Critical care explorations最新文献

{"title":"Blood Transfusion Practices in Intensive Care: A Prospective Observational Binational Study.","authors":"Andrew W J Flint, Alexis Poole, Senta Jorinde Raasveld, Michael Bailey, Karina Brady, Pin-Yen Chen, Yan Chen, D Jamie Cooper, Craig French, Alisa Higgins, Adam H Irving, Richard E McAllister, Ary Serpa Neto, Tony Trapani, Neil Waters, James Winearls, Michael C Reade, Erica M Wood, Alexander P J Vlaar, Zoe K McQuilten","doi":"10.1097/CCE.0000000000001197","DOIUrl":"10.1097/CCE.0000000000001197","url":null,"abstract":"<p><strong>Importance: </strong>Blood transfusions are a common and potentially lifesaving intervention in ICU patients but are associated with harm and often transfused inconsistently with guidelines. However, it is not well known how ICU transfusion practice has recently changed and if there is variation in transfusion practice.</p><p><strong>Objectives: </strong>To describe blood transfusion practices in ICU, the variation in practice across sites, and to compare transfusion practices against national guidelines and with prior published practice.</p><p><strong>Design, setting, and participants: </strong>A prospective, multicenter, binational, observational study conducted in 40 Australian and New Zealand ICUs from October 2021 to July 2022. All adult (≥ 18 yr) ICU patients admitted over 1 week were included and followed until ICU discharge or 28 days.</p><p><strong>Main outcomes and measures: </strong>Types of transfusion, thresholds and reasons for transfusions, the use of viscoelastic hemostatic assays (VHAs), variation in transfusion practice across sites, and changes in transfusion practice over time.</p><p><strong>Results: </strong>Of 927 patients, 217 (23.4%) received a blood transfusion during their ICU admission-192 (20.7%) received RBCs, 63 (6.8%) received platelets, 49 (5.3%) received fresh frozen plasma (FFP), and 29 (3.1%) received cryoprecipitate. Massive transfusion protocols were implemented nine times for six patients (0.7%). VHA were used in 25 of 268 (9.3%) non-RBC transfusions. Compared with national guidelines, 89.0% of RBC transfusions, 30.3% of platelet, 27.4% of FFP, and 20.0% of cryoprecipitate transfusions were consistent. Compared with ICU transfusion practices in 2008, after adjusting for confounding variables, ICU patients who received RBC and FFP were transfused more units each, and variation in total transfusions across sites increased for RBC, platelets, and FFP.</p><p><strong>Conclusions and relevance: </strong>Blood transfusions are common in ICU, but the practice is heterogeneous and frequently inconsistent with national guidelines, and the number of units transfused per patient has increased. More evidence is required.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 3","pages":"e1197"},"PeriodicalIF":0.0,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11845186/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143470272","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":"Variation in Corticosteroid Prescribing Practices for Patients With Septic Shock.","authors":"Kanupriya Soni, John S Minturn, Billie S Davis, Leigh A Bukowski, Jeremy M Kahn, Ian J Barbash","doi":"10.1097/CCE.0000000000001196","DOIUrl":"10.1097/CCE.0000000000001196","url":null,"abstract":"<p><strong>Objectives: </strong>Understanding sources of variation in acute care delivery may inform targeted strategies to promote evidence-uptake. We sought to characterize physician-level and ICU-level variation in corticosteroid prescribing for patients with septic shock.</p><p><strong>Design: </strong>We performed a retrospective cohort study using the electronic health record of a multihospital health system. We identified ICU patients with septic shock admitted between 2018 and 2020. Using medication administration data, we determined which patients received corticosteroids within 2 days of vasopressor initiation. We linked each patient to their attending physician of record using digital signatures from clinical documentation. We then fit a hierarchical mixed-effects logistic regression model to identify factors associated with corticosteroid use and quantify variation in corticosteroid administration across physicians and ICUs.</p><p><strong>Setting: </strong>Twenty-six ICUs across nine hospitals in the United States.</p><p><strong>Patients: </strong>ICU patients with septic shock.</p><p><strong>Measurements and main results: </strong>Of 5322 patients with vasopressor dependent septic shock, 1294 (24.3%) were treated with corticosteroids within 2 days of vasopressor initiation. We linked these patients to 174 unique attending physicians across 26 ICUs. At the ICU-level, median corticosteroid use was 21.8% (interquartile range [IQR], 18.5-25.7%). At the physician-level, median corticosteroid use was 22.0% (IQR, 11.9-32.7%). In the mixed-effects regression controlling for patient and physician characteristics, 16.5% of the variation in corticosteroid administration was attributable to the ICUs and 10.1% was attributable to the physicians.</p><p><strong>Conclusions: </strong>Both ICUs and physicians contribute to observed variation in the use of corticosteroids for vasopressor dependent septic shock. These findings underscore the need for multilevel interventions to standardize evidence-based practices in critical care.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 3","pages":"e1196"},"PeriodicalIF":0.0,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11845208/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143470273","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 Association Between Selective Serotonin Reuptake Inhibitors and the Incidence of Delirium in Critically Ill Patients: A Systematic Review.","authors":"Hailey Schwab, Benjamin Sines, Elizabeth Moreton, Ben Julian Palanca, C Adrian Austin","doi":"10.1097/CCE.0000000000001217","DOIUrl":"10.1097/CCE.0000000000001217","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate the: 1) correlation between the maintenance or cessation of selective serotonin reuptake inhibitors (SSRIs) during hospitalization and the incidence of delirium among critically ill patients; 2) evaluate the effectiveness of utilizing SSRIs as a potential intervention for managing delirium in critically ill adults; and 3) evaluate the effects of continuing SSRIs in patients who were previously prescribed these medications on incidence of delirium or withdrawal symptoms manifesting as delirium.</p><p><strong>Data sources: </strong>PubMed, Scopus, Embase, PsycInfo, and ProQuest Central, and additional studies identified from reference lists and relevant systematic reviews.</p><p><strong>Study selection: </strong>Studies included adults 18 years old and older with critical illness necessitating ICU care administered SSRIs during their hospital stay, where delirium and/or adverse effects were reported as outcomes.</p><p><strong>Data extraction: </strong>Two team members extracted data from included studies into evidence tables, which were subsequently discussed to synthesize and align the extracted findings. Extraction criteria included study population and the type of control or comparison group, exposures, primary and secondary outcome measures, results, and implications. We used Study Quality Assessment Tools provided by the National Heart, Lung, and Blood Institute and National Institutes of Health public websites along with the TREND checklist to evaluate the quality of articles and analyze for bias.</p><p><strong>Data synthesis: </strong>Two reviewers analyzed the studies' risk for bias. Analysis followed the Grading of Recommendations Assessment, Development, and Evaluation criteria used in Cochrane systematic reviews. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist to design and report the study.</p><p><strong>Conclusions: </strong>The cessation of SSRIs in patients who were previously prescribed these medications is associated with an increased incidence of delirium or withdrawal symptoms manifesting as delirium. Continuing these medications in the setting of critical illness may mitigate the risk of delirium. Further investigation is warranted into the impact of SSRIs on delirium in patients not taking these medications prior to ICU admission.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 2","pages":"e1217"},"PeriodicalIF":0.0,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11838155/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143443016","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":"Diagnostic Performance and Impact on Antimicrobial Treatment of a Multiplex Polymerase Chain Reaction in Critically Ill Patients With Pneumonia: A Multicenter Observational Study (The MORICUP-PCR Study: Morocco ICU Pneumonia-PCR study).","authors":"Younes Aissaoui, Ali Derkaoui, Abdelhamid Hachimi, Ayoub Bouchama, Tarek Dendane, Mouhssine Doumiri, Karim ElAidaoui, Amra Ziadi, Meryem Essafti, Latifa Oualili, Mehdi Khaddouri, Oumaima Mroune, Mehdi Oudrhiri Safiani, Mohammed Khallouki, Adnane Berdai, Brahim Boukatta, Ahmed Rhassane El Adib, Naoufel Madani, Nabila Soraa, Ayoub Belhadj, Jamal Eddine Kohen, Redouane Abouqal","doi":"10.1097/CCE.0000000000001220","DOIUrl":"10.1097/CCE.0000000000001220","url":null,"abstract":"<p><strong>Objectives: </strong>Managing severe pneumonia remains a challenge. Rapid diagnostic tests, such as multiplex polymerase chain reaction (mPCR), facilitate quick microorganism identification and may enable timely and appropriate antimicrobial therapy. However, studies from low-income countries are scarce. This study aimed to evaluate the diagnostic characteristics of mPCR and its impact on antibiotic therapy and outcomes in critically ill patients with pneumonia.</p><p><strong>Design: </strong>Multicenter observational study.</p><p><strong>Setting: </strong>Twelve ICUs across Morocco.</p><p><strong>Patients: </strong>Adult patients with pneumonia requiring invasive mechanical ventilation, including community-acquired pneumonia (CAP), hospital-acquired pneumonia (HAP), and ventilator-associated pneumonia (VAP).</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Respiratory samples were analyzed using both mPCR and conventional microbiological methods. The diagnostic performance of mPCR was evaluated, including its sensitivity and specificity. Additionally, the appropriateness of mPCR-induced modifications in empiric antibiotic therapy and their impact on patient outcomes were assessed. A total of 210 patients were included, with a median age of 50 years (range, 33-67 yr), of whom 66.2% were male. Pneumonia types were distributed as 30% CAP, 58% VAP, and 12% HAP. mPCR demonstrated a sensitivity of 96.9% (95% CI, 92.3-99.2%) and a specificity of 92% (95% CI, 91-93%). Following mPCR, antibiotic therapy modifications were observed in 58% of patients (n = 122), including de-escalation or cessation in 11% (n = 23), escalation in 26.5% (n = 56), adequacy adjustments in 7.5% (n = 16), and initiation of antibiotics in 13% (n = 27). The appropriateness of antibiotic therapy increased significantly from 38.7% (n = 83) to 67% (n = 141; difference, 27.5%; 95% CI, 18.3-36.7; p < 0.0001). Generalized mixed model analysis revealed that appropriate post-mPCR antibiotic therapy was associated with reduced mortality (adjusted odds ratio, 0.37; 95% CI, 0.15-0.93; p = 0.038).</p><p><strong>Conclusions: </strong>Our findings suggest that the use of mPCR is associated with a significant improvement in the appropriateness of empiric antibiotic therapy and is also associated with a positive impact on the outcome of patients with pneumonia.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 2","pages":"e1220"},"PeriodicalIF":0.0,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11826045/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143401033","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":"Association of Causative Pathogens With Acute Kidney Injury in Adult Patients With Community-Onset Sepsis.","authors":"Praruj Pant, Shingo Chihara, Vijay Krishnamoorthy, Miriam M Treggiari, Julia A Messina, Jamie R Privratsky, Karthik Raghunathan, Tetsu Ohnuma","doi":"10.1097/CCE.0000000000001219","DOIUrl":"10.1097/CCE.0000000000001219","url":null,"abstract":"<p><strong>Importance: </strong>The influence of disease-causing pathogen on acute kidney injury (AKI) in septic patients is poorly understood.</p><p><strong>Objectives: </strong>We examined the association of microbial pathogen with AKI among patients with community-onset sepsis.</p><p><strong>Design, setting, and participants: </strong>This was a retrospective cohort study. Patient data were acquired from the nationwide multicenter PINC AI Healthcare Database (2016-2020). Participants included adult patients with Centers for Disease Control and Prevention-defined community-onset sepsis.</p><p><strong>Main outcomes and measures: </strong>The primary exposure was pathogen type identified by culture growth. Microbial cultures from any site were included. The primary endpoint was development of AKI within 7 days of admission using the Kidney Disease: Improving Global Outcomes serum creatinine criteria. We used multilevel logistic regression to examine the association between pathogen type and AKI. Escherichia coli-positive cultures were used as the reference category.</p><p><strong>Results: </strong>We included 119,733 patients with community-onset sepsis. The median age was 67 years, 33.3% were mechanically ventilated, 36.1% received vasopressors, and hospital mortality was 13.1%. Forty-two thousand twenty-seven patients (35.1%) developed stage 1 AKI, 22,979 (19.2%) developed stage 2 AKI, and 25,073 (20.9%) developed stage 3 AKI. Relative to patients with E. coli infection (odds ratio [OR], 1.0), Proteus species (OR, 1.26; 95% CI, 1.06-1.50), and Streptococcus species (OR, 1.24; 95% CI, 1.10-1.41) were associated with increased odds of AKI. Meanwhile, Pseudomonas aeruginosa (OR, 0.56; 95% CI, 0.49-0.64) and Serratia species (OR, 0.70; 95% CI, 0.52-0.94) were associated with decreased odds of AKI.</p><p><strong>Conclusions and relevance: </strong>The causative pathogen in patients with sepsis may influence the development of AKI. Further mechanistic and clinical research is needed to confirm these findings and to explore how different pathogens may affect AKI risk in critically ill patients.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 2","pages":"e1219"},"PeriodicalIF":0.0,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11826047/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143401020","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":"Effect of Single-Prong Cannula Design With High Velocity Therapy: Comparable Efficacy at Lower Gas Flow Rates.","authors":"Charles Atwood, Jigme Sethi, Amy Bergeski, George C Dungan, Leonithas I Volakis, Jessica S Whittle","doi":"10.1097/CCE.0000000000001209","DOIUrl":"10.1097/CCE.0000000000001209","url":null,"abstract":"<p><strong>Objectives: </strong>High velocity therapy (HVT), a form of high-flow oxygen therapy, utilizing a small-bore nasal cannula has been widely used in acute care settings. A new dual-prong (newDP) cannula made using more comfortable material and a single-prong (SP) cannula were evaluated to compare comfort and functionality as measured by relief of dyspnea of patients with chronic obstructive pulmonary disease (COPD) receiving HVT therapy.</p><p><strong>Design: </strong>Randomized crossover evaluation.</p><p><strong>Setting: </strong>Outpatient and in patient critical care setting.</p><p><strong>Patients: </strong>Patients with hypercapnic COPD presenting with dyspnea above baseline.</p><p><strong>Interventions: </strong>HVT therapy was provided using an existing HVT dual-prong nasal cannula (traditional) to determine the most efficacious flow rate. Patients were then randomized to receive either the newDP cannula, or the SP cannula, and retitrated for optimal flow rate. During each session of therapy, Rated Perceived Dyspnea (RPD) scores, vital signs, transcutaneous carbon dioxide partial pressure (PTCco2) levels, and clinician/ patient perceptions were documented.</p><p><strong>Measurements and main results: </strong>Of 31 enrolled, 26 patients completed the trial. The median flow rate that relieved dyspnea for the traditional, newDP, and SP cannulas were 25 L/min (20-30 L/min), 25 L/min (19.1-30 L/min), and 15 L/min (13-17 L/min), respectively. The change in RPD from baseline for traditional, newDP, and SP were -1 (-1 to 0), -1 (-2 to -1), and -1 (-2 to -1). Change in RPD from baseline for newDP and SP compared with the traditional cannula was significantly different (p = 0.044 and p = 0.01, respectively). Changes in vital signs and PTCco2 were similar between the three cannula types compared with baseline. The SP cannula provided comparable therapeutic efficacy at significantly lower flow rates (traditional vs. SP; p < 0.0001 and newDP vs. SP; p < 0.0001).</p><p><strong>Conclusions: </strong>The new cannula designs provided comparable relief of dyspnea. The single-prong cannula provided comparable efficacy at significantly lower flow rates (traditional vs. SP; p < 0.0001 and newDP vs. SP; p < 0.0001). The use of a single-prong cannula with HVT warrants further study.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 2","pages":"e1209"},"PeriodicalIF":0.0,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11826042/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143401036","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":"Hydroxyurea for Malignant Pertussis in Critically Ill Children.","authors":"Matthieu Blanc, Clémence Marais, Alexandre Debs, Vladimir L Cousin, Pierre Tissières","doi":"10.1097/CCE.0000000000001218","DOIUrl":"10.1097/CCE.0000000000001218","url":null,"abstract":"<p><strong>Objectives: </strong>Malignant pertussis, the most severe manifestation of Bordetella pertussis infection, is characterized by multiple organ failure and a high mortality rate despite advanced intensive care measures. Hyperleukocytosis is the hallmark of malignant pertussis and necessitates urgent and aggressive interventions. Among the therapeutic options, leukoreduction via whole blood exchange (BE) transfusion has been associated with significant procedural risks and potential clinical deterioration. Hydroxyurea was recently proposed as a pharmacological alternative for leukoreduction. This study reports our clinical experience with hydroxyurea as an alternative to BE in managing infants with malignant pertussis admitted to a PICU.</p><p><strong>Design: </strong>Prospective case series.</p><p><strong>Setting: </strong>A referral PICU in France.</p><p><strong>Patients: </strong>Critically ill infants (n = 27) with severe pertussis infection.</p><p><strong>Interventions: </strong>Hydroxyurea therapy or BE transfusion.</p><p><strong>Measurements and main results: </strong>We reviewed all critically ill infants admitted to our unit for severe pertussis between January 2017 and July 2024. The primary outcome was 28-day survival, and the secondary outcome was the efficacy of hydroxyurea on blood leukocyte count reduction. Among the 27 infants admitted for severe pertussis, 12 exhibited features of malignant pertussis. Of these, seven were treated with hydroxyurea and five with BE. The majority of infants were term and under 3 months old. All patients required ventilatory support, with eight on invasive mechanical ventilation and three receiving extracorporeal membrane oxygenation therapy. Overall mortality was three of 12 (25%). Hydroxyurea was administered at a dose of 20 mg/kg/d for a median duration of 12 days. Hyperleukocytosis was successfully reduced within 7 days.</p><p><strong>Conclusions: </strong>Hydroxyurea is an alternative therapy for malignant pertussis infection that can efficiently address hyperleukocytosis with limited mortality.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 2","pages":"e1218"},"PeriodicalIF":0.0,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11826043/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143401038","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":"Invasive Arterial Pressure Monitoring: Are We Confident Making Decisions Based on Reliable Values?","authors":"Frédérique Schortgen, Caroline Le Bec","doi":"10.1097/CCE.0000000000001216","DOIUrl":"10.1097/CCE.0000000000001216","url":null,"abstract":"<p><p>A prerequisite for accurate invasive arterial pressure measurement is familiarity with measurement principles and pitfalls. Using an electronic survey, we assessed knowledge about invasive arterial pressure monitoring and current invasive arterial pressure monitoring practices in the ICU. The questionnaire was sent to nurses and physicians who are members of the French Intensive Care Society and the Réseau Européen de Recherche en Ventilation Artificielle network. Three hundred nine nurses and 76 physicians responded. We identified considerable gaps in knowledge and differences in practices that can significantly impact the reliability of invasive arterial pressure measurement, mainly the confusion between zeroing and leveling the transducer and the heterogeneity in external landmarks choice for the phlebostatic axis. In modern critical care, where mean arterial pressure targets are recommended and where patients are awake and/or frequently mobilized, standardized invasive arterial pressure monitoring is required.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 2","pages":"e1216"},"PeriodicalIF":0.0,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11822339/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392747","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":"Invasive Arterial Pressure Monitoring: Are We Confident Making Decisions Based on Reliable Values?","authors":"Frédérique Schortgen, Caroline Le Bec","doi":"10.1097/CCE.0000000000001216","DOIUrl":"10.1097/CCE.0000000000001216","url":null,"abstract":"<p><p>A prerequisite for accurate invasive arterial pressure measurement is familiarity with measurement principles and pitfalls. Using an electronic survey, we assessed knowledge about invasive arterial pressure monitoring and current invasive arterial pressure monitoring practices in the ICU. The questionnaire was sent to nurses and physicians who are members of the French Intensive Care Society and the Réseau Européen de Recherche en Ventilation Artificielle network. Three hundred nine nurses and 76 physicians responded. We identified considerable gaps in knowledge and differences in practices that can significantly impact the reliability of invasive arterial pressure measurement, mainly the confusion between zeroing and leveling the transducer and the heterogeneity in external landmarks choice for the phlebostatic axis. In modern critical care, where mean arterial pressure targets are recommended and where patients are awake and/or frequently mobilized, standardized invasive arterial pressure monitoring is required.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 2","pages":"e1216"},"PeriodicalIF":0.0,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11822339/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143416398","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":"Association of Obesity With Sedative Dosing, Sedative Response, and Clinical Outcomes in Mechanically Ventilated Critically Ill Children.","authors":"Shan L Ward, Onella S Dawkins-Henry, Lisa A Asaro, David Wypij, Martha A Q Curley","doi":"10.1097/CCE.0000000000001214","DOIUrl":"10.1097/CCE.0000000000001214","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to investigate the impact of obesity on the use of analgesics and sedatives, rates of iatrogenic withdrawal syndrome (IWS), and outcomes in mechanically ventilated pediatric patients. Additionally, it sought to assess whether a nurse-implemented sedation protocol would be equally effective for children with and without obesity.</p><p><strong>Design: </strong>Secondary analysis of the Randomized Evaluation of Sedation Titration for Respiratory Failure (RESTORE) pediatric multicenter clinical trial.</p><p><strong>Setting: </strong>Thirty-one U.S. PICUs.</p><p><strong>Patients: </strong>Children 1-17 years old, categorized as with or without obesity according to World Health Organization and Centers for Disease Control and Prevention criteria.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>The study assessed various factors including medication exposure, adequacy of pain and sedation management, IWS rates, and clinical outcomes. Obesity occurred in 22% of patients. Obesity did not influence choice of opiate, but it led to extended exposure to these medications. There were no differences in dosing per kilogram of admission weight, resulting in significantly higher daily and cumulative doses in those with obesity. In the protocolized sedation arm, patients with obesity received significantly higher median opiate doses compared with the nonobesity protocolized sedation group. IWS rates did not differ; however, protocolized sedation obesity patients experienced more instances of inadequate sedation, longer time to extubation readiness, longer duration of mechanical ventilation and PICU stay, and higher 28-day in-hospital mortality than the protocolized sedation nonobesity group. These weight-based differences were not noted in the usual care arm.</p><p><strong>Conclusions: </strong>This study underscores the significance of accounting for body habitus when selecting and dosing opiates in children with acute respiratory failure. Obesity had substantial impact on medication exposure and clinical outcomes, particularly within a structured, protocolized sedation regimen. Further research is warranted to explore the intricate relationship between medication dosing and clinical outcomes in children with obesity.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 2","pages":"e1214"},"PeriodicalIF":0.0,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11813009/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392745","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}