Critical care explorations最新文献

{"title":"Social Determinants of Health and Long‑Term Joblessness Among Severe COVID‑19 Survivors: Secondary Analysis of a Nationwide 2‑Year Prospective Cohort (COVID-19 Recovery Study II).","authors":"Akira Kawauchi, Mitsunobu Nakamura, Shuhei Maruyama, Shinichiro Morioka, Katsuji Teruya, Takeshi Nishida, Toshiyuki Harada, Hideki Yoshida, Satoshi Miike, Hideaki Kato, Junji Hatakeyama, Shigeki Fujitani, Tomohiro Asahi, Kensuke Nakamura, Yuichi Sato, Taku Oshima, Futoshi Nagashima, Kohei Ota, Tatsuya Fuchigami, Nobuyuki Nosaka, Hiroshi Kamijo, Takeshi Hattori, Hayato Taniguchi, Katrina Hauschildt, Snigdha Jain, Arisa Iba, Miyuki Hori, Yoko Muto, Mariko Hosozawa, Hiroyasu Iso","doi":"10.1097/CCE.0000000000001440","DOIUrl":"10.1097/CCE.0000000000001440","url":null,"abstract":"<p><strong>Objective: </strong>Return-to-work varies among previously employed patients after critical illness. Social determinants of health (SDH) may play a role in this variation. We compared patient characteristics and explored the association between SDH and long-term joblessness among patients who experienced severe COVID-19.</p><p><strong>Design: </strong>A secondary analysis of a prospective nationwide database.</p><p><strong>Settings: </strong>The COVID-19 Recovery Study II (CORES II) study, a nationwide prospective observational study in Japan that examined long-term symptoms and social status over two years following hospitalization.</p><p><strong>Patients: </strong>We included adults hospitalized with severe COVID-19 between April 1 and September 30, 2021, who were employed before hospitalization. SDH included education history and pre-hospitalization employment status.</p><p><strong>Measurements and main results: </strong>The primary outcome was joblessness at the first- and second-year follow-ups. We used generalized estimating equations for the main analysis to examine longitudinal associations between SDH and joblessness, with the SDH variables entered into the model as separate categorical variables.Of 3297 hospitalized patients, 337 met inclusion criteria. At the first-year follow-up, 275 had returned to work, whereas 62 (18.4%) remained jobless. At the second-year follow-up, 242 (82.3 %) had returned to work, and 52 (17.7%) remained jobless. Patients who were jobless at the first-year follow-up showed more persistent symptoms and greater physical and mental impairment compared with those who returned to work. Among SDH factors, non-permanent employment was associated with joblessness over the 2-year follow-up period (odds ratio 2.35; 95% CI [1.26-4.40]) compared with permanent employment. Education history was not associated with joblessness at the first- or second-year follow-ups.</p><p><strong>Conclusions: </strong>Non-permanent employment was associated with joblessness during the pandemic after hospitalization for severe COVID-19. Pre-hospitalization employment status may be relevant to long-term social recovery after critical illness.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"8 7","pages":"e1440"},"PeriodicalIF":2.9,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13387767/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148537957","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":"Likelihood of Bacterial Infection in Immunocompromised Patients Treated With IV Antibiotics for Possible Sepsis.","authors":"Simran Gupta, Lucia Millham, Laura DelloStritto, Anna A Agan, Cara McKenna, Chanu Rhee, Michael Klompas","doi":"10.1097/CCE.0000000000001443","DOIUrl":"10.1097/CCE.0000000000001443","url":null,"abstract":"<p><strong>Objectives: </strong>Immunocompromised patients with possible sepsis are typically treated immediately with empiric antibiotics given their high risk for poor outcomes. Clinical presentations of sepsis, however, are protean and many nonbacterial infections and noninfectious conditions can present similarly. We assessed the likelihood of bacterial infections in retrospect in immunocompromised vs. nonimmunocompromised patients treated empirically for sepsis.</p><p><strong>Design, setting and patients: </strong>We identified all adults treated for possible sepsis (blood culture draw, lactate measurement, and IV antibiotic administration) within 6 hours of emergency department (ED) arrival at nine hospitals between 2022 and 2024 and randomly selected 350 hospitalizations for structured medical record review, oversampling for immunocompromised status using administrative codes. Reviews were used to confirm immunocompromised status per Centers for Disease Control and Prevention criteria and determine post hoc likelihoods of bacterial infection.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Of the 350 patients, 186 (53.1%) were confirmed as immunocompromised and 164 (46.9%) as nonimmunocompromised. Immunocompromised patients more commonly presented with fevers, chills or rigors (66.0% vs. 32.0%, p < 0.001) and ED clinicians more often documented concern for sepsis (74% vs. 62%, p = 0.01) compared with nonimmunocompromised patients. Definite or probable bacterial infection was identified in 92 of 186 (49.5%) immunocompromised patients vs. 97 of 164 (59.1%) nonimmunocompromised patients (p = 0.07). Among immunocompromised patients without definite or probable bacterial infection, common alternative etiologies included viral or fungal infection, febrile neutropenia without clinical evidence of bacterial infection, progression of malignancy, and medication toxicity, whereas chronic heart or lung disease exacerbations, hypovolemia, and hypervolemia predominated among nonimmunocompromised patients.</p><p><strong>Conclusions: </strong>Only about one-half of immunocompromised patients treated empirically for possible sepsis had definite or probable bacterial infection in retrospect, compared with approximately three-fifths in nonimmunocompromised patients. These findings underscore the complexity of sepsis diagnosis, particularly in immunocompromised patients, and highlight important differences in the conditions that mimic bacterial sepsis in immunocompromised vs. nonimmunocompromised hosts.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"8 7","pages":"e1443"},"PeriodicalIF":2.9,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13375051/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148450848","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":"Drug Clearance and Dosing During CytoSorb Hemoadsorption: A Systematic Review.","authors":"Teresa Klaus, Patrick M Honoré, Gabriella Bottari, Silvia De Rosa, Detlef Kindgen-Milles, Antoine Schneider, Nandor Marczin, Harriet Adamson, Joerg Scheier, Efthymios N Deliargyris, Thomas D Nolin","doi":"10.1097/CCE.0000000000001444","DOIUrl":"10.1097/CCE.0000000000001444","url":null,"abstract":"<p><strong>Objective: </strong>CytoSorb (CS) hemoadsorption is increasingly used in critical care and cardiac surgery to remove inflammatory mediators and select drugs. This systematic review aimed to summarize available evidence on intentional drug removal as well as unintentional drug removal during CS therapy.</p><p><strong>Data sources: </strong>PubMed, congress abstracts, and CytoSorbents online literature database.</p><p><strong>Study selection: </strong>Eligible studies included benchtop, animal, and human pharmacokinetic investigations of drug removal during CS therapy as well as clinical reports describing CS use for drug overdose.</p><p><strong>Data extraction: </strong>Data from the eligible studies were extracted independently by two authors into Microsoft Excel.</p><p><strong>Data synthesis: </strong>Data were identified for drugs across multiple therapeutic classes, including analgesics, antiarrhythmics, anticonvulsants, antidepressants, antihypertensives, anti-infectives, antithrombotics, anxiolytics, and immunosuppressants. Drugs were categorized into low (< 30%), moderate (30-60%), or high (> 60%) removal rate, or by the relative increase in clearance attributable to CS: negligible (< 25%), low (25-100%), moderate (100-400%), or high (> 400%). Based on the assembled data and considering drug-, patient-, and circuit-specific factors, general dosing recommendations for concomitant medications were developed.</p><p><strong>Conclusions: </strong>CS therapy can alter drug concentrations for select agents with variable clinical relevance. CS can reduce perioperative bleeding risk through antithrombotic removal and treat certain drug overdoses. Unintentional drug removal during CS therapy may occur and practical guidance is provided for drugs with known susceptibility to removal.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"8 7","pages":"e1444"},"PeriodicalIF":2.9,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13372516/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148450836","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":"Relationship Between Cerebral Oximetry and Outcomes in Post-Cardiac Arrest Patients: A Systematic Review and Meta-Analysis.","authors":"Atul Phillips, Caralyn Bencsik, Ish Bains, Erica McKenzie, Andy Wong, Philippe Couillard, Julie A Kromm, Andreas H Kramer","doi":"10.1097/CCE.0000000000001427","DOIUrl":"10.1097/CCE.0000000000001427","url":null,"abstract":"<p><strong>Objectives: </strong>Poor neurologic outcomes are common in post-cardiac arrest patients. Reduced cerebral perfusion and inadequate oxygen delivery may persist even following return of spontaneous circulation (ROSC), which may exacerbate hypoxic-ischemic brain injury. Cerebral oximetry is a noninvasive method of assessing brain oxygenation. We performed a systematic review to assess whether post-arrest regional oxygen saturation (rSO2) during the initial 48 hours post-ROSC is associated with death or severe disability.</p><p><strong>Data sources: </strong>MEDLINE, Embase, Cochrane Central Register of Controlled Trials, World Health Organization Global Health Library.</p><p><strong>Study selection: </strong>We included studies reporting outcomes in adult post-arrest patients who underwent continuous cerebral oximetry immediately following ROSC for at least 6 hours.</p><p><strong>Data extraction: </strong>rSO2 over the 48 hours post-arrest was compared between patients with favorable vs. unfavorable outcomes, as dichotomized within individual studies.</p><p><strong>Data synthesis: </strong>Random effects models were used to pool studies. 10,876 records were identified, of which 16, with a total of 864 patients, met inclusion criteria. Twelve studies provided neurologic outcomes, and four reported only survival. rSO2 was similar at baseline, but higher at 24 hours (3.3%, 0.9-5.7%, p = 0.009) and 48 hours (2.1%, 0.3-3.9%, p = 0.02) post-arrest among patients with favorable outcomes. There was significant heterogeneity between studies. rSO2 averaged over time was significantly higher between 24 and 48 hours in patients with favorable outcomes (5.2%, 1.6-8.8%; p = 0.005). rSO2 was lower in studies where cardiac arrest duration was relatively longer (modeled difference -7.1%, -3.1% to -11.1%, p = 0.0005). Although very low rSO2 had high specificity for unfavorable outcome in two studies, no consistent threshold could be identified for use in neuroprognostication.</p><p><strong>Conclusions: </strong>Current evidence suggests that rSO2 during the initial 48 hours following ROSC is slightly lower in post-cardiac arrest patients with unfavorable neurologic outcomes (low certainty of evidence). Prospective research is needed to determine whether treatment of reduced rSO2 can improve outcomes.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"8 7","pages":"e1427"},"PeriodicalIF":2.9,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331409/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148378689","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":"Apnea Testing for Brain Death/Death by Neurologic Criteria in Adults: A Prospective Multicenter Observational Study Assessing the Relationship Between Methodology, Safety, and Duration.","authors":"Sean Cuninghame, John Basmaji, James Duffin, Andrew Healey, Beth Paltser, Michelle Snyder-Salehi, Alexander Yoshiki, J Gordon Boyd, Michael Hartwick, Karim Soliman, Jeffrey M Singh, David Katz, Janice Beitel, Ebenezer Ogunsakin, Marat Slessarev","doi":"10.1097/CCE.0000000000001437","DOIUrl":"10.1097/CCE.0000000000001437","url":null,"abstract":"<p><strong>Importance: </strong>Apnea testing is an integral component of brain death (BD) assessments. The optimal method of Apnea Testing is currently not known.</p><p><strong>Objectives: </strong>To describe the current use of apnea test methods, and compare the effect of the chosen apnea test method (passive oxygenation, continuous positive airway pressure [CPAP], or exogenous Co2) on safety and duration of apnea test in adult BD/death by neurologic criteria (DNC) organ donors.</p><p><strong>Design: </strong>A prospective multicenter observational study.</p><p><strong>Setting: </strong>Seventy-four ICUs in Ontario, Canada, who participate in organ donation practices.</p><p><strong>Patients: </strong>All BD/DNC assessments in Ontario, Canada, from July 2023 to August 2024.</p><p><strong>Interventions: </strong>None.</p><p><strong>Main outcomes and measures: </strong>Outcomes included the rate of apnea test attempts, completions, and adverse events. We also measured the incidence of each method used and the duration of the apnea test.</p><p><strong>Results: </strong>During the 1-year study period, a total of 368 BD/DNC assessments were performed, of which 361 (98%) attempted an apnea test. Of the 361 apnea tests attempted, 236 (65%) used passive oxygenation (tracheal insufflation), 103 (29%) used CPAP-based methods, and 22 (6%) used exogenous Co2. Nine tests were not completed: seven were terminated due to adverse events (all with passive oxygenation; five hypoxemia, two hemodynamic instability) and two due to observed respiratory effort. All adverse events occurred with the passive oxygenation method (p = 0.20). No statistically significant differences were seen in apnea test duration between methods. The median test durations were 12 minutes (interquartile range [IQR], 10-17 min), 12 minutes (IQR, 8-15 min), and 15 minutes (IQR, 11-25 min) for passive oxygenation, positive pressure, and exogenous Co2, respectively.</p><p><strong>Conclusions and relevance: </strong>In this large multicenter study, passive oxygenation was associated with a nonsignificant increase in adverse events compared with CPAP-based and exogenous Co2 methods. Exogenous Co2 did not shorten apnea test time. These findings support further investigation of CPAP-based methods as an alternative approach to apnea testing and refinement of Co2 delivery parameters.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"8 7","pages":"e1437"},"PeriodicalIF":2.9,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13327367/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148371145","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 Cutaneous Necrosis to Septic Shock: An ICU Case of Pancreatico portal Fistula Complicating Necrotizing Acute Pancreatitis.","authors":"Emma Jacq, Frederique Maire, Joel Cucherousset, Stéphane Charpentier, Thierry Tagne, Nelly Muller, Roland Amathieu, Mohamed Ghalayini","doi":"10.1097/CCE.0000000000001441","DOIUrl":"10.1097/CCE.0000000000001441","url":null,"abstract":"<p><strong>Background: </strong>Pancreaticoportal fistula is an exceptionally rare and potentially fatal vascular complication of necrotizing pancreatitis. Its clinical presentation can be atypical, leading to delayed diagnosis and management.</p><p><strong>Case summary: </strong>A 58-year-old woman with no previous medical history was admitted for severe necrotizing acute pancreatitis (lipase > 3000 IU/L, CTSI 6) of initially undetermined etiology. After initial improvement, she developed painful erythematous nodules on both legs on day 34, which rapidly evolved into necrotic lesions. On day 48, she was readmitted in septic shock with multiple organ failure. Contrast-enhanced CT revealed peripancreatic collections, portal vein thrombosis, and a communication between the collection and the portal system, consistent with a pancreaticoportal fistula. Skin biopsy demonstrated septal and lobular panniculitis with adipocyte necrosis, multinucleated giant cells, and focal microcalcifications, supporting the diagnosis of pancreatic panniculitis in the appropriate clinical context. Endoscopic ultrasound-guided drainage, octreotide, anticoagulation, and targeted antibiotics led to rapid hemodynamic stabilization, regression of skin lesions, and normalization of laboratory parameters, allowing ICU discharge on day 85.</p><p><strong>Conclusions: </strong>This case illustrates a rare association between erythema nodosum-like lesions and pancreaticoportal fistula complicating necrotizing pancreatitis. The cutaneous presentation preceded the septic shock and was the key to the underlying diagnosis.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"8 7","pages":"e1441"},"PeriodicalIF":2.9,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13327387/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148371180","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":"Patient- and Family-Centered Care, Communication, and Relationship Development Along a Technological Continuum in the ICU: A Scoping Review.","authors":"Brittany Benson, Mahour Taheri, Salima Suleman, Teresa Paslawski, Jennifer M O'Brien, Maria Cruz, Patrick Sullivan, Sahar Khan, Catherine Boden, Candace Abramyk, Eileen Reimche, Sabira Valiani, Cari McIlduff","doi":"10.1097/CCE.0000000000001429","DOIUrl":"10.1097/CCE.0000000000001429","url":null,"abstract":"<p><strong>Objectives: </strong>Effective multidirectional and longitudinal communication is essential to patient- and family-centered care (PFCC) in the ICU. While communication technologies have the potential to facilitate effective communication, their utilization, especially during the COVID-19 pandemic, has been variable. This scoping review answers the following research questions: What communication tools, strategies, and programs have been used in ICUs? What are their reported effects on PFCC and multidirectional communication? To what extent do these studies consider equity, diversity, and inclusion principles?</p><p><strong>Data sources: </strong>The scoping review followed Arksey and O'Malley's (2005) framework and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. We conducted a search covering the period from 2007 to 2024, focusing on the concepts of communication, ICU, and PFCC in OVID Medline, EBSCO CINAHL, and OVID Embase. Relevant studies were screened and reported in this review.</p><p><strong>Study selection: </strong>Searches identified 3280 unique sources, which were screened at a three-stage asynchronous review. A total of 131 articles were included in this review.</p><p><strong>Data extraction: </strong>Communication tools, strategies, and programs were categorized into technology-based and non-technology-based interventions. Technology-based interventions included eight subcategories such as data-enabled devices, electrolarynx, and eye trackers. Non-technology-based strategies included 13 subcategories such as family meetings, diaries, and dedicated personnel.</p><p><strong>Data synthesis: </strong>Positive outcomes were reported in 82% of studies for both technology-based and non-technology-based communication tools, strategies, and programs on PFCC.</p><p><strong>Conclusion: </strong>Most technology and non-technology communication tools, strategies, and programs positively impact communication and PFCC in the ICU. However, only 4% of studies focused on equity, diversity, and inclusion in the evaluation, design, or development of their intervention, indicating a need for further research in this area.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"8 7","pages":"e1429"},"PeriodicalIF":2.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13313720/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148347681","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 Qualitative Multicenter Study of Participant Experiences With an App-Based Mindfulness Intervention (Lift 2) for Critical Illness Survivors.","authors":"Talitha G Wilson, Madeline McDougal, Leah James, Sara Golden, Courtney Maxcy, Edlyn Wolwowicz, Christopher E Cox, Catherine L Hough, Kelly C Vranas","doi":"10.1097/CCE.0000000000001436","DOIUrl":"10.1097/CCE.0000000000001436","url":null,"abstract":"<p><strong>Importance: </strong>Persistent physical and mental health symptoms are common among ICU survivors and pose barriers to recovery. A randomized clinical trial of an app-based mindfulness intervention (Lift) for ICU survivors suggested improvement in mental health symptoms; however, participants' perceptions of the intervention and its influence on their recovery is unknown.</p><p><strong>Objectives: </strong>We sought to understand ICU survivors' perspectives on how the app-based mindfulness intervention influenced their recovery and identify potential mechanisms by which it influenced their physical/mental health symptoms.</p><p><strong>Design, setting, and participants: </strong>This is a preplanned qualitative study of participants in the Lift 2 clinical trial at three academic medical centers between 2019 and 2023. We performed semi-structured interviews (from March 2024 to June 2024) of adults who survived an ICU stay for acute cardiorespiratory failure and completed the 1-month mindfulness program (n = 85), purposively sampling the twice-daily meditation group.</p><p><strong>Analysis: </strong>We used a combined deductive/inductive approach to identify factors influencing the perceived effectiveness of the mindfulness intervention and general facilitators of recovery.</p><p><strong>Results: </strong>Nineteen participants were enrolled, including six women (32%). Median age was 60 years (interquartile range, 43-66 yr). We identified themes related to participants' perceptions of the intervention and its influence on their recovery, leveraging the Who-What-When-Where-Why-How framework to organize results. Themes included: a) participants' receptiveness to mindfulness influenced their perceptions of its benefit (\"who\"); b) breathing exercises and mindfulness videos were considered the most useful content (\"what\") given their positive impact on mind/body connection; c) participants described perceived reductions in dyspnea and hypertension (\"why\") after using the app; d) the app-based intervention was feasible and easy to use (\"how\"); and e) integration of mindfulness with other rehabilitation techniques was synergistic and facilitated recovery (\"where/when\").</p><p><strong>Conclusions: </strong>This qualitative study identifies potential mechanisms by which an app-based mindfulness intervention improved mental health and reduced physical symptom burden as perceived by ICU survivors. It also informs the development and implementation of future interventions to improve recovery from critical illness.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"8 7","pages":"e1436"},"PeriodicalIF":2.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13313680/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148347551","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 Mixed-Methods Research to Address Stagnant Operative Mortality Rates in Congenital Heart Surgery.","authors":"Alyssia Venna, Mitchell C Haverty, Areen Almarkhan, Alix Fetch, Janet Kreutzer, Lisa A Hom, David L Wessel, Ashraf S Harahsheh, Yuliya Domnina, Yves d'Udekem","doi":"10.1097/CCE.0000000000001435","DOIUrl":"10.1097/CCE.0000000000001435","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Operative mortality rates in the congenital heart disease population have remained stagnant at 2.8% for the last decade, prompting a mixed-methods exploration into what institutional factors might be at play.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;After experiencing 0% operative mortality for 365 days, we aimed to qualitatively identify institutional factors impacting operative mortality and compare them to perceived reasons for operative mortality.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;A convergent mixed-methods design was used to compare quantitative and qualitative data.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;This study was performed in a single-center pediatric heart center by a multidisciplinary cardiac research team between January 2020 and June 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Participants: &lt;/strong&gt;A retrospective review of 43 operative mortality records was conducted to determine patient characteristics and reasons for operative mortality. Semi-structured interviews were conducted with staff.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Analysis: &lt;/strong&gt;Quantitative data were analyzed using descriptive statistics to describe patient characteristics and reasons for perceived operative mortality. Qualitative data were analyzed using reflexive thematic analysis to identify themes related to institutional factors influencing operative mortality. Quantitative and qualitative data were compared by matching reasons for each operative mortality to qualitative themes in a joint display. A post hoc descriptive analysis was performed to identify additional perceived reasons for operative mortality following the 0% operative mortality period.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Records were assigned up to five reasons for operative mortality: technical failure, communication issues, intractable disease, management strategy, and decision-making. Semi-structured interviews identified institutional factors influencing operative mortality. Reasons for operative mortality were technical failure (n = 19 [22%]), intractable disease (n = 19 [22%]), communication (n = 18 [21%]), management strategy (n = 15 [18%]), and decision-making (n = 14 [16%]). Three qualitative themes emerged: 1) Implementing Best Medical Practices, 2) Fostering Healthy Interpersonal Relationships, and 3) Building a Responsive Organizational Structure. Upon comparison, factors encompassed by theme 1 were most comparable when the reason for operative mortality was technical failure, intractable disease, management strategy, or decision-making); theme 2 was most comparable when the reason was communication. Theme 3 was only related to one instance of operative mortality. A post hoc analysis revealed most subsequent deaths following the 0% operative mortality period were attributed to intractable disease.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Efforts to implement best medical practices are critical to improve operative mortality. A considerable effort should also be made to foster healthy relationships among staff. Buildi","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"8 7","pages":"e1435"},"PeriodicalIF":2.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13313730/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148347624","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":"Impact of Fostamatinib on Inflammatory Biomarkers in Hospitalized Patients With COVID-19.","authors":"Raquel S Da Cruz, Heather L Teague, Marcos J Ramos-Benitez, Sonya J Malavez-Cajigas, Trenton Williams, Rui Miao, Xin Tian, Gefei Lin, Laurence W Busse, Akram Khan, Ari Moskowitz, David N Hager, Todd W Rice, Adit A Ginde, Nicole M Iovine, Peter Chen, Basmah Safdar, Kevin W Gibbs, Ali Javaheri, Marjolein de Wit, Michelle Harkins, Kris Hudock, Lisa H Merck, Aaron Barksdale, Jeffrey M Sturek, Harry Schrager, Nathan I Shapiro, Michael Lanspa, Estelle Harris, Subhashini Sellers, Andrew J Goodwin, Mark A Tidswell, Michael R Filbin, Matthew S Shotwell, Matthew W Semler, Wesley H Self, Sean P Collins, Jeffrey R Strich","doi":"10.1097/CCE.0000000000001405","DOIUrl":"10.1097/CCE.0000000000001405","url":null,"abstract":"<p><strong>Objectives: </strong>Understanding the mechanistic impact of fostamatinib, a spleen tyrosine kinase inhibitor, in severe COVID-19 using biomarkers associated with disease severity is crucial for the development of host-directed therapeutics. We analyzed samples from a randomized clinical trial to investigate the impact of fostamatinib on multiple inflammatory biomarkers associated with COVID-19 disease severity.</p><p><strong>Design: </strong>Secondary analyses of biomarkers from a randomized clinical trial.</p><p><strong>Setting: </strong>Multicenter randomized clinical trial.</p><p><strong>Patients: </strong>A total of 400 adults hospitalized with COVID-19 were enrolled in a phase 3 randomized clinical trial. Absolute neutrophil counts (ANCs) were analyzed across 392 patients and biomarkers were measured in 190 patients with available plasma samples.</p><p><strong>Interventions: </strong>Adults hospitalized with COVID-19 were randomized to receive either fostamatinib (150 mg bid) or placebo. ANCs and 24 biomarkers were assessed at day 0 and over time using a multiplexed Meso Scale Discovery assay (Meso Scale Diagnostics LLC, Rockville, MD).</p><p><strong>Measurements and main results: </strong>At day 0, participants with World Health Organization ordinal scale 5-7 had elevated ANC counts, compared with ordinal scale 4. In addition, the levels of neutrophil-associated biomarkers, inflammatory cytokines, and mediators of endothelial dysfunction at day 0 were increased in the participants who were ordinal scale 5-7 vs. ordinal scale 4. Randomization to fostamatinib compared with placebo resulted in a decrease in ANC and several neutrophil-associated biomarkers, pro-inflammatory cytokines, and mediators of endothelial dysfunction/tissue damage. This differential finding was also demonstrated in a subgroup of patients (n = 85) with a hypoinflammatory phenotype.</p><p><strong>Limitations: </strong>Missing plasma samples and neutral phase 3 trial results.</p><p><strong>Conclusions: </strong>Randomization to fostamatinib resulted in lower neutrophil counts and levels of circulating biomarkers in hospitalized patients with COVID-19; however, the observed impact of fostamatinib was modest compared with prior studies.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"8 7","pages":"e1405"},"PeriodicalIF":2.9,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13290196/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148304336","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}