Critical care explorations最新文献

{"title":"Implementation of a Quality Improvement Tool \"Recover25\" to Guide the Care of Patients Experiencing Prolonged Critical Illness: A Mixed-Method Feasibility Study.","authors":"Laura Allum, Leah Homden, Nicholas Hart, Bronwen Connolly, Natalie Pattison, Louise Rose","doi":"10.1097/CCE.0000000000001265","DOIUrl":"10.1097/CCE.0000000000001265","url":null,"abstract":"<p><strong>Objectives: </strong>Few quality improvement (QI) tools are specifically designed to manage the care of patients experiencing prolonged critical illness. This risks omissions in care. To determine the implementation feasibility and clinician acceptability of our QI tool \"Recover25,\" we focused on actionable processes of care for patients with an ICU stay of over 7 days and their families.</p><p><strong>Design: </strong>Parallel convergent mixed-methods feasibility study conducted between February 2024 and May 2024.</p><p><strong>Setting: </strong>A mixed ICU in London, United Kingdom.</p><p><strong>Subjects: </strong>Patients with an ICU stay of more than 7 days, and the staff who care for them.</p><p><strong>Interventions: </strong>We invited representatives of all ICU professions to a weekly QI round.</p><p><strong>Measurements and main results: </strong>We recorded the time completed Recover25, the amount and type of actions generated following Recover25 use (i.e., what new care activities did it prompt), and the number and profession of staff attending each round. We administered the Theoretical Framework of Acceptability (TFA) questionnaire and conducted semi-structured clinician interviews. We calculated means (sds) or interquartile ranges (IQRs) (percentiles) of time to complete and a number of actions generated. We analyzed and integrated qualitative data using framework analysis informed by the TFA. \"Recover 25\" was used 34 times (65%) of 52 opportunities with 26 patients. Median (IQR) Recover25 completion time was 9.75 minutes (8.2-14.9 min) with a completion rate of 96% (89-100%). Recover25 usage prompted a median of 1 (IQR) (1-2) new action. There was a mean of 4 (sd 2) interprofessional team members attending each QI round. Nineteen clinicians completed 33 TFA questionnaires and 11 interviews. Recover25 was perceived as acceptable, with 94% reporting it aligned with their principles of good care, 85% perceiving it as a coherent intervention, and 67% perceiving it was effective. Interview data showed participants valued the emphasis on person-centered care and highlighted ways to improve implementation.</p><p><strong>Conclusion: </strong>Recover25 was perceived as feasible to implement and acceptable by staff. Further work is needed to understand the effects on patient experience and outcomes.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 5","pages":"e1265"},"PeriodicalIF":0.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12077562/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143999474","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":"Age and Saving Lives in Crisis Standards of Care: A Multicenter Cohort Study of Triage Score Prognostic Accuracy.","authors":"Michael Hermsen, Patrick G Lyons, Govind Persad, Alice F Bewley, Chengsheng Mao, Kaveri Chhikara, Anoop Mayampurath, Matthew Churpek, Monica E Peek, Yuan Luo, William F Parker","doi":"10.1097/CCE.0000000000001256","DOIUrl":"10.1097/CCE.0000000000001256","url":null,"abstract":"<p><strong>Importance: </strong>Current protocols to triage life support use scores that are biased and inaccurate.</p><p><strong>Objectives: </strong>To determine if adding age to triage protocols used in disaster scenarios improves the identification of critically ill patients likely to survive.</p><p><strong>Design, setting, and participants: </strong>Observational cohort study from March 1, 2020, to March 1, 2022, at 22 hospitals in three networks, divided into derivation (12 hospitals) and validation cohorts (ten hospitals). Participants were critically ill adults (90% COVID-19 positive) who would have needed life support during an overwhelming case surge. Life support was defined as vasoactive medications for shock, invasive or noninvasive mechanical ventilation, or oxygen therapy with Pao2/Fio2 less than 200.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was death in the intensive care unit. We fit logistic regression models using a modified Sequential Organ Failure Assessment (SOFA) score with and without age in the derivation cohort and assessed predictive performance in the validation cohort using area under the receiver operating characteristic curves (AUCs) and compared observed and predicted mortality.</p><p><strong>Results: </strong>The final analysis contained 7,660 patients with 16,711 life-support episodes. In the validation cohort, the AUC for age plus SOFA was significantly higher than the AUC for SOFA alone (0.66 vs. 0.54; p < 0.001). SOFA score substantially overpredicted mortality (13% predicted vs. 5% observed) for younger patients (< 40 yr) and underestimated mortality (14% predicted vs. 31% observed) for older patients (> 80 yr). In contrast, age plus SOFA had good calibration overall and across age groups. The addition of age improved but did not eliminate differences between observed and predicted mortality across racial-ethnic groups.</p><p><strong>Conclusions and relevance: </strong>Age-inclusive triage better identifies ICU survivors than SOFA alone and is more equitable. Incorporating age into prioritization algorithms could save more lives in a crisis scenario.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 5","pages":"e1256"},"PeriodicalIF":2.7,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12074069/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144048840","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":"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":"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":"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":"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}