Critical care explorations最新文献

{"title":"Reversible Myocardial Depression and Dilatation in COVID-19 Shock Patients.","authors":"Matthew J Fata, Steven M Hollenberg, Brent Klinkhammer, David Landers, George Rockett, Jana Tancredi, Zoltan Turi, Joseph E Parrillo","doi":"10.1097/CCE.0000000000001264","DOIUrl":"10.1097/CCE.0000000000001264","url":null,"abstract":"<p><strong>Importance: </strong>A characteristic pattern of bacterial and fungal septic shock is decreased left ventricular (LV) ejection fraction (LVEF) and modest dilatation of the LV. In survivors, the myocardial depression and dilatation are reversible within several days. In a cohort of 368 hospitalized COVID patients with shock from March 2020 to December 2021, 15 patients were identified with an echocardiogram determined depressed LVEF during acute shock, and a follow-up echocardiogram was performed.</p><p><strong>Objectives: </strong>Myocardial dysfunction and dilatation associated with COVID-19 are reversible.</p><p><strong>Design, setting, and participants: </strong>LVEF was determined by Simpson's rule and stroke volume (SV) was analyzed by Doppler. Based on the LVEF and cardiac index (CI), patients were categorized into groups with low or normal values using an ejection fraction of 45% and CI 2.2 L/min/m2 as the respective thresholds. A subset of 15 patients underwent serial echocardiography, which was performed at a median of 13 days (95% CI, 9-39 d) after the initial value.</p><p><strong>Main outcomes and measures: </strong>The LVEF and LV volumes recorded during initial and follow-up echo were analyzed using paired t test.</p><p><strong>Results: </strong>Comparing initial during acute shock with follow-up values, the mean (± sd) LVEF was 35.3 ± 8.1 vs. 43.8 ± 3.47 (p = 0.031), indexed SV 29.6 ± 1.9 mL vs. 31.7 ± 2.3 mL (p = 0.522), LV end-diastolic volume 182 ± 14.1 mL vs. 152.1 ± 12.9 mL (p = 0.025), and LV end-systolic volume 120.2 ± 13.1 mL vs. 90.1 ± 12.1 mL (p = 0.025), respectively.</p><p><strong>Conclusions and relevance: </strong>Serial echocardiographic studies of COVID-19 shock patients with reduced LVEF and ventricular dilatation demonstrate reversibility of myocardial depression and dilation with no change in SV, a finding strikingly similar to that seen in bacterial and fungal-induced septic shock. Thus, COVID-19 (viral) induced septic shock may have a similar pathogenetic mechanism of myocardial dysfunction to that seen with bacterial or fungal sepsis.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 6","pages":"e1264"},"PeriodicalIF":0.0,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12169969/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144287592","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":"Organ Procurement Organization Approach of ICU Families in Person Versus by Phone for Donation Authorization.","authors":"Qiang Zhang, Brandon McKown, Winnie Lau, Tamara A Strohm, Lisa A Paolillo, Alexandra K Glazier, Jill P Stinebring, David Y Hwang","doi":"10.1097/CCE.0000000000001277","DOIUrl":"10.1097/CCE.0000000000001277","url":null,"abstract":"<p><strong>Objectives: </strong>Due to hospital visitor restriction policies, the COVID-19 pandemic forced many conversations between ICU patients' families and organ procurement organizations (OPOs) to be conducted by phone, as opposed to in-person. We aimed to determine if OPO phone approaches are a negative predictor of authorization for donation.</p><p><strong>Design: </strong>Retrospective observational study.</p><p><strong>Setting: </strong>Hospitals partnering with New England Donor Services (NEDS) as their OPO.</p><p><strong>Patients/subjects: </strong>Multicenter database study of all ICU patients from 2017 to 2021 whose families had been approached by NEDS. Of note, registered organ donors who were declared brain dead were excluded due to their prior first-person authorization. However, registered organ donors who were candidates for donation after circulatory death were included in the analysis because of the family's role in controlling the timing of ventilator withdrawal and, thus, their critical role in determining donation success.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>In addition to whether OPO approaches occurred in person or by phone, we extracted covariate data on patient and surrogate demographics, OPO representative training, and extent of ICU-OPO collaboration. Univariate and multivariate analyses were conducted to determine predictors of successful authorization. Among 2240 approaches of potential organ donors, OPO donation discussions by phone constituted 221 of 1282 (17%) of authorizations, as opposed to 134 of 958 (14%) of failed attempts (p = 0.04). In a multivariate model, phone approach was no longer significantly negatively associated with authorization. However, patient race/ethnicity, registered status for donors after cardiac death, ICU-OPO collaboration, specialized OPO representative training, OPO representative being the sole participant in authorization discussions, and surrogate relationship were strong predictors.</p><p><strong>Conclusions: </strong>OPO approach by phone is not a barrier to organ donation. Strategies for successful donation discussions should focus on collaborative processes between ICU teams and OPOs and involvement of OPO representatives with special training for discussing authorization.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 6","pages":"e1277"},"PeriodicalIF":0.0,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144287591","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":"Organ Procurement Organization Approach of ICU Families in Person Versus by Phone for Donation Authorization.","authors":"Qiang Zhang, Brandon McKown, Winnie Lau, Tamara A Strohm, Lisa A Paolillo, Alexandra K Glazier, Jill P Stinebring, David Y Hwang","doi":"10.1097/CCE.0000000000001277","DOIUrl":"10.1097/CCE.0000000000001277","url":null,"abstract":"<p><strong>Objectives: </strong>Due to hospital visitor restriction policies, the COVID-19 pandemic forced many conversations between ICU patients' families and organ procurement organizations (OPOs) to be conducted by phone, as opposed to in-person. We aimed to determine if OPO phone approaches are a negative predictor of authorization for donation.</p><p><strong>Design: </strong>Retrospective observational study.</p><p><strong>Setting: </strong>Hospitals partnering with New England Donor Services (NEDS) as their OPO.</p><p><strong>Patients/subjects: </strong>Multicenter database study of all ICU patients from 2017 to 2021 whose families had been approached by NEDS. Of note, registered organ donors who were declared brain dead were excluded due to their prior first-person authorization. However, registered organ donors who were candidates for donation after circulatory death were included in the analysis because of the family's role in controlling the timing of ventilator withdrawal and, thus, their critical role in determining donation success.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>In addition to whether OPO approaches occurred in person or by phone, we extracted covariate data on patient and surrogate demographics, OPO representative training, and extent of ICU-OPO collaboration. Univariate and multivariate analyses were conducted to determine predictors of successful authorization. Among 2240 approaches of potential organ donors, OPO donation discussions by phone constituted 221 of 1282 (17%) of authorizations, as opposed to 134 of 958 (14%) of failed attempts (<i>p</i> = 0.04). In a multivariate model, phone approach was no longer significantly negatively associated with authorization. However, patient race/ethnicity, registered status for donors after cardiac death, ICU-OPO collaboration, specialized OPO representative training, OPO representative being the sole participant in authorization discussions, and surrogate relationship were strong predictors.</p><p><strong>Conclusions: </strong>OPO approach by phone is not a barrier to organ donation. Strategies for successful donation discussions should focus on collaborative processes between ICU teams and OPOs and involvement of OPO representatives with special training for discussing authorization.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 6","pages":"e1277"},"PeriodicalIF":0.0,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12160739/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144287590","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":"A Fatal Case of Monkeypox-Associated Encephalitis in a Non-HIV-Infected Patient.","authors":"Cristina Lopez, Rafael Sanchez-Sanchez, Diana Corona, Ana Belen Perez, Francisco Bravo, Maria de Alba, Antonio Bracero, Cristina Cazorla, Ana Vázquez, Maria Paz Sánchez-Seco, Ana Negredo, Ulises Gómez-Pinedo, Luis Martinez-Martinez, Julian Torre-Cisneros, Carmen de la Fuente","doi":"10.1097/CCE.0000000000001272","DOIUrl":"https://doi.org/10.1097/CCE.0000000000001272","url":null,"abstract":"<p><strong>Background: </strong>Mpox, formerly known as monkeypox, is an infectious disease caused by the mpox virus. Systemic involvement is rare and mpox-associated meningoencephalitis is an uncommon clinical presentation. Because mpox-associated meningoencephalitis is characterized by nonspecific clinical and incidental imaging findings, the disease is difficult to diagnose.</p><p><strong>Case summary: </strong>We present a case of fatal mpox-associated meningoencephalitis with negative polymerase chain reaction in cerebrospinal fluid (CSF) diagnosed at autopsy. A young immunocompetent patient with no significant medical history initially presented with genital mpox infection. Within 48 hours, he showed neurologic involvement requiring orotracheal intubation. His condition deteriorated rapidly, progressing to cerebral edema and brain death consistent with meningoencephalitis. Despite negative testing for mpox virus in CSF, the diagnosis was confirmed posthumously by autopsy, where histological examination revealed the presence of mpox virus in brain tissue.</p><p><strong>Conclusions: </strong>Mpox-associated meningoencephalitis should be considered as a potential diagnosis even in the absence of the mpox virus genome in CSF.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 6","pages":"e1272"},"PeriodicalIF":0.0,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144287588","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 Fatal Case of Monkeypox-Associated Encephalitis in a Non-HIV-Infected Patient.","authors":"Cristina Lopez, Rafael Sanchez-Sanchez, Diana Corona, Ana Belen Perez, Francisco Bravo, Maria de Alba, Antonio Bracero, Cristina Cazorla, Ana Vázquez, Maria Paz Sánchez-Seco, Ana Negredo, Ulises Gómez-Pinedo, Luis Martinez-Martinez, Julian Torre-Cisneros, Carmen de la Fuente","doi":"10.1097/CCE.0000000000001272","DOIUrl":"10.1097/CCE.0000000000001272","url":null,"abstract":"<p><strong>Background: </strong>Mpox, formerly known as monkeypox, is an infectious disease caused by the mpox virus. Systemic involvement is rare and mpox-associated meningoencephalitis is an uncommon clinical presentation. Because mpox-associated meningoencephalitis is characterized by nonspecific clinical and incidental imaging findings, the disease is difficult to diagnose.</p><p><strong>Case summary: </strong>We present a case of fatal mpox-associated meningoencephalitis with negative polymerase chain reaction in cerebrospinal fluid (CSF) diagnosed at autopsy. A young immunocompetent patient with no significant medical history initially presented with genital mpox infection. Within 48 hours, he showed neurologic involvement requiring orotracheal intubation. His condition deteriorated rapidly, progressing to cerebral edema and brain death consistent with meningoencephalitis. Despite negative testing for mpox virus in CSF, the diagnosis was confirmed posthumously by autopsy, where histological examination revealed the presence of mpox virus in brain tissue.</p><p><strong>Conclusions: </strong>Mpox-associated meningoencephalitis should be considered as a potential diagnosis even in the absence of the mpox virus genome in CSF.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 6","pages":"e1272"},"PeriodicalIF":0.0,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12160730/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144287589","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":"Why Has Biomarker-Guided Fluid Resuscitation for Sepsis Not Been Implemented in Clinical Practice?","authors":"Sanne Ter Horst, Jan C Ter Maaten, Matijs van Meurs, Jill Moser, Hjalmar R Bouma","doi":"10.1097/CCE.0000000000001274","DOIUrl":"10.1097/CCE.0000000000001274","url":null,"abstract":"<p><p>Sepsis is a dysregulated, potentially fatal host response to infection, characterized by heterogeneity in clinical presentation and organ failure mechanisms. Early hemodynamic resuscitation and antibiotics are crucial treatments. Current guidelines recommend a one-size-fits-all approach of 30 mL/kg fluids, which may worsen vascular leakage and organ dysfunction in some patients. Personalized strategies using biomarkers and dynamic fluid responsiveness assessments offer a more tailored approach, potentially preventing fluid overload while ensuring perfusion. A recent multiomics analysis identified sepsis subgroups benefiting from either liberal or restrictive fluid resuscitation, highlighting -omics' potential in personalized fluid management and the role of immune regulation and endothelial dysfunction in septic shock. Despite progress, methodological challenges hinder clinical implementation of biomarkers. Addressing issues like rapid point-of-care biomarker assays already at emergency department or ICU admission, standardizing sepsis diagnosis, robust external validation, and clinical trial enrichment is crucial for advancing biomarker-guided fluid management in clinical settings.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 6","pages":"e1274"},"PeriodicalIF":0.0,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12151020/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144251327","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":"Optimizing Recovery: Early Versus Delayed Chest Tube Removal in Pediatric Cardiac Surgery Patients: A Randomized Controlled Trial.","authors":"Abdulraouf M Z Jijeh, Ghassan A Shaath, Sameh R Ismail, Mohamed S Kabbani, Omar M Hijazi, Hayan Altaweel, Husam Hamada, Ammar Qadi, Anis Fatima, Abdrabo Abdrabo, Wiaam Ahmed, Nuha Ahmed, Ahmed Elsaoudi, Ahmed Yousef, Rehana Shafi, Husam I Ardah, Ahmad Elwy, Abdullah A Alghamdi","doi":"10.1097/CCE.0000000000001271","DOIUrl":"10.1097/CCE.0000000000001271","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the safety and efficacy of an early chest tube removal protocol in reducing tube duration without increasing complications following pediatric cardiac surgery.</p><p><strong>Design: </strong>A single-center, randomized controlled trial.</p><p><strong>Setting: </strong>Pediatric cardiac ICU.</p><p><strong>Patients: </strong>Two hundred fifteen pediatric patients with chest tubes after cardiac surgery.</p><p><strong>Interventions: </strong>Patients were randomized to early removal (drainage threshold < 6 mL/kg over 8 hr) or late removal (24-hr assessment) groups. Primary outcomes included chest tube duration, whereas secondary outcomes encompassed ICU stay, ventilation time, hospital stay, and complication rates.</p><p><strong>Measurements and main results: </strong>Median chest tube duration was significantly shorter in the early removal group (3 d) compared with the late removal group (4.9 d; p < 0.0001). Rates of fluid reaccumulation and pneumothorax were low and comparable between groups. Notably, no patients in either group required tube reinsertion. ICU and total hospital stay durations were similar across groups.</p><p><strong>Conclusions: </strong>An early chest tube removal protocol following pediatric cardiac surgery suggests a reduction in chest tube duration without increasing the risk of complications. These findings support the adoption of an evidence-based early removal approach to enhance patient comfort and optimize ICU resource utilization in pediatric cardiac surgery patients.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 6","pages":"e1271"},"PeriodicalIF":0.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12140733/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227984","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":"Retrospective Analysis of a Multicenter Observational Study of the Relationship Between Social Determinants of Health and Complications After Children's Heart Surgery.","authors":"Khurram Mustafa, Christopher Leahy, Deborah Ridout, Katherine L Brown","doi":"10.1097/CCE.0000000000001270","DOIUrl":"10.1097/CCE.0000000000001270","url":null,"abstract":"<p><strong>Importance: </strong>Epidemiological studies have highlighted disparities in illnesses and outcomes for critically unwell children.</p><p><strong>Objectives: </strong>We aimed to describe social characteristics and explore links with the outcome of postoperative complications with children's heart surgery.</p><p><strong>Design, setting, and participants: </strong>Retrospective analysis of a multicenter observational dataset including those under 17 years old undergoing heart surgery from October 2015 to June 2017 at five U.K. children's cardiac centers.</p><p><strong>Main outcomes and measures: </strong>Univariate and multivariable multinomial regression analyses were undertaken for the outcome of predefined postoperative complications.</p><p><strong>Results: </strong>Of 2898 cases meeting criteria, 2708 had complete data. Two thousand one hundred three (77.66%) had no complications, 369 (13.62%) had a single complication, 56 (2.06%) received Extracorporeal Life Support, and 179 (6.61%) had multiple complications. Children residing in low deprivation neighborhoods were under-represented: lowest quintile 361 (13.33%). Minoritized ethnic group was strongly linked to indices of deprivation: residence in neighborhoods with highest deprivation occurred with Bangladeshi, Black African, and Pakistani ethnicity and lowest deprivation with White ethnicities. Adjusted for clinical risk factors compared with the reference group (White), patients from Asian background had a significantly higher risk of developing single vs. no complications (odds ratio [OR], 1.53; 95% CI, 1.00-2.32) and Black patients had a higher risk of developing multiple vs. no complications (OR, 2.19; 95% CI, 1.09-4.41). Among single complications, Asian children had a higher risk of developing feeding issues (OR, 2.07; 95% CI, 1.13-3.28).</p><p><strong>Conclusions and relevance: </strong>Ethnicity and socioeconomic deprivation may be linked to greater risk of certain complications after pediatric cardiac surgery. Further exploration of inequities is needed in this population.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 6","pages":"e1270"},"PeriodicalIF":0.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12140732/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227986","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":"Mortality Prediction Performance Under Geographical, Temporal, and COVID-19 Pandemic Dataset Shift: External Validation of the Global Open-Source Severity of Illness Score Model.","authors":"Takeshi Tohyama, Liam G McCoy, Euma Ishii, Sahil Sood, Jesse Raffa, Takahiro Kinoshita, Leo Anthony Celi, Satoru Hashimoto","doi":"10.1097/CCE.0000000000001275","DOIUrl":"10.1097/CCE.0000000000001275","url":null,"abstract":"<p><strong>Background: </strong>Risk-prediction models are widely used for quality of care evaluations, resource management, and patient stratification in research. While established models have long been used for risk prediction, healthcare has evolved significantly, and the optimal model must be selected for evaluation in line with contemporary healthcare settings and regional considerations.</p><p><strong>Objectives: </strong>To evaluate the geographic and temporal generalizability of the models for mortality prediction in ICUs through external validation in Japan.</p><p><strong>Derivation cohort: </strong>Not applicable.</p><p><strong>Validation cohort: </strong>The care Japanese Intensive care PAtient Database from 2015 to 2022.</p><p><strong>Prediction model: </strong>The Global Open-Source Severity of Illness Score (GOSSIS-1), a modern risk model utilizing machine learning approaches, was compared with conventional models-the Acute Physiology and Chronic Health Evaluation (APACHE-II and APACHE-III)-and a locally calibrated model, the Japan Risk of Death (JROD).</p><p><strong>Results: </strong>Despite the demographic and clinical differences of the validation cohort, GOSSIS-1 maintained strong discrimination, achieving an area under the curve of 0.908, comparable to APACHE-III (0.908) and JROD (0.910). It also exhibited superior calibration, achieving a standardized mortality ratio (SMR) of 0.89 (95% CI, 0.88-0.90), significantly outperforming APACHE-II (SMR, 0.39; 95% CI, 0.39-0.40) and APACHE-III (SMR, 0.46; 95% CI, 0.46-0.47), and demonstrating a performance close to that of JROD (SMR, 0.97; 95% CI, 0.96-0.99). However, performance varied significantly across disease categories, with suboptimal calibration for neurologic conditions and trauma. While the model showed temporal stability from 2015 to 2019, performance deteriorated during the COVID-19 pandemic, broadly reducing performance across disease categories in 2020. This trend was particularly pronounced in GOSSIS compared with APACHE-III.</p><p><strong>Conclusions: </strong>GOSSIS-1 demonstrates robust discrimination despite substantial geographic dataset shift but shows important calibration variations across disease categories. In particular, in a complex model like GOSSIS-1, stresses on the health system, such as a pandemic, can manifest changes in model calibration.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 6","pages":"e1275"},"PeriodicalIF":0.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12140679/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227983","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":"Quantifying Healthcare Provider Perceptions of a Novel Deep Learning Algorithm to Predict Sepsis: Electronic Survey.","authors":"Karthik Ramesh, Aaron Boussina, Supreeth P Shashikumar, Atul Malhotra, Christopher A Longhurst, Christopher S Josef, Kimberly Quintero, Jake Del Rosso, Shamim Nemati, Gabriel Wardi","doi":"10.1097/CCE.0000000000001276","DOIUrl":"10.1097/CCE.0000000000001276","url":null,"abstract":"<p><strong>Importance: </strong>Sepsis is a major cause of morbidity and mortality, with early intervention shown to improve outcomes. Predictive modeling and artificial intelligence (AI) can aid in early sepsis recognition, but there remains a gap between algorithm development and clinical use. Despite the importance of user experience in adopting clinical predictive models, few studies have focused on provider acceptance and feedback.</p><p><strong>Objectives: </strong>To evaluate healthcare worker perception and acceptance of a deep learning sepsis prediction model in the emergency department (ED).</p><p><strong>Design, setting, and participants: </strong>COnformal Multidimensional Prediction Of SEpsis Risk (COMPOSER), a deep learning algorithm, is used at two EDs of a large academic medical center to predict sepsis before clear clinical presentation. An internally developed survey following the Checklist for Reporting Results of Internet E-Surveys was distributed to team members who received a COMPOSER alert.</p><p><strong>Analysis: </strong>Mann-Whitney U testing was performed on results stratified by provider experience.</p><p><strong>Results: </strong>A total of 114 responses were received: 76 from doctors of medicine/doctors of osteopathic medicine, 34 from registered nurses, and four from nurse practicioners/physician assistants. Of these, 53% were from providers with fewer than 5 years of experience. Seventy-seven percent of respondents had a positive or neutral perception of the alert's usefulness. Providers with 0-5 years of experience were more likely to expect sepsis after the alert (p = 0.021) and found the alert more useful (p = 0.016) compared with those with 6+ years of experience. Additionally, physicians with 0-5 years of experience were more likely to say the alert changed their patient management (p = 0.048).</p><p><strong>Conclusions: </strong>Less experienced providers were more likely to perceive benefit from the alert, which was overall received favorably. Future AI implementations might consider tailored alert patterns and education to enhance reception and reduce fatigue.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 6","pages":"e1276"},"PeriodicalIF":0.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12140755/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227985","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}