Critical care explorations最新文献

{"title":"The Maastricht Intensive Care COVID Cohort: A Critical Appraisal of the Predefined Research Questions.","authors":"Marieke S J N Wintjens, Eda Aydeniz, Frank van Rosmalen, Rob G H Driessen, Anne-Marije Hulshof, Dennis C J J Bergmans, Sander M J van Kuijk, Iwan C C van der Horst, Bas C T van Bussel","doi":"10.1097/CCE.0000000000001211","DOIUrl":"10.1097/CCE.0000000000001211","url":null,"abstract":"<p><strong>Importance: </strong>A review of the study processes and protocols afterward by the researchers themselves is scarce.</p><p><strong>Objectives: </strong>The present study aimed to evaluate the study design and the process of data collection of the Maastricht Intensive Care COVID (MaastrICCht) cohort during the COVID-19 pandemic. This evaluation provides information about the quality of the predefined questions and contributes to transparency in science.</p><p><strong>Design, setting, and participants: </strong>Critical appraisal of studies using data from the MaastrICCht cohort.</p><p><strong>Main outcomes and measures: </strong>Evaluation of the process of study design and data collection during the COVID-19 pandemic, focusing on the research process and results.</p><p><strong>Results: </strong>From March 2020 to April 2023, all patients diagnosed with COVID-19 admitted to the ICU at Maastricht University Medical Center + (n = 544) were included in the MaastrICCht cohort. In total, 37 studies were carried out until April 2024. Fifteen studies addressed 11 of the 13 predetermined research questions, whereas 22 additional studies were performed based on the initial research questions described in the design. Furthermore, 10 studies were conducted with other researchers in national and international collaboration as a response to new arising questions based on evidence that appeared relevant during the pandemic.</p><p><strong>Conclusions and relevance: </strong>Our critical appraisal indicated that using a study protocol enabled many publications and (inter)national collaborations, although formulating pertinent research questions in the context of a novel disease appeared daunting. Despite this, most questions were successfully addressed, whereas few were resolved by other researchers or lost importance due to the expanding body of knowledge.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 2","pages":"e1211"},"PeriodicalIF":0.0,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11793260/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143124109","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":"Proteomic Analyses in COVID-19-Associated Secondary Hemophagocytic Lymphohistiocytosis.","authors":"Susan P Canny, Ian B Stanaway, Sarah E Holton, Mallorie Mitchem, Allison R O'Rourke, Stephan Pribitzer, Sarah K Baxter, Mark M Wurfel, Uma Malhotra, Jane H Buckner, Pavan K Bhatraju, Eric D Morrell, Cate Speake, Carmen Mikacenic, Jessica A Hamerman","doi":"10.1097/CCE.0000000000001203","DOIUrl":"10.1097/CCE.0000000000001203","url":null,"abstract":"<p><strong>Context: </strong>COVID-19 has been associated with features of a cytokine storm syndrome with some patients sharing features with the hyperinflammatory disorder, secondary hemophagocytic lymphohistiocytosis (sHLH).</p><p><strong>Hypothesis: </strong>We hypothesized that proteins associated with sHLH from other causes will be associated with COVID-sHLH and that subjects with fatal COVID-sHLH would have defects in immune-related pathways.</p><p><strong>Methods and models: </strong>We identified two cohorts of adult patients presenting with COVID-19 at two tertiary care hospitals in Seattle, Washington in 2020 and 2021. In this observational study, we assessed clinical laboratory values and plasma proteomics. Subjects identified as having sHLH (ferritin > 1000 plus cytopenias in two or more lineages [WBC < 5000 odds ratio [OR] ANC (absolute neutrophil count) < 1000, hemoglobin < 9 or hematocrit < 27, platelets < 100,000], and elevated transaminases [either AST (aspartate aminotransferase) or ALT (alanine aminotransferase) > 30] OR subjects with a ferritin > 3000) were compared with those with COVID-19 without sHLH. We identified 264 patients with COVID-19 of whom 24 met our sHLH definition. Eight patients who died of COVID-sHLH underwent genomic sequencing to identify variants in immune-related genes.</p><p><strong>Results: </strong>Nine percent of enrolled COVID-19 subjects met our defined criteria for sHLH (n = 24/264). Using broad serum proteomic approaches (O-link and SomaScan), we identified three proteins increased in subjects with COVID-19-associated sHLH (soluble PD-L1 [sPD-L1], tumor necrosis factor-R1, and interleukin [IL]-18BP, p < 0.05 for O-link and false discovery rate < 0.05 for SomaScan), supporting a role for proteins previously associated with other forms of sHLH (IL-18BP and soluble tumor necrosis factor receptor 1). We also identified candidate proteins and pathways associated with COVID-sHLH, including sPD-L1 and the syntaxin pathway. We detected pathogenic variants in DOCK8 and TMPRSS15 in deceased individuals with COVID-sHLH, further suggesting that alterations in immune-related processes may contribute to hyperinflammation and fatal outcomes in COVID-19.</p><p><strong>Interpretations and conclusions: </strong>Proteins increased in COVID-19-associated sHLH, such as sPD-L1, and pathways, such as the syntaxin pathway, suggest important roles for the immune response in driving sHLH in the context of COVID-19.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 2","pages":"e1203"},"PeriodicalIF":0.0,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11789895/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143070187","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":"Corticosteroids in Cardiogenic Shock: A Retrospective Analysis of the Medical Information Mart for Intensive Care-IV Database.","authors":"Ghazal Haddad, David M Maslove, Lawrence Mbuagbaw, Emilie P Belley-Côté, Bram Rochwerg","doi":"10.1097/CCE.0000000000001210","DOIUrl":"10.1097/CCE.0000000000001210","url":null,"abstract":"<p><strong>Importance: </strong>While corticosteroid administration in septic shock has been shown to result in faster shock reversal and lower short-term mortality, the role of corticosteroids in the management of cardiogenic shock (CS) remains unexplored.</p><p><strong>Objectives: </strong>Determine the impact of corticosteroid administration on 90-day mortality (primary outcome) in patients admitted to a critical care unit with CS.</p><p><strong>Design, setting, and participants: </strong>In this retrospective cohort study, we used the critical care database of Medical Information Mart for Intensive Care-IV, and included all adult patients diagnosed with CS excluding repeated admissions, patients with adrenal insufficiency, those receiving baseline corticosteroids, and those requiring extracorporeal life support. We considered exposure based on receiving systemic corticosteroids from 6 hours before to 24 hours post-critical care admission.</p><p><strong>Main outcomes and measures: </strong>We calculated Cox proportional hazards using multivariate analysis for 90-day mortality (primary outcome). We also explored the association of corticosteroid use with hospital length of stay, ventilator-free days (VFDs), vasopressor-free days, ventilator-associated pneumonia, central-line-associated bloodstream infections, and hyperglycemia.</p><p><strong>Results: </strong>We included 2000 eligible patients, with 143 (7.2%) receiving systemic corticosteroids. Corticosteroid-treated patients were younger (67.7 vs. 71.2 yr; p = 0.006), had higher Sequential Organ Failure Assessment scores at baseline (9.4 vs. 7.8; p < 0.001), and more often required vasopressors (78% vs. 63%; p < 0.001), and invasive mechanical ventilation (73% vs. 45%; p < 0.001). Corticosteroid use was associated with increased 90-day mortality in multivariate analysis (hazard ratio, 1.60; 95% CI, 1.25-2.05) and fewer VFDs (2.8 d fewer; 95% CI, 0.35-5.26) with no effect on other secondary outcomes.</p><p><strong>Conclusions and relevance: </strong>Use of corticosteroids may be associated with increased mortality and a reduction in VFDs in patients admitted to critical care with CS. These findings suggesting potential harm of corticosteroids in CS might reflect unmeasured confounding and require corroboration through additional observational studies and ultimately randomized clinical trials.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 2","pages":"e1210"},"PeriodicalIF":0.0,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11789865/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143070184","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 Diagnostic Utility of Host RNA Biosignatures in Adult Patients With Sepsis: A Systematic Review and Meta-Analysis.","authors":"Mervin V Loi, Rehena Sultana, Tuong Minh Nguyen, Shi Ting Tia, Jan Hau Lee, Daniel O'Connor","doi":"10.1097/CCE.0000000000001212","DOIUrl":"10.1097/CCE.0000000000001212","url":null,"abstract":"<p><strong>Objectives: </strong>Sepsis is a life-threatening medical emergency, with a profound healthcare burden globally. Its pathophysiology is complex, heterogeneous and temporally dynamic, making diagnosis challenging. Medical management is predicated on early diagnosis and timely intervention. Transcriptomics is one of the novel \"-omics\" technologies being evaluated for recognition of sepsis. Our objective was to evaluate the performance of host gene expression biosignatures for the diagnosis of all-cause sepsis in adults.</p><p><strong>Data sources: </strong>PubMed/Ovid Medline, Ovid Embase, and Cochrane databases from inception to June 2023.</p><p><strong>Study selection: </strong>We included studies evaluating the performance of host gene expression biosignatures in adults who were diagnosed with sepsis using existing clinical definitions. Controls where applicable were patients without clinical sepsis.</p><p><strong>Data extraction: </strong>Data including population demographics, sample size, study design, tissue specimen, type of transcriptome, health status of comparator group, and performance of transcriptomic biomarkers were independently extracted by at least two reviewers.</p><p><strong>Data synthesis: </strong>Meta-analysis to describe the performance of host gene expression biosignatures for the diagnosis of sepsis in adult patients was performed using the random-effects model. Risk of bias was assessed according to the Quality Assessment of Diagnostic Accuracy Studies-2 tool. A total of 117 studies (n = 17,469), comprising 132 separate patient datasets, were included in our final analysis. Performance of transcriptomics for the diagnosis of sepsis against pooled controls showed area under the receiver operating characteristic curve (AUC, 0.86; 95% CI, 0.84-0.88). Studies using healthy controls showed AUC 0.87 (95% CI, 0.84-0.89), while studies using controls with systemic inflammatory response syndrome (SIRS) had AUC 0.84 (95% CI, 0.78-0.90). Transcripts with excellent discrimination against SIRS controls include UrSepsisModel, a 210 differentially expressed genes biosignature, microRNA-143, and Septicyte laboratory.</p><p><strong>Conclusions: </strong>Transcriptomics is a promising approach for the accurate diagnosis of sepsis in adults and demonstrates good discriminatory ability against both healthy and SIRS control subjects.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 2","pages":"e1212"},"PeriodicalIF":0.0,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11789890/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143070197","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":"Heterogeneity of Intermediate Care Organization Within a Single Healthcare System.","authors":"Aaron S Case, Chad H Hochberg, Binu Koirala, Eleni Flanagan, Souvik Chatterjee, William N Checkley, Ayse P Gurses, David N Hager","doi":"10.1097/CCE.0000000000001201","DOIUrl":"10.1097/CCE.0000000000001201","url":null,"abstract":"<p><p>Intermediate care (IC) is prevalent nationwide, but little is known about how to best organize this level of care. Using a 99-item cross-sectional survey assessing four domains (hospital and physical IC features, provider and nurse staffing, monitoring, and interventions/services), we describe the organizational heterogeneity of IC within a five-hospital healthcare system. Surveys were completed by nurse managers from 12 (86%) of 14 IC settings. Six IC settings (50%) were embedded within acute care wards, four (33%) were stand-alone units, and two (17%) were embedded within an ICU. All had a nurse-to-patient ratio of 1:3, provided continuous cardiac telemetry, continuous pulse oximetry, high-flow nasal oxygen, and bedside intermittent hemodialysis. Most (> 50%) permitted arterial lines, frequent nursing assessments (every 2 hr), and noninvasive ventilation or mechanical ventilation via a tracheostomy. Vasopressors were less often permitted (< 25% of settings). Models of IC vary greatly within a single healthcare system.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 1","pages":"e1201"},"PeriodicalIF":0.0,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11756875/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018390","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":"Multidimensional 1-Year Outcomes After Intensive Care Admission for Multisystem Inflammatory Syndrome in Children.","authors":"Thomas C Seijbel, Levi Hoste, Corinne M P Buysse, Karolijn Dulfer, Filomeen Haerynck, Matthijs de Hoog, Naomi Ketharanathan","doi":"10.1097/CCE.0000000000001213","DOIUrl":"10.1097/CCE.0000000000001213","url":null,"abstract":"<p><strong>Objectives: </strong>The COVID-19 pandemic gave rise to uncertainty concerning potential sequelae related to a severe acute respiratory syndrome coronavirus 2 infection. This landscape is currently unfolding with studies reporting sequelae on various domains (physical, cognitive, and psychosocial), although most studies focus on adults or only one domain. We sought to investigate concurrent sequelae on multiple domains 1 year after PICU admission for Multisystem Inflammatory Syndrome in Children (MIS-C).</p><p><strong>Design: </strong>Prospective cohort study.</p><p><strong>Setting: </strong>Two academic, tertiary referral hospitals in The Netherlands and Belgium.</p><p><strong>Patients: </strong>Patients (< 18 yr, <i>n</i> = 58) seen in-person 1-year after PICU admission for MIS-C.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Seventy MIS-C patients (62% male; median age, 10.0 [interquartile range, 7.4-13.0]) were admitted to the PICU, mostly (86%) due to (imminent) circulatory failure. The majority received IV immunoglobulins (95%), steroids (83%), and vasopressors and/or inotropes (72%). Invasive respiratory support and extracorporeal membrane oxygenation were necessary in 7% and 2%, respectively. All patients survived. Fifty-eight patients (83%) attended 1-year follow-up. Although most patients had normal functional performance scores (Pediatric Cerebral Performance Category, Pediatric Overall Performance Category, and Functional Status Score), 62% still experienced physical sequelae: fatigue (40%), headaches (27%), and decreased exercise tolerance (19%). Cognitive, behavioral, and psychological problems were reported in 14%, 13%, and 23%, respectively. This resulted in 22% requiring ongoing healthcare utilization, 9% not being able to return to full-time school attendance and cessation of hobbies in 7%.</p><p><strong>Conclusions: </strong>This is the first 1-year outcome study of MIS-C PICU patients to include both physical and psychosocial characteristics. One year after PICU admission, most children had normalized functional performance as measured by three validated performance scores. However, many still reported a variety of multidimensional sequelae at 1-year follow-up impacting daily life. This emphasizes the importance of continued investigative efforts and multidisciplinary follow-up programs to better understand pathophysiology and contributing factors to the MIS-C disease trajectory and initiate patient-specific interventions to improve outcome and social participation.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 1","pages":"e1213"},"PeriodicalIF":0.0,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11756874/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143030597","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":"Heterogeneity of Intermediate Care Organization Within a Single Healthcare System.","authors":"Aaron S Case, Chad H Hochberg, Binu Koirala, Eleni Flanagan, Souvik Chatterjee, William N Checkley, Ayse P Gurses, David N Hager","doi":"10.1097/CCE.0000000000001201","DOIUrl":"10.1097/CCE.0000000000001201","url":null,"abstract":"<p><p>Intermediate care (IC) is prevalent nationwide, but little is known about how to best organize this level of care. Using a 99-item cross-sectional survey assessing four domains (hospital and physical IC features, provider and nurse staffing, monitoring, and interventions/services), we describe the organizational heterogeneity of IC within a five-hospital healthcare system. Surveys were completed by nurse managers from 12 (86%) of 14 IC settings. Six IC settings (50%) were embedded within acute care wards, four (33%) were stand-alone units, and two (17%) were embedded within an ICU. All had a nurse-to-patient ratio of 1:3, provided continuous cardiac telemetry, continuous pulse oximetry, high-flow nasal oxygen, and bedside intermittent hemodialysis. Most (> 50%) permitted arterial lines, frequent nursing assessments (every 2 hr), and noninvasive ventilation or mechanical ventilation via a tracheostomy. Vasopressors were less often permitted (< 25% of settings). Models of IC vary greatly within a single healthcare system.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 1","pages":"e1201"},"PeriodicalIF":0.0,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11756875/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143030591","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":"Composite Primary Outcomes Reported in Studies of Critical Care: A Scoping Review.","authors":"Prashanti Marella, Sansuka De Silva, Antony G Attokaran, Kevin B Laupland, Lars Eriksson, Mahesh Ramanan","doi":"10.1097/CCE.0000000000001195","DOIUrl":"10.1097/CCE.0000000000001195","url":null,"abstract":"<p><strong>Objective: </strong>Composite primary outcomes (CPO) (incorporating both mortality and non-mortality outcomes) offer several advantages over mortality as an outcome for critical care research. Our objective was to explore and map the literature to report on CPO evaluated in critical care research.</p><p><strong>Data sources: </strong>PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, Scopus, and Cochrane Library from January 2000 to January 2024.</p><p><strong>Study selection: </strong>All studies (both non-randomized controlled trial [RCT] and RCT) conducted in ICUs treating adult patients (18 yr old or older) that described CPOs and their definitions, were included for mapping, reporting, and analyzing CPOs without any restrictions.</p><p><strong>Data extraction: </strong>Independent double-screening of abstracts/full texts and data extraction was performed using a pilot-tested extraction template. The data collected included characteristics of CPO, definitions, trends, and death handling techniques used while reporting the CPO.</p><p><strong>Data synthesis: </strong>Seventeen CPOs were extracted from 71 studies, predominantly reported in the setting of pharmaceutical studies (48/71, 67.6%), used RCT methodology (60/71, 84.5%), and were mostly single-center studies (55/71, 77.5%). Ventilator-free days were the most commonly reported CPO (29/71, 40.8%) with marked variability in the definition used and death handling (0 d in 33 studies and -1 d in 7 studies). The most common statistical paradigm used was frequentist (63/71, 88.7%) and the study follow-up time was 90 days with 28 studies using this timeline (28/71, 39.4%). Narrative synthesis highlighted the variability in defining CPO.</p><p><strong>Conclusions: </strong>CPOs are an emerging set of outcomes increasingly reported in critical care research. There was significant heterogeneity in definitions used, follow-up times, and reporting trends.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 1","pages":"e1195"},"PeriodicalIF":0.0,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11749510/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018388","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":"Investigation of a Novel Noninvasive Risk Analytics Algorithm With Laboratory Central Venous Oxygen Saturation Measurements in Critically Ill Pediatric Patients.","authors":"Sarah A Teele, Avihu Z Gazit, Craig Futterman, William G La Cava, David S Cooper, Steven M Schwartz, Joshua W Salvin","doi":"10.1097/CCE.0000000000001204","DOIUrl":"10.1097/CCE.0000000000001204","url":null,"abstract":"<p><strong>Background: </strong>Accurate assessment of oxygen delivery relative to oxygen demand is crucial in the care of a critically ill patient. The central venous oxygen saturation (Svo₂) enables an estimate of cardiac output yet obtaining these clinical data requires invasive procedures and repeated blood sampling. Interpretation remains subjective and vulnerable to error. Recognition of patient's evolving clinical status as well as the impact of therapeutic interventions may be delayed.</p><p><strong>Objective: </strong>The predictive analytics algorithm, inadequate delivery of oxygen (IDo₂) index, was developed to noninvasively estimate the probability of a patient's Svo₂ to fall below a preselected threshold.</p><p><strong>Derivation cohort: </strong>A retrospective multicenter cohort study was conducted using data temporally independent from the design and development phase of the IDo₂ index.</p><p><strong>Validation cohort: </strong>A total of 20,424 Svo₂ measurements from 3,018 critically ill neonates, infants, and children were retrospectively analyzed. Collected data included vital signs, ventilator data, laboratory data, and demographics.</p><p><strong>Prediction model: </strong>The ability of the IDo₂ index to predict Svo₂ below a preselected threshold (30%, 40%, or 50%) was evaluated for discriminatory power, range utilization, and robustness.</p><p><strong>Results: </strong>Area under the receiver operating characteristic curve (AUC) was calculated for each index threshold. Datasets with greater amounts of available data had larger AUC scores. This was observed across each configuration. For the majority of thresholds, Svo₂ values were observed to be significantly lower as the IDo₂ index increased.</p><p><strong>Conclusions: </strong>The IDo₂ index may inform decision-making in pediatric cardiac critical care settings by providing a continuous, noninvasive assessment of oxygen delivery relative to oxygen demand in a specific patient. Leveraging predictive analytics to guide timely patient care, including support for escalation or de-escalation of treatments, may improve care delivery for patients and clinicians.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 1","pages":"e1204"},"PeriodicalIF":0.0,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11741213/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018391","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":"Evaluating the Adequacy of Central Line-Associated Bloodstream Infection As a Quality Measure: A Cross-Sectional Analysis at a Single Tertiary Care Center.","authors":"Piyush Mathur, Amanda J Naylor, Moises Auron, Jean Beresian, Alexandra Tallman, Allison Griffith, Kathleen Seasholtz, Mariel Manlapaz, Katherine Zacharyasz, Reem Khatib, Shreya Mishra, Kathryn Haller, Thomas Fraser, Katherine Holman","doi":"10.1097/CCE.0000000000001205","DOIUrl":"10.1097/CCE.0000000000001205","url":null,"abstract":"<p><strong>Importance: </strong>The current definition of central line-associated bloodstream infection (CLABSI) may overestimate the true incidence of CLABSI as it is often unclear whether the bloodstream infection (BSI) is secondary to the central line or due to another infectious source.</p><p><strong>Objectives: </strong>We aimed to assess the prevalence and outcomes of central CLABSI at our institution, to identify opportunities for improvement, appropriately direct efforts for infection reduction, and identify gaps in the CLABSI definition and its application as a quality measure.</p><p><strong>Design setting and participants: </strong>Retrospective cross-sectional study of patients identified to have a CLABSI in the period 2018-2022 cared for at the value-based purchasing (VBP) units of a 1200-bed tertiary care hospital located in Cleveland, OH. Each CLABSI episode was assessed for relationship with central venous catheter (CVC), suspected secondary source of BSI, mortality associated with the CLABSI hospital encounter, and availability of infectious disease physician or primary physician documentation of infectious source.</p><p><strong>Main outcomes and measures: </strong>CLABSI episodes were classified as CVC related, CVC unrelated, and CVC relationship unclear. Mortality during the same encounter as the CLABSI event was assessed as an outcome measure. Descriptive statistics were performed.</p><p><strong>Results: </strong>A total of 340 CLABSI episodes occurred in adult patients in VBP units. Majority of the CLABSI, 77.5% (266), occurred in the ICU. Of the CLABSI analyzed, 31.5% (107) were classified as unrelated to the CVC; 25.0% (85) had an unclear source; 43% (148) were classified as CVC related. For CVC-related cases, <i>Staphylococcus</i> and <i>Candida</i> were the predominant organisms. For the CVC unrelated and unclear groups <i>Enterococcus</i> was most prevalent. The mortality rate was lowest among patients classified with a CVC-related BSI. The positive predictive value (PPV) of the Centers for Disease Control and Prevention CLABSI definition to predict a true CVC-related infection was found to be 58.0%.</p><p><strong>Conclusions and relevance: </strong>The definition of CLABSI as a surrogate for catheter-related BSI is inadequate, with a PPV of 58.0% (43.1-67.6%). Efforts should be redirected toward revising the CLABSI definition and possibly reevaluating its criteria. Resources should be assigned to further investigate and systematically prevent BSIs from secondary sources while adhering to existing CLABSI prevention bundles.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 1","pages":"e1205"},"PeriodicalIF":0.0,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11741216/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018389","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}