Journal of critical care最新文献

英文中文

Letter to the editor: “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 : 2025-02-12 DOI: 10.1016/j.jcrc.2025.155036

Ahmad Neyazi , Rachana Mehta , Shubham Kumar , Ranjana Sah

引用次数: 0

What every intensivist should know about ciprofol

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care

Pub Date : 2025-02-08 DOI: 10.1016/j.jcrc.2025.155034

Konica Chittoria , Arun Mukesh , Ankur Sharma , Shilpa Goyal , Nikhil Kothari

引用次数: 0

Emergency critical care - life-saving critical care before ICU admission: A consensus statement of a Group of European Experts

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care

Pub Date : 2025-02-05 DOI: 10.1016/j.jcrc.2025.155035

Martin W. Dünser , Robert Leach , Mo Al-Haddad , Raed Arafat , Tim Baker , Martin Balik , Ruth Brown , Luca Carenzo , Jim Connolly , Daniel Dankl , Christoph Dodt , Dinis Dos Reis Miranda , Aristomenis Exadaktylos , Srdjan Gavrilovic , Said Hachimi-Idrissi , Matthias Haenggi , Frank Hartig , Harald Herkner , Michael Joannidis , Abdo Khoury , Wilhelm Behringer

引用次数: 0

Electrical impedance tomography to set high pressure in time-controlled adaptive ventilation

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care

Pub Date : 2025-02-03 DOI: 10.1016/j.jcrc.2025.155033

Benjamin Pequignot , Mickael Lescroart , Bruno Levy , Antoine Kimounn , Matthieu Koszutski

Introduction

TCAV (Time controlled adaptive ventilation), a combination of settings applied to the APRV (airway pressure release ventilation) mode, provides personalized ventilation tailored to the lung condition in ARDS (acute respiratory distress syndrome). The objective was to evaluate whether electrical impedance tomography (EIT) could serve as a tool for guiding P_high level in TCAV for ARDS patients.

Methods

Eleven patients with moderate or severe ARDS were enrolled in a prospective single-center study in 2023. Patients were monitored with EIT (PulmoVista 500). P_high trial was conducted from 34 to 18 cmH₂O, with 4-cmH₂O P_high decrements every 5 min. Driving pressure was maintained constant by adjusting T_low. Best EIT-derived-P_high was defined as the pressure at the crossing point between overdistension and collapse curves.

Results

C_RS was significantly higher at P_high 18 cmH2O with 43 [32–50] mL/cmH2O than at P_high 34 with 20 mL/cmH2O [14–24], p < 0.005. Highest P_high levels caused significant overdistension in the anterior region and anterior compliance is significantly lower at P_high 34 with 10 [6–11] mL/cmH2O than at P_high 22 cmH2O with 18 [13–25] mL/cmH2O. Best EIT-derived P_high were 18, 22, 26 cmH₂O for four, five and two patients respectively.

Conclusion

EIT enabled detection of regional ventilation distribution on TCAV during a decremental P_high trial and thus enabled the determination of a best EIT-derived-P_high through an individualized approach, achieving best compromise between overdistension and collapse. The observed overdistention variability highlights the necessity of P_high level personalization on TCAV.

{"title":"Electrical impedance tomography to set high pressure in time-controlled adaptive ventilation","authors":"Benjamin Pequignot , Mickael Lescroart , Bruno Levy , Antoine Kimounn , Matthieu Koszutski","doi":"10.1016/j.jcrc.2025.155033","DOIUrl":"10.1016/j.jcrc.2025.155033","url":null,"abstract":"<div><h3>Introduction</h3><div>TCAV (Time controlled adaptive ventilation), a combination of settings applied to the APRV (airway pressure release ventilation) mode, provides personalized ventilation tailored to the lung condition in ARDS (acute respiratory distress syndrome). The objective was to evaluate whether electrical impedance tomography (EIT) could serve as a tool for guiding P<sub>high</sub> level in TCAV for ARDS patients.</div></div><div><h3>Methods</h3><div>Eleven patients with moderate or severe ARDS were enrolled in a prospective single-center study in 2023. Patients were monitored with EIT (PulmoVista 500). P<sub>high</sub> trial was conducted from 34 to 18 cmH<sub>2</sub>O, with 4-cmH<sub>2</sub>O P<sub>high</sub> decrements every 5 min. Driving pressure was maintained constant by adjusting T<sub>low</sub>. Best EIT-derived-P<sub>high</sub> was defined as the pressure at the crossing point between overdistension and collapse curves.</div></div><div><h3>Results</h3><div>C<sub>RS</sub> was significantly higher at P<sub>high</sub> 18 cmH2O with 43 [32–50] mL/cmH2O than at P<sub>high</sub> 34 with 20 mL/cmH2O [14–24], <em>p</em> < 0.005. Highest P<sub>high</sub> levels caused significant overdistension in the anterior region and anterior compliance is significantly lower at P<sub>high</sub> 34 with 10 [6–11] mL/cmH2O than at P<sub>high</sub> 22 cmH2O with 18 [13–25] mL/cmH2O. Best EIT-derived P<sub>high</sub> were 18, 22, 26 cmH<sub>2</sub>O for four, five and two patients respectively.</div></div><div><h3>Conclusion</h3><div>EIT enabled detection of regional ventilation distribution on TCAV during a decremental P<sub>high</sub> trial and thus enabled the determination of a best EIT-derived-P<sub>high</sub> through an individualized approach, achieving best compromise between overdistension and collapse. The observed overdistention variability highlights the necessity of P<sub>high</sub> level personalization on TCAV.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"87 ","pages":"Article 155033"},"PeriodicalIF":3.2,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143140548","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

Quantitative visualization of gastrointestinal motility in critically ill patients using a non-invasive single-channel electro amplifier: A prospective observational cohort feasibility study

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care

Pub Date : 2025-02-01 DOI: 10.1016/j.jcrc.2025.155031

Gen Aikawa PhD , Tetsuya Hoshino PhD , Hideaki Sakuramoto PhD , Akira Ouchi PhD , Mitsuki Ikeda MS , Misaki Kotani MS , Saiko Okamoto MSN , Yuki Enomoto PhD , Nobutake Shimojo PhD , Yoshiaki Inoue PhD

Background

This study aimed to evaluate the feasibility of using electrogastrography (EGG)/electroenterography (EEnG) to quantitatively visualize gastrointestinal (GI) motor function in critically ill patients.

Methods

EGG/EEnG were performed at baseline and before and after nutrition in critically ill patients with mechanical ventilation. Enteral nutrition varied in content. Dominant frequency (DF), dominant power (DP), and power ratio (PR) were calculated and compared with those from healthy controls (previous study; n = 50).

Results

Data from 20 % of patients were unstable and could not be analyzed. Of the 54 patients analyzed, 41 were on enteral nutrition, and their age and body mass index differed from controls. Gastric DF differed significantly between critically ill patients and controls (p < 0.001). No significant difference was noted in gastric log₁₀ DP between pre- and post-prandial periods in critically ill patients (2.79 vs 2.86, p = 0.328), but controls showed a significant increase (3.04 vs 3.22, p = 0.009). Critically ill patients had lower gastric log₁₀ DP than controls (pre-prandial p = 0.038; post-prandial p = 0.003). In the small intestine, log₁₀ DP did not differ significantly between pre- and post-prandial periods in critically ill patients (1.45 vs 1.52, p = 0.181), but controls showed a significant increase (1.70 vs 1.86, p < 0.001). Critically ill patients had lower small intestinal log₁₀ DP than controls (pre-prandial p = 0.004; post-prandial p < 0.001). PR was inferior in critically ill patients than in controls.

Conclusions

EGG/EEnG could enable quantitative visualization of GI motor function in critically ill patients. Larger studies can determine the association of GI symptoms with risk factors and prognostic factors.

{"title":"Quantitative visualization of gastrointestinal motility in critically ill patients using a non-invasive single-channel electro amplifier: A prospective observational cohort feasibility study","authors":"Gen Aikawa PhD , Tetsuya Hoshino PhD , Hideaki Sakuramoto PhD , Akira Ouchi PhD , Mitsuki Ikeda MS , Misaki Kotani MS , Saiko Okamoto MSN , Yuki Enomoto PhD , Nobutake Shimojo PhD , Yoshiaki Inoue PhD","doi":"10.1016/j.jcrc.2025.155031","DOIUrl":"10.1016/j.jcrc.2025.155031","url":null,"abstract":"<div><h3>Background</h3><div>This study aimed to evaluate the feasibility of using electrogastrography (EGG)/electroenterography (EEnG) to quantitatively visualize gastrointestinal (GI) motor function in critically ill patients.</div></div><div><h3>Methods</h3><div>EGG/EEnG were performed at baseline and before and after nutrition in critically ill patients with mechanical ventilation. Enteral nutrition varied in content. Dominant frequency (DF), dominant power (DP), and power ratio (PR) were calculated and compared with those from healthy controls (previous study; <em>n</em> = 50).</div></div><div><h3>Results</h3><div>Data from 20 % of patients were unstable and could not be analyzed. Of the 54 patients analyzed, 41 were on enteral nutrition, and their age and body mass index differed from controls. Gastric DF differed significantly between critically ill patients and controls (<em>p</em> < 0.001). No significant difference was noted in gastric log<sub>10</sub> DP between pre- and post-prandial periods in critically ill patients (2.79 vs 2.86, <em>p</em> = 0.328), but controls showed a significant increase (3.04 vs 3.22, <em>p</em> = 0.009). Critically ill patients had lower gastric log<sub>10</sub> DP than controls (pre-prandial <em>p</em> = 0.038; post-prandial <em>p</em> = 0.003). In the small intestine, log<sub>10</sub> DP did not differ significantly between pre- and post-prandial periods in critically ill patients (1.45 vs 1.52, <em>p</em> = 0.181), but controls showed a significant increase (1.70 vs 1.86, <em>p</em> < 0.001). Critically ill patients had lower small intestinal log<sub>10</sub> DP than controls (pre-prandial <em>p</em> = 0.004; post-prandial <em>p</em> < 0.001). PR was inferior in critically ill patients than in controls.</div></div><div><h3>Conclusions</h3><div>EGG/EEnG could enable quantitative visualization of GI motor function in critically ill patients. Larger studies can determine the association of GI symptoms with risk factors and prognostic factors.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"87 ","pages":"Article 155031"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080049","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

Target attainment of beta-lactam antibiotics and ciprofloxacin in critically ill patients and its association with 28-day mortality 重症患者使用β-内酰胺类抗生素和环丙沙星的目标达标率及其与 28 天死亡率的关系。

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care

Pub Date : 2025-02-01 DOI: 10.1016/j.jcrc.2024.154904

Sarah Dräger , Tim M.J. Ewoldt , Alan Abdulla , Wim J.R. Rietdijk , Nelianne J. Verkaik , Peter van Vliet , Ilse M. Purmer , Michael Osthoff , Birgit C.P. Koch , Henrik Endeman , DOLPHIN investigators

Objectives

This study aims to assess pharmacodynamic target attainment in critically ill patients and identify factors influencing target attainment and mortality outcomes.

Methods

We analysed data from the DOLPHIN trial. Beta-lactam and ciprofloxacin peak and trough concentration were measured within the first 36 h (T1) after initiation of treatment. The study outcome included the rate of pharmacodynamic target attainment of 100 % ƒT_{>1xEpidemiological cut-off value (ECOFF)} for beta-lactams, and of fAUC_0-24h/ECOFF>125 for ciprofloxacin at T1.

Results

The target attainment rates were 78.1 % (n = 228/292) for beta-lactams, and 41.5 % (n = 39/94) for ciprofloxacin, respectively. Lower estimated glomerular filtration rate and higher SOFA score were associated with target attainment. In patients receiving beta-lactams, 28-day mortality was significantly higher in patients who attained 100 % ƒT_>1xECOFF (28.9 % vs. 12.5 %; p = 0.01). In the multivariate analysis, attainment of 100 % ƒT_>4xECOFF, but not 100 % ƒT_>1xECOFF, was associated with a higher 28-day mortality (OR 2.70, 95 % CI 1.36–5.48 vs. OR 1.28, 95 % CI 0.53–3.34).

Conclusions

A high rate of target attainment (100 % ƒT_>1xECOFF) for beta-lactams and a lower rate for ciprofloxacin was observed. Achieving exposures of 100 % ƒT_>4xECOFF was associated with 28-day mortality. The impact of antibiotic target attainment on clinical outcome needs to be a focus of future research.

研究目的本研究旨在评估重症患者的药效学目标达成情况，并确定影响目标达成和死亡率结果的因素：我们分析了 DOLPHIN 试验的数据。我们对 DOLPHIN 试验的数据进行了分析。在开始治疗后的前 36 小时（T1）内测量了β-内酰胺类药物和环丙沙星的峰值和谷值浓度。研究结果包括β-内酰胺类药物 100 % ƒT>1x 流行病学临界值（ECOFF）和环丙沙星在 T1 的 fAUC0-24h/ECOFF>125 的药效学目标达标率：β-内酰胺类药物的达标率为 78.1%（n = 228/292），环丙沙星的达标率为 41.5%（n = 39/94）。估计肾小球滤过率较低和 SOFA 评分较高与达标率有关。在接受β-内酰胺类药物治疗的患者中，ƒT>1xECOFF达标率为100%的患者的28天死亡率明显更高（28.9% vs. 12.5%；p = 0.01）。在多变量分析中，达到 100 % ƒT>4xECOFF 的患者 28 天死亡率较高（OR 2.70，95 % CI 1.36-5.48 vs. OR 1.28，95 % CI 0.53-3.34），而达到 100 % ƒT>1xECOFF 的患者 28 天死亡率较低（OR 2.70，95 % CI 1.36-5.48 vs. OR 1.28，95 % CI 0.53-3.34）：观察发现，β-内酰胺类药物的达标率较高（100 % ƒT>1xECOFF ），而环丙沙星的达标率较低。达到 100 % ƒT>4xECOFF 的暴露与 28 天死亡率有关。抗生素目标达标率对临床结果的影响需要成为未来研究的重点。

{"title":"Target attainment of beta-lactam antibiotics and ciprofloxacin in critically ill patients and its association with 28-day mortality","authors":"Sarah Dräger , Tim M.J. Ewoldt , Alan Abdulla , Wim J.R. Rietdijk , Nelianne J. Verkaik , Peter van Vliet , Ilse M. Purmer , Michael Osthoff , Birgit C.P. Koch , Henrik Endeman , DOLPHIN investigators","doi":"10.1016/j.jcrc.2024.154904","DOIUrl":"10.1016/j.jcrc.2024.154904","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aims to assess pharmacodynamic target attainment in critically ill patients and identify factors influencing target attainment and mortality outcomes.</div></div><div><h3>Methods</h3><div>We analysed data from the DOLPHIN trial. Beta-lactam and ciprofloxacin peak and trough concentration were measured within the first 36 h (T1) after initiation of treatment. The study outcome included the rate of pharmacodynamic target attainment of 100 % <em>ƒ</em>T<sub>>1xEpidemiological cut-off value (ECOFF)</sub> for beta-lactams, and of <em>f</em>AUC<sub>0-24h</sub>/ECOFF>125 for ciprofloxacin at T1.</div></div><div><h3>Results</h3><div>The target attainment rates were 78.1 % (<em>n</em> = 228/292) for beta-lactams, and 41.5 % (<em>n</em> = 39/94) for ciprofloxacin, respectively. Lower estimated glomerular filtration rate and higher SOFA score were associated with target attainment. In patients receiving beta-lactams, 28-day mortality was significantly higher in patients who attained 100 % <em>ƒ</em>T<sub>>1xECOFF</sub> (28.9 % vs. 12.5 %; <em>p</em> = 0.01). In the multivariate analysis, attainment of 100 % <em>ƒ</em>T<sub>>4xECOFF</sub>, but not 100 % <em>ƒ</em>T<sub>>1xECOFF</sub>, was associated with a higher 28-day mortality (OR 2.70, 95 % CI 1.36–5.48 vs. OR 1.28, 95 % CI 0.53–3.34).</div></div><div><h3>Conclusions</h3><div>A high rate of target attainment (100 % <em>ƒ</em>T<sub>>1xECOFF</sub>) for beta-lactams and a lower rate for ciprofloxacin was observed. Achieving exposures of 100 % <em>ƒ</em>T<sub>>4xECOFF</sub> was associated with 28-day mortality. The impact of antibiotic target attainment on clinical outcome needs to be a focus of future research.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"85 ","pages":"Article 154904"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142288297","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

Macronutrient intake is different across Europe: Results of a Belgian cohort of critically ill adults

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care

Pub Date : 2025-01-31 DOI: 10.1016/j.jcrc.2025.155030

Karolien Dams , Denis Glorieux , Eric Gilbert , Nicolas Serck , Xavier Wittebole , Patrick Druwé , Marc Simon , Elisabeth De Waele , Jean-Charles Preiser

Background & Aims

Medical nutrition therapy (MNT) is fundamental for ICU patients. This post-hoc subgroup analysis of the prospective observational EuroPN survey aimed to assess MNT in the participating Belgian ICUs.

Methods

MNT practices in 9 Belgian ICUs (148 patients) were compared to 77 ICUs (1172 patients) from 11 European countries during the first 15 days for patients staying ≥5 days in ICU - and with the 2019 ESPEN guideline on clinical nutrition in ICU (<70 % of estimated energy expenditure in week 1 and up to 1.3 g/kg/d protein). Additionally, overfeeding was evaluated in the Belgian cohort.

Results

The Belgian cohort had longer median ICU and hospital length of stay, higher emergency room admission rates and delayed MNT initiation compared to overall (EN: day 2.5 [2.0;4.0] vs 2.0 [2.0;4.0] and PN: day 5.0 [3.0,7.0] vs 2.0 [2.0,4.0]). They received more often EN than PN. In week 1 overfeeding was on average present in 30 % (energy) and 15 % (protein) of observation days.

Conclusion

Similar to overall, the Belgian subgroup received a daily average moderate caloric and low protein intake. The gradual intake increase aligned with ESPEN guidelines, though temporary overfeeding occurred in about one third of the patients.

{"title":"Macronutrient intake is different across Europe: Results of a Belgian cohort of critically ill adults","authors":"Karolien Dams , Denis Glorieux , Eric Gilbert , Nicolas Serck , Xavier Wittebole , Patrick Druwé , Marc Simon , Elisabeth De Waele , Jean-Charles Preiser","doi":"10.1016/j.jcrc.2025.155030","DOIUrl":"10.1016/j.jcrc.2025.155030","url":null,"abstract":"<div><h3>Background & Aims</h3><div>Medical nutrition therapy (MNT) is fundamental for ICU patients. This post-hoc subgroup analysis of the prospective observational EuroPN survey aimed to assess MNT in the participating Belgian ICUs.</div></div><div><h3>Methods</h3><div>MNT practices in 9 Belgian ICUs (148 patients) were compared to 77 ICUs (1172 patients) from 11 European countries during the first 15 days for patients staying ≥5 days in ICU - and with the 2019 ESPEN guideline on clinical nutrition in ICU (<70 % of estimated energy expenditure in week 1 and up to 1.3 g/kg/d protein). Additionally, overfeeding was evaluated in the Belgian cohort.</div></div><div><h3>Results</h3><div>The Belgian cohort had longer median ICU and hospital length of stay, higher emergency room admission rates and delayed MNT initiation compared to overall (EN: day 2.5 [2.0;4.0] vs 2.0 [2.0;4.0] and PN: day 5.0 [3.0,7.0] vs 2.0 [2.0,4.0]). They received more often EN than PN. In week 1 overfeeding was on average present in 30 % (energy) and 15 % (protein) of observation days.</div></div><div><h3>Conclusion</h3><div>Similar to overall, the Belgian subgroup received a daily average moderate caloric and low protein intake. The gradual intake increase aligned with ESPEN guidelines, though temporary overfeeding occurred in about one third of the patients.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"87 ","pages":"Article 155030"},"PeriodicalIF":3.2,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143073205","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

Kidney recovery after iodinated contrast administration in patients with acute kidney injury receiving renal replacement therapy

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care

Pub Date : 2025-01-30 DOI: 10.1016/j.jcrc.2025.155015

Benjamin Khoo , Jan O. Friedrich , Gerald Lebovic , Swapnil Hiremath , Guy Fishman , Sara Wing , Alejandro Meraz-Munoz , Ziv Harel , Noam Goder , Amir Gal-Oz , Sean M. Bagshaw , Ron Wald

Background

Acute kidney injury (AKI) is common in hospitalized patients. Administration of iodinated contrast may impede kidney recovery but avoiding contrast may delay diagnosis and therapeutic interventions. There is limited data on the impact of contrast exposure in patients with established AKI receiving renal replacement therapy (RRT).

Methods

We conducted a retrospective cohort study which included all patients with AKI who received RRT at St Michael's Hospital in Toronto, Canada, from January 2007 to December 2022. The exposure was the receipt of iodinated contrast during the 14 days following RRT initiation and while the patient was still RRT-dependent. The primary outcome was RRT dependence at hospital discharge.

Results

1597 patients with AKI received RRT and 754 patients were included in our analysis. Of these, 185 patients received iodinated contrast. After propensity score weighting, the exposure to contrast was associated with a higher likelihood of RRT dependence at hospital discharge (Odds Ratio 1.73, 95 % confidence interval 1.13–2.53).

Conclusion

The receipt of contrast in patients with AKI receiving RRT was associated with an increased risk of RRT dependence at hospital discharge. Contrast exposure in RRT-dependent patients may delay recovery from AKI. The benefits of contrast should be carefully weighed against this risk in patients with AKI receiving RRT.

{"title":"Kidney recovery after iodinated contrast administration in patients with acute kidney injury receiving renal replacement therapy","authors":"Benjamin Khoo , Jan O. Friedrich , Gerald Lebovic , Swapnil Hiremath , Guy Fishman , Sara Wing , Alejandro Meraz-Munoz , Ziv Harel , Noam Goder , Amir Gal-Oz , Sean M. Bagshaw , Ron Wald","doi":"10.1016/j.jcrc.2025.155015","DOIUrl":"10.1016/j.jcrc.2025.155015","url":null,"abstract":"<div><h3>Background</h3><div>Acute kidney injury (AKI) is common in hospitalized patients. Administration of iodinated contrast may impede kidney recovery but avoiding contrast may delay diagnosis and therapeutic interventions. There is limited data on the impact of contrast exposure in patients with established AKI receiving renal replacement therapy (RRT).</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study which included all patients with AKI who received RRT at St Michael's Hospital in Toronto, Canada, from January 2007 to December 2022. The exposure was the receipt of iodinated contrast during the 14 days following RRT initiation and while the patient was still RRT-dependent. The primary outcome was RRT dependence at hospital discharge.</div></div><div><h3>Results</h3><div>1597 patients with AKI received RRT and 754 patients were included in our analysis. Of these, 185 patients received iodinated contrast. After propensity score weighting, the exposure to contrast was associated with a higher likelihood of RRT dependence at hospital discharge (Odds Ratio 1.73, 95 % confidence interval 1.13–2.53).</div></div><div><h3>Conclusion</h3><div>The receipt of contrast in patients with AKI receiving RRT was associated with an increased risk of RRT dependence at hospital discharge. Contrast exposure in RRT-dependent patients may delay recovery from AKI. The benefits of contrast should be carefully weighed against this risk in patients with AKI receiving RRT.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"87 ","pages":"Article 155015"},"PeriodicalIF":3.2,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074784","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

Elevated glycocalyx shedding components as the early predictors of unfavorable outcomes in patients after cardiac arrest: A single-center observational study

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care

Pub Date : 2025-01-24 DOI: 10.1016/j.jcrc.2025.155026

Dan He , Shuqun Hu , Ningjun Zhao , Xianliang Yan , Chenglei Su

Objective

To assess the association of serum glycocalyx shedding components (Heparan sulfate, HS; Hyaluronic acid, HA; Syndecan-1, Sdc-1) with outcomes after CA.

Methods

Patients who were comatose for >24 h after CA in the intensive care unit (ICU) of the Affiliated Hospital of Xuzhou Medical University from 9/2021 to 04/2023 were enrolled. Serum samples were collected 24 h after CA to measure the concentrations of glycocalyx shedding components. The outcomes were the 30-day Cerebral Performance Categories (CPC) scale and 30-day mortality. The association of glycocalyx shedding with outcomes was examined by regression analysis. The area under the curve was used to evaluate the value of glycocalyx shedding for predicting outcomes. Sensitivity analysis and subgroup analysis were conducted.

Results

111 patients were enrolled. The unfavorable group (CPC 3–5, n = 69) had significantly higher serum concentrations of HA and Sdc-1 than the favorable group (CPC 1–2, n = 42) (HA:149.7 ng/ml vs. 824.8 ng/ml, P < 0.001; Sdc-1: 303.8 ng/L vs. 447.0 ng/L, P = 0.026)but not HS. Elevated serum HA concentrations was an independent risk factor for unfavorable 30-day neurological function (OR = 2.485, 95 % CI = 1.656–3.729). For the 30-day mortality, the nonsurvivor group (n = 53) had significantly higher serum concentrations of HA, HS and Sdc-1 (HA: 177.3 ng/ml vs. 1106.7 ng/ml, P < 0.001; HS: 2403.7 ng/ml vs. 3383.3 ng/ml P = 0.030; Sdc-1: 352.1 ng/L vs. 487.8 ng/L, P = 0.005) than the survivor group (n = 58). However, only elevated serum HA and Sdc-1 concentrations are independent risk factors for 30-day mortality (HA: HR = 2.321, 95 % CI = 1.776–3.035; Sdc-1: HR = 1.702, 95 % CI = 1.038–2.792).

Conclusions

Elevated serum HA at 24 h after CA is an independent risk factor for 30-day unfavorable neurological function or mortality and elevated serum Sdc-1 concentrations is an independent risk factor for 30-day mortality. Our results suggested the potential value of serum glycocalyx shedding components as predictors for the outcomes in post-CA patients.

{"title":"Elevated glycocalyx shedding components as the early predictors of unfavorable outcomes in patients after cardiac arrest: A single-center observational study","authors":"Dan He , Shuqun Hu , Ningjun Zhao , Xianliang Yan , Chenglei Su","doi":"10.1016/j.jcrc.2025.155026","DOIUrl":"10.1016/j.jcrc.2025.155026","url":null,"abstract":"<div><h3>Objective</h3><div>To assess the association of serum glycocalyx shedding components (Heparan sulfate, HS; Hyaluronic acid, HA; Syndecan-1, Sdc-1) with outcomes after CA.</div></div><div><h3>Methods</h3><div>Patients who were comatose for >24 h after CA in the intensive care unit (ICU) of the Affiliated Hospital of Xuzhou Medical University from 9/2021 to 04/2023 were enrolled. Serum samples were collected 24 h after CA to measure the concentrations of glycocalyx shedding components. The outcomes were the 30-day Cerebral Performance Categories (CPC) scale and 30-day mortality. The association of glycocalyx shedding with outcomes was examined by regression analysis. The area under the curve was used to evaluate the value of glycocalyx shedding for predicting outcomes. Sensitivity analysis and subgroup analysis were conducted.</div></div><div><h3>Results</h3><div>111 patients were enrolled. The unfavorable group (CPC 3–5, <em>n</em> = 69) had significantly higher serum concentrations of HA and Sdc-1 than the favorable group (CPC 1–2, <em>n</em> = 42) (HA:149.7 ng/ml vs. 824.8 ng/ml, <em>P</em> < 0.001; Sdc-1: 303.8 ng/L vs. 447.0 ng/L, <em>P</em> = 0.026)but not HS. Elevated serum HA concentrations was an independent risk factor for unfavorable 30-day neurological function (OR = 2.485, 95 % CI = 1.656–3.729). For the 30-day mortality, the nonsurvivor group (<em>n</em> = 53) had significantly higher serum concentrations of HA, HS and Sdc-1 (HA: 177.3 ng/ml vs. 1106.7 ng/ml, <em>P</em> <em><</em> 0.001; HS: 2403.7 ng/ml vs. 3383.3 ng/ml <em>P</em> = 0.030; Sdc-1: 352.1 ng/L vs. 487.8 ng/L, <em>P</em> = 0.005) than the survivor group (<em>n</em> = 58). However, only elevated serum HA and Sdc-1 concentrations are independent risk factors for 30-day mortality (HA: HR = 2.321, 95 % CI = 1.776–3.035; Sdc-1: HR = 1.702, 95 % CI = 1.038–2.792).</div></div><div><h3>Conclusions</h3><div>Elevated serum HA at 24 h after CA is an independent risk factor for 30-day unfavorable neurological function or mortality and elevated serum Sdc-1 concentrations is an independent risk factor for 30-day mortality. Our results suggested the potential value of serum glycocalyx shedding components as predictors for the outcomes in post-CA patients.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"87 ","pages":"Article 155026"},"PeriodicalIF":3.2,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143038955","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

Predicting a strongly positive fluid balance in critically ill patients with acute kidney injury: A multicentre, international study

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care

Pub Date : 2025-01-23 DOI: 10.1016/j.jcrc.2025.155016

Kyle C. White , Rinaldo Bellomo , Kevin B. Laupland , Michelle L. Gatton , Marlies Ostermann , Philipa McIlroy , Stephen Luke , Peter Garrett , Alexis Tabah , Stephen Whebell , Prashanti Marella , James McCullough , Kiran Shekar , Antony G. Attokaran , Aashish Kumar , Jason Meyer , Barnaby Sanderson , Ary Serpa-Neto

Background

In critically ill patients with acute kidney injury (AKI), a fluid balance (FB) > 2 L at 72 h after AKI diagnosis is associated with adverse outcomes. Identification of patients at high-risk for such fluid accumulation may help prevent it.

Methods

We used Australian electronic medical record (EMR)-based clinical data to develop the “AKI-FB risk score”, validated it in a British cohort and used it to predict a positive FB >2 L at 72 h after AKI diagnosis.

Results

We developed the AKI-FB score in 32,030 patients with a median age of 63 years and a median APACHE 2 score of 16. We validated it in 4465 patients, with significant differences in admission diagnoses and interventions. The key score variables were admission after trauma, sepsis or septic shock, and, on the day of AKI diagnosis, highest creatinine, daily cumulative FB, mechanical ventilation, noradrenaline use, noradrenaline equivalent dose >0.07 μg/kg/min, lactate ≥2 mmol/L, transfusion, and nutritional support. A score threshold of 32 had a sensitivity of 75 % and a specificity of 72 % for predicting a > 2 L positive FB with an AUC-ROC of 0.805; 95 % CI 0.799 to 0.810. External validation demonstrated an AUC of 0.761 (95 % CI 0.746 to 0.775).

Conclusion

We developed and validated the “AKI-FB risk score” to predict patients who developed a positive FB >2 L within 72 h of AKI diagnosis. This prediction score was robust and facilitated the identification of high-risk AKI patients who could be the tarted for preventive measures and be included in future clinical trials of FB management.

{"title":"Predicting a strongly positive fluid balance in critically ill patients with acute kidney injury: A multicentre, international study","authors":"Kyle C. White , Rinaldo Bellomo , Kevin B. Laupland , Michelle L. Gatton , Marlies Ostermann , Philipa McIlroy , Stephen Luke , Peter Garrett , Alexis Tabah , Stephen Whebell , Prashanti Marella , James McCullough , Kiran Shekar , Antony G. Attokaran , Aashish Kumar , Jason Meyer , Barnaby Sanderson , Ary Serpa-Neto","doi":"10.1016/j.jcrc.2025.155016","DOIUrl":"10.1016/j.jcrc.2025.155016","url":null,"abstract":"<div><h3>Background</h3><div>In critically ill patients with acute kidney injury (AKI), a fluid balance (FB) > 2 L at 72 h after AKI diagnosis is associated with adverse outcomes. Identification of patients at high-risk for such fluid accumulation may help prevent it.</div></div><div><h3>Methods</h3><div>We used Australian electronic medical record (EMR)-based clinical data to develop the “AKI-FB risk score”, validated it in a British cohort and used it to predict a positive FB >2 L at 72 h after AKI diagnosis.</div></div><div><h3>Results</h3><div>We developed the AKI-FB score in 32,030 patients with a median age of 63 years and a median APACHE 2 score of 16. We validated it in 4465 patients, with significant differences in admission diagnoses and interventions. The key score variables were admission after trauma, sepsis or septic shock, and, on the day of AKI diagnosis, highest creatinine, daily cumulative FB, mechanical ventilation, noradrenaline use, noradrenaline equivalent dose >0.07 μg/kg/min, lactate ≥2 mmol/L, transfusion, and nutritional support. A score threshold of 32 had a sensitivity of 75 % and a specificity of 72 % for predicting a > 2 L positive FB with an AUC-ROC of 0.805; 95 % CI 0.799 to 0.810. External validation demonstrated an AUC of 0.761 (95 % CI 0.746 to 0.775).</div></div><div><h3>Conclusion</h3><div>We developed and validated the “AKI-FB risk score” to predict patients who developed a positive FB >2 L within 72 h of AKI diagnosis. This prediction score was robust and facilitated the identification of high-risk AKI patients who could be the tarted for preventive measures and be included in future clinical trials of FB management.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"87 ","pages":"Article 155016"},"PeriodicalIF":3.2,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143038956","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

首页上一页

下一页尾页

类型

全部化学•材料生命科学医学物理工程技术环境•农林材料科学地球科学法学管理学化学环境科学与生态学计算机科学教育学经济学农林科学人文科学生物学数学物理与天体物理心理学综合性期刊其他工业工程理学历史学农学文学信息工程

数据库

全部 ACS Publications Elsevier ieeexplore Springer The Royal Society of Chemistry Wiley

期刊

Journal of critical care

全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.

﹀