Journal of Critical Care Medicine最新文献

{"title":"Transition from ICU to home care with long-term invasive ventilation using a single-limb BiPAP circuit.","authors":"Mircea Stoian, Nicolae Demenciuc, Sergiu-Stefan Laszlo, Anca Motataianu, Dragoș-Florin Babă, Adina Stoian","doi":"10.2478/jccm-2026-0004","DOIUrl":"https://doi.org/10.2478/jccm-2026-0004","url":null,"abstract":"<p><strong>Background: </strong>Patients with chronic respiratory failure caused by severe neuromuscular impairment often require long-term respiratory support. Invasive mechanical ventilation (IMV) via tracheostomy is usually provided in intensive care units (ICUs), but in carefully selected cases, it can be safely transitioned to home care. The use of a single-limb ventilator circuit (Single BiPAP circuit with Whisper Swivel II), intended initially for non-invasive ventilation (NIV), may represent a cost-effective and practical alternative for long-term home IMV.</p><p><strong>Case presentation: </strong>We present a 50-year-old male with progressive neuromuscular disease and chronic respiratory failure, who required long-term IMV through a tracheostomy tube. After stabilization in the ICU, ventilation was maintained at home using a Single BiPAP circuit with Whisper Swivel II, combined with a mechanical insufflation-exsufflation (MIE) device for airway secretion clearance. The patient's family received structured training in tracheostomy care, ventilator operation, and secretion management. Over 32-month period, the patient maintained stable respiratory function, experienced a marked reduction in infectious exacerbations, and preserved an acceptable quality of life.</p><p><strong>Conclusion: </strong>In selected patients, long-term home IMV using a single-limb ventilator combined with an MIE device can be a safe, effective, and cost-efficient alternative to conventional ICU-based ventilation. Successful outcomes require structured patient and caregiver training, close follow-up, and coordinated multidisciplinary support.</p>","PeriodicalId":44227,"journal":{"name":"Journal of Critical Care Medicine","volume":"12 1","pages":"117-124"},"PeriodicalIF":1.7,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12909069/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146214478","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":"Late complications of the Rastelli procedure - infective endocarditis and homograft stenosis: A case report.","authors":"Elena-Andreea Sava, Ilie-Marius Ciorba, Claudiu-Ionut Sântean, Andrei Manea, Nicoleta-Maria Crăciun-Ciorba","doi":"10.2478/jccm-2026-0007","DOIUrl":"https://doi.org/10.2478/jccm-2026-0007","url":null,"abstract":"<p><strong>Introduction: </strong>Advances in surgical techniques have significantly improved the prognosis of patients with operated congenital heart malformations. However, late complications pose a challenge to therapeutic management. Although the Rastelli procedure has brought substantial benefits in the surgical correction of transposition of the great arteries in pediatric patients, it carries the burden of numerous complications into adulthood.</p><p><strong>Case presentation: </strong>We present the case of a 35-year-old man diagnosed at birth with D-transposition of the great arteries, atrial septal defect, ventricular septal defect and severe pulmonary stenosis. His medical history revealed two previous operations: a Blalock-Taussing shunt at the age of 4 months and a Rastelli procedure at the age of 3 years. The patient presented to the emergency room with fever and congestive heart failure symptoms. Subsequent investigations revealed two late complications of the Rastelli procedure: stenosis of the homograft connecting the pulmonary artery to the right ventricle and infective endocarditis.</p><p><strong>Conclusions: </strong>Although the clinical context may lead to the assumption that this is a case of congestive heart failure due to homograft stenosis, we must not overlook the possibility of overlapping infective endocarditis, which may also contribute to the development of heart failure.</p>","PeriodicalId":44227,"journal":{"name":"Journal of Critical Care Medicine","volume":"12 1","pages":"125-134"},"PeriodicalIF":1.7,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12908979/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146214377","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":"Impaired peripheral mononuclear cell metabolism in patients at risk of developing sepsis: A cohort study.","authors":"Velma Herwanto, Ya Wang, Maryam Shojaei, Alamgir Khan, Kevin Lai, Amith Shetty, Stephen Huang, Tracy Chew, Sally Teoh, Marek Nalos, Mandira Chakraborty, Anthony S McLean, Benjamin M P Tang","doi":"10.2478/jccm-2026-0010","DOIUrl":"https://doi.org/10.2478/jccm-2026-0010","url":null,"abstract":"<p><strong>Introduction: </strong>Dysregulated immune responses are central to progression of sepsis and closely associated with impaired cellular metabolism. However, most existing studies have focused on late-stage sepsis, leaving metabolic alterations during earlier stages of infection poorly characterised. This study aimed to determine whether immune cell metabolic impairment is already present during uncomplicated infection, prior to the development of sepsis, and to evaluate its potential as an early indicator of immune dysfunction and risk of progression.</p><p><strong>Materials and methods: </strong>Forty patients with sepsis (fulfilling Sepsis-3 criteria) and 27 patients with uncomplicated infection were recruited from the emergency department along with 20 healthy volunteers. Whole blood samples were collected to assess gene expression, cytokine levels, and cellular metabolic functions, including mitochondrial respiration, oxidative stress, and apoptosis in immune cells.</p><p><strong>Results: </strong>Mitochondrial respiration was significantly impaired in immune cells from both uncomplicated infection and sepsis patients compared with healthy controls (p < 0.05), with more pronounced impairment in established sepsis. Downregulation of BCL2 and BBC3 gene expression was observed in sepsis patients (p < 0.05), but not in uncomplicated infection, potentially contributing to differences in the severity of metabolic impairment. Impaired mitochondrial respiration was significantly associated with increased mitochondrial oxidative stress (p < 0.05), which was elevated in uncomplicated infection and further increased in sepsis. Oxidative stress levels also correlated with tumour necrosis factor-α (r = 0.330) and the expression of CYCS, TP53, SLC25A24, and TSPO (rs = -0.4926, -0.4422, 0.4382, and 0.4835, respectively). Despite these metabolic alterations, no significant differences in immune cell apoptosis were observed between uncomplicated infection and sepsis patients.</p><p><strong>Conclusions: </strong>Immune cell metabolic dysfunction is present in patients with uncomplicated infection before the clinical onset of sepsis. Early mitochondrial dysfunction and oxidative stress may represent promising targets for further investigation as early biomarkers of immune dysfunction and sepsis risk.</p>","PeriodicalId":44227,"journal":{"name":"Journal of Critical Care Medicine","volume":"12 1","pages":"64-77"},"PeriodicalIF":1.7,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12908991/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146214336","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":"Real-world clinical decision of andexanet alfa administration for intracranial hemorrhage during anticoagulant therapy using factor Xa inhibitor.","authors":"Shigeo Yamashiro, Keisuke Harada, Shunsuke Izumi, Yusuke Morikawa, Tomoko Ikemoto, Koki Kameno, Tomoaki Goto, Yuki Ohmori, Masatomo Kaji, Akitake Mukasa","doi":"10.2478/jccm-2025-0046","DOIUrl":"https://doi.org/10.2478/jccm-2025-0046","url":null,"abstract":"<p><strong>Introduction: </strong>Andexanet alfa shows excellent hemostatic efficacy in treating intracranial hemorrhage (ICH) during Xa inhibitor therapy. However, its optimal use remains uncertain.</p><p><strong>Aim of the study: </strong>This study aims to evaluate our clinical experience in managing Xa inhibitor-related ICH to clarify its appropriate application.</p><p><strong>Material and methods: </strong>This study was conducted as an observational, non-interventional study. We observed 63 cases of ICH in patients receiving anticoagulation therapy with apixaban, rivaroxaban, or edoxaban. After excluding 14 patients due to fatal outcomes or complete hemostasis, 49 patients were eligible for andexanet alfa administration.</p><p><strong>Results: </strong>The mean age and hematoma volume was 78 years and the 35ml, respectively. Based on patient characteristics and severity, andexanet alfa was administered to 23 patients, while 26 patients received usual care. Hemorrhage enlargement was absent in 22 cases (92.8%) in the andexanet group and in 22 cases (84.6%) in the usual care group. Hemorrhage expansion occurred in three cases from the usual care group, one patient undergoing emergency surgery and another died from uncontrollable intraoperative bleeding. Two patients (8.7%) in the andexanet group experienced thromboembolic events as adverse reactions. At 3 months, the modified Rankin Scale (mRS) was 3 or lower in 39% of the andexanet group and 50% of the standard care group.</p><p><strong>Conclusions: </strong>Although patient selection bias make it difficult to draw definitive conclusions, we recommend considering andexanet alfa administration for cases within several hours of the last Xa inhibitor dose to prevent neurological deterioration. Emergency surgical cases should also be eligible for andexanet alfa to ensure intraoperative safety. Further research is required to determine clinically appropriate indications for its use.</p>","PeriodicalId":44227,"journal":{"name":"Journal of Critical Care Medicine","volume":"12 1","pages":"78-83"},"PeriodicalIF":1.7,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12909070/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146214449","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":"Bimodal distribution of trauma-related acute kidney injury (TrAKI): A clinical review.","authors":"Eleni Sertaridou, Christina Alexopoulou, Vasilios Papaioannou","doi":"10.2478/jccm-2026-0009","DOIUrl":"https://doi.org/10.2478/jccm-2026-0009","url":null,"abstract":"<p><p>Severe trauma remains the leading cause of mortality and disability among young adults. Trauma-related Acute Kidney Injury (TrAKI) has been associated with worse outcomes, increased healthcare costs, and higher morbidity among survivors. The review aims to evaluate, from a pathophysiological perspective, the risk factors for TrAKI at different time points of trauma treatment, highlighting the need for early diagnosis of the syndrome and the implementation of preventive measures. TrAKI is triggered at the time the injury occurs and further worsened by factors related to resuscitation process and potential complications. Severe trauma, due to hemorrhagic shock, is considered to act as the first hit. All subsequent necessary lifesaving procedures applied in trauma management, such as fluid resuscitation, massive transfusion and emergency surgery, could act as second hit, triggering \"early\" TrAKI, within 24-72 hours, due to renal hypoperfusion, hypoxia and reperfusion injury (R/I). The following critical care treatment, seems to act as the final third hit, resulting in \"late\" TrAKI appeared in 5-7 days or even later, caused by distal complications. The incidence of TrAKI shows a biphasic pattern, with an \"early \"peak within 2-3 days after trauma, and a \"delayed\" occurring a week or later. This distinction could be of clinical importance because of its disparate pathophysiology and outcome. Early recognition of risk factors and diagnosis of TrAKI could improve the application of preventive measures and therapeutic treatment, reducing its prevalence.</p>","PeriodicalId":44227,"journal":{"name":"Journal of Critical Care Medicine","volume":"12 1","pages":"5-19"},"PeriodicalIF":1.7,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12908990/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146214365","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":"Latent class analysis to identify subphenotypes predicting pediatric splenic pseudoaneurysm following blunt spleen injuries: A post-hoc analysis.","authors":"Yuki Kishihara, Hideto Yasuda, Morihiro Katsura, Masahiro Kashiura, Shunsuke Amagasa, Yutaro Shinzato, Yutaka Kondo, Shigeki Kushimoto, Takashi Moriya","doi":"10.2478/jccm-2025-0037","DOIUrl":"10.2478/jccm-2025-0037","url":null,"abstract":"<p><strong>Aim of the study: </strong>The rupture of delayed formed splenic pseudoaneurysms after pediatric blunt splenic injuries undergoing nonoperative management (NOM) can be life-threatening. We aimed to identify the sub-phenotypes predicting delayed splenic pseudoaneurysm formation following pediatric blunt splenic injury using latent class analysis (LCA).</p><p><strong>Material and methods: </strong>In this retrospective observational study conducted using a multicenter cohort of pediatric trauma patients, we included pediatric patients (aged ≤16 years) who sustained blunt splenic injuries and underwent NOM from 2008 to 2019. LCA was performed using clinically important variables, and 2-5 sub-phenotypes were identified. The optimal number of sub-phenotypes was determined on the basis of clinical importance and Bayesian information criterion. The association between sub-phenotyping and delayed splenic pseudoaneurysm formation was analyzed using univariate logistic regression analysis with odds ratios (ORs) and 95% confidence intervals (CIs).</p><p><strong>Results: </strong>The LCA included 434 patients and identified three optimal sub-phenotypes. Contrast extravasation (CE) of initial CT in the spleen was observed in 22 patients (68.8%) in Sub-phenotype 1, 49 patients (25.7%) in Sub-phenotype 2, and 22 patients (10.4%) in Sub-phenotype 3 (p = 0.007). Delayed splenic pseudoaneurysm was observed in 46 patients (10.6%), including seven patients (21.9%) in Sub-phenotype 1, 25 patients (13.1%) in Sub-phenotype 2, and 14 patients (6.6%) in Sub-phenotype 3 (p = 0.01). Logistic regression analysis for delayed splenic pseudoaneurysm formation using Sub-phenotype 3 as the reference revealed an OR (95% CI) of 3.94 (1.45-10.7) in Sub-phenotype 1 and 2.12 (1.07-4.21) in Sub-phenotype 2.</p><p><strong>Conclusions: </strong>The LCA identified three sub-phenotypes showing statistically significant differences for delayed splenic pseudoaneurysm formation. Our findings suggest that cases with CE on initial CT imaging may be at increased risk of delayed splenic pseudoaneurysm formation.</p>","PeriodicalId":44227,"journal":{"name":"Journal of Critical Care Medicine","volume":"11 4","pages":"389-398"},"PeriodicalIF":1.7,"publicationDate":"2025-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12593356/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145483239","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":"Evaluation of PRVC and SIMV ventilation techniques on hemodynamic metrics and arterial blood gases in ICU patients with multiple trauma: A randomized, triple-blind study.","authors":"Majid Vatankhah Tarbebar, Saeed Kashani, Fatemeh Darsareh, Tayyebeh Zarei, Bibi Mona Razavi, Latifeh Farzanfar, Mehrdad Sayadinia, Pourya Adibi, Mansour Shabani, Mehrdad Malekshoar, Milad Mohammadi","doi":"10.2478/jccm-2025-0043","DOIUrl":"10.2478/jccm-2025-0043","url":null,"abstract":"<p><strong>Background: </strong>In the Intensive Care Unit (ICU), mechanical ventilation is frequently employed to assist critically injured patients with breathing. The two conventional methods are SIMV and PRVC. This research sought to evaluate these techniques, particularly concerning patient stability and the preservation of optimal blood gas levels.</p><p><strong>Methods: </strong>We carried out a parallel-group, randomized, triple-blind clinical trial. One hundred two patients with multiple traumas admitted to the ICU were randomly allocated to either the SIMV group or the PRVC mode group. The main outcome was measured through blood hemodynamic parameters, blood pressure, and heart rate in mechanically ventilated patients with multiple traumas. The secondary outcome measured was the composition of arterial blood gases (pH, PaCO2, PaO2, HCO3, and SpO2).</p><p><strong>Result: </strong>The average age in the SIMV and PRVC groups was 38.53±16.29 and 38.04±15.26 years, respectively, showing no statistical significance. Arterial blood gas parameters, including arterial blood pH, PaCO2, PaO2, HCO3, and SpO2, were similar in the SIMV and PRVC groups at the beginning of admission and 8 and 12 hours after admission, and there was no significant difference. Comparing vital signs including blood pressure (systolic, diastolic, and mean arterial pressure) and heart rate was similar in the SIMV and PRVC groups at the beginning of admission and 8 and 12 hours after admission.</p><p><strong>Conclusion: </strong>No significant justification was identified to favor one approach over the other for trauma patients receiving ventilatory support. Both groups stayed consistent regarding vital signs and other health indicators.</p>","PeriodicalId":44227,"journal":{"name":"Journal of Critical Care Medicine","volume":"11 4","pages":"376-382"},"PeriodicalIF":1.7,"publicationDate":"2025-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12592848/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145483255","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":"Incidence rate of post-intensive care syndrome-family in Japan: A post-hoc analysis of a prospective observational study.","authors":"Akihiro Takaba, Masaaki Sakuraya, Daisuke Kawakami, Shigeki Fujitani","doi":"10.2478/jccm-2025-0042","DOIUrl":"10.2478/jccm-2025-0042","url":null,"abstract":"<p><strong>Background: </strong>Family members in intensive care units (ICUs) may develop post-intensive care syndrome-family (PICSF), characterized by psychiatric disorders such as anxiety, depression, and post-traumatic stress disorders (PTSD). A previous study reported that approximately 13% of patient families in Japan develop PICS-F symptoms six months following ICU discharge, which is lower compared to other countries. However, this figure may be underestimated by administrative claims data in Japan. Although clinical guidelines recommend interventions to prevent PICS-F, the implementation rate of these interventions in Japan remains unclear. This study addresses the epidemiology of PICSF among family members of ICU survivors and the implementation of interventions for preventing PICS-F in Japan.</p><p><strong>Methods: </strong>A post-hoc analysis of a prospective multicenter cohort study was conducted, focusing on mechanically ventilated ICU survivors and their closest relatives. This study covered 16 ICUs in 14 hospitals between April 2019 and September 2020, using questionnaires to assess the PICS-F symptoms among relatives using the Hospital Anxiety (HADS-A) and Depression (HADS-D) Scale and the Impact of Event Scale-Revised (IES-R). The implementation rate of interventions to prevent PICS-F was also evaluated.</p><p><strong>Results: </strong>Of the 151 surveyed relatives, 104 relatives were assessed after 6 months. Notably, PICS-F was identified among 45.2% of relatives, with depression (36.5%), anxiety (31.7%), and PTSD (24.0%). Relatives with PICS-F were less likely to maintain their original employment compared to those without (61.3% vs 85.3%, P=0.047). While 63.5% of relatives received at least one preventive intervention during the ICU stay, more than one-third received none.</p><p><strong>Conclusions: </strong>The incidence of PICS-F in Japan is higher than previously reported, affecting nearly half of patient relatives. Moreover, the implementation rate of interventions to prevent PICS-F is low. These findings suggest the need for reinforced socioeconomic support.</p>","PeriodicalId":44227,"journal":{"name":"Journal of Critical Care Medicine","volume":"11 4","pages":"399-408"},"PeriodicalIF":1.7,"publicationDate":"2025-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12593363/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145483210","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":"Age-related differences in sepsis outcomes: A comparative analysis of elderly and very elderly ICU patients.","authors":"Ozgur Kilic, Enver Demircan","doi":"10.2478/jccm-2025-0034","DOIUrl":"10.2478/jccm-2025-0034","url":null,"abstract":"<p><strong>Background: </strong>The rapid aging of the global population has amplified the clinical and economic burden of sepsis, a leading cause of morbidity and mortality in the elderly. Within this demographic, the \"very elderly\" (≥80 years) represent a particularly vulnerable subgroup. This study evaluates and compares the outcomes and prognostic factors of elderly (65-79 years) and very elderly ICU patients with sepsis or septic shock.</p><p><strong>Methods: </strong>A retrospective observational study was conducted in a single-center ICU, including 251 patients aged ≥65 years diagnosed with sepsis or septic shock. Patients were categorized as elderly (65-79 years, N=162) or very elderly (≥80 years, N=89). Data on demographics, comorbidities, laboratory results, infection sources, treatments, and outcomes were collected. Prognostic factors for mortality were analyzed using binary logistic regression.</p><p><strong>Results: </strong>The very elderly group exhibited higher rates of dementia, immobility, and fungal infections, while malignancy was more prevalent in the elderly group. ICU length of stay was longer in the very elderly group (median 8 vs. 6 days, P=0.027). ICU mortality was lower in the very elderly group, showing a trend toward significance but not reaching statistical significance (70.8% vs. 82.1%, P=0.056). Shared predictors of mortality included higher SOFA scores, malignancy, hospital-acquired sepsis, invasive mechanical ventilation, and acute kidney injury.</p><p><strong>Conclusion: </strong>This study highlights differences in sepsis outcomes between elderly and very elderly patients. The findings underscore the importance of developing and implementing age-specific management strategies to improve outcomes in these high-risk populations. These insights contribute to a more tailored and effective approach to geriatric critical care.</p>","PeriodicalId":44227,"journal":{"name":"Journal of Critical Care Medicine","volume":"11 4","pages":"337-346"},"PeriodicalIF":1.7,"publicationDate":"2025-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12592921/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145483218","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":"Impact of protein intervention timings on critically ill patients: A systematic review and meta- analysis.","authors":"Pranav Kumar Sharma, Sanjiya Arora, Tirth Bhavsar, Mamta Kamboj, Rahul Kamboj, Varnika Gupta, Anitha Sigamani Ramamurthi, Kumari Uthayakumar, Ajay Singh, Sachin Mahendrakumar Chaudhary, Arghadip Das, Arianisa Bajrami, Sumesh Singh, Devendra Tripathi","doi":"10.2478/jccm-2025-0047","DOIUrl":"10.2478/jccm-2025-0047","url":null,"abstract":"<p><strong>Background: </strong>Critically ill patients experience metabolic alterations that promote muscle atrophy and protein catabolism, increasing morbidity and mortality. While adequate protein provision is essential, the optimal timing remains controversial. Guidelines recommend higher protein targets, but evidence from randomized controlled trials is limited and inconsistent.</p><p><strong>Aim: </strong>To evaluate the effects of early versus late protein supplementation on mortality, complications, and clinical outcomes in critically ill patients.</p><p><strong>Methods: </strong>A systematic review and meta-analysis were conducted using PubMed, Embase, Cochrane Library, and Google Scholar (January 2010-December 2022). Studies comparing early and late protein administration in adult ICU patients were included. Primary outcomes were mortality, infectious complications, overall complications, pneumonia, ICU/hospital length of stay, and mechanical ventilation duration.</p><p><strong>Results: </strong>Thirteen studies (8 RCTs, 3 retrospective, 2 prospective cohorts) involving 10,672 patients were analyzed. Mortality (RR = 0.87, 95% CI: 0.74-1.04, p = 0.11; I² = 36%), overall complications (RR = 0.87, 95% CI: 0.74-1.02, p = 0.08; I² = 26%), infectious complications (RR = 0.86, 95% CI: 0.58-1.27, p = 0.37; I² = 65%), and pneumonia (RR = 0.78, 95% CI: 0.41-1.48, p = 0.34; I² = 0%) showed no significant differences between early protein (EP) and late protein (LP) groups. EP significantly reduced ICU length of stay (MD = -0.28 days, 95% CI: -0.33 to -0.23, p < 0.00001; I² = 99%) and mechanical ventilation duration (MD = -0.66 days, 95% CI: -0.90 to -0.41, p < 0.00001; I² = 85%), but was associated with a longer hospital stay (MD = 0.47 days, 95% CI: 0.31-0.63, p < 0.00001; I² = 98%).</p><p><strong>Conclusion: </strong>Early protein supplementation does not significantly affect mortality or major complications but may shorten ICU stay and ventilation duration. High heterogeneity for some outcomes warrants cautious interpretation.</p>","PeriodicalId":44227,"journal":{"name":"Journal of Critical Care Medicine","volume":"11 4","pages":"323-336"},"PeriodicalIF":1.7,"publicationDate":"2025-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12592978/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145483234","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}