Journal of critical care最新文献

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Authors response: “Urea to creatinine ratio as a predictor of persistent critical illness” 作者的回应是：“尿素与肌酐比值是持续危重疾病的预测因子”。

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care

Pub Date : 2024-12-07 DOI: 10.1016/j.jcrc.2024.154988

Liran Statlender , Tzippy Shochat , Pierre Singer

引用次数: 0

Weekly flipped classroom modules in intensive care medical training: Feasibility and acceptance 重症医学培训中每周翻转课堂模式：可行性与接受度。

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care

Pub Date : 2024-12-06 DOI: 10.1016/j.jcrc.2024.154986

Johannes B.J. Scholte, Johannes C. Strehler

Background

Teaching intensive care medicine competencies poses challenges due to trainees' heterogenous backgrounds, shift schedules, and short rotations. To address these challenges, weekly flipped classroom modules (FCMs) were introduced, combining online preparation, control questions, and an on-site course co-facilitated by a trainee and an intensivist. This study aimed to evaluate the feasibility and acceptance of these FCMs.

Methods

This pre-post intervention study used a triangulated methodology. Learning management system (LMS) user data were analysed regarding preparation and mobile access. Pre- and post-surveys assessed trainees' perception of training formats, learning motivation, and preparation benefits using Likert scales. Open-ended responses were evaluated through content analysis.

Results

All 30 trainees accessed the LMS, with an average online participation rate of 78 %, higher among fellows (89 %) than residents (71 %). Mobile devices were used by 20 trainees (67 %), and over half of FCM activities were accessed this way. Training formats with FCMs scored significantly higher post-implementation. The FCMs scored 4.7 (SD = 0.5), outperforming other teaching formats (p < 0.04). Perceived learning motivation scores increased from 19.0 (SD = 4.5) pre-FCM to 23.8 (SD = 3.0) post-FCM (p < 0.001). Median perceived preparation benefit rose from 15 to 18 (p < 0.001). Trainees appreciated the flexibility, quality, variety of materials, and control question. Acknowledging FCMs as relevant starting point for acquiring fundamental ICU knowledge.

Conclusions

Weekly FCMs are both feasibly and well-accepted and may enhance learning motivation in intensive care training. Further multicentre and qualitative studies are recommended to validate their impact.

背景：教学重症医学能力提出了挑战，由于学员的异质背景，轮班时间表，短轮转。为了应对这些挑战，我们引入了每周一次的翻转课堂模块（fcm），它结合了在线准备、控制问题以及由一名实习生和一名强化医生共同指导的现场课程。本研究旨在评估这些fcm的可行性和可接受性。方法：本研究采用三角法进行干预前后研究。对学习管理系统（LMS）的用户数据进行了准备和移动访问分析。调查前和调查后使用李克特量表评估受训者对培训形式、学习动机和准备效益的感知。开放式回答通过内容分析进行评估。结果：所有30名学员都访问了LMS，平均在线参与率为78%，研究员（89%）高于住院医师（71%）。20名学员（67%）使用移动设备，超过一半的FCM活动是通过这种方式进行的。使用fcm的培训格式在实施后得分明显更高。结论：每周fcm是可行的，并且被广泛接受，可以提高重症监护训练的学习动机。建议进一步进行多中心和定性研究，以证实其影响。

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引用次数: 0

Letter to the Editor: Urea to creatinine ratio as a predictor of persistent critical illness 致编辑的信：尿素与肌酐比值作为持续危重疾病的预测因子

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care

Pub Date : 2024-12-03 DOI: 10.1016/j.jcrc.2024.154987

Chen Liu , Jie Weng , Zhe Xu , Keying Li , Zhenshen Ma , Zhiyi Wang

引用次数: 0

Contemporary assessment of short- and functional 90-days outcome in old intensive care patients suffering from COVID-19 COVID-19老年重症监护患者90天短期和功能性结局的当代评估

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care

Pub Date : 2024-12-03 DOI: 10.1016/j.jcrc.2024.154984

Raphael Romano Bruno , Bernhard Wernly , Antonio Artigas , Kristina Fuest , Stefan J. Schaller , Lisa Dannenberg , Detlef Kindgen-Milles , Malte Kelm , Michael Beil , Sigal Sviri , Muhammed Elhadi , Michael Joannidis , Sandra Oeyen , Eumorfia Kondili , Rui Moreno , Susannah Leaver , Bertrand Guidet , Dylan W. De Lange , Hans Flaatten , Wojciech Szczeklik , Christian Jung

Purpose

There are limited data about the outcome of old intensive care (ICU) patients suffering from Covid-19 in the post-vaccination era. This study distinguishes the pre- and post-acute illness living conditions of ICU survivors from non-survivors.

Methods

This prospective international multicenter study included 642 old (≥ 70 years) ICU patients, including data ranging from pre-illness condition to functional 90-days follow-up. The primary endpoint was the difference of living conditions of ICU-survivors before ICU admission and 90-days after ICU discharge. Secondary outcomes were 90-days mortality, and quality of life.

Results

A total of 642 patients were included. Significantly more ICU survivors lived at their own homes without support before ICU admission than non-survivors (p = 0.016), while more non-survivors resided in nursing homes (p = 0.016). ICU mortality was 39 %, 30-days and 90 days mortality were 47 %and 55 %. After 90 days, only 22 % maintained the same living conditions. Surviving patients viewed ICU admission positively after 90 days, while relatives were more uncertain. Quality of life indicated a self-reported average score of 60 (50–75).

Conclusion

Living conditions influence the outcome of critically ill old patients suffering from Covid-19. Only a minority returned to their initial habitat after ICU survival.

Trial registration number NCT04321265

目的：疫苗接种后，老年重症监护（ICU）患者感染Covid-19的预后数据有限。本研究区分了ICU幸存者和非幸存者的急性疾病前和急性疾病后的生活条件。方法：本前瞻性国际多中心研究纳入642例老年（≥70岁）ICU患者，包括从病前状态到功能90天随访的数据。主要终点是ICU患者入院前和出院后90天的生活状况差异。次要结局是90天死亡率和生活质量。结果：共纳入642例患者。ICU幸存者比非幸存者在ICU入院前住在自己家中没有支持的人数显著增加（p = 0.016），而非幸存者住在养老院的人数显著增加（p = 0.016）。ICU病死率为39%，30天和90天病死率分别为47%和55%。90天后，只有22%的人保持了同样的生活条件。存活患者90天后对ICU入院的态度是积极的，而家属则不确定。生活质量表明自我报告的平均得分为60分（50-75分）。结论：生活条件影响老年危重患者的预后。只有少数在ICU存活后回到了最初的栖息地。试验注册号bernct04321265。

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引用次数: 0

Challenges and opportunities in antibiotic allergy de-labeling in intensive care units: The time is now! 重症监护病房抗生素过敏去标签化的挑战与机遇：时机已到！

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care

Pub Date : 2024-11-28 DOI: 10.1016/j.jcrc.2024.154978

Marcela de Almeida Lopes , Aurelie Gouel-Cheron , Saad Nseir

引用次数: 0

Platelet dysfunction in heatstroke-induced coagulopathy: A retrospective observational study 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 : 2024-11-28 DOI: 10.1016/j.jcrc.2024.154982

Yuri Endo , Ryota Inokuchi , Miyuki Yamamoto , Ryohei Horie , Toshifumi Asada , Koichi Kashiwa , Kazuki Fujishiro , Masao Iwagami , Kent Doi

Purpose

Severe heatstroke is often complicated by disseminated intravascular coagulation (DIC). The aim of this study was to evaluate platelet function assessed through thromboelastography (TEG) at the emergency department (ED) and DIC severity among patients with heatstroke.

Materials and methods

We performed a retrospective single-tertiary hospital cohort study. Patients admitted to an intensive care unit (ICU) with heatstroke were enrolled. Platelet function was evaluated as the difference between citrated functional fibrinogen-maximum amplitude (CFF-MA) and citrated rapid TEG-maximum amplitude (CRT-MA) at the ED. DIC was defined as a score ≥ 4 points based on the Japanese Association of Acute Medicine score.

Results

A total of 31 patients with heatstroke were enrolled. The median platelet count was 18.1 × 10⁴/μL, (interquartile range [IQR]: 12.6–25.0 × 10⁴/μL), and the median platelet function evaluated as CFF-MA-CRT-MA was 34.4 mm (IQR: 27.8–37.8 mm). Among several clinical and TEG-related parameters, the platelet function was strongly correlated with the DIC score (R = −0.63, p < 0.001) and significantly associated with DIC development (area under the receiver operating characteristic curve 0.87 [95 % confidence interval: 0.72–0.99]).

Conclusions

These results suggested that platelet dysfunction occurs in heatstroke-induced DIC, indicating that platelet function evaluation by TEG can provide complementary information and enhance our understanding about the subtypes of heatstroke.

目的：重症中暑常并发弥散性血管内凝血（DIC）。本研究的目的是评估急诊科（ED）通过血栓弹性成像（TEG）评估的血小板功能和中暑患者的DIC严重程度。材料和方法我们进行了一项回顾性的单三级医院队列研究。中暑入住重症监护病房（ICU）的患者被纳入研究。血小板功能以ED时柠檬酸功能纤维蛋白原最大振幅（CFF-MA）和柠檬酸快速teg最大振幅（ct -ma）的差异来评估。DIC定义为根据日本急性医学协会评分≥4分。结果共纳入31例中暑患者。血小板计数中位数为18.1 × 104/μL（四分位数间距[IQR]: 12.6 ~ 25.0 × 104/μL）， CFF-MA-CRT-MA评价血小板功能中位数为34.4 mm （IQR: 27.8 ~ 37.8 mm）。在多项临床及teg相关参数中，血小板功能与DIC评分密切相关(R = - 0.63, p <；0.001)，并与DIC发展显著相关（受试者工作特征曲线下面积0.87[95%可信区间：0.72-0.99]）。结论热休克致DIC存在血小板功能障碍，TEG评价血小板功能可提供补充信息，增进对热休克亚型的认识。

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引用次数: 0

Letter to the Editor: “Outcomes of continuous renal replacement therapy versus peritoneal dialysis as a renal replacement therapy modality in patients undergoing venoarterial 72 extracorporeal membrane oxygenation” 致编辑的信：“持续肾替代治疗与腹膜透析作为肾替代治疗方式在静脉动脉72体外膜氧合患者中的效果”

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care

Pub Date : 2024-11-28 DOI: 10.1016/j.jcrc.2024.154979

Wei-Zhen Tang, Wei-Ze Xu, Tai-Hang Liu

引用次数: 0

Antibiotic allergy de-labeling in the intensive care unit: The prospective ADE-ICU study 重症监护室中的抗生素过敏去标签化：前瞻性 ADE-ICU 研究

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care

Pub Date : 2024-11-27 DOI: 10.1016/j.jcrc.2024.154977

Salma Alamin , Rachel Egan , Barbara Cusack , Amanda Sherwin , Emily Naylor , Fiona Carroll , Marie E. Ward , Mary Kelly , Deirdre Doyle , Ignacio Martin-Loeches , Niall Conlon , Sean Keane

Purpose

Critically ill patients in the intensive care unit (ICU) are frequently prescribed antibiotics, with many reporting an antibiotic allergy label, predominantly to penicillin. Mislabeling contributes to suboptimal antibiotic use, increasing multidrug-resistant organisms and Clostridium difficile infections, and increased hospital length of stay. This prospective study implemented an antibiotic allergy assessment and testing program in the ICU, independently of clinical immunology/allergy services.

Materials and methods

Trained ICU staff prospectively identified and risk assessed eligible patients as having a non-immune mediated drug reaction, or a low, intermediate or high risk antibiotic allergy. Non-immune mediated reactions were directly de-labeled. Low-risk allergies underwent direct drug provocation testing, while intermediate-risk allergies included skin testing followed by drug provocation testing. High-risk allergies were confirmed without testing.

Results

Of 71 eligible patients, 62 underwent assessment. Antibiotic allergy de-labeling occurred in 48 of 51 patients (94 %) with a non-immune, low or intermediate risk allergy. High risk allergies were confirmed in 11 patients (18 %). The study resulted in increased penicillin use and decreased broad-spectrum antibiotic use. No adverse events occurred from testing.

Conclusions

This study shows the feasibility of ICU led antibiotic allergy assessment and testing, highlighting a potential model for implementation in settings lacking immunology/allergy services.

目的重症监护室（ICU）中的重症患者经常被处方抗生素，其中许多人报告了抗生素过敏标签，主要是对青霉素过敏。标示不当会导致抗生素使用不达标、耐多药菌和艰难梭菌感染增加以及住院时间延长。这项前瞻性研究在重症监护病房实施了一项抗生素过敏评估和检测计划，独立于临床免疫学/过敏服务。材料和方法经过培训的重症监护病房工作人员前瞻性地将符合条件的患者识别为非免疫介导的药物反应或低、中或高风险抗生素过敏患者，并进行风险评估。非免疫介导反应直接去标签。对低风险过敏者直接进行药物激发试验，对中风险过敏者先进行皮肤测试，然后再进行药物激发试验。结果 71 名符合条件的患者中有 62 人接受了评估。51 名患者中有 48 人（94%）对非免疫、低度或中度过敏发生了抗生素过敏。有 11 名患者（18%）确认了高风险过敏。这项研究增加了青霉素的使用，减少了广谱抗生素的使用。结论这项研究显示了 ICU 主导的抗生素过敏评估和检测的可行性，突出了在缺乏免疫学/过敏服务的环境中实施的潜在模式。

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引用次数: 0

The interplay between organizational culture and burnout among ICU professionals: A cross-sectional multicenter study 组织文化与 ICU 专业人员职业倦怠之间的相互作用：一项横断面多中心研究

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care

Pub Date : 2024-11-27 DOI: 10.1016/j.jcrc.2024.154981

Niek Kok , Cornelia Hoedemaekers , Malaika Fuchs , Alexander D. Cornet , Esther Ewalds , Harold Hom , Esther Meijer , Iwan Meynaar , Margo van Mol , Walther van Mook , Mariëlle van der Steen-Dieperink , Arthur van Zanten , Hans van der Hoeven , Jelle van Gurp , Marieke Zegers

Purpose

Organizational culture is considered a protective factor against burnout among ICU professionals. The aim of this study is to study the association between organizational culture as a potential antecedent to previously found mediating risk factors for burnout, namely, work-life balance and moral distress.

Materials and methods

Multicenter cross sectional study in eleven Dutch ICUs. The primary outcome measure was the core symptom of burnout, emotional exhaustion, measured using the validated Dutch version of the Maslach Burnout Inventory. Organizational culture was assessed using the Culture of Care Barometer, which measures five aspects of organizational culture. Moral distress and work-life balance were measured with validated questionnaires.

Results

696 ICU professionals (39.7 %) responded. All aspects of the CoCB were negatively associated with the emotional exhaustion component of burnout, both in univariable and multivariable models. Four aspects of organizational culture were significantly associated to the serial association between moral distress, work-to-home spillovers, and emotional exhaustion. For these aspects, the total indirect association was equal or larger than the total direct association.

Conclusions

Multiple aspects of organizational culture reduce burnout among ICU professionals in a largely indirect manner, via moral distress and work-life balance. Improving organizational culture can mitigate burnout symptoms among ICU clinicians.

目的组织文化被认为是 ICU 专业人员职业倦怠的保护因素。本研究旨在研究组织文化作为潜在前因与之前发现的职业倦怠中介风险因素（即工作与生活的平衡和精神压力）之间的关联。主要结果测量指标是职业倦怠的核心症状--情绪衰竭，使用经过验证的荷兰版马斯拉奇职业倦怠量表进行测量。组织文化采用护理文化晴雨表进行评估，该晴雨表可测量组织文化的五个方面。结果 696 名重症监护室专业人员（39.7%）做出了回应。在单变量和多变量模型中，CoCB 的所有方面都与职业倦怠的情感衰竭部分呈负相关。组织文化的四个方面与道德困扰、工作对家庭的溢出效应和情感衰竭之间的序列关联有明显的相关性。结论组织文化的多个方面在很大程度上通过道德困扰和工作与生活的平衡，以间接的方式减轻了 ICU 专业人员的职业倦怠。改善组织文化可以减轻 ICU 临床医生的职业倦怠症状。

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Authors reply: “Outcomes of continuous renal replacement therapy versus peritoneal dialysis as a renal replacement therapy modality in patients undergoing venoarterial 72 extracorporeal membrane oxygenation" 作者回复："持续肾脏替代疗法与腹膜透析作为接受静脉-动脉72体外膜氧合患者的肾脏替代疗法的疗效"

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care

Pub Date : 2024-11-26 DOI: 10.1016/j.jcrc.2024.154980

Peerapat Thanapongsatorn , Nisha Wanichwecharungruang , Nattachai Srisawat

引用次数: 0

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