Critical Care Research and Practice最新文献

{"title":"Incidence of and Risk Factors for Do-Not-Resuscitate Orders in Critically Ill Children: Insights From a Tertiary Care Center in Saudi Arabia.","authors":"Tareq Alayed, Waad Al-Sowat, Abdullah Alturki, Fahad Aljofan, Moath Alabdulsalam, Tariq Alofisan, Raghad Alhuthil, Munirah Alshalawi, Mansour Alghamdi","doi":"10.1155/ccrp/9948312","DOIUrl":"10.1155/ccrp/9948312","url":null,"abstract":"<p><p><b>Objectives:</b> To investigate the incidence and determinants of do-not-resuscitate (DNR) orders, as well as mortality-associated risk factors, in the pediatric intensive care unit (PICU) of a tertiary care center in Saudi Arabia. <b>Design:</b> Retrospective cohort study. <b>Setting:</b> The PICU at the King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia. <b>Patients:</b> Patients aged 1 week to 14 years who were admitted to the PICU between January 2021 and December 2023. <b>Interventions:</b> None. <b>Measurements and Main Results:</b> Of the 3344 patients admitted to the PICU, 53.1% were male; the median age was 3 years (interquartile range: 0-8). The most common underlying conditions were neurological in 723 patients (21.6%), hematological/oncological in 463 (13.9%), and cardiovascular in 417 (12.5%). DNR orders were issued for 6.4% of admissions; among the 213 patients with DNR orders, 24 (11.3%) had a history of resuscitation before the DNR order. The mortality rate was significantly higher among patients with DNR orders (42.3%) compared to those without (1.3%; <i>p</i> < 0.001). Of all 3344 patients, 130 (3.9%) died; of these, 90 (69.2%) had DNR orders. Predictors of DNR status included male gender, hematological/oncological and cardiovascular diseases, bone marrow transplantation, respiratory distress, sepsis, seizures, bleeding, and need for mechanical ventilation (<i>p</i> < 0.05). <b>Conclusions:</b> This study revealed a DNR order rate of 6.4% among all PICU admissions, with 69.2% of PICU deaths occurring in patients with DNR status. Further analysis is warranted to understand the factors influencing DNR decisions and their impact on patient outcomes.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2025 ","pages":"9948312"},"PeriodicalIF":1.8,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12271712/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144676094","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":"Prediction of Gastric Residual Volume by Ultrasonography in Critically Ill Children Undergoing Enteral Nutrition.","authors":"Jinjiu Hu, Qiaoying Zhang, Xin Wan, Hui Zhang, Qiao Shen, Fei Li, Ye Cai, Yuqian Meng, Peng Liu, Xianlan Zheng","doi":"10.1155/ccrp/1049746","DOIUrl":"10.1155/ccrp/1049746","url":null,"abstract":"<p><p><b>Background:</b> Bedside ultrasonography is capable of evaluating gastric residual volume (GRV) and facilitating the identification of feeding intolerance (FI) among critically ill pediatric patients; however, a specialized predictive model tailored to this demographic has yet to be established. This study aims to develop a predictive model for the estimation of GRV using ultrasonography in this specific patient group. <b>Methods:</b> This prospective observational study included critically ill pediatric patients receiving enteral nutrition (EN). Clinical data, including gender, age, weight, height, gastric antrum cross-sectional area (CSA) in supine and right lateral positions, and qualitative grading system scores (Grade 0-2), were collected. GRV was measured by suctioning gastric contents under real-time ultrasound guidance, which was considered the actual GRV. The predictive models for GRV were developed using linear regression analysis. The agreement between predicted and actual GRV values was assessed using Bland-Altman analysis. <b>Results:</b> A total of 108 children were included in the analysis. Significant differences (<i>p</i> < 0.05) were observed in GRV, GRV per kilogram, supine and right lateral decubitus (RLD) CSA among grades. Spearman correlation analysis revealed strong correlations between RLD CSA (<i>r</i> = 0.88, <i>p</i> < 0.001) and qualitative grading system scores (<i>r</i> = 0.86, <i>p</i> < 0.001) with suctioned GRV. A predictive model was developed using RLD CSA and qualitative grading system scores as predictors: GRV (mL) = -12.9 + 10.3 (RLD CSA [cm²]) + 3.3 × Grade 1 + 10.1 × Grade 2. This model demonstrated an adjusted coefficient of determination (<i>R</i> ²) of 0.878, Akaike's information criterion (AIC) of 873.43, and Bayesian information criterion (BIC) of 884.06. Bland-Altman analysis showed a mean difference of 0.1 mL/kg between predicted and suctioned GRV, with 95% limits of agreement (LoA) ranging from -1.65 to 1.87 mL/kg. <b>Conclusion:</b> The results suggest that ultrasound-based monitoring can predict GRV in critically ill children. In addition, the qualitative grading system can differentiate between high and low GRV, potentially serving as a rapid screening tool for identifying patients with high GRV.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2025 ","pages":"1049746"},"PeriodicalIF":1.8,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208764/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144530232","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 Length of Stay and Incidence of Hospital-Acquired Anaemia in Critically Ill Patients: A Retrospective Cohort Study.","authors":"Bushra Al Amer, Ghaleb Alharbi, Abdulaziz Alrashdi, Hameed Alrashedi, Majd Alsaeed, Razan Almahubi, Yara Almarshad","doi":"10.1155/ccrp/8884182","DOIUrl":"10.1155/ccrp/8884182","url":null,"abstract":"<p><p>Hospital-acquired anaemia (HAA) is characterised by initially normal haemoglobin levels upon admission that are lowered during the hospital stay. The decreased haemoglobin levels related to the days of intensive care unit (ICU) hospitalisation may explain the effect of other interventions on haemoglobin levels. This study aimed to investigate the association between decreased haemoglobin levels and days of hospitalisation in critically ill patients in the Qassim region by analysing haemoglobin levels within the first 7, 14, and 21 days after ICU admission. A total of 180 patients were admitted during the study period. Patients with gastrointestinal bleeding, transfusion-dependent anaemia, a history of anaemia or bleeding, those with chronic kidney disease or on dialysis, and those who had hematologic or other malignancies were excluded (<i>n</i> = 97). Finally, those who were at least 18 years old, was within the normal range of haemoglobin upon admission to the ICU and had been hospitalized for at least 21 days in the ICU were included (<i>n</i> = 83). The initial average haemoglobin concentration was higher in men (15.24 g/dL) than in women (13.45 g/dL). Both experienced a significant and relatively parallel decline in haemoglobin levels (8.95 g/dL) and (8.66 g/dL), respectively, throughout the 21 day hospitalization period. The <i>p</i> value (< 0.001) suggests that the fixed effects are statistically significant, indicating that time (days) has a significant effect on haemoglobin levels. This study found a consistent decrease in haemoglobin levels over the ICU hospitalisation period, suggesting a progressive condition or treatment effect leading to reduced haemoglobin levels. However, further studies are required to analyse the causes of HAA in ICU.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2025 ","pages":"8884182"},"PeriodicalIF":1.8,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12133354/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144217258","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":"Caffeine Treatment for Prostaglandin E1-Induced Apnea Prevention in Congenital Heart Disease Neonates: A Randomized Clinical Trial.","authors":"Ladan Salamati, Bahar Dehghan, Mohammad Reza Sabri, Alireza Ahmadi, Mehdi Ghaderian, Chehreh Mahdavi, Davood Ramezani Nezhad, Atefeh Karbasi, Mohsen Sedighi","doi":"10.1155/ccrp/4923280","DOIUrl":"10.1155/ccrp/4923280","url":null,"abstract":"<p><p><b>Background:</b> Congenital heart diseases (CHDs) are structural abnormalities of the heart or great vessels. Prostaglandin E1 (PGE1) is used to maintain the ductus arteriosus open in neonates with ductal-dependent heart lesions but is associated with apnea. We aimed to investigate the effects of caffeine therapy on the occurrence of apnea in neonates with CHD. <b>Methods:</b> This single-blinded randomized clinical trial was performed on 51 CHD neonates who were treated with PGE1 or PGE1 + caffeine. PGE1 dose ranged from 0.01 to 0.1 mcg/kg/min, and caffeine was administered initially at 20 mg/kg, followed by a daily bolus dose of 10 mg/kg. Demographic and clinical data, prevalence of apnea, and PGE1 side effects were recorded and analyzed. <b>Results:</b> A total of 51 CHD neonates receiving PGE1 + caffeine (<i>n</i> = 25) and PGE1 (<i>n</i> = 26) were included. The median age of total neonates was 2 (1-7) days, and 57% were female. There was no statistically significant difference between the baseline characteristics of participants, but neonates in the caffeine group received a higher mean dose of PGE1 (0.03 ± 0.17 vs. 0.02 ± 0.02, <i>p</i>=0.049) over the course of the treatment. The prevalence of apnea was 20% in the PGE1 + caffeine group and 42% in the PGE1 group (<i>p</i>=0.086). In the Cox regression model, the age of neonates had a significant effect on time to apnea in patients receiving caffeine (HR = 0.87, <i>p</i>=0.04). <b>Conclusion:</b> Our findings fail to demonstrate that caffeine therapy reduces PGE1-induced apnea. A larger randomized controlled trial is required to confirm or refute the efficacy of caffeine in reducing the incidence of apnea associated with PGE1 infusion. <b>Trial Registration:</b> Iranian Registry of Clinical Trials: IRCT20220503054729N1.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2025 ","pages":"4923280"},"PeriodicalIF":1.8,"publicationDate":"2025-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12086028/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144102988","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":"Acute Ischemic and Hemorrhagic Cerebrovascular Strokes After Cardiac Surgery: Incidence, Predictors, and Outcomes.","authors":"Mohamed Laimoud, Mosleh Nazzal Alanazi, Patricia Machado, Mary Jane Maghirang, Suha Althibait, Shatha Al-Mutlaq, Munirah Alomran, Imad Bou-Saad, Lamees Subhi, Reem Almutairi, Renad Nadhreen, Hamza Busaleh, Sreedevi Pillai, Saranya Sidharthan, Tareq Almazeedi, Zohair Al-Halees","doi":"10.1155/ccrp/6645363","DOIUrl":"https://doi.org/10.1155/ccrp/6645363","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Background:&lt;/b&gt; Many studies have attempted to determine the incidence, predictors, and outcomes of cerebrovascular stroke after cardiac surgery, with different, sometimes contradictory, results because of differences in population risk profiles, study design, and surgical details. &lt;b&gt;Methods:&lt;/b&gt; We retrospectively reviewed the records of all adult patients who underwent cardiac surgery between January 2018 and January 2023. Univariate, multivariable, and survival analyses were performed to identify the outcomes and predictors of ischemic and hemorrhagic strokes. &lt;b&gt;Results:&lt;/b&gt; Of the 1334 patients studied, 70 (5.2%) patients had ischemic stroke, 23 (1.7%) had intracranial hemorrhage (ICH), and 9 (0.7%) had combined ischemic and hemorrhagic strokes. The patients who developed strokes had longer cardiopulmonary bypass (CPB) time (165.5 [126, 234] versus 136 [104, 171] min, &lt;i&gt;p&lt;/i&gt; &lt; 0.001) and aortic cross-clamping time (112 [79, 163] versus 89 [75, 121.5] min, &lt;i&gt;p&lt;/i&gt; &lt; 0.001), with higher rates of intra-aortic balloon pump (IABP) use (13.3% vs. 4.4%, &lt;i&gt;p&lt;/i&gt; &lt; 0.001), veno-arterial extracorporeal membrane oxygenation use (24.8% vs. 12.37%, &lt;i&gt;p&lt;/i&gt; &lt; 0.001), and mediastinal exploration for bleeding (22.9% vs. 8.9%, &lt;i&gt;p&lt;/i&gt; &lt; 0.0011). The patients who developed strokes showed increased hospital mortality (37.1% vs. 5.6%, &lt;i&gt;p&lt;/i&gt; &lt; 0.001), new need for dialysis (29.5% vs. 10.7%, &lt;i&gt;p&lt;/i&gt; &lt; 0.001), higher rate of tracheostomy (13.3% vs. 1.2%, &lt;i&gt;p&lt;/i&gt; &lt; 0.001), and longer intensive care unit (ICU) stay (12 [7, 28] versus 3 [2, 8] days, &lt;i&gt;p&lt;/i&gt; &lt; 0.001) and post-ICU stay (16 [7, 39] versus 5 [3, 10] days, &lt;i&gt;p&lt;/i&gt; &lt; 0.001). Follow-up for 36.4 (21.67, 50.7) months revealed an insignificant mortality difference, but there was an increased risk of recurrent cerebrovascular strokes. Cox-proportional hazards regression showed an increased risk of hospital mortality after cardiac surgery in patients who developed acute ischemic stroke (HR: 5.075, 95% CI: 3.28-7.851, &lt;i&gt;p&lt;/i&gt; &lt; 0.001) and ICH (HR: 12.288, 95% CI: 7.576-19.93, &lt;i&gt;p&lt;/i&gt; &lt; 0.001). Logistic multivariable regression showed that increased age, hyperlactatemia, redo cardiotomy, history of old stroke, CPB time, and perioperative IABP use were the predictors of ischemic stroke. Young age, old ICH, hyperlactatemia, and hypoalbuminemia were the predictors of postoperative ICH. Postoperative ICH, ischemic stroke, atrial fibrillation, chronic kidney disease, blood lactate level 24 h after surgery, and increased age were the independent predictors of mortality. &lt;b&gt;Conclusions:&lt;/b&gt; Ischemic and hemorrhagic cerebrovascular strokes are serious complications that increase postoperative mortality and prolong hospitalization after cardiac surgery. Atrial fibrillation was not a significant predictor of postoperative stroke but was a predictor of hospital mortality. Careful attention should be given to maintaining hemodynamic stability and minimizing CPB time, especially in patients with a hist","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2025 ","pages":"6645363"},"PeriodicalIF":1.8,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12058317/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144015289","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":"Reassessing the Risk: A Retrospective Analysis of CLABSI Risk in Femoral, Internal Jugular, and Subclavian Central Venous Catheters.","authors":"Alexandra Vaughan-Masamitsu, Wesley Paulson, Robert Hodes, Cain Dudek","doi":"10.1155/ccrp/8193419","DOIUrl":"https://doi.org/10.1155/ccrp/8193419","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Background:&lt;/b&gt; Central line-associated bloodstream infections (CLABSIs) represent a significant healthcare challenge due to their association with increased morbidity, mortality, and financial burden. Current guidelines discourage the use of the femoral vein (FV) for central venous catheter (CVC) placement due to a perceived higher infection risk compared to the internal jugular vein (IJV) or subclavian (SCV) sites. However, recent evidence questions this assumption and suggests that femoral CVCs may carry similar risks to other sites, emphasizing the need for updated analyses. &lt;b&gt;Objective:&lt;/b&gt; The goal of this study was to address the misconception that femoral CVCs have a higher associated risk for developing CLABSI compared to other central line sites. This study evaluates risk for CLABSI across FV, IJV, and SCV sites. &lt;b&gt;Methods:&lt;/b&gt; Using the TriNetX Research Network to conduct a retrospective cohort analysis, initial queries identified 99,216 patients who were encountered between 2014 and 2025 for CVC placement. Following propensity score matching, 65,265 of these patients were retained for statistical analysis. Patients were categorized based on anatomic CVC placement sites into IJV, SCV, and FV cohorts. CLABSI incidence was determined using ICD-10-CM codes within 1 day to 1 month post-CVC insertion. Sensitivity analyses were conducted for the 2014-2025 period, as well as for the 2014-2019 and 2019-2025 periods to assess overall risk and evaluate for changes in CLABSI risk by anatomic site over time. Outcomes were compared using risk percentages, risk ratios, and odds ratios with 95% confidence intervals to compare differences in risk for CLABSI across different sites. &lt;b&gt;Results:&lt;/b&gt; Overall, femoral CVCs were not associated with a statistically significant higher risk of CLABSI compared to IJV or FV CVCs from the overall period of 2014-2025. Only the risk difference between IJV and SCV CVCs over 2014-2025 showed a statistically significant difference. IJV CVCs were associated with a higher risk of CLABSI compared with SCV CVCs, with a risk difference of 0.089% (95% CI: 0.006%, 0.171%, &lt;i&gt;Z&lt;/i&gt; = 2.11, &lt;i&gt;p&lt;/i&gt;=0.0348), a risk ratio of 1.708 (95% CI: 1.033, 2.826), and an odds ratio of 1.71 (95% CI:1.033, 2.831). Over the 2014-2019 period, there was no statistically significant risk difference between the IJV and FV cohorts (risk difference 0.09%, 95% CI: -0.035%, 0.215%, &lt;i&gt;Z&lt;/i&gt; = 1.415, &lt;i&gt;p&lt;/i&gt;=0.1569). Comparing the IJV to SCV CLABSI rates for the 2014-2019 period, the risk difference was 0.112% (95% CI: -0.009%, 0.234%, &lt;i&gt;Z&lt;/i&gt; = 1.81, &lt;i&gt;p&lt;/i&gt;=0.07). For the 2019-2025 period between the IJV and FV cohorts, the risk difference was -0.077% (higher risk in the FV cohort), which was not a statistically significant difference (95% CI: -0.193%, 0.04%, &lt;i&gt;Z&lt;/i&gt; = -1.289, &lt;i&gt;p&lt;/i&gt;=0.1974). Comparing the IJV to SCV CLABSI rates for the 2019-2025 period, the risk difference was 0.117% (95% CI: = -0.006%, 0.24%, &lt;i&gt;Z&lt;/i&gt; = 1.861, ","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2025 ","pages":"8193419"},"PeriodicalIF":1.8,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12055310/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144054352","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 and Risk Factors of Ventilator-Associated Pneumonia in Cardiac Arrest in Patients With Selective Digestive Decontamination.","authors":"Erik Roman-Pognuz, Stefano Di Bella, Alberto Enrico Maraolo, Mauro Giuffrè, Chiara Robba, Giuseppe Ristagno, Clifton W Callaway, Umberto Lucangelo","doi":"10.1155/ccrp/7669466","DOIUrl":"10.1155/ccrp/7669466","url":null,"abstract":"<p><p><b>Background:</b> Out-of-hospital cardiac arrest (OHCA) is a leading cause of morbidity and mortality. Temperature management (TM) is recommended since hyperthermia is associated with worse outcomes. Pneumonia is a frequent occurrence following OHCA, and some studies suggest that TM may have a negative impact on its development. Selective digestive decontamination (SDD) is used in some centers to reduce the incidence of pneumonia in intensive care unit (ICU), but its use remains controversial. This study aims to assess the incidence, risk factors and clinical course of VAP after OHCA. <b>Methods:</b> We conducted a retrospective cohort study on 169 consecutive OHCA patients after their admission in ICU. All patients were treated with TM and SDD. Pharyngeal swabs were analyzed twice weekly. The primary outcome was the incidence of VAP and non-VAP. Secondary aim was to identify the risk factors associated with VAP and its effect on patients' outcome. <b>Results:</b> Incidence of VAP was 5.3%, while incidence of non-VAP was 9.5%. In multivariate analysis, male gender (sHR 3.01; CI 1.1-7.9), increase of white blood cells (WBC) count > 30% over 5 days (sHR 2.32; CI 1.23-3.9), heart disease (sHR 2.4; CI 1.36-4.59), and bacterial colonization of the pharynx (sHR 2.79; CI 1.13-4.39) were significantly associated with VAP. <b>Conclusions:</b> Pharyngeal colonization could be useful to identify patients at higher risk of VAP development. The low rate of VAP in this cohort suggests that SDD can prevent VAP after OHCA. Further studies are needed to explore the potential of SDD in OHCA patients.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2025 ","pages":"7669466"},"PeriodicalIF":1.8,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11964724/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143774596","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":"Significance of Right Ventricular Dysfunction in Predicting Short-Term Survival Among Patients With Sepsis and Septic Shock: A Prognostic Analysis.","authors":"Sukrisd Koowattanatianchai, Patchara Kochaiyapatana, Narueporn Eungsuwat, Vimonsri Rangsrisaeneepitak, Katkanit Thammakumpee, Kiraphol Kaladee","doi":"10.1155/ccrp/5511135","DOIUrl":"10.1155/ccrp/5511135","url":null,"abstract":"<p><p><b>Objective:</b> This study sought to evaluate the association between right ventricular (RV) dysfunction and short-term in-hospital mortality among patients with sepsis and septic shock. <b>Methods:</b> A prospective cohort study was conducted on adult patients admitted at Burapha University Hospital for sepsis and septic shock from October 1, 2022, through June 30, 2023, who underwent echocardiography within 72 h after admission. RV dysfunction and other echocardiographic findings were analyzed and defined using the American Society of Echocardiography criteria. The primary outcome examined in this study was 28-day in-hospital mortality. Secondary outcomes included maximal blood lactate levels, length of intensive care unit (ICU) stay, and duration of mechanical ventilation. <b>Results:</b> A total of 104 patients (mean age: 69.54 ± 14.88 years) were enrolled in this study. Among the included patients, 32 (30.8%) developed septic shock whereas 20 (19.2%) exhibited RV dysfunction. Cox regression analysis showed that patients with RV dysfunction had a 28-day in-hospital mortality rate 5.53 times higher than that of patients with normal RV function (95% confidence intervals: 1.98-15.42; <i>p</i>=0.001). Regarding the secondary outcomes, patients with RV dysfunction exhibited a significantly higher mean serum lactate level (5.72 ± 4.96 vs. 3.74 ± 3.29 mmol/L; <i>p</i>=0.034) and length of ICU stay (6.50 ± 2.86 vs. 2.84 ± 1.56 days; <i>p</i>=0.020) than did those with normal RV function. <b>Conclusions:</b> RV dysfunction was associated with increased short-term mortality among patients with sepsis and septic shock. Assessing RV function among these patients facilitates precise prognostication and aids in guiding treatment strategies aimed at reducing mortality. <b>Trial Registration:</b> ClinicalTrials.gov identifier: NCT06193109.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2025 ","pages":"5511135"},"PeriodicalIF":1.8,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11928220/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693958","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":"Safety of Early Mobilization in Adult Neurocritical Patients: An Exploratory Review.","authors":"Leonardo Arzayus-Patiño, José Luis Estela-Zape, Valeria Sanclemente-Cardoza","doi":"10.1155/ccrp/4660819","DOIUrl":"10.1155/ccrp/4660819","url":null,"abstract":"<p><p><b>Introduction:</b> Early mobilization has shown significant benefits in the rehabilitation of critically ill patients, including improved muscle strength, prevention of physical deconditioning, and reduced hospital length of stay. However, its safety in neurocritical patients, such as those with strokes, traumatic brain injuries, and postsurgical brain surgeries, remains uncertain. This study aims to map and examine the available evidence on the safety of early mobilization in adult neurocritical patients. <b>Methods:</b> A scoping review was conducted following PRISMA-SCR guidelines and the Joanna Briggs Institute (JBI) methodology. The research question focused on the safety of early mobilization in neurocritical patients, considering adverse events, neurological changes, hemodynamic changes, and respiratory changes. A comprehensive search was performed in databases such as PubMed, BVS-LILACS, Ovid MEDLINE, and ScienceDirect, using specific search strategies. The selected studies were assessed for methodological quality using JBI tools. <b>Results:</b> Of 1310 identified articles, 25 were included in the review. These studies comprised randomized controlled trials, prospective observational studies, retrospective studies, and pre- and postimplementation intervention studies. The review found that early mobilization in neurocritical patients is generally safe, with a low incidence of severe adverse events, and does not increase the risk of vasospasm, and most complications were manageable with protocol adjustments and continuous monitoring. <b>Conclusion:</b> Early mobilization in neurocritical patients has been shown to be potentially safe under specific conditions, without a significant increase in severe complications when properly monitored. However, the available evidence is limited by the heterogeneity of protocols and study designs, emphasizing the need for further research. The importance of tailoring mobilization protocols to each patient and ensuring continuous monitoring is highlighted. Additional studies with larger sample sizes are needed to fully understand the associated risks and optimize mobilization strategies.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2025 ","pages":"4660819"},"PeriodicalIF":1.8,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11879591/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558270","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":"Rurality and Outcomes of Patients Undergoing Mechanical Thrombectomy for Acute Ischemic Stroke.","authors":"Cassidy Lavin, Jacob Epstein, Alvin Huanwen Chen, Minahil Cheema, Jerry Yang, Alexa Aquino, Angie Chan, Nancy Le, Gillian Cooper, Ambra Palushi, Chad Schrier, Dheeraj Gandhi, Seemant Chaturvedi, Jessica Downing, Quincy K Tran","doi":"10.1155/ccrp/4995600","DOIUrl":"10.1155/ccrp/4995600","url":null,"abstract":"<p><p><b>Objective:</b> To investigate differences in outcomes among patients with acute ischemic stroke from large vessel occlusion (AIS-LVO) transferred from rural and urban hospitals to University of Maryland Medical Center (UMMC) for mechanical thrombectomy (MT). <b>Methods:</b> We identified patients with AIS-LVO transferred to UMMC for MT from July 2016 to June 2023. Primary outcome was good neurologic outcome, defined as 90-day modified Rankin score 0-2. Multivariable logistic regression was used to identify predictors for the primary outcome. <b>Results:</b> We analyzed 526 patients, 233 (44%) transferred from rural hospitals in Maryland. Median NIHSS was 17 [IQR 14-20] and was similar between groups. Patients from state-designated rural hospitals were transferred from a longer distance (difference of 57.8 km, <i>p</i>=0.001), but had shorter intervals from last known well time to recanalization (difference 19 min, <i>p</i>=0.24). They had similar odds of good neurologic outcome (OR 0.88, 95% CI 0.43-1.78, <i>p</i>=0.72). <b>Conclusions:</b> Patients transferred from rural areas for MT for AIS-LVO, at our institution, had a similar likelihood of achieving 90-day mRS 0-2 as those transferred from urban areas.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2025 ","pages":"4995600"},"PeriodicalIF":1.8,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11824784/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434272","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}