Critical Care最新文献

{"title":"Relationship between skin microvascular blood flow and capillary refill time in critically ill patients","authors":"Alexandra Morin, Louai Missri, Tomas Urbina, Vincent Bonny, Maxime Gasperment, Juliette Bernier, Jean-Luc Baudel, Eduardo Kattan, Eric Maury, Jérémie Joffre, Hafid Ait-Oufella","doi":"10.1186/s13054-025-05285-y","DOIUrl":"https://doi.org/10.1186/s13054-025-05285-y","url":null,"abstract":"Capillary refill time (CRT) and skin blood flow (SBF) have been reported to be strong predictors of mortality in critically ill patients. However, the relationship between both parameters remains unclear. We conducted a prospective observational study in a tertiary teaching hospital. All patients older than 18 years admitted in the intensive care unit (ICU) with circulatory failure and a measurable CRT were included. We assessed index SBF by laser doppler flowmetry and CRT on the fingertip, at T0 (Within the first 48 h from admission) and T1 (4 to 6 h later). Correlation was computed using Spearman or Pearson’s formula. During a 2-month period, 50 patients were included, 54% were admitted for sepsis. At baseline median CRT was 2.0 [1.1–3.9] seconds and median SBF was 46 [20–184] PU. At baseline SBF strongly correlated with CRT (R2 = 0.89; p < 0.0001, curvilinear relationship), this correlation was maintained whether patients were septic or not (R2 = 0.94; p = 0.0013; R2 = 0.87; p < 0.0001, respectively), and whether they received norepinephrine or not (R2 = 0.97; p = 0.0035; R2 = 0.92; p < 0.0001, respectively). Between T0 and T1, changes in SBF also significantly correlated with changes in CRT (R2 = 0.34; p < 0.0001). SBF was related to tissue perfusion parameters such as arterial lactate level (p = 0.02), whilst no correlation was found with cardiac output. In addition, only survivors significantly improved their SBF between T0 and T1. SBF was a powerful predictor of day-28 mortality as the AUROC at T0 was 85% [95% IC [76–91]] and at T1 90% [95% IC [78–100]]. We have shown that index CRT and SBF were correlated, providing evidence that CRT is a reliable marker of microvascular blood flow. Trial registration Comité de protection des personnes Ouest II N° 2023-A02046-39.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"10 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143083826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"“The NET effect”: Neutrophil extracellular traps—a potential key component of the dysregulated host immune response in sepsis","authors":"Andrew Retter, Mervyn Singer, Djillali Annane","doi":"10.1186/s13054-025-05283-0","DOIUrl":"https://doi.org/10.1186/s13054-025-05283-0","url":null,"abstract":"Neutrophils release neutrophil extracellular traps (NETs) as part of a healthy host immune response. NETs physically trap and kill pathogens as well as activating and facilitating crosstalk between immune cells and complement. Excessive or inadequately resolved NETs are implicated in the underlying pathophysiology of sepsis and other inflammatory diseases, including amplification of the inflammatory response and inducing thrombotic complications. Here, we review the growing evidence implicating neutrophils and NETs as central players in the dysregulated host immune response. We discuss potential strategies for modifying NETs to improve patient outcomes and the need for careful patient selection.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"28 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143125309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Consistency between metagenomic next-generation sequencing versus traditional microbiological tests for infective disease: systemic review and meta-analysis","authors":"Chengxi Liu, Xiao Song, Jihai Liu, Liang Zong, Tao Xu, Xu Han, Fan Li, Bo Li, Huadong Zhu, Di Shi","doi":"10.1186/s13054-025-05288-9","DOIUrl":"https://doi.org/10.1186/s13054-025-05288-9","url":null,"abstract":"Pathogen identification is essential in sepsis and septic shock. Metagenomic next-generation sequencing (mNGS) is a novel pathogen detection method with several advantages over traditional tests. However, the consistency between mNGS and traditional pathogen tests requires further investigation. We aimed to assess the consistency between mNGS and traditional pathogen tests and to identify the factors influencing this consistency. This systematic review and meta-analysis involved a comprehensive search of mNGS and traditional pathogen tests in PubMed, Embase, Scopus, Web of Science, and the Cochrane Library. Data from included studies were extracted, and kappa consistency between mNGS and traditional tests was calculated. Study quality was evaluated using the QUADAS-2 tool. The search identified 415 studies, of which 27 were included in the analysis, involving 4112 individuals. Meta-analysis showed a pooled consistency of 0.319 ± 0.013 (p < 0.001), indicating a moderate relationship. In terms of sample type, cerebrospinal fluid showed the highest pooled kappa consistency at 0.500 ± 0.029 (p < 0.001). Immunocompromised patients had a lower pooled kappa consistency of 0.294 ± 0.014 (p < 0.001) compared to 0.321 ± 0.028 (p < 0.001) in immunocompetent patients. Positive percent agreement of mNGS was 83.63% over traditional microbiological test, and negative percent agreement was 54.59%. This review demonstrates a moderate relationship between mNGS and traditional pathogen tests, indicating a complex relationship between these two methods. Sterile samples show higher consistency than non-sterile samples. Immune function deficiency may reduce the consistency between mNGS and traditional tests. Further research is needed on the use of mNGS in sepsis and septic shock.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"15 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143077487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: Beta-blockers in refractory hypoxemia on venovenous extracorporeal membrane oxygenation: a double-edged sword","authors":"Dawid L. Staudacher, Tobias Wengenmayer, Matthieu Schmidt","doi":"10.1186/s13054-024-05242-1","DOIUrl":"https://doi.org/10.1186/s13054-024-05242-1","url":null,"abstract":"&lt;p&gt;&lt;b&gt;Correction: Critical Care (2023) 27:360&lt;/b&gt; &lt;b&gt;https://doi.org/10.1186/s13054-023-04648-7&lt;/b&gt;&lt;/p&gt;&lt;p&gt;Following publication of the original article [1], the authors identified an errors in Figure 1. It should indicate CO = 0.80 instead of CO = 0.67 in A a) ARPDS patient on V-V ECMO and g/dl instead of mg/dl in A a), b) and c). Both the incorrect and correct Figure 1 are given hereafter.&lt;/p&gt;&lt;br/&gt;&lt;p&gt;The incorrect Figure 1:&lt;/p&gt;&lt;figure&gt;&lt;figcaption&gt;&lt;b data-test=\"figure-caption-text\"&gt;Fig. 1&lt;/b&gt;&lt;/figcaption&gt;&lt;picture&gt;&lt;source srcset=\"//media.springernature.com/lw685/springer-static/image/art%3A10.1186%2Fs13054-024-05242-1/MediaObjects/13054_2024_5242_Fig1_HTML.png?as=webp\" type=\"image/webp\"/&gt;&lt;img alt=\"figure 1\" aria-describedby=\"Fig1\" height=\"644\" loading=\"lazy\" src=\"//media.springernature.com/lw685/springer-static/image/art%3A10.1186%2Fs13054-024-05242-1/MediaObjects/13054_2024_5242_Fig1_HTML.png\" width=\"685\"/&gt;&lt;/picture&gt;&lt;p&gt;&lt;b&gt;A&lt;/b&gt; Schematic representation of ECMO flow and cardiac output. Red indicates V-V ECMO flow, and blue indicates cardiac output. For illustrative purposes, recirculation is neglected; &lt;b&gt;a&lt;/b&gt; Patient with ARDS and V-V ECMO support. The Q&lt;sub&gt;ECMO&lt;/sub&gt;/CO ratio is 0.67, with saturation at 100%. DO&lt;sub&gt;2&lt;/sub&gt; is 500 ml/min. &lt;b&gt;b&lt;/b&gt; The same patient with increased oxygen demand, for example, due to infection and fever. Q&lt;sub&gt;ECMO&lt;/sub&gt; remains the same while CO is increased. This results in a ratio of 0.40, saturation of 85%, but a significantly increased DO2 of 850 ml/min. &lt;b&gt;c&lt;/b&gt; Patient with increased oxygen demand treated with beta-blocker. The higher Q&lt;sub&gt;ECMO&lt;/sub&gt;/CO ratio improved arterial oxygen saturation, but the DO2 drops to 665 ml/min.&lt;b&gt; B &lt;/b&gt;Displays three ARDS patients undergoing V-V ECMO therapy, in whom beta-blockers were titrated based on their effects. The measurements were taken three times each after reaching a steady state&lt;/p&gt;&lt;span&gt;Full size image&lt;/span&gt;&lt;svg aria-hidden=\"true\" focusable=\"false\" height=\"16\" role=\"img\" width=\"16\"&gt;&lt;use xlink:href=\"#icon-eds-i-chevron-right-small\" xmlns:xlink=\"http://www.w3.org/1999/xlink\"&gt;&lt;/use&gt;&lt;/svg&gt;&lt;/figure&gt;&lt;br/&gt;&lt;p&gt;The correct Figure 1:&lt;/p&gt;&lt;figure&gt;&lt;figcaption&gt;&lt;b data-test=\"figure-caption-text\"&gt;Fig. 1&lt;/b&gt;&lt;/figcaption&gt;&lt;picture&gt;&lt;source srcset=\"//media.springernature.com/lw685/springer-static/image/art%3A10.1186%2Fs13054-024-05242-1/MediaObjects/13054_2024_5242_Fig2_HTML.png?as=webp\" type=\"image/webp\"/&gt;&lt;img alt=\"figure 2\" aria-describedby=\"Fig2\" height=\"682\" loading=\"lazy\" src=\"//media.springernature.com/lw685/springer-static/image/art%3A10.1186%2Fs13054-024-05242-1/MediaObjects/13054_2024_5242_Fig2_HTML.png\" width=\"685\"/&gt;&lt;/picture&gt;&lt;p&gt;&lt;b&gt;A&lt;/b&gt; Schematic representation of ECMO flow and cardiac output. Red indicates V-V ECMO flow, and blue indicates cardiac output. For illustrative purposes, recirculation is neglected; &lt;b&gt;a&lt;/b&gt; Patient with ARDS and V-V ECMO support. The Q&lt;sub&gt;ECMO&lt;/sub&gt;/CO ratio is 0.80, with saturation at 100%. DO&lt;sub&gt;2&lt;/sub&gt; is 500 ml/min. &lt;b&gt;b&lt;/b&gt; The same","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"22 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143077461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hallucinations and disturbed behaviour in the critically ill: incidence, patient characteristics, associations, trajectory, and outcomes","authors":"Thomas Niccol, Marcus Young, Natasha E. Holmes, Kartik Kishore, Sobia Amjad, Michele Gaca, Rinaldo Bellomo, Ary Serpa Neto","doi":"10.1186/s13054-025-05290-1","DOIUrl":"https://doi.org/10.1186/s13054-025-05290-1","url":null,"abstract":"To use natural language processing (NLP) to study the incidence, characteristics, trajectory, associations, and outcomes of hallucinations and disturbed behaviour in intensive care unit (ICU) patients. We used NLP to scan clinical progress notes of a large cohort of ICU patients to detect words indicating that a patient had experienced hallucinations. We also used NLP to detected disturbed behaviour during ICU stay. Moreover, we studied the use of antipsychotic medications in a nested cohort. Finally, we obtained the demographics, trajectory, associations, and outcome of these patients. We conducted a non-interventional, observational study of 7525 patients. We found that 625 (8.31%) had experienced hallucinations. Among these, 623 (99.7%) also had NLP-diagnosed behavioural disturbance (NLP-Dx-BD). In contrast, in patients without hallucinations, only 3274 (47.4%) were NLP-Dx-BD positive. Among the 2904 nested cohort patients with electronic medications data, 252 (8.7%) experienced hallucinations. Of these, 60 (23.8%) received medications compared with 147 (5.5%) (p < 0.001) patients without hallucinations. There was no difference on outcomes in patients with or without hallucination. Hallucinations affect one in 12 ICU patients and are strongly associated with disturbed behaviour, and the use of antipsychotic medications. Hallucinations may represent another phenotype of critical illness associated neurocognitive dysfunction and require a dedicated research program.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"15 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143072119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing cultural competence and communication in ICU: addressing family conflicts","authors":"Amir Vahedian-Azimi","doi":"10.1186/s13054-025-05298-7","DOIUrl":"https://doi.org/10.1186/s13054-025-05298-7","url":null,"abstract":"&lt;p&gt;&lt;b&gt;Dear Editor,&lt;/b&gt;&lt;/p&gt;&lt;p&gt;I am writing this letter in reference to a recent study published in Critical Care entitled “understanding and addressing a difficult family in ICU” [1]. I would like to commend the authors for their interesting study of this important topic that explain conflicts between ICU staff and patient/family as a source of additional stress in an already tense. However, one issue requires further consideration.&lt;/p&gt;&lt;p&gt;While mentalization offers significant benefits, it also has inherent weaknesses including potential oversimplification and the need for more empirical support that must be acknowledged [2]. Cultural contexts and conditions profoundly influence various aspects of care, as well as the communication dynamics between the patient/family and the healthcare team [3]. Neglecting these cultural factors can hinder the establishment of a truly beneficial and positive therapeutic relationship [4].&lt;/p&gt;&lt;p&gt;To foster effective collaboration, it is essential to encourage both active and passive participation from the patient/family alongside the healthcare team. Active participation involves the healthcare team comprehensively informing the patient/family about all facets of the patient's care, both during hospitalization and after discharge. This process should be conducted with careful consideration of the evolving needs and concerns of both the patient and their family.&lt;/p&gt;&lt;p&gt;Conversely, passive participation refers to mere presence at the patient's bedside. While this is undoubtedly important, it often fails to yield positive outcomes, particularly for critically ill patients in intensive care units (ICUs) who face unique challenges similar to the case reported in the article [1]. In many instances, such passive involvement may lead to negative psychological effects and an increased risk of acquired infections.&lt;/p&gt;&lt;p&gt;To improve cultural competence in healthcare, it is vital to recognize how diverse beliefs, attitudes, values, and backgrounds impact patient care [4]. Healthcare providers must cultivate skills that enhance cross-cultural communication and actively engage in understanding their patients' cultural perspectives. This includes acknowledging language barriers that can complicate communication and affect the accuracy of symptom descriptions or diagnoses [5]. Employing interpreters and fostering an inclusive environment can significantly improve patient-provider interactions.&lt;/p&gt;&lt;p&gt;Moreover, healthcare organizations should prioritize training that enhances cultural awareness among staff members. By doing so, they can better accommodate diverse patient populations and ensure that care is respectful of cultural differences. Ultimately, promoting cultural competence leads to improved health outcomes and a more equitable healthcare system for all patients. I would appreciate if Victoria and colleagues could reflect on my comment.&lt;/p&gt;&lt;p&gt;No datasets were generated or analysed during the current study.&lt;/p&gt;&lt;dl&gt;&lt;dt style=\"min","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"7 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143056561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of healthy sleep patterns with incident sepsis: a large population-based prospective cohort study","authors":"Meina Zou, Di Lu, Zhexin Luo, Ninghao Huang, Wenxiu Wang, Zhenhuang Zhuang, Zimin Song, Wendi Xiao, Tao Huang, Renyu Ding","doi":"10.1186/s13054-025-05287-w","DOIUrl":"https://doi.org/10.1186/s13054-025-05287-w","url":null,"abstract":"The role that sleep patterns play in sepsis risk remains poorly understood. The objective was to evaluate the association between various sleep behaviours and the incidence of sepsis. In this prospective cohort study, we analysed data from the UK Biobank (UKB). A total of 409,570 participants who were free of sepsis at baseline were included. We used a composite sleep score that considered the following five sleep behaviours: sleep chronotype, sleep duration, insomnia, snoring, and daytime sleepiness. Cox proportional hazards regression analysis was used to estimate the associations between healthy sleep scores and incident sepsis. During a mean follow-up of 13.54 years, 13,357 (3.26%) incident sepsis cases were recorded. Among the 409,570 participants with a mean age of 56.47 years, 184,124 (44.96%) were male; 9942 (2.43%) reported 0 to 1 of the five healthy sleep behaviours; 46,270 (11.30%) reported 2 behaviours; 115,272 (28.14%) reported 3 behaviours; 150,522 (36.75%) reported 4 behaviours; and 87,564 (21.38%) reported 5 behaviours at baseline. Each one-point increase in the sleep score was associated with a 5% lower risk of developing sepsis (hazard ratio (HR), 0.95; 95% confidence interval (CI), 0.93–0.97). Compared with a healthy sleep score of 0–1, for a sleep score of 5, the multivariate-adjusted HR (95% CI) for sepsis was 0.76 (0.69–0.83). In addition, we found that the negative correlation was stronger in participants who were aged < 60 years than in their older counterparts (p for interaction < 0.001). However, healthy sleep pattern was not associated with sepsis-related death and critical care admission. Findings from this cohort study suggest that a healthy sleep pattern may reduce the risk of developing sepsis, particularly among younger individuals.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"22 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143055312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ulinastatin treatment mitigates glycocalyx degradation and associated with lower postoperative delirium risk in patients undergoing cardiac surgery: a multicentre observational study","authors":"Xiao Ran, Tingting Xu, Jieqiong Liu, Shaobing Yang, Fang Luo, Rongxue Wu, Juan Tan, Hang Ruan, Qin Zhang","doi":"10.1186/s13054-025-05296-9","DOIUrl":"https://doi.org/10.1186/s13054-025-05296-9","url":null,"abstract":"Ulinastatin (UTI), recognized for its anti-inflammatory properties, holds promise for patients undergoing cardiac surgery. This study aimed to investigate the relationship between intraoperative UTI administration and the incidence of delirium following cardiac surgery. A retrospective analysis was performed on a retrospective cohort of 6,522 adult cardiac surgery patients to evaluate the relationship between UTI treatment and the incident of postoperative delirium (POD) in patients ongoing cardiac surgery. This was followed by a prospective observational cohort study of 241 patients and an in vitro study to explore the findings and the potential role of UTI in preventing cardiac ischemia–reperfusion induced glycocalyx degradation. Both univariate and multivariate logistic regression analyses in retrospective cohort indicated that intraoperative administration of UTI was associated with a significant lower risk of POD among cardiac surgery patients, a finding confirmed through employing propensity score matching. The subsequent prospective observational cohort further supported these findings (adjusted Odds Ratio = 0.392, 95% CI: 0.157–0.977, P = 0.044). Furthermore, UTI mitigated glycocalyx degradation, as demonstrated by in vitro study. UTI administration may mitigate glycocalyx degradation, potentially lowering the risk of POD in cardiac surgery patients, offering valuable insights for future interventions to prevent POD and enhance patient outcomes. Trial registration number ClinicalTrials.gov (No. NCT06268249). Retrospectively registered 4 February 2024.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"39 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143055310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of early administration of fibrinogen replacement therapy in traumatic haemorrhage: a systematic review and meta-analysis of randomised controlled trials with narrative synthesis of observational studies","authors":"Tom Burt, Ashley Guilliam, Elaine Cole, Ross Davenport","doi":"10.1186/s13054-025-05269-y","DOIUrl":"https://doi.org/10.1186/s13054-025-05269-y","url":null,"abstract":"In severely injured trauma patients, hypofibrinoginaemia is associated with increased mortality. There is no evidence-based consensus for what constitutes optimal fibrinogen therapy, treatment dose or timing of administration. The aim of this systematic review was to evaluate the effects of early fibrinogen replacement, either cryoprecipitate or fibrinogen concentrate (FgC) on mortality, transfusion requirements and deep venous thrombosis (DVT). A systematic search of studies was performed on MEDLINE, EMBASE and clinicaltrials.gov databases using standardised search criteria. All clinical studies which examined the use of either cryoprecipitate or FgC in patients with traumatic haemorrhage within 4 h of admission to hospital were included. Primary outcome was mortality (28-day, 30-day or in-hospital). Secondary outcomes were DVT incidence and blood component transfusions. A narrative synthesis was performed for all observational studies. Meta-analysis was completed for all included RCTs for mortality with pre-defined sub-group analysis of FgC and cryoprecipitate use. Grading of Recommendations Assessment, Development, and Evaluation was used to assess the quality of evidence. Overall, 1906 studies were screened with 12 studies included and five RCTs (all suitable for meta-analysis) totalling 1758 participants. Three RCTs reported FgC therapy, and two used cryoprecipitate. Four out of five RCTs examined empiric fibrinogen replacement for suspected traumatic haemorrhage. There was no difference in the primary outcome of mortality: early fibrinogen replacement (24%) vs control (25%), OR 1.03 (95% CI; 0.68–1.56). Subgroup analysis found no difference in outcome between the FgC and control: 18.1% vs 10.9% respectively, OR 1.99 (95% CI; 0.80–4.94). Similarly for cryoprecipitate, there was no difference in mortality between groups: cryoprecipitate (24.9%) vs control (26.1%), OR 0.71 (95% CI, 0.25–2.01). Reporting of transfusion data precluded meta-analysis. There was no difference in DVT incidence: fibrinogen replacement (3%) vs control (4%), OR 0.73 (0.43, 1.25). Overall, the quality of evidence was graded as low due to indirectness and imprecision. There is no association between early fibrinogen replacement and mortality, DVT or transfusion requirements. We found no superiority between FgC or cryoprecipitate. This systematic review highlights the urgent need for further RCTs to assess the efficacy of early fibrinogen replacement, preferred strategy (goal-directed vs empiric) as well as optimal therapeutic product for both patient outcome and cost effectiveness.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"25 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143049744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early phosphate changes as potential indicator of unreadiness for artificial feeding: a secondary analysis of the EPaNIC RCT","authors":"C. Lauwers, L. Langouche, P. J. Wouters, A. Wilmer, G. Van den Berghe, M. P. Casaer, J. Gunst","doi":"10.1186/s13054-025-05273-2","DOIUrl":"https://doi.org/10.1186/s13054-025-05273-2","url":null,"abstract":"As compared to withholding parenteral nutrition (PN) until one week after intensive care unit (ICU) admission, Early PN prolonged ICU dependency in the EPaNIC randomized controlled trial (RCT). The Refeeding RCT showed improved outcome by temporary macronutrient restriction in ICU patients developing refeeding hypophosphatemia, defined as a phosphate decrease of > 0.16 mmol/L to levels < 0.65 mmol/L. We hypothesized that early phosphate changes may identify critically ill patients who are harmed by Early PN, and that dynamic phosphate changes are more discriminative than an absolute threshold for hypophosphatemia. In this secondary analysis of the EPaNIC RCT, we studied whether absolute hypophosphatemia (AHP; < 0.65 mmol/L on the second ICU-day), relative hypophosphatemia (RHP; > 0.16 mmol/L decrease over the first 2 ICU-days), or a combination of both (CHP) interacted with the randomized nutritional strategy for its impact on outcome, adjusted for risk factors. In case of significant interaction, we studied whether the respective change could be predicted by baseline characteristics. Of 3520 patients with available phosphate measurements, AHP developed in 9.1%, RHP in 23.7%, and CHP in 5.3% of patients. RHP, but not AHP or CHP, interacted with the randomized intervention for its impact on outcome (p = 0.01). In RHP patients, Early PN independently associated with a lower likelihood of an earlier discharge alive from ICU (adjusted HR 0.75 [0.65–0.87]). In patients without RHP, Early PN did not significantly associate with this outcome (adjusted HR 0.93 [0.86–1.00]). Development of RHP was only poorly predicted by admission characteristics (adjusted pseudo R-squared = 1.7%). Development of RHP may identify patients who are particularly harmed by early PN. Future studies should prospectively validate the potential of including RHP in a ready-to-feed indicator.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"25 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143049745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}