Journal of critical care最新文献

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Waveform analysis of central venous pressure in infants undergoing tetralogy of Fallot repair 法洛四联症患儿中心静脉压波形分析

IF 2.9 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care

Pub Date : 2026-01-19 DOI: 10.1016/j.jcrc.2025.155381

Riccardo Asnaghi , Benedetta Bertesago , Lucrezia Colombo , Rossana Volontè , Devika Richmann , Nicolò Pini , Nimrod Goldshtrom , Manuela Ferrario

引用次数: 0

Spatial visualization of sepsis prediction: The big picture for accuracy and feature selection impact 脓毒症预测的空间可视化：准确性和特征选择影响的大图景

IF 2.9 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care

Pub Date : 2026-01-19 DOI: 10.1016/j.jcrc.2025.155371

Alexandra Albu , Holger Lindner , Verena Schneider-Lindner

引用次数: 0

Identification of high-risk patient groups through unsupervised machine learning of intraoperative oscillometric blood pressure trends 通过术中血压振荡趋势的无监督机器学习识别高危患者群体

IF 2.9 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care

Pub Date : 2026-01-19 DOI: 10.1016/j.jcrc.2025.155372

Simone Kagerbauer , Bettina Jungwirth , Armin Podtschaske , Hans A. Kestler

引用次数: 0

Hemodynamic parameter space characteristics: In silico study 血流动力学参数空间特征：计算机研究

IF 2.9 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care

Pub Date : 2026-01-19 DOI: 10.1016/j.jcrc.2025.155378

Borut Kirn , Estefanía Žugelj Tapia , Marko Žličar

引用次数: 0

Letter to the editor: “Associations of positive end-expiratory pressure (PEEP) with extubationfailure and clinical outcomes in invasively ventilated patients with acute brain injury: A secondary analysis of the ENIO study” 致编辑的信：“急性脑损伤有创通气患者呼气末正压（PEEP）与拔管失败和临床结果的关系：ENIO研究的二次分析”

IF 2.9 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care

Pub Date : 2026-01-13 DOI: 10.1016/j.jcrc.2025.155415

Zhenhao Liu , Yanqing Gong

引用次数: 0

Hemodynamic impact of dexmedetomidine in critically ill patients with and without cirrhosis: A retrospective cohort study 右美托咪定对伴或不伴肝硬化危重患者血液动力学的影响：一项回顾性队列研究。

IF 2.9 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care

Pub Date : 2026-01-12 DOI: 10.1016/j.jcrc.2026.155424

Grace M. Conroy , Jason R. Yerke , Michael A. Rudoni , Aanchal Kapoor , Stephanie N. Bass

Purpose

This study aims to compare adverse hemodynamic effects of dexmedetomidine in critically ill patients with and without cirrhosis.

Materials and methods

We conducted a retrospective, observational cohort study of adult patients who received at least 2 h of a dexmedetomidine infusion while admitted to a medical or surgical intensive care unit between November 2018 and December 2021 at multiple hospitals within the Cleveland Clinic. Patients were divided into cohorts with and without cirrhosis. The primary objective was to compare the incidence of adverse hemodynamic events between groups, defined as incidence of bradycardia during dexmedetomidine infusion. Secondary outcomes included incidence of severe bradycardia and hypotension within 24 h of dexmedetomidine initiation. A multivariable logistic regression was performed for bradycardia and hypotension during drug infusion.

Results

In total, 157 patients were included; 37 patients with and 120 without cirrhosis. Patients with cirrhosis had similar baseline heart rate but higher cardiac SOFA (0 [0,3] vs. 0 [0,0]; p = 0.01). Patients with cirrhosis demonstrated a higher incidence of bradycardia (40.5% vs. 22.5%; RR 1.9 [95% CI 1.1–3.2]). After adjustment, the odds of developing bradycardia during dexmedetomidine infusion were greater in the cirrhosis group (adjusted OR 2.24 [95% CI 0.96–5.21]). The cirrhosis group had increased odds of developing hypotension in the first 24 h (adjusted OR 2.36 [95% CI 0.99–5.63]).

Conclusions

Dexmedetomidine use was associated with higher rates of bradycardia, severe bradycardia, and hypotension in patients with cirrhosis. Future research is needed on dexmedetomidine use based on severity of liver disease.

目的：本研究旨在比较右美托咪定在合并和不合并肝硬化的危重患者中的不良血流动力学影响。材料和方法：我们对2018年11月至2021年12月在克利夫兰诊所多家医院的内科或外科重症监护病房住院期间接受至少2小时右美托咪定输注的成年患者进行了回顾性观察性队列研究。患者被分为有肝硬化和无肝硬化两组。主要目的是比较两组之间不良血流动力学事件的发生率，定义为右美托咪定输注期间心动过缓的发生率。次要结局包括右美托咪定起始24小时内严重心动过缓和低血压的发生率。对药物输注期间的心动过缓和低血压进行多变量logistic回归分析。结果：共纳入157例患者；37例有肝硬化，120例无肝硬化。肝硬化患者基线心率相似，但心脏SOFA较高（0 [0,3]vs. 0 [0,0]; p = 0.01）。肝硬化患者的心动过缓发生率更高（40.5%比22.5%;RR 1.9 [95% CI 1.1-3.2]）。调整后，肝硬化组右美托咪定输注期间发生心动过缓的几率更大（调整后OR为2.24 [95% CI 0.96-5.21]）。肝硬化组在前24小时发生低血压的几率增加（调整后OR为2.36 [95% CI 0.99-5.63]）。结论：右美托咪定的使用与肝硬化患者心动过缓、严重心动过缓和低血压的发生率升高有关。基于肝病严重程度的右美托咪定的使用需要进一步的研究。

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引用次数: 0

Machine learning to assess correlated sociodemographic and socioeconomic community-level data and association with sepsis incidence 机器学习评估相关的社会人口和社会经济社区水平数据及其与败血症发生率的关联。

IF 2.9 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care

Pub Date : 2026-01-12 DOI: 10.1016/j.jcrc.2025.155421

Zahra Aghababa , Jason N. Kennedy , RuoFei Yin , Christina F. Mair , Kristina E. Rudd

引用次数: 0

ICU transfer delay and mortality after ward-onset shock 重症监护病房转移延迟和病死率

IF 2.9 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care

Pub Date : 2026-01-10 DOI: 10.1016/j.jcrc.2026.155423

Tongjuan Zou , Chansokhon Ngan , Wanhong Yin

Purpose

To assess whether intensive care unit (ICU) transfer delay after ward-onset shock is associated with mortality, and whether early point-of-care ultrasound (POCUS) is associated with outcomes.

Materials and methods

Retrospective cohort study using an ICU registry linked to electronic health records at West China Hospital (Jan 1, 2019–Jan 31, 2024). Adults with ward-onset shock requiring first ICU transfer were included. Transfer delay was grouped as <3 h, 3–6 h, or > 6 h. Multivariable logistic regression adjusted for age, APACHE II, and SOFA. Early POCUS was defined as ultrasound within 6 h of shock onset.

Results

Among 3535 patients, in-hospital mortality was 24.0%. Mortality increased across delay groups: 18.0% (<3 h; n = 2849), 40.7% (3–6 h; n = 150), and 51.5% (>6 h; n = 536). Versus <3 h, adjusted odds of in-hospital death were higher for 3–6 h (OR 2.34, 95% CI 1.62–3.38) and > 6 h (OR 3.27, 95% CI 2.65–4.03) (both P < 0.001). Early POCUS (n = 251, 7.1%) was associated with lower in-hospital mortality (adjusted OR 0.57, 95% CI 0.37–0.84; P = 0.005) and lower 28-day mortality (adjusted OR 0.47, 95% CI 0.30–0.72; P < 0.001).

Conclusions

ICU transfer delay after ward-onset shock was independently associated with increased mortality, whereas early POCUS was associated with lower mortality.

目的评估重症监护病房（ICU）转移延迟是否与死亡率相关，以及早期护理点超声（POCUS）是否与预后相关。材料和方法使用与电子健康记录相关的华西医院ICU注册表进行回顾性队列研究（2019年1月1日- 2024年1月31日）。包括需要首次ICU转移的病房性休克成人。转移延迟分为<；3小时、3 - 6小时和>； 6小时。多变量logistic回归调整了年龄、APACHE II和SOFA。早期POCUS定义为休克发生后6小时内的超声检查。结果3535例患者住院死亡率为24.0%。延迟组死亡率增加：18.0%(3小时；n = 2849), 40.7%（3 - 6小时；n = 150）和51.5%（6小时；n = 536）。与3小时相比，3 - 6小时（OR 2.34, 95% CI 1.62-3.38）和6小时（OR 3.27, 95% CI 2.65-4.03）的调整后住院死亡几率更高（P均为0.001）。早期POCUS （n = 251, 7.1%）与较低的住院死亡率（校正OR 0.57, 95% CI 0.37-0.84; P = 0.005）和较低的28天死亡率（校正OR 0.47, 95% CI 0.30-0.72; P < 0.001）相关。结论住院休克后icu转移延迟与死亡率增加独立相关，而早期POCUS与较低死亡率相关。

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引用次数: 0

Letter to the editor: “Recovery of motor functions and cognitive functions in patients with intensive care unit–acquired weakness” 致编辑的信：“重症监护病房获得性虚弱患者运动功能和认知功能的恢复”。

IF 2.9 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care

Pub Date : 2026-01-09 DOI: 10.1016/j.jcrc.2025.155351

Jinyin Bai , Guifen Gan

We congratulate Aoyama et al. for demonstrating that cognitive status at ICU discharge is linked to 4-week motor recovery in ICU-AW survivors (J Crit Care 2026; 91:155273). We caution, however, against causal over-interpretation of this retrospective cohort, urge adoption of target-trial emulation (inverse-probability weighting or instrumental variables) and a prospective, adequately powered (≈ 120 patients) multicentre RCT. Routine post-ICU cognitive screening (MoCA) and delirium monitoring (CAM-ICU) could enable early triage to multidisciplinary rehabilitation and should be validated in nationwide data.

我们祝贺青山等人证明了ICU出院时的认知状态与ICU- aw幸存者4周运动恢复有关（J Crit Care 2026; 91:155273）。然而，我们警告不要对该回顾性队列进行因果过度解释，敦促采用目标试验模拟（逆概率加权或工具变量）和前瞻性、足够有力（约120例患者）的多中心RCT。常规的icu后认知筛查（MoCA）和谵妄监测（CAM-ICU）可以实现多学科康复的早期分类，并应在全国数据中进行验证。

引用次数: 0

The impact of ketamine on ICU mortality in patients with sepsis: A retrospective cohort study 氯胺酮对脓毒症ICU患者死亡率的影响：一项回顾性队列研究。

IF 2.9 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care

Pub Date : 2026-01-06 DOI: 10.1016/j.jcrc.2025.155422

Yifei Liu , Jie Yue , Guangdong Wang , Yuxia Jiang , Aihua Shu

Background

Sepsis represents a systemic inflammatory response syndrome triggered by infection, potentially resulting in critical organ dysfunction with life-threatening consequences. Ketamine demonstrates efficacy in suppressing the release of inflammatory factors, thereby contributing significantly to the mitigation of inflammatory response of patients with sepsis while preserving vital organ functionality.

Objective

This study aims to examine the effect of ketamine administration on the ICU mortality rate of patients with sepsis.

Methods

This retrospective analysis utilized data from the MIMIC-IV database (n = 25,252 ICU patients). Primary outcomes were 7-day and 14-day ICU mortality rates, while secondary outcomes included ICU and total hospital length of stay. Covariates were adjusted using propensity score matching (PSM), and statistical analysis was performed using R software.

Results

After PSM, the analysis cohort included 2612 patients. Ketamine administration was significantly associated with reduced 7-day ICU mortality (HRs: 0.65 [0.48, 0.89], 0.63 [0.46, 0.86], 0.62 [0.45, 0.85]; all P < 0.05). No significant differences were observed in 14-day mortality. ICU and total hospital stays were longer in the ketamine group.

Conclusion

In this retrospective cohort, ketamine exposure was associated with lower 7-day ICU mortality; however, residual confounding and heterogeneity in timing, dose, and indication for ketamine use cannot be excluded. The longer hospital and ICU stays observed in ketamine-treated patients further underscore the need for prospective trials to clarify efficacy, optimal timing, and safety before routine adoption.

背景：脓毒症是一种由感染引发的全身性炎症反应综合征，可能导致关键器官功能障碍，危及生命。氯胺酮具有抑制炎症因子释放的功效，从而在保持重要器官功能的同时，显著缓解败血症患者的炎症反应。目的：探讨氯胺酮对脓毒症ICU患者死亡率的影响。方法：回顾性分析利用MIMIC-IV数据库的数据（n = 25,252例ICU患者）。主要结局是7天和14天ICU死亡率，次要结局包括ICU和总住院时间。协变量采用倾向评分匹配（PSM）进行调整，并采用R软件进行统计分析。结果：PSM后，分析队列包括2612例患者。氯胺酮给药与降低ICU 7天死亡率显著相关(hr: 0.65[0.48, 0.89], 0.63[0.46, 0.86], 0.62[0.45, 0.85]；均P结论：在本回顾性队列中，氯胺酮暴露与降低ICU 7天死亡率相关，但不能排除氯胺酮使用时间、剂量和适应症的残留混杂和异质性。氯胺酮治疗患者在医院和ICU的住院时间较长，这进一步强调了在常规采用氯胺酮之前进行前瞻性试验以阐明疗效、最佳时机和安全性的必要性。

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