Critical Care最新文献

{"title":"Impact of lumbar cerebrospinal fluid drainage to control intracranial hypertension in patients with severe traumatic brain injury: a retrospective monocentric cohort","authors":"Geoffrey Dagod, Marlène Laurens, Jean-Paul Roustan, Pauline Deras, Elie Courvalin, Mehdi Girard, Hugues Weber, Xavier Capdevila, Jonathan Charbit","doi":"10.1186/s13054-024-05199-1","DOIUrl":"https://doi.org/10.1186/s13054-024-05199-1","url":null,"abstract":"External lumbar drainage (ELD) of cerebrospinal fluid may help control intracranial pressure following a traumatic brain injury. We aimed to assess the efficacy and safety of ELD in post-traumatic intracranial hypertension (IH). This retrospective monocentric cohort study was conducted in the trauma critical care unit of the regional Level-I trauma centre between January 2012 and December 2022. All traumatic brain injury patients with IH (≥ 22 mmHg despite optimal sedation) were included. Data collection focused on the duration and management of IH, complications related to ELD, and outcomes (6-month Glasgow Outcome Scale [GOS]). The influence of ELD on the duration of IH was assessed using a multivariable Cox regression analysis, while its impact on the 6-month GOS (“unfavourable outcome” GOS 1–3, “good outcome” GOS 4–5) was evaluated using a multivariable logistic regression analysis. Ninety patients (mean age 37 [SD, 16], injury severity score [ISS] 29 [IQR, 24–34]) were analyzed during the study period. Of these, 50 (56%) benefited from an ELD during their hospitalization (ELD group). The IH duration was significantly reduced in the ELD group (hazard ratio [HR] 1.74 [95% confidence interval (CI) 1.05–2.87; p = 0.03]). One patient (2%) experienced a cerebral herniation following ELD placement, and two others (4%) developed device-associated meningitis. The ELD group was significantly associated with a lower likelihood of an unfavourable outcome (OR 0.32 [95% CI 0.13–0.77]; p = 0.011) compared to the no ELD group. ELD appears in our cohort to be a safe and effective strategy to control post-traumatic IH, with an acceptable benefit-risk ratio. Our analysis even suggests a potential outcome improvement in patients treated by ELD compared with those having no cerebrospinal fluid drainage.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"27 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142917133","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":"Systemic inflammation and cardiac surgery: insights from the RECCAS trial","authors":"Minghao Luo","doi":"10.1186/s13054-024-05230-5","DOIUrl":"https://doi.org/10.1186/s13054-024-05230-5","url":null,"abstract":"<p>I read with great interest the RECCAS trial, in which the investigators explored the effects of intraoperative cytokine removal during cardiac surgery [1]. It addresses a critical issue: the modulation of systemic inflammation in cardiac surgical patients. The authors concluded that haemoadsorption (HA) did not result in significant reductions in cytokine levels on intensive care unit (ICU) admission or subsequently and observed no significant differences in organ dysfunction, ICU and hospital lengths of stay, or mortality rates. While the study provides valuable insights, certain aspects warrant further discussion to better contextualize the findings and implications.</p><p>The study population raises concerns regarding the generalizability and clinical relevance of the results. The inclusion of exclusively older patients (> 65 years), with a mean age of 74 years, lacks a clear justification in the manuscript. Age is a key determinant of inflammatory response severity, with evidence suggesting that older adults exhibit reduced endothelial activation, impaired cytokine signaling, and attenuated innate immune responses, as highlighted in sepsis-related studies [2]. Moreover, nearly half of the patients did not undergo bypass surgery, valve surgery, or a combination of both, which differs significantly from the populations typically reported in cardiac surgery trials [3, 4]. Understanding the types of surgical procedures performed is essential, as surgical type may have a significant impact on systemic inflammation. Additional information regarding surgical type could provide deeper insights.</p><p>Blinding is another methodological aspect that requires clarification. Procedural interventions such as HA introduce inherent challenges to blinding to surgeons, particularly due to the visible presence of additional equipment in the operating theatre. The trial does not specify how performance bias was mitigated under these circumstances. Furthermore, details regarding the use of concurrent anti-inflammatory treatments, such as glucocorticoids, or the amount of blood transfusion administered during the perioperative period are absent. Both factors could profoundly influence systemic inflammation and may have confounded the study’s outcomes.</p><p>With respect to outcomes and analysis, the selection of IL-6 levels on ICU admission as the primary outcome, while relevant to systemic inflammation, may have limited clinical relevance. Additionally, the lack of assessment of key organ-specific biomarkers, such as creatinine and bilirubin, limits insight into complications like acute kidney injury or liver dysfunction after surgery. Other inflammatory markers, such as C reactive protein, while being non-specific, could offer important insights into the degree of acute inflammation. Furthermore, the statistical analysis did not adhere to the intention-to-treat principle, with one participant excluded after randomization, which raises concerns about potent","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"27 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142917134","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":"Megakaryocyte in sepsis: the trinity of coagulation, inflammation and immunity","authors":"Tianzhen Hua, Fenghua Yao, Haitao Wang, Wei Liu, Xiaomei Zhu, Yongming Yao","doi":"10.1186/s13054-024-05221-6","DOIUrl":"https://doi.org/10.1186/s13054-024-05221-6","url":null,"abstract":"Megakaryocytes are traditionally recognized as cells responsible for platelet production. However, beyond their role in thrombopoiesis, megakaryocytes also participate in inflammatory responses and regulate immune system functions. Sepsis, characterized by life-threatening organ dysfunction due to a dysregulated response to infection, prominently features coagulopathy, severe inflammation, and immune dysfunction as key pathophysiological aspects. Given the diverse functions of megakaryocytes, we explore their roles in coagulation in the context of sepsis, and also in inflammatory and immune regulation. We try to infer future research directions and potential strategies for sepsis prevention and treatment based on the properties of megakaryocytes. The purpose of this review is to both highlight and provide an update on the functions of megakaryocytes and pathophysiological changes in sepsis. Specific emphasis is given to the role of megakaryocytes in sepsis, which suggests value of future research and clinical application. ","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"25 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142908359","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":"Lack of up-to-date studies and data conversion may lead to biased results: a response to Wang et al","authors":"Ali Ait Hssain, Amir Vahedian-Azimi, Abdulsalam Saif Ibrahim, Ibrahim Fawzy Hassan, Elie Azoulay, Michael Darmon","doi":"10.1186/s13054-024-05223-4","DOIUrl":"https://doi.org/10.1186/s13054-024-05223-4","url":null,"abstract":"<p>We would like to thank Wang et al. for reading carefully our work and bringing up the comments [1]. Regarding the deadline for literature searches on November 1, 2022, and the potential removal of crucial data, It should be said that the mentioned studies [2, 3], which focused on COVID-19 patients, were identified in our initial search. Nonetheless, we made a deliberate decision to exclude COVID-19 patients from our analysis based on stringent inclusion criteria aimed at maintaining the focus and stability of our review. The reason for this exclusion lies in the unique pathophysiological mechanisms and clinical management associated with COVID-19, which could confound the incidence and outcomes of hospital infections in Extra corporeal membrane oxygenation (ECMO) patients. The objective of our study, focusing on a homogeneous patient population, is to provide clearer insights into the incidence and risk factors for hospital infections in ECMO patients without the confounding variables introduced by COVID-19. However, we believe that our findings remain valuable for understanding the general incidence and risk factors for hospital infections in adult patients undergoing ECMO.</p><p>We recognize the importance of applying appropriate transformations to ratio data when conducting meta-analyses, as untransformed raw ratio data may deviate from the assumptions of normal distribution. In our study, we primarily reported the incidence of nosocomial infections as pooled ratios with a 95% confidence interval and utilized the random-effects restricted maximum likelihood Model to account for methodological variations and sample diversity across studies. Given the significant heterogeneity observed, we performed sensitivity analyses to identify influential studies and assess its impact on our pooled estimates. We agree that conducting a sensitivity analysis that compares results from transformed data with untransformed data could enhance the robustness of our findings. While our current approach provides valuable insights, using a logit transformation or Freeman-Tukey double arcsine transformation, as you suggested, stabilizes variance and may potentially yield different results, although these differences are likely to be minimal and would not lead to biased conclusions (Table 1).</p><figure><figcaption><b data-test=\"table-caption\">Table 1 Pooled incidence nosocomial infection per 1000 ECMO-day based on three methods</b></figcaption><span>Full size table</span><svg aria-hidden=\"true\" focusable=\"false\" height=\"16\" role=\"img\" width=\"16\"><use xlink:href=\"#icon-eds-i-chevron-right-small\" xmlns:xlink=\"http://www.w3.org/1999/xlink\"></use></svg></figure><p>Furthermore, it is essential to emphasize that the integrity of our results has been strengthened by thorough assessments for heterogeneity, publication bias, and data behavior through various statistical evaluations. As shown in our manuscript [4], we have already conducted extensive methodological reviews, ","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"336 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142905016","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":"Hemoadsorption in cardiac surgery, limitations of low-risk patient selection and minimal cytokine levels","authors":"Gonzalo Ramírez-Guerrero, Cristian Pedreros-Rosales","doi":"10.1186/s13054-024-05229-y","DOIUrl":"https://doi.org/10.1186/s13054-024-05229-y","url":null,"abstract":"<p>Dear Editor,</p><p>We read with interest the recent article by Hohn et al., addressing the efficacy of the hemoadsorption technique in managing cytokine elevation following cardiac surgery, with a particular focus on renal outcomes and the evolving role of extracorporeal blood purification. The RECCAS study on CytoSorb® and the SIRAKI02 randomized trial on oXiris® membranes represent pivotal contributions to this field. Yet, they also share limitations that must be carefully considered [1, 2].</p><p>The RECCAS study examined the use of CytoSorb® in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). Baseline IL-6 levels during surgery were comparable between groups, at 13.7 pg/mL in the treatment group and 13.8 pg/mL in the control group. However, IL-6 levels measured at ICU admission were elevated in both 155.8 ± 159.6 pg/mL in the control group and 214.4 ± 328.8 pg/mL in the CytoSorb group. These levels continued to rise within the first 48 h of ICU admission, with a total peak of 8786.5 pg/mL observed (Supplemental Table 4). Despite these inflammatory markers, the intervention yielded no significant differences in primary inflammation outcomes [1].</p><p>Similarly, the SIRAKI02 trial assessed the oXiris® membrane and found no significant reduction in IL-6 levels during cardiac surgery, with baseline levels of 4.30 ± 4.01 pg/mL (extracorporeal blood purification) and 5.83 ± 8.84 pg/mL (standard care). At ICU admission, IL-6 levels were 47.0 ± 88.0 pg/mL in the treatment group and 63.8 ± 121.0 pg/mL in the control group [2].</p><p>Nevertheless, the SIRAKI02 trial demonstrated a significant reduction in AKI incidence from 39.7% in the standard care group to 28.4% in the intervention group (p = 0.03). In addition, RECCAS study showed secondary benefits, including reduced renal replacement therapies (RRT) duration (therefore, improving renal recovery) and improved hemodynamic stability. The authors reported a significantly shorter duration of renal replacement therapy in the treatment group (2.3 ± 0.6 days) compared to the control group (5.3 ± 1.2 days; p = 0.029) [1, 2]. These results collectively highlight the potential of hemoadsorption in improving renal and systemic outcomes in patients with AKI following cardiac surgery rather than solely focusing on cytokine removal, a concept demonstrated by Jansen’s experiments [3].</p><p>These outcomes (SIRAKI02 and RECCAS) highlight that renal benefits may occur independently of significant cytokine modulation, particularly when baseline IL-6 levels are as low as those observed in both groups, reflecting patients with a low risk of post-pump syndrome. This suggests that mechanisms beyond IL-6 reduction may drive these renal benefits. In addition, these results highlight the importance of patient selection and the role of IL-6 levels in AKI. The SIRAKI02 and RECCAS trials demonstrated significant elevations in IL-6 during the first hours of ICU admission. These findings justify the n","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"26 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142901596","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":"Non-adrenergic vasopressors for vasodilatory shock or perioperative vasoplegia: a meta-analysis of randomized controlled trials","authors":"Yuki Kotani, Alessandro Belletti, Filippo D’Amico, Alessandra Bonaccorso, Patrick M. Wieruszewski, Tomoko Fujii, Ashish K. Khanna, Giovanni Landoni, Rinaldo Bellomo","doi":"10.1186/s13054-024-05212-7","DOIUrl":"https://doi.org/10.1186/s13054-024-05212-7","url":null,"abstract":"Excessive exposure to adrenergic vasopressors may be harmful. Non-adrenergic vasopressors may spare adrenergic agents and potentially improve outcomes. We aimed to conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the efficacy of non-adrenergic vasopressors in adult patients receiving vasopressor therapy for vasodilatory shock or perioperative vasoplegia. We searched PubMed, Embase, and Cochrane Library for RCTs comparing non-adrenergic vasopressors with adrenergic vasopressors alone or placebo in critically ill or perioperative patients. Each eligible study was categorized into septic shock, cardiac surgery, or non-cardiac surgery. Non-adrenergic vasopressors included vasopressin, terlipressin, selepressin, angiotensin II, methylene blue, and hydroxocobalamin. The primary outcome was mortality at longest follow-up. We conducted a random-effects meta-analysis. We registered the protocol in PROSPERO International Prospective Register of Systematic Reviews (CRD42024505039). Among 51 eligible RCTs totaling 5715 patients, the predominant population was septic shock in 30 studies, cardiac surgery in 11 studies, and non-cardiac surgery in 10 studies. Cochrane risk-of-bias tool for randomized trials version 2 identified 17 studies as low risk of bias. In septic shock, mortality was significantly lower in the non-adrenergic group (960/2232 [43%] vs. 898/1890 [48%]; risk ratio [RR], 0.92; 95% confidence interval [95% CI], 0.86–0.97; P = 0.03; I2 = 0%), with none of the individual non-adrenergic vasopressors showing significant survival benefits. No significant mortality difference was observed in patients undergoing cardiac surgery (34/410 [8.3%] vs. 47/412 [11%]; RR, 0.82; 95% CI, 0.55–1.22; P = 0.32; I2 = 12%) or those undergoing non-cardiac surgery (9/388 [2.3%] vs. 18/383 [4.7%]; RR, 0.66; 95% CI, 0.31–1.41; P = 0.28; I2 = 0%). Administration of non-adrenergic vasopressors was significantly associated with reduced mortality in patients with septic shock. However, no single agent achieved statistical significance in separate analyses. Although the pooled effects of non-adrenergic vasopressors on survival did not reach statistical significance in patients undergoing cardiac or non-cardiac surgery, the confidence intervals included the possibility of both no effect and a clinically important benefit from non-adrenergic agents. These findings justify the conduct of further RCTs comparing non-adrenergic vasopressors to usual care based on noradrenaline alone.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"10 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142901594","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":"High rates of cefidercol plasma target attainment: results of a retrospective cohort study in 31 critically ill ICU patients","authors":"Hans Theodor Naumann, Rainer Höhl, Martina Kinzig, Sophie Salat, Vanessa Bartsch, Fritz Sörgel, Ralph Bertram, Joerg Steinmann","doi":"10.1186/s13054-024-05214-5","DOIUrl":"https://doi.org/10.1186/s13054-024-05214-5","url":null,"abstract":"<p>Cefiderocol is a catechol-conjugated cephalosporin indicated for adults with limited treatment options, which suffer from systemic infections with aerobic Gram-negative bacteria. These include nosocomial pathogens such as Enterobacterales, <i>Stenotrophomonas maltophilia</i> and extensively drug-resistant bacteria like carbapenem-resistant <i>Acinetobacter baumannii</i> and <i>Pseudomonas aeruginosa</i> [1]. Cefiderocol displays linear pharmacokinetics, as both the plasma concentration area under the curve and the maximum plasma concentration increase proportionally with the dosage, ranging from 100 to 2000 mg.</p><p>We conducted a retrospective therapeutic drug monitoring (TDM) study for cefiderocol including 31 intensive care patients with bacterial infections that were treated at ICUs at Klinikum Nürnberg, Nuremberg, Germany between April 2021 and October 2023. This study was approved by the institutional review board at Klinikum Nürnberg (IRB-2024-15). Key patients’ clinical and demographic data are provided in Table 1, further details are found in additional file 1.\u0000</p><figure><figcaption><b data-test=\"table-caption\">Table 1 Key demographic and clinical characteristics of the patients included</b></figcaption><span>Full size table</span><svg aria-hidden=\"true\" focusable=\"false\" height=\"16\" role=\"img\" width=\"16\"><use xlink:href=\"#icon-eds-i-chevron-right-small\" xmlns:xlink=\"http://www.w3.org/1999/xlink\"></use></svg></figure><p>Twenty-one patients of this study were infected with multidrug-resistant Gram-negative bacteria. <i>P. aeruginosa</i> was by far the most prevalent isolate (n = 12), four others were Enterobacterales, one isolate each was identified as <i>A. baumannii</i> and four as <i>S. maltophilia</i>. The remaining ten patients were treated with cefiderocol empirically after multiple antibiotic pre-therapies.</p><p>Patients were given cefiderocol for 1–10 days with one patient being treated for 43 days (median: 5 days, interquartile range (IQR): 2–8). Based upon a standard dosing regimen of 2000 mg for 3 h every 8 h (with an upfront loading dose administered in 60 min), the patients received adjusted amounts of cefiderocol, taking TDM and creatinine clearance (CrCl) into account. Thus, individual patients were administered one to four doses of 750–2000 mg of cefiderocol, resulting in total daily doses ranging from 750 to 8000 mg (median: 3000 mg, IQR: 2000–4000).</p><p>Cefiderocol concentrations were analysed from blood samples taken 30–60 min before administration of the next dose, defining them as C<sub>min</sub> values (trough levels). Analytics was performed by liquid chromatography with tandem mass spectrometry, with a turnaround time of less than 2 h. According to EUCAST we assumed a minimal inhibitory concentrations (MIC) breakpoint of cefiderocol of 2 µg/mL irrespective of the specific bacterium in our study. A C<sub>min</sub> above 8 µg/mL of total cefiderocol (4 × minimum inhibitory concentration) was defined as suffi","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"44 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142901595","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 role of rapid multiplex molecular syndromic panels in the clinical management of infections in critically ill patients: an experts-opinion document","authors":"Francisco Javier Candel, Miguel Salavert, Rafael Cantón, José Luis del Pozo, Fátima Galán-Sánchez, David Navarro, Alejandro Rodríguez, Juan Carlos Rodríguez, Montserrat Rodríguez-Aguirregabiria, Borja Suberviola, Rafael Zaragoza","doi":"10.1186/s13054-024-05224-3","DOIUrl":"https://doi.org/10.1186/s13054-024-05224-3","url":null,"abstract":"Rapid multiplex molecular syndromic panels (RMMSP) (3 or more pathogens and time-to-results < 6 h) allow simultaneous detection of multiple pathogens and genotypic resistance markers. Their implementation has revolutionized the clinical landscape by significantly enhancing diagnostic accuracy and reducing time-to-results in different critical conditions. The current revision is a comprehensive but not systematic review of the literature. We conducted electronic searches of the PubMed, Medline, Embase, and Google Scholar databases to identify studies assessing the clinical performance of RMMSP in critically ill patients until July 30, 2024. A multidisciplinary group of 11 Spanish specialists developed clinical questions pertaining to the indications and limitations of these diagnostic tools in daily practice in different clinical scenarios. The topics covered included pneumonia, sepsis/septic shock, candidemia, meningitis/encephalitis, and off-label uses of these RMMSP. These tools reduced the time-to-diagnosis (and therefore the time-to-appropriate treatment), reduced inappropriate empiric treatment and the length of antibiotic therapy (which has a positive impact on antimicrobial stewardship and might be associated with lower in-hospital mortality), may reduce the length of hospital stay, which could potentially lead to cost savings. Despite their advantages, these RMMSP have limitations that should be known, including limited availability, missed diagnoses if the causative agent or resistance determinants are not included in the panel, false positives, and codetections. Overall, the implementation of RMMSP represents a significant advancement in infectious disease diagnostics, enabling more precise and timely interventions. This document addresses relevant issues related to the use of RMMSP on different critically ill patient profiles, to standardize procedures, assist in making management decisions and help specialists to obtain optimal outcomes.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"35 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142905015","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":"Dynamic assessment of signal entropy for prognostication and secondary brain insult detection after traumatic brain injury","authors":"Stefan Yu Bögli, Ihsane Olakorede, Erta Beqiri, Xuhang Chen, Ari Ercole, Peter Hutchinson, Peter Smielewski","doi":"10.1186/s13054-024-05228-z","DOIUrl":"https://doi.org/10.1186/s13054-024-05228-z","url":null,"abstract":"Entropy quantifies the level of disorder within a system. Low entropy reflects increased rigidity of homeostatic feedback systems possibly reflecting failure of protective physiological mechanisms like cerebral autoregulation. In traumatic brain injury (TBI), low entropy of heart rate and intracranial pressure (ICP) predict unfavorable outcome. Based on the hypothesis that entropy is a dynamically changing process, we explored the origin and value of entropy time trends. 232 continuous recordings of arterial blood pressure and ICP of TBI patients with available clinical information and 6-month outcome (Glasgow Outcome Scale) were accessed form the Brain Physics database. Biosignal entropy was estimated as multiscale entropy (MSE) that aggregates entropy at several time scales (20 coarse graining steps starting from 0.1 Hz). MSE was calculated repeatedly for consecutive, overlapping 6 h segments. Percentage monitoring time (ptime) or dosage (duration*level/hour) below different cutoffs were evaluated against outcome using univariable and multivariable analyses, and propensity score matching. Associations to clinical and monitoring metrics were explored using correlation coefficients. Lastly, individual secondary brain insults (deviations in ICP, cerebral perfusion pressure – CPP, or pressure reactivity) were assessed in relation to changes in MSE. Increased MSE abp and MSE cpp ptime (OR 1.28 (1.07–1.58) and OR 1.50 (1.16–2.03) for MSE abp and cpp respectively) and dose (OR 1.12 (1.02–1.27) and OR 1.21 (1.06–1.46) for MSE abp and cpp respectively) were associated with poor outcome even after propensity score matching within multivariable models correcting for ICP, CPP, and the pressure reactivity index. MSE trajectories differed significantly dependent on outcome. The entropy metrics displayed weak correlations to clinical parameters. Individual episodes of deranged physiology were associated with decreases in the MSE metrics from both cerebral and systemic biosignals. Biosignal entropy of changes dynamically after TBI. The assessment of these variations augments individualized, dynamic, outcome prognostication and identification of secondary cerebral insults. Additionally, these explorations allow for further exploitation of the extensive physiological data lakes acquired for each TBI patient within an intensive care environment.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"33 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142901597","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":"Definitions, epidemiology, and outcomes of persistent/chronic critical illness: a scoping review for translation to clinical practice","authors":"Hiroyuki Ohbe, Kasumi Satoh, Takaaki Totoki, Atsushi Tanikawa, Kasumi Shirasaki, Yoshihide Kuribayashi, Miku Tamura, Yudai Takatani, Hiroyasu Ishikura, Kensuke Nakamura","doi":"10.1186/s13054-024-05215-4","DOIUrl":"https://doi.org/10.1186/s13054-024-05215-4","url":null,"abstract":"Medical advances in intensive care units (ICUs) have resulted in the emergence of a new patient population—those who survive the initial acute phase of critical illness, but require prolonged ICU stays and develop chronic critical symptoms. This condition, often termed Persistent Critical Illness (PerCI) or Chronic Critical Illness (CCI), remains poorly understood and inconsistently reported across studies, resulting in a lack of clinical practice use. This scoping review aims to systematically review and synthesize the existing literature on PerCI/CCI, with a focus on definitions, epidemiology, and outcomes for its translation to clinical practice. A scoping review was conducted using MEDLINE and Scopus, adhering to the PRISMA-ScR guidelines. Peer-reviewed original research articles published until May 31, 2024 that described adult PerCI/CCI in their definitions of patient populations, covariates, and outcomes were included. Data on definitions, epidemiology, and outcomes were extracted by a data charting process from eligible studies and synthesized. Ninety-nine studies met the inclusion criteria. Of these studies, 64 used the term CCI, 18 used PerCI, and 17 used other terms. CCI definitions showed greater variability, while PerCI definitions remained relatively consistent, with an ICU stay ≥ 14 days for CCI and ≥ 10 days for PerCI being the most common. A meta-analysis of the prevalence of PerCI/CCI among the denominators of “all ICU patients”, “sepsis”, “trauma”, and “COVID-19” showed 11% (95% confidence interval 10–12%), 28% (22–34%), 24% (15–33%), and 35% (20–50%), respectively. A meta-analysis of in-hospital mortality was 27% (26–29%) and that of one-year mortality was 45% (32–58%). Meta-analyses of the prevalence of CCI and PerCI showed 17% (16–18%) and 18% (16–20%), respectively, and those for in-hospital mortality were 28% (26–30%) and 26% (24–29%), respectively. Functional outcomes were generally poor, with many survivors requiring long-term care. This scoping review synthesized many studies on PerCI/CCI, highlighting the serious impact of PerCI/CCI on patients’ long-term outcomes. The results obtained underscore the need for consistent terminology with high-quality research for PerCI/CCI. The results obtained provide important information to be used in discussions with patients and families regarding prognosis and care options. ","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"32 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2024-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142888102","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}