Critical care explorations最新文献

{"title":"Mechanical Power Is Associated With Mortality in Pressure-Controlled Ventilated Patients: A Dutch, Single-Center Cohort Study.","authors":"Jamilla Goedegebuur, Floor E Smits, Jacob W M Snoep, Petra J Rietveld, Franciska van der Velde, Evert de Jonge, Abraham Schoe","doi":"10.1097/CCE.0000000000001190","DOIUrl":"10.1097/CCE.0000000000001190","url":null,"abstract":"<p><strong>Importance: </strong>Mechanical power (MP) could serve as a valuable parameter in clinical practice to estimate the likelihood of adverse outcomes. However, the safety thresholds for MP in mechanical ventilation remain underexplored and contentious.</p><p><strong>Objectives: </strong>This study aims to investigate the association between MP and hospital mortality across varying degrees of lung disease severity, classified by Pao2/Fio2 ratios.</p><p><strong>Design, setting, and participants: </strong>This is a retrospective cohort study using automatically extracted data. Patients admitted to the ICU of a tertiary referral hospital in The Netherlands between 2018 and 2024 and ventilated in pressure-controlled mode were included.</p><p><strong>Main outcomes and measures: </strong>Logistic regression, adjusted for age, sex, Acute Physiology and Chronic Health Evaluation-IV score, and Pao2/Fio2 ratio, was used to calculate the odds ratio (OR) for all-cause in-hospital mortality.</p><p><strong>Results: </strong>A total of 2184 patients were analyzed, with a mean age of 62.5 ± 13.8 years, of whom 1508 (70.2%) were male. The mean MP was highest in patients with the lowest Pao2/Fio2 ratios (21.5 ± 6.5 J/min) compared with those with the highest ratios (12.0 ± 3.8 J/min; p < 0.001). Adjusted analyses revealed that increased MP was associated with higher mortality (OR, 1.06; 95% CI, 1.03-1.09 per J/min increase). Similarly, MP normalized for body weight showed a stronger association with mortality (OR, 1.004; 95% CI, 1.002-1.006 per J/min/kg increase). An increase in mortality was seen when MP exceeded 16-18 J/min.</p><p><strong>Conclusions and relevance: </strong>Our findings demonstrate a significant association between MP and hospital mortality, even after adjusting for key confounders. Mortality increases notably when MP exceeds 16-18 J/min. Normalized MP presents an even stronger association with mortality. These results underscore the need for further research into ventilation strategies that consider MP adjustments.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"6 12","pages":"e1190"},"PeriodicalIF":0.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11661764/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142857247","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":"Preferred Language and Race Impact Code Status in Critically Ill Children.","authors":"Stephanie Granada, Michelle R Mayeda, Jessica C Fowler, Wynne E Morrison, Nadir Yehya","doi":"10.1097/CCE.0000000000001192","DOIUrl":"10.1097/CCE.0000000000001192","url":null,"abstract":"<p><strong>Importance: </strong>Few studies have assessed the relationships between language, race, and code status in a PICU.</p><p><strong>Objectives: </strong>We aimed to identify whether non-English language preference (NELP) or race was associated with code status in a PICU.</p><p><strong>Design, setting, and participants: </strong>This was a single-center retrospective cohort study of 45,143 patients admitted to the PICU between January 2013 and December 2022, excluding those with pre-PICU do not resuscitate (DNR) orders.</p><p><strong>Main outcomes and measures: </strong>Two separate exposures were tested simultaneously (NELP and race/ethnicity) for association with the primary outcome of placement of a DNR order in the PICU (logistic regression). The secondary outcome was time to DNR order in patients in whom DNR orders were placed (Cox regression). Potential confounders were age, Pediatric Risk of Mortality III at 12 hours score, religion, admission diagnosis, and hospital length of stay before PICU admission.</p><p><strong>Results: </strong>Patients with Spanish-preference, Arabic-preference, or other NELP had higher odds of having a DNR order placed during PICU admission relative to English-preference (all adjusted odds ratios [aORs] between 1.81 and 3.59; all p < 0.001). Among patients with a DNR, Other NELP patients had faster times to DNR (adjusted hazard ratio, 1.77; 95% CI, 1.30-2.39; p < 0.001). Non-Hispanic Black patients consistently had lower odds of having a DNR order relative to non-Hispanic White patients (aOR, 0.77; 95% CI, 0.65-0.91; p = 0.002). Results were consistent in sensitivity analyses.</p><p><strong>Conclusions and relevance: </strong>Children with NELP had higher odds of having a new DNR order placed in the PICU, whereas non-Hispanic Black patients had lower odds. NELP may be correlated with unmeasured illness severity, thereby confounding the relationship between language and probability of DNR. However, our data support that demographic factors, such as Black race, are strong predictors of a change in code status to DNR and time to DNR.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"6 12","pages":"e1192"},"PeriodicalIF":0.0,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11658735/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142848719","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":"Machine Learning-Based Prediction Model for ICU Mortality After Continuous Renal Replacement Therapy Initiation in Children.","authors":"Sameer Thadani, Tzu-Chun Wu, Danny T Y Wu, Aadil Kakajiwala, Danielle E Soranno, Gerard Cortina, Rachana Srivastava, Katja M Gist, Shina Menon","doi":"10.1097/CCE.0000000000001188","DOIUrl":"10.1097/CCE.0000000000001188","url":null,"abstract":"<p><strong>Background: </strong>Continuous renal replacement therapy (CRRT) is the favored renal replacement therapy in critically ill patients. Predicting clinical outcomes for CRRT patients is difficult due to population heterogeneity, varying clinical practices, and limited sample sizes.</p><p><strong>Objective: </strong>We aimed to predict survival to ICUs and hospital discharge in children and young adults receiving CRRT using machine learning (ML) techniques.</p><p><strong>Derivation cohort: </strong>Patients less than 25 years of age receiving CRRT for acute kidney injury and/or volume overload from 2015 to 2021 (80%).</p><p><strong>Validation cohort: </strong>Internal validation occurred in a testing group of patients from the dataset (20%).</p><p><strong>Prediction model: </strong>Retrospective international multicenter study utilizing an 80/20 training and testing cohort split, and logistic regression with L2 regularization (LR), decision tree, random forest (RF), gradient boosting machine, and support vector machine with linear kernel to predict ICU and hospital survival. Model performance was determined by the area under the receiver operating characteristic curve (AUROC) and the area under the precision-recall curve (AUPRC) due to the imbalance in the dataset.</p><p><strong>Results: </strong>Of the 933 patients included in this study, 538 (54%) were male with a median age of 8.97 years and interquartile range (1.81-15.0 yr). The ICU mortality was 35% and hospital mortality was 37%. The RF had the best performance for predicting ICU mortality (AUROC, 0.791 and AUPRC, 0.878) and LR for hospital mortality (AUROC, 0.777 and AUPRC, 0.859). The top two predictors of ICU survival were Pediatric Logistic Organ Dysfunction-2 score at CRRT initiation and admission diagnosis of respiratory failure.</p><p><strong>Conclusions: </strong>These are the first ML models to predict survival at ICU and hospital discharge in children and young adults receiving CRRT. RF outperformed other models for predicting ICU mortality. Future studies should expand the input variables, conduct a more sophisticated feature selection, and use deep learning algorithms to generate more precise models.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"6 12","pages":"e1188"},"PeriodicalIF":0.0,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11654792/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142840557","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":"Understanding the Acid-Base Response to Respiratory Derangements: Finding, and Clinically Applying, the In Vivo Base Excess.","authors":"Micah L A Heldeweg, Kenrick Berend, Patrick Schober, František Duška","doi":"10.1097/CCE.0000000000001191","DOIUrl":"10.1097/CCE.0000000000001191","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the base excess response during acute in vivo carbon dioxide changes.</p><p><strong>Design: </strong>Secondary analysis of individual participant data from experimental studies.</p><p><strong>Setting: </strong>Three experimental studies investigating the effect of acute in vivo respiratory derangements on acid-base variables.</p><p><strong>Subjects: </strong>Eighty-nine (canine and human) carbon dioxide exposures.</p><p><strong>Interventions: </strong>Arterial carbon dioxide titration through environmental chambers or mechanical ventilation.</p><p><strong>Measurements and main results: </strong>For each subject, base excess was calculated using bicarbonate and pH using a fixed buffer power of 16.2. Analyses were performed using linear regression with arterial dioxide (predictor), base excess (outcome), and studies (interaction term). All studies show different baselines and slopes for base excess across carbon dioxide titrations methods. Individual subjects show substantial, and potentially clinically relevant, variations in base excess response across the hypercapnic range. Using a mathematical simulation of 10,000 buffer power coefficients we determined that a coefficient of 12.1 (95% CI, 9.1-15.1) instead of 16.2 facilitates a more conceptually appropriate in vivo base excess equation for general clinical application.</p><p><strong>Conclusions: </strong>In vivo changes in carbon dioxide leads to changes in base excess that may be clinically relevant for individual patients. A buffer power coefficient of 16.2 may not be appropriate in vivo and needs external validation in a range of clinical settings.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"6 12","pages":"e1191"},"PeriodicalIF":0.0,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11651497/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142847421","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":"Something New Under the Sun: Farewell from the Founding Editor.","authors":"Timothy G Buchman","doi":"10.1097/CCE.0000000000001180","DOIUrl":"10.1097/CCE.0000000000001180","url":null,"abstract":"","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"6 12","pages":"e1180"},"PeriodicalIF":0.0,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11654789/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142831257","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":"Rehabilitation and Social Determinants of Health in Critical Illness Recovery Literature: A Systematic Review.","authors":"Lindsey E Fresenko, Charlotte Rutherfurd, Lauren E Robinson, Cayla M Robinson, Ashley A Montgomery-Yates, Rachel Hogg-Graham, Peter E Morris, Tammy L Eaton, Joanne M McPeake, Kirby P Mayer","doi":"10.1097/CCE.0000000000001184","DOIUrl":"10.1097/CCE.0000000000001184","url":null,"abstract":"<p><strong>Objectives: </strong>Patients who survive critical illness navigate arduous and disparate recovery pathways that include referrals and participation in community-based rehabilitation services. Examining rehabilitation pathways during recovery is crucial to understanding the relationship on patient-centered outcomes. Furthermore, an understanding of social determinants of health (SDOH) in relation to outcomes and rehabilitation use will help ensure equitable access for future care. Therefore, there is a need to define and understand patient care pathways, specifically rehabilitation after discharge, through a SDOH lens after surviving a critical illness to improve long-term outcomes.</p><p><strong>Data sources: </strong>MEDLINE, PubMed, Web of Science Core Collection (Clarivate), the CINAHL, and the Physiotherapy Evidence Database.</p><p><strong>Study selection and data extraction: </strong>A systematic review of the literature was completed examining literature from inception to March 2024. Articles were included if post-hospital rehabilitation utilization was reported in adult patients who survived critical illness. Discharge disposition was examined as a proxy for rehabilitation pathways. Patients were grouped by patient diagnosis for grouped analysis and reporting of data. Two independent researchers reviewed manuscripts for inclusion and data were extracted by one reviewer using Covidence. Both reviewers used the Newcastle-Ottawa Scale to assess risk of bias.</p><p><strong>Data synthesis: </strong>Of 72 articles included, only four articles reported detailed rehabilitation utilization. The majority of the studies included were cohort studies (91.7%) with most articles using a retrospective design (56.9%). The most common patient population was acute respiratory diagnoses (51.4%). Most patients were discharged directly home from the hospital (75.4%). Race/ethnicity was the most frequently reported SDOH (43.1%) followed by insurance status (13.9%) and education (13.9%).</p><p><strong>Conclusions: </strong>The small number of articles describing rehabilitative utilization allows for limited understanding of rehabilitation pathways following critical illness. The reporting of detailed rehabilitation utilization and SDOH are limited in the literature but may play a vital role in the recovery and outcomes of survivors of critical illness.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"6 12","pages":"e1184"},"PeriodicalIF":0.0,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11644866/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142815328","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":"What Clinicians Think About When They Think About Sepsis: Results From a Survey Across the University of Maryland Medical System.","authors":"Jerry M Yang, Samuel A Tisherman, Surbhi Leekha, Angela Smedley, Blaine Kenaa, Samantha King, Connie Wu, David J Kim, Dorsey Dowling, Jonathan D Baghdadi","doi":"10.1097/CCE.0000000000001183","DOIUrl":"10.1097/CCE.0000000000001183","url":null,"abstract":"<p><strong>Importance: </strong>Sepsis, a leading cause of death in the hospital, is a heterogeneous syndrome without a defined or specific set of symptoms.</p><p><strong>Objectives: </strong>We conducted a survey of clinicians in practice to understand which clinical findings they tend to associate with sepsis.</p><p><strong>Design, setting, and participants: </strong>A survey was distributed to physicians and advanced practice providers across a multihospital health system during April 2022 and May 2022 querying likelihood of suspecting sepsis and initiating sepsis care in response to various normal and abnormal clinical findings.</p><p><strong>Analysis: </strong>Strength of association between clinical findings and suspicion of sepsis were based on median and interquartile range of complete responses. Comparisons between individual questions were performed using Wilcoxon rank-sum testing.</p><p><strong>Results: </strong>Among 179 clinicians who opened the survey, 68 (38%) completed all questions, including 53 (78%) attending physicians representing six different hospitals. Twenty-nine respondents (43%) worked primarily in the ICU, and 16 (24%) worked in the emergency department. The clinical findings most strongly associated with suspicion of sepsis were hypotension, tachypnea, coagulopathy, leukocytosis, respiratory distress, and fever. The abnormal clinical findings least likely to prompt suspicion for sepsis were elevated bilirubin, elevated troponin, and abdominal examination suggesting ileus. On average, respondents were more likely to suspect sepsis with high temperature than with low temperature (p = 0.008) and with high WBC count than with low WBC count (p = 0.003).</p><p><strong>Conclusions: </strong>Clinicians in practice tend to associate the diagnosis of sepsis with signs of severe illness, such as hypotension or respiratory distress, and systemic inflammation, such as fever and leukocytosis. Except for coagulopathy, nonspecific laboratory indicators of organ dysfunction have less influence on decision-making.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"6 12","pages":"e1183"},"PeriodicalIF":0.0,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11630952/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142803730","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":"Crystalloid Liberal or Vasopressors Early Resuscitation in Sepsis-Study of Treatment's Echocardiographic Mechanisms (CLOVERS-STEM).","authors":"Michael J Lanspa, Akram Khan, Patrick G Lyons, Michelle N Gong, Ali A Naqvi, Siddharth Dugar, Abhijit Duggal, Nicholas J Johnson, Jacob H Schoeneck, Lane Smith, Somnath Bose, Nathan I Shapiro, Tatyana Shvilkina, Danielle Groat, Jason R Jacobs, Troy D Olsen, Steven Cannavina, Daniel B Knox, Eliotte L Hirshberg, Wesley H Self, Samuel M Brown","doi":"10.1097/CCE.0000000000001182","DOIUrl":"10.1097/CCE.0000000000001182","url":null,"abstract":"<p><strong>Importance: </strong>Receipt of fluid and vasopressors, common treatments in septic shock, may affect cardiac function.</p><p><strong>Objectives: </strong>We sought to determine whether a liberal or restrictive fluid resuscitation strategy was associated with changes in cardiac function.</p><p><strong>Design: </strong>We prospectively studied a subset of patients enrolled in the Crystalloid Liberal or Vasopressors Early Resuscitation in Sepsis (CLOVERS) trial, performing echocardiography at baseline and at 24 hours after randomization. Among patients who had an echocardiogram performed at 24 hours, we measured left ventricular global longitudinal strain (LV GLS) and right ventricular free-wall longitudinal strain (RVFWLS). We performed linear regressions with dependent variables of LV GLS, change in LV GLS (ΔLV GLS), and RVFWLS using treatment assignment as an independent variable. We adjusted for ratio of early diastolic mitral inflow velocity to early diastolic mitral annulus velocity, mean arterial pressure, and history of congestive heart failure and myocardial infarction.</p><p><strong>Setting: </strong>Emergency department and ICUs.</p><p><strong>Patients: </strong>Adults with sepsis enrolled in the CLOVERS trial.</p><p><strong>Main outcomes and measures: </strong>We enrolled 180 patients. Our analytic cohort comprised 131 patients with an echocardiogram performed at 24 hours. We observed no differences between treatment arms with respect to demographic, clinical, or echocardiographic data at baseline. We observed no association between restrictive fluid assignment and LV GLS (coefficient, 1.22; p = 0.23), ΔLV GLS (-1.97; p = 0.27), or RVFWLS (2.33; p = 0.19).</p><p><strong>Conclusions and relevance: </strong>In a subset of patients enrolled in CLOVERS, we observed no association between receipt of fluid and vasopressors and short-term changes in cardiac function. Decreased enrollment may limit inferences.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"6 12","pages":"e1182"},"PeriodicalIF":0.0,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11631020/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142803725","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":"ICU Admission Preferences in the Hypothetical Event of Acute Critical Illness: A Survey of Very Old Norwegians and Their Next-of-Kins.","authors":"Gabriele Leonie Schwarz, Elisabeth Skaar, Ingrid Miljeteig, Karl Ove Hufthammer, Karen E A Burns, Reidar Kvåle, Hans Flaatten, Margrethe A Schaufel","doi":"10.1097/CCE.0000000000001185","DOIUrl":"10.1097/CCE.0000000000001185","url":null,"abstract":"<p><strong>Objectives: </strong>To explore older patients' ICU admission preferences and their next-of-kins' ability to predict these preferences.</p><p><strong>Design: </strong>Self-administered survey.</p><p><strong>Setting: </strong>Three outpatient clinics, urban tertiary teaching hospital, Norway.</p><p><strong>Patients: </strong>Purposive sample of outpatients 80 years old or older regarded as potential ICU candidates and their next-of-kins.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>We asked about the patients' ICU admission preferences in three hypothetical scenarios of acute critical illness. Next-of-kin respondents were asked to make a proxy statement regarding the older respondents' wishes regarding ICU admission. For each treatment choice, all respondents could provide their level of confidence. Additionally, we sought to identify demographic and healthcare-related characteristics that potentially influenced ICU admission preferences and proxy accuracy. Of 202 outpatients 80 years old or older, equal proportions opted for (39%; CI, 33-45%) and against (40%; CI, 34-46%) ICU admission, and one in five (21%; CI, 17-26%) did not wish to engage decision-making. Male gender, religiosity, and prior ICU experience increased the likelihood of older respondents opting for ICU admission. Although next-of-kins' proxy statements only weakly agreed with the older respondents' true ICU admission preferences (52%; CI, 45-59%), they agreed with the next-of-kins' own ICU admission preferences (79%; CI, 73-84%) to a significantly higher degree. Decisional confidence was high for both the older and the next-of-kin respondents.</p><p><strong>Conclusions: </strong>In this purposive sample of Norwegian potential ICU candidates 80 years old or older, we found substantial variation in the ICU admission preferences of very old patients. The next-of-kins' proxy statements did not align with the ICU admission preferences of the older respondents in half of the pairs, but next-of-kins' and older respondents' confidence levels in rendering these judgments were high.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"6 12","pages":"e1185"},"PeriodicalIF":0.0,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11630954/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142803727","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":"Shoshin Beriberi in a Child With Intestinal Failure: A Case Report.","authors":"Madeleine Böhrer, Paige Burgess, Tais Da Costa Sao Pedro, Dana Liza Boctor, Samantha Boggs","doi":"10.1097/CCE.0000000000001187","DOIUrl":"10.1097/CCE.0000000000001187","url":null,"abstract":"<p><strong>Background: </strong>Acute illness states with increased metabolic demand can precipitate severe thiamine deficiency if physiologic needs exceed endogenous stores and supplementation. Patients with preexisting risk factors such as parenteral nutrition (PN) dependence, eating disorders, gastrointestinal disorders, or surgeries are especially vulnerable.</p><p><strong>Case summary: </strong>A 9-year-old girl with short bowel syndrome receiving long-term PN, including standard thiamine supplementation, presented with refractory shock following aspiration. Profound hyperlactatemia, cardiac dysfunction, and vasoactive requirements persisted despite extracorporeal membrane oxygenation and resolved only after treatment with parenteral thiamine.</p><p><strong>Conclusions: </strong>Hemodynamic collapse due to thiamine deficiency (Shoshin beriberi) may occur during acute illness in children with nutritional risk factors and should be considered in refractory hyperlactatemia. Timely treatment with parenteral thiamine can support dramatic hemodynamic recovery. Treatment of suspected thiamine deficiency should not be delayed for laboratory confirmation as current thiamine reference ranges correlate poorly with clinical severity, and functional testing may not be readily available.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"6 12","pages":"e1187"},"PeriodicalIF":0.0,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11627479/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142789734","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}