Critical care explorations最新文献

{"title":"Representation of Hispanic Patients in Clinical Trials for Respiratory Failure: A Systematic Review.","authors":"Emily A Harlan, Kaitlin Malley, Grecia Quiroga, Eman Mubarak, Pema Lama, Amanda Schutz, Adolfo Cuevas, Catherine L Hough, Theodore J Iwashyna, Mari Armstrong-Hough, Thomas S Valley","doi":"10.1097/CCE.0000000000001193","DOIUrl":"10.1097/CCE.0000000000001193","url":null,"abstract":"<p><strong>Objectives: </strong>Hispanic individuals comprise one-fifth of the U.S. population and Hispanic patients with acute hypoxemic respiratory failure (AHRF) experience higher odds of death compared with non-Hispanic White patients. Representation of Hispanic patients in clinical trials for respiratory failure is critical to address this inequity. We conducted a systematic review to examine the inclusion of Hispanic patients in randomized controlled trials for AHRF and assessed language as a potential barrier to enrollment.</p><p><strong>Data sources: </strong>National Library of Medicine PubMed, Elsevier Embase, and Cochrane Central Register of Controlled Trials databases through January 2024.</p><p><strong>Study selection: </strong>Randomized controlled trials assessing AHRF interventions enrolling U.S. patients receiving mechanical ventilation, noninvasive mechanical ventilation, or high-flow nasal cannula were included. The systematic review was registered prospectively through PROSPERO (CRD42023437828).</p><p><strong>Data extraction: </strong>Two authors independently screened studies and extracted data for each included study.</p><p><strong>Data synthesis: </strong>Ninety-four trials published from 1975 to 2023 were included; 33.0% (n = 31) of studies reported ethnicity, and 11.2% of participants in studies reporting race or ethnicity (1,320/11,780) were identified as Hispanic. The proportion of Hispanic-identified participants was significantly lower than the U.S. Hispanic population from 1996 to 2019 (p < 0.01). Starting in 2020, the proportion of Hispanic-identified participants was significantly higher than the U.S. population (27.8% vs. 19.1%; p < 0.01). Two studies (4.9%) reporting race or ethnicity excluded non-English speaking participants; the remainder did not specify language requirements for enrollment.</p><p><strong>Conclusions: </strong>Hispanic-identified individuals were underrepresented in trials for AHRF until 2020 when Hispanic patient representation increased during COVID-19. Exclusion of participants who do not speak English may represent a barrier to trial enrollment.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 1","pages":"e1193"},"PeriodicalIF":0.0,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11732656/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142973722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding ICU Nursing Knowledge, Perceived Barriers, and Facilitators of Sepsis Recognition and Management: A Cross-Sectional Study.","authors":"Katherine A Kissel, Karla D Krewulak, Thérèse G Poulin, Ken Kuljit S Parhar, Daniel J Niven, Vanessa M Doiron, Kirsten M Fiest","doi":"10.1097/CCE.0000000000001200","DOIUrl":"10.1097/CCE.0000000000001200","url":null,"abstract":"<p><strong>Importance: </strong>Nursing workforce changes, knowledge translation gaps, and environmental/organizational barriers may impact sepsis recognition and management within the ICU.</p><p><strong>Objectives: </strong>To: 1) evaluate current ICU nursing knowledge of sepsis recognition and management, 2) explore individual and environmental or organizational factors impacting nursing recognition and management of sepsis using the Theoretical Domains Framework (TDF), and 3) describe perceived barriers and facilitators to nursing recognition and management of patients with sepsis.</p><p><strong>Design, setting, and participants: </strong>This cross-sectional survey was administered to nurses working in four general system ICUs between October 24, 2023, and January 30, 2024.</p><p><strong>Main outcomes and measures: </strong>Quantitative questions (single/multiple choice, true/false, and Likert-based questions eliciting agreement with a statement) were analyzed using descriptive statistics. Open-ended questions exploring barriers and facilitators to sepsis recognition and management were analyzed using qualitative content analysis.</p><p><strong>Results: </strong>A total of 101 completed survey responses were retained. Most nurses agreed early sepsis detection saves lives (n = 98, 97%, TDF domain Beliefs About Consequences) and that nursing care can improve patient outcomes (n = 97, 96%, TDF domain Optimism). Fewer nurses agreed it was easy to identify priority sepsis interventions based on order urgency (n = 53, 53%, TDF domain Memory, Attention, and Decision Processes). Reoccurring barriers and facilitators to sepsis recognition and management were commonly identified across the TDF domains of Knowledge, Skills, Environmental Context and Resources, and Social Influences, including competency deficit (with facilitators including support from colleagues), workload or staffing, and equipment or resource availability.</p><p><strong>Conclusion and relevance: </strong>ICU nursing sepsis recognition and management is impacted by numerous individual, environmental, and organizational factors. Recommendations include enhanced competency development or support, utilization of structured reinforcement measures (involving the interdisciplinary team and imploring the use of integrative technologies), and addressing equipment/resource-related gaps. Future research and improvement initiatives should use a theory-informed approach to overcome the pervasive, complex challenges impeding timely sepsis recognition and management.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 1","pages":"e1200"},"PeriodicalIF":0.0,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11732647/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142973730","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":"Three-Dimensional Electrical Impedance Imaging During Spontaneous Breathing Trials in Patients With Acute Hypoxic Respiratory Failure: A Pilot Study.","authors":"Nilton Barbosa da Rosa, Tzu-Jen Kao, John Brinton, Patrick J Offner, Ellen L Burnham, Jennifer L Mueller","doi":"10.1097/CCE.0000000000001198","DOIUrl":"10.1097/CCE.0000000000001198","url":null,"abstract":"<p><p>The purpose of this work is to evaluate the feasibility of lung imaging using 3D electrical impedance tomography (EIT) during spontaneous breathing trials (SBTs) in patients with acute hypoxic respiratory failure. EIT is a noninvasive, nonionizing, real-time functional imaging technique, suitable for bedside monitoring in critically ill patients. EIT data were collected in 24 mechanically ventilated patients immediately preceding and during a SBT on two rows of 16 electrodes using a simultaneous multicurrent source EIT system for 3D imaging. Dynamic 3D EIT images of conductivity were computed, as well as the EIT-derived rapid shallow breathing index, regional ventilation delay, global inhomogeneity index, and time traces of tidal volumes. 3D reconstructions and derived measures demonstrated inhomogeneity in ventilation distribution within patients. We conclude that 3D EIT images can provide information regarding ventilatory heterogeneity across the lung and may be useful in guiding ventilator management.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 1","pages":"e1198"},"PeriodicalIF":0.0,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11732654/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142973728","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 Complete Blood Count Sepsis Index Using Monocyte Distribution Width for Early Detection of Sepsis in Patients Without Obvious Signs.","authors":"Scott Levin, Nima Sarani, Jeremiah Hinson, Melissa Naiman, Chad Cannon, Aria Smith, Benjamin Steinhart, Arnaud DeBraine, Sarah Kehoe, Bryan Immhoff, Yasir Taribichi, Alexandra Malinovska, Kemi Badaki-Makun","doi":"10.1097/CCE.0000000000001194","DOIUrl":"10.1097/CCE.0000000000001194","url":null,"abstract":"<p><strong>Objectives: </strong>Exploiting the complete blood count (CBC) with differential (CBC-diff) for early sepsis detection has practical value for emergency department (ED) care, especially for those without obvious presentations. The objective of this study was to develop the CBC Sepsis Index (CBC-SI) that incorporates monocyte distribution width (MDW) to enhance rapid sepsis screening.</p><p><strong>Design: </strong>A retrospective observational study.</p><p><strong>Setting: </strong>The ED of the University of Kansas Medical Center, United States.</p><p><strong>Patients: </strong>All adult patients (age 18 or over) presenting to the ED between August 8, 2020, and April 1, 2022, that received a CBC-diff as part of routine clinical care.</p><p><strong>Interventions: </strong>MDW, WBC count, and neutrophil-to-lymphocyte ratio were used to develop a CBC-SI (0 low to 5 high risk) for early sepsis detection. The diagnostic performance of CBC-SI was evaluated for patients with and without obvious early signs of sepsis.</p><p><strong>Measurements and main results: </strong>In a cohort of 51,407 ED visits, 1,683 (3.3%) met sepsis criteria; 1,343 (79.8%) septic patients presented with obvious signs and 340 (20.2%) without. The overall area under the curve of the CBC-SI was 0.83 (95% CI, 0.81-0.85). A CBC-SI of greater than or equal to 1 point exhibited a sensitivity of 83.1% (95% CI, 79.9-86.2%) and specificity of 64.8% (95% CI, 64.0-65.5%). Superior performance was observed in the patient subgroup presenting without obvious signs; greater than or equal to 1 point, 81.1% (95% CI, 73.2-88.9%) sensitivity and 69.1% (95% CI, 68.3-69.9%) specificity. Septic patients without obvious signs exhibited delays in antibiotic administration from arrival (median 4.7 vs. 3.4 hr; p < 0.001) and higher rates of ICU admission (43.8% vs. 27.9%; p < 0.001) and in-hospital mortality (14.7% vs. 9.8%; p = 0.011) compared with the septic subgroup presenting with obvious signs.</p><p><strong>Conclusions: </strong>The CBC-SI demonstrated strong performance for early sepsis detection. Its performance was best for nonobvious presentations, suggesting highest utility in a subgroup that is most susceptible to delayed interventions and poorer outcomes.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 1","pages":"e1194"},"PeriodicalIF":0.0,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11729153/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960282","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":"Using Electronic Health Records to Identify the Daily Primary Provider During Hospitalization.","authors":"Nicholas E Ingraham, Daniel Shyu, Tom Phelan, Nathan Mesfin, Benjamin Langworthy, Rachel Kohn, Meeta Prasad Kerlin, R Adams Dudley","doi":"10.1097/CCE.0000000000001189","DOIUrl":"10.1097/CCE.0000000000001189","url":null,"abstract":"<p><strong>Objectives: </strong>Providers vary in their impact on clinical outcomes, but this is rarely accounted for in healthcare research. By failing to identify the provider responsible for a patient's care, investigators miss an opportunity to account for nonrandom variation in outcomes. Prior methods of identifying responsible providers have relied on manual chart review, which is time-consuming and expensive, or analysis of claims data, which has been demonstrated to be inaccurate. To address these gaps, we sought to develop an algorithm using electronic health record (EHR) data to identify the responsible provider for each day of a patient's hospitalization.</p><p><strong>Design: </strong>A multicenter retrospective cohort study.</p><p><strong>Setting: </strong>Midwest healthcare system.</p><p><strong>Patients: </strong>Hospitalized patients and their providers.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>We first confirmed high inter-rater reliability of manual chart review to identify the responsible provider. Using manual chart review as the gold standard, we then assessed the accuracy of an automated algorithm in a set of randomly selected patients. The agreement between two independent physicians in their determination of the responsible provider by chart review was 100%. Among 200 randomly selected patients, the algorithm identified the same responsible provider as the physician chart reviewer on 93% (3372/3626; 95% CI, 92-94%) of patient-days.</p><p><strong>Conclusions: </strong>Readily available EHR data can be used to assign patients to providers daily with a high degree of accuracy. This methodology could be applied in healthcare research to identify sources of variation other than the intervention being studied.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"6 12","pages":"e1189"},"PeriodicalIF":0.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11661743/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142866711","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 Is Associated With Mortality in Pressure-Controlled Ventilated Patients: A Dutch, Single-Center Cohort Study.","authors":"Jamilla Goedegebuur, Floor E Smits, Jacob W M Snoep, Petra J Rietveld, Franciska van der Velde, Evert de Jonge, Abraham Schoe","doi":"10.1097/CCE.0000000000001190","DOIUrl":"10.1097/CCE.0000000000001190","url":null,"abstract":"<p><strong>Importance: </strong>Mechanical power (MP) could serve as a valuable parameter in clinical practice to estimate the likelihood of adverse outcomes. However, the safety thresholds for MP in mechanical ventilation remain underexplored and contentious.</p><p><strong>Objectives: </strong>This study aims to investigate the association between MP and hospital mortality across varying degrees of lung disease severity, classified by Pao2/Fio2 ratios.</p><p><strong>Design, setting, and participants: </strong>This is a retrospective cohort study using automatically extracted data. Patients admitted to the ICU of a tertiary referral hospital in The Netherlands between 2018 and 2024 and ventilated in pressure-controlled mode were included.</p><p><strong>Main outcomes and measures: </strong>Logistic regression, adjusted for age, sex, Acute Physiology and Chronic Health Evaluation-IV score, and Pao2/Fio2 ratio, was used to calculate the odds ratio (OR) for all-cause in-hospital mortality.</p><p><strong>Results: </strong>A total of 2184 patients were analyzed, with a mean age of 62.5 ± 13.8 years, of whom 1508 (70.2%) were male. The mean MP was highest in patients with the lowest Pao2/Fio2 ratios (21.5 ± 6.5 J/min) compared with those with the highest ratios (12.0 ± 3.8 J/min; p < 0.001). Adjusted analyses revealed that increased MP was associated with higher mortality (OR, 1.06; 95% CI, 1.03-1.09 per J/min increase). Similarly, MP normalized for body weight showed a stronger association with mortality (OR, 1.004; 95% CI, 1.002-1.006 per J/min/kg increase). An increase in mortality was seen when MP exceeded 16-18 J/min.</p><p><strong>Conclusions and relevance: </strong>Our findings demonstrate a significant association between MP and hospital mortality, even after adjusting for key confounders. Mortality increases notably when MP exceeds 16-18 J/min. Normalized MP presents an even stronger association with mortality. These results underscore the need for further research into ventilation strategies that consider MP adjustments.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"6 12","pages":"e1190"},"PeriodicalIF":0.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11661764/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142857247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preferred Language and Race Impact Code Status in Critically Ill Children.","authors":"Stephanie Granada, Michelle R Mayeda, Jessica C Fowler, Wynne E Morrison, Nadir Yehya","doi":"10.1097/CCE.0000000000001192","DOIUrl":"10.1097/CCE.0000000000001192","url":null,"abstract":"<p><strong>Importance: </strong>Few studies have assessed the relationships between language, race, and code status in a PICU.</p><p><strong>Objectives: </strong>We aimed to identify whether non-English language preference (NELP) or race was associated with code status in a PICU.</p><p><strong>Design, setting, and participants: </strong>This was a single-center retrospective cohort study of 45,143 patients admitted to the PICU between January 2013 and December 2022, excluding those with pre-PICU do not resuscitate (DNR) orders.</p><p><strong>Main outcomes and measures: </strong>Two separate exposures were tested simultaneously (NELP and race/ethnicity) for association with the primary outcome of placement of a DNR order in the PICU (logistic regression). The secondary outcome was time to DNR order in patients in whom DNR orders were placed (Cox regression). Potential confounders were age, Pediatric Risk of Mortality III at 12 hours score, religion, admission diagnosis, and hospital length of stay before PICU admission.</p><p><strong>Results: </strong>Patients with Spanish-preference, Arabic-preference, or other NELP had higher odds of having a DNR order placed during PICU admission relative to English-preference (all adjusted odds ratios [aORs] between 1.81 and 3.59; all p < 0.001). Among patients with a DNR, Other NELP patients had faster times to DNR (adjusted hazard ratio, 1.77; 95% CI, 1.30-2.39; p < 0.001). Non-Hispanic Black patients consistently had lower odds of having a DNR order relative to non-Hispanic White patients (aOR, 0.77; 95% CI, 0.65-0.91; p = 0.002). Results were consistent in sensitivity analyses.</p><p><strong>Conclusions and relevance: </strong>Children with NELP had higher odds of having a new DNR order placed in the PICU, whereas non-Hispanic Black patients had lower odds. NELP may be correlated with unmeasured illness severity, thereby confounding the relationship between language and probability of DNR. However, our data support that demographic factors, such as Black race, are strong predictors of a change in code status to DNR and time to DNR.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"6 12","pages":"e1192"},"PeriodicalIF":0.0,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11658735/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142848719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Machine Learning-Based Prediction Model for ICU Mortality After Continuous Renal Replacement Therapy Initiation in Children.","authors":"Sameer Thadani, Tzu-Chun Wu, Danny T Y Wu, Aadil Kakajiwala, Danielle E Soranno, Gerard Cortina, Rachana Srivastava, Katja M Gist, Shina Menon","doi":"10.1097/CCE.0000000000001188","DOIUrl":"10.1097/CCE.0000000000001188","url":null,"abstract":"<p><strong>Background: </strong>Continuous renal replacement therapy (CRRT) is the favored renal replacement therapy in critically ill patients. Predicting clinical outcomes for CRRT patients is difficult due to population heterogeneity, varying clinical practices, and limited sample sizes.</p><p><strong>Objective: </strong>We aimed to predict survival to ICUs and hospital discharge in children and young adults receiving CRRT using machine learning (ML) techniques.</p><p><strong>Derivation cohort: </strong>Patients less than 25 years of age receiving CRRT for acute kidney injury and/or volume overload from 2015 to 2021 (80%).</p><p><strong>Validation cohort: </strong>Internal validation occurred in a testing group of patients from the dataset (20%).</p><p><strong>Prediction model: </strong>Retrospective international multicenter study utilizing an 80/20 training and testing cohort split, and logistic regression with L2 regularization (LR), decision tree, random forest (RF), gradient boosting machine, and support vector machine with linear kernel to predict ICU and hospital survival. Model performance was determined by the area under the receiver operating characteristic curve (AUROC) and the area under the precision-recall curve (AUPRC) due to the imbalance in the dataset.</p><p><strong>Results: </strong>Of the 933 patients included in this study, 538 (54%) were male with a median age of 8.97 years and interquartile range (1.81-15.0 yr). The ICU mortality was 35% and hospital mortality was 37%. The RF had the best performance for predicting ICU mortality (AUROC, 0.791 and AUPRC, 0.878) and LR for hospital mortality (AUROC, 0.777 and AUPRC, 0.859). The top two predictors of ICU survival were Pediatric Logistic Organ Dysfunction-2 score at CRRT initiation and admission diagnosis of respiratory failure.</p><p><strong>Conclusions: </strong>These are the first ML models to predict survival at ICU and hospital discharge in children and young adults receiving CRRT. RF outperformed other models for predicting ICU mortality. Future studies should expand the input variables, conduct a more sophisticated feature selection, and use deep learning algorithms to generate more precise models.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"6 12","pages":"e1188"},"PeriodicalIF":0.0,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11654792/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142840557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding the Acid-Base Response to Respiratory Derangements: Finding, and Clinically Applying, the In Vivo Base Excess.","authors":"Micah L A Heldeweg, Kenrick Berend, Patrick Schober, František Duška","doi":"10.1097/CCE.0000000000001191","DOIUrl":"10.1097/CCE.0000000000001191","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the base excess response during acute in vivo carbon dioxide changes.</p><p><strong>Design: </strong>Secondary analysis of individual participant data from experimental studies.</p><p><strong>Setting: </strong>Three experimental studies investigating the effect of acute in vivo respiratory derangements on acid-base variables.</p><p><strong>Subjects: </strong>Eighty-nine (canine and human) carbon dioxide exposures.</p><p><strong>Interventions: </strong>Arterial carbon dioxide titration through environmental chambers or mechanical ventilation.</p><p><strong>Measurements and main results: </strong>For each subject, base excess was calculated using bicarbonate and pH using a fixed buffer power of 16.2. Analyses were performed using linear regression with arterial dioxide (predictor), base excess (outcome), and studies (interaction term). All studies show different baselines and slopes for base excess across carbon dioxide titrations methods. Individual subjects show substantial, and potentially clinically relevant, variations in base excess response across the hypercapnic range. Using a mathematical simulation of 10,000 buffer power coefficients we determined that a coefficient of 12.1 (95% CI, 9.1-15.1) instead of 16.2 facilitates a more conceptually appropriate in vivo base excess equation for general clinical application.</p><p><strong>Conclusions: </strong>In vivo changes in carbon dioxide leads to changes in base excess that may be clinically relevant for individual patients. A buffer power coefficient of 16.2 may not be appropriate in vivo and needs external validation in a range of clinical settings.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"6 12","pages":"e1191"},"PeriodicalIF":0.0,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11651497/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142847421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Something New Under the Sun: Farewell from the Founding Editor.","authors":"Timothy G Buchman","doi":"10.1097/CCE.0000000000001180","DOIUrl":"10.1097/CCE.0000000000001180","url":null,"abstract":"","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"6 12","pages":"e1180"},"PeriodicalIF":0.0,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11654789/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142831257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}