Critical care explorations最新文献

{"title":"Race and the Inaccuracy of Pulse Oximetry With Hypoxemia in a Pediatric Cardiac ICU.","authors":"Matthew T Coghill, Mark A Law, Lece V Webb, Ahmed Asfari, Santiago Borasino","doi":"10.1097/CCE.0000000000001237","DOIUrl":"10.1097/CCE.0000000000001237","url":null,"abstract":"<p><strong>Objectives: </strong>To ascertain the potential effects of hypoxemia and race on pulse oximetry in a population of patients, including those for whom hypoxemia is a normal state secondary to intracardiac mixing in an ICU setting.</p><p><strong>Design: </strong>Retrospective, observational, cohort study.</p><p><strong>Setting: </strong>A single center's pediatric cardiac ICU (CICU).</p><p><strong>Patients: </strong>Eight hundred forty-one patients undergoing bypass operations during a 52-month period (June 2019-October 2023). Predominantly, patients with congenital heart disease. The median age was 7.1 months with 58% younger than 1 year old and 88% younger than 10 years old.</p><p><strong>Interventions: </strong>Arterial blood saturations, as measured by a hemoximeter, were recorded for all patients after bypass operations. These were time-matched, with high-fidelity, to pulse oximeter values.</p><p><strong>Measurements and main results: </strong>The mean oximetric difference, or \"pulse oximetry overestimation,\" was defined as arterial oxygen saturation minus that predicted by pulse oximetry, was greater for Black than for White patients (-3.18% vs. -2.19%, p = 0.006). Regression shows a significant effect of Sao2 on oximetric difference (p < 0.001) and mildly significant trend for the categorical race (p = 0.03) as well as their composite interaction term (p = 0.047). Oximetric difference was exaggerated with increasing hypoxemia. At normal oxygen saturations, the oximetric difference was greater for Black when compared with White patients (p = 0.002 for patients with Sao2 > 94%). This effect if race is not statistically significant at other Sao2 ranges that are clinically important in patients with intracardiac mixing.</p><p><strong>Conclusions: </strong>This study redemonstrates effect of increasing hypoxemia on oximetric difference. Race may have an independent effect on oximetric difference. This adds to the body of literature that has previously suggested that pulse oximetry, relied upon as a vital sign, may introduce explicit race-related bias into the bedside interpretation of a patient's clinical state.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 4","pages":"e1237"},"PeriodicalIF":0.0,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11936562/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702228","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":"Right Atrial Dysfunction Is Prevalent in Pediatric Acute Respiratory Distress Syndrome and Reflects Pulmonary Hypertension and Right Ventricular Dysfunction.","authors":"Nathan D Markiewitz, Yan Wang, Robert A Berg, Nadir Yehya, Celeste Dixon, Laura Mercer-Rosa, Adam S Himebauch","doi":"10.1097/CCE.0000000000001230","DOIUrl":"10.1097/CCE.0000000000001230","url":null,"abstract":"<p><strong>Importance: </strong>Right atrial (RA) dysfunction is associated with worse outcomes in some populations with pulmonary hypertension or respiratory failure but the prevalence and correlates of RA dysfunction in pediatric acute respiratory distress syndrome (PARDS) are unknown.</p><p><strong>Objectives: </strong>The aim of this study was to evaluate RA function by characterizing the prevalence and pattern of RA dysfunction within the first 24 hours of PARDS onset. We hypothesized that RA dysfunction would be common and correlate with the presence of pulmonary hypertension and right ventricular (RV) systolic dysfunction.</p><p><strong>Design, setting, and participants: </strong>Retrospective, single-center cohort study at a tertiary care PICU of children (< 18 yr) with a clinically obtained echocardiogram within 24 hours following PARDS diagnosis and healthy controls without cardiopulmonary disease.</p><p><strong>Main outcomes and measures: </strong>Echocardiograms were evaluated for conventional and speckle-tracking (or strain) echocardiographic measures of RA and RV systolic function. Nonparametric summary statistics, comparisons, and correlational analyses were completed.</p><p><strong>Results: </strong>Ninety-two PARDS patients and 55 controls were included. Using a priori thresholds (> 2 sds of control values), 49% (n = 45) of PARDS patients demonstrated RA dysfunction in at least one RA functional metric. The maximal RA strain during the reservoir phase was reduced in PARDS compared with controls (median 40.2% vs. 53.7%; p < 0.001). Patients with echocardiographic evidence of pulmonary hypertension had lower maximal RA strain during the reservoir phase (31.7%) compared with patients without (40.5%; p < 0.05). Patients with higher brain-type natriuretic peptide plasma concentrations had worse RA function. RA function significantly correlated with conventional and strain measures of RV systolic function.</p><p><strong>Conclusions and relevance: </strong>RA dysfunction is common within the first 24 hours of PARDS onset. RA dysfunction during the reservoir phase is associated with pulmonary hypertension and RV systolic dysfunction. Future studies investigating trajectories of RA function and their association with outcomes in PARDS patients are needed.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 3","pages":"e1230"},"PeriodicalIF":0.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11922415/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143660107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Pilot Study Assessing the Utility of Quantitative Myeloid-Derived Suppressor Cell Measurements in Detecting Posttraumatic Infection.","authors":"Grant E O'Keefe, Yiyang Wu, Nina Mirabadi, Minjun Apodaca, Qian Qui, Chihiro Morishima","doi":"10.1097/CCE.0000000000001228","DOIUrl":"10.1097/CCE.0000000000001228","url":null,"abstract":"<p><strong>Objectives: </strong>Biomarkers that facilitate earlier diagnosis of posttraumatic infection could improve outcomes by expediting treatment and mitigating complications, including sepsis. We hypothesized that circulating myeloid-derived suppressor cell (MDSC) counts could identify patients with posttraumatic infection.</p><p><strong>Design, setting, and patients: </strong>We conducted a single-center, prospective observational pilot study of trauma victims who required greater than or equal to 48 hours of mechanical ventilation. Whole blood was collected and tested by flow cytometry.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Samples were analyzed in real-time with an 11-parameter quantitative MDSC assay. Two physician adjudications of infection were performed through a blinded review of medical records. MDSC and other cell counts were compared between subjects with and without posttraumatic infection using non-parametric methods. Data are presented as medians (25th-75th percentile). The area under the receiver operating characteristic (ROC) curves were used to assess the accuracy of cell counts for diagnosing infection. Most subjects (n = 39) were male (79%) with a median age of 48 (interquartile range [IQR] 32-65), Injury Severity Score of 29 (IQR 21-41), and ICU length of stay of 13 days (IQR 8-19). Twenty-one (54%) developed an infection and 11 (28%) of the cohort died. We compared total MDSC (T-MDSC) counts closest to the day of infection diagnosis with the initial T-MDSC counts in subjects without infection. T-MDSC counts were higher in those with infection compared to those without infection (696 [368-974] and 304 [181-404] cells/μL, respectively; p < 0.001). Lymphocyte, neutrophil, and CD45+ leukocyte counts were not statistically different between the groups. The area under the ROC curve distinguishing those with infection from those without for T-MDSC was 0.83 (p < 0.001).</p><p><strong>Conclusions: </strong>MDSC counts determined by quantitative whole blood flow cytometrics can detect posttraumatic infection and may be useful to guide further diagnostic testing in critically ill trauma victims.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 3","pages":"e1228"},"PeriodicalIF":0.0,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11918587/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143660105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Pilot Study Assessing the Utility of Quantitative Myeloid-Derived Suppressor Cell Measurements in Detecting Posttraumatic Infection.","authors":"Grant E O'Keefe, Yiyang Wu, Nina Mirabadi, Minjun Apodaca, Qian Qui, Chihiro Morishima","doi":"10.1097/CCE.0000000000001228","DOIUrl":"https://doi.org/10.1097/CCE.0000000000001228","url":null,"abstract":"<p><strong>Objectives: </strong>Biomarkers that facilitate earlier diagnosis of posttraumatic infection could improve outcomes by expediting treatment and mitigating complications, including sepsis. We hypothesized that circulating myeloid-derived suppressor cell (MDSC) counts could identify patients with posttraumatic infection.</p><p><strong>Design setting and patients: </strong>We conducted a single-center, prospective observational pilot study of trauma victims who required greater than or equal to 48 hours of mechanical ventilation. Whole blood was collected and tested by flow cytometry.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Samples were analyzed in real-time with an 11-parameter quantitative MDSC assay. Two physician adjudications of infection were performed through a blinded review of medical records. MDSC and other cell counts were compared between subjects with and without posttraumatic infection using non-parametric methods. Data are presented as medians (25th-75th percentile). The area under the receiver operating characteristic (ROC) curves were used to assess the accuracy of cell counts for diagnosing infection. Most subjects (<i>n</i> = 39) were male (79%) with a median age of 48 (interquartile range [IQR] 32-65), Injury Severity Score of 29 (IQR 21-41), and ICU length of stay of 13 days (IQR 8-19). Twenty-one (54%) developed an infection and 11 (28%) of the cohort died. We compared total MDSC (T-MDSC) counts closest to the day of infection diagnosis with the initial T-MDSC counts in subjects without infection. T-MDSC counts were higher in those with infection compared to those without infection (696 [368-974] and 304 [181-404] cells/μL, respectively; <i>p</i> < 0.001). Lymphocyte, neutrophil, and CD45+ leukocyte counts were not statistically different between the groups. The area under the ROC curve distinguishing those with infection from those without for T-MDSC was 0.83 (<i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>MDSC counts determined by quantitative whole blood flow cytometrics can detect posttraumatic infection and may be useful to guide further diagnostic testing in critically ill trauma victims.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 3","pages":"e1228"},"PeriodicalIF":0.0,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11918587/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143660104","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":"Interferon Regulatory Factor 3 Exacerbates the Severity of COVID-19 in Mice.","authors":"Wendy E Walker, Luiz F Garcia, Pedro M Palermo, Nawar Hakim, Dinesh G Goswami, Alok K Dwivedi, Douglas M Watts","doi":"10.1097/CCE.0000000000001225","DOIUrl":"10.1097/CCE.0000000000001225","url":null,"abstract":"<p><strong>Context: </strong>Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in 2019, causing the COVID-19 pandemic. While most infected people experienced mild illness, others progressed to severe disease, characterized by hyperinflammation and respiratory distress. There is still much to learn about the innate immune response to this virus. Interferon regulatory factor 3 (IRF3) is a transcription factor that is activated when pattern recognition receptors detect viruses. Upon activation, IRF3 induces the expression of interferon beta (IFN-β) and interferon-stimulated genes, which protect the host from viral infection. However, coronaviruses antagonize this pathway, delaying type 1 IFN production. It is, therefore, unclear how IRF3 influences COVID-19 disease. Our prior reports showed that IRF3 promotes harmful inflammation during bacterial sepsis in mice.</p><p><strong>Hypothesis: </strong>We hypothesized that IRF3 cannot effectively control the SARS-CoV-2 viral load and instead promotes harmful inflammation during severe COVID-19.</p><p><strong>Methods and models: </strong>We used mice transgenic for the human angiotensin converting-enzyme 2 transgene, driven by the keratin 18 promoter (K18-ACE2 mice) that were IRF3 deficient or IRF3 sufficient to test how IRF3 influences COVID-19 disease.</p><p><strong>Results: </strong>Upon infection with SARS-CoV-2, K18-ACE2 mice showed a dose-dependent disease, characterized by mortality, lethargy, weight loss, and lung pathology, reminiscent of clinical COVID-19. However, K18-ACE2 mice lacking IRF3 were protected from severe disease with reduced mortality (84.6% vs. 100%) and disease score. We found that IRF3 promoted IFN-β production in the lungs and reprogrammed the cytokine profile, while viral load in the lungs was similar in the presence or absence of IRF3.</p><p><strong>Interpretations and conclusions: </strong>These data indicated that IRF3 played a detrimental role in murine COVID-19 associated with changes in IFN-β and inflammatory cytokines.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 3","pages":"e1225"},"PeriodicalIF":0.0,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11918655/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143660106","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":"Host Response Protein Biomarkers Indicative of Persistent Acute Kidney Injury in Critically Ill COVID-19 Patients.","authors":"Thei S Steenvoorden, Koen C de Kruijf, Brent Appelman, Bas Moggre, Lieuwe D J Bos, Alexander P J Vlaar, Reneé A Douma, Fabrice Uhel, Jesper Kers, Jetta J Oppelaar, Lonneke A van Vught, Martijn Beudel, Paul W G Elbers, W Joost Wiersinga, Tom van der Poll, Liffert Vogt, Hessel Peters-Sengers","doi":"10.1097/CCE.0000000000001222","DOIUrl":"10.1097/CCE.0000000000001222","url":null,"abstract":"<p><strong>Importance: </strong>Sepsis-related host-response anomalies contribute to acute kidney injury (AKI) duration. Data on the host-response specific to COVID-19-associated AKI (COVID-AKI) in critically ill patients is limited.</p><p><strong>Objectives: </strong>We postulated that persistent COVID-AKI (> 48 hr) differs in host response from transient (< 48 hr) or no COVID-AKI.</p><p><strong>Design, setting, and participants: </strong>This prospective biomarker study observed patients with severe acute respiratory syndrome coronavirus 2 infection, without chronic kidney disease, in three ICUs from March 2020 to July 2020. AKI was assessed by hourly urine output and daily plasma creatinine.</p><p><strong>Main outcomes and measures: </strong>Luminex and enzyme-linked immunosorbent assay were used to analyze 48 plasma protein biomarkers across six pathophysiological domains, which were tested with mixed-effects models.</p><p><strong>Results: </strong>Of 177 included patients, 106 (59.9%) had AKI within the first 48 hours of admission, of whom 76 (71.7%) had persistent AKI and 30 (28.3%) transient AKI. Those with persistent AKI often had obesity, hypertension, and a higher Sequential Organ Failure Assessment score due to the renal component. Longitudinal analyses revealed that seven proteins were elevated in persistent AKI compared with no AKI. These were related to inflammation (triggering receptor expressed on myeloid cells 1, p < 0.001; tumor necrosis factor receptor 1, p < 0.001; procalcitonin, p = 0.001), complement activation (mannan-binding lectin serine protease-2, p = 0.001), kidney dysfunction (cystatin C, p < 0.001; neutrophil gelatinase-associated lipocalin, p < 0.001), and lung dysfunction (Clara cell secretory protein 16, p < 0.001). AKI (duration) was not associated with differences in the cytokine signaling, endothelial cell activation, or coagulation domains.</p><p><strong>Conclusions and relevance: </strong>In contrast with sepsis-associated AKI, primarily inflammation-related biomarker levels correlated with COVID-AKI persistence. This study offers insights into COVID-AKI and may guide approaches to mitigate its persistence.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 3","pages":"e1222"},"PeriodicalIF":0.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11908758/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143627095","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 Case for Telemedicine-Enhanced Nighttime Staffing in a Neuro-ICU.","authors":"Belinda L Udeh, Nicolas R Thompson, Ryan D Honomichl, Brittany R Lapin, Irene L Katzan, Lori Griffiths, Joao A Gomes","doi":"10.1097/CCE.0000000000001231","DOIUrl":"10.1097/CCE.0000000000001231","url":null,"abstract":"<p><strong>Importance: </strong>This study compares the health outcomes and healthcare utilization of two staffing models for specialized neuro-ICU (NICU): a 24/7 intensive staffing (IS) model and a daytime 12-hour intensivist model with 12-hour nocturnal telemedicine-enhanced (TE) coverage. The IS model was studied from July 2016 to June 2017. The TE model was studied during the implementation period from July 2017 to June 2018.</p><p><strong>Objectives: </strong>To compare the health outcomes and healthcare utilization of two staffing models for a specialized NICU.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting and participants: </strong>NICU with 24 beds in a 1200-bed urban, quaternary care, academic hospital in Northeast Ohio. Participants were critically ill patients with primary neurologic injuries admitted to the NICU between July 2016 and June 2018.</p><p><strong>Main outcomes and measures: </strong>Multivariable logistic, and negative binomial regression analysis compared the following outcomes: mortality, ICU length of stay (LOS), hospital LOS, and ventilator days. Demographics and patient characteristics, including Acute Physiology and Chronic Health Evaluation scores, were used in model adjustments.</p><p><strong>Results: </strong>Three thousand seventy-three patients were studied: n equals to 1542 IS (average age 61 yr [sd 17], 49% female, 73% White race) and n equals to 1531 TE (average age 62 yr (sd 17), 49% female, 70% White race). The TE model required less staff than IS model (5 vs. 9 staff intensivists), respectively. Compared with IS, the TE cohort had similar demographics and clinical indications, although the groups differed on the distribution of the body systems necessitating ICU admission. TE model was protective of ICU mortality compared with IS model (odds ratio = 0.59; 95% CI, 0.43-0.82; p = 0.002). However, TE was associated with a 10% increase in ICU LOS (incident rate ratio [IRR] = 1.10; 95% CI, 1.03-1.18; p = 0.006) and a 13% increase in total LOS (IRR = 1.13; 95% CI, 1.06-1.20; p < 0.001). There was no difference in ventilator days between groups.</p><p><strong>Conclusions and relevance: </strong>The availability of critical care staff is not keeping pace with demand, especially in specialized ICUs, including NICU. The TE model required fewer staff with similar clinical outcomes. This is a preliminary study highlighting that alternate specialized ICU staffing models could require fewer labor requirements while still maintaining quality of care. Further research is required to assess the true impact of LOS differences and examine the impact of these models on physician burnout and retention. This new understanding would provide additional guidance on ICU staffing options and telemedicine costs to hospitals, ensuring efficient and effective resource allocation as ICU demands continue to increase.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 3","pages":"e1231"},"PeriodicalIF":0.0,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11884836/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558434","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":"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}