Critical Care Medicine最新文献

Objective: To determine the characteristics and effectiveness of nurse-led family communication interventions in the ICU.

Data sources: PubMed, Web of Science, PsychInfo, CINAHL, Embase, Cochrane Library, and relevant article citations from January 1995 to July 2025.

Study selection: We included randomized controlled trials (RCTs) and quasi-experimental studies evaluating nurse-led family communication interventions in adult ICUs.

Data extraction: Two independent reviewers assessed evidence levels and risk of bias using the Cochrane tool and the Joanna Briggs Institute's Critical Appraisal Tools. Data were synthesized according to the Preferred Reporting Items for Systematic Reviews guidelines, and interventions were summarized with the Template for Intervention Description and Replication Checklist.

Data synthesis: Seven RCTs and seven quasi-experimental studies were included. The most common nurse-family communication model was an in-person, structured, and dynamically tailored intervention during the patient's ICU stay. Nurses played five core roles: information delivery and clarification, emotional support, family assessment, family meeting facilitation, and transitional support. Bedside ICU nurses led information delivery and multidimensional family assessments. Internal research nurses handled information clarification, structured needs assessment, and family meeting coordination. External research nurses focused on family meeting support, structured emotional support, and transitional care. Although the interventions may improve communication quality (standardized mean differences [SMD] = 0.26) and reduce hospital length of stay (LOS) (mean differences [MD] = -3.87 d), they appear to have limited effects on psychologic distress, satisfaction, ICU LOS, or mortality; they may also increase family meeting frequency/duration and lower overall costs.

Conclusions: The conclusions of our systematic review are limited by considerable heterogeneity in intervention intensity, implementer profiles, and adaptation descriptions. Future interventions should define optimal dosage and outline best practices for evidence-based intervention tailoring and implementation. Healthcare institutions should integrate specialized nursing roles, such as training bedside nurses or establishing dedicated communication facilitators. This approach may leverage nurses' expertise to enhance communication quality and improve outcomes.

Objectives: To evaluate the compatibility of the Society of Critical Care Medicine's (SCCM) Critical Care Data Dictionary (C2D2) with the Observational Medical Outcomes Partnership (OMOP) Common Data Model (CDM) and initiate a set of steps extending OMOP to accommodate specialized critical care data elements.

Design: Systematic analysis and mapping study using a three-tiered semantic matching approach to demonstrate technical feasibility and identify fundamental challenges in critical care data standardization.

Setting: Critical care medicine informatics research environment.

Subjects: The SCCM's C2D2 elements.

Interventions: None.

Measurements and main results: We evaluated the compatibility of C2D2 clinical variables with the OMOP CDM using a three-tier classification system (full match, partial match, and no match). Our analysis of 226 C2D2 elements revealed that 49.6% of concepts had full OMOP equivalents, 46.4% required modification, and 4.0% had no suitable mapping. Key incompatibilities were identified in ventilator parameters, composite scoring systems, and advanced organ support documentation. A large language model-based semantic matching system yielded a precision of 59.5%, recall of 87.0%, and F1 score of 70.7% at an optimized similarity threshold of 0.90. These findings highlight the need to harmonize data standardization approaches within the field of critical care, including how to handle concept stacking within single variables, age-specific criteria, and specialized constructs that were curated through the SCCM Delphi process, but reveal an OMOP mapping incompatibility or missing variables.

Conclusions: Extending the OMOP CDM for critical care is technically feasible and requires targeted modifications to accommodate composite scores, temporal precision, and specialized critical care concepts as well as the resources needed to support this build. The community acutely faces crucial decisions about whether to pursue OMOP integration, adapt the C2D2 for version 2.0 compatibility, work toward OMOP vocabulary inclusion through Observational Health Data Sciences and Informatics processes, or collaborate with electronic health record vendors for native critical care standards support. These decisions require balancing technical feasibility with long-term sustainability and maintenance considerations.

Objectives: To describe and interpret psychologic distress in patients with acute pulmonary embolism and construct the psychologic image.

Design: A descriptive qualitative study based system-based model of stress.

Setting: A tertiary hospital in Changchun, Jilin Province, China.

Subjects: Acute and critical care clinicians, cardiovascular ICU clinicians, extended care workers, and Physical and mental healthcare professionals, etc.

Interventions: None.

Measurements and main results: This study is a descriptive qualitative study, conducting semi-structured in-depth interviews with patients who met the inclusion and exclusion criteria in a tertiary hospital in Changchun City, with reference to the six dimensions of the system-based model of stress to analyze the data. A total of 16 hospitalized patients with acute pulmonary embolism were included, and five themes (The powerlessness of staring into the dark abyss, Pursuing self-worth and a life of dignity, Cognitive bias, Polarized coping strategies, and Social support bridge between family and hospital interactions) and 11 subthemes were ultimately distilled.

Conclusions: Acute pulmonary embolism is a sudden and life-threatening cardiovascular emergency and critical illness. The problem of psychologic distress in patients with acute pulmonary embolism is of concern, with patients showing a strong sense of powerlessness and uncertainty in the face of sudden critical illness. In the future, it is recommended that a systematic psychologic intervention strategy for patients with pulmonary embolism be developed in conjunction with universal psychologic therapies to complement the existing comprehensive care program, alleviate negative emotions, and improve quality of life.

Objectives: The clinical efficacy of short-acting β-blockers in the management of sepsis remains uncertain. In particular, the comparative effects of two commonly used agents-esmolol and landiolol-have not been clearly established. This network meta-analysis aims to systematically evaluate and compare the effects of esmolol, landiolol, and standard of care (SOC) on mortality in patients with sepsis.

Data sources: A systematic search of PubMed, Web of Science, Embase, MEDLINE, CENTRAL, ClinicalTrials.gov , preprints, and citation searching was conducted before April 15, 2025.

Study selection: Randomized controlled trials that enrolled adult patients (≥ 18 yr) diagnosed with sepsis or septic shock and treated with β-blockers and conducted in ICUs.

Data extraction: Data were extracted on study characteristics, enrolled patients' characteristics, administration strategies of drugs, and key clinical outcomes (including 28-d mortality, ICU length of stay, and other relevant endpoints).

Data synthesis: A total of 1165 records were identified through searches of five databases, registries, and relevant references up to April 15, 2025. Ten studies involving 1035 patients were included, after screening and eligibility assessment. Compared with esmolol, landiolol was associated with increased 28-day mortality (relative risk [RR], 1.57; 95% CI, 1.08-2.30; low certainty) and higher norepinephrine requirements (mean difference [MD], 0.17 μg/kg/min; 95% CI, 0.02-0.32; low certainty). Esmolol significantly reduced 28-day mortality (RR, 0.69; 95% CI, 0.56-0.85; moderate certainty) and 24-hour heart rate (MD, -16.92 beats/min; 95% CI, -23.49 to -10.36; moderate certainty) compared with SOC. In contrast, landiolol increased norepinephrine use compared with SOC (MD, 0.09 μg/kg/min; 95% CI, 0.01-0.18; moderate certainty).

Conclusions: Among patients with sepsis treated with β-blockers, esmolol probably improves clinical outcomes compared with SOC. However, the effect of landiolol remains uncertain due to the low certainty of evidence. Esmolol may confer a relative clinical advantage over landiolol, but further studies are needed to confirm this finding and elucidate the underlying mechanisms.