Critical care explorations最新文献

{"title":"Comparative Evaluation of Lipopolysaccharide Administration Methods to Induce Acute Lung Injury in Murine Models: Efficacy, Consistency, and Technical Considerations.","authors":"Eva Kuhar, Duncan J Stewart, Doreen Engelberts, Forough Jahandideh, Matthew S Jeffers, Julie Khang, Haibo Zhang, Arnold S Kristof, Bernard Thébaud, Arul Vadivel, Dean A Fergusson, Manoj M Lalu","doi":"10.1097/CCE.0000000000001292","DOIUrl":"10.1097/CCE.0000000000001292","url":null,"abstract":"<p><strong>Context: </strong>Direct preclinical lipopolysaccharide acute lung injury (ALI) models are commonly used to study acute respiratory distress syndrome. Differences in lipopolysaccharide delivery methods may impact lung injury severity and reproducibility.</p><p><strong>Hypothesis: </strong>We hypothesized that the severity and variability of ALI outcomes in mice would differ depending on the technique of lipopolysaccharide administration.</p><p><strong>Methods and models: </strong>Male and female C57BL/6 mice were administered lipopolysaccharide (2.25 mg/kg) via four methods: 1) intratracheal intubation; 2) intranasal; 3) surgical transtracheal by either needle puncture; or 4) by catheter. ALI severity and variability were assessed at 72 hours post-lipopolysaccharide via histological scoring and bronchoalveolar lavage fluid (BALF) analysis (total protein, cell counts, interleukin-6 [IL-6]). The relative distribution of Evans Blue dye was also assessed for each model (lungs vs. stomach).</p><p><strong>Results: </strong>Distinct lung injury patterns were observed between the four methods. The transtracheal with catheter method demonstrated significantly greater lung injury scores than the intratracheal intubation and intranasal techniques. Both transtracheal methods produced greater alveolar neutrophil counts, increased proteinaceous debris, fewer hyaline membranes, and lower variability than non-surgical techniques. The transtracheal with catheter method produced higher BALF total cell counts and IL-6 levels than intratracheal intubation. Transtracheal methods also resulted in more localized Evans Blue dye distribution in the lungs. Male mice exhibited more severe lung injury scores and higher BALF protein concentrations than females.</p><p><strong>Interpretation and conclusions: </strong>This study demonstrates that the choice of technique to administer lipopolysaccharide impacts injury severity, phenotype, and variability. The surgical transtracheal with catheter technique produced the most robust and least variable ALI phenotype; however, this technique is associated with increased procedural complexity. Our results will allow researchers to tailor their model choice to align with their specific study objectives.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 8","pages":"e1292"},"PeriodicalIF":2.7,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144736097","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":"Health Economic Evaluations in Intensive Care: An Updated Systematic Review.","authors":"Christina-Le Nguyen, Wai Chung Tse, Thomas M Carney, Alayna Carrandi, Mussab Fagery, Alisa M Higgins","doi":"10.1097/CCE.0000000000001288","DOIUrl":"10.1097/CCE.0000000000001288","url":null,"abstract":"<p><strong>Objectives: </strong>Intensive care is a critical but resource-intensive component of healthcare. Health economic evaluations, such as cost-effectiveness analyses (CEAs), offer valuable insights for decision-making by weighing the costs and benefits of various healthcare interventions. We aimed to identify and summarize the existing health economic evaluations within intensive care and identify areas for future research.</p><p><strong>Data sources: </strong>We searched six academic databases to identify full health economic evaluations of ICU interventions published between 1993 and 2023. Databases included: Ovid (MEDLINE, Embase, and evidence based medicine (EBM) Reviews [Health Technology Assessments and National Health Service (NHS) Economic Evaluation Database]), EBSCO (CINAHL and EconLit), and Web of Science.</p><p><strong>Study selection: </strong>Health economic evaluations of interventions for adult patients in the ICU were included. Economic evaluations include CEAs, cost-utility, cost-benefit, and cost-minimization analyses, while pediatric, animal and weaning center studies were excluded.</p><p><strong>Data extraction: </strong>Data were extracted by two independent reviewers. Study quality was assessed using the Consolidated Health Economic Evaluation Reporting Standards checklist.</p><p><strong>Data synthesis: </strong>We identified 219 relevant studies published between 1993 and 2023, with a significant rise in publications over the last decade. Most studies (97%) had good to excellent reporting quality. Incremental cost-effectiveness ratios (ICERs) ranged from dominant (more effective and less expensive) to $753,874 per life saved. ICERs for both cost per quality-adjusted life-years and cost per life-year gained ranged from dominant to dominated (more costly and less effective). Three studies (1%) were published in low- and middle-income countries (LMICs) and 58% of studies were modeling studies.</p><p><strong>Conclusions: </strong>Despite the importance of economic evidence in healthcare decision-making, there is a relative scarcity of cost-effectiveness studies in intensive care compared with other medical fields. Available economic evaluations in intensive care are characterized by significant heterogeneity. The wide range of ICERs for life saved, life-years gained, and quality-adjusted life-years reflects the diversity of ICU patients, interventions, and evaluation methods. Future research in LMICs and increasing trial-based research is recommended.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 7","pages":"e1288"},"PeriodicalIF":0.0,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12269819/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144651532","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":"Epidemiology of Community-Acquired Versus Hospital-Acquired Sepsis in Acute Hospitals in Ireland, 2016-2022.","authors":"Emer M Liddy, Doaa K Amin, Declan J McKeown, Michael J O'Dwyer, Akke Vellinga","doi":"10.1097/CCE.0000000000001289","DOIUrl":"10.1097/CCE.0000000000001289","url":null,"abstract":"<p><strong>Importance: </strong>Sepsis is a leading cause of morbidity and mortality. Understanding sepsis epidemiology is crucial to enable clinicians to identify patients at highest risk of developing and dying from sepsis.</p><p><strong>Objectives: </strong>While community-acquired (CA) sepsis has been identified as more common than hospital-acquired (HA) sepsis, HA sepsis has led to increased morbidity and mortality. Few studies, however, have analyzed CA and HA sepsis by site of infection or by patient comorbidities. The aim of this analysis was to describe the epidemiology of patients with CA and HA sepsis diagnosed in Ireland.</p><p><strong>Design, setting, and participants: </strong>This was a retrospective cohort study. The setting was all Irish acute public hospitals from 2016 to 2022. Data were extracted from the Hospital In-Patient Enquiry (HIPE) system recording all discharges from acute public hospitals, if a sepsis-related diagnostic code was included.</p><p><strong>Main outcomes and measures: </strong>Univariate and multivariate analysis was conducted to compare CA and HA sepsis events and their association with sepsis-associated mortality.</p><p><strong>Results: </strong>The number of CA vs. HA sepsis events in the database was 86,011 (85.2%) vs. 14,930 (14.8%). HA sepsis patients were 1.5 times more likely to die in hospital compared with CA. Of diagnoses analyzed, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was identified as the strongest risk factor predictive of mortality (odds ratio [OR] = 2.4) followed by cardiac disease (OR, 1.9) and influenza or pneumonia (OR, 1.9). Sepsis patients with a lower socioeconomic status had a 20% higher likelihood of death.</p><p><strong>Conclusions and relevance: </strong>This analysis highlighted a significant increased risk of sepsis-associated mortality for patients diagnosed with sepsis as a result of a HA infection and key infection types and comorbidities including SARS-CoV-2, influenza or pneumonia, cancer, and cardiac disease.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 7","pages":"e1289"},"PeriodicalIF":0.0,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12266915/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144638921","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":"Association of Dynamic Arterial Elastance With Fluid Responsiveness in Critically Ill Children.","authors":"Sarah B Walker, Kyle S Honegger, Michael S Carroll, Debra E Weese-Mayer, Tellen D Bennett, L Nelson Sanchez-Pinto","doi":"10.1097/CCE.0000000000001291","DOIUrl":"10.1097/CCE.0000000000001291","url":null,"abstract":"<p><strong>Objectives: </strong>Cardiac mechanical efficiency has been shown to be a predictor of fluid responsiveness (FR) in adults. Our goal was to assess the association between mechanical efficiency as measured by dynamic arterial elastance (Eadyn) and mean arterial pressure (MAP) after fluid bolus in children with MAP less than or equal to 50th percentile for age.</p><p><strong>Design: </strong>This was a retrospective, observational cohort study.</p><p><strong>Setting/patients: </strong>This studied IV crystalloid fluid boluses of greater than or equal to 10 mL/kg given to patients less than or equal to 18 years old within the first 72 hours of admission to an academic PICU.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Eadyn was calculated in 10-second intervals during the 20 minutes pre-bolus. FR was defined as an increase of greater than or equal to 10% in MAP from pre-bolus to the average MAP over 20 minutes post-bolus. Kruskal-Wallis test was used to assess associations. We analyzed 490 fluid boluses given to children with MAP less than or equal to 50th percentile for age across 365 PICU encounters. Pre-bolus Eadyn was not associated with FR (p > 0.1). This lack of association persisted in subgroup analysis among those mechanically ventilated or on vasoactive medication, and in stratification by MAP percentile for age and duration of time in MAP percentile. Additionally, mechanical efficiency was high (Eadyn > 0.7) for most children, even in the lowest MAP percentile for age cohorts.</p><p><strong>Conclusions: </strong>Further research is needed in children to understand the changing cardiac physiology of children as blood pressure decreases to develop more targeted, age-based shock management strategies.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 7","pages":"e1291"},"PeriodicalIF":0.0,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144638920","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":"Evaluation of Hydrocortisone Discontinuation Strategies in Septic Shock: A Retrospective Cohort Study.","authors":"Hanine O AlMubayedh, Rayd A AlMehizia, Abdul Salam, Razan M AlGhunaim, Othman Mohammed, Abdullah A Alrbiaan, Nada S AlQadheeb","doi":"10.1097/CCE.0000000000001290","DOIUrl":"https://doi.org/10.1097/CCE.0000000000001290","url":null,"abstract":"<p><strong>Importance: </strong>While corticosteroid administration in septic shock has been shown to reduce vasopressor requirements and accelerate shock reversal, the optimal discontinuation strategy remains unexplored.</p><p><strong>Objectives: </strong>The purpose of this study was to assess whether rates of hemodynamic instability differ among patients with septic shock undergoing abrupt hydrocortisone discontinuation compared with gradual tapering.</p><p><strong>Design, setting, and participants: </strong>A retrospective cohort study conducted in five medical and surgical ICUs at a tertiary care hospital, involving adult patients (≥ 18 yr) with septic shock who received at least 48 hours of stress-dose hydrocortisone (≥ 200 mg/d).</p><p><strong>Main outcomes and measures: </strong>The primary outcome was hemodynamic instability, defined as vasopressor reinitiation during tapering or within 72 hours of hydrocortisone discontinuation. Secondary outcomes included dysglycemia, duration of mechanical ventilation, ICU and hospital length of stay, and mortality.</p><p><strong>Results: </strong>Patients were grouped based on their hydrocortisone discontinuation strategy into abrupt and gradual tapering groups. A total of 414 patients were included in this evaluation. Gradual tapering was associated with higher rates of hemodynamic instability (29.2% vs. 12.9%; p < 0.001), more frequent dysglycemia (59.4% vs. 43.1%; p < 0.001), longer hydrocortisone use (9.9 vs. 4.1 d; p < 0.001), and extended mechanical ventilation (20 vs. 15 d; p = 0.014) and ICU stay (23 vs. 17 d; p = 0.008). Total hydrocortisone duration was the strongest independent predictor of post-discontinuation hemodynamic instability, regardless of strategy (adjusted odds ratio, 1.083; 95% CI, 1.025-1.145; p = 0.004).</p><p><strong>Conclusions and relevance: </strong>While abrupt hydrocortisone discontinuation was associated with fewer ICU-related adverse events, hydrocortisone duration was the primary factor influencing hemodynamic instability post-discontinuation among patients with septic shock. Prospective studies are needed to determine the optimal discontinuation strategy in septic shock.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 7","pages":"e1290"},"PeriodicalIF":0.0,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144638922","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":"Troubleshooting Severe Airflow Obstruction With a Pressure-Limited Transport Ventilator: Lessons From Two Cases.","authors":"Peter M Reardon, Melody J Bishop, Christopher J Yarnell, Jason A Benaim, Chris Barclay, G Veronica Tello, Andy Pan","doi":"10.1097/CCE.0000000000001285","DOIUrl":"10.1097/CCE.0000000000001285","url":null,"abstract":"<p><p>Presentations of status asthmaticus or severe chronic obstructive pulmonary disease exacerbation can present a formidable challenge to effective invasive ventilation. The optimal ventilation strategy targets low respiratory rates and high inspiratory flow rates to prolong the expiratory time and minimize dynamic hyperinflation. Although the resulting high peak pressures can usually be accommodated by ICU ventilators, some ventilators have a relatively limited peak pressure capacity as determined by the turbine. Here, we describe two cases of severe airflow obstruction where the desired ventilation strategy required a peak pressure over the capacity of the Hamilton T1 transport ventilator. Changing to a pressure regulated strategy, maximizing the driving pressure, and titrating the inspiratory time overcame the limitation. But, this strategy comes at a cost. Clinicians should be made aware of the possibility of a pressure limitation in their ventilator and understand how to adjust their ventilation strategy appropriately during transitions.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 7","pages":"e1285"},"PeriodicalIF":0.0,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144638991","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":"Right Ventricular Longitudinal Strain Predicts Weaning Success in Cardiogenic Shock Patients Supported by a Microaxial Flow Pump.","authors":"Konstantinos Rapis, Francesco Paolo Lo Muzio, Alessandro Faragli, David Wainstejn, Vivienne Nelki, Frank Spillmann, Carsten Tschöpe, Alessio Alogna","doi":"10.1097/CCE.0000000000001283","DOIUrl":"10.1097/CCE.0000000000001283","url":null,"abstract":"<p><strong>Importance: </strong>The effect of left ventricular (LV) mechanical unloading on right ventricular (RV) function in patients with cardiogenic shock (CS) remains poorly understood, yet may have significant implications for device weaning and patient outcomes.</p><p><strong>Objectives: </strong>To investigate the short-term effects of LV unloading using a transaortic valve axial flow pump (Impella) on RV function and to assess its predictive value for successful device weaning in patients with CS.</p><p><strong>Design: </strong>Retrospective analysis of CS patients who received Impella support between 2018 and 2021.</p><p><strong>Setting and participants: </strong>Single-center study conducted at the German Heart Center, Charité Universitätsmedizin Berlin, Germany. The study included 41 ICU patients with CS due to LV dysfunction who required Impella support for at least 72 hours.</p><p><strong>Main outcomes and measures: </strong>Biventricular function was evaluated by echocardiography and advanced strain imaging during the weaning process. The primary outcome was successful Impella weaning. Associations between changes in RV free-wall longitudinal strain (RVFWLS) and weaning outcomes were assessed using multiple logistic regression.</p><p><strong>Results: </strong>Patients received Impella support for a median duration of 216 hours (interquartile range, 144-264 hr). Eighteen patients (43.9%) were successfully weaned, while 23 (56.1%) required LVAD implantation (31.7%) or died (24.4%). LV unloading significantly improved RV systolic function, as demonstrated by increased RV fractional area change, tricuspid annular systolic velocity, and RVFWLS. Notably, patients who failed weaning showed a significantly lower change in RVFWLS (ΔRVFWLS) during the weaning process, which emerged as an independent predictor of weaning outcome.</p><p><strong>Conclusions and relevance: </strong>Impella-mediated LV unloading enhances both LV and RV function in CS patients. However, inadequate RV longitudinal systolic reserve, as indicated by lower ΔRVFWLS during weaning, is associated with weaning failure and may guide clinical decisions regarding prolonged mechanical circulatory support or transition to durable devices.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 7","pages":"e1283"},"PeriodicalIF":0.0,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12266926/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144638990","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":"Effect of Inhaled Volatile and IV Anesthetics on Biological Markers of Inflammation in Adult ICU and Thoracic Surgical Patients: A Systematic Review and Meta-Analysis.","authors":"Soroush Rouhani, Sanchit Gupta, Hira Raheel, Aggie Duan Gao, Ciara Hanley, Xingshan Cao, Alla Iansavitchene, Brian H Cuthbertson, Marat Slessarev, Ewan C Goligher, Aleksandra Leligdowicz, Douglas D Fraser, Beverley A Orser, Angela Jerath","doi":"10.1097/CCE.0000000000001280","DOIUrl":"10.1097/CCE.0000000000001280","url":null,"abstract":"<p><strong>Objectives: </strong>Inhaled anesthetics may reduce alveolar and systemic inflammation in surgical and critically ill patients. This study aimed to perform a systematic review and meta-analysis comparing the effect of inhaled volatile and IV anesthetics on alveolar and plasma cytokines in patients with surgical or medical acute lung injury.</p><p><strong>Data sources: </strong>Medline, Embase, and Cochrane CENTRAL databases from 2000 to July 2021.</p><p><strong>Study selection: </strong>Randomized control trials, prospective, and retrospective observational studies comparing inhaled volatile to IV anesthetics in ventilated adult patients with acute lung injury from lung resection or critical illness.</p><p><strong>Data extraction: </strong>A systematic review and meta-analysis was performed. Primary outcome was alveolar inflammatory cytokines levels that were meta-analyzed using a random effects model. Secondary outcomes were plasma inflammatory cytokine levels, mortality, pulmonary complications, and duration of hospital and ICU stay. The quality of studies was assessed using the Cochrane Risk of Bias tool for randomized control trials and the Cochrane Risk Of Bias In Non-randomized Studies of Interventions tool for retrospective cohort studies.</p><p><strong>Data synthesis: </strong>From 2522 screened studies, 28 (27 thoracic surgery and 1 ICU, n = 4175) were included. Meta-analysis of patients undergoing lung resection demonstrated lower levels of alveolar tumor necrosis factor-alpha (TNF-α) (standard mean difference 1.04; 95% CI, 0.32-1.77; p < 0.01; I2 82%) and interleukin (IL)-6 (0.64; 95% CI, 0.52-0.75; I2 0%; p < 0.01) at 1-2 hours in the inhaled anesthesia group, with no difference in other cytokines at various time points. The single ICU study demonstrated lower plasma TNF-α and IL-6 and alveolar TNF-α, IL-6, and IL-8 at 48 hours in patients sedated with sevoflurane compared with midazolam. Clinical outcomes were infrequently reported.</p><p><strong>Conclusions: </strong>Limited evidence suggests that inhaled anesthesia may reduce proinflammatory cytokines TNF-α and IL-6 during lung resection and critical illness. Further studies are needed to clarify its effects on biological markers and clinical outcomes.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 7","pages":"e1280"},"PeriodicalIF":0.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602473","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":"Long-Term Cardiopulmonary Function After COVID-19-Associated Acute Respiratory Distress Syndrome: A Multicenter Case-Control Study.","authors":"Fernando Luis Scolari, Marciane Maria Rover, Geraldine Trott, Mariana Motta Dias da Silva, Denise de Souza, Aline Paula Miozzo, Jennifer Menna Barreto de Souza, Gabrielle Nunes da Silva, Raíne Fogliati De Carli Schardosim, Emelyn de Souza Roldão, Rosa da Rosa Minho Dos Santos, Duane Mocellin, Gabriela Soares Rech, Carolina Rothmann Itaqui, Lucas Gobetti da Luz, Gabriel Beilfuss Rieth, Thiago Costa Lisboa, Ana Carolina Mardini, Juliana Cardozo Fernandes, Bruna Oliveira Lago, Luciane Facchi, Anderson Donelli da Silveira, Igor Gorski Benedetto, Marcelle Klein Draghetti, Tiago Pacheco, Debora Vaccaro Fogazzi, Milena Soriano Marcolino, Ana Carolina Peçanha Antonio, Paulo Roberto Schvartzman, Bruna Brandao Barreto, Caroline Cabral Robinson, Maicon Falavigna, Luiz Antonio Nasi, Cassiano Teixeira, Carisi Anne Polanczyk, Regis Goulart Rosa","doi":"10.1097/CCE.0000000000001286","DOIUrl":"10.1097/CCE.0000000000001286","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to evaluate long-term pulmonary function, cardiopulmonary exercise capacity, chest CT findings, and health-related quality of life (HRQoL) in survivors of COVID-19 complicated by acute respiratory distress syndrome (ARDS).</p><p><strong>Design, setting, and patients: </strong>This is a multicentric case-control study conducted from February 2023 to December of 2023. Pulmonary function tests, cardiopulmonary exercise testing (CPET), chest CT, and HRQoL (using EuroQol 5D three-level [EQ-5D-3L]) were performed at least 12 months after hospital discharge among cases (COVID-19 complicated by ARDS) and at the time of inclusion among controls (family members/friends matched for sex and age).</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>A total of 114 COVID-19 ARDS survivors and 115 controls were included. The mean age was 54 years and 52.4% of the participants were men. Time from hospital discharge to evaluation was 22 months (20.99-41.41 mo) among cases. Persistent symptoms, including memory loss (48.2%), fatigue (42.1%), and anxiety (31.6%), were reported by 73.6% of the COVID-19 ARDS survivors. Cases had significantly reduced pulmonary function, with lower diffusing capacity for carbon monoxide (DLCO) of 6.85 mmol/min/Kpa (5.44-8.37 mmol/min/Kpa) vs. 7.36 mmol/min/Kpa (6.43-8.96 mmol/min/Kpa; p = 0.012) and % of predicted DLCO of 81.0% (70.2-90.4%) vs. 89.3% (78.9-99.9%; p < 0.001), compared with controls, as well as a higher frequency of moderate to severe DLCO impairment (10.5% vs. 0.8%; p = 0.002). In CPET, cases demonstrated lower peak oxygen consumption (21.9 mL/kg/min [18.2-29 mL/kg/min] vs. 25.8 mL/kg/min [21.6-31.9 mL/kg/min]; p < 0.001). Chest CT revealed a greater prevalence of ground-glass opacities in cases (53.5% vs. 16.5%; p < 0.001) and emphysema (6.1% vs. 0%; p = 0.043). HRQoL, using EQ-5D-3L utility scores, were significantly lower in cases, with worse mobility (p < 0.001), self-care (p < 0.001), and anxiety/depression (p = 0.04) dimension scores compared with controls.</p><p><strong>Conclusions: </strong>COVID-19 ARDS survivors exhibit significant long-term impairments in pulmonary function, exercise capacity, and quality of life and abnormal chest CT findings compared with family controls with same sex and age.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 7","pages":"e1286"},"PeriodicalIF":0.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602542","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":"Temperature Trajectories Correlate With Cardiac Function in Patients With Sepsis.","authors":"Annabel H Lu, Vardhmaan Jain, Po-Han Chen, Matthew M Churpek, Philip A Verhoef, Arshed A Quyyumi, Sivasubramanium V Bhavani","doi":"10.1097/CCE.0000000000001282","DOIUrl":"10.1097/CCE.0000000000001282","url":null,"abstract":"<p><strong>Objectives: </strong>Body temperature trajectories of infected patients are associated with dynamic clinical and immune responses to infection. Our objective was to evaluate the association between temperature trajectory subphenotypes and cardiac dysfunction determined by echocardiography.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Four hospitals within an academic healthcare system from 2016 to 2019.</p><p><strong>Patients: </strong>Adult patients with suspicion of infection who underwent transthoracic echocardiography within 48 hours of admission.</p><p><strong>Interventions: </strong>Using a validated model, patients were classified into four temperature trajectory subphenotypes. The primary outcome compared between subphenotypes was left ventricular dysfunction, defined as ejection fraction less than or equal to 50%.</p><p><strong>Measurements and main results: </strong>One thousand nine hundred twenty-three hospitalized septic patients were classified into four subphenotypes: \"hyperthermic, slow resolvers\" (n = 264, 14%), \"hyperthermic, fast resolvers\" (302, 16%), \"normothermic\" patients (903, 47%), and \"hypothermic\" patients (454, 24%). Left ventricular and right ventricular dysfunction was significantly different between subphenotypes. Hypothermic patients exhibited the highest levels of left ventricular dysfunction (208, 46%; p < 0.01) and right ventricular dysfunction (169, 39%; p < 0.01). In the multivariable logistic regression analysis, adjusting for demographics, comorbidities, and severity of illness, membership in the hypothermic group (odds ratio, 2.65; 95% CI, 1.87-3.80; p < 0.01) was associated with significantly reduced left ventricular ejection fraction compared with hyperthermic slow resolvers as reference. Hypothermic patients also had the highest levels of vasopressor use (27%; p < 0.01), inotrope use (11%; p < 0.01), and in-hospital mortality (12%; p < 0.01).</p><p><strong>Conclusions: </strong>Temperature trajectories in sepsis are significantly associated with cardiac dysfunction, with hypothermic patients having the highest odds ratio of both left and right ventricular dysfunction. Bedside temperature monitoring could be a readily available marker to prompt early echocardiographic assessment, though further studies are needed to validate the relationship.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 7","pages":"e1282"},"PeriodicalIF":0.0,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144593184","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}