Journal of critical care最新文献

英文中文

Bio-inspired gloden jackal optimization of XGBoost model enhances 30-day sepsis mortality predictions. XGBoost模型的仿生金豺优化增强了30天败血症死亡率预测。

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care

Pub Date : 2025-01-07 DOI: 10.1016/j.jcrc.2024.155013

Hemant Kumar, Rashi Agarwal, Amit Yadav

引用次数: 0

Systematic review and meta-analysis of the treatment of hypernatremia in adult hospitalized patients: impact on mortality, morbidity, and treatment-related side effects

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care

Pub Date : 2025-01-06 DOI: 10.1016/j.jcrc.2024.155012

Nuanprae Kitisin , Nattaya Raykateeraroj , Yukiko Hikasa , Larissa Bianchini , Nuttapol Pattamin , Anis Chaba , Akinori Maeda , Sofia Spano , Glenn Eastwood , Kyle White , Rinaldo Bellomo

Background

Hypernatremia is relatively common in acutely ill patients and associated with mortality. Guidelines recommend a slow rate of correction (≤ 0.5 mmol/L per hour). However, a faster correction rate may be safe and improve outcomes.

Objectives

To evaluate the impact of sodium correction rates on mortality and hospital length of stay and to assess types of hypernatremia treatment and treatment side effects.

Methods

We conducted a systematic review and meta-analysis according to PRISMA guidelines, searching Ovid MEDLINE, Embase, and CENTRAL databases from inception to August 2024. Studies reporting sodium correction rates and clinical outcomes in hospitalized adults were included. A random-effects meta-analysis assessed mortality and hospital length of stay, with subgroup analyses exploring correction timing and severity. Treatment method and side effects were analyzed qualitatively.

Results

We reviewed 4445 articles and included 12 studies. Faster correction rates (> 0.5 mmol/L/h) overall showed no significant change in mortality and a high level of heterogeneity (OR 0.68, 95 % CI: 0.38–1.24, I² = 95 %). However, subgroup analyses found significantly lower mortality with faster correction of hypernatremia at the time of hospital admission (OR 0.48, 95 % CI: 0.35–0.68, I² = 2 %), with fast correction within the first 24 h of diagnosis (OR 0.48, 95 % CI: 0.31–0.73, I² = 65 %), and for severe hypernatremia (OR 0.55, 95 % CI: 0.33–0.92, I² = 79 %). There was no significant different in hospital length of stay by correction rate. No major neurological complications were reported when the correction rate was < 1 mmol/L/h.

Conclusion

Faster sodium correction appears safe and may benefit patients with severe admission-related hypernatremia, particularly within the first 24 h. Further studies are needed to refine correction protocols.

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引用次数: 0

Impact of initial jugular vein insertion site selection for central venous catheter placement on hemodialysis catheter complications 中心静脉置管起始颈静脉置管位置选择对血液透析导管并发症的影响。

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care

Pub Date : 2025-01-03 DOI: 10.1016/j.jcrc.2024.155011

Kamel A. Gharaibeh , Mohammad O. Abdelhafez , Kolman E.B. Guedze , Hussain Siddiqi , Abdurrahman M. Hamadah , Avelino C. Verceles

Purpose

This study evaluated the impact of choosing the right versus left internal jugular vein (IJV) for initial central venous catheter (CVC) placement on hemodialysis catheter-related outcomes in critically ill patients.

Materials and methods

Medical records from the University of Maryland Medical Center were reviewed for adult critical care patients who received an IJV CVC between January 1, 2019, and December 31, 2022, and later required an additional temporary hemodialysis catheter.

Results

The study included 214 patients, with 100 (46.7 %) receiving the primary CVC in the right IJV and 114 (53.3 %) in the left IJV. The right IJV group had higher hemodialysis catheter re-insertion rates (40 % vs. 2.6 % in the left IJV group, P < 0.001) related to using a different site other than the right IJV for the initial hemodialysis catheter (85 % for the right IJV group vs. 1.75 % for the left IJV group). Hemodialysis catheters were exchanged over a guidewire in 23 % of the right IJV group vs. 0.9 % in the left IJV group (P < 0.001). Additionally, 38 % of patients in the right IJV group required three venous access interventions, with 14 % needing four or more, versus only 2.6 % requiring three interventions in the left IJV group.

Conclusions

Initiating CVC placement in the right IJV in critically ill patients is associated with a higher risk of hemodialysis catheter re-catheterization related to the use of veins other than the right IJV for hemodialysis catheter placement and an increased need for venous access interventions compared to placement in the left IJV.

目的：本研究评估危重患者选择右颈内静脉（IJV）与左颈内静脉（CVC）初始置管对血液透析导管相关结局的影响。材料和方法：回顾了马里兰大学医学中心在2019年1月1日至2022年12月31日期间接受IJV CVC的成人重症监护患者的医疗记录，这些患者后来需要额外的临时血液透析导管。结果：该研究包括214例患者，其中100例（46.7%）在右侧IJV接受原发性CVC， 114例（53.3%）在左侧IJV接受原发性CVC。右侧IJV组血液透析导管再插入率更高（40%，左侧IJV组为2.6%）。结论：危重患者在右侧IJV中启动CVC放置与血液透析导管再插入的风险更高相关，这与使用静脉而不是右侧IJV进行血液透析导管放置有关，并且与左侧IJV放置相比，静脉通道干预的需求增加。

{"title":"Impact of initial jugular vein insertion site selection for central venous catheter placement on hemodialysis catheter complications","authors":"Kamel A. Gharaibeh , Mohammad O. Abdelhafez , Kolman E.B. Guedze , Hussain Siddiqi , Abdurrahman M. Hamadah , Avelino C. Verceles","doi":"10.1016/j.jcrc.2024.155011","DOIUrl":"10.1016/j.jcrc.2024.155011","url":null,"abstract":"<div><h3>Purpose</h3><div>This study evaluated the impact of choosing the right versus left internal jugular vein (IJV) for initial central venous catheter (CVC) placement on hemodialysis catheter-related outcomes in critically ill patients.</div></div><div><h3>Materials and methods</h3><div>Medical records from the University of Maryland Medical Center were reviewed for adult critical care patients who received an IJV CVC between January 1, 2019, and December 31, 2022, and later required an additional temporary hemodialysis catheter.</div></div><div><h3>Results</h3><div>The study included 214 patients, with 100 (46.7 %) receiving the primary CVC in the right IJV and 114 (53.3 %) in the left IJV. The right IJV group had higher hemodialysis catheter re-insertion rates (40 % vs. 2.6 % in the left IJV group, <em>P</em> < 0.001) related to using a different site other than the right IJV for the initial hemodialysis catheter (85 % for the right IJV group vs. 1.75 % for the left IJV group). Hemodialysis catheters were exchanged over a guidewire in 23 % of the right IJV group vs. 0.9 % in the left IJV group (<em>P</em> < 0.001). Additionally, 38 % of patients in the right IJV group required three venous access interventions, with 14 % needing four or more, versus only 2.6 % requiring three interventions in the left IJV group.</div></div><div><h3>Conclusions</h3><div>Initiating CVC placement in the right IJV in critically ill patients is associated with a higher risk of hemodialysis catheter re-catheterization related to the use of veins other than the right IJV for hemodialysis catheter placement and an increased need for venous access interventions compared to placement in the left IJV.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"87 ","pages":"Article 155011"},"PeriodicalIF":3.2,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927251","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}

引用次数: 0

Can ChatGPT-4 perform as a competent physician based on the Chinese critical care examination?

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care

Pub Date : 2025-01-02 DOI: 10.1016/j.jcrc.2024.155010

Xueqi Wang, Jin Tang, Yajing Feng, Cijun Tang, Xuebin Wang

Background

The use of ChatGPT in medical applications is of increasing interest. However, its efficacy in critical care medicine remains uncertain. This study aims to assess ChatGPT-4's performance in critical care examination, providing insights into its potential as a tool for clinical decision-making.

Methods

A dataset from the Chinese Health Professional Technical Qualification Examination for Critical Care Medicine, covering four components—fundamental knowledge, specialized knowledge, professional practical skills, and related medical knowledge—was utilized. ChatGPT-4 answered 600 questions, which were evaluated by critical care experts using a standardized rubric.

Results

ChatGPT-4 achieved a 73.5 % success rate, surpassing the 60 % passing threshold in four components, with the highest accuracy in fundamental knowledge (81.94 %). ChatGPT-4 performed significantly better on single-choice questions than on multiple-choice questions (76.72 % vs. 51.32 %, p < 0.001), while no significant difference was observed between case-based and non-case-based questions.

Conclusion

ChatGPT demonstrated notable strengths in critical care examination, highlighting its potential for supporting clinical decision-making, information retrieval, and medical education. However, caution is required regarding its potential to generate inaccurate responses. Its application in critical care must therefore be carefully supervised by medical professionals to ensure both the accuracy of the information and patient safety.

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引用次数: 0

Letter to the editor: “Platelet dysfunction in heatstroke-induced coagulopathy: A retrospective observational study” 致编辑的信：“中暑诱导凝血功能障碍的血小板功能障碍：一项回顾性观察研究”。

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care

Pub Date : 2024-12-26 DOI: 10.1016/j.jcrc.2024.155008

Yudai Iwasaki, Takayuki Ogura

引用次数: 0

Authors reply: “Platelet dysfunction in heatstroke-induced coagulopathy: A retrospective observational study” 作者回复：“血小板功能障碍在中暑引起的凝血功能障碍：一项回顾性观察研究”。

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care

Pub Date : 2024-12-26 DOI: 10.1016/j.jcrc.2024.155009

Ryota Inokuchi , Kent Doi

引用次数: 0

Fluid management in adult patients undergoing venoarterial extracorporeal membrane oxygenation: A scoping review 接受静脉体外膜氧合的成人患者的液体管理：范围回顾。

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care

Pub Date : 2024-12-21 DOI: 10.1016/j.jcrc.2024.155007

Ali Jendoubi , Quentin de Roux , Solène Ribot , Aurore Vanden Bulcke , Camille Miard , Bérénice Tiquet , Bijan Ghaleh , Renaud Tissier , Matthias Kohlhauer , Nicolas Mongardon

Background

The use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) as a cardiocirculatory support has tremendously increased in critically ill patients. Although fluid therapy is an essential component of the hemodynamic management of VA-ECMO patients, the optimal fluid resuscitation strategy remains controversial. We performed a scoping review to map out the existing knowledge on fluid management in terms of fluid type, dosing and the impact of fluid balance on VA-ECMO patient outcomes.

Methods

A literature search within PubMed and EMBASE was conducted from database inception to April 2024. We included all studies involving critically ill adult patients, supported by VA-ECMO regardless of clinical indication (cardiogenic shock or extracorporeal cardiopulmonary resuscitation) with or without Renal Replacement Therapy and describing fluid resuscitation strategies or focusing on fluid type or reporting the impact of fluid balance on clinical outcomes and mortality. Details of study population, ECMO indications, fluid types, resuscitation strategies, fluid balance and outcome measures were extracted.

Results

Sixteen studies met inclusion criteria, including 14 clinical studies and two experimental animal studies. We found a lack of studies comparing restrictive and liberal approaches. No study has compared the efficacy and safety of balanced and saline solutions. The place of albumin, as an alternative fluid, should be investigated. Despite their heterogeneity, studies found a negative impact of both early and cumulative fluid overload on survival and renal outcomes.

Conclusions

The available literature on the fluid management in VA-ECMO setting is scarce. More high-quality evidence is needed regarding optimal fluid dosing, type and resuscitation endpoints in order to standardize practice and improve outcomes.

背景：在危重患者中，静脉动脉体外膜氧合（VA-ECMO）作为一种心肺支持手段的使用急剧增加。尽管液体治疗是VA-ECMO患者血流动力学管理的重要组成部分，但最佳液体复苏策略仍存在争议。我们进行了一项范围审查，以从液体类型、剂量和液体平衡对VA-ECMO患者结果的影响方面列出现有的液体管理知识。方法：检索PubMed和EMBASE自建库至2024年4月的文献。我们纳入了所有涉及危重成人患者的研究，无论临床指征（心源性休克或体外心肺复苏）如何支持VA-ECMO，无论是否采用肾脏替代治疗，并描述液体复苏策略或关注液体类型或报告液体平衡对临床结果和死亡率的影响。提取了研究人群、ECMO适应症、液体类型、复苏策略、液体平衡和结果测量的详细信息。结果：16项研究符合纳入标准，包括14项临床研究和2项实验动物研究。我们发现缺乏比较限制和自由方法的研究。没有研究比较过平衡溶液和生理盐水溶液的有效性和安全性。应调查白蛋白作为替代液体的位置。尽管存在异质性，但研究发现，早期和累积的液体过载对生存和肾脏结局都有负面影响。结论：关于VA-ECMO环境下液体管理的文献很少。需要更多关于最佳液体剂量、类型和复苏终点的高质量证据，以便规范实践并改善结果。

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引用次数: 0

Hemodynamic effects of slower versus faster intravenous fluid bolus rates in critically ill patients: An observational study 在危重病人中较慢和较快静脉输液速度的血流动力学影响：一项观察性研究。

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care

Pub Date : 2024-12-18 DOI: 10.1016/j.jcrc.2024.154985

Daniere Yurie Vieira Tomotani , Flávio Geraldo Rezende Freitas , Alexandre Biasi Cavalcante , Ary Serpa Neto , Rodrigo Cruvinel Figueiredo , Rodrigo Santos Biondi , João Manoel Silva-Jr , Bruno Adler Maccagnan Pinheiro Besen , Jorge Luiz da Rocha Paranhos , Fernando José da Silva Ramos , Fernanda Chohfi Atallah , Thiago Miranda Lopes de Almeida , Maria Aparecida de Souza , Fernando Godinho Zampieri , Flávia Ribeiro Machado , BRICNet

Purpose

We compared the immediate and sustained effects of 500 mL of crystalloid administered at slow (333 mL/h) versus fast rates (999 mL/h) on mean arterial pressure (MAP) in critically ill patients.

Materials and methods

Hemodynamic variables were collected immediately before and every 30 min up to 60 min after the end of the infusion. The primary outcome was the adjusted difference in MAP.

Results

We included 146 patients (slow rate: 71, fast rate: 75). One hour after the end of the infusion, there was no difference in the overall mean marginal effect on MAP between the groups [1.9 mmHg (95 % CI: −1.5 to 5.3 mmHg), p = 0.27] or on the perfusion parameters. Similarly, no difference was found in the immediate effect after 90 min [overall marginal effect: 1.1 mmHg (95 % CI: −2.3 to 4.6 mmHg); p = 0.52]. In patients with cardiac output (CO) monitoring, there was an increase in CO in the fast rate group (overall mean marginal effect: 1.78 L/min (95 % CI: 0.08 to 3.48 L/min); p = 0.04).

Conclusion

In critically ill patients, crystalloid infusion at both fast and slow rates did not lead to immediate or sustained differences in MAP. However, fast infusion may result in a greater increase in CO.

目的：我们比较了500 mL晶体以慢速（333 mL/h）和快速（999 mL/h）给药对危重患者平均动脉压（MAP）的即时和持续影响。材料与方法：在注射前及注射结束后每隔30分钟至60分钟采集血液动力学参数。主要终点是MAP调整后的差异。结果：纳入146例患者（慢速71例，快速75例）。注射结束1小时后，两组间MAP的总体平均边际效应[1.9 mmHg (95% CI: -1.5 ~ 5.3 mmHg), p = 0.27]或灌注参数均无差异。同样，90分钟后的即时效果也没有差异[总体边际效应：1.1 mmHg (95% CI: -2.3至4.6 mmHg)；p = 0.52]。在进行心输出量（CO）监测的患者中，快速组的CO增加(总体平均边际效应：1.78 L/min (95% CI: 0.08 ~ 3.48 L/min)；p = 0.04)。结论：在危重患者中，快速和慢速晶体输注均不会导致MAP立即或持续的差异。然而，快速输注可能导致CO的更大增加。

{"title":"Hemodynamic effects of slower versus faster intravenous fluid bolus rates in critically ill patients: An observational study","authors":"Daniere Yurie Vieira Tomotani , Flávio Geraldo Rezende Freitas , Alexandre Biasi Cavalcante , Ary Serpa Neto , Rodrigo Cruvinel Figueiredo , Rodrigo Santos Biondi , João Manoel Silva-Jr , Bruno Adler Maccagnan Pinheiro Besen , Jorge Luiz da Rocha Paranhos , Fernando José da Silva Ramos , Fernanda Chohfi Atallah , Thiago Miranda Lopes de Almeida , Maria Aparecida de Souza , Fernando Godinho Zampieri , Flávia Ribeiro Machado , BRICNet","doi":"10.1016/j.jcrc.2024.154985","DOIUrl":"10.1016/j.jcrc.2024.154985","url":null,"abstract":"<div><h3>Purpose</h3><div>We compared the immediate and sustained effects of 500 mL of crystalloid administered at slow (333 mL/h) versus fast rates (999 mL/h) on mean arterial pressure (MAP) in critically ill patients.</div></div><div><h3>Materials and methods</h3><div>Hemodynamic variables were collected immediately before and every 30 min up to 60 min after the end of the infusion. The primary outcome was the adjusted difference in MAP.</div></div><div><h3>Results</h3><div>We included 146 patients (slow rate: 71, fast rate: 75). One hour after the end of the infusion, there was no difference in the overall mean marginal effect on MAP between the groups [1.9 mmHg (95 % CI: −1.5 to 5.3 mmHg), <em>p</em> = 0.27] or on the perfusion parameters. Similarly, no difference was found in the immediate effect after 90 min [overall marginal effect: 1.1 mmHg (95 % CI: −2.3 to 4.6 mmHg); <em>p</em> = 0.52]. In patients with cardiac output (CO) monitoring, there was an increase in CO in the fast rate group (overall mean marginal effect: 1.78 L/min (95 % CI: 0.08 to 3.48 L/min); <em>p</em> = 0.04).</div></div><div><h3>Conclusion</h3><div>In critically ill patients, crystalloid infusion at both fast and slow rates did not lead to immediate or sustained differences in MAP. However, fast infusion may result in a greater increase in CO.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"86 ","pages":"Article 154985"},"PeriodicalIF":3.2,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142864356","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}

引用次数: 0

A retrospective Cohort study on the effect of the LOw-molecular weighT heparin (LMWH) nadroparin dose on anti-XA levels in a mixed medical-surgical ICU population: CLOT-Xa 内外科混合型重症监护病房人群中低分子肝素（LMWH）纳度肝素剂量对抗 XA 水平影响的回顾性队列研究：CLOT-Xa。

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care

Pub Date : 2024-12-17 DOI: 10.1016/j.jcrc.2024.154991

Lisanne van Berkel , Marnix Kuindersma , Ingrid D. van Iperen , Henk J. Adriaansen , Janine J.J. Hulstein , Peter E. Spronk

Purpose

Low-molecular-weight heparins (LMWHs) are widely used for prevention and treatment of venous thromboembolism (VTE) in critically ill patients. The objective of this study was to assess the dose-response relationship between nadroparin dose and anti-Xa activity in ICU patients.

Materials and methods

Critically ill adult patients who were admitted to the ICU, and received at least three subcutaneous injections of nadroparin were included. The dose-effect relationship between nadroparin dose and anti-Xa level was analysed through a mixed-effects logistic regression model.

Results

In total, 327 ICU patients were included. Median anti-Xa levels ranged from <0.1 IU/mL after nadroparin 0–37 IU/kg/day to 0.6 IU/mL after nadroparin >85 IU/kg/day (p < 0.01). Among all 1520 anti-Xa measurements, 859 (57 %) measurements were in the desired anti-Xa range. The best adequacy of anti-Xa levels was observed in nadroparin doses of 38–85 IU/kg (73 %). No differences in the odds of bleeding events or VTE between different anti-Xa levels were found.

Conclusions

We found a clear dose-response relationship between nadroparin dose and anti-Xa levels. Increasing nadroparin doses led to more adequate anti-Xa levels without a change in the occurrence of VTE or major bleeding events, suggesting that LMWH therapy can be successfully and safely personalized using anti-Xa guided dosing.

目的：低分子肝素（LMWHs）广泛用于预防和治疗危重患者静脉血栓栓塞（VTE）。本研究的目的是评估在ICU患者中nadroparin剂量与抗xa活性之间的剂量-反应关系。材料和方法：纳入ICU收治的至少三次皮下注射纳红素的危重成人患者。通过混合效应logistic回归模型分析nadroparin剂量与抗xa水平的量效关系。结果：共纳入327例ICU患者。中位抗xa水平为85 IU/kg/天(p)。结论：我们发现nadroparin剂量与抗xa水平之间存在明显的剂量-反应关系。增加nadroparin剂量导致抗xa水平更足，而静脉血栓栓塞或大出血事件的发生没有变化，这表明低分子肝素治疗可以成功和安全地个体化使用抗xa引导剂量。

{"title":"A retrospective Cohort study on the effect of the LOw-molecular weighT heparin (LMWH) nadroparin dose on anti-XA levels in a mixed medical-surgical ICU population: CLOT-Xa","authors":"Lisanne van Berkel , Marnix Kuindersma , Ingrid D. van Iperen , Henk J. Adriaansen , Janine J.J. Hulstein , Peter E. Spronk","doi":"10.1016/j.jcrc.2024.154991","DOIUrl":"10.1016/j.jcrc.2024.154991","url":null,"abstract":"<div><h3>Purpose</h3><div>Low-molecular-weight heparins (LMWHs) are widely used for prevention and treatment of venous thromboembolism (VTE) in critically ill patients. The objective of this study was to assess the dose-response relationship between nadroparin dose and anti-Xa activity in ICU patients.</div></div><div><h3>Materials and methods</h3><div>Critically ill adult patients who were admitted to the ICU, and received at least three subcutaneous injections of nadroparin were included. The dose-effect relationship between nadroparin dose and anti-Xa level was analysed through a mixed-effects logistic regression model.</div></div><div><h3>Results</h3><div>In total, 327 ICU patients were included. Median anti-Xa levels ranged from <0.1 IU/mL after nadroparin 0–37 IU/kg/day to 0.6 IU/mL after nadroparin >85 IU/kg/day (<em>p</em> < 0.01). Among all 1520 anti-Xa measurements, 859 (57 %) measurements were in the desired anti-Xa range. The best adequacy of anti-Xa levels was observed in nadroparin doses of 38–85 IU/kg (73 %). No differences in the odds of bleeding events or VTE between different anti-Xa levels were found.</div></div><div><h3>Conclusions</h3><div>We found a clear dose-response relationship between nadroparin dose and anti-Xa levels. Increasing nadroparin doses led to more adequate anti-Xa levels without a change in the occurrence of VTE or major bleeding events, suggesting that LMWH therapy can be successfully and safely personalized using anti-Xa guided dosing.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"86 ","pages":"Article 154991"},"PeriodicalIF":3.2,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846874","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}

引用次数: 0

Clinical outcomes of cardiogenic shock among critically ill patients admitted to intensive care units in Australia and New Zealand from 2003 to 2022 2003年至2022年澳大利亚和新西兰重症监护病房危重患者心源性休克的临床结果

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care

Pub Date : 2024-12-16 DOI: 10.1016/j.jcrc.2024.155001

Wisam Al-Bassam , Samer Noaman , Rahul Kumar , Neil Glassford , Daryl Jones , Carys Jones , William Chan , David M. Kaye , David Pilcher , Rinaldo Bellomo , Yehya shehabi , Ary Serpa Neto

Purpose

Patients with Cardiogenic shock (CS) admitted to intensive care units (ICUs) have high mortality rates. We aimed to investigate the changes patient characteristics and outcomes over time among patients admitted to the ICU with CS.

Methods

Retrospective study utilizing a large bi-national ICU database from 2003 to 2022. Patient characteristics and outcomes based on the ICU admission diagnosis of CS were evaluated and changes in outcomes over time after adjusting for key baseline variables were assessed.

Results

During the study period, among CS patients, there were significant reductions in severity of illness (APACHE III from 80 to 72 and Australian and New Zealand Risk of Death Scores from 0.34 to 0.30, both p < 0.001). There was also a significant increase in admissions from emergency departments (32 % to 41 %, p < 0.001). Over time, unadjusted hospital mortality decreased from 57 % in 2003 to 41 % in 2022 (P < 0.001). After adjustment for severity of illness, the odds ratios for hospital mortality also decreased to 0.49 (95 % CI, 0.38 to 0.64) compared with 2003 (p < 0.001).

Conclusions

Over twenty years period, among patients with CS admitted to ICU, there has been a significant change in the epidemiological characteristics and a decrease in absolute and adjusted mortality rates.

目的：入住重症监护病房（icu）的心源性休克（CS）患者死亡率高。我们的目的是调查入住ICU的CS患者的特征和结果随时间的变化。方法：回顾性研究利用2003 - 2022年大型两国ICU数据库。评估基于CS的ICU入院诊断的患者特征和结局，并评估调整关键基线变量后结局随时间的变化。结果：在研究期间，CS患者的病情严重程度显著降低(APACHE III评分从80降至72，澳大利亚和新西兰死亡风险评分从0.34降至0.30，均为p。结论：20多年来，ICU收治的CS患者的流行病学特征发生了显著变化，绝对死亡率和调整死亡率均有所下降。

{"title":"Clinical outcomes of cardiogenic shock among critically ill patients admitted to intensive care units in Australia and New Zealand from 2003 to 2022","authors":"Wisam Al-Bassam , Samer Noaman , Rahul Kumar , Neil Glassford , Daryl Jones , Carys Jones , William Chan , David M. Kaye , David Pilcher , Rinaldo Bellomo , Yehya shehabi , Ary Serpa Neto","doi":"10.1016/j.jcrc.2024.155001","DOIUrl":"10.1016/j.jcrc.2024.155001","url":null,"abstract":"<div><h3>Purpose</h3><div>Patients with Cardiogenic shock (CS) admitted to intensive care units (ICUs) have high mortality rates. We aimed to investigate the changes patient characteristics and outcomes over time among patients admitted to the ICU with CS.</div></div><div><h3>Methods</h3><div>Retrospective study utilizing a large bi-national ICU database from 2003 to 2022. Patient characteristics and outcomes based on the ICU admission diagnosis of CS were evaluated and changes in outcomes over time after adjusting for key baseline variables were assessed.</div></div><div><h3>Results</h3><div>During the study period, among CS patients, there were significant reductions in severity of illness (APACHE III from 80 to 72 and Australian and New Zealand Risk of Death Scores from 0.34 to 0.30, both <em>p</em> < 0.001). There was also a significant increase in admissions from emergency departments (32 % to 41 %, p < 0.001). Over time, unadjusted hospital mortality decreased from 57 % in 2003 to 41 % in 2022 (<em>P</em> < 0.001). After adjustment for severity of illness, the odds ratios for hospital mortality also decreased to 0.49 (95 % CI, 0.38 to 0.64) compared with 2003 (<em>p</em> < 0.001).</div></div><div><h3>Conclusions</h3><div>Over twenty years period, among patients with CS admitted to ICU, there has been a significant change in the epidemiological characteristics and a decrease in absolute and adjusted mortality rates.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"86 ","pages":"Article 155001"},"PeriodicalIF":3.2,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846875","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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