Critical care explorations最新文献

{"title":"When End-of-Life Becomes the Beginning of New Life: Application of the Society of Critical Care Medicine Clinical Practice Guidelines on Adult End-of-Life Care in the ICU to the Setting of Donation After Circulatory Death.","authors":"Ian M Oppenheim, Rita N Bakhru, Carolina B Maciel, Katharina M Busl","doi":"10.1097/CCE.0000000000001458","DOIUrl":"10.1097/CCE.0000000000001458","url":null,"abstract":"<p><p>The recently published Society of Critical Care Medicine Guidelines on Adult End-of-Life Care in the ICU provide a detailed and well-thought-out approach to a vital component of critical care, although they explicitly refrain from discussing how they may apply to organ donation. As representatives of the Donor Care Unit Network for Optimizing Recovery (DONOR), a group of intensivists experienced in managing donation after circulatory death (DCD), we wish to endorse equal delivery of high-quality end-of-life (EOL) care for organ donors. Although some logistical differences must be addressed, the EOL recommendations outlined in the Guidelines are still applicable to patients being evaluated for or undergoing DCD. Recent accounts of unacceptable patient care in the setting of DCD highlight a critical threat to patient welfare and public trust. Our mandate is clear: implement and audit protocols that guarantee dignity and symptom control while demonstrating that DCD remains wholly consistent with a compassionate, honorable, and fulfilling EOL.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"8 8","pages":"e1458"},"PeriodicalIF":2.9,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13433020/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148649858","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 Case Report on Cerebral Autoregulation in Posterior Reversible Encephalopathy Syndrome After Aneurysmal Subarachnoid Hemorrhage.","authors":"Miriam Weiss, Nick Kastenholz, Catharina Conzen-Dilger, Hans Clusmann, Soojin Park, Gerrit Alexander Schubert","doi":"10.1097/CCE.0000000000001453","DOIUrl":"10.1097/CCE.0000000000001453","url":null,"abstract":"<p><strong>Background: </strong>Disturbed cerebral autoregulation remains a theoretical contributor to posterior reversible encephalopathy syndrome (PRES), but it has not been captured before. We report invasively measured autoregulation indices in a 50-year-old female with aneurysmal subarachnoid hemorrhage.</p><p><strong>Case summary: </strong>PRES developed after induced hypertension and intra-arterial nimodipine infusion as treatment for delayed cerebral ischemia. The poorest autoregulation values were observed a week before PRES, at the time of delayed cerebral ischemia and sepsis. A second, less pronounced deterioration of autoregulation occurred before PRES diagnosis. Relevant comorbidities potentially related to PRES were fetal-type arterial supply to the posterior circulation, pneumonia, and steroid application.</p><p><strong>Conclusions: </strong>This is the first reported case with cerebral autoregulation measurements during PRES. Hypothetically, autoregulation could have contributed to PRES in a setting of persistent hypertension, immunological factors, and a more susceptible posterior circulation. Further data are required to reliably investigate the relationship between autoregulation and PRES.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"8 8","pages":"e1453"},"PeriodicalIF":2.9,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13433057/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148649857","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":"Amino Acid Deficiency Secondary to Continuous Venovenous Hemofiltration in Acute Decompensation of Organic Acidemias: An Anabolic Dead End?","authors":"Chloé Grosyeux, Noémie Cammiciotto, Elise Jeannesson, Eva Feigerlova, Valentine Villada, Camille Wicker, Michael Levy, Manuel Schiff, Apolline Imbard, David Coelho, François Feillet, Arnaud Wiedemann","doi":"10.1097/CCE.0000000000001413","DOIUrl":"10.1097/CCE.0000000000001413","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the impact of continuous renal replacement therapy (CRRT) on plasma amino acid (AA) concentrations in patients with acute metabolic decompensation of organic acidemias (OAs), and to explore whether AA supplementation during CRRT may mitigate AA depletion.</p><p><strong>Design: </strong>Multicenter retrospective observational study.</p><p><strong>Setting: </strong>PICUs managing acute metabolic decompensations of OAs.</p><p><strong>Patients or subjects: </strong>Patients with confirmed OAs who underwent CRRT for severe acute metabolic decompensation.</p><p><strong>Interventions: </strong>CRRT was initiated according to current guidelines in cases of severe decompensation. Standard metabolic management included high caloric intake through carbohydrates and lipids with temporary protein withdrawal (24-48 hr). In one patient, AA supplementation (2 g/kg) during CRRT combined with thiamin and citrate (anaplerotic therapy) was administered.</p><p><strong>Measurements and main results: </strong>Plasma AA concentrations were measured before and after CRRT in nine patients with a median age of 21 days (interquartile range [IQR], 3-570 d). Quantitative variables are expressed as medians (IQR, 25th-75th). Before CRRT, 31% (95% CI, 24-39) of plasma AAs were below the normal range compared with 69% (95% CI, 59-77) after CRRT (p < 0.0001). A significant increase in lactatemia was observed following CRRT, without evidence of organ failure: median 2.2 mmol/L (IQR, 1.3-2.3) before CRRT vs. 5.3 mmol/L (IQR, 3.2-7.1) after CRRT; Hodges-Lehmann median difference +3.2 (95% CI, 0.8-5.6; p = 0.0065). In the patient receiving AA supplementation with anaplerotic therapy, plasma AA status improved markedly, with 65% of AAs below normal before CRRT vs. 15% after CRRT.</p><p><strong>Conclusions: </strong>In acute decompensated OAs, CRRT performed without protein supplementation, as currently recommended, significantly reduces total plasma AA concentrations and may impair restoration of anabolism. AA infusion during CRRT could help preserve or restore protein anabolism. Prospective studies are needed to assess the safety and efficacy of AA supplementation during CRRT, with or without anaplerotic therapy, in this setting.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"8 8","pages":"e1413"},"PeriodicalIF":2.9,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13433117/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148649871","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":"Severe Diltiazem Poisoning Managed With CytoSorb Hemoadsorption and Supportive Therapies: A Case Report.","authors":"Juul M Cox, Julia A M Verwaaijen, Ruben M F Hendriks, Dorien Smeets, Suzanne van Rijswijk, Tessa M Bosch","doi":"10.1097/CCE.0000000000001454","DOIUrl":"10.1097/CCE.0000000000001454","url":null,"abstract":"<p><strong>Background: </strong>Severe intoxication with nondihydropyridine calcium channel blockers, such as diltiazem, is associated with high morbidity and mortality. Evidence supporting extracorporeal treatment strategies remains limited. This case integrates serial toxicokinetic measurements with adjunctive hemoadsorption in sustained-release diltiazem poisoning.</p><p><strong>Case summary: </strong>A 73-year-old man presented with coma, complete atrioventricular block, refractory hypotension, and severe lactic acidosis. Despite optimized supportive therapy including vasopressors, calcium supplementation, hyperinsulinemic-euglycemic therapy, and continuous renal replacement therapy, he remained hemodynamically unstable. CytoSorb hemoadsorption was initiated 6 hours after ICU admission. Shortly thereafter, sinus rhythm was restored, serum lactate rapidly declined, and vasopressor and insulin requirements were progressively reduced, allowing discontinuation of extracorporeal support. The patient recovered and was discharged home.</p><p><strong>Conclusions: </strong>Retrospective analysis demonstrated elevated diltiazem concentrations with delayed, capacity-limited elimination. This case supports considering hemoadsorption in unstable patients with severe diltiazem poisoning despite conventional measures and highlights the need for systematic pharmacokinetic evaluation in future studies.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"8 8","pages":"e1454"},"PeriodicalIF":2.9,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13433092/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148649945","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":"IgM-Enriched Immunoglobulin As Adjunctive Therapy in Adult Sepsis and Septic Shock: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.","authors":"Khaled Sewify, Ragheb Elmessery, Omar Alzuwayed, Wael Gomaa, Abdulaziz Alshaer, Atheer Almutairi, Eslam Abdelshafey, Massimo Girardis","doi":"10.1097/CCE.0000000000001451","DOIUrl":"10.1097/CCE.0000000000001451","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To evaluate randomized adult evidence on adjunctive immunoglobulin M (IgM)-enriched immunoglobulin for sepsis and septic shock, with emphasis on short-term mortality, endpoint heterogeneity, statistical robustness, and harms reporting.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data sources: &lt;/strong&gt;MEDLINE, PubMed, Embase, CENTRAL, and Web of Science were searched from inception to September 2025. Reference lists of eligible articles and relevant reviews were screened, forward citation searching was performed, and study registers were checked for additional records.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study selection: &lt;/strong&gt;Randomized controlled trials enrolling adults with sepsis, severe sepsis, or septic shock were eligible when they evaluated an IgM-enriched immunoglobulin preparation in addition to standard care and reported extractable mortality or clinically relevant outcomes. The protocol-concordant core synthesis included English-language adult Pentaglobin trials with extractable short-term mortality data. Two post hoc extensions were labeled explicitly: a language-inclusive Pentaglobin sensitivity analysis and an exploratory formulation-class analysis incorporating the phase II Concentrated IgM for Application (CIGMA) trimodulin trial.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data extraction: &lt;/strong&gt;Two reviewers independently screened records, assessed full texts, extracted study characteristics, endpoint timing, mortality events, and reported adverse events, and resolved disagreements by discussion or third-reviewer adjudication. Risk of bias was assessed with Cochrane Risk of Bias 2 tool for randomized trials, and certainty was judged with the Grading of Recommendations Assessment, Development, and Evaluation principles.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data synthesis: &lt;/strong&gt;Six English-language randomized Pentaglobin trials with extractable short-term mortality data (411 participants) contributed to the protocol-concordant core synthesis. The primary pooled estimate was directionally favorable but statistically inconclusive (odds ratio [OR], 0.65; 95% CI, 0.39-1.07; I2 = 9%). Restriction to exact 28-day mortality also remained inconclusive (OR, 0.84; 95% CI, 0.50-1.43; I2 = 0%). An alternative risk-ratio model was similarly nonsignificant (risk ratio, 0.76; 95% CI, 0.55-1.06; I2 = 0%). Statistically significant estimates arose only in exploratory post hoc analyses: the language-inclusive Pentaglobin sensitivity analysis (OR, 0.57; 95% CI, 0.34-0.95; I2 = 16%) and the exploratory formulation-class model including CIGMA (OR, 0.64; 95% CI, 0.43-0.94; I2 = 5%). Safety reporting was incomplete in most Pentaglobin reports.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Current randomized adult evidence does not justify routine use of IgM-enriched immunoglobulin in unselected sepsis or septic shock. Direct Pentaglobin evidence remains statistically inconclusive, whereas statistically significant estimates appear only after exploratory expansion to historical or indirect formulation-level evidence. Efficac","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"8 8","pages":"e1451"},"PeriodicalIF":2.9,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13433055/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148649940","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":"Clinical and Culture-Based Predictors of Gut Microbiome Alpha Diversity at the Time of ICU Admission.","authors":"Dakota Ma, Anne-Catrin Uhlemann, Julian A Abrams, Daniel E Freedberg","doi":"10.1097/CCE.0000000000001455","DOIUrl":"10.1097/CCE.0000000000001455","url":null,"abstract":"<p><strong>Objectives: </strong>Microbiome-based therapies to improve gut colonization resistance are being developed for the ICU, but their efficacy may depend on the baseline gut microbiome at ICU admission. We sought to identify clinical predictors of alpha diversity at ICU admission.</p><p><strong>Design: </strong>Retrospective reanalysis of a randomized clinical trial (NCT03865706).</p><p><strong>Setting: </strong>Single-center ICU.</p><p><strong>Patients: </strong>ICU patients with sepsis as the primary diagnosis who were receiving broad-spectrum antibiotics and could be enrolled within 24 hours of ICU admission.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Demographic and clinical characteristics for medical ICU patients with sepsis were recorded during a previously published randomized clinical trial. Deep rectal swabs were collected within 24 hours of ICU admission and sequenced to describe alpha diversity (Shannon index) and cultured for vancomycin-resistant Enterococcus (VRE). Patients were organized into tertiles of Shannon diversity (low, middle, high) with a primary outcome of a lower Shannon tertile at ICU admission. Overall, 90 patients were enrolled. The three variables of location before ICU admission (adjusted odds ratio [aOR], 3.54; 95% CI, 1.21-10.3 for ICU transfer vs. emergency department [ED]; aOR, 6.09; 95% CI, 1.89-19.6 for hospital ward vs. ED), prior culture-proven infection within 1 year (aOR, 2.46; 95% CI, 1.02-5.96), and VRE status on ICU admission (aOR, 4.18; 95% CI, 1.44-12.1 for positive vs. negative swab) were sufficient to describe a quasi-linear trend in alpha diversity at ICU admission.</p><p><strong>Conclusions: </strong>Baseline gut microbiome Shannon alpha diversity at ICU admission could be described with three readily ascertained clinical variables. Our model shows promise as a preliminary framework of factors that collectively best predict baseline alpha diversity at ICU admission and warrants validation in larger independent cohorts.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"8 7","pages":"e1455"},"PeriodicalIF":2.9,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13406136/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148586362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erratum: The Vigilance Gradient: Eleven Years of Adverse Event Trends in Pediatric Critical Care: Erratum.","authors":"Devika Singh, Michael R Miller, Maitray A Patel, Cory Anderson, Douglas D Fraser","doi":"10.1097/CCE.0000000000001446","DOIUrl":"10.1097/CCE.0000000000001446","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1097/CCE.0000000000001407.].</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"8 7","pages":"e1446"},"PeriodicalIF":2.9,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13395483/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148581558","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":"From Opinions to Outcomes: Optimizing Survey Methods and Principles Applicable to the Delphi Process in Critical Care Research.","authors":"Deepa Ramadurai, Vitaly Herasevich, Scott Bolesta, Gretchen M Brophy, Deyin Doreen Hsing, Philippe R Bauer, Pooja Amar Nawathe, Robert MacLaren, Ashish K Khanna, C Jessica Dine","doi":"10.1097/CCE.0000000000001438","DOIUrl":"10.1097/CCE.0000000000001438","url":null,"abstract":"<p><strong>Background: </strong>Survey research in critical care has dramatically increased over the past 25 years, and use of surveys within Delphi methods, which provide consensus definitions for heterogeneous disease states, has similarly expanded significantly. It is crucial for survey researchers to understand the nuances of survey development and expectations of information provided by surveys, to use them correctly. Few simple sources exist to guide development considerations to generate high-quality survey research. No studies to our knowledge exist that draw parallels between the principles of survey research as a guide within the Delphi process, as one potential conduit between a steering committee and expert panel.</p><p><strong>Methods: </strong>We present a narrative review of and framework for rigorous design of survey research, highlighting the applicability to the design of surveys administered within Delphi methods.</p><p><strong>Results and conclusions: </strong>The methodologic considerations presented for survey research and Delphi methods can inform high-quality critical care research.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"8 7","pages":"e1438"},"PeriodicalIF":2.9,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13391133/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148537903","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 Same Instrument, Differently Tuned? Surveys, Delphi Studies, and the Search for Structured Disagreement.","authors":"Prashant Nasa, Marcus J Schultz, Denise Battaglini","doi":"10.1097/CCE.0000000000001457","DOIUrl":"10.1097/CCE.0000000000001457","url":null,"abstract":"","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"8 7","pages":"e1457"},"PeriodicalIF":2.9,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13391127/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148537887","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":"Can We Identify Severe Dysbiosis at the Bedside?","authors":"Umair Ansari, Jihad Mallat","doi":"10.1097/CCE.0000000000001456","DOIUrl":"10.1097/CCE.0000000000001456","url":null,"abstract":"","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"8 7","pages":"e1456"},"PeriodicalIF":2.9,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13387769/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148551838","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}