Critical care explorations最新文献

{"title":"Acute Respiratory Failure Survivors' Perspectives on Patient-Centered Communication: A Mixed Methods Study.","authors":"Diana C Bouhassira, Suratsawadee Kruahong, Martha Abshire Saylor, Ann M Parker, Megan M Hosey, Alison E Turnbull, Katie E Hauschildt","doi":"10.1097/CCE.0000000000001492","DOIUrl":"10.1097/CCE.0000000000001492","url":null,"abstract":"<p><strong>Importance: </strong>Many acute respiratory failure (ARF) survivors develop psychiatric sequelae. Inpatient psychologic distress is an important risk factor.</p><p><strong>Objectives: </strong>Evaluate ARF survivors' perspectives on patient-centered communication and its relationship to the inpatient psychologic experience.</p><p><strong>Design, setting, and participants: </strong>A mixed methods prospective observational study involving one survey and a semi-structured interview administered within 6 weeks of discharge to ARF survivors from two hospitals in the same system (August 2024 to December 2025). ARF was defined as greater than or equal to 24 hours of mechanical ventilation, high-flow nasal cannula, or noninvasive positive pressure ventilation. Fifty-six survivors were enrolled; 20 participated in interviews. Twenty-four survivors (43%) were male, 28 survivors (50%) were identified as Black or African American, 25 survivors (45%) were White, and three survivors (5%) were Hispanic. ARF was most commonly due to respiratory (50%), cardiovascular (23%), or gastrointestinal (7%) disease. Forty-three participants (77%) were mechanically ventilated.</p><p><strong>Analysis: </strong>Qualitative interviews were analyzed using grounded theory. Quantitative measures included the \"Heard and Understood\" (H&U) measure, the Hospital Anxiety and Depression Scale, the Impact of Events-6 Scale, a 0-100 visual analog scale measuring perceived health, and the EuroQol-5 dimension quality of life measure. Associations between H&U measure responses and mental health outcomes were tested using the Wilcoxon rank-sum and chi-square tests.</p><p><strong>Results: </strong>Patient-centered communication was characterized by meaningful interpersonal relationships, transparent and responsive communication, effective healthcare dynamics, and timely care. Communication perceived as patient-centered improved psychologic well-being, uncertainty tolerance, and engaged shared decision-making. Twenty-one of 56 (38%) participants felt \"completely\" H&U. Those who did had lower anxiety (4 [1-6] vs. 7 [5-10]; p < 0.01) and depression (6 [5-10] vs. 10 [7-13]; p = 0.02) scores, greater perceived health (80 [70-90] vs. 60 [43-78]; p < 0.01), and greater health-related quality of life (0.84 [0.62-0.94] vs. 0.55 [0.29-0.72]; p < 0.01).</p><p><strong>Conclusions: </strong>Patient-centered communication may improve psychologic well-being in ARF survivors while admitted and after discharge.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"8 10","pages":"e1492"},"PeriodicalIF":2.9,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13619236/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149076968","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":"Safety of Protocolized Motorized Verticalization in Critically Ill Patients With Impaired Consciousness and Invasive Devices, Including External Ventricular Drains.","authors":"Tarek Dakakni, Leslie D Roebuck","doi":"10.1097/CCE.0000000000001491","DOIUrl":"10.1097/CCE.0000000000001491","url":null,"abstract":"<p><strong>Objectives: </strong>Critically ill patients with impaired consciousness and concurrent invasive devices remain understudied in ICU mobilization research. Motorized verticalization enables graded upright weight bearing without requiring active patient participation, but device safety in high-acuity neurocritical care populations is not well characterized. We evaluated the safety of a protocolized motorized verticalization program with invasive device dislodgement as the primary outcome.</p><p><strong>Design: </strong>Single-center retrospective cohort study.</p><p><strong>Setting: </strong>Neurocritical care unit at a Level 1 trauma and comprehensive stroke center.</p><p><strong>Patients: </strong>Adults receiving motorized verticalization therapy between October 1, 2024, and October 1, 2025, according to the institutional protocol.</p><p><strong>Interventions: </strong>Protocolized motorized verticalization therapy using a graded upright weight-bearing approach with the VitalGo Total Lift Bed, beginning at 10° and progressing incrementally based on physiologic tolerance. Sessions occurred three to four times daily with individualized duration and angle advancement. Angle intensity was categorized as low (< 30°), moderate (30°-45°), or high (> 45°).</p><p><strong>Measurements and main results: </strong>Thirty-three patients underwent 153 treatment sessions comprising 409 verticalization angle exposures. The cohort was high acuity (mean Glasgow Coma Scale 8 ± 3); 90.9% were intubated, 93.9% had central venous catheters (CVCs), and 36.4% had concurrent endotracheal tubes (ETTs), CVCs, and external ventricular drains (EVDs) . No device dislodgements occurred across any session or exposure, and no session termination due to ICP crisis or hemodynamic instability. Applying the rule-of-three statistical analysis, using angle exposures as the event opportunity denominator, the upper bound adverse event risk was less than 0.7% overall, less than 1.1% for moderate angles, and less than 2% for EVD-associated exposure. Most exposures (65.2%) occurred at moderate angles, totaling 14,443 minutes. A subset of EVD patients tolerated angles greater than 45°, including up to 75°.</p><p><strong>Conclusions: </strong>Protocolized motorized verticalization therapy was implemented without observed ETT, CVC, or EVD dislodgement in this high-acuity cohort. Findings support further multicenter evaluation of motorized verticalization effects on device safety, physiologic tolerance, neurologic recovery, and patient-centered outcomes.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"8 10","pages":"e1491"},"PeriodicalIF":2.9,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13619198/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149077001","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":"Stop Predicting, Start Testing: A Dynamic Approach for Using Dobutamine in Septic Shock.","authors":"Jihad Mallat, Gustavo Adolfo Ospina-Tascón","doi":"10.1097/CCE.0000000000001488","DOIUrl":"10.1097/CCE.0000000000001488","url":null,"abstract":"","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"8 10","pages":"e1488"},"PeriodicalIF":2.9,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13619256/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149077015","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":"Erratum: Drug Clearance and Dosing During CytoSorb Hemoadsorption: A Systematic Review: Erratum.","authors":"Teresa Klaus, Patrick M Honoré, Gabriella Bottari, Silvia De Rosa, Detlef Kindgen-Milles, Antoine Schneider, Nandor Marczin, Harriet Adamson, Joerg Scheier, Efthymios N Deliargyris, Thomas D Nolin","doi":"10.1097/CCE.0000000000001470","DOIUrl":"10.1097/CCE.0000000000001470","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1097/CCE.0000000000001444.].</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"8 9","pages":"e1470"},"PeriodicalIF":2.9,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13585309/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148993059","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":"Vasopressor Use Among Adults With Sepsis in Uganda and Rwanda: A Multicenter Retrospective Cohort Study.","authors":"William S Girard, Farah Turkistani, Reagan Kakande, Victor Adejayan, Muhammad Zulfiqar, Michael Ndyomugabe, Phoebe Gruccio, Philemon Ojuman, Eva Otoupalova, Paulin R Banguti, Dennis Hopkinson, Jean Paul Mvukiyehe, Aamer Syed, Elisabeth Riviello, Edwin Nuwagira, Christopher C Moore","doi":"10.1097/CCE.0000000000001481","DOIUrl":"10.1097/CCE.0000000000001481","url":null,"abstract":"<p><strong>Objectives: </strong>Africa has the highest global sepsis burden. Yet, sepsis treatment guidelines, including those for vasopressor use, incorporate data from high-income settings. We aimed to determine patterns of vasopressor use among adults admitted to hospital with sepsis in East Africa.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>One hospital in Uganda and two hospitals in Rwanda.</p><p><strong>Patients: </strong>Adults admitted to hospital with sepsis, defined as suspected infection and greater than or equal to 2 quick Sequential Organ Failure Assessment criteria.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>We performed an analysis of pooled data from two retrospective studies of adults with sepsis admitted to hospital in Rwanda or Uganda. Of 471 septic patients analyzed, 263 (57%) were female, the median (interquartile) age was 51 years (36-65), 121 (26%) were living with HIV, 113 (24%) received a vasopressor, and death occurred in 139 patients (30%). In the univariable logistic regression analysis, higher respiratory rate and Universal Vital Assessment (UVA) scores; lower blood pressure, oxygen saturation, and Glasgow Coma Scale score at the time of sepsis diagnosis; presence of abdominal infection; and receiving a greater volume of IV fluids predicted receipt of a vasopressor. In the multivariable analysis, higher UVA mortality risk scores (adjusted odds ratio 1.25; 95% CI, 1.14-1.27; p < 0.001) predicted vasopressor receipt. We replicated these findings in exploratory machine learning analyses.</p><p><strong>Conclusions: </strong>In patients with sepsis in East Africa, UVA score and hospitalization in Uganda were predictive of vasopressor administration. Further research is required to address existing knowledge gaps in the role, timing, and indications for vasopressors in sepsis management in Africa.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"8 9","pages":"e1481"},"PeriodicalIF":2.9,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13574389/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148946416","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":"Diagnostic Uncertainty and Antibiotic Timing in Sepsis: Observational Validation of a Dual-Axis Decision Model.","authors":"Danielle Currey, Jonathan Siff, Satya Sahoo, Yasir Tarabichi","doi":"10.1097/CCE.0000000000001472","DOIUrl":"10.1097/CCE.0000000000001472","url":null,"abstract":"<p><strong>Importance: </strong>Sepsis treatment requires balancing the benefits of timely antibiotic administration against the risks of over-treatment under diagnostic uncertainty. Although treatment urgency likely reflects both the probability of infection and physiologic severity, this joint structure has not previously been quantified using real-world clinical data.</p><p><strong>Objectives: </strong>To determine whether real-world antibiotic timing in the emergency department reflects a dual-axis pattern integrating probability of infection and physiologic severity.</p><p><strong>Design, setting, and participants: </strong>Retrospective observational cohort study using structured electronic health record data from adult emergency department encounters at a large urban safety-net health system from January 2019 through June 2025. A random forest model estimated the probability of sustained antibiotic treatment, P(treated infection), for suspected infection from early demographic, physiologic, and laboratory data, and physiologic severity was measured using the Modified Early Warning Score at 3 hours.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was time-to-antibiotics within 24 hours of presentation. The secondary outcome was a composite of ICU stay or in-hospital death among patients treated after 3 hours.</p><p><strong>Results: </strong>The study included 199,062 emergency department visits over 6.5 years. Of these, 83,910 visits were used for model development, and the remaining 115,152 emergency department encounters comprised a temporally held-out cohort used for model evaluation and downstream observational analyses. The P(treated infection) model demonstrated good discrimination (C-statistic, 0.86). Antibiotic timing followed a continuous gradient across jointly increasing P(treated infection) and physiologic severity, and restricted cubic spline regression confirmed significant contributions from both axes and their interaction (interaction, p = 0.0013). Among patients treated after 3 hours, antibiotic timing later-than-expected based on a patient's dual-axis position was associated with a higher rate of 3-day ICU stay or in-hospital death after adjustment for P(treated infection), physiologic severity, and their interaction (p < 0.001).</p><p><strong>Conclusions: </strong>Real-world antibiotic timing in suspected sepsis appears to reflect a dual-axis pattern consistent with clinicians integrating P(treated infection) and physiologic severity. Making this structure explicit may help identify unwarranted practice variation and inform future decision support strategies for timely treatment.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"8 9","pages":"e1472"},"PeriodicalIF":2.9,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13561231/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148922186","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":"Testing Transferability of a Mortality Risk Model for Interhospital Transfer Using Real-World Electronic Health Records: External Validation and Model Enhancement.","authors":"Rachel A Hadler, Sahithi Krishnaveni Lakamana, Tristan Moorman, Selen Bozkurt","doi":"10.1097/CCE.0000000000001442","DOIUrl":"10.1097/CCE.0000000000001442","url":null,"abstract":"<p><strong>Background: </strong>Mortality risk is often uncertain at the time of interhospital transfer (IHT).</p><p><strong>Objectives: </strong>We examined what happens when a published machine learning model for post-transfer mortality, SafeNET, is deployed in an independent health system with substantial data fragmentation and missingness and assessed the extent to which local model development can compensate for cross-system data limitations.</p><p><strong>Derivation cohort: </strong>SafeNET was evaluated from published specifications using its original 14-variable feature schema and applied without modification. Locally trained gradient-boosting models (Categorical Boosting [CatBoost], Light Gradient Boosting, Extreme Gradient Boosting) were developed using a stratified 70/30 train-test split with five-fold cross-validation, class weighting, and random under-sampling to address class imbalance (~1:27).</p><p><strong>Validation cohort: </strong>We included 14,728 adult patients (≥ 18 yr) undergoing IHT at a multihospital academic health system from January 1, 2023, to December 31, 2023. Functional status variables were missing in 85% of encounters, limiting direct implementation of the original feature set.</p><p><strong>Prediction model: </strong>Discrimination, classification metrics (precision, recall, F1 score), and calibration (Brier score) were compared across SafeNET and locally trained models on the held-out test set.</p><p><strong>Results: </strong>SafeNET achieved performance that closely approximated its development-site results (area under the receiver operating characteristic curve [AUC-ROC], 0.87; F1, 0.73; 95% CI, 0.69-0.77), indicating strong external consistency. Locally trained CatBoost models outperformed SafeNET (AUC-ROC, 0.92; F1, 0.74; 95% CI, 0.72-0.78) and demonstrated improved calibration (Brier 0.04 vs. 0.055). Key variables, including functional status, were missing in 85% of encounters, limiting direct implementation of the original feature set. Although recall exceeded 0.70 across most models, precision remained below 080 for several configurations, indicating important trade-offs relevant to clinical deployment.</p><p><strong>Conclusions: </strong>SafeNET's performance was reproducible in an external health system, supporting its portability. However, local models trained on system-specific electronic health record patterns achieved markedly higher accuracy and calibration. Real-world replication revealed major data-availability barriers and highlighted the tension between acceptable recall and suboptimal precision in critical-care prognostic applications.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"8 9","pages":"e1442"},"PeriodicalIF":2.9,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13561170/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148922198","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":"Likelihood of Bacterial Infection in Immunocompromised Patients Treated With IV Antibiotics for Possible Sepsis: Erratum.","authors":"Simran Gupta, Lucia Millham, Laura DelloStritto, Anna A Agan, Cara McKenna, Chanu Rhee, Michael Klompas","doi":"10.1097/CCE.0000000000001485","DOIUrl":"https://doi.org/10.1097/CCE.0000000000001485","url":null,"abstract":"","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"8 9","pages":"e1485"},"PeriodicalIF":2.9,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148914867","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":"Erratum: Likelihood of Bacterial Infection in Immunocompromised Patients Treated With IV Antibiotics for Possible Sepsis: Erratum.","authors":"Simran Gupta, Lucia Millham, Laura DelloStritto, Anna A Agan, Cara McKenna, Chanu Rhee, Michael Klompas","doi":"10.1097/CCE.0000000000001485","DOIUrl":"10.1097/CCE.0000000000001485","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1097/CCE.0000000000001443.].</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"8 9","pages":"e1485"},"PeriodicalIF":2.9,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13557749/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148922174","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":"Building Clinical Artificial Intelligence at the PICU Bedside: Recognizing the Clinician-Builder.","authors":"David Gilad, Abraham Tsur, Reut Kassif Lerner","doi":"10.1097/CCE.0000000000001486","DOIUrl":"10.1097/CCE.0000000000001486","url":null,"abstract":"<p><p>Several of the highest-value problems in critical care-synthesizing fragmented bedside data, surfacing the tacit heuristics of experienced clinicians, generating accurate family-facing explanations, and decision support-are too specialized, too local, and too embedded in uncodified practice to specify from outside the unit; the market they represent is often too small to repay commercial development. This commentary argues for recognizing a missing translational figure: the clinician-builder-a frontline clinician who identifies workflow failures and prototypes tools to address them, much as the clinician-scientist did for molecular medicine. Because a prototype is not a product, the clinician-builder co-develops intended use, evidence, and governance with institutional artificial intelligence (AI) centers. Pediatric intensive care should not be the last setting to receive clinical AI, but among the first where it is judged-and a blueprint for other specialties.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"8 9","pages":"e1486"},"PeriodicalIF":2.9,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13557764/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148914859","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}