Critical care explorations最新文献

{"title":"Early Risk Stratification of Patients After Successfully Resuscitated Out-of-Hospital Cardiac Arrest Without ST-Segment Elevation-The Angiography After Out-of-Hospital Cardiac Arrest Without ST-Segment Elevation (TOMAHAWK) Risk Score.","authors":"Tharusan Thevathasan, Eva Spoormans, Ibrahim Akin, Georg Fuernau, Ulrich Tebbe, Karl Georg Haeusler, Michael Oeff, Christian Hassager, Stephan Fichtlscherer, Uwe Zeymer, Janine Pöss, Michelle Roßberg, Mohamed Abdel-Wahab, Alexander Jobs, Suzanne de Waha, Jorrit Lemkes, Holger Thiele, Carsten Skurk, Anne Freund, Steffen Desch","doi":"10.1097/CCE.0000000000001221","DOIUrl":"10.1097/CCE.0000000000001221","url":null,"abstract":"<p><strong>Objectives: </strong>Existing scores for risk stratification after out-of-hospital cardiac arrest (OHCA) are either medically outdated, limited to registry data, small cohorts, and certain healthcare systems only, or include rather complex calculations. The objective of this study was to develop an easy-to-use risk prediction score for short-term mortality in patients with successfully resuscitated OHCA without ST-segment elevation on the post-resuscitation electrocardiogram, derived from the Angiography after Out-of-Hospital Cardiac Arrest without ST-Segment Elevation (TOMAHAWK) trial. The risk score was externally validated in the Coronary Angiography after Cardiac Arrest Trial (COACT) cohort (shockable arrest rhythms only) and additional hospitals from Berlin, Germany (shockable and nonshockable arrest rhythms).</p><p><strong>Design: </strong>Predefined subanalysis of the TOMAHAWK trial.</p><p><strong>Setting: </strong>Development and external validation across 52 centers in three countries.</p><p><strong>Patients: </strong>Adult patients with successfully resuscitated OHCA and no ST-segment elevations.</p><p><strong>Interventions: </strong>Utilization of the TOMAHAWK risk score upon hospital admission.</p><p><strong>Measurements and main results: </strong>The risk score was developed using a backward stepwise regression analysis. Between one and four points were attributed to each variable in the risk score, resulting in a score with three risk categories for 30-day mortality: low (0-2), intermediate (3-6), and high (7-10). Five variables emerged as independent predictors for 30-day mortality and were used as risk score parameters: age of 72 years old or older, known diabetes, unshockable initial electrocardiogram rhythm, time until return of spontaneous circulation greater than or equal to 23 minutes, and admission arterial lactate level greater than or equal to 8 mmol/L. The 30-day mortality rates for each risk category were 23.6%, 68.8%, and 86.2%, respectively (p < 0.001) with a good discrimination at an area under the curve of 0.82. External validation in the COACT and Berlin cohorts showed short-term mortality rates of 23.1% and 20.4% (score 0-2), 44.8% and 48.1% (score 3-6), and 78.9% and 73.3% (score 7-10), respectively (each p < 0.001).</p><p><strong>Conclusions: </strong>The TOMAHAWK risk score can be easily calculated in daily clinical practice and strongly correlated with mortality in patients with successfully resuscitated OHCA without ST-segment elevation on post-resuscitation electrocardiogram.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 3","pages":"e1221"},"PeriodicalIF":0.0,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11884833/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143560415","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":"Otoacoustic Emissions Testing to Identify Hearing Loss in the ICU: A Feasibility Study.","authors":"Ramya Kaushik, Nicholas Reed, Lauren E Ferrante","doi":"10.1097/CCE.0000000000001223","DOIUrl":"10.1097/CCE.0000000000001223","url":null,"abstract":"<p><strong>Objectives: </strong>Hearing impairment is associated with delirium among ICU patients and a lack of functional recovery among older ICU survivors. We assessed the feasibility of using otoacoustic emissions (OAEs) testing to screen for preexisting hearing loss in the ICU.</p><p><strong>Design: </strong>Pilot study.</p><p><strong>Setting: </strong>Medical ICU at a tertiary medical center.</p><p><strong>Patients: </strong>All adults (age ≥ 18) and admitted to the medical ICU between November 29, 2021, and December 03, 2021, were eligible for the study.</p><p><strong>Interventions: </strong>OAE is a noninvasive, nonparticipatory tool that is used to screen for hearing loss by detecting intracochlear motion in response to auditory stimulation. The presence or absence of OAE was tested at six frequencies (1 k, 1.5 k, 2 k, 3 k, 4 k hertz).</p><p><strong>Measurements and main results: </strong>The primary outcome of feasibility was defined a priori as completion of greater than or equal to 70% of attempted tests. Average time of test completion and barriers or facilitators were also measured as outcomes. A patient passed OAE testing if at least two of six frequencies were detected in at least one ear, suggesting they did not have moderate or severe hearing impairment (that would require an amplifier). Data were also gathered on demographics, delirium, ventilation, sedation, illness severity, and ambient noise. Of 31 patients approached, 23 (74.2%) underwent testing. Eight patients (25.8%) were unable to be tested, most commonly due to elevated ambient noise. Among the 18 patients with complete data, six patients screened positive for hearing loss. The average time for OAE test completion per ear was 152.6 seconds (sd = 97.6 s).</p><p><strong>Conclusions: </strong>OAE testing is a feasible method to screen for hearing loss in the ICU, including in nonparticipatory patients. Identification of hearing loss would facilitate improved communication through interventions such as amplifiers and accommodations. Future studies should evaluate whether identification and treatment of hearing loss in the ICU may reduce delirium and improve post-ICU recovery.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 3","pages":"e1223"},"PeriodicalIF":0.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11878990/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544855","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":"Mechanical Power in Pressure-Controlled Ventilation: A Simple and Reliable Bedside Method.","authors":"Jacob W M Snoep, Petra J Rietveld, Franciska van der Velde-Quist, Evert de Jonge, Abraham Schoe","doi":"10.1097/CCE.0000000000001224","DOIUrl":"10.1097/CCE.0000000000001224","url":null,"abstract":"<p><strong>Background: </strong>Mechanical power (MP) represents the amount of energy applied by the ventilator to the respiratory system over time. There are two main methods to calculate MP in mechanical ventilation. The first is the geometric method, which directly measures the dynamic inspiratory area of the pressure-volume loop during the respiratory cycle. The second involves using various algebraic equations to estimate MP. However, almost all calculations are either complex or not reliable compared with the geometric method, considered the gold standard. This study aimed to develop an easy to use, reliable equation for bedside calculation of MP and to compare its accuracy with other existing equations for calculating MP.</p><p><strong>Methods: </strong>In a preliminary study, we measured MP in 56 cases who were mechanically ventilated and without spontaneous breathing efforts. The measurements were done at the ICU of a single university medical center in the Netherlands.</p><p><strong>Results: </strong>We found that the MP can be accurately calculated using an equation that incorporates the plateau pressure in 56 cases in 42 patients. The MP estimated with our new proposed equation (MP calculated using plateau pressure) correlated well with the reference value of MP with a bias of 0.2 J/min. The 95% limits of agreement (LoAs) were -3.1 to + 3.4 J/min. Other equations give the following bias and LoAs; bias of -0.8, LoA -3.8 to 1.9 J/min (van der Meijden equation), bias of -1.9, LoA -3.7 to -0.0 J/min (comprehensive Becher equation), bias of -2.4, LoA -4.5 to -0.3 J/min (simplified Becher equation), and a bias of -1.9, LoA -3.7 to 0.1 J/min (linear model equation).</p><p><strong>Conclusions: </strong>The equation we propose to calculate MP in pressure-controlled ventilation is a reliable, simple, and accurate alternative for the previously published equations. Consequently, this method is highly suitable for routine use in clinical practice.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 3","pages":"e1224"},"PeriodicalIF":0.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11878992/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544854","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":"Exploring the Extent and Depth of Clinical Education on Sepsis SEP-1 Core Measure and the Reported Impact on Outcomes and Compliance rate: A Scoping Review.","authors":"Alexis J Wells, Alysha Sapp, Danielle K Walker, Kathy A Baker","doi":"10.1097/CCE.0000000000001215","DOIUrl":"10.1097/CCE.0000000000001215","url":null,"abstract":"<p><strong>Objectives: </strong>This scoping review aimed to understand the extent and depth of education provided on the severe sepsis and septic shock management bundle quality measure (SEP-1) to frontline clinicians to elicit insight regarding the impact on patient outcomes, the compliance rate, and any efforts to alleviate concerns about clinical judgment challenges with SEP-1.</p><p><strong>Data sources: </strong>Seven databases were used: ProQuest, EBSCO Host, Embase, Web of Science, PubMed, MEDLINE, and CINAHL for studies published in 2015 and later using key terms related to sepsis and SEP-1 quality measure.</p><p><strong>Study selection: </strong>Two independent reviewers selected studies that mentioned the Centers for Medicare and Medicaid Services SEP-1 and included education to frontline clinicians on the quality measure as one of the interventions.</p><p><strong>Data extraction: </strong>Data extraction included study design, publication type, what was educated to frontline clinicians, Bennet and Bennet's \"depth of knowledge\" through education provided, and any mention of patient outcomes and change in SEP-1 compliance rate from the study.</p><p><strong>Data synthesis: </strong>The initial search yielded 493 articles. After screening for eligibility criteria, 20 studies were ultimately included. When evaluating what details of SEP-1 are being educated, 95% (19/20) of the studies focused on how to identify sepsis as well as the bundle elements required to pass the measure (19/20); however, the deeper details of the measure that allow clinical judgment and still pass the measure are severely lacking.</p><p><strong>Conclusions: </strong>Multiple education opportunities not currently addressed in the literature may lead to improvement of the national SEP-1 compliance rate and alleviate clinician concern that the quality measure does not allow for clinical judgment. Without deeper education, this knowledge gap could be a key factor in why the quality measure national compliance rate has halted, raising calls to retire the measure prematurely.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 3","pages":"e1215"},"PeriodicalIF":0.0,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11875573/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143528093","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":"Blood Transfusion Practices in Intensive Care: A Prospective Observational Binational Study.","authors":"Andrew W J Flint, Alexis Poole, Senta Jorinde Raasveld, Michael Bailey, Karina Brady, Pin-Yen Chen, Yan Chen, D Jamie Cooper, Craig French, Alisa Higgins, Adam H Irving, Richard E McAllister, Ary Serpa Neto, Tony Trapani, Neil Waters, James Winearls, Michael C Reade, Erica M Wood, Alexander P J Vlaar, Zoe K McQuilten","doi":"10.1097/CCE.0000000000001197","DOIUrl":"10.1097/CCE.0000000000001197","url":null,"abstract":"<p><strong>Importance: </strong>Blood transfusions are a common and potentially lifesaving intervention in ICU patients but are associated with harm and often transfused inconsistently with guidelines. However, it is not well known how ICU transfusion practice has recently changed and if there is variation in transfusion practice.</p><p><strong>Objectives: </strong>To describe blood transfusion practices in ICU, the variation in practice across sites, and to compare transfusion practices against national guidelines and with prior published practice.</p><p><strong>Design, setting, and participants: </strong>A prospective, multicenter, binational, observational study conducted in 40 Australian and New Zealand ICUs from October 2021 to July 2022. All adult (≥ 18 yr) ICU patients admitted over 1 week were included and followed until ICU discharge or 28 days.</p><p><strong>Main outcomes and measures: </strong>Types of transfusion, thresholds and reasons for transfusions, the use of viscoelastic hemostatic assays (VHAs), variation in transfusion practice across sites, and changes in transfusion practice over time.</p><p><strong>Results: </strong>Of 927 patients, 217 (23.4%) received a blood transfusion during their ICU admission-192 (20.7%) received RBCs, 63 (6.8%) received platelets, 49 (5.3%) received fresh frozen plasma (FFP), and 29 (3.1%) received cryoprecipitate. Massive transfusion protocols were implemented nine times for six patients (0.7%). VHA were used in 25 of 268 (9.3%) non-RBC transfusions. Compared with national guidelines, 89.0% of RBC transfusions, 30.3% of platelet, 27.4% of FFP, and 20.0% of cryoprecipitate transfusions were consistent. Compared with ICU transfusion practices in 2008, after adjusting for confounding variables, ICU patients who received RBC and FFP were transfused more units each, and variation in total transfusions across sites increased for RBC, platelets, and FFP.</p><p><strong>Conclusions and relevance: </strong>Blood transfusions are common in ICU, but the practice is heterogeneous and frequently inconsistent with national guidelines, and the number of units transfused per patient has increased. More evidence is required.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 3","pages":"e1197"},"PeriodicalIF":0.0,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11845186/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143470272","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":"Variation in Corticosteroid Prescribing Practices for Patients With Septic Shock.","authors":"Kanupriya Soni, John S Minturn, Billie S Davis, Leigh A Bukowski, Jeremy M Kahn, Ian J Barbash","doi":"10.1097/CCE.0000000000001196","DOIUrl":"10.1097/CCE.0000000000001196","url":null,"abstract":"<p><strong>Objectives: </strong>Understanding sources of variation in acute care delivery may inform targeted strategies to promote evidence-uptake. We sought to characterize physician-level and ICU-level variation in corticosteroid prescribing for patients with septic shock.</p><p><strong>Design: </strong>We performed a retrospective cohort study using the electronic health record of a multihospital health system. We identified ICU patients with septic shock admitted between 2018 and 2020. Using medication administration data, we determined which patients received corticosteroids within 2 days of vasopressor initiation. We linked each patient to their attending physician of record using digital signatures from clinical documentation. We then fit a hierarchical mixed-effects logistic regression model to identify factors associated with corticosteroid use and quantify variation in corticosteroid administration across physicians and ICUs.</p><p><strong>Setting: </strong>Twenty-six ICUs across nine hospitals in the United States.</p><p><strong>Patients: </strong>ICU patients with septic shock.</p><p><strong>Measurements and main results: </strong>Of 5322 patients with vasopressor dependent septic shock, 1294 (24.3%) were treated with corticosteroids within 2 days of vasopressor initiation. We linked these patients to 174 unique attending physicians across 26 ICUs. At the ICU-level, median corticosteroid use was 21.8% (interquartile range [IQR], 18.5-25.7%). At the physician-level, median corticosteroid use was 22.0% (IQR, 11.9-32.7%). In the mixed-effects regression controlling for patient and physician characteristics, 16.5% of the variation in corticosteroid administration was attributable to the ICUs and 10.1% was attributable to the physicians.</p><p><strong>Conclusions: </strong>Both ICUs and physicians contribute to observed variation in the use of corticosteroids for vasopressor dependent septic shock. These findings underscore the need for multilevel interventions to standardize evidence-based practices in critical care.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 3","pages":"e1196"},"PeriodicalIF":0.0,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11845208/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143470273","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 Association Between Selective Serotonin Reuptake Inhibitors and the Incidence of Delirium in Critically Ill Patients: A Systematic Review.","authors":"Hailey Schwab, Benjamin Sines, Elizabeth Moreton, Ben Julian Palanca, C Adrian Austin","doi":"10.1097/CCE.0000000000001217","DOIUrl":"10.1097/CCE.0000000000001217","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate the: 1) correlation between the maintenance or cessation of selective serotonin reuptake inhibitors (SSRIs) during hospitalization and the incidence of delirium among critically ill patients; 2) evaluate the effectiveness of utilizing SSRIs as a potential intervention for managing delirium in critically ill adults; and 3) evaluate the effects of continuing SSRIs in patients who were previously prescribed these medications on incidence of delirium or withdrawal symptoms manifesting as delirium.</p><p><strong>Data sources: </strong>PubMed, Scopus, Embase, PsycInfo, and ProQuest Central, and additional studies identified from reference lists and relevant systematic reviews.</p><p><strong>Study selection: </strong>Studies included adults 18 years old and older with critical illness necessitating ICU care administered SSRIs during their hospital stay, where delirium and/or adverse effects were reported as outcomes.</p><p><strong>Data extraction: </strong>Two team members extracted data from included studies into evidence tables, which were subsequently discussed to synthesize and align the extracted findings. Extraction criteria included study population and the type of control or comparison group, exposures, primary and secondary outcome measures, results, and implications. We used Study Quality Assessment Tools provided by the National Heart, Lung, and Blood Institute and National Institutes of Health public websites along with the TREND checklist to evaluate the quality of articles and analyze for bias.</p><p><strong>Data synthesis: </strong>Two reviewers analyzed the studies' risk for bias. Analysis followed the Grading of Recommendations Assessment, Development, and Evaluation criteria used in Cochrane systematic reviews. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist to design and report the study.</p><p><strong>Conclusions: </strong>The cessation of SSRIs in patients who were previously prescribed these medications is associated with an increased incidence of delirium or withdrawal symptoms manifesting as delirium. Continuing these medications in the setting of critical illness may mitigate the risk of delirium. Further investigation is warranted into the impact of SSRIs on delirium in patients not taking these medications prior to ICU admission.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 2","pages":"e1217"},"PeriodicalIF":0.0,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11838155/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143443016","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 Performance and Impact on Antimicrobial Treatment of a Multiplex Polymerase Chain Reaction in Critically Ill Patients With Pneumonia: A Multicenter Observational Study (The MORICUP-PCR Study: Morocco ICU Pneumonia-PCR study).","authors":"Younes Aissaoui, Ali Derkaoui, Abdelhamid Hachimi, Ayoub Bouchama, Tarek Dendane, Mouhssine Doumiri, Karim ElAidaoui, Amra Ziadi, Meryem Essafti, Latifa Oualili, Mehdi Khaddouri, Oumaima Mroune, Mehdi Oudrhiri Safiani, Mohammed Khallouki, Adnane Berdai, Brahim Boukatta, Ahmed Rhassane El Adib, Naoufel Madani, Nabila Soraa, Ayoub Belhadj, Jamal Eddine Kohen, Redouane Abouqal","doi":"10.1097/CCE.0000000000001220","DOIUrl":"10.1097/CCE.0000000000001220","url":null,"abstract":"<p><strong>Objectives: </strong>Managing severe pneumonia remains a challenge. Rapid diagnostic tests, such as multiplex polymerase chain reaction (mPCR), facilitate quick microorganism identification and may enable timely and appropriate antimicrobial therapy. However, studies from low-income countries are scarce. This study aimed to evaluate the diagnostic characteristics of mPCR and its impact on antibiotic therapy and outcomes in critically ill patients with pneumonia.</p><p><strong>Design: </strong>Multicenter observational study.</p><p><strong>Setting: </strong>Twelve ICUs across Morocco.</p><p><strong>Patients: </strong>Adult patients with pneumonia requiring invasive mechanical ventilation, including community-acquired pneumonia (CAP), hospital-acquired pneumonia (HAP), and ventilator-associated pneumonia (VAP).</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Respiratory samples were analyzed using both mPCR and conventional microbiological methods. The diagnostic performance of mPCR was evaluated, including its sensitivity and specificity. Additionally, the appropriateness of mPCR-induced modifications in empiric antibiotic therapy and their impact on patient outcomes were assessed. A total of 210 patients were included, with a median age of 50 years (range, 33-67 yr), of whom 66.2% were male. Pneumonia types were distributed as 30% CAP, 58% VAP, and 12% HAP. mPCR demonstrated a sensitivity of 96.9% (95% CI, 92.3-99.2%) and a specificity of 92% (95% CI, 91-93%). Following mPCR, antibiotic therapy modifications were observed in 58% of patients (n = 122), including de-escalation or cessation in 11% (n = 23), escalation in 26.5% (n = 56), adequacy adjustments in 7.5% (n = 16), and initiation of antibiotics in 13% (n = 27). The appropriateness of antibiotic therapy increased significantly from 38.7% (n = 83) to 67% (n = 141; difference, 27.5%; 95% CI, 18.3-36.7; p < 0.0001). Generalized mixed model analysis revealed that appropriate post-mPCR antibiotic therapy was associated with reduced mortality (adjusted odds ratio, 0.37; 95% CI, 0.15-0.93; p = 0.038).</p><p><strong>Conclusions: </strong>Our findings suggest that the use of mPCR is associated with a significant improvement in the appropriateness of empiric antibiotic therapy and is also associated with a positive impact on the outcome of patients with pneumonia.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 2","pages":"e1220"},"PeriodicalIF":0.0,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11826045/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143401033","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 Causative Pathogens With Acute Kidney Injury in Adult Patients With Community-Onset Sepsis.","authors":"Praruj Pant, Shingo Chihara, Vijay Krishnamoorthy, Miriam M Treggiari, Julia A Messina, Jamie R Privratsky, Karthik Raghunathan, Tetsu Ohnuma","doi":"10.1097/CCE.0000000000001219","DOIUrl":"10.1097/CCE.0000000000001219","url":null,"abstract":"<p><strong>Importance: </strong>The influence of disease-causing pathogen on acute kidney injury (AKI) in septic patients is poorly understood.</p><p><strong>Objectives: </strong>We examined the association of microbial pathogen with AKI among patients with community-onset sepsis.</p><p><strong>Design, setting, and participants: </strong>This was a retrospective cohort study. Patient data were acquired from the nationwide multicenter PINC AI Healthcare Database (2016-2020). Participants included adult patients with Centers for Disease Control and Prevention-defined community-onset sepsis.</p><p><strong>Main outcomes and measures: </strong>The primary exposure was pathogen type identified by culture growth. Microbial cultures from any site were included. The primary endpoint was development of AKI within 7 days of admission using the Kidney Disease: Improving Global Outcomes serum creatinine criteria. We used multilevel logistic regression to examine the association between pathogen type and AKI. Escherichia coli-positive cultures were used as the reference category.</p><p><strong>Results: </strong>We included 119,733 patients with community-onset sepsis. The median age was 67 years, 33.3% were mechanically ventilated, 36.1% received vasopressors, and hospital mortality was 13.1%. Forty-two thousand twenty-seven patients (35.1%) developed stage 1 AKI, 22,979 (19.2%) developed stage 2 AKI, and 25,073 (20.9%) developed stage 3 AKI. Relative to patients with E. coli infection (odds ratio [OR], 1.0), Proteus species (OR, 1.26; 95% CI, 1.06-1.50), and Streptococcus species (OR, 1.24; 95% CI, 1.10-1.41) were associated with increased odds of AKI. Meanwhile, Pseudomonas aeruginosa (OR, 0.56; 95% CI, 0.49-0.64) and Serratia species (OR, 0.70; 95% CI, 0.52-0.94) were associated with decreased odds of AKI.</p><p><strong>Conclusions and relevance: </strong>The causative pathogen in patients with sepsis may influence the development of AKI. Further mechanistic and clinical research is needed to confirm these findings and to explore how different pathogens may affect AKI risk in critically ill patients.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 2","pages":"e1219"},"PeriodicalIF":0.0,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11826047/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143401020","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 Single-Prong Cannula Design With High Velocity Therapy: Comparable Efficacy at Lower Gas Flow Rates.","authors":"Charles Atwood, Jigme Sethi, Amy Bergeski, George C Dungan, Leonithas I Volakis, Jessica S Whittle","doi":"10.1097/CCE.0000000000001209","DOIUrl":"10.1097/CCE.0000000000001209","url":null,"abstract":"<p><strong>Objectives: </strong>High velocity therapy (HVT), a form of high-flow oxygen therapy, utilizing a small-bore nasal cannula has been widely used in acute care settings. A new dual-prong (newDP) cannula made using more comfortable material and a single-prong (SP) cannula were evaluated to compare comfort and functionality as measured by relief of dyspnea of patients with chronic obstructive pulmonary disease (COPD) receiving HVT therapy.</p><p><strong>Design: </strong>Randomized crossover evaluation.</p><p><strong>Setting: </strong>Outpatient and in patient critical care setting.</p><p><strong>Patients: </strong>Patients with hypercapnic COPD presenting with dyspnea above baseline.</p><p><strong>Interventions: </strong>HVT therapy was provided using an existing HVT dual-prong nasal cannula (traditional) to determine the most efficacious flow rate. Patients were then randomized to receive either the newDP cannula, or the SP cannula, and retitrated for optimal flow rate. During each session of therapy, Rated Perceived Dyspnea (RPD) scores, vital signs, transcutaneous carbon dioxide partial pressure (PTCco2) levels, and clinician/ patient perceptions were documented.</p><p><strong>Measurements and main results: </strong>Of 31 enrolled, 26 patients completed the trial. The median flow rate that relieved dyspnea for the traditional, newDP, and SP cannulas were 25 L/min (20-30 L/min), 25 L/min (19.1-30 L/min), and 15 L/min (13-17 L/min), respectively. The change in RPD from baseline for traditional, newDP, and SP were -1 (-1 to 0), -1 (-2 to -1), and -1 (-2 to -1). Change in RPD from baseline for newDP and SP compared with the traditional cannula was significantly different (p = 0.044 and p = 0.01, respectively). Changes in vital signs and PTCco2 were similar between the three cannula types compared with baseline. The SP cannula provided comparable therapeutic efficacy at significantly lower flow rates (traditional vs. SP; p < 0.0001 and newDP vs. SP; p < 0.0001).</p><p><strong>Conclusions: </strong>The new cannula designs provided comparable relief of dyspnea. The single-prong cannula provided comparable efficacy at significantly lower flow rates (traditional vs. SP; p < 0.0001 and newDP vs. SP; p < 0.0001). The use of a single-prong cannula with HVT warrants further study.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 2","pages":"e1209"},"PeriodicalIF":0.0,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11826042/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143401036","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}