Critical care explorations最新文献

{"title":"Alteration in Indole Metabolites After Cardiopulmonary Bypass Surgery in Neonates and Infants.","authors":"Matthew K Leroue, Aline B Maddux, Tanner Lehmann, Sierra Niemiec, Christopher A Mancuso, Ludmila Khailova, Peter M Mourani, Jelena Klawitter, Jesse A Davidson","doi":"10.1097/CCE.0000000000001267","DOIUrl":"10.1097/CCE.0000000000001267","url":null,"abstract":"<p><strong>Importance: </strong>Cardiopulmonary bypass (CPB) surgery is associated with changes in the intestinal microbiome. Metabolism of tryptophan into the indole pathway is entirely facilitated by the intestinal microbiome, and indole metabolites play a critical role in intestinal epithelial integrity, intestinal and systemic vascular tone, and intestinal and systemic immune response.</p><p><strong>Objectives: </strong>To evaluate the impact of CPB on microbial-derived indole metabolites and their association with clinical outcomes.</p><p><strong>Design, setting, and participants: </strong>Prospective cohort study of neonates and infants younger than 6 months of age undergoing CPB at a quaternary children's hospital.</p><p><strong>Main outcomes and measures: </strong>Serum samples underwent quantitative pathway mapping via mass spectroscopy. Clinical outcomes of interest included cardiac ICU (CICU) length of stay and Vasoactive-Inotropic Score (VIS) at 48 hours.</p><p><strong>Results: </strong>Ninety patients between 2 and 169 days old were enrolled. Patients showed significant postoperative changes in seven of eight indole metabolites. A two-fold increase in preoperative levels of indole-3-carboxylic acid was associated with 0.63 odds of requiring vasoactive medications at 48 hours (p = 0.023) and among those subjects still requiring vasoactives at 48 hours, they had an average 7.1% decrease in VIS at 48 hours (p = 0.005), and a 12.25% reduction in CICU length of stay (p = 0.001). Higher levels of indole-3-carboxylic acid preoperatively and at 24 and 48 hours postoperatively were also significantly associated with decreased CICU length of stay. Conversely, increased levels of several metabolites, including indole-3-lactic acid, indole-3-carbaldhyde, indole-3-propionic acid, tryptamine, and tryptophol, in the preoperative and postoperative period were associated with higher VIS at 48 hours and increased CICU length of stay.</p><p><strong>Conclusions and relevance: </strong>CPB was associated with significant changes in indole metabolite levels postoperatively. Indole-3-carboxylic acid, which suppresses T-regulatory (Treg) differentiation, is associated with improved patient outcomes, whereas other metabolites, that promote Treg differentiation, were associated with worse outcomes.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 5","pages":"e1267"},"PeriodicalIF":0.0,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12055184/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055167","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":"Early Pupil Abnormality Frequency Predicts Poor Outcomes and Enhances International Mission for Prognosis and Analysis of Clinical Trials in Traumatic Brain Injury (IMPACT) Model Prognostication in Traumatic Brain Injury.","authors":"Divya Veerapaneni, Naveen Arunachalam Sakthiyendran, Yili Du, Leigh Ann Mallinger, Allyson Reinert, So Yeon Kim, Chuong Nguyen, Ali Daneshmand, Mohamad Abdalkader, Shariq Mohammed, Josée Dupuis, Kevin N Sheth, Emily J Gilmore, David Greer, Charlene J Ong","doi":"10.1097/CCE.0000000000001257","DOIUrl":"10.1097/CCE.0000000000001257","url":null,"abstract":"<p><strong>Importance: </strong>In patients with traumatic brain injury (TBI), baseline pupillary assessment is routine; however, the occurrence rate and clinical significance of pupil abnormalities over the early course of hospitalization remain poorly characterized.</p><p><strong>Objectives: </strong>To determine whether the occurrence and frequency of pupil abnormalities within the first 72 hours of ICU admission are associated with unfavorable discharge outcomes and to assess whether incorporating this frequency improves the performance of an established prognostic model.</p><p><strong>Design, setting, and participants: </strong>This was a retrospective observational study of adults admitted with a primary diagnosis of TBI to a single tertiary care ICU between 2018 and 2022. Inclusion criteria included at least three quantitative pupillometry assessments within the first 72 hours.</p><p><strong>Main outcomes and measures: </strong>Quantitative pupillometry was used to calculate the Neurological Pupil index (NPi) at each assessment. Abnormalities were defined as NPi less than 3 in either eye, NPi asymmetry greater than or equal to 0.7, or pupil size asymmetry greater than or equal to 1 mm. The primary outcome was unfavorable discharge disposition (death, hospice, or long-term care). Multivariable logistic regression was used to evaluate the association between pupil abnormality frequency and outcomes, and model performance was compared using goodness-of-fit tests with and without pupil frequency added to the International Mission for Prognosis and Analysis of Clinical Trials in TBI (IMPACT) model.</p><p><strong>Results: </strong>Among 131 patients (median age, 59 yr; 30% women), 35% had an unfavorable discharge disposition. Pupil abnormalities occurred in 60% of mild, 61% of moderate, and 88% of severe TBI patients. For each 1% increase in the frequency of pupil abnormalities over 72 hours, the odds of unfavorable discharge increased by 3% (odds ratio, 1.03; 95% CI, 1.01-1.05). Adding pupil abnormality frequency to the IMPACT model improved its goodness-of-fit (χ2 = 5.24; p = 0.02).</p><p><strong>Conclusions and relevance: </strong>Pupil abnormalities are common across TBI severities, particularly in severe cases. A higher frequency of abnormal pupil measurements within the first 72 hours is associated with unfavorable outcomes and significantly enhances the predictive performance of established TBI prognostic models. Serial quantitative pupillometry may offer clinically valuable, dynamic prognostic information in the acute care setting.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 5","pages":"e1257"},"PeriodicalIF":0.0,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12043342/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144044617","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 Journey of Exploration in Critical Care Continues to Evolve.","authors":"Tamas Szakmany","doi":"10.1097/CCE.0000000000001254","DOIUrl":"10.1097/CCE.0000000000001254","url":null,"abstract":"","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 5","pages":"e1254"},"PeriodicalIF":0.0,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12106234/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144031672","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 Benzodiazepines on Outcomes of Mechanically Ventilated Pediatric Intensive Care Patients: A Retrospective Cohort Study.","authors":"Amanda R Kolmar, Daniela Bravo, Ricardo A Fonseca, Michael A Kramer, Jinli Wang, Kristin P Guilliams, Brian M Fuller","doi":"10.1097/CCE.0000000000001255","DOIUrl":"https://doi.org/10.1097/CCE.0000000000001255","url":null,"abstract":"<p><strong>Importance: </strong>Benzodiazepines are the most frequently used sedatives in PICUs, but they are increasingly associated with negative outcomes. Understanding their impact on patient outcomes is critical to provide better sedative management for patients.</p><p><strong>Objective: </strong>Our objective was to determine the impact of midazolam and lorazepam on clinical outcomes among subjects requiring mechanical ventilation in the PICU. We hypothesized that subjects receiving benzodiazepines for tolerance of mechanical ventilation will demonstrate worse clinical outcomes when compared with those not receiving benzodiazepines.</p><p><strong>Design: </strong>Single-center, retrospective cohort study.</p><p><strong>Setting and participants: </strong>PICU of a tertiary-care medical center. One thousand fifty-four pediatric participants requiring invasive mechanical ventilation between June 2018 and December 2022. Participants were categorized into those who received benzodiazepine-inclusive sedation regimens (n = 747) and those who received nonbenzodiazepine regimens (n = 307).</p><p><strong>Interventions: </strong>None.</p><p><strong>Main outcomes and measures: </strong>Subjects were sorted into groups of benzodiazepine-sedative regimens (midazolam and lorazepam, only lorazepam) or nonbenzodiazepine-sedation regimens. The primary outcome was ventilator-free days (VFDs). Statistical analysis was performed using multivariable linear regression and propensity-score matching.</p><p><strong>Results: </strong>Subjects receiving continuous and/or intermittent benzodiazepines had fewer VFDs compared with the nonbenzodiazepine group (median 21.0 vs. 26.7; p < 0.001). The benzodiazepine group had fewer ICU-free and hospital-free days, higher delirium scores, and a greater need for withdrawal-tapering medications. This was redemonstrated in subjects only receiving intermittent benzodiazepines as well. Younger subjects were more likely to receive benzodiazepines.</p><p><strong>Conclusions and relevance: </strong>Our study demonstrates an association between children receiving both continuous and intermittent benzodiazepine sedation and worse clinical outcomes. These patients have fewer VFDs and longer length of stay, higher doses of nonbenzodiazepine sedatives, and increased need for withdrawal tapering medications and antipsychotics. It is unclear in this retrospective study if the outcomes were worse because the subjects received benzodiazepines or because subjects receiving benzodiazepines were sicker and thus required benzodiazepines in their analgosedative regimen. Further investigation is warranted into the impact of benzodiazepines on patient outcomes, nonpharmacologic management of sedation, improvement in bedside assessment of analgosedation, and optimal balance between over- and under-sedation.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 5","pages":"e1255"},"PeriodicalIF":0.0,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12040031/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144058974","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 Time to Completion of at Least 30 mL/kg and Hospital Outcomes Among Patients With Septic Shock.","authors":"Mark Piehl, Festus F Adejumo, Valerie De Maio","doi":"10.1097/CCE.0000000000001253","DOIUrl":"https://doi.org/10.1097/CCE.0000000000001253","url":null,"abstract":"<p><strong>Importance: </strong>Sepsis is the leading cause of inpatient mortality in the United States. The optimal timing and volume of fluid resuscitation for septic shock remain a topic of debate.</p><p><strong>Objectives: </strong>This study evaluated the effect of time to completion of at least 30 mL/kg of fluid and the impact of smaller fluid volumes on hospital outcomes among patients with septic shock.</p><p><strong>Design, setting, and participants: </strong>Retrospective cohort study in a large community healthcare system (310,000 annual emergency visits) of all adults (age ≥ 18 yr) admitted from January 2017 to December 2022 with an International Classification of Diseases, 10th Revision diagnosis of sepsis and an initial emergency department (ED) systolic blood pressure (SBP) less than 90 mm Hg, mean arterial blood pressure less than 65 mm Hg, and/or lactate greater than or equal to 4 mmol/L.</p><p><strong>Main outcomes and measures: </strong>The main outcomes include hospital mortality, ICU admission, mechanical ventilation, and vasopressor use. The relationship between time to completion of 30 mL/kg and the main outcomes was assessed using generalized linear models.</p><p><strong>Results: </strong>Among the 1602 patients who met inclusion criteria, 1190 (74.3%) received at least 30 mL/kg of fluid after ED arrival. The overall mortality rate was 24.2%, with 28.7% requiring mechanical ventilation and 64.3% requiring vasopressors. Receipt of at least 30 mL/kg between 2 and 3 hours from the time of initial ED SBP (time zero) was associated with lower odds of mortality (odds ratio [OR], 0.61; 95% CI, 0.39-0.97; p = 0.04) and mechanical ventilation use (OR, 0.43; 95% CI, 0.29-0.65; p < 0.01) compared with other intervals. Compared with receiving 30 mL/kg or greater, receiving at least 20 but less than 30 mL/kg within the first hour was associated with the lowest odds of mortality (OR, 0.33; 95% CI, 0.11-0.97; p = 0.04).</p><p><strong>Conclusions and relevance: </strong>Our findings show that receipt of 30 mL/kg of fluid within 3 hours is associated with reduced mortality and the need for mechanical ventilation among patients with septic shock. These results support the current Surviving Sepsis Campaign fluid recommendations.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 5","pages":"e1253"},"PeriodicalIF":0.0,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039987/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144038229","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":"Improved Prediction of Fluid Responsiveness in Ventilated Patients With Low Tidal Volume: The Role of Preload Variation.","authors":"Antonio Gordillo Brenes, Lourdes León Montañés, Benjamín Hernández Alonso, Samer Alarabe Peinado, Ángel Sánchez Rodríguez","doi":"10.1097/CCE.0000000000001259","DOIUrl":"https://doi.org/10.1097/CCE.0000000000001259","url":null,"abstract":"<p><strong>Objectives: </strong>To analyze whether two levels of preload, one reduced by the application of tourniquets with sphygmomanometer cuffs and the other increased by passive leg elevation, improve the predictive capacity of pulse pressure variation (PPV) and stroke volume variation (SVV) of fluid responsiveness in patients ventilated with low tidal volume (Vt).</p><p><strong>Design: </strong>Prospective cohort study.</p><p><strong>Setting: </strong>ICU at the University Hospital of Cádiz (Spain).</p><p><strong>Patients: </strong>Patients diagnosed with septic shock, on controlled invasive mechanical ventilation without spontaneous breathing, with a Vt of 6 mL/kg predicted body weight and considered for an intravascular volume load due to hemodynamic instability.</p><p><strong>Interventions: </strong>Patient position changes: supine position and passive leg raise. Placement of pressure cuff compression at 60 mm Hg in one upper limb and the two lower limbs. Administration of 10 mL/kg of saline solution in 10 minutes.</p><p><strong>Measurements and results: </strong>Twenty-eight tests were obtained. The baseline characteristics of the responders and nonresponders were similar. The baseline variables PPV and SVV had a limited ability to predict the response to fluids, with areas under the curve of 0.71 and 0.66, respectively. However, its predictive capacity increases significantly with different maneuvers, with the best prediction of the difference between the PPV value during the application of tourniquets and the PPV value in the supine position, with an area under the receiver operating characteristic curve of 0.97.</p><p><strong>Conclusions: </strong>Lowering preload using tourniquets improves the predictive capacity of PPV and SVV for fluid responsiveness in patients ventilated with low Vt.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 5","pages":"e1259"},"PeriodicalIF":0.0,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12040047/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144026901","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":"Pawsitive Care: Canine-Assisted Intervention for Anxiety in ICU Patients and Family Members: A Single-Center, Single-Arm Study.","authors":"Kathleen Cook, Clare Robertson, Kiran Gudivada, Imogen Mitchell, Mary Nourse, Megan M Hosey, Catherine Paterson, Sumeet Rai","doi":"10.1097/CCE.0000000000001258","DOIUrl":"https://doi.org/10.1097/CCE.0000000000001258","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate the effect of canine-assisted intervention (CAI) on anxiety symptoms among intensive care patients and their family members.</p><p><strong>Design: </strong>Prospective, single-center, single-arm, nonrandomized, within-subject study design.</p><p><strong>Setting: </strong>Tertiary hospital ICU.</p><p><strong>Patients/subjects: </strong>Adult (≥ 16 yr) ICU patients and their family members.</p><p><strong>Interventions: </strong>Individual CAI (therapy dog) sessions, lasting at least 15 minutes.</p><p><strong>Measurements and main results: </strong>Primary outcome: change in Visual Analog Scale for Anxiety (VAS-A) among patients and family members; secondary outcomes (patient cohort): change in: 1) Numeric Pain Rating Scale, 2) physiologic vital signs, and 3) intervention-related adverse events. A total of 141 participants (70 patients and 71 family members) were recruited. The median (interquartile range [IQR]) age (yr) was 63 (49-71) for patients, and 51 (36-61) for family members. There was a significant reduction in anxiety scores after the intervention, with median (IQR) VAS-A scores changing from 5 (1-7) to 0 (0-4 [p < 0.001]) for the patient cohort and from 6 (5-8) to 3 (1-5 [p < 0.001]) for the family cohort. Majority of patients (56/70 [62%]) and family members (63/68 [93%]) demonstrated a greater than or equal to 2-point reduction in VAS-A scores. In terms of pain, median (IQR) scores among the patient cohort were also lower post-intervention (0 [0-5] vs. 0 [0-2]; p < 0.001). There were no statistically significant changes in physiologic vital signs (heart rate, respiratory rate, and systolic blood pressure) among patients following the intervention. Additionally, there were no reported dog bites, scratches, or other adverse events during CAI.</p><p><strong>Conclusions: </strong>CAI offers immediate therapeutic benefits in reducing anxiety symptoms in ICU patients and their family members with no observed adverse effects. It may also have a potential role as an adjunctive therapy for pain management in ICU patients. Further research should explore the influence on longer-term psychologic outcomes for ICU patients and family members.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 5","pages":"e1258"},"PeriodicalIF":0.0,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12040009/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144044618","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":"Surfactant Protein D and Club Cell Secretory Protein as Biomarkers of Disease Severity and Fostamatinib Efficacy in Severe COVID-19.","authors":"Marcos J Ramos-Benitez, Rui Miao, Andrea P Rivera-Torres, Mercedes Lacourt-Ventura, Sonya J Malavez-Cajigas, Xin Tian, Heather L Teague, Wilfredo De Jesus-Rojas, Robert Reger, Anthony F Suffredini, Christopher King, Steven D Nathan, Richard W Childs, Jeffrey R Strich","doi":"10.1097/CCE.0000000000001252","DOIUrl":"https://doi.org/10.1097/CCE.0000000000001252","url":null,"abstract":"<p><strong>Objectives: </strong>The objective of the study was to evaluate whether epithelial injury biomarkers-club cell secretory protein (CC16), surfactant protein D (SPD), surfactant protein A (SPA), and receptor for advanced glycation end-products (RAGE)-could prognosticate disease severity and predict treatment responses in hospitalized COVID-19 patients receiving fostamatinib.</p><p><strong>Design: </strong>Retrospective analysis of samples collected from a randomized, placebo-controlled clinical trial evaluating the safety and efficacy of fostamatinib in hospitalized COVID-19 patients.</p><p><strong>Setting: </strong>Hospitalized patients in a multicenter clinical trial.</p><p><strong>Patients: </strong>Hospitalized COVID-19 patients requiring supplemental oxygen.</p><p><strong>Interventions: </strong>Longitudinal measurement of soluble biomarkers of epithelial injury in patients enrolled in the clinical trial.</p><p><strong>Measurements and main results: </strong>Biomarkers of epithelial injury (CC16, SPD, SPA, and RAGE) were measured to assess their prognostic and predictive value. Elevated SPD levels were strongly associated with disease severity and predicted faster clinical improvement with fostamatinib treatment. SPD and CC16 levels remained stable in the fostamatinib group compared with increased levels in the placebo group over 29 days, reflecting alveolar recovery and improved epithelial integrity. SPA and RAGE showed no significant predictive value for clinical outcomes in this setting.</p><p><strong>Conclusions: </strong>SPD and CC16 are valuable biomarkers for assessing lung epithelial injury in severe COVID-19. These biomarkers can serve as prognostic indicators of disease severity and predictive markers of response to fostamatinib, guiding therapeutic strategies to improve outcomes in patients with severe respiratory complications.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 4","pages":"e1252"},"PeriodicalIF":0.0,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12020689/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055648","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 Pleural Manometry to Explore the Physiology Behind Paradoxical Compliance Response to Abdominal Compression-A Case of \"Unexpandable\" Lung in Acute Respiratory Distress Syndrome.","authors":"Charles-Étienne Martel-Pelletier, Brian Laufer, Marc Brosseau, Julien Viau-Lapointe, Jan-Alexis Tremblay","doi":"10.1097/CCE.0000000000001260","DOIUrl":"https://doi.org/10.1097/CCE.0000000000001260","url":null,"abstract":"<p><strong>Background: </strong>Recent reports have described an intriguing pathophysiological phenomenon in acute respiratory distress syndrome (ARDS), with the paradoxical improvement of respiratory mechanics after maneuvers raising intra-abdominal pressure in the context of low positive end-expiratory pressure.</p><p><strong>Case summary: </strong>We hereby present a case exhibiting this paradoxical physiology during mechanical ventilation for severe COVID-19-associated ARDS and discuss the findings of our physiologic assessment of this condition with invasive pleural manometry performed at the bedside.</p><p><strong>Conclusions: </strong>Even though it is rare, awareness of this intriguing condition is paramount to the critical care physician as the lung mechanics of these patients can deteriorate with traditional treatment strategies.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 4","pages":"e1260"},"PeriodicalIF":0.0,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12017789/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144065412","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":"Brain CT Scan Diagnostic and Prognostic Value in Patients With Acute Liver Failure and Cerebral Edema: A Multicenter Cohort Study.","authors":"Filipe S Cardoso, William M Lee, Constantine J Karvellas","doi":"10.1097/CCE.0000000000001251","DOIUrl":"https://doi.org/10.1097/CCE.0000000000001251","url":null,"abstract":"<p><strong>Objective: </strong>Patients with acute liver failure (ALF) may develop cerebral edema. We aimed to study the CT scan diagnostic and prognostic value among patients with ALF and cerebral edema.</p><p><strong>Design: </strong>International multicenter retrospective cohort.</p><p><strong>Setting: </strong>U.S. Acute Liver Failure Study Group prospective registry.</p><p><strong>Patients: </strong>Consecutive patients with ALF within the registry from January 1998 to August 2016.</p><p><strong>Interventions: </strong>The primary exposure was cerebral edema on CT scan. The primary endpoint was 21-day post-inclusion transplant-free survival (TFS).</p><p><strong>Measurements and main results: </strong>Among 2108 patients with ALF, 243 (11.5%) had a brain CT scan. Among those 243 patients, 105 (43.2%) had cerebral edema and 11 (4.5%) later developed tonsillar herniation. Patients with cerebral edema on CT scan were younger (36 vs. 46 yr; p < 0.001) and more often females (81.0% vs. 63.8%; p = 0.003), had more acetaminophen-related ALF (61.0% vs. 39.4%; p < 0.001), required more frequently invasive mechanical ventilation on day 1 (73.3% vs. 55.8%; p = 0.005), and had higher maximum days 1-7 model for end-stage liver disease (MELD) score (39 vs. 35; p = 0.002) than others. Following adjustment for confounders (age, acetaminophen toxicity, and severity of disease by MELD), cerebral edema was associated with lower odds of 21-day TFS (adjusted odds ratio = 0.36 [95% CI, 0.18-0.72]; C-statistic = 0.81 [95% CI, 0.75-0.86]; p = 0.003). However, cerebral edema was not associated with selection for liver transplant (22.9% vs. 16.1%; p = 0.18).</p><p><strong>Conclusions: </strong>In our cohort of patients with ALF, brain CT scan use increased overtime. Among those with a brain CT scan, about two in five had cerebral edema. Cerebral edema on CT scan was independently associated with worse 21-day TFS but did not preclude transplant. Brain CT scan may provide additional diagnostic and prognostic information in selected patients with ALF.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 4","pages":"e1251"},"PeriodicalIF":0.0,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12002376/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144061533","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}