Critical care explorations最新文献

{"title":"Supporting Informed Surrogate Decision-Making in Deceased Donor Intervention Research: Co-Creating Educational Materials With Families.","authors":"Nicholas Murphy, Charles Weijer, Janice Beitel, Mary Donaghy, Norma French, Christine Goddard, Jed Adam Gross, Marat Slessarev","doi":"10.1097/CCE.0000000000001416","DOIUrl":"https://doi.org/10.1097/CCE.0000000000001416","url":null,"abstract":"<p><p>Deceased donor intervention research aims to improve organ donation and transplantation outcomes, but its feasibility often depends on obtaining valid informed consent from surrogate decision makers during a difficult time for families in the ICU. Consent discussions may be complicated by grief, decisional burden, and the complexity of donor interventions, creating risks to comprehension, trust, and voluntariness. In this letter, we describe a collaborative model for co-creating consent and educational materials with deceased donors' family members developed for a donor intervention trial in Canada. We outline our co-creation process and present five practical lessons learned, emphasizing trust, visual communication, standardization, the supportive role of educational tools, and iterative refinement. Our experience demonstrates that materials developed in partnership with donor families can enhance clarity, relevance, and sensitivity while supporting research coordinators. Our approach offers a scalable framework for improving informed consent processes and facilitating ethically robust donor intervention research.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"8 5","pages":"e1416"},"PeriodicalIF":2.7,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147847031","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":"Extracorporeal Membrane Oxygenation Combined With Esophageal Pressure-Guided Mechanical Ventilation as Salvage Therapies in Postpneumonectomy Acute Respiratory Distress Syndrome.","authors":"Emmanuelle Guérin, Jade Roland, India Sourieau, Alex Arame, Juliette Didier, Alexandre Prieu, Bertrand Hermann, Nicolas Bréchot, Daniel Talmor, Jean-Luc Diehl","doi":"10.1097/CCE.0000000000001398","DOIUrl":"https://doi.org/10.1097/CCE.0000000000001398","url":null,"abstract":"<p><strong>Background: </strong>Massive hemoptysis and postpneumonectomy acute respiratory distress syndrome (ARDS) are rare but life-threatening conditions with limited therapeutic options. This case highlights the feasibility of combining venovenous extracorporeal membrane oxygenation (VV-ECMO) with esophageal pressure-guided ventilation to support both surgical and respiratory management in a critically ill patient.</p><p><strong>Case summary: </strong>A 67-year-old woman developed massive hemoptysis after bronchoscopic biopsy of a left hilar lung mass. Despite bronchial artery embolization and selective right lung ventilation, severe ARDS ensued. A salvage left pneumonectomy was performed under VV-ECMO due to refractory bleeding. Postoperatively, the patient developed right-lung ARDS with total airway closure and high elastance. Esophageal pressure monitoring enabled safe adjustment of ventilator settings. She was weaned from ECMO on postoperative day 16 and later discharged from ICU. Final pathology confirmed an atypical carcinoid tumor with negative margins.</p><p><strong>Conclusion: </strong>VV-ECMO can enable life-saving pneumonectomy in select patients. Esophageal pressure monitoring may optimize ventilation in postpneumonectomy ARDS with severe mechanical impairment.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"8 5","pages":"e1398"},"PeriodicalIF":2.7,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13143506/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147847524","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":"Extracorporeal Membrane Oxygenation for Pneumocystis Pneumonia: Outcomes in Patients From the Extracorporeal Life Support Organization.","authors":"Kyle J Henry, Emily R Thompson, Kealy Ham, Holenarasipur R Vikram, Rodrigo Cartin-Ceba, Georges Khattar, Jonathan D'Cunha, Andrew H Limper, Ayan Sen, Bhavesh Patel, Aaron M Pulsipher","doi":"10.1097/CCE.0000000000001414","DOIUrl":"https://doi.org/10.1097/CCE.0000000000001414","url":null,"abstract":"<p><strong>Objectives: </strong>Pneumocystis jirovecii pneumonia (PCP) can cause severe hypoxemic respiratory failure in immunocompromised patients. Contemporary outcomes of venovenous extracorporeal membrane oxygenation (VV ECMO) support for PCP are poorly characterized, and existing reports are limited to small case series.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>International registry study using the Extracorporeal Life Support Organization (ELSO) registry.</p><p><strong>Patients/subjects: </strong>Adults with PCP-associated hypoxemic respiratory failure supported with VV ECMO between 2011 and 2024.</p><p><strong>Interventions: </strong>VV ECMO.</p><p><strong>Measurements and main results: </strong>A total of 209 patients with PCP-associated respiratory failure supported with VV ECMO were identified. The overall in-hospital mortality was 60.8%. Survivors were younger than nonsurvivors (median age 41.9 vs. 46.8 yr; p = 0.047). Duration of mechanical ventilation before VV ECMO was longer among nonsurvivors (median 4.7 vs. 1.6 d; p = 0.019). The proportion of patients with HIV infection was similar among survivors and nonsurvivors (19.5% vs. 22.1%; p = 0.73). Pre-ECMO vasopressor use, prone positioning, and renal replacement therapy were common and did not differ between groups. Clinical course was characterized by prolonged VV ECMO support (median 18.6 d) and frequent complications, including pneumothorax (21.1%), renal replacement therapy during VV ECMO (31.6%), intracranial hemorrhage or stroke (7.7%), and major pulmonary or gastrointestinal hemorrhage (16.8%). PCP accounted for a small proportion of VV ECMO runs reported to the ELSO registry throughout the study period at 0.36% of reported cases. No significant temporal trend in mortality was observed.</p><p><strong>Conclusions: </strong>PCP-associated respiratory failure supported with VV ECMO is associated with substantial mortality and prolonged VV ECMO support. These findings provide contemporary benchmarks that may inform VV ECMO candidacy discussions and expectations in this challenging patient population.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"8 5","pages":"e1414"},"PeriodicalIF":2.7,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13143505/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147847540","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":"Real-Time Evaluation of a Large Language Model for Clinical Practice Guideline Development.","authors":"Brian L Erstad","doi":"10.1097/CCE.0000000000001409","DOIUrl":"https://doi.org/10.1097/CCE.0000000000001409","url":null,"abstract":"<p><strong>Background: </strong>The purpose of this study was to evaluate the capability of a large language model (LLM) for performing each of the steps of clinical practice guideline development from framing a healthcare question to creating the evidence-to-decision framework.</p><p><strong>Methods: </strong>The LLM tool used for this study was OpenAI Generative Pretrained Transformer (GPT)-4o. This evaluation of an LLM was conducted concomitantly with development of a clinical practice guideline on neuromuscular blockade in adults with acute respiratory distress syndrome for the Society of Critical Care Medicine. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) handbook provided the steps of the process that served as the outline for this evaluation of GPT-4o. Each request for information posed to the LLM was performed during or soon after the same period as the respective step of the process being conducted by the guideline panel. The results follow the major sections of the GRADE process: framing the healthcare question and selecting and rating the importance of outcomes, summarizing the evidence and quality of evidence, and going from evidence to recommendations.</p><p><strong>Results and conclusions: </strong>The LLM demonstrated the most usefulness for the initial step of the guideline development process that involved framing the healthcare question and selecting and rating outcomes. The limitations of the LLM became most apparent during the remaining steps of the development process.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"8 5","pages":"e1409"},"PeriodicalIF":2.7,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13120502/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147792448","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 Vigilance Gradient: Nine Years of Adverse Event Trends in Pediatric Critical Care.","authors":"Devika Singh, Michael R Miller, Maitray A Patel, Cory Anderson, Douglas D Fraser","doi":"10.1097/CCE.0000000000001407","DOIUrl":"10.1097/CCE.0000000000001407","url":null,"abstract":"<p><strong>Objectives: </strong>To examine 11-year trends in adverse events (AEs) in a pediatric critical care unit (PCCU), assess the impact of the COVID-19 pandemic on patient safety, and evaluate associations between patient acuity and AE severity.</p><p><strong>Design: </strong>Retrospective cohort study using interrupted time series analyses and mixed-effects multinomial regression.</p><p><strong>Setting: </strong>A single-center PCCU monitored via the Adverse Event Management System from January 2013 to December 2023.</p><p><strong>Patients: </strong>A total of 7290 critically ill and injured pediatric patients admitted to the PCCU over the study period.</p><p><strong>Interventions: </strong>None (observational study). Exposure variables included the COVID-19 pandemic period, invasive mechanical ventilation and noninvasive ventilation.</p><p><strong>Measurements and main results: </strong>Demographics, length of stay (LoS), disposition, and AE severity were assessed. The baseline AE rate was 11.94 events per 100 cases. At pandemic onset, AE rates rose by 5.20 events per 100 cases (p = 0.004), then declined 0.81 events per 100 cases quarterly (p = 0.010). Post-pandemic, rates increased 1.94 events per 100 cases quarterly (p = 0.009). LoS decreased 0.01 days quarterly pre-pandemic (p = 0.009), was stable during the pandemic, then increased 0.25 days quarterly post-pandemic (p = 0.033). Higher Pediatric Index of Mortality 2 scores were associated with fewer \"near miss\" events and more \"MinModSev\" (minimal, moderate, or severe) AEs. Both mechanical ventilation (p = 0.039) and noninvasive ventilation (p = 0.015) increased the odds of \"MinModSev\" AEs.</p><p><strong>Conclusions: </strong>This PCCU experienced a transient increase in AEs during COVID-19, followed by recovery and a post-pandemic rise in both AE rates and LoS. Higher illness severity and respiratory support were associated with more severe AEs. These findings underscore the importance of data-driven monitoring systems to sustain patient safety during and after healthcare crises.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"8 5","pages":"e1407"},"PeriodicalIF":2.7,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13120637/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147792366","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":"Ketamine for Analgosedation in Critically Ill Mechanically Ventilated Children: A Systematic Review and Meta-Analysis.","authors":"David J Zorko, Domi Zou, Sameer Sharif, Karin Dearness, Bram Rochwerg, Melissa J Parker","doi":"10.1097/CCE.0000000000001408","DOIUrl":"https://doi.org/10.1097/CCE.0000000000001408","url":null,"abstract":"<p><strong>Objectives: </strong>We conducted a systematic review and meta-analysis to compare continuous ketamine infusion to other analgosedatives in critically ill children receiving invasive mechanical ventilation (IMV).</p><p><strong>Data sources: </strong>We searched four electronic databases and trial registries to September 1, 2025. We searched published conference abstracts from two major critical care conferences (2022 to 2025).</p><p><strong>Study selection: </strong>We preregistered the protocol on PROSPERO (CRD42025631768). Reviewers screened abstracts and full texts independently and in duplicate. We included randomized controlled trials (RCTs) and nonrandomized studies comparing ketamine to other analgosedatives in critically ill children receiving IMV.</p><p><strong>Data extraction: </strong>Independently and in duplicate, we conducted data extraction. We assessed risk of bias using the Risk Of Bias instrument for Use in SysTematic reviews for RCTs or Risk Of Bias In Nonrandomized Studies of Interventions tool, and certainty of evidence using Grading of Recommendations, Assessment, Development, and Evaluation. We pooled data using random-effects models.</p><p><strong>Data synthesis: </strong>We included three RCTs and five nonrandomized studies (n = 1436 participants). Pooled analysis demonstrated that ketamine may have no effect on IMV duration (mean difference, 0.00 d; 95% CI, 0.03 d fewer to 0.03 d more; low certainty) and may reduce opioid exposure (mean difference, -8.88 µg/kg cumulative fentanyl equivalents; 95% CI, -6.99 to -10.77; low certainty). We found an uncertain effect of ketamine on delirium, withdrawal, length of stay, clinically important hypotension, and mortality compared with other analgosedatives. Long-term outcomes were not measured in included studies.</p><p><strong>Conclusions: </strong>There is a paucity of studies examining ketamine analgosedation in children receiving IMV, yielding mostly very low certainty evidence for patient-important outcomes due to imprecision and issues related to serious risk of bias of included studies. Methodologically rigorous RCTs are needed to better understand the potential role of ketamine analgosedation in the PICU.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"8 5","pages":"e1408"},"PeriodicalIF":2.7,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13120503/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147792436","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":"Post-ICU Outcomes in a Low-Resource Setting: A Cohort Study From Rwanda.","authors":"Geofrey Bahati, Wellars Niragire, Faustin Niyonshuti, Eric Mugwaneza, Dawit Kebede Huluka, Christian M Mukwesi","doi":"10.1097/CCE.0000000000001399","DOIUrl":"https://doi.org/10.1097/CCE.0000000000001399","url":null,"abstract":"<p><strong>Importance: </strong>Survivorship after critical illness in low-resource settings is inadequately characterized.</p><p><strong>Objectives: </strong>To assess 90-day mortality and multidimensional recovery following ICU discharge.</p><p><strong>Design, setting, and participants: </strong>Prospective cohort of adults discharged alive from a national referral ICU in Rwanda.</p><p><strong>Main outcomes and measures: </strong>Mortality, functional status (Modified Barthel Index), cognition (Mini-Mental State Examination), and anxiety and depression (Generalized Anxiety Disorder-7, Patient Health Questionnaire-9).</p><p><strong>Results: </strong>Among 62 participants (mean age 41 ± 16 yr; 50% male), 90-day mortality was 12.9%. By day 90, only 48.4% achieved full functional independence, while 36.8% remained impaired. Normal cognition increased from 22.6% at discharge to 51.6% at follow-up. Notably, 30.6% of survivors reported severe anxiety or depression.</p><p><strong>Conclusions and relevance: </strong>ICU survivorship in this low-resource setting is marked by substantial persistent morbidity. These findings underscore critical gaps in post-ICU care and the urgent need for scalable, context-appropriate survivorship strategies.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"8 5","pages":"e1399"},"PeriodicalIF":2.7,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13120580/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147792353","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":"Performance of Thromboelastography 6s Difference in Reaction Time Between Heparinase-Free and Heparinase-Containing Channel for Detecting Subtherapeutic Unfractionated Heparin Anticoagulation in a Pediatric Cardiac ICU.","authors":"Keisuke Nishida, Yusaku Ito, Kota Nakajima, Yusuke Seino, Mana Mitsuguro, Nobuhisa Gommori, Miyako Kyogoku, Madoka Iwahashi, Muneyuki Takeuchi","doi":"10.1097/CCE.0000000000001400","DOIUrl":"10.1097/CCE.0000000000001400","url":null,"abstract":"<p><strong>Objectives: </strong>In cases where anti-Xa activity is not routinely measurable, estimating heparin efficacy using the activated partial thromboplastin time (APTT) is challenging, and misestimation may risk bleeding or thrombotic complications. We aimed to assess the utility of the difference in reaction time between thromboelastography 6s heparinase-free and heparinase-containing channel, termed \"ΔR,\" as a potential diagnostic test for monitoring the heparin effect in a pediatric cardiac ICU (PCICU), using anti-Xa activity as a reference standard, and APTT (seconds and preoperative ratio; APTT at sampling divided by the preoperative value) as comparators.</p><p><strong>Design: </strong>Single-center, prospective observational diagnostic performance study.</p><p><strong>Setting: </strong>The PCICU of a national cardiovascular center in Japan.</p><p><strong>Patients: </strong>Consecutive patients younger than 18 years old who received unfractionated heparin in the PCICU between July 5, 2024, and May 31, 2025.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>The ΔR, anti-Xa activity, and APTT (seconds and preoperative ratio) were measured for each patient on concurrent samples. Among 59 patients, the ΔR correlated moderately with anti-Xa (r = 0.67; p < 0.001), whereas correlations between anti-Xa activity and APTT were weak (seconds: r = 0.06; p = 0.65 and ratio: r = 0.24; p = 0.066). For the primary target condition (anti-Xa < 0.1 international units/mL), ΔR achieved an area under the curve of 0.934 (95% CI, 0.841-0.996) with an optimal cutoff of 5.6 min (95% CI, 4.35-6.35), yielding 96% sensitivity and 83% specificity, thus outperforming APTT (seconds and ratio; p < 0.001).</p><p><strong>Conclusions: </strong>ΔR showed a moderate correlation with anti-Xa and high discriminative performance in identifying subtherapeutic anticoagulation, thus supporting its use as a surrogate marker for heparin monitoring in PCICUs. However, further external validation and outcome-based studies are needed to confirm these findings.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"8 4","pages":"e1400"},"PeriodicalIF":2.7,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13098772/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147730950","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":"Comparing Clinical Outcomes in Cardiac Surgical Patients Who Receive Sugammadex Versus Placebo: A Prospective Randomized Blinded Controlled Trial.","authors":"Steven B Greenberg, Noah Ben-Isvy, Andrew R Locke, Nikola Dobrilovic, Rebecca Shamberg, Andrew Bochenek, Daneel Patoli, Chi Wang, Mohammed Minhaj","doi":"10.1097/CCE.0000000000001406","DOIUrl":"https://doi.org/10.1097/CCE.0000000000001406","url":null,"abstract":"<p><strong>Objectives: </strong>To compare the difference in the number of cardiopulmonary bypass surgical patients who receive sugammadex vs. placebo and who meet the Society of Thoracic Surgery early extubation quality benchmark.</p><p><strong>Design: </strong>Single-center, randomized, double-blind, placebo-controlled trial.</p><p><strong>Setting: </strong>Participants were enrolled at a single U.S. hospital between August 2023 and July 2025.</p><p><strong>Patients: </strong>Seventy-four eligible cardiac surgery patients undergoing cardiopulmonary bypass with anticipated institutional fast-track extubation were enrolled; 64 were included in the analysis.</p><p><strong>Interventions: </strong>Administration of either sugammadex or placebo 15 minutes after arrival to the ICU following cardiac surgery.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was the number of patients meeting the Society of Thoracic Surgery quality benchmark of early extubation in the sugammadex vs. placebo groups. Secondary outcomes encompassed specifics related to clinical outcomes, medication requirements, and nursing perception.</p><p><strong>Measurements and main results: </strong>Surgery duration (p = 0.0004), bypass duration (p = 0.0177), and intraoperative blood products (p = 0.0003) were all increased in the sugammadex group. No difference was observed in the primary outcome and 96.9% of patients in both groups were extubated within 6 hours after surgery. However, all patients in the sugammadex group achieved a train of four greater than or equal to 0.9 before extubation compared with only 37.5% of the placebo group (p < 0.0001). The intraoperative dose of rocuronium (mean p = 0.0119; median p = 0.0047) was significantly increased in the sugammadex group. All additional demographics and secondary outcomes were comparable between groups.</p><p><strong>Conclusions: </strong>This trial found no difference in the number of patients who achieved the early extubation benchmark in the sugammadex vs. placebo groups; however, a significant number of patients in the placebo group had residual neuromuscular weakness as defined by quantitative neuromuscular monitoring. Further studies are required to investigate the implications of the high incidence of quantitative monitoring related weakness in this population without the use of sugammadex.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"8 4","pages":"e1406"},"PeriodicalIF":2.7,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13102434/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147792406","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":"Sympathomimetic Overdose With Lisdexamfetamine in a Pediatric Patient Resulting in Stress Cardiomyopathy-A Case Report.","authors":"Hailey Guertin, Rhiannan Pinnell, Robert Chen, Nancy G Murphy, Madeleine Böhrer","doi":"10.1097/CCE.0000000000001401","DOIUrl":"https://doi.org/10.1097/CCE.0000000000001401","url":null,"abstract":"<p><strong>Background: </strong>Sympathomimetic overdoses, as seen in amphetamine ingestions, are known to have cardiac effects ranging from tachycardia and hypertension to coronary vasospasm and myocardial infarction. Stress cardiomyopathy is rare in pediatric patients and has not been reported in association with the extended-release preparation of lisdexamfetamine, indicated for the treatment of attention-deficit hyperactivity disorder.</p><p><strong>Case summary: </strong>A 17-year-old girl presented with an intentional ingestion of lisdexamfetamine and signs and symptoms of a sympathomimetic toxidrome. She was found to have severe cardiac dysfunction, which worsened within 24 hours of ingestion and required intubation and management of acute heart failure.</p><p><strong>Conclusions: </strong>Stress cardiomyopathy due to extended-release stimulant ingestion is a possible outcome of intentional ingestion. Providers should be vigilant and monitor for signs of cardiac dysfunction.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"8 4","pages":"e1401"},"PeriodicalIF":2.7,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13102433/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147792388","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}