Critical care explorations最新文献

{"title":"Inflammatory Subphenotypes for Fluid Management in Acute Respiratory Distress Syndrome: A Subgroup-Level Signal, not an Individual Prescription.","authors":"Joris Pensier, Emmanuel Lorne","doi":"10.1097/CCE.0000000000001484","DOIUrl":"10.1097/CCE.0000000000001484","url":null,"abstract":"","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"8 9","pages":"e1484"},"PeriodicalIF":2.9,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13549657/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148908386","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":"Characterizing Cardiovascular Function In The Inflammatory Subphenotypes of Acute Respiratory Distress Syndrome.","authors":"Minesh Chotalia, Muzzammil Ali, Ravi Chotalia, Dhruv Parekh, Jaimin M Patel, Mansoor N Bangash","doi":"10.1097/CCE.0000000000001483","DOIUrl":"10.1097/CCE.0000000000001483","url":null,"abstract":"<p><strong>Objectives: </strong>To compare transthoracic echocardiography (TTE) and cardiovascular parameters in patients with hyper- and hypoinflammatory acute respiratory distress syndrome (ARDS), derived using a validated, artificial intelligence clinical classifier. To compare overlap between latent class analysis-derived cardiovascular subphenotypes and clinical classifier-derived inflammatory subphenotypes of ARDS.</p><p><strong>Design: </strong>Retrospective single-center cohort study.</p><p><strong>Setting: </strong>University Hospital ICU, Birmingham, United Kingdom.</p><p><strong>Patients: </strong>Intubated patients who received a transthoracic echocardiogram within 7 days of ARDS onset between April 2016 and December 2021.</p><p><strong>Measurements and main results: </strong>A total of 691 patients were included, age 61 years (interquartile range, 50-72 yr), 65% male, 41% 90-day mortality rate. A total of 30% (<i>n</i> = 207) were classified as hyperinflammatory and had higher mortality (64% vs. 31%; <i>p</i> < 0.0001) compared with the hypoinflammatory subgroup. Right ventricular (RV) size and function did not differ between hyper- and hypoinflammatory subphenotypes. Instead, the hyperinflammatory subgroup exhibited a hyperdynamic cardiovascular profile with higher left ventricular ejection fraction and cardiac output. Latent class analysis identified four cardiovascular subphenotypes; RV-related profiles were predominantly hypoinflammatory, whereas the hyperdynamic cardiovascular subtype was enriched in hyperinflammatory patients.</p><p><strong>Conclusions: </strong>Inflammatory and cardiovascular subphenotypes represent complementary but distinct axes of ARDS pathobiology. The hyperinflammatory subphenotype aligns with a hyperdynamic circulation, whereas RV dysfunction may be mechanistically independent.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"8 9","pages":"e1483"},"PeriodicalIF":2.9,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13549566/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148908399","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":"Cryptic and Overt Acute Kidney Injury Share Biomarker Characteristics in Pediatric Acute Respiratory Distress Syndrome.","authors":"Celeste G Dixon, Arthur M Lee, Julie C Fitzgerald, Nadir Yehya","doi":"10.1097/CCE.0000000000001482","DOIUrl":"10.1097/CCE.0000000000001482","url":null,"abstract":"<p><strong>Importance: </strong>Patients with acute respiratory distress syndrome (ARDS) are at risk for higher morbidity and mortality with concurrent acute kidney injury (AKI). AKI diagnosis relies on serum creatinine, which is confounded by fluid overload. Use of fluid overload-adjusted creatinine can diagnose AKI (termed Cryptic AKI) that would otherwise be missed by the traditional Kidney Disease Improving Global Outcomes (KDIGO) definition. It is unknown whether Cryptic AKI is biochemically distinct from patients without AKI.</p><p><strong>Objectives: </strong>Determine whether pediatric ARDS patients with Cryptic AKI have a biochemical profile that is similar or distinct from patients with KDIGO-defined AKI or no AKI.</p><p><strong>Design setting and participants: </strong>Observational study of 333 pediatric ARDS patients in a quaternary PICU.</p><p><strong>Main outcomes and measures: </strong>Mortality, length of stay, and ventilator-free days were measured for all patients. Biomarkers indicative of tissue damage and inflammation were measured on days 1, 3, and 7 of ARDS.</p><p><strong>Results: </strong>Cryptic AKI was associated with higher mortality and longer length of stay than no AKI, similar to KDIGO AKI. Biomarkers angiopoietin-2, pro-collagen III N-terminal peptide, heat shock protein 70, tumor necrosis factor receptor 1, and interleukin-8 were significantly higher in Cryptic and KDIGO AKI than in no AKI.</p><p><strong>Conclusions and relevance: </strong>Cryptic AKI is clinically significant and represents true kidney injury, with a biomarker profile similar to KDIGO AKI and distinct from patients without AKI.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"8 9","pages":"e1482"},"PeriodicalIF":2.9,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13549548/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148908428","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 Divergent Metabolomic Landscape of COVID-19 and Community-Acquired Pneumonia.","authors":"Vassiliki Rapti, Spyros Foutadakis, Nikolaos Kakavoulis, Lamprini Skorda, Evangelos J Giamarellos-Bourboulis, Garyfallia Poulakou","doi":"10.1097/CCE.0000000000001473","DOIUrl":"10.1097/CCE.0000000000001473","url":null,"abstract":"<p><strong>Objectives: </strong>To map and compare the serum metabolome of hospitalized patients with COVID-19 or community-acquired pneumonia (CAP).</p><p><strong>Design: </strong>Observational matched cohort study using an untargeted metabolomics approach.</p><p><strong>Setting: </strong>Serum samples were obtained at the time of hospital admission as part of two clinical trials conducted in hospitalized patients.</p><p><strong>Patients: </strong>A matched cohort design was applied, including patients with COVID-19 and CAP, matched according to age, sex, and Charlson Comorbidity Index. The patient samples were obtained from two clinical studies, namely the suPAR-guided Anakinra Treatment for Validation of the Risk and Management of Respiratory Failure by COVID-19 (SAVE) trial (ClinicalTrials.gov identifier: NCT04357366; European Union Drug Regulating Authorities (EudraCT) number: 2020-001466-11) and the A randomized clinical trial of oral Clarithromycin in Community-acquired pneumonia to attenuatE inflammatory responseS and improve outcomeS (ACCESS trial) (ClinicalTrials.gov identifier: NCT04724044; EudraCT number: 2020-004452-15). The total study population comprised 92 patients.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>A total of 3555 metabolites were detected, and differential analysis recovered more than 70% of the metabolome as altered between conditions. Metabolite pathway analysis highlighted pathways related to the citric acid cycle and arachidonic metabolism as activated in CAP, while COVID-19 was mainly driven by alterations in amino acid metabolism and metabolites related to mitochondrial function.</p><p><strong>Conclusions: </strong>Extensive divergence was observed in the metabolomic landscape of patients with COVID-19 or CAP, underscoring the disease-specific metabolic adaptations and providing potential targets for diagnostic and therapeutic development.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"8 9","pages":"e1473"},"PeriodicalIF":2.9,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13549596/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148901748","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":"Characteristics and Reported Practices of ICUs Participating in the Sedation, Analgesia and Delirium Management International Study: Variability in Site-Level Management of Mechanically Ventilated Patients.","authors":"Sangeeta Mehta, Sherihane Bensemmane, Kiyan Heybati, Nanki Ahluwalia, Michelle S Chew, Lisa Burry, Federico Carlos Carini, Giuseppe Citerio, Dylan deLange, Ib Jammer, Geert Meyfroidt, Jorge Salluh, Fabio Silvio Taccone, Bjorn Weiss, Lara Prisco","doi":"10.1097/CCE.0000000000001479","DOIUrl":"10.1097/CCE.0000000000001479","url":null,"abstract":"<p><strong>Objective: </strong>To describe site-level ICU organizational policies and implementation of pain, agitation, and delirium (PAD) best practices before the COVID-19 pandemic, and perceived changes during the pandemic.</p><p><strong>Design: </strong>International site-level questionnaire study.</p><p><strong>Setting: </strong>Participating sites completed a standardized electronic Case Report Form between January 5, 2022 and March 31, 2023.</p><p><strong>Patients/centers: </strong>Ninety-three ICUs caring for adult patients from 79 hospitals across 27 countries in North America, South America, and Europe.</p><p><strong>Interventions: </strong>Each ICU submitted data on site characteristics, staffing, implementation of PAD protocols and assessment tools prepandemic, and perceived changes during the COVID-19 pandemic. Descriptive statistics and multivariable logistic regressions were performed using R.</p><p><strong>Measurements and main results: </strong>Of 93 ICUs, 63% were university-affiliated, and 59% reported a closed physician staffing model. Most managed mixed patient populations (78%), with a nurse-to-patient ratio for ventilated patients of 1:2 (45%) or 1:1 (39%). Physiotherapists and pharmacists were available in 83% and 68% of ICUs, respectively. Over 75% reported routine use of validated PAD scales, most commonly Richmond Agitation Sedation Scale (86%), Confusion Assessment Method for ICU (59%), and Numeric Rating Scale (44%). Protocols were most available for spontaneous breathing trials (60%) and sedation (58%), followed by delirium (53%), mobilization (47%), and pain (46%). University affiliation and 1:1 nurse staffing was associated with reported use of delirium or mobilization protocols. The presence of a weaning protocol was associated with higher odds of daily sedation interruption (adjusted odds ratio [aOR] 3.80; 95% CI, 1.43-10.89; p = 0.009), and use of sedation protocols (aOR 5.95; 95% CI, 2.29-16.86; p < 0.001). Nearly one-half of ICUs reported drug shortages during the pandemic, and 62% prohibited any visitation.</p><p><strong>Conclusions: </strong>ICU organizational structures and reported PAD practices vary widely worldwide. Despite international guidelines, many ICUs lack consistent implementation of evidence-based sedation, analgesia, and delirium management strategies.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"8 9","pages":"e1479"},"PeriodicalIF":2.9,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13544736/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148893270","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":"When the Pathogen Shapes the Host: Metabolic Divergence in COVID-19 and Community-Acquired Pneumonia.","authors":"Narges Alipanah-Lechner","doi":"10.1097/CCE.0000000000001478","DOIUrl":"10.1097/CCE.0000000000001478","url":null,"abstract":"","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"8 9","pages":"e1478"},"PeriodicalIF":2.9,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13549631/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148901707","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":"Protein Quantification Platforms For Use In Critical Care Precision Medicine Trials: A Scoping Review.","authors":"Ross R McMullan, Donovan Campbell, Anna Rea, Chris McGrath, Rhian Dowding, Marry R Smit, Vittorio Scaravilli, Jonathan E Millar, Jun Kataoka, Leanne M C Hays, Bronagh Blackwood, Bronwen Connolly, Jonathan A Silversides, Daniel F McAuley, Kiran Reddy","doi":"10.1097/CCE.0000000000001477","DOIUrl":"10.1097/CCE.0000000000001477","url":null,"abstract":"<p><strong>Objectives: </strong>Among precision medicine approaches in critical care, protein biomarker quantification offers a timely and reproducible route to patient subtyping, but the landscape of automated platforms suitable for near-patient deployment remains unclear. This review aimed to identify available automated platforms for quantitative measurement of human protein biomarkers in blood, serum, or plasma, in order to support planning for precision medicine trials.</p><p><strong>Data sources: </strong>PubMed, Embase, and Espacenet were searched for eligible sources. Relevant company correspondence was also included where available.</p><p><strong>Study selection: </strong>Publication reports, patent reports, and company correspondence were eligible if they described commercially available platforms meeting a prespecified definition of automation for quantitative measurement of one or more human protein biomarkers in blood, serum, or plasma.</p><p><strong>Data extraction: </strong>Data were extracted on device model, manufacturer, and analytes measured. Eligible devices were extracted as separate device records, including multiple devices reported within a single source.</p><p><strong>Data synthesis: </strong>Overall, 228 sources were included, comprising 211 publication reports, 14 patent reports, and three company correspondence reports. Publications contributed 256 publication-derived device records representing 74 distinct automated device models from 34 manufacturers. The most frequently represented devices were Ella (n = 48), LUMIPULSE G1200 (n = 25), LUMIPULSE G600II (n = 17), cobas e 411 (n = 13), and Simoa HD-X (n = 12). Multiplex capability was identified for eight devices in included publications, with two additional multiplex-capable platforms identified through company correspondence. Across publication-derived device records, inflammatory and neurologic biomarkers predominated. The most frequently reported inflammatory biomarkers were procalcitonin (n = 36), interleukin (IL)-6 (n = 35), tumor necrosis factor (TNF)-α (n = 22), and IL-10 (n = 14). The most frequently reported neurologic biomarkers were neurofilament light chain (n = 34), p-tau217 (n = 31), Aβ42 (n = 29), Aβ40 (n = 27), and p-tau181 (n = 27).</p><p><strong>Conclusions: </strong>Automated platforms for quantitative protein biomarker measurement span numerous devices and manufacturers, but multiplex capability remains limited. More standardized device-level reporting would strengthen platform selection for biomarker-enabled trials and future clinical implementation.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"8 9","pages":"e1477"},"PeriodicalIF":2.9,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13544706/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892706","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":"Cardiac Dysfunction in Blunt Traumatic Brain Injury Patients.","authors":"Harry Kuperstein, Sam Tierney, Shabnam Parsa, Yoli Meydan, Benjamin Krauss, Ambika Mukhi, Jeffrey Stahl, Daniel Rutigliano, James Vosswinkel, Sahar Ahmad, Randeep Jawa","doi":"10.1097/CCE.0000000000001480","DOIUrl":"10.1097/CCE.0000000000001480","url":null,"abstract":"<p><strong>Importance: </strong>Cardiac dysfunction following blunt traumatic brain injury (TBI) has been commonly defined as new decreased ejection fraction (EF) or new regional wall motion abnormalities (RWMAs).</p><p><strong>Objectives: </strong>We assessed cardiac dysfunction after blunt TBI by echocardiographic signatures, association with intracranial abnormalities, and clinical findings.</p><p><strong>Design, setting, and participants: </strong>Retrospective cohort study of adult blunt TBI patients hospitalized at an American College of Surgeons verified Level 1 Trauma Center during 2022-2023 who underwent echocardiography (echo) within 48 hours of admission. Patients with preexisting cardiac comorbidities were excluded.</p><p><strong>Main outcomes and measures: </strong>The trauma registry at a Level 1 Trauma Center and corresponding electronic medical record were reviewed for TBI patients. Echo reports were evaluated for cardiac dysfunction as measured by EF, RWMAs, and fractional shortening (FS). FS is a simple M-mode measure predictive of systolic function defined as the percentage change in left ventricular diameter between the end of diastole and systole.</p><p><strong>Results: </strong>Of 105 blunt TBI patients meeting inclusion criteria, 81 had normal FS, 23 patients had decreased FS below 30%, and 1 had increased FS on echo. All 81 patients with normal FS had preserved EF, but 19 of 23 (83%) patients with decreased FS also had preserved EF. Patients with decreased FS had increased ICU length of stay, inpatient mortality, and craniotomy/craniectomy rates. Subarachnoid hemorrhage was the most frequent intracranial abnormality in patients with decreased FS.</p><p><strong>Conclusions and relevance: </strong>FS was depressed in a subset of TBI patients with above adverse in-hospital outcomes. Our data suggest FS below 30% may be a useful echocardiographic parameter associated with clinically significant cardiac dysfunction in blunt TBI patients.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"8 9","pages":"e1480"},"PeriodicalIF":2.9,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13544710/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148893254","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":"Beyond Biochemical Clearance: Linking Immunosuppressive Bile-Acid Removal to Host Defense and Clinical Outcomes in Severe Liver Failure.","authors":"Chetan R Kalal, Piyush Gupta","doi":"10.1097/CCE.0000000000001475","DOIUrl":"10.1097/CCE.0000000000001475","url":null,"abstract":"","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"8 9","pages":"e1475"},"PeriodicalIF":2.9,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13529109/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148852065","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":"Beyond Biochemical Clearance: Linking Immunosuppressive Bile-Acid Removal to Host Defense and Clinical Outcomes in Severe Liver Failure.","authors":"Chetan R Kalal, Piyush Gupta","doi":"10.1097/CCE.0000000000001475","DOIUrl":"https://doi.org/10.1097/CCE.0000000000001475","url":null,"abstract":"","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"8 9","pages":"e1475"},"PeriodicalIF":2.9,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13529109/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868552","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}