American Journal of Critical Care最新文献_第8页

Interprofessional Simulation-Based Training to Facilitate ABCDEF Bundle Implementation. 基于跨专业模拟的培训，以促进ABCDEF捆绑实施。

IF 2.6 3区医学

American Journal of Critical Care Pub Date : 2025-11-01 DOI: 10.4037/ajcc2025955

Mikita Fuchita, Lorel Huber, Deena Costa, Anuj B Mehta, Dan Matlock, Ryan Good

{"title":"Interprofessional Simulation-Based Training to Facilitate ABCDEF Bundle Implementation.","authors":"Mikita Fuchita, Lorel Huber, Deena Costa, Anuj B Mehta, Dan Matlock, Ryan Good","doi":"10.4037/ajcc2025955","DOIUrl":"10.4037/ajcc2025955","url":null,"abstract":"Background: The ABCDEF bundle improves outcomes of patients in the intensive care unit, but its adoption remains low worldwide due to multiple implementation barriers. Interprofessional simulation training may help facilitate ABCDEF bundle implementation.Objectives: To evaluate the feasibility of an interprofessional simulation-based training to facilitate ABCDEF bundle implementation.Methods: A 90-minute interprofessional training program was designed and implemented. Each simulation started with a deeply sedated patient receiving mechanical ventilation, and interprofessional learners assessed sedation and delirium, conducted spontaneous awakening trials, managed delirium and agitation using multicomponent nonpharmacologic interventions, and mobilized the patient out of bed. Feasibility of the training was evaluated by using a participant survey on simulation experiences and measuring participants' attitudes toward ABCDEF bundle implementation before and after training.Results: Sixteen clinicians from different disciplines and with various years of intensive care unit experience participated. Most participants agreed that the simulation was realistic, relevant, important to practice, and stress provoking and would improve their clinical performance. After the training, participants reported increased comfort and willingness to perform spontaneous awakening trials, comfort in managing patients with delirium and agitation, and confidence in collaborating with other team members to mobilize patients receiving mechanical ventilation out of bed.Conclusions: The interprofessional simulation training was feasible and well accepted and increased positive attitudes toward ABCDEF bundle implementation.","PeriodicalId":7607,"journal":{"name":"American Journal of Critical Care","volume":"34 6","pages":"463-468"},"PeriodicalIF":2.6,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13213887/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145420978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

From Ancient Enemas to Tube Feeding, II: Clinical Outcomes and Future Directions Surrounding Commercial Versus Food-Based Formulas in Critical Illness. 从古代灌肠到管饲，II：危重疾病中商业配方与食品配方的临床结果和未来方向。

IF 2.2 3区医学

American Journal of Critical Care Pub Date : 2025-11-01 DOI: 10.4037/ajcc2025636

Sanil N Gandhi, Yeonsu Song, Matthew J Landry, Atul Malhotra, Rohit Loomba, Jennifer L Martin, Biren B Kamdar

{"title":"From Ancient Enemas to Tube Feeding, II: Clinical Outcomes and Future Directions Surrounding Commercial Versus Food-Based Formulas in Critical Illness.","authors":"Sanil N Gandhi, Yeonsu Song, Matthew J Landry, Atul Malhotra, Rohit Loomba, Jennifer L Martin, Biren B Kamdar","doi":"10.4037/ajcc2025636","DOIUrl":"10.4037/ajcc2025636","url":null,"abstract":"This article is the second in a 2-part series examining the role of commercial and food-based enteral formulas in critical illness. Part I (published in the September 2025 issue of AJCC) reviewed the historical evolution, administration, and nutritional content of formulas; part II focuses on clinical outcomes and future directions. Enteral feeding is essential in the intensive care unit to support patients who cannot meet nutritional needs orally. Although commercial formulas remain the standard of care, the use of food-based formulas is expanding. In this part of the review, we examine the evidence comparing commercial versus food-based formulas across gastrointestinal symptoms (eg, constipation, diarrhea, reflux), renal effects (eg, electrolyte disturbances, uremia), and endocrine effects (eg, hyperglycemia, insulin resistance). We also explore nonclinical outcomes such as patient satisfaction, circadian rhythm effects, environmental considerations, and access disparities. Notably, much of the current evidence arises from pediatric or outpatient settings, underscoring the need for high-quality research in intensive care unit populations. These evolving patterns highlight critical gaps in knowledge that must be addressed to optimize intensive care unit nutrition practices. Together with part I, this article offers a comprehensive overview to guide evidence-based selection and implementation of enteral nutrition in critical care.","PeriodicalId":7607,"journal":{"name":"American Journal of Critical Care","volume":"34 6","pages":"469-476"},"PeriodicalIF":2.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12634140/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145420954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Thromboelastography in Children Undergoing Extracorporeal Membrane Oxygenation. 接受体外膜氧合的儿童血栓弹性成像。

IF 2.2 3区医学

American Journal of Critical Care Pub Date : 2025-11-01 DOI: 10.4037/ajcc2025823

Wataru Sakai, Tomohiro Chaki, Yuki Ogasawara, Yuko Nawa, Yuki Ichisaka, Tomohiro Nawa, Haruki Niwano, Hidetsugu Asai, Noriyoshi Ebuoka, Michiaki Yamakage

{"title":"Thromboelastography in Children Undergoing Extracorporeal Membrane Oxygenation.","authors":"Wataru Sakai, Tomohiro Chaki, Yuki Ogasawara, Yuko Nawa, Yuki Ichisaka, Tomohiro Nawa, Haruki Niwano, Hidetsugu Asai, Noriyoshi Ebuoka, Michiaki Yamakage","doi":"10.4037/ajcc2025823","DOIUrl":"10.4037/ajcc2025823","url":null,"abstract":"Background: Children undergoing extracorporeal membrane oxygenation (ECMO) are at risk of hematologic and coagulation complications, including intracranial hemorrhage. Thromboelastography is used to monitor anticoagulation in patients receiving ECMO, but no data for its use in children are available.Objective: To evaluate the incidence of complications when managing anticoagulation with thromboelastography or with conventional coagulation tests (activated clotting time, plasma fibrinogen level, and platelet count) among children receiving venoarterial or venovenous ECMO.Methods: This single-center, prospective, retrospective, observational study included patients less than 18 years old who required ECMO. Outcomes were compared between a conventional test group and a thromboelastography group. The primary outcome was critical hemorrhage or pump failure leading to treatment termination.Results: Each group included 17 patients. Twenty-one patients (17 in the conventional test group, 4 in the thromboelastography group) were enrolled retrospectively. Thirteen patients (all in the thromboelastography group) were enrolled prospectively beginning December 26, 2022. Patient age did not differ between groups (median [IQR] age, 2 [0-6] months). Significantly fewer critical complications occurred in the thromboelastography group (11%) than in the conventional test group (59%) (odds ratio, 10.71; 95% CI, 1.84-62.5; P = .01). The 30-day survival rate after ECMO was higher in the thromboelastography group than in the conventional test group, but the difference was not significant (P = .08).Conclusions: Managing anticoagulation with thromboelastography, as compared with conventional tests, decreased the frequency of critical complications among children undergoing ECMO.","PeriodicalId":7607,"journal":{"name":"American Journal of Critical Care","volume":"34 6","pages":"458-462"},"PeriodicalIF":2.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145420935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Response. 响应。

IF 2.2 3区医学

American Journal of Critical Care Pub Date : 2025-11-01 DOI: 10.4037/ajcc2025347

Catherine Green

引用次数: 0

Exploring the Effects of Virtual Reality on the Patient Experience in Adult and Pediatric Intensive Care. 探索虚拟现实对成人和儿童重症监护患者体验的影响。

IF 2.2 3区医学

American Journal of Critical Care Pub Date : 2025-11-01 DOI: 10.4037/ajcc2025625

Margo A Halm

引用次数: 0

Association of Serum Anion Gap and Mortality in Critically Ill Patients Receiving Mechanical Circulatory Support. 接受机械循环支持的危重病人血清阴离子间隙与死亡率的关系。

IF 2.2 3区医学

American Journal of Critical Care Pub Date : 2025-11-01 DOI: 10.4037/ajcc2025708

Muni Rubens, Sandeep Appunni, Anshul Saxena, Venkataraghavan Ramamoorthy, Calvin Mathew, Atulya Aman Khosla, Rehan Sha, Veda Rabishanker, Ajith Gopal, Yanjia Zhang, Sandra Chaparro, Javier Jimenez, Eduardo Martinez DuBouchet

{"title":"Association of Serum Anion Gap and Mortality in Critically Ill Patients Receiving Mechanical Circulatory Support.","authors":"Muni Rubens, Sandeep Appunni, Anshul Saxena, Venkataraghavan Ramamoorthy, Calvin Mathew, Atulya Aman Khosla, Rehan Sha, Veda Rabishanker, Ajith Gopal, Yanjia Zhang, Sandra Chaparro, Javier Jimenez, Eduardo Martinez DuBouchet","doi":"10.4037/ajcc2025708","DOIUrl":"https://doi.org/10.4037/ajcc2025708","url":null,"abstract":"Background: Mechanical circulatory support (MCS) devices are used to restore circulation in patients with end-stage heart failure. Serum anion gap is a marker of acid-base disorders.Objective: To investigate whether serum anion gap is a predictor of hospital and intensive care unit mortality in patients receiving MCS and to compare its predictive utility with that of serum lactate level and Sequential Organ Failure Assessment (SOFA) score.Methods: This retrospective analysis of data from Medical Information Mart for Intensive Care-IV database, 2008-2019, included adult patients receiving MCS. The Harrell C statistic was used to compare the predictive utility of serum anion gap with that of serum lactate level and SOFA score for hospital and intensive care unit mortality.Results: Of 688 patients receiving MCS, 134 had an anion gap of less than 13 mEq/L; 139, of 13 to 14 mEq/L; 159, of 15 to 17 mEq/L; and 256, of greater than 17 mEq/L. The C statistic (95% CI) for hospital mortality was 0.632 (0.611-0.662) for serum anion gap, 0.684 (0.631-0.694) for lactate, and 0.689 (0.628-0.704) for SOFA score. The C statistic (95% CI) for intensive care unit mortality was 0.642 (0.623-0.662) for serum anion gap, 0.691 (0.646-0.702) for lactate, and 0.694 (0.668-0.711) for SOFA score.Conclusions: Higher serum anion gaps were associated with greater levels of hospital and intensive care unit mortality among patients receiving MCS and had a low predictive utility for these outcomes.","PeriodicalId":7607,"journal":{"name":"American Journal of Critical Care","volume":"34 6","pages":"419-428"},"PeriodicalIF":2.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145420940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Renal Impact of Prolonged Sevoflurane Sedation in Intensive Care Unit Patients: An Observational Study. 重症监护病房患者长期七氟醚镇静对肾脏的影响：一项观察性研究。

IF 2.2 3区医学

American Journal of Critical Care Pub Date : 2025-11-01 DOI: 10.4037/ajcc2025963

Mona Assefi, Annalisa Chiarito, Florian Blanchard, Elodie Baron, Noémie Clavieras, Arthur James, Jean-Michel Constantin

{"title":"Renal Impact of Prolonged Sevoflurane Sedation in Intensive Care Unit Patients: An Observational Study.","authors":"Mona Assefi, Annalisa Chiarito, Florian Blanchard, Elodie Baron, Noémie Clavieras, Arthur James, Jean-Michel Constantin","doi":"10.4037/ajcc2025963","DOIUrl":"10.4037/ajcc2025963","url":null,"abstract":"Background: Due to their rapid onset and minimal accumulation, volatile agents are used for prolonged sedation in intensive care unit (ICU) patients. However, potential renal effects, particularly polyuria and nephrogenic diabetes insipidus, remain a concern during sevoflurane use.Objective: To evaluate the prevalence of and the factors associated with polyuria during prolonged sevoflurane sedation in ICU patients.Methods: This observational study included consecutive ICU patients (July 2019 to July 2023) receiving sevoflurane, excluding those with prior renal replacement therapy. Sevoflurane was administered via an anesthetic conserving device at physicians' discretion. Demographic data, clinical characteristics, and laboratory parameters were collected from ICU records. Multivariate analysis was used to identify factors associated with polyuria.Results: Among 76 patients, 32 (42%) with a median (IQR) sevoflurane duration of 118 (76-165) hours developed polyuria (>3000 mL/d) during the first 7 days. Polyuria was associated with higher urine output, serum sodium level, and osmolarity. Multivariate analysis revealed that prolonged sevoflurane exposure (>1 day) increased the risk of polyuria (odds ratio [95% CI], 1.26 [1.08-1.53]; P = .009). Acute kidney injury was negatively associated with polyuria (odds ratio [95% CI], 0.25 [0.07-0.79]; P = .02). Baseline renal function, weight, and diuretic dose did not differ between patients with and patients without polyuria.Conclusions: Polyuria is a complication of prolonged sevoflurane sedation; prevalence increases with exposure duration. These findings highlight the need to monitor urine output and serum sodium level during sedation.","PeriodicalId":7607,"journal":{"name":"American Journal of Critical Care","volume":"34 6","pages":"439-448"},"PeriodicalIF":2.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145420984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Discussion Guide for the Assefi Article. 关于Assefi文章的讨论指南。

IF 2.2 3区医学

American Journal of Critical Care Pub Date : 2025-11-01 DOI: 10.4037/ajcc2025840

Grant A Pignatiello

引用次数: 0

Ethical Considerations in Discharge Planning for Patients in the Intensive Care Unit. 重症监护病房病人出院计划中的伦理考虑。

IF 2.2 3区医学

American Journal of Critical Care Pub Date : 2025-11-01 DOI: 10.4037/ajcc2025417

HyunBin You, Sang Bin You

引用次数: 0

Toleration of a Speaking Valve Placed In-Line With the Ventilator Circuit in Critically Ill Tracheostomized Patients. 危重气管造口患者与呼吸机回路同步放置说话阀的耐受性。

IF 2.2 3区医学

American Journal of Critical Care Pub Date : 2025-11-01 DOI: 10.4037/ajcc2025258

Malcolm Lemyze, Marion Lecorche, Chems-Eddine Laouki, Maxime Granier, Jihad Mallat

{"title":"Toleration of a Speaking Valve Placed In-Line With the Ventilator Circuit in Critically Ill Tracheostomized Patients.","authors":"Malcolm Lemyze, Marion Lecorche, Chems-Eddine Laouki, Maxime Granier, Jihad Mallat","doi":"10.4037/ajcc2025258","DOIUrl":"https://doi.org/10.4037/ajcc2025258","url":null,"abstract":"Background: Being deprived of the ability to speak is a dehumanizing experience for critically ill patients receiving prolonged mechanical ventilation support in the intensive care unit (ICU). A speaking valve is often used only once a patient with a tracheostomy can be disconnected from the ventilator.Objective: To study the toleration of a one-way speaking valve connected in-line with the ventilator circuit in ICU patients with chronic critical illness and a tracheostomy.Methods: A retrospective cohort study was conducted in a 15-bed ICU and a 5-bed post-ICU weaning center from October 2021 through February 2024. All patients had undergone tracheostomy placement in the ICU because of difficulty with weaning from mechanical ventilation.Results: Of the 47 included patients, the in-line speaking valve trial was unsuccessful in only 4 (9%). Three of the patients in whom the trial was unsuccessful had severe obesity (no patients with successful trials had severe obesity, P < .001) and the fourth patient had severe laryngeal dysfunction. Patients in whom the in-line speaking valve trial was successful could be maintained under this mechanical ventilation modality until they were fully disconnected from the ventilator.Conclusions: An in-line speaking valve trial was successfully performed in most of the patients with a tracheostomy. An in-line speaking valve can safely restore the natural way of communication for ventilator-dependent critically ill patients with tracheostomies. Larger studies are needed of patients with severe obesity or severe laryngeal dysfunction.","PeriodicalId":7607,"journal":{"name":"American Journal of Critical Care","volume":"34 6","pages":"e59-e64"},"PeriodicalIF":2.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145421063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0