Journal of critical care最新文献

英文中文

Derivation and validation of a prediction rule for sedative-associated delirium during acute respiratory failure requiring mechanical ventilation 需要机械通气的急性呼吸衰竭期间镇静剂相关性谵妄预测规则的推导和验证

IF 2.9 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care

Pub Date : 2025-12-31 DOI: 10.1016/j.jcrc.2025.155407

Niall T. Prendergast , Chukwudi A. Onyemekwu , Kelly M. Toth , Christopher A. Franz , Georgios D. Kitsios , Bryan J. McVerry , Pratik P. Pandharipande , E. Wesley Ely , Timothy D. Girard

Objective

To derive and validate a simple, transparent model that quantifies risk for sedative-associated delirium in mechanically ventilated ICU patients, which could be used to guide decisions about personalized sedation.

Design

We performed backward stepwise logistic regression to derive a model predictive of sedative-associated delirium. We validated this model internally using hundredfold bootstrapping. We then validated this model externally in a separate prospective cohort of mechanically ventilated ICU patients.

Setting

Five US hospitals, including one academic, one private, and three veterans hospitals.

Patients

The parent cohort consisted of 1040 patients with either septic or cardiogenic shock, acute respiratory failure, or both. From the parent cohort 836 patients who received mechanical ventilation were selected to comprise the derivation cohort.

Interventions

None.

Measurements and main results

Backwards stepwise regression produced a model with age, BMI, sepsis, SOFA, malignancy, COPD, sex, and doses of opioids, propofol, and benzodiazepines as predictors of sedative-associated delirium. The model had very good discriminative power, with an area under the receiver-operator curve (AUROC) of 0.83. Internal validation via bootstrapping showed preserved discriminatory function with an AUROC of 0.81 and graphical evidence of good calibration. External validation in a separate set of 340 patients showed good discrimination, with AUROC of 0.70.

Conclusions

Risk for sedative-associated delirium during acute respiratory failure requiring mechanical ventilation can be quantified using a simple, transparent model, which can now be validated in a prospective study.

目的建立并验证一个简单、透明的模型，量化机械通气ICU患者镇静相关性谵妄的风险，用于指导个性化镇静的决策。设计：我们采用后向逐步逻辑回归来推导预测镇静剂相关性谵妄的模型。我们在内部使用百倍bootstrapping验证了该模型。然后，我们在机械通气ICU患者的单独前瞻性队列中外部验证了该模型。5家美国医院，包括1家学术医院、1家私立医院和3家退伍军人医院。患者：父母队列包括1040例感染性休克或心源性休克、急性呼吸衰竭或两者兼有的患者。从父母队列中选择836例接受机械通气的患者组成衍生队列。干预：测量和主要结果通过反向逐步回归建立了一个模型，该模型将年龄、BMI、败血症、SOFA、恶性肿瘤、COPD、性别以及阿片类药物、异丙酚和苯二氮卓类药物的剂量作为镇静剂相关性谵妄的预测因子。该模型具有很好的判别能力，接收-操作曲线下面积（AUROC）为0.83。通过自举进行的内部验证显示，AUROC为0.81，保留了判别函数，图形证据表明校准良好。在另外340例患者中进行的外部验证显示出良好的鉴别，AUROC为0.70。结论：在需要机械通气的急性呼吸衰竭期间，镇静剂相关谵妄的风险可以通过一个简单、透明的模型来量化，现在可以在一项前瞻性研究中进行验证。

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引用次数: 0

Comment on “Is ketamine safe for traumatic brain injury? A systematic review and meta-analysis” “氯胺酮对创伤性脑损伤安全吗？”系统回顾和荟萃分析”

IF 2.9 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care

Pub Date : 2025-12-31 DOI: 10.1016/j.jcrc.2025.155413

Wael Ghaly Elmasry , Ahmed Mohammed Abdelbaky , Ahmed Hossameldin Ahmed Awad

引用次数: 0

Comment on “Associations of positive end-expiratory pressure (PEEP) with extubation failure and clinical outcomes in invasively ventilated patients with acute brain injury: A secondary analysis of the ENIO study” “有创通气急性脑损伤患者呼气末正压（PEEP）与拔管失败及临床结果的关系：ENIO研究的二次分析”

IF 2.9 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care

Pub Date : 2025-12-31 DOI: 10.1016/j.jcrc.2025.155412

Prateek Pandey , Amit Kumar Mishra , Nimesh Kumar Dubey

引用次数: 0

What every intensivist should know about how to survive alarm fatigue with the F.ALARM method 每个重症监护医师都应该知道的关于如何用f.a alarm方法度过警报疲劳的知识。

IF 2.9 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care

Pub Date : 2025-12-29 DOI: 10.1016/j.jcrc.2025.155406

Judy Edworthy , Elif Özcan

引用次数: 0

Machine learning survival analysis for predicting kidney disease progression in patients with acute kidney injury undergoing continuous kidney replacement therapy: An analysis of the LINKA database 机器学习生存分析预测急性肾损伤患者持续肾脏替代治疗的肾脏疾病进展：LINKA数据库分析

IF 2.9 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care

Pub Date : 2025-12-24 DOI: 10.1016/j.jcrc.2025.155419

Donghwan Yun , Ari Hong , Kwangsoo Kim , Jeonghwan Lee , Yaerim Kim , Kyubok Jin , Ji Eun Kim , Shin Young Ahn , Gang-Jee Ko , Seokwoo Park , Sejoong Kim , Hee-Yeon Jung , Jang-Hee Cho , Sun-Hee Park , Eun Sil Koh , Sungjin Chung , Jung Pyo Lee , Jung Nam An , Sung Gyun Kim , Dong Ki Kim , Seung Seok Han

Purpose

The progression of acute kidney injury (AKI) to end-stage kidney disease (ESKD) poses challenges due to high risks of comorbidities and poor outcomes. This study aimed to develop and validate machine learning survival models for predicting ESKD in patients receiving continuous kidney replacement therapy (CKRT) for AKI.

Methods

A total of 1444 AKI patients who survived beyond one week after CKRT were included. Data from six hospitals were used to develop the model, and data from two hospitals formed the validation cohort. A comprehensive set of 122 clinical and laboratory variables was utilized to construct prediction models, including CoxBoost, Elastic-Net Cox, random survival forest, and Cox proportional hazards models. Model performance was assessed using the concordance index (C-index).

Results

The CoxBoost model demonstrated superior performance, with a C-index of 0.811 (95 % confidence interval, 0.756–0.865) in the internal validation cohort and 0.742 (0.700–0.788) in the external validation cohort. This model reduced the variable set to 23 key parameters, with 24-h urine output on day 7 of CKRT, preexisting chronic kidney disease, and day 7 kidney function and systemic laboratory measures identified as the most critical predictors. A simplified scoring system derived from six binarized variables effectively stratified patients into low-, intermediate-, and high-risk groups for ESKD progression.

Conclusion

This machine learning survival approach highlights a set of critical, readily measurable predictors of ESKD risk and may support targeted risk stratification, bedside decision-making, and more efficient allocation of post-CKRT surveillance and kidney-care resources.

目的：急性肾损伤（AKI）进展为终末期肾病（ESKD），由于合并症的高风险和不良预后，提出了挑战。本研究旨在开发和验证机器学习生存模型，以预测接受持续肾脏替代治疗（CKRT）的AKI患者的ESKD。方法：共纳入1444例CKRT术后存活1周以上的AKI患者。来自六家医院的数据被用于开发模型，来自两家医院的数据形成验证队列。利用122个临床和实验室变量构建预测模型，包括Cox boost、Elastic-Net Cox、随机生存森林和Cox比例风险模型。采用一致性指数（C-index）评估模型的性能。结果：CoxBoost模型表现出较好的性能，内部验证队列的c指数为0.811(95%置信区间0.756 ~ 0.865)，外部验证队列的c指数为0.742（0.700 ~ 0.788）。该模型将变量集减少到23个关键参数，其中CKRT治疗第7天的24小时尿量、既往存在的慢性肾脏疾病、第7天的肾功能和系统实验室测量被确定为最关键的预测因素。一个由6个二值化变量组成的简化评分系统有效地将患者分为ESKD进展的低、中、高风险组。结论：这种机器学习生存方法强调了一套关键的、易于测量的ESKD风险预测指标，并可能支持有针对性的风险分层、床边决策，以及更有效地分配ckrt后监测和肾脏护理资源。

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引用次数: 0

Diagnostic accuracy of superior vena cava variability by transthoracic echocardiography as a fluid responsiveness predictor in critically ill patients 经胸超声心动图对危重病人上腔静脉变异性作为液体反应性预测指标的诊断准确性。

IF 2.9 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care

Pub Date : 2025-12-23 DOI: 10.1016/j.jcrc.2025.155420

Diego Ugalde , Jorge Montoya , Juan N. Medel , Daniela Eisen , Antoine Vieillard-Baron

Background

Fluid administration is frequent in critically ill patients and its used should be tailored. A recent window to evaluate the superior vena cava variability (SVC) obtained with transthoracic echocardiography might allow fluid responsiveness prediction. Our objective is to evaluate its diagnostic accuracy as such.

Methods

We conducted a prospective study in a single intensive care unit in an academic center, including consecutive sedated, ventilated adults with elevated lactate or abnormal clinical perfusion or norepinephrine infusion of 0,1 μg/kg/min or more with <7 days of stay, excluding patients with inadequate acoustic window or special contact precautions. We performed a transthoracic critical care echocardiography adding the SVC respiratory variability and then a mini-fluid challenge as a reference test to evaluate its diagnostic accuracy and obtaining the area under receiver operating characteristic curve (AUROC).

Results

From 100 patients, 55 were excluded, mainly because of insufficient acoustic window. In 45 analysed patients, 16 were fluid responders and 29 non-responders. SVC had an AUROC of 0,88. A cutoff value of 10,14 % had 93.75 % sensitivity and 75.86 % specificity with Youden's index of 0,69,912 while 19,42 % was a high specificity cutoff and 16,03 % a balanced one.

Conclusion

Transthoracic SVC variation is hard to obtain and has a good diagnostic accuracy for detecting fluid responsiveness and it could be used in some ventilated patients with hemodynamic instability.

Registration: ClinicalTrials.gov: NCT05211765.

背景：在危重患者中，输液是常见的，需要有针对性地使用。最近通过经胸超声心动图评估上腔静脉变异性（SVC）的窗口可能允许预测液体反应。我们的目标是评估其诊断的准确性。方法：我们在某学术中心的单个重症监护病房进行了一项前瞻性研究，包括连续镇静、通气的成人，其乳酸升高或临床灌注异常或去甲肾上腺素输注0.1 μg/kg/min或更高。结果：从100例患者中，55例被排除，主要是因为声窗不足。在分析的45例患者中，16例有液体反应，29例无反应。SVC的AUROC为0.88。截断值为10.14%，敏感性为93.75%，特异性为75.86%，约登指数为0.69912，高特异性截断值为19.42%，平衡截断值为16.03%。结论：经胸SVC变化难以获得，对检测液体反应性有较好的诊断准确性，可用于部分通气患者的血流动力学不稳定。注册：ClinicalTrials.gov: NCT05211765。

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引用次数: 0

Letter to the Editor “The association between albumin-corrected anion gap and in-hospital mortality in critically ill COPD patients: A multicenter retrospective study from eICU collaborative research database” 致编辑的信“危重COPD患者白蛋白校正阴离子间隙与住院死亡率的关系：来自eICU合作研究数据库的多中心回顾性研究”。

IF 2.9 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care

Pub Date : 2025-12-22 DOI: 10.1016/j.jcrc.2025.155410

Susu He , Yongkang Wang

引用次数: 0

Feeding-associated hypophosphatemia in critically ill patients. A multicentre, observational study 危重病人喂养相关性低磷血症。一项多中心观察性研究。

IF 2.9 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care

Pub Date : 2025-12-22 DOI: 10.1016/j.jcrc.2025.155400

Anis Chaba , Ra'eesa Doola , Kevin B. Laupland , Kiran Shekar , Aashish Kumar , Alexis Tabah , Mahesh Ramanan , Felicity Edwards , Rinaldo Bellomo , Kyle C. White , On behalf of Queensland Critical Care Research Network (QCCRN)

Background

Feeding-associated hypophosphataemia in critically ill patients is a well-recognised phenomenon that has been associated with adverse outcomes. However, the research has been limited by various definitions and small sample sizes.

Methods

A multicentre retrospective cohort study of critically ill patients from six intensive care units in Queensland, Australia. Feeding-associated hypophosphataemia was defined as a decrease of >0.16 mmol.L⁻¹ and a phosphate nadir of 0.80 ≤ mmol.L⁻¹ within 24 h of nutrition commencement.

Results

A total of 10,672 patients, with a mean age of 56 ± 17 years and a mean Acute Physiology and Chronic Health Evaluation III score of 63 ± 27, were included. On the day of nutrition commencement, 7801 (73 %) patients were invasively ventilated, and 7053 (66 %) were on vasopressor support. Within 24 h of nutrition, 1298 (13 %) developed moderate to severe feeding-associated hypophosphataemia. Crude hospital mortality was higher in the moderate/severe feeding-associated hypophosphatemia group compared to the control group (18 % vs. 14 %, p < 0.001). Caloric quantity (aOR = 1.06; 95 %CI [1.02, 1.10]), feeding commenced within 48 h of admission (aOR = 1.56; 95 %CI [1.28, 1.91]) and receiving insulin on the day of feeding start (aOR = 1.22; 95 %CI [1.07, 1.40]) were independently associated with developing feeding-associated hypophosphataemia. After adjustment for confounders, moderate-severe feeding-associated hypophosphataemia was independently associated with an increased risk of 30-day hospital mortality (HR = 1.30; 95 %CI [1.08 to 1.56]).

Conclusion

In a large group of critically ill patients, almost one in seven patients experienced moderate to severe hypophosphatemia after starting to consume calories. The dose of caloric intake and early nutrition initiation were linked to its development. Additionally, moderate to severe hypophosphatemia was independently associated with a higher risk of 30-day hospital mortality.

背景：在危重患者中，喂养相关的低磷血症是一种公认的与不良后果相关的现象。然而，研究受到各种定义和小样本量的限制。方法：对澳大利亚昆士兰州6个重症监护病房的危重患者进行多中心回顾性队列研究。喂养相关性低磷血症定义为>.16 mmol的减少。L-1和磷酸盐最低点0.80≤mmol。L-1在营养开始后24小时内。结果：共纳入10672例患者，平均年龄56±17岁，急性生理和慢性健康评估III平均评分63±27分。在营养开始当天，7801例（73%）患者接受有创通气，7053例（66%）患者接受血管加压素支持。在喂食24小时内，1298（13%）发生了中度至重度喂食相关的低磷血症。与对照组相比，中度/重度喂养相关低磷血症组的粗死亡率更高（18% vs. 14%）。结论：在一大批危重患者中，几乎七分之一的患者在开始摄入卡路里后出现中度至重度低磷血症。热量摄入的剂量和早期营养开始与它的发展有关。此外，中度至重度低磷血症与较高的30天住院死亡率风险独立相关。

{"title":"Feeding-associated hypophosphatemia in critically ill patients. A multicentre, observational study","authors":"Anis Chaba , Ra'eesa Doola , Kevin B. Laupland , Kiran Shekar , Aashish Kumar , Alexis Tabah , Mahesh Ramanan , Felicity Edwards , Rinaldo Bellomo , Kyle C. White , On behalf of Queensland Critical Care Research Network (QCCRN)","doi":"10.1016/j.jcrc.2025.155400","DOIUrl":"10.1016/j.jcrc.2025.155400","url":null,"abstract":"<div><h3>Background</h3><div>Feeding-associated hypophosphataemia in critically ill patients is a well-recognised phenomenon that has been associated with adverse outcomes. However, the research has been limited by various definitions and small sample sizes.</div></div><div><h3>Methods</h3><div>A multicentre retrospective cohort study of critically ill patients from six intensive care units in Queensland, Australia. Feeding-associated hypophosphataemia was defined as a decrease of >0.16 mmol.L<sup>−1</sup> and a phosphate nadir of 0.80 ≤ mmol.L<sup>−1</sup> within 24 h of nutrition commencement.</div></div><div><h3>Results</h3><div>A total of 10,672 patients, with a mean age of 56 ± 17 years and a mean Acute Physiology and Chronic Health Evaluation III score of 63 ± 27, were included. On the day of nutrition commencement, 7801 (73 %) patients were invasively ventilated, and 7053 (66 %) were on vasopressor support. Within 24 h of nutrition, 1298 (13 %) developed moderate to severe feeding-associated hypophosphataemia. Crude hospital mortality was higher in the moderate/severe feeding-associated hypophosphatemia group compared to the control group (18 % vs. 14 %, <em>p</em> < 0.001). Caloric quantity (aOR = 1.06; 95 %CI [1.02, 1.10]), feeding commenced within 48 h of admission (aOR = 1.56; 95 %CI [1.28, 1.91]) and receiving insulin on the day of feeding start (aOR = 1.22; 95 %CI [1.07, 1.40]) were independently associated with developing feeding-associated hypophosphataemia. After adjustment for confounders, moderate-severe feeding-associated hypophosphataemia was independently associated with an increased risk of 30-day hospital mortality (HR = 1.30; 95 %CI [1.08 to 1.56]).</div></div><div><h3>Conclusion</h3><div>In a large group of critically ill patients, almost one in seven patients experienced moderate to severe hypophosphatemia after starting to consume calories. The dose of caloric intake and early nutrition initiation were linked to its development. Additionally, moderate to severe hypophosphatemia was independently associated with a higher risk of 30-day hospital mortality.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"92 ","pages":"Article 155400"},"PeriodicalIF":2.9,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145819291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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Lighting the path to personalized sedation in the ICU 照亮了ICU个性化镇静的道路

IF 2.9 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care

Pub Date : 2025-12-20 DOI: 10.1016/j.jcrc.2025.155408

Rafael Badenes , Thomas Godet , Yuki Kotani

引用次数: 0

Authors reply: “The clinical outcome of Montelukast versus co-enzyme Q10 in adult patients with sepsis: A randomized controlled clinical trial” 作者回复：“孟鲁司特与辅酶Q10在成人脓毒症患者中的临床效果：一项随机对照临床试验”

IF 2.9 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care

Pub Date : 2025-12-20 DOI: 10.1016/j.jcrc.2025.155416

Ghada Hussein ELadly , Salwa Omar Elkhattab Amin , Nagwa Ali Sabri , May Ahmed Shawki

引用次数: 0

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