Critical care explorations最新文献

{"title":"Challenges of Ventilator Procurement and Distribution in the ICU During the COVID-19 Pandemic: A Scoping Review.","authors":"David Wang, Marko Nemet, Gabriele A Dos Anjos, Sara N Zec, Claudia C Zambrano, Lucrezia Rovati, Hieu Truong, Yue Dong","doi":"10.1097/CCE.0000000000001248","DOIUrl":"10.1097/CCE.0000000000001248","url":null,"abstract":"<p><strong>Objectives: </strong>The goal of this scoping review was to review some of the challenges hospitals faced in dealing with the shortage of ventilators during the COVID-19 pandemic and the solutions they were able to implement or suggested. By highlighting these problems and solutions, we hope this review can catalyze further discussions about how to better prepare for future pandemics and medical supply shortages.</p><p><strong>Data sources: </strong>A comprehensive search strategy using identifying key words was applied to several different databases to procure relevant literature.</p><p><strong>Study selection: </strong>Four thousand two hundred fifty-nine studies were found in the initial search. Inclusion and exclusion criteria were created and applied to screen studies. Included studies focused on the supply and distribution of ventilators during the COVID-19 pandemic. In the case where reviewers disagreed about whether a study should be included, a third reviewer acted as a tie-breaker.</p><p><strong>Data extraction: </strong>Thirty-three studies were included for final data extraction. Two independent reviewers collected various data points from these studies, including the main challenges discussed by the authors, the level of ventilator shortage being addressed, whether ventilator sharing was discussed, and the limitations of the study.</p><p><strong>Data synthesis: </strong>A third reviewer compared the collected data and decided on the results.</p><p><strong>Conclusions: </strong>Some of the common solutions for the ventilator shortage discussed included augmenting overall ventilator supply through increased production, transporting ventilators between hospitals, ventilator sharing, designing new ventilators, and repurposing other resources to help address shortages of supplies.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 4","pages":"e1248"},"PeriodicalIF":0.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11957643/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143736306","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":"Women Physicians in Leadership Roles in Critical Care Medicine or Academic Medicine-A Systematic Literature Review.","authors":"Shahla Siddiqui, Bhargavi Gali, Elizabeth Cotter, Margo Short, Megan McNichol, Teresa A Mulaikal, Jessica Cassavaugh, Jarva Chow, Cortessa Russell, Shweta Y Golhar, Talia K Ben-Jacob","doi":"10.1097/CCE.0000000000001249","DOIUrl":"10.1097/CCE.0000000000001249","url":null,"abstract":"<p><strong>Objective: </strong>To systematically review and synthesize the evidence surrounding factors impacting women rising to leadership positions in critical care medicine (CCM).</p><p><strong>Data sources: </strong>PubMed, Embase, Web of Science, and Cochrane Library from 2011 to 2024.</p><p><strong>Study selection: </strong>Articles included were cohort studies, surveys, and interviews addressing women physicians practicing in CCM and related fields of academic medicine.</p><p><strong>Data extraction: </strong>Causes of not rising to leadership among women were extracted and tabulated along with other pertinent study characteristics.</p><p><strong>Data synthesis: </strong>The database searches generated 892 records. Thirty-nine studies met inclusion criteria for data extraction. The included articles represented seven countries, with 30 studies originating in the United States. Only two studies were from CCM, whereas others addressed leadership in other academic and clinical fields of medicine, medical journals, and societies and medical faculty. Twenty-six studies were qualitative, observational studies; five were survey based and eight included interviews. Using thematic analysis, the following five domains emerged: pipeline issues, lack of opportunities, lack of self-efficacy, lack of mentorship, and sustaining women in leadership.</p><p><strong>Conclusions: </strong>While the satisfaction rates of women in CCM were high, challenges remain for women to obtain leadership opportunities. A culture of support could better nurture and sustain women in leadership roles. More CCM-focused gender bias research is needed. Future targets for interventions include gender bias training, awareness, and developing strategies to break through the cycle of gender preferential promotions in CCM.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 4","pages":"e1249"},"PeriodicalIF":0.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11957621/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143736309","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":"Performance of Pediatric Risk of Mortality IV in Brazilian PICUs: A Multicenter Prospective Study.","authors":"Gustavo Rodrigues-Santos, Arnaldo Prata-Barbosa, Fernanda Lima-Setta, Pedro Henrique Nunes Costa Silami, Mariana Barros Genuíno de Oliveira, Jaqueline Rodrigues Robaina, José Colleti Júnior, Felipe Rezende Caino de Oliveira, Luís Fernando Andrade de Carvalho, Mariana Digiovanni, Ana Paula Novaes Bellinat, Thiago Peres da Silva, Taisa Roberta Ramos Nantes de Castilho, Simone Camera Gregory, Ana Carolina Cabral Pinheiro Scarlato, Paula Marins Riveiro, José Oliva Proença Filho, Antonio José Ledo Alves da Cunha, Maria Clara de Magalhães-Barbosa, Claudia de Souza Lopes","doi":"10.1097/CCE.0000000000001243","DOIUrl":"10.1097/CCE.0000000000001243","url":null,"abstract":"<p><strong>Importance: </strong>This is the first Brazilian study evaluating the performance of Pediatric Risk of Mortality (PRISM) IV and the first to use the calibration belt technique.</p><p><strong>Objectives: </strong>This study aimed to evaluate the performance of PRISM IV in a large cohort of patients admitted to Brazilian PICUs.</p><p><strong>Design, setting and participants: </strong>This is a longitudinal, prospective, multicenter study conducted in 36 Brazilian PICUs with children between 29 days and 18 years old admitted from March 2020 to March 2022.</p><p><strong>Main outcomes and measures: </strong>PRISM IV's performance was assessed using the standardized mortality ratio (SMR), the area under the receiver operating characteristic curve (AUROC) with 95% CI, and the calibration belt with 80% and 95% CI.</p><p><strong>Results: </strong>A total of 12,046 patients from 36 PICUs were included. Observed overall in-hospital mortality was higher than predicted: observed = 249 (2.1%) × predicted = 188.1 (1.56%) (SMR = 1.32 [95% CI, 1.16-1.50]); discrimination was good (AUROC = 0.86 [95% CI, 0.83-0.89]), and calibration was poor, underestimating mortality over a wide range of predicted mortality (2-61%). To explore the impact of the COVID-19 pandemic on PRISM IV's performance, we divided the study period into prevaccine and postvaccine. In the prevaccine period, the SMR was 1.38 (95% CI, 1.17-1.62), the AUROC was 0.84 (95% CI, 0.80-0.88), and the range of miscalibration was broader than in the total cohort (underestimation in the 2-98% range). In the postvaccine period, the SMR was 1.26 (95% CI, 1.03-1.51), the AUROC was 0.90 (95% CI, 0.86-0.94), and the calibration belt underestimated mortality in a narrower range of 3-46% of predicted mortality.</p><p><strong>Conclusions and relevance: </strong>PRISM IV showed good discrimination but miscalibration across a wide range of predicted mortality and different COVID-19 pandemic periods in a large cohort. Further research with subgroup analyses are needed to develop strategies to improve the performance of PRISM IV in different and heterogeneous Brazilian healthcare contexts.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 4","pages":"e1243"},"PeriodicalIF":0.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11957651/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143736307","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":"Evaluation of Plasma Biomarkers to Understand the Biology and Heterogeneity of Treatment Effect in Lower Tidal Volume Ventilation Facilitated by Extracorporeal CO2 Removal in Acute Hypoxemic Respiratory Failure: A Secondary Analysis of the REST Trial.","authors":"Andrew J Boyle, Kiran Reddy, John Conlon, Georg Auzinger, Jonathan Bannard-Smith, Nicholas A Barrett, Luigi Camporota, Michael A Gillies, Colette Jackson, Clíona McDowell, Brijesh Patel, Gavin D Perkins, Tamás Szakmány, William Tunnicliffe, Ingeborg D Welters, James J McNamee, Daniel F McAuley, Cecilia M O'Kane","doi":"10.1097/CCE.0000000000001246","DOIUrl":"10.1097/CCE.0000000000001246","url":null,"abstract":"<p><strong>Objectives: </strong>In patients with acute hypoxemic respiratory failure (AHRF), the use of lower tidal volume ventilation facilitated by veno-venous extracorporeal CO2 removal (vv-ECCO2R) does not improve clinical outcomes. The primary objective of this analysis was to evaluate for differences in indices of systemic inflammation and ventilator-induced lung injury between patients treated with lower tidal volume ventilation facilitated by vv-ECCO2R and standard care. Secondary objectives included an evaluation for heterogeneity of treatment effect.</p><p><strong>Design: </strong>Substudy of a randomized clinical trial.</p><p><strong>Setting: </strong>Nine U.K. ICUs.</p><p><strong>Patients: </strong>Moderate-to-severe AHRF (Pao2: Fio2 < 150mmHg [20ka]).</p><p><strong>Intervention: </strong>Plasma samples obtained at baseline and day 3.</p><p><strong>Measurements and main results: </strong>The primary outcome was day 3 C-reactive protein (CRP). Clinical outcomes included 90-day mortality and ventilator-free days (VFD) until day 28. Exploratory analyses included an evaluation of plasma indices of lung injury, inflammation, and heterogeneity of treatment effect (HTE). Seventy-nine patients were enrolled, and 69 patients had paired plasma samples taken at baseline and day 3. There was no difference in day 3 plasma CRP (intervention 138.6 [70.4, 189.4] vs. standard care 113.0 [62.7, 233.8] mg/L; p = 0.72). Between baseline and day 3, there was a greater increase in plasma interleukin-18 in patients that received intervention compared with those that received standard care (Δ 337.7 [-128.9, 738.9] vs. 6.4 [-457.2, 6.4] pg/mL p = 0.05). In patients with high interleukin-18, allocation to intervention was associated with increased VFDs (p = 0.03). Similarly in patients with a hyperinflammatory phenotype, the intervention was independently associated with increased VFDs (p < 0.01) and decreased 90-day mortality (p = 0.01).</p><p><strong>Conclusions: </strong>In patients with moderate-to-severe AHRF, lower tidal volume ventilation, facilitated by vv-ECCO2R, was not associated with a difference in day 3 plasma CRP, but was associated with an increase in plasma interleukin-18 between baseline and day 3. Baseline plasma interleukin-18 and inflammatory phenotypes may identify subgroups of patients with moderate-to-severe AHRF that benefit from lower tidal volume ventilation facilitated by vv-ECCO2R.</p><p><strong>Trial registration: </strong>NCT02654327.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 4","pages":"e1246"},"PeriodicalIF":0.0,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11952827/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143722849","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":"Health-Related Quality of Life of Adult Sepsis Survivors Following Critical Illness: A Systematic Review.","authors":"Sheraya De Silva, Anna Urwin, Chantal Grimwood, Ethan K E Goh, Alisa M Higgins, Carol L Hodgson","doi":"10.1097/CCE.0000000000001238","DOIUrl":"10.1097/CCE.0000000000001238","url":null,"abstract":"<p><strong>Objective: </strong>As survival following sepsis improves, there is increased attention on the health-related quality of life (HRQoL) of survivors following critical illness. The aim of this study is to systematically review the literature on the HRQoL of adult sepsis survivors following critical illness.</p><p><strong>Data sources: </strong>OVID MEDLINE, Embase, and CINAHL were searched using a combination of MeSH subject headings and keywords.</p><p><strong>Study selection: </strong>English-language studies published between January 2009 and June 2024, which investigated the HRQoL of adult sepsis survivors at 90 days or more following critical illness.</p><p><strong>Data extraction: </strong>Extracted data from included studies comprised HRQoL findings, the instruments administered, and representation of adult survivors following critical illness. Risk-of-bias quality assessment was assessed using the Cochrane Risk of Bias In Non-Randomised Studies - of Exposure tool. Selection of studies, data extraction, and quality assessment were conducted independently by two reviewers.</p><p><strong>Data synthesis: </strong>Thrity-three eligible studies were yielded from 25,611 records, with the sample size among included studies ranging from 55 to 2,151 participants. Included studies were mostly conducted in Europe. The EuroQol 5-dimension three-level instrument was most commonly administered (19 [58%] studies). Our review found that adult sepsis survivors following critical illness have lower HRQoL than population norms, regardless of follow-up timepoint. No significant difference was found in the HRQoL of adult survivors following critical illness with or without sepsis. High risk of bias in included studies was mostly due to missing data and confounding.</p><p><strong>Conclusions: </strong>As survival following critical illness improves, future research on improving long-term HRQoL following sepsis is crucial.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 4","pages":"e1238"},"PeriodicalIF":0.0,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11949298/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143733111","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":"Outcome Predictions at Two Time Points among Surrogates and Physicians of Mechanically Ventilated Patients.","authors":"Benjamin Dufour, Hannah M Duehren, Ashley Eaton England, Kevin Keuper, Thomas V Quinn, Raj C Shah, Quyen M Diep, James Gerhart, Jared A Greenberg","doi":"10.1097/CCE.0000000000001235","DOIUrl":"10.1097/CCE.0000000000001235","url":null,"abstract":"<p><strong>Objectives: </strong>The decisions surrogates and physicians make for incapacitated critically ill patients depend in part on their expectations for patient recovery. We sought to determine whether the accuracy of surrogate and physician outcome predictions made during the ICU stay improves over time.</p><p><strong>Design: </strong>Survey study.</p><p><strong>Setting: </strong>Academic Medical Center.</p><p><strong>Subjects: </strong>Surrogates and physicians of 100 mechanically ventilated patients from March 2018 to April 2019.</p><p><strong>Interventions: </strong>At the end of the first week of mechanical ventilation and 1 week later, participants indicated on visual analog scales (0-100%) expectations that the patient would require mechanical ventilation in 1 month, require artificial nutrition in 1 month, be alive in 3 months, and be living at home in 3 months. Patient status was determined at 1 and 3 months.</p><p><strong>Measurements and main results: </strong>Area under the receiver operating characteristic curves (AUROCs) were determined for each outcome, at each time point. Patients who died within the first month were considered to require mechanical ventilation and artificial nutrition in the primary analysis. AUROCs for initial surrogate predictions were 0.61 (95% CI, 0.50-0.72) for mechanical ventilation, 0.67 (95% CI, 0.56-0.78) for artificial nutrition, 0.66 (95% CI, 0.55-0.7) for survival, and 0.61 (95% CI, 0.50-0.73) for living at home. AUROCs for initial physician predictions were 0.60 (95% CI, 0.49-0.71) for mechanical ventilation, 0.72 (95% CI, 0.61-0.0.83) for artificial nutrition, 0.69 (95% CI, 0.59-0.80) for survival, and 0.76 (95% CI, 0.66-0.85) for living at home. Average expectations among surrogates and physicians were highly stable over time; adjustments made to expectations did not result in more accurate predictions for the measured outcomes (p > 0.05).</p><p><strong>Conclusions: </strong>Among surrogates and physicians of patients who were mechanically ventilated for 1 week, outcome predictions were better than would be expected by chance and not significantly improved 1 week later.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 4","pages":"e1235"},"PeriodicalIF":0.0,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11949294/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143733557","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 Impact of Extended-Hours Patient Recruitment on Critical Care Clinical Trial Enrollment.","authors":"John H Lee, Jacob Vine, Max Meier, Alan Berkovitz, Lakshman Balaji, Anne V Grossestreuer, Ari Moskowitz, Katherine M Berg, Michael W Donnino","doi":"10.1097/CCE.0000000000001239","DOIUrl":"10.1097/CCE.0000000000001239","url":null,"abstract":"<p><strong>Importance: </strong>Patient recruitment is a critical factor in running successful and timely clinical trials in the critical care field where the timing of presentation of patients is difficult to predict and the study interventions are often time sensitive.</p><p><strong>Objectives: </strong>The goal of this study was to analyze the timing of patient enrollments from previous clinical trials to identify patterns and assess the impact of providing extended-hours coverage on patient enrollment.</p><p><strong>Design, setting, and participants: </strong>This was a retrospective cohort study at a tertiary academic hospital in the United States between 2016 and 2024 on patients who were enrolled in five recent critical care clinical trials.</p><p><strong>Main outcomes and measures: </strong>We reviewed the patient enrollment data. We quantified the number of enrollments during business hours (9 am-5 pm) compared with outside of business hours and analyzed the frequency of enrollment by day of the week and time of day.</p><p><strong>Results: </strong>There were 352 patients enrolled between 2016 and 2024 across five clinical trials. A total of 242 patients (68.8%) were enrolled outside of business hours. 72.4% of patients were enrolled during weekdays and 27.6% during weekends. The enrollment pattern did not differ significantly across days of the week, ranging from 45 (12.8%) on Friday to 56 (15.9%) on Thursday. Enrollment from 2 pm to 10 pm accounted for more than 50% of the total enrollments. Recruiting only during business hours would have resulted in an additional 15 years to complete one of the trials.</p><p><strong>Conclusions and relevance: </strong>A review of our five recent critical care trials showed that nearly 70% of enrollment occurred outside of business hours. Limiting recruitment to only business hours would have resulted in a prohibitively longer time to complete the trials. This analysis provides a strong motivation and rationale for extending research staffing coverage beyond business hours.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 4","pages":"e1239"},"PeriodicalIF":0.0,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11949290/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143733559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring Peripheral and Respiratory Muscle Weakness and Functional Impairments in ICU Patients: Insights From a Resource-Constrained Setting.","authors":"Shanita Chhiba, Susan D Hanekom, Alison R Lupton-Smith","doi":"10.1097/CCE.0000000000001245","DOIUrl":"10.1097/CCE.0000000000001245","url":null,"abstract":"<p><strong>Importance and objectives: </strong>The aim of this study was to explore peripheral and respiratory muscle structure and strength from unit admission to hospital discharge among ICU patients in a resource-constrained setting.</p><p><strong>Design: </strong>Prospective, observational study.</p><p><strong>Setting: </strong>Tertiary academic hospital.</p><p><strong>Participants: </strong>Newly intubated critically ill adults admitted to the medical and surgical ICUs and expected to be mechanically ventilated for more than 48 hours were included in the study.</p><p><strong>Main outcomes and measures: </strong>Ultrasonography of the right hemi-diaphragm and quadriceps muscles were taken at admission for 3 consecutive days. Respiratory and peripheral muscle strength were evaluated using the Medical Research Council-Sum Score, dynamometry and maximal inspiratory pressure (MIP) at awakening, ICU discharge and hospital discharge.</p><p><strong>Results: </strong>Forty-five participants were included, with a median (interquartile range) age of 34.5 (24.3-47.4) years and 73% were male. Most of the change in diaphragm thickness was observed on day 3, with 5 (22%) participants showing a decrease of more than 10% from baseline. Minimal changes in rectus femoris cross-sectional area were noted during the first 3 days. Eleven participants (44%) presented with ICU-acquired weakness at awakening, which decreased to 7 (29%) participants at ICU discharge and 5 (24%) participants at hospital discharge. The mean ± sd percentage of predicted quadriceps force was 22.2 ± 5.1 N at hospital discharge. The mean ± sd percentage of predicted MIP scores was 29.6% ± 10.5% at ICU discharge and 29.1% ± 8.6% at hospital discharge.</p><p><strong>Conclusions and relevance: </strong>Patients discharged from the ICU in a resource-constrained setting presented with peripheral and respiratory muscle weakness, with minimal change in muscle structure shown by ultrasonography, despite short ICU stays, low Acute Physiology and Chronic Health Evaluation II scores, and a relatively young age. Future research should explore whether these findings indicate a distinct phenotype of critical illness in such environments.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 4","pages":"e1245"},"PeriodicalIF":0.0,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11949296/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143732625","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":"Multicenter Development and Prospective Validation of eCARTv5: A Gradient-Boosted Machine-Learning Early Warning Score.","authors":"Matthew M Churpek, Kyle A Carey, Ashley Snyder, Christopher J Winslow, Emily Gilbert, Nirav S Shah, Brian W Patterson, Majid Afshar, Alan Weiss, Devendra N Amin, Deborah J Rhodes, Dana P Edelson","doi":"10.1097/CCE.0000000000001232","DOIUrl":"10.1097/CCE.0000000000001232","url":null,"abstract":"<p><strong>Background: </strong>Early detection of clinical deterioration using machine-learning early warning scores may improve outcomes. However, most implemented scores were developed using logistic regression, only underwent retrospective validation, and were not tested in important subgroups.</p><p><strong>Objective: </strong>The objective of our multicenter retrospective and prospective observational study was to develop and prospectively validate a gradient-boosted machine model (eCARTv5) for identifying clinical deterioration on the wards.</p><p><strong>Derivation cohort: </strong>All adult patients admitted to the inpatient medical-surgical wards at seven hospitals in three health systems for model development (2006-2022).</p><p><strong>Validation cohort: </strong>All adult patients admitted to the inpatient medical-surgical wards and at 21 hospitals from three health systems for retrospective (2009-2023) and prospective (2023-2024) external validation.</p><p><strong>Prediction model: </strong>Predictor variables (demographics, vital signs, documentation, and laboratory values) were used in a gradient-boosted trees algorithm to predict ICU transfer or death in the next 24 hours. The developed model (eCARTv5) was compared with the Modified Early Warning Score (MEWS), the National Early Warning Score (NEWS), and eCARTv2 using the area under the receiver operating characteristic curve (AUROC).</p><p><strong>Results: </strong>The development cohort included 901,491 admissions, the retrospective validation cohort included 1,769,461 admissions, and the prospective validation cohort included 205,946 admissions. In retrospective validation, eCARTv5 had the highest AUROC (0.834; 95% CI, 0.834-0.835), followed by eCARTv2 (0.775 [95% CI, 0.775-0.776]), NEWS (0.766 [95% CI, 0.766-0.767]), and MEWS (0.704 [95% CI, 0.703-0.704]). eCARTv5's performance remained high (AUROC ≥0.80) across a range of patient demographics, clinical conditions, and during prospective validation.</p><p><strong>Conclusion: </strong>We developed eCARTv5, which performed better than eCARTv2, NEWS, and MEWS retrospectively, prospectively, and across a range of subgroups. These results served as the foundation for Food and Drug Administration clearance for its use in identifying deterioration in hospitalized ward patients.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 4","pages":"e1232"},"PeriodicalIF":0.0,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11949291/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143733149","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":"Visual-Guided Transillumination Method for Accurate Percutaneous Tracheal Tube Placement.","authors":"Diane C McLaughlin, Michael P Schaller, Julian Bösel, Mohamad Chmayssani","doi":"10.1097/CCE.0000000000001227","DOIUrl":"10.1097/CCE.0000000000001227","url":null,"abstract":"<p><strong>Background: </strong>Percutaneous tracheostomy (PT) is generally considered a safe procedure, but complications such as malpositioning, bleeding, and tracheal ring rupture remain concerns, particularly during initial needle insertion. This study investigates the feasibility, ease of use, and safety of a novel device and technique for bedside PT, named the Illuminated Tracheal Alignment Guide (iTAG).</p><p><strong>Methods: </strong>An interventional pilot study evaluated the feasibility and safety of the iTAG device and method. The study was approved by our local institutional review board and a Food and Drug Administration waiver was granted for use of our device. Patients in a neurocritical care unit requiring tracheostomy were screened and consented for inclusion. Exclusion criteria included significant vascular overlap and specific ventilator settings. The iTAG method involves a laser light source and a needle guide with a hard stop, used in conjunction with standard PT equipment. Data on demographics, procedure details, and early complications were collected and compared with historical control data from patients who underwent standard tracheostomy (ST).</p><p><strong>Results: </strong>From January 2023 to July 2024, 30 patients underwent PT using the iTAG device. The mean time from intubation to tracheostomy was 15.53 days, with a mean ICU length of stay of 31.14 days. The iTAG group experienced significantly fewer early complications compared with the historical ST control group, including reduced hemorrhage, and there were no instances of tracheal ring fracture, posterior wall injury, or pneumothorax. The iTAG method allowed for safe PT in all patients.</p><p><strong>Conclusions: </strong>The iTAG device enhances the safety and efficacy of PT by providing precise visualization and limiting needle penetration, reducing early complications. Its use expands patient candidacy for PT and offers a valuable tool for training less-experienced practitioners. Further research with larger cohorts and randomized controlled trials is needed to confirm these findings and establish the iTAG method as a standard of care for PT.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 4","pages":"e1227"},"PeriodicalIF":0.0,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11949292/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143722765","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}