Critical Care Research and Practice最新文献

{"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":"https://doi.org/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":1.8,"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}

{"title":"Noise in the Intensive Care Unit: A Narrative Review of Its Characteristics, Clinical Impact, and Reduction Strategies.","authors":"Charikleia S Vrettou, Panagiotis T Koliotsis, Spyretta Golemati, Giorgos Mastorakis, Vassiliki Karaviti, Sofia Mavromati, Maria Tagara, Maria P Papadopoulou, Ioanna Dimopoulou","doi":"10.1155/ccrp/4782724","DOIUrl":"https://doi.org/10.1155/ccrp/4782724","url":null,"abstract":"<p><strong>Aims: </strong>Noise in the intensive care unit (ICU) is an environmental stressor affecting both patients and healthcare professionals. This narrative review synthesizes evidence from over 2 decades of research regarding ICU noise levels, sources, acoustic characteristics, and clinical impact.</p><p><strong>Design: </strong>Narrative review.</p><p><strong>Data sources: </strong>A literature search was conducted in PubMed for studies published between January 2000 and July 2025. Search terms included combinations of ICU, intensive care, noise, sound levels, alarm fatigue, acoustic environment, delirium, sleep disruption, burnout, and hospital design. Reference lists of relevant reviews and original studies were screened.</p><p><strong>Review methods: </strong>Eligible publications included original research, simulation studies, systematic reviews, clinical guidelines, and qualitative reports focusing on adult ICUs. Only English-language studies were included. Data were narratively synthesized to describe noise levels, sources, impacts, and mitigation strategies.</p><p><strong>Results: </strong>Sound levels in most ICUs routinely exceed 55-60 dBA, with peak levels often surpassing 85-90 dBA-far above World Health Organization recommendations. Common noise sources include medical equipment alarms, staff activity, and environmental design features such as open layouts and reflective surfaces. Acoustic characteristics such as unpredictability and poor nighttime attenuation amplify stress. In patients, noise contributes to sleep fragmentation, circadian disruption, increased sedation needs, delirium, and adverse psychological outcomes. Among staff, excessive noise impairs communication, increases cognitive load, and contributes to fatigue and burnout. While various architectural, behavioral, and bundled interventions have shown promise, most demonstrate limited long-term effectiveness.</p><p><strong>Conclusion: </strong>Despite clear guidelines, ICU noise remains inadequately managed due to systemic barriers, including cultural norms, infrastructural constraints, and a lack of enforcement.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2026 ","pages":"4782724"},"PeriodicalIF":1.8,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13071535/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147692938","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":"Clinical Scores for Predicting Outcomes in Pediatric Oncology Sepsis: A Systematic Review and Meta-Analysis.","authors":"Jesús Ángel Domínguez-Rojas, Silvio Torres, Alejandra Méndez Aceituno, Anita Arias, Gabriela Sequeria, Daniel Tatay, Lupe Mora Robles, Clotilde Mireya Muñoz, Luis Llano","doi":"10.1155/ccrp/1818873","DOIUrl":"https://doi.org/10.1155/ccrp/1818873","url":null,"abstract":"<p><strong>Background: </strong>Pediatric oncology patients with sepsis are at high risk of morbidity and mortality due to immunosuppression and acute or fulminant multiorgan dysfunction. There have been many clinical scores proposed for risk of mortality prediction (PELOD-2, pSOFA, and Phoenix), but it remains unknown how well these scores predict risk in pediatric oncology patients with sepsis.</p><p><strong>Objective: </strong>To systematically review and meta-analysis the predictive performance of clinical scores and evaluate the incremental benefit of biomarkers in pediatric oncology patients.</p><p><strong>Methods: </strong>A systematic search was conducted in PubMed, Web of Science, Scopus, and Embase through 2025. Eligible studies were those that assessed PELOD-2, pSOFA, Phoenix, or prognostic scores in pediatric oncology patients with sepsis. Risk of bias assessment was completed using QUADAS-2. Random-effects meta-analysis was used to pool sensitivity, specificity, and area under the curve (AUC) estimates across studies.</p><p><strong>Results: </strong>A total of 32 articles were summarized with cohorts of 50-1200 patients per study. PELOD-2 and pSOFA demonstrated consistent and strong discrimination for mortality (AUC 0.78-0.88) while the Phoenix score demonstrated moderate discriminatory ability (AUC 0.72-0.83) and little validation. Procalcitonin, C-reactive protein, lactate, and other biomarkers improved predictive accuracy when combined with clinical scores. In summary, the overall risk of bias was rated to be moderate, largely due to predominately retrospective designs.</p><p><strong>Conclusions: </strong>PELOD-2 and pSOFA are the most validated prognostic tools for pediatric oncology patients with sepsis, while the Phoenix score may be useful in selected settings. Integration of biomarkers improves risk stratification. Prospective multicenter studies are needed to refine prognostic models and guide early interventions in this high-risk population.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2026 ","pages":"1818873"},"PeriodicalIF":1.8,"publicationDate":"2026-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13051830/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147634815","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":"Prevalence, Risk Factors, Characteristics, and Clinical Outcomes of Thrombocytopenia in the Intensive Care Unit: A Prospective Single-Center Cohort Study.","authors":"Zainab A Almardod, Kishore G Sam, Eman E Younis","doi":"10.1155/ccrp/4492230","DOIUrl":"https://doi.org/10.1155/ccrp/4492230","url":null,"abstract":"<p><strong>Background: </strong>Thrombocytopenia is a common hematologic abnormality in the intensive care unit (ICU), affecting approximately 50% of patients. It is associated with increased mortality and bleeding risk. Despite its clinical significance, epidemiological studies on ICU-related thrombocytopenia in Gulf Cooperation Council countries remain limited.</p><p><strong>Methods: </strong>This prospective observational cohort study was conducted to investigate the prevalence, risk factors, characteristics, and clinical outcomes of thrombocytopenia in the ICU. We included ICU patients admitted for ≥ 24 h, excluding pregnant women and individuals under 18. Thrombocytopenia was defined as a platelet count < 150 × 10⁹/L after ruling out pseudothrombocytopenia. Patients were stratified by thrombocytopenia severity and followed until discharge, death, or 30 days post onset. Risk factors were analyzed using multivariable modified Poisson regression models. The Naranjo probability scale and the 4Ts score were used for causal assessment of drug-induced thrombocytopenia (DIT) and heparin-induced thrombocytopenia (HIT). Primary outcomes included three-month ICU mortality and major bleeding. Kaplan-Meier with log-rank tests assessed time-to-mortality.</p><p><strong>Results: </strong>The study enrolled 276 patients; 38.8% had thrombocytopenia, including 23.4% with severe thrombocytopenia. The incidence of new-onset thrombocytopenia was 22.5%. DIT was suspected in 15% of cases, including five patients with potential HIT. Shock diagnosis was a significant predictor of new-onset thrombocytopenia (adjusted risk ratio = 2.26, 95% confidence interval: 1.35-3.79). Thrombocytopenic patients had higher Acute Physiology and Chronic Health Evaluation (APACHE) IV scores (<i>p</i> < 0.001) and experienced more major bleeding events (16.8% vs. 8.3%, <i>p</i> = 0.03) and higher mortality rates (27.1% vs. 5.3%, <i>p</i> < 0.001) with reduced time-to-mortality (log-rank <i>p</i> = 0.01). New-onset thrombocytopenia was independently associated with major bleeding and mortality.</p><p><strong>Conclusion: </strong>Thrombocytopenia is prevalent in the ICU, correlating to disease severity, major bleeding, and mortality. The study's findings underscore the need for timely recognition and effective management of thrombocytopenia to improve patient outcomes.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2026 ","pages":"4492230"},"PeriodicalIF":1.8,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12968733/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147436606","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 Auditory and Tactile Stimulation on the Level of Consciousness and Physiological Parameters in ICU Patients With Altered Consciousness.","authors":"Vinay Kumari, Choki Dema, Jyoti Sarin","doi":"10.1155/ccrp/8835519","DOIUrl":"10.1155/ccrp/8835519","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the effectiveness of multisensory stimulation in enhancing consciousness levels and physiological parameters among critically ill patients in the ICU.</p><p><strong>Methods: </strong>A quasi-experimental, nonequivalent control group pretest-post-test design was employed. Seventy-one patients with Glasgow Coma scale (GCS) scores below 13 were recruited through convenience sampling. Participants were divided into an experimental group (<i>n</i> = 34), which received multisensory stimulation twice daily for 7 days, and a comparison group (<i>n</i> = 37), which received standard ICU care. Physiological indicators (heart rate, respiration rate, blood pressure, temperature, SpO₂, and glucose) and consciousness levels (GCS) were determined before and after the intervention. Data were analyzed using SPSS version 20.0, with statistical significance established at <i>p</i> ≤ 0.05.</p><p><strong>Result: </strong>Experimental and comparison groups showed significant differences in consciousness from day 4 to 7 with higher GCS scores in the experimental group. Repeated measures ANOVA demonstrated improvement in GCS scores from the evening of day 2 till day 7 (<i>p</i> = 0.05). In contrast, the comparison group experienced a higher incidence of physiological adverse events such as tachycardia and bradycardia.</p><p><strong>Conclusion: </strong>Multisensory stimulation is a safe and effective method to enhance consciousness in critically ill patients without inducing adverse physiological effects. Early integration of MSS into ICU protocols is recommended. Further research is needed to explore MSS's efficacy across diverse medical conditions.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2026 ","pages":"8835519"},"PeriodicalIF":1.8,"publicationDate":"2026-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12933182/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147311172","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":"Persistent Severe Acute Kidney Injury Among Critically Ill Patients: Outcomes and Predictive Markers-A Single-Center Retrospective Cohort Study.","authors":"Tung Phi Nguyen, Thang Trong Khong, Hoai Thi Thu Vu, Nam Ngoc Phuong Nguyen, Phong Van Phan, Hue Thi Le, Tra Thi Hoang, Huyen Thi Nguyen, Loan Thi Phan, Yen Thi Kim Nguyen, Phuong Khanh Nguyen Hoang","doi":"10.1155/ccrp/6920702","DOIUrl":"https://doi.org/10.1155/ccrp/6920702","url":null,"abstract":"<p><strong>Background: </strong>Persistent severe acute kidney injury (PS-AKI)-recently standardized as Kidney Disease: Improving Global Outcomes (KDIGO) Stage 3 persisting ≥ 72 h, or renal replacement therapy/death after Stage 3 diagnosis-has emerged as a trajectory-based phenotype complementing conventional KDIGO staging. Evidence in contemporary intensive care unit (ICU) cohorts remains limited.</p><p><strong>Methods: </strong>We retrospectively studied adults admitted to a tertiary ICU (January 2024-June 2025). Acute kidney injury (AKI) was staged per KDIGO 2012, with trajectories classified as Stage 1 AKI, transient AKI (Stage 2-3 resolving within 48 h), persistent mild-moderate AKI, or PS-AKI. The primary outcome was in-hospital mortality; secondary outcomes included renal recovery. Predictors of PS-AKI were explored using logistic regression and gradient boosting with SHAP attribution.</p><p><strong>Results: </strong>Among 139 ICU patients with AKI screened, 106 met criteria. Most AKI was community-acquired (97/106, 91.5%). PS-AKI accounted for 23% (24/106) and carried the worst outcomes, with in-hospital mortality 54% and renal recovery 17%. Within Stage 2-3, PS-AKI was associated with substantially worse outcomes than non-PS trajectories (mortality 54% vs 10.8%; adjusted HR for death 2.23, 95% CI 0.69-7.21; adjusted OR for renal recovery 0.07, 95% CI 0.01-0.24). A 72-h landmark analysis showed similar but nonsignificant trends. Inflammatory profiles distinguished PS-AKI, with higher neutrophil-to-lymphocyte ratio (NLR), C-reactive protein (CRP), and lower platelets. The composite NLR-to-platelet ratio (NLR/PLT) was independently associated with PS-AKI (adjusted OR 2.51 per doubling, 95% CI 1.52-4.12; AUC 0.86), while the systemic immune-inflammation index (SII) showed no significant association.</p><p><strong>Conclusions: </strong>In this predominant community-acquired ICU cohort, PS-AKI was common and strongly associated with poor in-hospital outcomes. The co-occurrence of inflammation and thrombocytopenia, summarized by NLR/PLT, may represent a simple exploratory signal for early-risk appraisal. These findings support further research into trajectory-based AKI phenotypes and the potential utility of inflammation-hematologic markers in predicting persistence.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2026 ","pages":"6920702"},"PeriodicalIF":1.8,"publicationDate":"2026-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12910387/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146221010","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 Neuromuscular Electrical Stimulation on Biological Markers in Critically Ill Patients: A Systematic Review and Meta-Analysis.","authors":"Amanda de Oliveira Santos, Matheus Cardoso Santos, Maíra Avila Fontes Trindade, Danielle Alves de Andrade Rebouças, Carlos José Oliveira de Matos, Fernanda Oliveira de Carvalho, Paulo Ricardo Martins-Filho, Érika Ramos Silva","doi":"10.1155/ccrp/5382735","DOIUrl":"10.1155/ccrp/5382735","url":null,"abstract":"<p><strong>Purpose: </strong>Neuromuscular electrical stimulation (NMES) has been increasingly used to preserve or restore neuromuscular function in critically ill patients. However, its effects on inflammatory biomarkers and its safety require to be fully elucidated. This study aimed to analyze the available evidence on the impact of NMES on biological markers in critically ill patients.</p><p><strong>Methods: </strong>This systematic review followed a preregistered protocol (PROSPERO: CRD42023424413). A comprehensive search was conducted in PubMed, EMBASE, Web of Science, Scopus, PEDro, CENTRAL, and Google Scholar to identify randomized controlled trials (RCTs) comparing NMES with control interventions and reporting outcomes related to biological markers.</p><p><strong>Results: </strong>Ten RCTs were included in this review. Meta-analyses revealed a significant acute increase in interleukin-10 levels (SMD: 0.60; 95% CI: 0.11 to 1.08; <i>p</i> = 0.02) and a delayed reduction in serum C-reactive protein levels (SMD: -0.74; 95% CI: -1.09 to -0.40; <i>p</i> < 0.0001) following NMES application.</p><p><strong>Conclusions: </strong>Available evidence suggests that NMES can modulate systemic inflammation in mechanically ventilated critically ill patients, with early anti-inflammatory effects (IL-10 elevation) and subsequent attenuation of inflammation (CRP reduction). These findings support the safety of NMES during active phases of critical illness. Further high-quality RCTs are warranted to standardize stimulation protocols, characterize biomarker dynamics, and elucidate the underlying mechanisms to guide evidence-based clinical use.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2026 ","pages":"5382735"},"PeriodicalIF":1.8,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12820417/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146031088","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":"Liberal Versus Restrictive Blood Transfusion Strategies in Neurocritical Care: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.","authors":"Ayesha Shaukat, Muhammad Ahmed Zahoor, Komal Khan, Aiman Shahid Khan, Rubaisha Saleem, Anupama Ariyasiri, Syed Abdul Aziz Jameel, Shahab Afridi, Syeda Javeria Salman, Noor Naeem, Marib Ashraf, Amamah Rauf Chaudhry, Zobia Ahmad, Muhammad Omar Larik, Muhammad Hasanain, Muhammad Umair Anjum, Aymar Akilimali","doi":"10.1155/ccrp/6179847","DOIUrl":"10.1155/ccrp/6179847","url":null,"abstract":"<p><strong>Introduction: </strong>Neurocritical care patients, including those with traumatic brain injury, subarachnoid hemorrhage, and intracerebral hemorrhage, often develop anemia, compromising brain oxygen delivery and increasing morbidity and mortality. Blood transfusion strategies, either liberal or restrictive, are commonly used to manage anemia in these patients, but the optimal approach remains unclear due to mixed results in existing studies.</p><p><strong>Methods: </strong>A systematic search of PubMed, Cochrane Library, ScienceDirect, and Google Scholar from inception to December 2024 for randomized controlled trials (RCTs) evaluating restrictive versus liberal transfusion strategies in adult neurocritical care patients. Outcomes included mortality, Glasgow Outcome Scale (GOS), red blood cell (RBC) units transfused, sepsis, intensive care unit (ICU)/hospital length of stay, and secondary complications. The study is registered with PROSPERO (CRD42025635426).</p><p><strong>Findings: </strong>The analysis included seven RCTs with 1941 patients. The restrictive strategy significantly reduced the number of RBC units transfused per patient (MD: 2.36; 95% CI: 1.08-3.64; <i>p</i> = 0.0003) and was associated with a lower incidence of sepsis (RR: 0.73; 95% CI: 0.56-0.96; <i>p</i> = 0.02). There were no significant differences between restrictive and liberal strategies for ICU (RR 0.74; 95% CI 0.28-1.91; <i>p</i> = 0.53), in-hospital (RR 0.77; 95% CI 0.35-1.68), 30-day (RR 0.91; 95% CI 0.70-1.18), 6-month (RR 0.98; 95% CI 0.67-1.44), or long-term mortality (RR 1.00; 95% CI 0.80-1.24). GOS scores at 6 months showed no significant difference (RR 0.94; 95% CI 0.83-1.07). ICU and hospital length of stay were also comparable between strategies. Secondary outcomes, including stroke, brain hypoxia, intracranial hypertension, and other non-neurological complications, showed no significant differences between the two strategies.</p><p><strong>Conclusion: </strong>Restrictive transfusion strategies are as effective as liberal strategies in terms of mortality and neurological complications, with additional benefits such as fewer RBC transfusions and lower sepsis rates. These findings support restrictive strategies as a safer approach to managing anemia in neurocritical care, though further research on long-term outcomes is needed.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2026 ","pages":"6179847"},"PeriodicalIF":1.8,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12793887/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145967473","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":"Analysis of Influencing Factors of Junior ICU Nurses' Recognition and Response Abilities to Clinical Deterioration: A Cross-Sectional Study.","authors":"Xueqin Guo, Xianke Wang, Chenzi Xu, Yuhan Wang, Xin Li, Lijuan Xiong, Huan Jin","doi":"10.1155/ccrp/3230912","DOIUrl":"10.1155/ccrp/3230912","url":null,"abstract":"<p><strong>Aim: </strong>To evaluate the current status and explore influencing factors of junior intensive care unit (ICU) nurses' recognition and response capabilities to clinical deterioration.</p><p><strong>Design: </strong>This cross-sectional study followed the STROBE statement.</p><p><strong>Methods: </strong>From November 2024 to January 2025, 260 junior ICU nurses from five tertiary hospitals in China were recruited. Data were collected using a validated 25-item questionnaire spanning six dimensions to assess their recognition and response abilities. SPSS was used for statistical analyses, including descriptive statistics, Kruskal-Wallis H/Mann-Whitney <i>U</i> tests, and multiple linear regression to examine differences under sociodemographic and occupational factors.</p><p><strong>Results: </strong>The total score for recognition and response abilities among 250 junior ICU nurses was 99 (95, 103), with an average item score of 3.96 ± 0.83. Dimension scores ranked from lowest to highest: emergency handling, evaluation, teamwork, disease information analysis, disease information acquisition, and clinical decision-making. Education level, work experience, and participation in disease observation training were identified as significant influencing factors.</p><p><strong>Conclusions: </strong>Junior ICU nurses in China demonstrate relatively strong overall observation skills but insufficient clinical decision-making abilities. Nursing managers and educators should integrate these factors into training to enhance young nurses' capabilities in recognizing and responding to clinical deterioration, which is crucial for improving critical care outcomes.</p><p><strong>Patient or public contribution: </strong>Patients and the public were not directly involved in the design, implementation, or reporting of this study. However, the results of the study emphasize the importance of improving primary ICU nurses' clinical decision-making skills and emergency response skills, which may have an impact on patient care.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2025 ","pages":"3230912"},"PeriodicalIF":1.8,"publicationDate":"2025-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12717636/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145805876","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":"Droxidopa in Critical Care: A Systematic Review of an Emerging Off-Label Practice.","authors":"Carlos Valladares, Franklyn Vega Batista, Marc Faltas, Mareya Menteyas, Katherine Chiapaikeo-Poco","doi":"10.1155/ccrp/4830160","DOIUrl":"10.1155/ccrp/4830160","url":null,"abstract":"<p><strong>Background: </strong>Prolonged use of intravenous (IV) vasopressors in critically ill patients is associated with significant complications. Droxidopa, a norepinephrine precursor approved for neurogenic orthostatic hypotension, has gained interest as an off-label agent for facilitating vasopressor weaning in ICU settings. This systematic review aimed to evaluate the efficacy and safety of droxidopa for vasopressor weaning in ICU patients.</p><p><strong>Methods: </strong>A systematic review was conducted following PRISMA guidelines. Databases searched included PubMed, Embase, Cochrane, and Web of Science through April 2025. Eligible studies reporting primary clinical data on droxidopa use in ICU patients were included. Outcomes included time to IV vasopressor discontinuation, duration of droxidopa use, ICU length of stay (LOS), and ICU mortality, and results were narratively synthesized. The risk of bias was assessed using the ROBINS-I and the JBI checklists.</p><p><strong>Results: </strong>Seven studies involving 161 ICU patients were included. Five studies reported time to vasopressor discontinuation, ranging from 29 to 120 h. The duration of droxidopa use ranged from 87 to 192 h. Two studies reported ICU LOS, ranging from 18 to 44 days. ICU mortality was inconsistently reported. These findings are primarily drawn from small, retrospective studies and should be interpreted cautiously.</p><p><strong>Discussion: </strong>Findings suggest that droxidopa may effectively facilitate vasopressor weaning in critically ill patients. However, variations in dosing, patient selection, and outcome reporting limit generalizability. Evidence is drawn primarily from small, retrospective studies, some available only as abstracts.</p><p><strong>Conclusion: </strong>Available evidence on droxidopa for vasopressor weaning in ICU patients remains limited and heterogeneous, with very low certainty. Further research is warranted. No funding was received for this review, and the review was not prospectively registered.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2025 ","pages":"4830160"},"PeriodicalIF":1.8,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12714080/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145805894","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}