Journal of Critical Care Medicine最新文献

{"title":"Artificial intelligence algorithms based approach in evaluating COVID-19 patients and management.","authors":"Ioana Hălmaciu, Anca Meda Văsieșiu, Andrei Manea, Andrei Dragomir, Ioana Tripon, Vlad Vunvulea, Cristian Boeriu, Andrea Rus, Minodora Dobreanu","doi":"10.2478/jccm-2025-0032","DOIUrl":"10.2478/jccm-2025-0032","url":null,"abstract":"<p><strong>Introduction: </strong>COVID-19 pneumonia manifests with a wide range of clinical symptoms, from minor flu-like signs to multi-organ failure. Chest computed tomography (CT) is the most effective imaging method for assessing the extent of the pulmonary lesions and correlates with disease severity. Increased workloads during the COVID-19 pandemic led to the development of various artificial intelligence tools to enable quicker diagnoses and quantitative evaluations of the lesions.</p><p><strong>Aim of the study: </strong>This study aims to analyse the correlation between lung lesions identified on CT scans and the biological inflammatory markers assessed, to establish the survival rate among patients.</p><p><strong>Methods: </strong>This retrospective study included 120 patients diagnosed with moderate to severe COVID-19 pneumonia who were admitted to the intensive care unit and the internal medicine department between September 2020 and October 2021. Each patient underwent a chest CT scan, which was subsequently analysed by two radiologists and an AI post-processing software. On the same day, blood was collected from the patients to determine inflammatory markers. The markers analysed in this study include the neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio, platelet-lymphocyte ratio, systemic immune-inflammatory index, systemic inflammation response index, systemic inflammation index, and serum interleukin-6 value.</p><p><strong>Results: </strong>There were strong and very strong correlations between the derived inflammatory markers, interleukin-6, and the CT severity scores obtained by the AI algorithm (r=0.851, p<0.001 in the case of NLR). Higher values of the inflammatory markers and high lung opacity scores correlated with a decreased survival rate. Crazy paving was also associated with an increased risk of mortality (OR=2.89, p=0.006).</p><p><strong>Conclusions: </strong>AI-based chest CT analysis plays a crucial role in assessing patients with COVID-19 pneumonia. When combined with inflammatory markers, it provides a reliable and objective method for evaluating COVID-19 pneumonia, enhancing the accuracy of diagnosis.</p>","PeriodicalId":44227,"journal":{"name":"Journal of Critical Care Medicine","volume":"11 3","pages":"247-256"},"PeriodicalIF":1.7,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12321253/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144790323","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":"Hyperglycemia, diabetes, and de novo diabetes in patients hospitalized in intensive care units for COVID-19 in Colombia: Results from a longitudinal cohort study.","authors":"John Jaime Sprockel, Ana Maria Perez, Maria Camila Chamorro, Jose Alejandro Vergel, Ximena Espinosa, Juan Carlos Vargas, Carlos Angarita, Jhon Edinson Parra","doi":"10.2478/jccm-2025-0026","DOIUrl":"10.2478/jccm-2025-0026","url":null,"abstract":"<p><strong>Introduction: </strong>Hyperglycemia and diabetes have been identified as risk factors for severe COVID-19 and death, with a high rate of reported de novo diabetes. We evaluated their incidence and relationship with adverse outcomes in critically ill COVID-19 patients.</p><p><strong>Methods: </strong>Prospective single-center longitudinal cohort study in adults hospitalized in intensive care units for confirmed COVID-19. ROC curves for serum glucose and glycated hemoglobin were plotted in relation to 60-day mortality. A Cox proportional hazards model was used to assess the association of diabetes and de novo diabetes with 60-day mortality.</p><p><strong>Results: </strong>547 patients were included, with a mean age of 59.8 years; 133 (24.3%) had a history of diabetes, and 67 (12.2%) had de novo diabetes. At 60 days, 317 (57.9%) had died. For mortality, the AUC for glucose at admission was 0.55 (95% CI: 0.48 - 0.62) and 0.51 (95% CI: 0.41 - 0.62) for glycated hemoglobin. In the Cox model, diabetes had an HR of 0.888 (95% CI: 0.695 - 1.135, p: 0.344), history of DM had an HR of 0.881 (95% CI: 0.668 - 1.163, p: 0.371), and de novo diabetes had an HR of 0.963 (95% CI: 0.672 - 1.378, p: 0.835).</p><p><strong>Conclusion: </strong>There was a high incidence of de novo diabetes in patients hospitalized in intensive care for COVID-19. Neither hyperglycemia, history of diabetes, nor de novo diabetes were associated with the development of complications or 60-day mortality.</p>","PeriodicalId":44227,"journal":{"name":"Journal of Critical Care Medicine","volume":"11 3","pages":"257-264"},"PeriodicalIF":1.7,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12321255/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144790328","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":"Rethinking peer review in medicine: From trust to transformation.","authors":"Dan Longrois, Sacha Rozencwaig, Pierre-Grégoire Guinot","doi":"10.2478/jccm-2025-0035","DOIUrl":"10.2478/jccm-2025-0035","url":null,"abstract":"","PeriodicalId":44227,"journal":{"name":"Journal of Critical Care Medicine","volume":"11 3","pages":"205-207"},"PeriodicalIF":1.7,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12321251/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144790332","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":"Exploring pharmacological strategies in the management of ARDS: Efficacy, limitations, and future directions.","authors":"Sultan Almuntashiri","doi":"10.2478/jccm-2025-0030","DOIUrl":"10.2478/jccm-2025-0030","url":null,"abstract":"<p><p>Acute respiratory distress syndrome (ARDS) is a severe inflammatory reaction in the lungs caused by sudden pulmonary and systemic injuries. Clinically, this diverse syndrome is marked by sudden hypoxemic respiratory failure and the presence of bilateral lung infiltrates visible on a chest X-ray. ARDS management remains largely supportive, with a focus on optimizing mechanical ventilation strategies and addressing the underlying causes of lung injury. The current pharmacological approach for ARDS primarily focuses on corticosteroids, neuromuscular blocking agents, and beta-2 agonists, however, none has been definitively proven to be consistently effective in improving clinical outcomes. This review summarizes the latest evidence regarding the effectiveness and limitations of these pharmacological interventions, identifying key areas where further research is needed.</p>","PeriodicalId":44227,"journal":{"name":"Journal of Critical Care Medicine","volume":"11 3","pages":"208-220"},"PeriodicalIF":1.7,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12321257/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144790327","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":"Transient systolic anterior motion in a patient with junctional rhythm in the intensive care unit.","authors":"Alfred Ibrahimi, Saimir Kuci, Ormir Shurdha, Romina Teliti","doi":"10.2478/jccm-2025-0021","DOIUrl":"10.2478/jccm-2025-0021","url":null,"abstract":"<p><p>Systolic anterior motion (SAM) of the mitral valve refers to the unusual movement of the anterior and sometimes the posterior mitral valve leaflets toward the left ventricular outflow tract (LVOT) during systole. This phenomenon is most frequently associated with the asymmetric septal variant of hypertrophic cardiomyopathy (HCM), but it can also occur in conditions like acute myocardial infarction, diabetes mellitus, hypertensive heart disease, after mitral valve repair, and even in asymptomatic individuals during dobutamine stress tests. We present a case of transient SAM induced by a junctional rhythm along with high doses of dobutamine and nitroglycerin in an intensive care unit (ICU) setting. Transesophageal echocardiography (TEE) played a crucial role in detecting SAM and showed that transitioning from a junctional rhythm to a ventricular paced rhythm led to an improvement in the SAM condition.</p>","PeriodicalId":44227,"journal":{"name":"Journal of Critical Care Medicine","volume":"11 3","pages":"307-311"},"PeriodicalIF":1.7,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12321250/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144790333","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":"Comparative analysis of outcomes between anemic and non-anemic critically ill elderly patients in a geriatric ICU in Egypt: A focused study.","authors":"Manar Mamdouh Abd Al Kader, Manar Mostafa Adel Maamoun, Walaa W Aly, Heba Youssif Youssif, Mennatallah Safwat Elaraby","doi":"10.2478/jccm-2025-0028","DOIUrl":"10.2478/jccm-2025-0028","url":null,"abstract":"<p><strong>Background: </strong>Numbers of elderly patients who are being admitted to the intensive care unit (ICU) are increasing; Among ICU patients, elderly patients represent a particular subgroup, with a proportion of up to 50% for patients aged 65 years and over, and on average about 35% of admissions for patients older than 70-75 years. Also, those aged 80 years and older represent around 15% of total ICU population. In Egypt, a study conducted in seven regions found that geriatric patients represent around 48.5% of total ICU admission. Elderly individuals are more susceptible to anemia due to multiple comorbidities and age related changes. Anemia is a common problem among critically ill elderly patients with serious consequences. It is recognized as an independent risk factor for increased mortality and morbidity. In fact, anemia is the most prevalent hematologic disorder in the ICU. The prevalence of anemia among critically ill patients admitted to the ICU ranges from 60 to 66%. Approximately 60% of critically ill patients are anemic at admission, and an additional 40-50% develop anemia during their ICU stay. The condition is particularly common among older patients. Low hemoglobin (Hb) concentrations are associated with prolonged ICU and hospital stays, as well as increased mortality rates. Therefore, anemia is consequently a significant public health issue from the medical and economic perspectives.</p><p><strong>Aim: </strong>To compare outcomes between anemic and non-anemic critically ill elderly patients admitted to the Geriatric ICU at Ahmed Shawky geriatric Hospital, Ain Shams University hospitals.</p><p><strong>Subjects and methods: </strong>A Prospective cohort study was conducted on two hundred sixteen elderly patients of both sexes aged 60 years old or older. It was carried out in the geriatric ICU at Ahmed Shawky geriatric Hospital, Ain Shams University Hospitals. Data collection included participants demographics, medical history, full labs assessment and anemia evaluation based on hemoglobin level, Severity of illness was assessed by validated scoring systems, including the Sequential organ failure assessment (SOFA score) on the first day of admission, as well as Acute physiology and chronic Health Evaluation (APACHE II, APACHE IV). Additionally, the Mortality Probability Model Score (MPM0-III) was applied at first day of admission, 48hours and 72 hours following ICU admission. Anemia management strategies were documented, including the use of blood transfusions, iron therapy and other supportive treatments. Clinical outcomes assessed included ICU length of stay, Site of discharge, in-hospital Mortality and the incidence of Hospital acquired infections.</p><p><strong>Results: </strong>On admission 172(79.6%) of studied subjects were anemic, (90)41.7% had mild anemia, 56(25.9%) had moderate anemia and 26(12%) had severe anemia. Anemic patients showed significantly higher SOFA, MPM 24hrs, MPM 48hrs, MPM 72hrs, APACHE4, SAPSII","PeriodicalId":44227,"journal":{"name":"Journal of Critical Care Medicine","volume":"11 3","pages":"290-300"},"PeriodicalIF":1.7,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12321256/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144790325","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":"Non-invasive SpO2/FiO2 ratio (SFR) as surrogate for PaO2/FiO2 ratio (PFR): A scoping review.","authors":"Madhura Reddy, Malavika Kulkarni, Sushma Thimmaiah Kanakalakshmi, Laxmi Shenoy, Rama Rani KrishnaBhat","doi":"10.2478/jccm-2025-0024","DOIUrl":"10.2478/jccm-2025-0024","url":null,"abstract":"<p><p>Patient oxygenation significantly impacts clinical outcomes, and continuous monitoring is essential, especially in critical care settings where hypoxia is the leading cause of mortality. PFR (PaO2/FiO2 ratio or P/F ratio) is an invasive method for measuring oxygenation requiring arterial blood gas (ABG) sampling, however it carries complications making non-invasive methods more desirable. SFR (SpO2/FiO2 ratio or S/F ratio), a non-invasive tool based on pulse oximetry, provides a cost-effective and rapid way to monitor oxygenation status, especially in settings where advanced methods are unavailable. A total of 575 articles were screened from databases including Web of Science, Scopus, PubMed, and CINAHL, with 32 articles meeting the inclusion criteria for this scoping review wherein SFR was used as a surrogate for PFR and a diagnostic tool for acute lung injury and ARDS. A total of 81,637 patient records were analyzed, including ABG values, pulse oximetry readings, mechanical ventilator settings, and patient diagnoses. The study population included adults, pediatric patients, and neonates admitted to critical care units, with common diagnoses including acute hypoxemic respiratory failure, ARDS, and COVID-19. In the context of COVID-19, SFR was used to predict the need for mechanical ventilation, with a cut-off of 300 indicating a threshold for imminent ventilation requirement. The studies demonstrated statistically significant sensitivity and specificity for SFR, highlighting its utility as a non-invasive tool for assessing oxygenation status. SFR has shown potential as a reliable non-invasive surrogate for determining oxygenation status across all populations.</p>","PeriodicalId":44227,"journal":{"name":"Journal of Critical Care Medicine","volume":"11 3","pages":"221-232"},"PeriodicalIF":1.7,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12321259/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144790330","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":"Assessing volume status in heart failure: The role of renal duplex ultrasound in evaluating cardiorenal morbidity and heart failure mortality.","authors":"Mohamed Elsayed Elrokh, Waleed Shehata Hassan, Ramadan Ahmed Khalil, Ayman Nehad Moharam, Emad Eldin Omar Abdelaziz","doi":"10.2478/jccm-2025-0029","DOIUrl":"10.2478/jccm-2025-0029","url":null,"abstract":"<p><strong>Background: </strong>Critical care physicians face challenges managing decompensated heart failure. This study aims to examine the volume status of patients with decompensated heart failure and evaluate the effectiveness of the renal resistive index (RRI) and renal venous flow pattern (VFP) in assessing volume status and predicting outcomes related to cardiorenal syndrome and mortality.</p><p><strong>Patients and methods: </strong>This prospective study was conducted in the intensive care unit of Kasr Elainy Hospital at Cairo University with patients admitted for acute decompensated heart failure (ADHF). Patients were subjected to clinical screening, laboratory measurements, and echocardiographic examination, including cardiac index renal duplex.</p><p><strong>Results: </strong>This study included 61 patients with a mean age of 64.8±9.1 years. Renal duplex parameters were 0.692±0.087 for the mean RRI, and the percentages of VFP were as follows: continuous 49.2%, biphasic 27.9%, and monophasic 23%. Elevated proBNP levels and IVC collapsibility index were significantly associated with RRI ≥0.75 and abnormal VFP patterns in assessing volume status. The ROC curve of the RRI, VFP, proBNP, SOFA score, ADHERE risk score, and GWTG-HF score for AKI occurrence showed that RRI has 68% sensitivity to detect AKI, but VFP has better results with 86.4% sensitivity. RRI has a prognostic role in predicting in-hospital mortality in acute heart failure, as RRI has 83.3% sensitivity, and VFP showed better results with 83.3% sensitivity. Also, VFP had a better predictive value for the incidence of 3 months mortality with 90.9% sensitivity, while RRI has 63.4% sensitivity.</p><p><strong>Conclusion: </strong>Renal duplex measures, such as VFP and RRI, are highly effective prognostic tools for identifying worsening renal function. Beyond renal outcomes, these measures also serve as reliable predictors of mortality and survival in patients with acute decompensated heart failure, offering clinicians the opportunity to tailor therapeutic approaches early during treatment.</p>","PeriodicalId":44227,"journal":{"name":"Journal of Critical Care Medicine","volume":"11 3","pages":"275-289"},"PeriodicalIF":1.7,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12321260/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144790324","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":"Comparative assessment of hemodynamic changes and outcomes in ventilator weaning.","authors":"Dina Zeid Roushdy, Hossam Ahmed Saad, Randa Aly Soliman, Mohammed Aly Shehata, Mohammed Amin Fakhir","doi":"10.2478/jccm-2025-0022","DOIUrl":"10.2478/jccm-2025-0022","url":null,"abstract":"<p><strong>Introduction: </strong>Mechanical ventilation is fundamental for the management of critically ill patients. The mode of mechanical ventilation may impact the patient in different ways. This study aimed to assess the hemodynamic changes occurring when transitioning between Volume-Controlled Ventilation (VCV) to Variable Pressure Support (VPS) and VCV to Pressure Support (PS) by echocardiography. Also, a comparison between the spontaneous breathing modes in terms of outcomes, specifically, weaning of mechanical ventilation, days on a ventilator, hospital days, and survival, was conducted.</p><p><strong>Methods: </strong>This prospective observational study was conducted on 40 mechanically ventilated patients who showed readiness for weaning from Mechanical ventilation. When transitioning between VCV and VPS in arm A and from VCV to PS in arm B, an echocardiographic assessment (transesophageal echocardiography and transthoracic echocardiography) was performed. Both modes were further compared in terms of weaning and the success of liberation from mechanical ventilation.</p><p><strong>Results: </strong>By comparing both arms, there was a significant difference in velocity time integral (VTI) and stroke volume (SV) for TEE and TTE with p-values of 0.044, 0.022, and 0.05, 0.059, respectively. Also, the cardiac output (CO) showed a statistically significant difference between both arms with a p-value of 0.04. On the other side, there was no statistically significant difference between both arms in terms of ventilator days (p-value of 0.88), length of stay (p-value of 0.651), weaning trial success (p-value of 0.525), and survival rate (p-value of 0.525).</p><p><strong>Conclusion: </strong>The study showed that VPS is a promising modality that can be used in place of PS as a weaning mode. It provides better patient comfort and a more physiological way of breath delivery. The study also concluded that TTE and TEE will show similar results in most patients and that both can be used interchangeably.</p>","PeriodicalId":44227,"journal":{"name":"Journal of Critical Care Medicine","volume":"11 3","pages":"265-274"},"PeriodicalIF":1.7,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12321258/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144790326","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":"Refractory metabolic acidosis and acute abdominal compartment syndrome following Holmium Laser Enucleation of Prostate (HoLEP).","authors":"Murugananth Nithiyananthan, Shitalkumar Sharad Shah, Aarthi Suhitharan, Suhitharan Thangavelautham","doi":"10.2478/jccm-2025-0027","DOIUrl":"10.2478/jccm-2025-0027","url":null,"abstract":"<p><strong>Introduction: </strong>Holmium Laser Enucleation of the Prostate (HoLEP) is a widely used minimally invasive surgical technique for benign prostatic hyperplasia (BPH), offering advantages such as reduced bleeding, shorter hospitalization, and elimination of TURP syndrome. However, complications related to fluid absorption and capsular perforation can still occur. We report a rare case of severe refractory metabolic acidosis and acute abdominal compartment syndrome (ACS) following HoLEP.</p><p><strong>Case presentation: </strong>A 74-year-old male with diabetes and hypertension underwent HoLEP for a 180-ml prostate, during which 106 liters of normal saline irrigation were used over three hours. Intraoperatively, the patient developed sudden respiratory distress and hypotension, with arterial blood gas analysis revealing severe metabolic acidosis (pH 7.141, HCO₃ 11 mEq/L, Cl 115 mEq/L), primarily due to excessive saline absorption and hyperchloremia. The patient required intubation, vasopressor support, and emergency dialysis due to worsening hemodynamic instability. Postoperative imaging revealed intra-abdominal fluid collection, which was drained percutaneously. After two days of intensive ICU management, the acidosis resolved, and the patient was successfully extubated.</p><p><strong>Conclusion: </strong>This is the first case highlighting the potential risks of normal saline absorption and the effect of capsular perforation, which caused ACS and refractory acidosis, and required CRRT due to the prolonged duration of HoLEP.</p>","PeriodicalId":44227,"journal":{"name":"Journal of Critical Care Medicine","volume":"11 3","pages":"301-306"},"PeriodicalIF":1.7,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12321252/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144790331","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}