Critical Care Research and Practice最新文献

{"title":"Potential Drug-Drug Interactions in Critically Ill Neonates: Association With Clinical Outcomes in a Prospective Cohort.","authors":"Daniel Paiva Marques, Andreza Kelly Fernandes da Silva, Iris Ucella de Medeiros, Ramon Weyler Duarte Leopoldino, Antonio Gouveia Oliveira, Waldenice de Alencar Morais Lima, Rand Randall Martins","doi":"10.1155/ccrp/1033282","DOIUrl":"10.1155/ccrp/1033282","url":null,"abstract":"<p><strong>Background and aims: </strong>Neonates admitted to neonatal intensive care units (NICUs) are frequently exposed to multiple medications, increasing the risk of potential drug-drug interactions (pDDIs). However, the clinical impact of these interactions remains poorly understood in this population. This study aimed to evaluate the occurrence of pDDIs in critically ill neonates and their association with clinical outcomes and laboratory parameters.</p><p><strong>Methods: </strong>This prospective cohort study included 365 neonates admitted to a NICU in Brazil between March 2023 and March 2024. Pharmacotherapy was monitored daily for the identification of pDDIs using the UpToDate database. Interactions were grouped according to their potential clinical outcomes and analyzed for their association with clinical and laboratory parameters. The evaluated parameters included heart rate, respiratory rate, blood pressure, creatinine clearance, urine output, and blood urea nitrogen.</p><p><strong>Results: </strong>A total of 255 neonates (69.9%) experienced at least one pDDI, most of which were classified as risk category C (88.0%). The most frequent mechanisms of pDDIs were associated with heart rate changes (27.4%), nephrotoxicity (18.3%), central nervous system (CNS) depression (14.8%), and hypotension (14.8%). Neonates with pDDIs associated with heart rate changes had higher heart rates (158.1 ± 16.7 vs. 148.7 ± 17.0 bpm; <i>p</i> < 0.001). Nephrotoxic pDDIs were associated with reduced creatinine clearance (14.4 ± 13.5 vs. 25.8 ± 18.2 mL/min/1.73 m²; <i>p</i> < 0.001) and higher blood urea nitrogen levels (52.9 ± 36.2 vs. 27.6 ± 24.4 mg/dL; <i>p</i> < 0.001). pDDIs associated with hypotension significantly reduced mean arterial pressure (51.1 ± 11.5 vs. 58.3 ± 11.8 mmHg; <i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>pDDIs are frequent in NICUs and are associated with clinically relevant changes, particularly those involving an increased risk of higher heart rates, renal impairment, and hypotension.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2026 ","pages":"1033282"},"PeriodicalIF":1.6,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13669534/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149216879","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":"Efficacy of Eye Movement Desensitization and Reprocessing (EMDR) on Anxiety Severity Among Physicians and Nurses Working in Intensive Care Units.","authors":"Nastran Hatami, Mina Jouzi, Sara Kord, Behrooz Zarasvand","doi":"10.1155/ccrp/7865426","DOIUrl":"10.1155/ccrp/7865426","url":null,"abstract":"<p><strong>Background: </strong>Physicians and nurses working in intensive care units (ICUs) are frequently exposed to emotionally demanding and high-stress situations, placing them at increased risk for anxiety. Eye movement desensitization and reprocessing (EMDR) has shown promise in reducing anxiety in various high-stress populations; however, its effectiveness among ICU staff remains underexplored.</p><p><strong>Objective: </strong>To evaluate the efficacy of EMDR in reducing anxiety severity among ICU physicians and nurses.</p><p><strong>Methods: </strong>This quasi-experimental study was conducted among 60 ICU staff members who were allocated to either an EMDR intervention group (<i>n</i> = 30) or a control group (<i>n</i> = 30). Anxiety severity was assessed using the Beck Anxiety Inventory (BAI) at baseline and post-intervention. The EMDR protocol consisted of eight sessions delivered twice weekly. Data were analyzed using paired <i>t</i>-tests and ANCOVA controlling for baseline anxiety. Internal consistency of the BAI was assessed using Cronbach's alpha.</p><p><strong>Results: </strong>All participants completed the study with no dropouts. Baseline characteristics were comparable between groups. The EMDR group showed a significant reduction in anxiety from baseline to post-intervention (<i>p</i> < 0.01), whereas the control group showed no significant change. ANCOVA revealed a significant effect of EMDR on post-intervention anxiety scores (F(1,57) = 4.21, <i>p</i> = 0.045). Cronbach's alpha for the BAI in this sample was 0.89.</p><p><strong>Conclusion: </strong>EMDR significantly reduced anxiety among ICU physicians and nurses. Given the high emotional burden in critical care settings, EMDR may be a valuable component of mental health support programs for healthcare professionals. Further randomized controlled trials with long-term follow-up are recommended.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2026 ","pages":"7865426"},"PeriodicalIF":1.6,"publicationDate":"2026-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13451961/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148698133","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":"Investigating the Predictive Power of the National Early Warning Score in Predicting Outcomes Among Intensive Care Unit Patients.","authors":"Mahmoud Yousefifard, Madeeh Heydarzadeh Jazi, Maryam Esmaeili, Parvaneh Asgari","doi":"10.1155/ccrp/3647049","DOIUrl":"10.1155/ccrp/3647049","url":null,"abstract":"<p><strong>Aim: </strong>The aim of this study is to determine the predictive power of the National Early Warning Score in identifying the outcomes of intensive care unit (ICU) patients.</p><p><strong>Methods: </strong>In this study, 300 patients hospitalized in the ICUs (medical and general) of two teaching hospitals affiliated with Tehran University of Medical Sciences were evaluated and followed up for 30 days between June 2023 and April 2024. The samples were selected by convenience sampling based on inclusion criteria. A checklist containing the components of early warning criteria introduced by Braden, SOFA and APACHE II, as well as outcomes of hospitalization in the ward, was used. The early warning criteria were assessed by the researcher at the time of admission, as well as 6 and 24 h after the admission of patients to ICU. The collected data were analysed by SPSS-27 and STATA-14 software using Kruskal-Wallis, Pearson and chi-square tests, as well as the area under the receiver operating characteristic (ROC) curve of early warning system.</p><p><strong>Results: </strong>The mean age of patients was 41 years (31-56), and 63.70% of them were male. Comparison of the area under the ROC curve of early warning tool showed that the early warning score in predicting death at the time of admission, 6 h after admission and 24 h after admission was 0.697, 0.712 and 0.87, respectively. Also, this score in predicting adverse outcomes at the time of admission, 6 h after admission and 24 h after admission was 0.700, 0.784 and 0.936, respectively. In other words, the early warning system had a good predictive power in indicating the occurrence of outcomes at all three times (at admission, 6 hours after admission and 24 h after admission), but the best time to predict death and adverse outcomes was estimated to be 24 h after admission.</p><p><strong>Conclusion: </strong>By evaluating the predictive power of early warning score in identifying the outcomes of patients hospitalized in ICUs, we found that the early warning score at 24 h after admission had a higher predictive power than other times.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2026 ","pages":"3647049"},"PeriodicalIF":1.6,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13389633/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148563032","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 Remimazolam on Postoperative Delirium in Surgical ICU Patients: A Single-Center Prospective Cohort Study.","authors":"Jiajia Hong, Chengjin Zhao, Lin Lin","doi":"10.1155/ccrp/3315388","DOIUrl":"10.1155/ccrp/3315388","url":null,"abstract":"<p><strong>Aim: </strong>Postoperative delirium is a clinically important complication among patients admitted to a surgical intensive care unit (ICU). Remimazolam is increasingly used for perioperative and ICU sedation, but its association with postoperative delirium after elective surgery remains uncertain. This study evaluated the association between remimazolam-based postoperative sedation and postoperative delirium in surgical ICU patients.</p><p><strong>Design: </strong>A single-center prospective cohort study.</p><p><strong>Methods: </strong>Adult patients admitted to a surgical ICU after elective surgery between June 2024 and May 2025 were categorized according to their early postoperative sedation strategy. The remimazolam group was compared with a nonremimazolam sedation strategy group, which included patients receiving dexmedetomidine, midazolam, propofol/ciprofol, or no continuous sedative infusion. The primary outcome was postoperative delirium within the first 5 postoperative days or during the ICU stay, whichever was shorter. Delirium was assessed using the Confusion Assessment Method for the ICU and/or the Intensive Care Delirium Screening Checklist when patients were sufficiently arousable. Stabilized inverse probability of treatment weighting was used to reduce measured baseline imbalance. Weighted logistic regression was used for delirium, and weighted median regression was used for skewed continuous outcomes.</p><p><strong>Results: </strong>Of 307 patients assessed for eligibility, 208 were enrolled, and 204 were included in the final analysis, of whom 125 received remimazolam and 79 received nonremimazolam sedation strategies. Postoperative delirium occurred in 15 patients (12.0%) in the remimazolam group and 7 patients (8.9%) in the comparator group. After inverse probability weighting, remimazolam was not statistically significantly associated with postoperative delirium (adjusted odds ratio 1.69, 95% confidence interval 0.61-4.69; <i>p</i> = 0.312). Mechanical ventilation duration was longer in the remimazolam group (median difference 6.00 h, 95% confidence interval 2.00-8.00; <i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>Remimazolam was not statistically significantly associated with postoperative delirium compared with nonremimazolam sedation strategies. However, the low event rate, wide confidence interval, and heterogeneous comparator group mean that clinically important differences cannot be excluded. The longer ventilation duration observed in the remimazolam group should be interpreted cautiously because residual confounding may remain. <b>Trial Registration:</b> Chinese Clinical Trial Registry: ChiCTR2400085877.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2026 ","pages":"3315388"},"PeriodicalIF":1.6,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13277771/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148296821","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":"Adapting Evidence-Based Practice Guidelines for Sedation, Analgesia, Withdrawal, and Delirium Assessment and Management in Critically Ill Children.","authors":"Muneera Al-Jelaify, Gamal Hasan, Mohamad-Hani Temsah, Mohammed Almazyad, Ali Alhaboob, Majed Alabdulhafid, Fahad Alsohime, Abdullah Alturki, Waleed Albuali, Alanoud Almuhareb, Abdulaziz Alsoqati, Ivan D Florez, Yasser S Amer, Ayman Al-Eyadhy","doi":"10.1155/ccrp/7830579","DOIUrl":"10.1155/ccrp/7830579","url":null,"abstract":"<p><strong>Objectives: </strong>To adapt evidence-based clinical practice guidelines (CPGs) for sedation, analgesia, withdrawal, and delirium assessment and management with a focus on early mobility in critically ill children admitted to a pediatric intensive care unit (PICU).</p><p><strong>Design: </strong>The panel included two groups: the guideline adaptation group (GAG), which consisted of two consultant pediatric intensivists, a clinical pharmacist, a senior nurse specialist, and a general pediatrician and a CPG methodologist, and an external review and consultation group, which included five consultant pediatric intensivists, a clinical pharmacist, and two CPG expert physicians. A formal methodology for CPG adaptation was followed and included three phases: set-up, adaptation, and finalization.</p><p><strong>Results: </strong>The provided assessment tools and management algorithms focused on adequacy of sedation and analgesia, medication selection, dosing, initiation, and adjustment for both noninvasive and invasive mechanical ventilation; withdrawal assessment; weaning of sedation and analgesia; withdrawal management; delirium screening; delirium management; as well as early mobility facilitation. Implementation tools included behavioral scoring tool for sedation and pain, Withdrawal Assessment Tool with a management guide, screening score for delirium with a management guide, 3 clinical management algorithms for sedation management, analgesia management, and weaning process.</p><p><strong>Conclusions: </strong>Based on a systematic adaptation framework and the interdisciplinary and multidisciplinary approach, the present study formulated an adapted CPG with practically applicable implementation tools and management algorithms that might help standardize sedation, analgesia, and withdrawal assessment and management in critically ill children at the PICU. We recommend further studies to clarify the generalizability, impact of its implementation, and practices to overcome potential barriers.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2026 ","pages":"7830579"},"PeriodicalIF":1.6,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13263535/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148253835","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":"Effects of a Glutamine and Arginine Combination on the Inflammatory Response in a Lipopolysaccharide-Induced Sepsis Model at Different Time Points of Supplementation.","authors":"Maulydia Maulydia, Nancy Margarita Rehatta, Subijanto Marto Soedarmo, Widjiati Widjiati","doi":"10.1155/ccrp/9960244","DOIUrl":"10.1155/ccrp/9960244","url":null,"abstract":"<p><p>Activation of the NF-κB signaling pathway in sepsis plays a crucial role in the expression of TNF-α, IL-8, and MMP-8, which can further exacerbate the condition. The management of sepsis requires complex strategies. Glutamine and arginine are amino acids that can modulate inflammatory processes and enhance immune function, and their levels are often deficient in sepsis. This study aimed to analyze the effects of glutamine and arginine combination (GAC) on TNF-α, NF-κB, IL-8, and MMP-8 expressions in sepsis. Seventy-two <i>Rattus norvegicus</i> were divided into three main intervention groups, each of which was further divided into three subgroups that received therapy initiated at different time points (6 h, 24 h, and 48 h) after the intervention. Therapy was administered once daily for three consecutive days. Termination was performed 2 h after the final therapy, after which jejunal tissues were collected. The administration of GAC resulted in different cells expressing IL-8 (<i>p</i> = 0.026) in the 24-h treatment group and MMP-8 (<i>p</i> < 0.001) in the 6-h treatment group. No differences were found in cells expressing TNF-α, NF-κB, and IL-8 in the 6-h treatment group (<i>p</i> > 0.05); TNF-α, NF-κB, and MMP-8 in the 24-h treatment group (<i>p</i> > 0.05); and TNF-α, NF-κB, IL-8, and MMP-8 in the 48-h treatment group (<i>p</i> > 0.05). The supplementation of GAC demonstrated different cells expressing IL-8 (in therapy started at 24 h) and MMP-8 (in therapy started at 6 h). Future studies should be conducted on dose evaluation over a longer research duration to validate more specific results.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2026 ","pages":"9960244"},"PeriodicalIF":1.6,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13261681/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148253853","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":"Identification and Characterization of Sepsis Phenotypes in an Indian Cohort.","authors":"Fabia Edathadathil, Georg Gutjahr, Dipu Sathyapalan, Sanjeev Singh","doi":"10.1155/ccrp/9921379","DOIUrl":"10.1155/ccrp/9921379","url":null,"abstract":"<p><strong>Background: </strong>Sepsis has a heterogenous clinical presentation with distinct regional epidemiological profiles. The study aims to identify clinical phenotypes from an Indian sepsis cohort.</p><p><strong>Methods: </strong>The cohort included all adult patients admitted through the emergency department with a presumed diagnosis of sepsis following Surviving Sepsis Guidelines criteria. The unsupervised k-means clustering method was used, and the identified Indian clusters were compared using distance matching to phenotypic clusters in Seymour et al., which had previously identified four reproducible sepsis phenotypes in large Western ICU cohorts. The association of focus of infection and outcomes among the clusters were assessed.</p><p><strong>Results: </strong>Of the 1009 patients, four clusters were identified. Age (<i>p</i> = 0.024) and gender (<i>p</i> = 0.04) significantly differed among the clusters. The Indian clusters that exhibited close association to the alpha, beta, gamma, and delta phenotypes reported in Seymour et al. were termed i-Alpha (254, 25%), i-Beta (141, 14%), i-Gamma (389, 39%), and i-Delta (225, 22.3%) respectively. The clusters demonstrated significant variations in clinical profiles and outcomes. Septic shock and in-hospital mortality were highest among i-Alpha at 19% (48/254) and i-Beta at 34% (48/141) (<i>p</i> < 0.001), respectively. Prevalence of pneumonia (<i>p</i> = 0.018), SSI (<i>p</i> = 0.011), and bacteremia (<i>p</i> = 0.004) significantly differed among the clusters. <i>Pseudomonas</i> (<i>p</i> = 0.008) and <i>Staphylococcus aureus</i> (<i>p</i> = 0.02) were also observed to be significantly different. i-Gamma was characterized by a lower mortality rate and a high prevalence of soft tissue infections.</p><p><strong>Conclusion: </strong>Understanding these unique phenotypes can guide personalized treatment and improve sepsis outcomes in resource-limited settings, highlighting the importance of localized research in sepsis management.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2026 ","pages":"9921379"},"PeriodicalIF":1.6,"publicationDate":"2026-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13238234/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148200436","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":"Correction to \"Integrating Central Venous and Arterial Line Placement Training for Respiratory Therapists: A Sustainable Strategic Approach to Enhance Patient Care\".","authors":"","doi":"10.1155/ccrp/9872796","DOIUrl":"https://doi.org/10.1155/ccrp/9872796","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1155/ccrp/3224037.].</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2026 ","pages":"9872796"},"PeriodicalIF":1.8,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13239277/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148200398","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":"Comparison of Volatile Anesthesia and Intravenous Anesthesia for Endovascular Thrombectomy in Acute Ischemic Stroke Patients Under General Anesthesia: A Systematic Review and Meta-Analysis.","authors":"Marluce Gois de Oliveira, Wellington de Araujo, Leonardo Saraiva Guimaraes de Oliveira, Livia Kneipp Rodrigues, Lucas Area Leao Barreto, Yara Silva Dias, Nathan Pace, Talmage Egan","doi":"10.1155/ccrp/7360200","DOIUrl":"10.1155/ccrp/7360200","url":null,"abstract":"<p><strong>Background: </strong>Endovascular thrombectomy (EVT) is a well-established treatment for acute ischemic stroke (AIS). However, the optimal choice of general anesthesia (GA) during this procedure remains uncertain. This study aims to compare the effects of volatile anesthesia (VA) and total intravenous anesthesia (TIVA) on outcomes in AIS patients undergoing EVT.</p><p><strong>Methods: </strong>We conducted a systematic search of PubMed, Embase, and Cochrane databases for studies comparing VA and TIVA in this context. Key outcomes assessed were favorable functional outcome (defined as a Modified Rankin Scale [mRS] 0-2), mortality, successful recanalization (mTICI 2b/3), and intraoperative mean arterial pressure (MAP). A subgroup analysis was also performed for patients with anterior circulation stroke.</p><p><strong>Results: </strong>A total of 568 patients from four observational studies were included, of whom 187 (33%) received TIVA. In the unadjusted analysis, no statistically significant differences were observed between TIVA and VA in terms of favorable functional outcome (OR 1.28; <i>p</i> = 0.403), mortality (OR 0.54; <i>p</i> = 0.082), successful recanalization (OR 1.38; <i>p</i> = 0.344), or MAP (MD -0.56; <i>p</i> = 0.755). Adjusted ORs (aORs) were extracted from multivariable models, with covariates varying across studies. The aORs suggested TIVA may be associated with improved outcomes, being linked to a higher likelihood of favorable functional outcome (aOR 1.96, 95% CI [1.15-3.34], <i>p</i> = 0.013) and reduced mortality (aOR 0.40, 95% CI [0.20-0.79], <i>p</i> = 0.008). In the subgroup of patients with anterior circulation stroke, TIVA was similarly associated with better recovery (aOR 2.66; <i>p</i> = 0.033) and lower mortality (aOR 0.38; <i>p</i> = 0.002) at 3 months, but no significant differences were found when the timing after stroke was not specified.</p><p><strong>Conclusion: </strong>Among AIS patients undergoing EVT, TIVA may lead to improved functional outcome and reduced mortality compared to VA. These findings support the use of TIVA as a potentially more favorable strategy in this context, warranting further prospective trials.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2026 ","pages":"7360200"},"PeriodicalIF":1.6,"publicationDate":"2026-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13218072/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148139260","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":"Thromboelastography Associates to Decreased Plasma Transfusions in the Medical Intensive Care Unit: A Retrospective Study.","authors":"Daniel F Lewandowski, Connor M Bunch, Morgan N Howard, Chun-Hui Lin, Fiona G Clowney, Austin J Parsons, Michael J Sheehan, Sulmaz Zahedi, Kristopher Mosier, Rachel A Eklund, Ileana Lopez-Plaza, Joseph B Miller, Jennifer L Swiderek","doi":"10.1155/ccrp/5575261","DOIUrl":"10.1155/ccrp/5575261","url":null,"abstract":"<p><p>Bleeding patients in the medical intensive care unit (MICU) are often coagulopathic, yet the best way to guide blood product resuscitation for the critically ill is not settled. Viscoelastic tests, such as thromboelastography (TEG), are increasingly used by intensivists to guide resuscitation and restore hemostasis. We performed a retrospective study of patients admitted to the MICU at a single tertiary care center in Detroit, Michigan, USA, with a high prevalence of decompensated cirrhosis and septic shock. The historical cohort included patients prior to TEG being available in the MICU. The observational cohort included data where TEG was available and applied in our MICU to guide blood product use. Patients were included if they were an adult > 18 years of age with an initial admission to Henry Ford Hospital MICU who received any blood component therapy. A total of 927 patients met inclusion criteria with 487 (52.5%) patients in the historical cohort and 440 (47.5%) in the observational cohort. Compared with the historical cohort, patients of the observational cohort were administered significantly less plasma (658.3 mL/patient (IQR = 931) vs. 410.8 mL/patient (IQR = 381), <i>p</i> < 0.001). There was no significant difference in mortality (54.4% vs. 50.5%, <i>p</i> = 0.408) or hospital length of stay (LOS) (13 days vs. 14 days, <i>p</i> = 0.08). In a generalized MICU population, the introduction of TEG-guided blood component resuscitation was associated with conserved plasma without significant effect on mortality or LOS. No causation can be drawn to TEG from the retrospective nature of this study. However, this study provides impetus to further study blood product stewardship potentially derived from viscoelastic test-guided transfusions in a general MICU population.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2026 ","pages":"5575261"},"PeriodicalIF":1.6,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13096790/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147785183","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}