of Mg and to establish optimal monitoring and correction strategies in aSAH management.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":"40 4","pages":"582-593"},"PeriodicalIF":2.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12696571/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145726793","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}