Critical care science最新文献

{"title":"Going green for perioperative hemodynamic monitoring: a golden opportunity for middle-income countries.","authors":"Frederic Michard, Mario Diego Teles Correia, Flavio Eduardo Nacul, Vinícius Caldeira Quintão","doi":"10.62675/2965-2774.20250379","DOIUrl":"10.62675/2965-2774.20250379","url":null,"abstract":"","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":"37 ","pages":"e20250379"},"PeriodicalIF":0.0,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12133084/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144175965","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":"Fluid therapy should be as short as possible.","authors":"Romina Aparecida Dos Santos Gomes, Alexandre Rodrigues Ferreira, Adriana Teixeira Rodrigues, Maria do Carmo Barros de Melo, Jaisson Gustavo da Fonseca","doi":"10.62675/2965-2774.20250310","DOIUrl":"10.62675/2965-2774.20250310","url":null,"abstract":"","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":"37 ","pages":"e20250310"},"PeriodicalIF":0.0,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12094693/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144175838","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":"Frailty influences clinical outcomes in critical patients: a post hoc analysis of the PalMuSIC study.","authors":"Ana Mestre, Rodrigo Afonso, André Ferreira-Simões, Iuri Correia, João Gonçalves Pereira","doi":"10.62675/2965-2774.20250229","DOIUrl":"10.62675/2965-2774.20250229","url":null,"abstract":"<p><strong>Objective: </strong>Frailty is a multidimensional syndrome characterized by diminished physiological reserve, increasing the risk of adverse outcomes, particularly in intensive care unit patients. The Clinical Frailty Scale, ranging from 1 (nonfrail) to 9 (terminally ill), is widely used to quantify frailty. This post hoc analysis of the Palliative Multicenter Study in Intensive Care (PalMuSIC) assesses the impact of frailty and clinical severity on short- and long-term outcomes.</p><p><strong>Methods: </strong>This subanalysis involved 23 Portuguese intensive care units and 335 patients. Patients admitted between March 1 and May 15, 2019, aged ≥ 18 years, and hospitalized for > 24 hours in the intensive care unit were eligible. The severity of illness was assessed using SAPS II, and frailty was assessed using the clinical frailty scale, which was recorded by a nurse and a doctor in charge. Patients were classified as frail (clinical frailty scale score ≥ 5), prefrail (clinical frailty scale score = 4), or nonfrail (clinical frailty scale score < 4). The outcomes measured included intensive care unit and hospital LOS (length of stay), need for organ support, infections, mortality at hospital discharge and mortality at 6 months post discharge. We divided the population in half according to the length of their intensive care unit stay to evaluate a possible interaction between intensive care unit length of stay and frailty.</p><p><strong>Results: </strong>The mean age was 63.2 years, and 66% were male. The mean SAPS II score was 41.8. Frailty was observed in 23.0% of the patients. Frail patients had higher hospital mortality (39.0% frail patients versus 28.2% prefrail patients versus 11.8% nonfrail patients) and 6-month mortality (frail 49.4% frail patients versus 30.6% prefrail patients versus 15.6% nonfrail patients). Patients with longer intensive care unit stays had higher 6-month mortality rates than did those with shorter intensive care unit stays did, which resulted in more frail patients: odds ratio (95% confidence interval) 3.1 (1.2 - 7.8) versus odds ratio 1.8 (0.9 - 4.0) in nonfrail patients.</p><p><strong>Conclusion: </strong>Frailty may significantly impact hospital and 6-month mortality. In our cohort, a longer intensive care unit length of stay was associated with worse long-term outcomes, especially in frail patients.</p>","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":"37 ","pages":"e20250229"},"PeriodicalIF":0.0,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12094690/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144175842","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":"Practice of ventilation in critically ill pediatric patients: protocol for an international, long-term, observational study, and results of the pilot feasibility study.","authors":"Relin van Vliet, Jonathan Willem Jochem Melger, Frederique Paulus, Reinout Alexander Bem, Robert Gorge Theodoor Blokpoel, Marcus Josephus Schultz, David Michael Paul van Meenen, Martin Christiaan Jacques Kneyber","doi":"10.62675/2965-2774.20250398","DOIUrl":"10.62675/2965-2774.20250398","url":null,"abstract":"<p><strong>Objective: </strong>This manuscript describes the protocol of an investigator-initiated, international, multicenter, long-term, prospective observational study named PRactice of VENTilation in PEDiatric Patients (PRoVENT-PED), designed to investigate the epidemiology, respiratory support practices and outcomes of critically ill pediatric patients.</p><p><strong>Design: </strong>Data will be collected biannually over 10 years during predefined 4-week intervals, with an additional optional period to accommodate data collection during an epidemic or pandemic. The specific focus of PRoVENT-PED will evolve as the study progresses, initially emphasizing collecting detailed ventilator data from invasively ventilated patients. In later phases, the focus will shift to noninvasive respiratory support and typical aspects of respiratory support, like patient-ventilator asynchronies, weaning practices, and rescue therapies, as extracorporeal support. PRoVENT-PED includes patients under 18 years of age, admitted to a participating intensive care unit, and receiving respiratory support. The endpoints vary with the focus in each phase but will always include a set of key settings and ventilation parameters and related outcomes. If applicable, potentially modifiable factors and associations with outcomes will be studied. The pilot feasibility study demonstrated that the electronic capturing system effectively collects all necessary data within a reasonable time limit, with little missing data.</p><p><strong>Conclusion: </strong>PRoVENT-PED is a 10-year, international, multicenter study focused on collecting data on respiratory support practices in critically ill pediatric patients. Its scope evolves from invasive to noninvasive ventilatory support, ultimately encompassing patient-ventilator asynchronies, weaning practices, and rescue therapies.</p>","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":"37 ","pages":"e20250398"},"PeriodicalIF":0.0,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12094694/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144175973","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":"Home care after intensive care unit-discharge: global differences.","authors":"Cassiano Teixeira, Regis Goulart Rosa","doi":"10.62675/2965-2774.20250269","DOIUrl":"10.62675/2965-2774.20250269","url":null,"abstract":"<p><p>Significant physical and neuropsychiatric challenges, diminished life quality, and heightened demand for healthcare services often mark the period following discharge from the intensive care unit and hospitalization. Most follow-up care for these patients relies on clinic-based models, necessitating visits to healthcare facilities for rehabilitation and continued monitoring. However, this approach can create barriers for the most severely affected individuals, potentially worsening health inequities. In contrast, home care offers a viable solution by providing essential social support and assistance to patients with varying healthcare needs, allowing them to preserve their independence within the familiar environment of their own homes and communities. This model presents a promising alternative to the conventional clinic-based post-intensive care unit recovery system. It is cost-effective and better aligned with the preferences of an increasing number of individuals who choose to stay at home rather than move to institutional settings for care.</p>","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":"37 ","pages":"e20250269"},"PeriodicalIF":0.0,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12094691/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144175969","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 practices in patients intubated in the emergency department compared with those in patients in the intensive care unit.","authors":"Jariya Sereeyotin, Christopher Yarnell, Sangeeta Mehta","doi":"10.62675/2965-2774.20250247","DOIUrl":"10.62675/2965-2774.20250247","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to compare sedation management during and after intubation in the emergency department with that in the intensive care unit.</p><p><strong>Methods: </strong>This was a single-center retrospective cohort study of adults who were intubated in the emergency department or intensive care unit and who received mechanical ventilation between January 2018 and February 2022. We collected data from electronic medical records. The primary outcome was the duration from intubation to the first documentation of light sedation, which was defined as a Sedation Agitation Scale score of 3 - 4.</p><p><strong>Results: </strong>This study included 264 patients, 95 (36%) of whom were intubated in the emergency department and 169 (64%) in the intensive care unit. With respect to the anesthetic agents used for intubation, ketamine was the most frequently used drug in the emergency department and was used more frequently than in the intensive care unit (61% versus 40%; p = 0.001). Propofol was the predominant sedative used in the intensive care unit, with a higher prevalence than in the emergency department (50% versus 33%; p = 0.01). Additionally, benzodiazepines and fentanyl were more frequently used in the intensive care unit (39% versus 6%; p < 0.001 and 68% versus 9.5%; p < 0.001, respectively). Within 24 hours after intubation, 68% (65/95) of the emergency department patients and 82% (138/169) of the patients intubated in the intensive care unit achieved light sedation, with median durations of 13.5 hours and 10.5 hours, respectively. Patients who were intubated in the emergency department were less likely to achieve light sedation at 24 hours (adjusted hazard ratio 0.64; p = 0.04; 95%CI, 0.42 - 0.97).</p><p><strong>Conclusion: </strong>Compared with intensive care unit patients, critically ill patients who were intubated in the emergency department are at risk of deeper sedation and a longer time to achieve light sedation.</p>","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":"37 ","pages":"e20250247"},"PeriodicalIF":0.0,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12094695/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144175906","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":"Understanding Bayesian analysis of clinical trials: an overview for clinicians.","authors":"Callum Taylor, Kathryn Puxty, Tara Quasim, Martin Shaw","doi":"10.62675/2965-2774.20250267","DOIUrl":"10.62675/2965-2774.20250267","url":null,"abstract":"<p><p>Bayesian analysis is being used with increasing frequency in critical care research and brings advantages and disadvantages compared to traditional Frequentist techniques. This study overviews this methodology and explains the terminology encountered when appraising this literature. Setting different priors can impact the interpretation of new results, and we describe an approach to understanding this. Finally, the strengths and challenges of adopting a Bayesian analysis compared to Frequentist techniques are explored.</p>","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":"37 ","pages":"e20250267"},"PeriodicalIF":0.0,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12094692/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144175909","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 between computer-guided and conventional paper-based insulin infusion protocols in the treatment of acute hyperglycemic syndromes: an observational study.","authors":"Laura Andrade Mesquita, Marcos Tadashi Kakitani Toyoshima, Carolina Luz Silva, Alina Coutinho Rodrigues Feitosa","doi":"10.62675/2965-2774.20250164","DOIUrl":"10.62675/2965-2774.20250164","url":null,"abstract":"","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":"37 ","pages":"e20250164"},"PeriodicalIF":0.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12094689/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144175726","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":"Pulmonary artery pressure assessed by catheterization and its concordance with transthoracic echocardiographic estimates in patients with pulmonary arterial hypertension: experience of the Colombian Pulmonary Hypertension Network in a real-life study.","authors":"Mauricio Orozco-Levi, Alejandro Londoño, Rafael Conde, Manuel Conrado Pacheco Gallego, Julián Cortes Colorado, Carlos Jaime Velázquez, Ricardo Gómez Palau, Lucila Teresa Flórez de Arco, Juliana De Luque, Ana Maria Pérez-Zauner, Alba Ramírez-Sarmiento","doi":"10.62675/2965-2774.20250182","DOIUrl":"10.62675/2965-2774.20250182","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the correlation and concordance of pulmonary artery systolic pressure values measured via right heart catheterization and estimated via transthoracic echocardiography based on data from a multicenter cohort of patients with pulmonary hypertension in Colombia.</p><p><strong>Methods: </strong>A retrospective study was conducted of patients with pulmonary hypertension classified into Groups 1 or 4 according to the definitions of the ESC/ERS-PH-2022 guidelines. Patients were obtained from the Colombian Pulmonary Hypertension Network (HAPredco) database.</p><p><strong>Results: </strong>A total of 633 patients were identified and included in this study. Among these patients, 77.7% (n = 492) had complete data from transthoracic echocardiography at diagnosis, 58,3% (n = 369) had complete data from right heart catheterization at the time of diagnosis, and 264 (41.7%) had complete data from both tests at diagnosis, with a difference in days between them of 1 (84). The values of pulmonary artery systolic pressure estimated by transthoracic echocardiography and those obtained by right heart catheterization were significantly correlated (p < 0.001) in the entire population evaluated, as was the correlation assessed for those patients with a gap of ≤ 7 days (p = 0.0001) or ≤ 48 hours (p = 0.041) between the two examinations; however, these findings presented a low Spearman (0.32 for ≤ 7 days and 0.264 for ≤ 48 hours) and Lin´s correlation coefficient (0.32 for ≤ 7 days and 0.21 for ≤ 48 hours).</p><p><strong>Conclusion: </strong>The pulmonary artery systolic pressure values estimated via transthoracic echocardiography and measured via right heart catheterization were significantly but weakly linearly correlated, with low concordance. These findings suggest interindividual variability between the pulmonary artery systolic pressure values obtained by the two methods, which may have clinical significance in follow-up and decision-making.</p>","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":"37 ","pages":"e20250182"},"PeriodicalIF":0.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12094696/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144175902","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":"Feasibility of implementing extracorporeal cardiopulmonary resuscitation in a middle-income country: systematic review and cardiac arrest case series.","authors":"Gabriel Afonso Dutra Kreling, Pedro Vitale Mendes, Luis Carlos Maia Cardozo Junior, Karina Turaça Kasahaya, Marcelo Park, Ludhmila Abrahão Hajjar, Ian Ward A Maia","doi":"10.62675/2965-2774.20250320","DOIUrl":"10.62675/2965-2774.20250320","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the consistency of current evidence supporting the use of extracorporeal cardiopulmonary resuscitation to treat patients with cardiac arrest and assess the plausibility of implementing an extracorporeal cardiopulmonary resuscitation program in a public health care system hospital in a middle-income country.</p><p><strong>Methods: </strong>A systematic review, meta-analysis, meta-regression analysis, and trial sequence analysis were performed to assess the consistency of current evidence supporting the use of extracorporeal cardiopulmonary resuscitation to treat patients with cardiac arrest. Additionally, a local cardiac arrest registry was analyzed to identify potential patients eligible for extracorporeal cardiopulmonary resuscitation.</p><p><strong>Results: </strong>The systematic review included 31 studies. The main and sensitivity analyses consistently demonstrated that extracorporeal cardiopulmonary resuscitation was associated with favorable neurological outcomes (cerebral performance category 1 or 2, RR 1.45, 95%CI 1.19 - 1.77) and survival (RR 1.29, 95%CI 1.10 - 1.52). Age was inversely related to neurological outcome and survival. Our cardiac arrest registry included 55 patients with a median age of 54 years and a survival rate of 18.2% (10/55). Survivors had an initial shockable rhythm. In the most inclusive scenario, 13 patients would have been eligible for extracorporeal cardiopulmonary resuscitation. Under stricter criteria (age ≤ 65 years, low-flow time ≤ 30 min, and number of defibrillations ≥ 3), 4 patients would have been eligible.</p><p><strong>Conclusion: </strong>Extracorporeal cardiopulmonary resuscitation in patients with refractory cardiac arrest is associated with improved neurological outcomes and survival. The use of an extracorporeal cardiopulmonary resuscitation program in our hospital is plausible. Using conservative eligibility criteria, we estimate that at least four patients would be eligible for extracorporeal cardiopulmonary resuscitation within six months of the program initiation.</p>","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":"37 ","pages":"e20250320"},"PeriodicalIF":0.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12094697/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144175835","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}