Critical care explorations最新文献

{"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}

{"title":"Unmet Nonmedication Needs After Hospital Discharge and Adverse Outcomes Among Acute Respiratory Failure Survivors in Brazil: A Prospective Feasibility Study.","authors":"Sérgio R R Decker, Danielle do A Pereira, Gabriela S Rech, Rosa da R M Dos Santos, Denise de Souza, Raíne F De Carli, Geraldine Trott, Ana P de Souza, Janine Gonzaga, Lauren S Costa, Jonas M Wolf, Gregory S Medeiros, Bruna Conte, Laura C Madeira, Livia Biason, Maria D Rosa, Mariana F Mattioni, Isabela T Muller, Carolia Bayer, Odanor F T Filho, Marcelo Kern, Cassiano Teixeira, Harris L Carmichael, Victor D Dinglas, Samuel M Brown, Dale M Needham, Regis G Rosa","doi":"10.1097/CCE.0000000000001279","DOIUrl":"10.1097/CCE.0000000000001279","url":null,"abstract":"<p><strong>Importance: </strong>In-hospital survivorship for acute respiratory failure has improved, but unmet nonmedication healthcare needs may contribute to adverse events post-discharge.</p><p><strong>Objectives: </strong>To evaluate the feasibility of characterizing early unmet nonmedication discharge needs, classified as durable medical equipment (DME), home health services (HHS), and follow-up medical appointments (FUA) for acute respiratory failure survivors in Brazil. Secondary objectives include describing the profile of needs, unmet needs, and adverse outcomes post-discharge.</p><p><strong>Design: </strong>Prospective feasibility cohort study, with enrollment between October 2020 and March 2021.</p><p><strong>Setting: </strong>One tertiary teaching hospital from Southern Brazil with 76 ICU beds.</p><p><strong>Participants: </strong>Adult survivors from acute respiratory failure who were discharged home.</p><p><strong>Main outcomes and measures: </strong>Our primary outcome was the feasibility of measuring unmet nonmedication needs between 7 and 28 days post-discharge, considering greater than 80% of data completeness as feasible. Secondary outcomes included the characterization of needs and needs unmet per type at 1 month and the crude risk of all-cause death, hospital readmission, and urgent visits to the emergency department at 3 months post-discharge.</p><p><strong>Results: </strong>Of 337 patients screened, 72 were enrolled, and data on unmet nonmedication needs were collected from 66 patients, resulting in a primary feasibility outcome of 91.7%. The median age was 59 years, 38.9% were female, most were self-declared White, and were employed before admission. During the index admission, 87.3% were diagnosed with COVID-19, and 79.2% received invasive mechanical ventilation. The frequency of nonmedication discharge needs was 48 (72.7%) for DME, 54 (81.8%) for HHS, and 60 (90.9%) for FUA. At 1 month, 36 (58.1%) had at least one need unmet; at 3 months, 12 (19.0%) had at least one adverse outcome.</p><p><strong>Conclusions and relevance: </strong>Detailed measurement of nonmedication needs post-discharge for acute respiratory failure survivors in Brazil is feasible. Unmet nonmedication needs are a common problem to be addressed in this population.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 7","pages":"e1279"},"PeriodicalIF":0.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12245325/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144510016","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":"Surgical ICU Admission Criteria: A Scoping Review.","authors":"Kenneth L Abbott, Philip Hong, Matthew M Ruppert, Purvi P Patel, Philip A Efron, Natasha Keric, Lewis J Kaplan, Niels D Martin, Tyler J Loftus","doi":"10.1097/CCE.0000000000001278","DOIUrl":"10.1097/CCE.0000000000001278","url":null,"abstract":"<p><strong>Objectives: </strong>The aims of this scoping review were to: 1) explore factors driving surgical ICU (SICU) admission decisions, 2) provide an environmental scan of SICU admission practices, and 3) identify underexamined domains relevant for SICU triage, admission, and discharge inquiries.</p><p><strong>Data sources: </strong>Embase, PubMed, and Medline were queried from inception to April 18, 2024, for English-language peer-reviewed studies related to adult SICU admission criteria and decision-making; neonatal ICU, PICU, veterinary ICU, and military ICU data and gray literature were excluded. Studies were not limited by design.</p><p><strong>Study selection: </strong>Following duplicate removal, 363 of the initial 625 abstracts remained. After content screening, 54 abstracts remained topic aligned. Full-text review identified 44 articles appropriate for analysis.</p><p><strong>Data extraction: </strong>Abstracted data addressed SICU structure, function, findings, and potential future directions.</p><p><strong>Data synthesis: </strong>Most included studies (n = 23, 52%) focused on identifying risk factors for SICU admission or risk factors for the need for SICU admission, including demographics, comorbidities, and procedural specifics. Admission protocol evaluation studies were less common (n = 5, 11%), but offered promise in reducing unnecessary admissions using preoperative or postoperative interventions. Future inquiry domains included admission and discharge protocol development (n = 17, 39%), risk factors for ICU admission or the need for ICU admission (n = 16, 36%), multicenter studies (n = 16, 36%), additional or specific patient populations (n = 15, 34%), prospective studies (n = 14, 32%), costs (n = 6, 14%), and implementation of embedded clinical decision-support aids to inform SICU triage decision-making (n = 2, 5%). No included studies presented results regarding SICU discharge decision-making or ICU stress adaptations relevant during surge episodes.</p><p><strong>Conclusions: </strong>Research on SICU triage decision-making primarily focuses at admission risk factor discovery, with less emphasis on protocol evaluation and implementation practices. Future research should focus on refining existing SICU triage approaches that include discharge and surge-based decision-making coupled with deployable clinical decision-support aids.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 7","pages":"e1278"},"PeriodicalIF":0.0,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12190075/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144487449","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":"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":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12160739/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144287591","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 (<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":"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":"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":"144287588","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}