Critical care science最新文献

{"title":"How to use intensive care unit scoring systems: a practical guide for the intensivist.","authors":"Giulliana Martines Moralez, Filipe Sousa Amado, Gloria Adriana Rocha Martins, Antonio Paulo Nassar Junior, Jorge Ibrain Figueira Salluh","doi":"10.62675/2965-2774.20250347","DOIUrl":"https://doi.org/10.62675/2965-2774.20250347","url":null,"abstract":"","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":"37 ","pages":"e20250347"},"PeriodicalIF":0.0,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A target trial emulation of dexmedetomidine to treat agitation in the intensive care unit.","authors":"Ary Serpa Neto, Marcus Young, Atthaphong Phongphithakchai, Akinori Maeda, Yukiko Hikasa, Nuttapol Pattamin, Nuanprae Kitisin, Gehan Premaratne, Gabriel Chan, Joseph Furler, Meg Stevens, Dinesh Pandey, Hossein Jahanabadi, Yahya Shehabi, Rinaldo Bellomo","doi":"10.62675/2965-2774.20250010","DOIUrl":"https://doi.org/10.62675/2965-2774.20250010","url":null,"abstract":"<p><strong>Objective: </strong>Agitation is a major problem in the intensive care unit. However, no treatment has clearly emerged as effective and safe. Using target trial emulation, we aimed to test the hypothesis that early intervention with dexmedetomidine would accelerate agitation resolution.</p><p><strong>Methods: </strong>We read clinical notes in an electronic medical records system with natural language processing to identify patients with agitation. We obtained their demographics, trajectories, associations, and outcomes. We used g-formulas to study the possible effects of dexmedetomidine on agitation resolution and key outcomes.</p><p><strong>Results: </strong>We screened 7525 patients. Overall, 2242 patients (29.8%) developed within-intensive care unit agitation, and 2052 (27.3%) were eligible for inclusion in the target trial emulation, with 314 treated with dexmedetomidine. Dexmedetomidine-treated patients had more severe illness and were more likely to have unplanned emergency admissions with medical diagnoses. However, they achieved higher rates of resolution of within-intensive care unit agitation (94% versus 72%; p < 0.001) and lower 30-day mortality (5% versus 9%; p = 0.033). Early initiation of dexmedetomidine accelerated the resolution of agitation (risk ratio [RR] 1.13 [95%CI 1.03 - 1.21]; risk difference [RD] 9.8% [95%CI 2.6% - 15.4%]); extubation by Day 30 (RR 1.03 [95%CI 1.02 - 1.04]; RD 3.1% [95%CI 2.2% - 4.2%]); and reduced the chance of having a tracheostomy by Day 30 (RR 0.67 [95%CI 0.34 - 0.99]; RD -3.5% [95%CI -7.0% - -0.0%]).</p><p><strong>Conclusion: </strong>Through target trial emulation analysis, early dexmedetomidine was associated with an increased rate of resolution of agitation and extubation and decreased tracheostomy risk.</p>","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":"37 ","pages":"e20250010"},"PeriodicalIF":0.0,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Practical approaches to the tasks of preserving autonomy and respecting vulnerability among critically ill adult patients: a narrative review.","authors":"João Gabriel Rosa Ramos, Camila Vasconcelos, Luciana Dadalto","doi":"10.62675/2965-2774.20250234","DOIUrl":"https://doi.org/10.62675/2965-2774.20250234","url":null,"abstract":"<p><p>Respect for autonomy and human vulnerability are bioethical principles that are frequently involved in decision-making dilemmas in the context of critical care. Multiple challenges are involved in the tasks of assessing and respecting the autonomy of critically ill patients with respect to the critical illness in question, patients' cognitive status and the context of intensive care units; furthermore, time constraints and emotional stress complicate decision-making for all stakeholders in this context. In addition, critically ill patients are inherently vulnerable to multiple sources of potential unintended harm. Therefore, clinicians working in intensive care units must develop the skills necessary to acknowledge, assess and mitigate those risks. In this manuscript, we review the literature on this topic. We also propose a practical approach that can help overcome some of those challenges; specifically, we advocate for the adoption of a relational approach to autonomy and shared decision-making, which could help overcome those challenges, thereby promoting more effective and ethical patient care.</p>","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":"37 ","pages":"e20250234"},"PeriodicalIF":0.0,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cross-cultural adaptation of the State Behavioral Scale to Brazilian Portuguese.","authors":"Janaína Santana Dantas, Martha Moreira Cavalcante Castro, Carolina Villa Nova Aguiar","doi":"10.62675/2965-2774.20250183","DOIUrl":"https://doi.org/10.62675/2965-2774.20250183","url":null,"abstract":"<p><strong>Objective: </strong>To perform a cross-cultural adaptation of the State Behavioral Scale to Brazilian Portuguese, assess its psychometric quality and use the scale to evaluate the level of sedation of patients on mechanical ventilation in the pediatric intensive care unit of a tertiary care hospital.</p><p><strong>Methods: </strong>After receiving authorization by the main author, the State Behavioral Scale was adapted according to the following steps: translation of the original version into Portuguese; synthesis of the Portuguese versions; evaluation by a committee of judges; reverse translation by native speakers of the source language; synthesis of retroversions; pretest; and evaluation of psychometric quality.</p><p><strong>Results: </strong>The adapted scale was administered to 20 patients by four evaluators, who performed daily evaluations in pairs simultaneously and independently. The intraclass correlation coefficient was 0.939 (p < 0.001) for the State Behavioral Scale and 0.976 (p < 0.001) for the COMFORT-B scale. The two scales were strongly correlated, with Spearman coefficients ranging from 0.884 to 0.908 (p < 0.001). In the study sample, most children (n = 43 observations; 48.9%) had scores of -1 (responsive to light touch or voice) or 0 (awake and able to calm down), which corresponded to light sedation.</p><p><strong>Conclusion: </strong>The translated and adapted version of the State Behavioral Scale showed high interrater agreement and high correlation with the COMFORT-B scale. The application of the scale showed an adequate level of sedation in most patients.</p>","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":"37 ","pages":"e20250183"},"PeriodicalIF":0.0,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prediction of PaO2 from SpO2 values in critically ill invasively ventilated patients: rationale and protocol for a patient-level analysis of ERICC, LUNG SAFE, PRoVENT and PRoVENT-iMiC (PRoPERLy II).","authors":"Simon Corrado Serafini, David M P van Meenen, Luigi Pisani, Ary Serpa Neto, Luciano César Pontes Azevedo, Tai Pham, Eya Sahraoui, Giacomo Bellani, John G Laffey, Marcus J Schultz, Guido Mazzinari","doi":"10.62675/2965-2774.20250270","DOIUrl":"https://doi.org/10.62675/2965-2774.20250270","url":null,"abstract":"<p><strong>Introduction: </strong>In patients with acute respiratory distress syndrome (ARDS), mortality risk is typically assessed using the arterial partial pressure of oxygen (PaO2) divided by the fraction of inspired oxygen (FiO2), known as the PaO2/FiO2 ratio. Recently, the SpO2/FiO2 ratio, which uses peripheral oxygen saturation (SpO2) instead of PaO2, has been suggested as a reasonable alternative when there is little access to arterial blood gas analyses. Additionally, equations that predict PaO2 from SpO2 values could offer another viable method for assessment.</p><p><strong>Aim: </strong>To evaluate the accuracy of methods for predicting PaO2 from SpO2 values and compare risk stratification based on measured versus predicted PaO2/FiO2 ratios using a large database that harmonizes the individual data of patients included in four observational studies.</p><p><strong>Methods and analysis: </strong>The individual data from four observational studies ('Epidemiology of Respiratory Insufficiency in Critical Care study' [ERICC], 'Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure' [LUNG SAFE], 'PRactice of VENTilation in critically ill patients without ARDS' [PRoVENT], and 'PRactice of VENTilation in critically ill patients in Middle-income Countries' [PRoVENT-iMiC]) were harmonized and pooled into a database named 'PRoPERLy II'. The primary endpoint of this planned analysis will be the accuracy of currently available methods to predict PaO2 from SpO2 values. The secondary endpoint will be the accuracy of classification based on SpO2/FiO2 ratio and the predicted PaO2/FiO2 ratio.</p><p><strong>Dissemination: </strong>Our planned analysis addresses a clinically important research question by comparing different equations for predicting PaO2 from SpO2 values.</p>","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":"37 ","pages":"e20250270"},"PeriodicalIF":0.0,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Uncovering knowledge of pediatric sepsis and recognition of septic shock: a survey among Brazilian pediatricians.","authors":"Andrea Maria Cordeiro Ventura, Orlei Ribeiro Araujo, José Colleti Junior, Daniela Carla de Souza","doi":"10.62675/2965-2774.20250143","DOIUrl":"https://doi.org/10.62675/2965-2774.20250143","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the ability of Brazilian pediatricians to recognize sepsis and septic shock in children.</p><p><strong>Methods: </strong>A cross-sectional multicenter survey was conducted among Brazilian pediatricians between May and June 2023, before the release of the new Phoenix sepsis criteria in 2024. An online electronic system was used for surveys to characterize the knowledge and skills of physicians in the diagnosis and treatment of sepsis in children. The questions related to the diagnosis and treatment of sepsis and septic shock in children were based on the International Pediatric Sepsis Consensus Conference, the American College of Critical Care Medicine Guidelines, and the Surviving Sepsis Campaign in Pediatrics. Descriptive statistical analyses were performed using R software.</p><p><strong>Results: </strong>Pediatricians were surveyed about the recognition, knowledge, and management of pediatric patients with sepsis and septic shock. The responses of 355 physicians from all regions of Brazil were analyzed, with the majority from the southeastern region of the country (53.3%). In clinical practice, the most utilized criteria for diagnosing sepsis included inappropriate tachycardia (92%), temperature alteration (88.2%), and the presence of a suspected or confirmed infectious focus (87.9%). For septic shock, capillary refill time alteration (87.1%), arterial hypotension (84.8%), and changes in the level of consciousness (82.2%) were the predominant indicators. A total of 55.6% pediatricians reported having the potential to obtain venous or intraosseous access within 5 minutes, and 59.3% could administer antibiotics within the first hour. Approximately one-quarter (27.5%) of the participants responded that it was possible to infuse 40 - 60mL/kg in 1 hour. The most commonly used solution for fluid resuscitation was isotonic saline (70.9%), followed by Ringer's lactate (45.0%). The infusion of a vasopressor was considered in patients who did not improve after receiving an infusion of 40 - 60mL/kg (75.8%).</p><p><strong>Conclusion: </strong>This is the first study to assess the knowledge of sepsis and septic shock among the Brazilian pediatric population. The results reveal a significant deficiency in the recognition of sepsis. This study demonstrated a gap between evidence and clinical practice. Adherence to international guidelines needs to be improved.</p>","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":"37 ","pages":"e20250143"},"PeriodicalIF":0.0,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antimicrobial resistance of Streptococcus pneumoniae from invasive pneumococcal disease in Brazil.","authors":"Pedro Kurtz, Pedro Fernandez Del Peloso, Fernando Augusto Bozza","doi":"10.62675/2965-2774.20250204","DOIUrl":"https://doi.org/10.62675/2965-2774.20250204","url":null,"abstract":"","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":"37 ","pages":"e20250204"},"PeriodicalIF":0.0,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The quandary of anticoagulation for sepsis patients with new-onset atrial fibrillation.","authors":"Cassiano Teixeira, Túlio Frederico Tonietto","doi":"10.62675/2965-2774.20250120","DOIUrl":"10.62675/2965-2774.20250120","url":null,"abstract":"","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":"37 ","pages":"e20250120"},"PeriodicalIF":0.0,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11975273/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659892","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":"The case for an international severity of illness scoring system.","authors":"Alexander Tracy, Jorge Ibrain Figueira Salluh, Eirik Alnes Buanes, Dave A Dongelmans, Stefano Finazzi, Bharath Kumar Tirupakuzhi Vijayaraghavan, Nazir Lone, David Pilcher, Matti Reinikainen, Menbeu Sultan, David Thomson, Wangari Waweru-Siika, Rashan Haniffa, Abigail Beane","doi":"10.62675/2965-2774.20250293","DOIUrl":"10.62675/2965-2774.20250293","url":null,"abstract":"","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":"37 ","pages":"e20250293"},"PeriodicalIF":0.0,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11975272/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659885","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":"Multicenter observational study of patients who underwent cardiac surgery and were hospitalized in an intensive care unit (BraSIS 2): study protocol and statistical analysis plan.","authors":"Nair Naiara Barros de Vasconcelos, Renato Carneiro de Freitas Chaves, Carolina de Moraes Pellegrino, Guilherme Martins de Souza, Veronica Neves Fialho Queiroz, Carmen Silvia Valente Barbas, Flávio Takaoka, Ricardo Luiz Cordioli, Sandrigo Mangini, Fabio de Vasconcelos Papa, Hélio Penna Guimarães, Adriano José Pereira, Ary Serpa Neto, Andre Gulinelli, Anna Clara Legal, Caio Vinicius Gouvêa Jaoude, Eduardo Paolinelli, Eric Benedet Lineburger, Erick César de Farias Albuquerque, Evaldo Gomes Ferreira Filho, Fabio Barlem Hohmann, Felipe Galdino, Felipe Souza Lima Vianna, Frederico Toledo Campo Dall'Orto, Lucas Tramujas, Luciano Ribeiro Pereira Silva, Maxim Goncharov, Paulo César Gottardo, Roberto Rabello Filho, Thais Dias Midega, Vinicius Barbosa Galindo, Vinícius Caldeira Quintão, Viviane Cordeiro Veiga, Thiago Domingos Corrêa, João Manoel Silva Júnior","doi":"10.62675/2965-2774.20250222","DOIUrl":"10.62675/2965-2774.20250222","url":null,"abstract":"<p><strong>Background: </strong>The perioperative management of patients undergoing cardiac surgery is highly complex and involves numerous factors. There is a strong association between cardiac surgery and perioperative complications. The Brazilian Surgical Identification Study (BraSIS 2) aims to assess the incidence of death and early postoperative complications, identify potential risk factors, and examine both the demographic characteristics of patients and the epidemiology of cardiovascular procedures.</p><p><strong>Methods and analysis: </strong>BraSIS 2 is a multicenter observational study of patients who undergo cardiac surgery and who are admitted to the intensive care unit. The primary objective is to describe the risk factors and incidence of mortality or severe postoperative complications occurring within the first 3 postoperative days of cardiac surgery or until intensive care unit discharge (whichever event occurs first). Severe postoperative complications include acute myocardial infarction, acute respiratory distress syndrome, cardiorespiratory arrest with return of spontaneous circulation, Kidney Disease Improving Global Outcomes stage ≥ 2, a new surgical approach being conducted in an unscheduled event of urgency or emergency, renal replacement therapy, septic shock, severe bleeding, severe hemodynamic instability, stroke, unplanned reintubation, and unplanned use of a circulatory assistance device. The secondary outcomes include the evaluation of patient characteristics and descriptions of the performed surgeries and administered anesthesia. This study will also assess intraoperative and postoperative complications, as well as risk factors associated with postoperative complications and mortality. We expect to recruit 500 patients from at least 10 Brazilian intensive care units. Trial registration: NCT06154473; partial results.</p>","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":"37 ","pages":"e20250222"},"PeriodicalIF":0.0,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11869817/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143617869","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}