Journal of critical care最新文献

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Temporal clustering of septic patients with acute kidney injury

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care

Pub Date : 2025-02-27 DOI: 10.1016/j.jcrc.2024.154970

Wonsuk Oh , Kullaya Takkavatakarn , Umesh Gidwani , John Oropello , Roopa Kohli-Seth , Girish Nadkarni , Ankit Sakhuja

引用次数: 0

Extending professional military healthcare to defense operations through supportive AI-assistant trained on high quality treatment data

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care

Pub Date : 2025-02-27 DOI: 10.1016/j.jcrc.2024.154972

Andreas J. Wagner , Meyer Jürgen

引用次数: 0

Prediction of cardiac arrest in the pediatric cardiac intensive care unit: A time-series machine learning approach

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care

Pub Date : 2025-02-27 DOI: 10.1016/j.jcrc.2024.154958

Jiaying Lu , Stephanie R. Brown , Yuhua Wu , Kejun Dong , Del Bold , Darren Liu , Jocelyn R. Grunwell , Xiao Hu

引用次数: 0

Microcirculation properties of 20 % albumin in sepsis; a randomised controlled trial

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care

Pub Date : 2025-02-27 DOI: 10.1016/j.jcrc.2025.155039

Rachael A.F. Cusack , Alejandro Rodríguez , Ben Cantan , Alexis Garduno , Elizabeth Connolly , Gabor Zilahi , John Davis Coakley , Ignacio Martin-Loeches

Introduction

Sepsis and septic shock are associated with microcirculatory dysfunction, significantly impacting patient outcomes. This study aimed to evaluate the effects of a 20 % albumin bolus on microcirculation compared to crystalloid resuscitation in fluid-responsive patients (ClinicalTrials.gov ID: NCT05357339).

Methods

We conducted a single-centre randomised controlled trial, enrolling 103 patients (Albumin n = 52, Control n = 51). Fluid responsiveness was assessed, and fluid was administered in boluses of 100 ml to clinical effect. Microcirculation was measured using the Side stream Dark Field camera and AVA 4.3 software. Baseline characteristics, macrohaemodynamics, and microcirculation parameters were recorded. Three patients were excluded from analysis.

Results

The final cohort comprised 100 patients, 35 (35 %) females with a mean age of 58 years (range: 18–86). The mean APACHE score was 28 (range: 7–45), and the mean SOFA score was 9.4 (range: 1–17). No significant differences in APACHE (26.24 vs. 29.4, p = 0.069) or SOFA (9.08 vs. 9.78, p = 0.32) scores were found for albumin and control group respectively. The albumin group had worse microcirculation at baseline but demonstrated significant improvements in microvascular density and activity at 15 min and 60 min (p < 0.005), while the control group exhibited no significant changes. Additionally, both groups were fluid responsive, with a mean pulse pressure variability of 17 % at admission. There were no significant differences in overall fluid balances, vasopressor days, length of ICU stay, or mortality between groups.

Conclusion

This study demonstrates that a 20 % albumin bolus significantly enhances microcirculation in fluid-responsive patients with septic shock. These findings underscore the potential benefits of targeted microcirculation therapy in critically ill patients.

{"title":"Microcirculation properties of 20 % albumin in sepsis; a randomised controlled trial","authors":"Rachael A.F. Cusack , Alejandro Rodríguez , Ben Cantan , Alexis Garduno , Elizabeth Connolly , Gabor Zilahi , John Davis Coakley , Ignacio Martin-Loeches","doi":"10.1016/j.jcrc.2025.155039","DOIUrl":"10.1016/j.jcrc.2025.155039","url":null,"abstract":"<div><h3>Introduction</h3><div>Sepsis and septic shock are associated with microcirculatory dysfunction, significantly impacting patient outcomes. This study aimed to evaluate the effects of a 20 % albumin bolus on microcirculation compared to crystalloid resuscitation in fluid-responsive patients <em>(</em><span><span><em>ClinicalTrials.gov</em></span><svg><path></path></svg></span> <em>ID:</em> <span><span><em>NCT05357339</em></span><svg><path></path></svg></span><em>).</em></div></div><div><h3>Methods</h3><div>We conducted a single-centre randomised controlled trial, enrolling 103 patients (Albumin <em>n</em> = 52, Control <em>n</em> = 51). Fluid responsiveness was assessed, and fluid was administered in boluses of 100 ml to clinical effect. Microcirculation was measured using the Side stream Dark Field camera and AVA 4.3 software. Baseline characteristics, macrohaemodynamics, and microcirculation parameters were recorded. Three patients were excluded from analysis.</div></div><div><h3>Results</h3><div>The final cohort comprised 100 patients, 35 (35 %) females with a mean age of 58 years (range: 18–86). The mean APACHE score was 28 (range: 7–45), and the mean SOFA score was 9.4 (range: 1–17). No significant differences in APACHE (26.24 vs. 29.4, <em>p</em> = 0.069) or SOFA (9.08 vs. 9.78, <em>p</em> = 0.32) scores were found for albumin and control group respectively. The albumin group had worse microcirculation at baseline but demonstrated significant improvements in microvascular density and activity at 15 min and 60 min (<em>p</em> < 0.005), while the control group exhibited no significant changes. Additionally, both groups were fluid responsive, with a mean pulse pressure variability of 17 % at admission. There were no significant differences in overall fluid balances, vasopressor days, length of ICU stay, or mortality between groups.</div></div><div><h3>Conclusion</h3><div>This study demonstrates that a 20 % albumin bolus significantly enhances microcirculation in fluid-responsive patients with septic shock. These findings underscore the potential benefits of targeted microcirculation therapy in critically ill patients.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"87 ","pages":"Article 155039"},"PeriodicalIF":3.2,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143510155","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

Do weather, season or day of the week affect ICU admissions?

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care

Pub Date : 2025-02-27 DOI: 10.1016/j.jcrc.2024.154959

Mauricio Villavicencio, Juan Garcia-Mendez, Brian Pickering, Daniel Diedrich, Vitaly Herasevich

引用次数: 0

Hearing loss assessment by pure tone audiometry amongst the survivors of intensive care unit: A prospective observational cohort study

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care

Pub Date : 2025-02-26 DOI: 10.1016/j.jcrc.2025.155042

Sai Saran , Abhishek Bahadur Singh , Avinash Agrawal , Saumitra Misra , Suhail Sarwar Siddiqui , Ayush Lohiya , Prabhaker Misra

Purpose

To assess hearing deficits (HD) through pure tone audiometry (PTA), amongst the survivors of intensive care unit (ICU).

Methods

In this prospective observational study, ICU survivors aged 18 years and above were subjected to PTA and were classified into two groups based on PTA findings as those “with HD” and “without HD”. Demographic and clinical factors were compared between these groups with a p-value of ≤0.05 considered as significant.

Results

One hundred and two survivors were enrolled with a median age of 25.5 years (23–30.5), and acute physiology and chronic health evaluation (APACHE II) score of 19 (14–22). Sixty were diagnosed (58.89 %) with HD based on PTA, and forty-two (41.2 %) without HD. More than 80 % of the survivors (52/60) had sensorineural hearing loss (SNHL). Propensity match analysis, after the exact matching of the APACHE-II score between those “with HD” and “without HD”, revealed that patients with HD had a longer duration of shock days (mean ± SD) (0.96 ± 1.24 vs 1.68 ± 1.28; p value: 0.022), received higher maximum noradrenaline dose (0.03 v/s 0.06 μg/kg/min; p value: 0.004), longer duration of endotracheal tube (2.04 ± 1.17 vs 3.52 ± 2.06) days; p value:0.009), more days on mechanical ventilation (2.24 ± 1.33 vs 4.44 ± 5.12; p value: 0.011), and length of stay in the ICU (7.2 ± 3.8 vs 9.24 ± 4.68; p value: 0.013) than those without HD.

Conclusions

Hearing deficits are present in majority of the survivors of critical illness and audiometric screening is recommended.

Trial Registration: Clinical trials registry. India (CTRI/2022/01/039539) dated 18.01.2022. https://ctri.nic.in/Clinicaltrials/login.php

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引用次数: 0

Point-of-care regional anesthesia in intensive care units: A multi-center professional practice evaluation

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care

Pub Date : 2025-02-20 DOI: 10.1016/j.jcrc.2025.155029

Raïko Blondonnet , Camille Haumont , Céline Lambert , Dominique Morand , Laurent Zieleskiewicz , Matthieu Jabaudon , for the WEEKALR Study Group , SFAR Research Network

引用次数: 0

Authors reply: “Does extracorporeal cardiopulmonary resuscitation improve survival with favorable neurological outcome in out-of-hospital cardiac arrest? A systematic review and meta-analysis”

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care

Pub Date : 2025-02-16 DOI: 10.1016/j.jcrc.2025.155037

Linda Pagura , Enrico Fabris , Serena Rakar , Marco Gabrielli , Enzo Mazzaro , Gianfranco Sinagra , Davide Stolfo

引用次数: 0

Multisystem hemodynamic effects of terlipressin in cirrhosis: A scoping review

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care

Pub Date : 2025-02-16 DOI: 10.1016/j.jcrc.2025.155038

Jeremy Skvarce , Albert Bui , Peter Oro , Saloni Sachar , Mary Pat Harnegie , Aanchal Kapoor , Christina C. Lindenmeyer , Matthew T. Siuba

Introduction

Hepatorenal syndrome (HRS-AKI) is a serious complication of advanced liver disease. Pharmacologic options are limited in effectiveness, therefore liver transplantation is the definitive therapy. Early investigation into terlipressin as a first-line therapy for HRS-AKI has been promising but expected hemodynamic changes across organ systems in patients with cirrhosis have not been thoroughly examined.

Methods

We conducted a scoping review of the literature including adult patients with cirrhosis who received terlipressin and hemodynamic parameters were recorded. Non-human studies, case reports, conference abstracts, and review articles were excluded. Searches were performed up to December 2024 in the following databases: MEDLINE, Embase, Cochrane Library, Scopus, Web of Science, and CINAHL.

Results

Of 2022 studies retrieved, 56 studies met inclusion criteria. Heart rate, mean arterial pressure, and cardiac output were the most reported parameters. Pulmonary arterial pressure and wedge pressure were the next most common. Systemic vascular resistance, hepatic and renal measures such as resistive indices and portal pressure gradients had fewer studies. Studies reported decreased heart rate, increased mean arterial pressure, decreased cardiac output/index, and increased systemic vascular resistance. Other hemodynamic outcomes were more varied across studies.

Conclusions

Terlipressin exerts a variety of hemodynamic effects across organ systems and vascular beds. More studies are required to understand if any hemodynamic parameters might predict terlipressin response or adverse events.

{"title":"Multisystem hemodynamic effects of terlipressin in cirrhosis: A scoping review","authors":"Jeremy Skvarce , Albert Bui , Peter Oro , Saloni Sachar , Mary Pat Harnegie , Aanchal Kapoor , Christina C. Lindenmeyer , Matthew T. Siuba","doi":"10.1016/j.jcrc.2025.155038","DOIUrl":"10.1016/j.jcrc.2025.155038","url":null,"abstract":"<div><h3>Introduction</h3><div>Hepatorenal syndrome (HRS-AKI) is a serious complication of advanced liver disease. Pharmacologic options are limited in effectiveness, therefore liver transplantation is the definitive therapy. Early investigation into terlipressin as a first-line therapy for HRS-AKI has been promising but expected hemodynamic changes across organ systems in patients with cirrhosis have not been thoroughly examined.</div></div><div><h3>Methods</h3><div>We conducted a scoping review of the literature including adult patients with cirrhosis who received terlipressin and hemodynamic parameters were recorded. Non-human studies, case reports, conference abstracts, and review articles were excluded. Searches were performed up to December 2024 in the following databases: MEDLINE, Embase, Cochrane Library, Scopus, Web of Science, and CINAHL.</div></div><div><h3>Results</h3><div>Of 2022 studies retrieved, 56 studies met inclusion criteria. Heart rate, mean arterial pressure, and cardiac output were the most reported parameters. Pulmonary arterial pressure and wedge pressure were the next most common. Systemic vascular resistance, hepatic and renal measures such as resistive indices and portal pressure gradients had fewer studies. Studies reported decreased heart rate, increased mean arterial pressure, decreased cardiac output/index, and increased systemic vascular resistance. Other hemodynamic outcomes were more varied across studies.</div></div><div><h3>Conclusions</h3><div>Terlipressin exerts a variety of hemodynamic effects across organ systems and vascular beds. More studies are required to understand if any hemodynamic parameters might predict terlipressin response or adverse events.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"87 ","pages":"Article 155038"},"PeriodicalIF":3.2,"publicationDate":"2025-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143421242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Generalization of regional citrate anticoagulation for continuous renal replacement therapy is not associated with an increased rate of severe complications

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care

Pub Date : 2025-02-14 DOI: 10.1016/j.jcrc.2025.155032

Doreen Bachmann , Céline Monard , Tatiana Kelevina , Yannis Ahmad , Menno Pruijm , Jean-Daniel Chiche , Antoine Guillaume Schneider

Background

Contraindications to regional citrate anticoagulation (RCA) for continuous renal replacement therapy (CRRT) have recently been challenged. We aimed to assess the safety of the generalization of RCA to all CRRT sessions.

Methods

We reviewed all CRRT sessions performed in our ICU during two periods (P1:2018–2019 and P2:2020–2022). RCA was considered as contraindicated in situations at risk of citrate accumulation (lactate >4 mmol/L and/or prothrombin time < 40 %) during P1 but not P2. We reviewed CRRT modality, filter lifespan, and therapy-associated complications including citrate accumulation, electrolyte and acid/base disturbances, and blood transfusion requirements. CRRT efficacy was assessed by serum creatinine and urea kinetics across circuits' lifespan.

Results

We studied 1877 circuits in 467 (P1:245, P2:222) patients. The proportion of patients with risk factors for citrate accumulation was similar between both periods (P1:35 %, P2:32 % p = 0.61). During P2, RCA was used in more circuits (93 vs 66 %, p < 0.001) and filter lifespan was longer (44 vs 32 h, p < 0.001). CRRT efficacy was similar between the two periods. Although risk factors for citrate accumulation were present at first circuit initiation in more RCA circuits during P2 (25 vs 11 %, p = 0.002), the rate of citrate accumulation remained similar (0.3 vs 0.4 %, p = 0.72). There was no increase in the rates of electrolyte disturbances or significant bleeding. There was, however, a higher rate of metabolic acidoses during P2 (13 vs. 9 %, p = 0.01).

Conclusion

In an experienced team, generalization of RCA to nearly all patients requiring CRRT extended median filter lifespan without increasing the rate of significant complications.

{"title":"Generalization of regional citrate anticoagulation for continuous renal replacement therapy is not associated with an increased rate of severe complications","authors":"Doreen Bachmann , Céline Monard , Tatiana Kelevina , Yannis Ahmad , Menno Pruijm , Jean-Daniel Chiche , Antoine Guillaume Schneider","doi":"10.1016/j.jcrc.2025.155032","DOIUrl":"10.1016/j.jcrc.2025.155032","url":null,"abstract":"<div><h3>Background</h3><div>Contraindications to regional citrate anticoagulation (RCA) for continuous renal replacement therapy (CRRT) have recently been challenged. We aimed to assess the safety of the generalization of RCA to all CRRT sessions.</div></div><div><h3>Methods</h3><div>We reviewed all CRRT sessions performed in our ICU during two periods (P1:2018–2019 and P2:2020–2022). RCA was considered as contraindicated in situations at risk of citrate accumulation (lactate >4 mmol/L and/or prothrombin time < 40 %) during P1 but not P2. We reviewed CRRT modality, filter lifespan, and therapy-associated complications including citrate accumulation, electrolyte and acid/base disturbances, and blood transfusion requirements. CRRT efficacy was assessed by serum creatinine and urea kinetics across circuits' lifespan.</div></div><div><h3>Results</h3><div>We studied 1877 circuits in 467 (P1:245, P2:222) patients. The proportion of patients with risk factors for citrate accumulation was similar between both periods (P1:35 %, P2:32 % <em>p</em> = 0.61). During P2, RCA was used in more circuits (93 vs 66 %, <em>p</em> < 0.001) and filter lifespan was longer (44 vs 32 h, p < 0.001). CRRT efficacy was similar between the two periods. Although risk factors for citrate accumulation were present at first circuit initiation in more RCA circuits during P2 (25 vs 11 %, <em>p</em> = 0.002), the rate of citrate accumulation remained similar (0.3 vs 0.4 %, <em>p</em> = 0.72). There was no increase in the rates of electrolyte disturbances or significant bleeding. There was, however, a higher rate of metabolic acidoses during P2 (13 vs. 9 %, <em>p</em> = 0.01).</div></div><div><h3>Conclusion</h3><div>In an experienced team, generalization of RCA to nearly all patients requiring CRRT extended median filter lifespan without increasing the rate of significant complications.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"87 ","pages":"Article 155032"},"PeriodicalIF":3.2,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143421241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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