世界危重病急救学杂志(英文版)最新文献

{"title":"Determinants of fatal outcome in septic shock patients with euthyroid sick syndrome.","authors":"Mirza Kovacevic, Visnja Nesek-Adam, Semir Klokic, Mehmet Yilmaz","doi":"10.5492/wjccm.v15.i1.115599","DOIUrl":"10.5492/wjccm.v15.i1.115599","url":null,"abstract":"<p><strong>Background: </strong>Septic shock is a leading cause of mortality in intensive care, and euthyroid sick syndrome (ESS) may influence outcomes. Identifying predictors of fatal outcome in this population is crucial for guiding management.</p><p><strong>Aim: </strong>To identify clinical and laboratory predictors of 28-day mortality in patients with septic shock and ESS, and to evaluate the prognostic value of markers such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), prognostic index (PI), and modified Glasgow prognostic score (mGPS), the vasoactive drug-dependent index (VDI), and shock index (SI).</p><p><strong>Methods: </strong>In this prospective observational study, 95 patients with septic shock and ESS admitted between May 2024 and August 2025 were analyzed. Demographic, clinical, and laboratory data were collected at admission and on days 1, 3, and 7. Prognostic markers - NLR, PLR, PI, and mGPS, VDI, and SI were analyzed. Associations with 28-day mortality were evaluated using standard statistical tests.</p><p><strong>Results: </strong>Of the 95 patients (mean age 61 ± 14.6 years; female/male ratio 52/43), 53 (52%) died. Duration of mechanical ventilation (<i>P</i> = 0.013) and intensive care unit (ICU) length of stay (<i>P</i> = 0.005) were significantly associated with mortality. Acute Physiology and Chronic Health Evaluation II (<i>P</i> = 0.014) and Simplified Acute Physiology Score II (<i>P</i> = 0.001) scores correlated positively with fatal outcome. Predictive laboratory parameters included base excess and free thyroxine (FT4) at admission (<i>P</i> = 0.013, <i>P</i> < 0.001); free triiodothyronine and FT4 on day 1 (<i>P</i> = 0.007, <i>P</i> < 0.001); red blood cells (RBC) and lymphocytes on day 2 (<i>P</i> = 0.027, <i>P</i> = 0.049); and white blood cells, pO₂, thyroid-stimulating hormone, and FT4 on day 3 (all <i>P</i> < 0.05). Variables positively correlated with mortality included neutrophils, lactate, C-reactive protein, and albumin, while pH, pO₂, bicarbonate, RBC, platelets, and thyroid hormones were negatively correlated. SI on day 3 (<i>P</i> = 0.027) and mGPS on day 1 (<i>P</i> = 0.030) were significant prognostic indices.</p><p><strong>Conclusion: </strong>The 28-day mortality among patients with septic shock and ESS was 52%. Duration of mechanical ventilation, ICU stay, severity scores, laboratory parameters, and indices such as SI and mGPS were significantly associated with outcome. The presence of ESS may contribute to adverse prognosis, and combined evaluation of clinical and laboratory factors can improve risk stratification in this high-risk population.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"15 1","pages":"115599"},"PeriodicalIF":0.0,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13010245/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147516336","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":"Burden and impact of acute kidney injury in acute liver failure: A systematic review.","authors":"Armin Ahmed, Medhavi Gautam, Afzal Azim, Banadana Chakravarti, Meenakshi Tiwari","doi":"10.5492/wjccm.v15.i1.111114","DOIUrl":"10.5492/wjccm.v15.i1.111114","url":null,"abstract":"<p><strong>Background: </strong>Acute kidney injury (AKI) affects 40%-80% of patients with acute liver failure (ALF) and arises from complex mechanisms, including hemodynamic instability, drug toxicity, and direct renal insults. Unlike chronic liver disease, AKI in ALF is poorly studied.</p><p><strong>Aim: </strong>To consolidate current evidence and guide future research and interventions to improve outcomes in ALF patients with AKI.</p><p><strong>Methods: </strong>This systematic review followed PRISMA guidelines, searching databases from 2000 to 2024 for studies on AKI in ALF. We included studies focused on adult, English-language, full-length epidemiological studies. Data were extracted on study design, patient demographics, risk factors, and outcomes. Methodological quality was assessed using a tailored 5-point tool. Data were summarized using descriptive statistics and analyzed with GraphPad Prism and MedCalc software.</p><p><strong>Results: </strong>This systematic review analyzed nine studies published between 2009 and 2024, encompassing 6031 patients with ALF, of whom 62.9% developed AKI. Most studies were retrospective and varied in methodology, setting, and population. Only three studies reported independent risk factors for the development of AKI among ALF patients, with significant variation in the risk factors studied. AKI in ALF patients significantly increased mortality, with hazard ratios ranging from 2.77 to 11.61. The review highlights the need for standardized diagnostic criteria and risk stratification to guide prevention and improve clinical outcomes in ALF.</p><p><strong>Conclusion: </strong>AKI is common in ALF, increasing morbidity and mortality; standardised diagnosis and targeted management strategies are urgently needed.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"15 1","pages":"111114"},"PeriodicalIF":0.0,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13010469/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147517199","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":"Dysregulation of renin-angiotensin-aldosterone axis in septic shock: Emerging roles of angiotensin-(1-5) and alamandine.","authors":"Arunkumaar Srinivasan, Ponnsusamy Dhivya","doi":"10.5492/wjccm.v15.i1.114670","DOIUrl":"10.5492/wjccm.v15.i1.114670","url":null,"abstract":"<p><p>The renin-angiotensin-aldosterone system (RAAS) undergoes profound dysregulation during septic shock, defined by persistent hypotension requiring vasopressors to maintain mean arterial pressure ≥ 65 mmHg plus lactate > 2 mmol/L, with mortality exceeding 40%. The classical RAAS pathway becomes impaired with elevated renin but paradoxically low angiotensin (Ang) II levels, correlating with poor outcomes. The alternative Ang-converting enzyme 2-Ang-(1-7)-mas receptor axis provides counter-regulatory effects but represents a \"double-edged sword\" in sepsis. Elevated circulating Ang-converting enzyme 2 paradoxically predicts worse outcomes, possibly through excessive Ang II depletion contributing to vasoplegia. Downstream metabolites including Ang-(1-5) and alamandine show cardioprotective properties in experimental models. Ang-(1-5) may serve as a biomarker reflecting RAAS dysregulation severity. Elevated dipeptidyl peptidase 3 exacerbates dysfunction by degrading Ang II. Experimental Ang-(1-7) infusion prevented septic shock and reduced vasopressor requirements. However, human randomized trials remain limited. Future research should focus on biomarker-guided patient stratification and multicenter trials establishing clinical utility of alternative RAAS modulation.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"15 1","pages":"114670"},"PeriodicalIF":0.0,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13010565/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147516359","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":"Advancing emergency airway management: Video laryngoscope <i>vs</i> intubating laryngeal mask airway in critical care.","authors":"Gemechu Dereje Feyissa","doi":"10.5492/wjccm.v15.i1.117127","DOIUrl":"10.5492/wjccm.v15.i1.117127","url":null,"abstract":"<p><p>This editorial comments on the randomized controlled trial by Aggarwal <i>et al</i>, which demonstrates video laryngoscope (VL) superiority over intubating laryngeal mask airway (ILMA) for emergency intubation in critically ill patients-first-pass success (87.5% <i>vs</i> 53.1%), intubation times (44.0 ± 19.7 seconds <i>vs</i> 82.5 ± 14.5 seconds), and reduced complications including oral trauma (0% <i>vs</i> 26.9%) and sore throat (3.1% <i>vs</i> 26.9%). VL's camera-enhanced visualization ensures precise navigation in high-stakes scenarios where patients have limited physiological reserve, positioning it as the frontline device per updated Difficult Airway Society guidelines. ILMA retains value as rescue ventilation during failed VL attempts despite its longer procedure times and tissue trauma risks, warranting availability in all emergency airway algorithms. These rigorous findings guide intensivists toward protocol revisions prioritizing VL training, resource allocation, and simulation drills-particularly in resource-limited intensive care units. Future multicenter trials should validate performance across difficult airways and evaluate cost-effectiveness to optimize implementation globally.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"15 1","pages":"117127"},"PeriodicalIF":0.0,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13010403/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147517250","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":"Myoclonus associated with tranexamic acid administration in a patient on veno-arterial extracorporeal membrane oxygenation support: A case report.","authors":"Fotios Dimitriadis, Theodoros Pitsolis, Kyriaki Kolovou, Sissy Maragoulia, Evangelia Theodorou, Giorgos Konstantinou, Theodora Soulele, Ioannis Vlahodimitris, Michail Zervos, Paraskevi Salata, Dimitrios Elaiopoulos, Stergios Gatzonis, Stavros Dimopoulos","doi":"10.5492/wjccm.v15.i1.115620","DOIUrl":"10.5492/wjccm.v15.i1.115620","url":null,"abstract":"<p><strong>Background: </strong>Tranexamic acid (TXA) is widely used as an antifibrinolytic agent to reduce bleeding in cardiac and extracorporeal circulation settings. Neurological adverse effects, including seizures and myoclonus, are rare and not well documented in patients supported by extracorporeal membrane oxygenation (ECMO).</p><p><strong>Case summary: </strong>We report the case of a 52-year-old male with ST-elevation myocardial infarction and severe left ventricular dysfunction, who was transferred to our intensive care unit department under veno-arterial (VA)-ECMO support and continuous renal replacement therapy (CRRT). To maintain ECMO oxygenator function and due to decreasing fibrinogen levels, endovenous one gram TXA twice a day was administered and within hours after the second dose, the patient developed generalized myoclonic jerks. A non-contrast brain computed tomography revealed no acute or chronic abnormalities, and neurological evaluation attributed the findings to TXA as the most likely cause due to TXA overdose. Following discontinuation of TXA, the symptoms resolved within 48 hours.</p><p><strong>Conclusion: </strong>This case highlights a rare neurological complication associated with TXA overdose, occurring in patient with VA-ECMO and CRRT. Clinicians should remain vigilant for such adverse effects in this context.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"15 1","pages":"115620"},"PeriodicalIF":0.0,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13010879/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147517062","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":"Use of radiograph scoring systems to assess pulmonary disease severity in patients with COVID-19 pneumonia.","authors":"Hayder Mohammed, Khalid Y Fadul, Syed G A Naqvi, Nadir Kharma, Alhady Alfian Yusof, Shabbir Ahmad, Munawar Farooq, Sasha Javid, Ahmed Mohamed, Manar E Abdel-Rahman, Tim Harris","doi":"10.5492/wjccm.v15.i1.113684","DOIUrl":"10.5492/wjccm.v15.i1.113684","url":null,"abstract":"<p><strong>Background: </strong>Severe acute respiratory syndrome coronavirus 2 causes pneumonia in most hospitalized patients, often leading to hypoxemia and the need for supplemental oxygen. While chest computed tomography is highly sensitive, chest radiographs (CXR) offer a practical alternative in high-volume settings. Scoring systems like Radiographic Assessment of Lung Edema (RALE) and BRIXIA standardize CXR interpretation and quantify severity, but their relationship with oxygen delivery requirements in coronavirus disease 2019 (COVID-19) patients remains unclear.</p><p><strong>Aim: </strong>To evaluate whether the initial emergency department (ED) radiograph could predict subsequent oxygen support requirements. The secondary aim was to assess inter- and intra-rater agreement of the scoring systems.</p><p><strong>Methods: </strong>This retrospective cohort study examined consecutive COVID-19 patients presenting to a large tertiary hospital ED (May-June 2020) who required admission and underwent CXR within 24 hours of arrival. Infiltrate severity on ED radiographs was scored using the BRIXIA and RALE systems. Oxygen support was categorized by delivery device, and associations were examined using logistic regression.</p><p><strong>Results: </strong>Data was analyzed from 950 COVID-19 patients (90.6% male, mean age: 48.4 ± 12.3 years). Predictive performance showed notable variation: At ED admission, both BRIXIA and RALE scores had the highest discriminatory ability [area under the curve (AUC) = 0.74; 95% confidence interval (CI): 0.69-0.79] for predicting oxygen delivery <i>via</i> high flow nasal cannula/continuous positive airway pressure/Bi-level positive airway pressure. Prediction for non-rebreather mask yielded lower AUCs (BRIXIA: 0.65; RALE: 0.62), with nasal cannula use showing limited discrimination (BRIXIA: 0.56; RALE: 0.54). During hospitalization, predictive performance remained modest across all modalities. The AUCs for intubation were 0.63 (BRIXIA) and 0.62 (RALE), while for high flow nasal cannula/continuous positive airway pressure/Bi-level positive airway pressure, values dropped slightly to 0.62 and 0.59, respectively. Non-rebreather mask prediction maintained an AUC of 0.62 for both scores, and nasal cannula predictions remained low (BRIXIA: 0.56; RALE: 0.52). Inter- and intra-rater agreement was excellent in both scores, with inter-rater agreement at 95% (95%CI: 0.94-0.96) and intra-rater agreement at 97% (95%CI: 0.96-0.98) for BRIXIA and 98% (95%CI: 97-98) for RALE.</p><p><strong>Conclusion: </strong>Both RALE and BRIXIA scores effectively predicted the need for advanced respiratory support in ED COVID-19 patients and demonstrated excellent inter-rater and intra-rater reliability. While their predictive power diminished during hospitalization, both scores remain valuable for initial triage, with BRIXIA particularly useful for ruling out the need for high-level oxygen support.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"15 1","pages":"113684"},"PeriodicalIF":0.0,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13010830/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147517227","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 the implementation of the Critical Care Asia and Africa Intensive Care Unit registry in Ethiopia.","authors":"Adam D Laytin, Ayalew Zewdie, Menbeu Sultan, Amelia J Brandt, Ararso B Olani, Geremew Werkeshe, Sean M Berenholtz, William Checkley, Bhakti Hansoti","doi":"10.5492/wjccm.v15.i1.115938","DOIUrl":"10.5492/wjccm.v15.i1.115938","url":null,"abstract":"<p><strong>Background: </strong>Intensive care unit (ICU) capacity is underdeveloped in sub-Saharan Africa, and outcomes for critical care lag behind higher resource settings. It is essential to understand local case-mix, processes of care and clinical outcomes in African ICUs to close these gaps. To this end, ICU registries are valuable tools for clinical research, quality improvement and capacity building. The Critical Care in Asia and Africa (CCAA) Network has specially developed a novel ICU registry for resource-limited settings.</p><p><strong>Aim: </strong>To evaluate the feasibility, acceptability, and perceived sustainability of the CCAA ICU registry in the Ethiopian clinical context.</p><p><strong>Methods: </strong>Eight months following the pilot implementation of the CCAA ICU registry at two academic medical centers in Addis Ababa, Ethiopia, we conducted a qualitative evaluation. We conducted key informant interviews and focus group discussions with members of the ICU registry team, medical and nursing staff, and leadership team. We coded and analyzed transcripts deductively using a thematic content approach.</p><p><strong>Results: </strong>Emergent themes related to feasibility included data collection, data quality and factors necessary for success. Those related to acceptability included utility, accessibility and comparison to other methods. Those related to perceived sustainability included institutional future, ownership and expansion. Overall, respondents felt that the CCAA ICU registry was feasible and acceptable in their ICUs. They identified important threats to perceived sustainability including multiple channels of communication and infrastructure and human resource limitations, and proposed adaptations to address these threats.</p><p><strong>Conclusion: </strong>The CCAA ICU registry is a promising tool for research and quality improvement in ICUs in sub-Saharan Africa, but successful implementation requires a clear understanding of regional and institutional influencing factors.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"15 1","pages":"115938"},"PeriodicalIF":0.0,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13010629/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147516660","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":"Ventilatory strategies in intensive care: Balancing clinical outcomes and cost-effectiveness.","authors":"Orivaldo Alves Barbosa","doi":"10.5492/wjccm.v15.i1.113310","DOIUrl":"10.5492/wjccm.v15.i1.113310","url":null,"abstract":"<p><p>Ventilatory strategies shape both outcomes and healthcare expenditures in acute respiratory failure. In resource-limited settings, choosing interventions that provide the greatest value is crucial. Evidence from India indicates that non-invasive ventilation may reduce mortality, intensive care unit stay, and treatment costs to nearly one-fifth of those associated with invasive mechanical ventilation. Comparative data from other low-income and middle-income countries reinforce the importance of prioritizing scalable, protocolized strategies with favorable cost-effectiveness profiles. This editorial discusses why economic considerations are indispensable in critical care, highlights key limitations in available studies, and emphasizes that the value of ventilatory support depends heavily on context - particularly pricing, capacity constraints, and local willingness-to-pay thresholds. Strengthening multicenter economic research, especially in low-income and middle-income countries, is vital to guide policy decisions and ensure equitable, sustainable deployment of ventilatory technologies.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"15 1","pages":"113310"},"PeriodicalIF":0.0,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13010552/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147517225","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":"Physiotherapy approaches for pain control in patients who are critically ill.","authors":"Ana Claudia Ometto, Gustavo Brasil Marcelino, Gabriella Cristina Nogueira Pereira, Felipe Farah Pinheiro Rodrigues, Raquel Afonso Caserta Eid, Arnaldo Alves da Silva","doi":"10.5492/wjccm.v15.i1.108062","DOIUrl":"10.5492/wjccm.v15.i1.108062","url":null,"abstract":"<p><p>Pain is a significant challenge in critical care settings, affecting patient outcomes, recovery time, and quality of life. While pharmacological interventions remain the cornerstone of pain management in intensive care units (ICUs), they are associated with numerous adverse effects including respiratory depression, delirium, and prolonged ICU stays. To examine evidence-based physiotherapy approaches that can effectively complement traditional pain management strategies in patients who are critically ill. We conducted a comprehensive literature review of physiotherapy modalities used for pain control in ICU settings. The review focused on six key interventions: Early mobilization, positioning, postural management, manual therapy techniques, thermotherapy, transcutaneous electrical nerve stimulation (TENS), and photobiomodulation (PBM). Evidence supports the efficacy of physiotherapy interventions in reducing pain intensity and improving patient comfort in critical care environments. Early mobilization prevents complications of immobility while indirectly reducing pain through improved circulation and endorphin release. Proper positioning techniques alleviate pressure on painful areas and reduce the incidence of pressure injuries. Manual therapy provides pain relief through neural mobilization and muscle relaxation. Thermotherapy offers significant analgesic effects with minimal side effects. TENS and PBM demonstrate promising results as nonpharmacological pain management options, with PBM showing efficacy through its impact on cellular metabolism and neural pathways. Evidence supports physiotherapy interventions as effective nonpharmacological adjuncts to conventional pain management in critical care, demonstrating efficacy through multiple modalities that enhance patient comfort while potentially reducing opioid requirements.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"15 1","pages":"108062"},"PeriodicalIF":0.0,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13010795/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147517128","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":"Sedation and analgesia strategies in the neuro intensive care unit.","authors":"Zachary I Merhavy, Tereque Raeburn, Gloria M Torres-Ayala, Melissa A McCulloch, Thomas C Varkey","doi":"10.5492/wjccm.v14.i4.111787","DOIUrl":"10.5492/wjccm.v14.i4.111787","url":null,"abstract":"<p><p>Intensivists are often plagued with the challenges of managing critically ill patients in the neurocritical intensive care unit (neuro ICU); one such challenge is the level of illness and the need for sedation, inhibiting the provider's ability to adequately assess the patient. Most sedatives alter neurological and physical exam findings, only compounding potential barriers to providing the best care for each patient. It is important to emphasize that even in the altered mentation of these patients, physical and neurological exams reign supreme as diagnostic tools and should be used in conjunction with multimodal neuromonitoring methods, rather than labs or imaging alone. Additionally, selecting the appropriate analgesic(s) and sedative(s) based on these findings are highly important when determining the best course of individualized management. Thus, providers in the neuro ICU should be highly familiar with the appropriate analgesic and sedative options available in order to determine not only which may be best for each patient, but to also better understand how each drug may impact assessment findings. This comprehensive review aims to provide a structured overview of the pertinent sedatives commonly used in neuro ICUs, their risks and benefits, and how providers can best utilize each in practice to further improve patient outcomes. The novel contribution of this work provides comparative drug tables, dosing guidance for pediatric and very elderly (> 85-years-old) populations, and an exploration into the future possibilities of utilizing artificial intelligence and the human gut microbiome to further enhance the prospects of precision medicine.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"14 4","pages":"111787"},"PeriodicalIF":0.0,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12687082/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145727388","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}