Critical Care and Resuscitation最新文献

英文中文

Global disparities in scientific publications: A 5-year analysis of 10 critical care journals 科学出版物的全球差异：10种重症监护期刊的5年分析

IF 1.7 4区医学 Q3 CRITICAL CARE MEDICINE

Critical Care and Resuscitation

Pub Date : 2025-10-16 DOI: 10.1016/j.ccrj.2025.100137

R. Daltro-Oliveira MD , A. Quintairos MD, PhD , L.I.O. Santos MD , F. Amado MD , J.I.F. Salluh MD, PhD , A.P. Nassar Jr. MD, PhD

Objective

To evaluate the global distribution of original research articles in intensive care journals, analysing differences by country income level and assessing study characteristics, including type, funding, and accessibility.

Design

A retrospective bibliometric analysis of original research articles published between 2018 and 2022.

Setting

The 10 intensive care journals with the highest 2022 Impact Factors, as identified by Clarivate Analytics.

Participants

Original research articles (observational studies and randomised controlled trials) in adult intensive care, excluding paediatric and preclinical studies.

Main outcome measures

Country of affiliation of the corresponding author (classified by World Bank income level), study type, funding source, number of participating centres, open-access status, and thematic category.

Results

Among 12,441 manuscripts reviewed, we included 4982 original research articles. Of these, 4479 (89.9 %) were from high-income countries (HICs), 446 (9.0 %) from upper-middle-income countries (UMICs), 53 (1.1 %) from lower-middle-income countries (LMICs), and 4 (0.1 %) from low-income countries (LICs). Overall, 434 (8.7 %) were randomised controlled trials, with higher proportions in UMICs (13.2 %) and LMIC (20.8 %) studies compared with HICs (8.1 %). Multicenter design was reported in 44.6 % of all studies, but less frequently in UMICs (29.1 %) and LMICs (30.2 %). The median sample size was 228 patients (interquartile range, 76-1052), ranging from 231 in HICs to 211 in UMICs and 100 in LMICs. Funding was reported in 56.9 % of studies, most often from public sources. Public funding supported 28.0 % of UMICs and 9.4 % of LMICs studies, compared with 14.3 % of HIC studies. Open-access articles represented 44.8 % overall and were more common among funded studies.

Conclusions

Publications from UMICs, LMICs, and LICs remain underrepresented in high-impact intensive care journals. Structural barriers, limited funding, and potential publication bias contribute to this imbalance. Addressing these gaps requires greater funding opportunities, equitable collaborations, and stronger editorial commitment to inclusivity.

目的评估重症监护期刊原创研究文章的全球分布，分析不同国家收入水平的差异，评估研究特征，包括类型、资助和可及性。design对2018年至2022年间发表的原创研究文章进行回顾性文献计量分析。由Clarivate Analytics确定的2022年影响因子最高的10种重症监护期刊。参与者：成人重症监护的原始研究文章（观察性研究和随机对照试验），不包括儿科和临床前研究。主要结果测量通讯作者所属国家（按世界银行收入水平分类）、研究类型、资金来源、参与中心数量、开放获取状况和专题类别。结果在12441篇审稿中，纳入4982篇原创研究论文。其中，4479人（89.9%）来自高收入国家（HICs）， 446人（9.0%）来自中高收入国家（UMICs）， 53人（1.1%）来自中低收入国家（LMICs）， 4人（0.1%）来自低收入国家（lic）。总体而言，434项（8.7%）为随机对照试验，其中UMICs（13.2%）和LMIC（20.8%）研究的比例高于HICs（8.1%）。44.6%的研究报告了多中心设计，但在低收入国家（29.1%）和低收入国家（30.2%）的研究较少。中位样本量为228例（四分位数范围为76-1052），从高收入国家的231例到低收入国家的211例和低收入国家的100例。56.9%的研究报告有资金，大多数来自公共来源。公共资金支持28.0%的中低收入国家研究和9.4%的中低收入国家研究，而高收入国家研究的这一比例为14.3%。开放获取文章占44.8%，在受资助的研究中更为常见。结论来自中低收入国家、低收入国家和低收入国家的出版物在高影响力重症监护期刊上的代表性仍然不足。结构性障碍、有限的资金和潜在的发表偏倚导致了这种不平衡。解决这些差距需要更多的融资机会、公平的合作以及对包容性更强的编辑承诺。

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引用次数: 0

Sepsis in the absence of fever: Determining the criteria for and feasibility of future therapeutic temperature management trials 无发热的脓毒症：确定未来治疗性体温管理试验的标准和可行性

IF 1.7 4区医学 Q3 CRITICAL CARE MEDICINE

Critical Care and Resuscitation

Pub Date : 2025-10-16 DOI: 10.1016/j.ccrj.2025.100135

Kyle C. White FCICM MPH , Kevin B. Laupland FCICM PhD , Manoj Saxena MBBCh PhD , Bianca Crichton BHealSc , James McCullough FCICM , Prashanti Marella FCICM , Alexis Tabah FCICM , Peter Garrett FCICM , Maneesha Tol FCICM , Antony G. Attokaran FCICM , Stephen Luke FCICM , Aashish Kumar FCICM , Sananta Dash FCICM , Sebastiaan Blank FCICM , Karthik Venkatesh FCICM , Ashwin Subramaniam FCICM PhD , Julieann Coombes PhD , Chloe Edwards BN, MPH , Paul J. Young MBChB PhD , Queensland Critical Care Research Network (QCCRN)

Objective

The purpose of this study is to examine the occurrence, characteristics, and outcomes of intensive care unit (ICU) patients with sepsis and the absence of fever.

Design

Multicentre, retrospective cohort study.

Setting

Twelve ICUs in Queensland, Australia.

Participants

Adults (≥18 years) admitted to the ICU with sepsis between 1 January 2015 and 31 December 2021 were eligible for inclusion. Patients admitted with seizures, traumatic brain injury, postcardiac arrest, end-of-life care, and elective surgery were excluded, as were readmissions.

Main outcome measures

The primary outcome was fever deficit (defined as degree-hours under 38.3°C) during the first 72 h of ICU admission, and all-cause 30-day mortality was the key secondary outcome.

Results

Of 89,117 admissions, 15,612 were included. Admission temperatures were ≥38.3°C in 1026 (6.6%), 37.5–38.2°C in 2096 (13.4%), 36–37.4°C in 9216 (59.0%), and <36°C in 3274 (21.0%). Temperatures changed rapidly over the first 12 h and, by 24 h, approached reasonably stable levels. For the admission temperature groups of ≥38.3°C, 37.5–38.2°C, 36–37.4°C, and <36°C, fever deficits were a median of 47 (interquartile range (IQR), 24 to 72), 53 (IQR, 29 to 83), 69 (IQR, 40 to 100), and 85 (IQR, 52 to 123) degree-hours, respectively, and 147 (14%), 248 (12%), 1,104 (12%), and 549 (17%) died by day 30. After controlling for confounders, a high fever deficit, defined as a fever deficit above the median, during the first 24 h of ICU admission, was not associated with all-cause 30-day mortality (OR 1.02, 95% CI, 0.93–1.13; p = 0.7).

Conclusion

Fever deficits were large, particularly when the initial body temperature was not febrile. Only 1 in 15 ICU patients with sepsis had an initial body temperature ≥38.3°C. Approximately 2000 adults a year with sepsis and an initial body temperature <37.5°C would potentially be eligible for a trial of therapeutic hyperthermia in our 12 ICUs.

目的探讨重症监护病房（ICU）脓毒症患者无发热的发生、特点和预后。设计：多中心、回顾性队列研究。在澳大利亚昆士兰州设置12个icu。2015年1月1日至2021年12月31日期间因脓毒症入住ICU的成人（≥18岁）符合纳入条件。因癫痫发作、外伤性脑损伤、心脏骤停、临终关怀和择期手术入院的患者被排除在外，再入院的患者也被排除在外。主要转归指标主要转归指标为ICU入院前72小时的发热不足（定义为38.3℃以下的度小时），全因30天死亡率是关键的次要转归指标。结果89117名住院患者中，15612人入选。入院温度为1026年≥38.3℃（6.6%），2096年37.5-38.2℃（13.4%），9216年36 - 37.4℃（59.0%），3274年36℃（21.0%）。在最初的12小时内，温度迅速变化，到24小时时，温度接近相当稳定的水平。入院温度≥38.3°C、37.5-38.2°C、36 - 37.4°C和36°C组的发热差中位数分别为47（四分位间距（IQR）， 24 - 72）、53 （IQR, 29 - 83）、69 （IQR, 40 - 100）和85 （IQR, 52 - 123）度-小时，第30天死亡147（14%）、248（12%）、1104（12%）和549（17%）。在控制混杂因素后，在ICU入院的前24小时内，高热不足（定义为高于中位数的发烧不足）与全因30天死亡率无关（OR 1.02, 95% CI, 0.93-1.13; p = 0.7）。结论发热亏大，尤其是初体温不发热时。15例ICU脓毒症患者中仅有1例初始体温≥38.3℃。每年大约有2000名患有脓毒症且初始体温为37.5°C的成年人可能有资格在我们的12个icu中进行治疗性热疗试验。

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引用次数: 0

Critical care outcome prediction equation model, version 7 重症监护结果预测方程模型，版本7

IF 1.7 4区医学 Q3 CRITICAL CARE MEDICINE

Critical Care and Resuscitation

Pub Date : 2025-10-16 DOI: 10.1016/j.ccrj.2025.100131

Graeme J. Duke MD, FCICM, FANZCA , Steven Hirth MIT , John D. Santamaria MD, FRACP, FCICM, FCCP , Frank Shann MD, FRACP, FCICM , David Pilcher FCICM, FRACP, MRCP , Felix Oberender PhD, FRACP, FCICM , Cameron Knott FRACP, FCICM , John Moran MD, FRACP, FCICM, FANZCA

Objective

Mortality prediction models are used for benchmarking, audit, research, and epidemiology. This report describes the development and validation methodology, for version 7 of the critical care outcome prediction equation for monitoring adult intensive care unit (ICU) mortality risk.

Design

This was a multiphase study incorporating data extraction, curation, aggregation, modelling, and validation applied to jurisdictional administrative datasets to model 90-day survival.

Setting

The study was conducted across 28 public and 19 private hospitals in state of Victoria, Australia, with an adult population of 5.28 million.

Participants

A total of 215,148 consecutive adult hospital separations receiving intensive care over 5 years, July 2019–June 2024, were included in the study.

Main outcome measures

The main outcome measures included the case fatality rate (CFR) and standardised 90-day mortality ratio (SMR) at the provider level with model fit assessed for calibration (Brier score; Hosmer–Lemeshow statistic [H₁₀]), discrimination (area under the receiver-operator characteristic and precision-recall curves), classification (CFR and SMR results for ICU-years classified within ±3 standard deviation [SD]), and dispersion (dispersion value [ϕ]; SD random effect [τ]) characteristics.

Results

The CFR was found to be 12.0 (95% confidence interval: 11.8–12.1) per 100 separations and 16.1 (95% confidence interval: 15.7–16.4) per 100 persons. A total of 7771 (53.7%) admission diagnoses were aggregated into 24 clinical diagnosis groups and eight demographic (final) model variables. The following results were obtained: mean Brier score = 0.08; H₁₀ = 15.95; area under the receiver-operator characteristic curve = 0.85; area under the precision-recall curve = 0.43. A total of 126 (54.1%) CFR results and 220 (94.4%) SMR values were within ±3 SD. A total of 105 (45.3%) CFR-outlier ICU-years were reclassified as SMR inliers, with no CFR inlier reclassified as an SMR outlier. Overdispersion metrics: ϕ = 2.80; τ = 0.15.

Conclusions

Critical care outcome prediction equation, version 7 is a parsimonious hospital mortality prediction model for adult intensive care admissions, derived from administrative data common to all jurisdictions.

目的死亡率预测模型用于基准测试、审计、研究和流行病学。本报告描述了用于监测成人重症监护病房（ICU）死亡风险的重症监护结果预测方程第7版的开发和验证方法。这是一项多阶段研究，包括数据提取、整理、汇总、建模和验证，应用于管辖区行政数据集，以模拟90天的生存期。该研究在澳大利亚维多利亚州的28家公立医院和19家私立医院进行，这些医院的成年人口为528万。在2019年7月至2024年6月期间，共有215,148名连续5年接受重症监护的成人医院分离患者被纳入该研究。主要结局指标包括在提供者水平上的病死率（CFR）和标准化90天死亡率（SMR），模型拟合评估用于校准（Brier评分；Hosmer-Lemeshow统计量[H10]），鉴别（接受者-操作者特征和精度-召回率曲线下的面积），分类（icu年的CFR和SMR结果分类在±3个标准差[SD]内），和分散(分散值[φ]；SD随机效应[τ])特征。结果CFR为12.0(95%可信区间：11.8 ~ 12.1)/ 100次，16.1(95%可信区间：15.7 ~ 16.4)/ 100人。共7771例（53.7%）入院诊断汇总为24个临床诊断组和8个人口学（最终）模型变量。结果表明：平均Brier评分= 0.08；H10 = 15.95；接受者-操作者特征曲线下面积= 0.85；精密度-召回率曲线下面积= 0.43。126例（54.1%）CFR结果和220例（94.4%）SMR值在±3 SD范围内。共有105例（45.3%）CFR异常icu年被重新分类为SMR异常，没有CFR异常被重新分类为SMR异常。过分散指标：φ = 2.80；τ = 0.15。结论重症监护结局预测方程（version 7）是一个简化的成人重症监护入院医院死亡率预测模型，该模型来源于所有司法管辖区通用的行政数据。

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引用次数: 0

The gastrointestinal microbiome in critical illness: A Clinician's guide to mechanisms, emerging tools, and therapeutic questions 危重疾病中的胃肠道微生物组：临床医生对机制、新兴工具和治疗问题的指导

IF 1.7 4区医学 Q3 CRITICAL CARE MEDICINE

Critical Care and Resuscitation

Pub Date : 2025-10-16 DOI: 10.1016/j.ccrj.2025.100132

Angaj Ghosh MBBS, FACEM, FCICM , Tess Evans MBBS , Calum J. Walsh PhD , Matthew J. Maiden PhD , Timothy P. Stinear PhD , Adam M. Deane PhD

There is considerable interest in the gastrointestinal (GI) microbiome and its interaction with disease processes, but existing reviews tend to assume ecological and microbiological knowledge that critical care clinicians may not have. In this review, we present an overview of the GI microbiome for the critical care clinician and highlight unanswered questions pertinent to the field.

The human GI microbiome can now be mapped and its relationship with organ function interrogated. Multiomics approaches that integrate data from multiple sources, including the microbiome, epigenome, transcriptome, metabolome, and proteome, offer promise in unravelling the hitherto inconsistent results of interventions to modify the microbiome, with a view to improving outcomes.

Resident microbes are implicated in local and systemic immune dysregulation during critical illness. While the mechanisms underlying relationships between the GI microbiome and organ function in health and disease remain incompletely understood, a byproduct of saccharolytic fermentation of dietary fibre in the colon, short-chain fatty acids (SCFAs), are a key modulator of these relationships. Pertinent to the use of prebiotic formulations in treating chronic disease and critical illness, are the comparatively unexplored bidirectional interactions between the microbiome and host. More observational and interventional data, using advanced laboratory techniques, are needed to understand if these are causal relationships.

人们对胃肠道（GI）微生物组及其与疾病过程的相互作用相当感兴趣，但现有的综述倾向于假设危重病临床医生可能不具备的生态学和微生物学知识。在这篇综述中，我们为重症监护临床医生介绍了胃肠道微生物组的概述，并强调了与该领域相关的未回答的问题。人类胃肠道微生物组现在可以被绘制，它与器官功能的关系可以被询问。多组学方法整合了来自多个来源的数据，包括微生物组、表观基因组、转录组、代谢组和蛋白质组，为揭示迄今为止不一致的干预结果提供了希望，以改善结果。在危重疾病期间，常驻微生物与局部和全身免疫失调有关。虽然胃肠道微生物群与健康和疾病中器官功能之间关系的潜在机制尚不完全清楚，但结肠中膳食纤维糖解发酵的副产物短链脂肪酸（SCFAs）是这些关系的关键调节剂。与使用益生元制剂治疗慢性疾病和危重疾病相关的是微生物组和宿主之间相对未被探索的双向相互作用。需要使用先进的实验室技术获得更多的观察性和干预性数据，以了解这些是否存在因果关系。

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引用次数: 0

A study of Professor Bellomo's contribution to cardiac arrest research 贝洛莫教授对心脏骤停研究的贡献

IF 1.7 4区医学 Q3 CRITICAL CARE MEDICINE

Critical Care and Resuscitation

Pub Date : 2025-09-01 DOI: 10.1016/j.ccrj.2025.100120

Glenn M. Eastwood BN BN(Hons) GDipNurs CritCare, PhD, Niklas Nielsen MD, PhD

引用次数: 0

Unravelling the paradox of vitamin C research in sepsis 揭示败血症中维生素C研究的悖论

IF 1.7 4区医学 Q3 CRITICAL CARE MEDICINE

Critical Care and Resuscitation

Pub Date : 2025-09-01 DOI: 10.1016/j.ccrj.2025.100134

Tomoko Fujii MD, PhD , Clive N. May PhD , Yugeesh R. Lankadeva PhD

Professor Rinaldo Bellomo’s lasting impact on critical care research stems from his commitment to structured, biologically grounded research programs over isolated studies. His work on vitamin C in sepsis exemplifies this approach. While early enthusiasm grew around combination therapies involving vitamin C, Rinaldo championed a cautious, rigorous, and methodical investigation. He worked closely with collaborators to address key methodological issues, including dosing, stability, and the design of appropriate control groups, which ultimately led to the international VITAMINS trial. This landmark study compared vitamin C, hydrocortisone, and thiamine to hydrocortisone alone in septic shock and found no clinical benefit. Rinaldo embedded a pharmacokinetic substudy to confirm supraphysiological serum vitamin C levels, ensuring biological plausibility of the trial design. Beyond clinical research, he fostered translational research with the Florey Institute using a preclinical sheep model of sepsis. This collaboration uncovered critical mechanisms of septic acute kidney injury and led to the development of mega-dose sodium ascorbate therapy. The program progressed from proof-of-concept to a double-blind pilot randomised trial in septic shock and now underpins a national multicentre phase Ib and II clinical trials. Rinaldo’s legacy is defined by scientific rigour, mentorship, and humility. His visionary, disciplined approach remains a model for impactful research and continues to guide ongoing efforts to advance care for critically ill patients.

教授里纳尔多·贝洛莫对重症监护研究的持久影响源于他对结构化的、基于生物学的研究项目的承诺，而不是孤立的研究。他关于维生素C在败血症中的作用的研究就是这种方法的例证。虽然早期人们对含维生素C的联合疗法热情高涨，但里纳尔多主张进行谨慎、严格和有条不紊的研究。他与合作者密切合作，解决了关键的方法学问题，包括剂量、稳定性和适当对照组的设计，这最终导致了国际维生素试验。这项具有里程碑意义的研究将维生素C、氢化可的松和硫胺素与单用氢化可的松治疗感染性休克进行了比较，发现没有临床益处。Rinaldo嵌入了一项药代动力学亚研究，以确认超生理血清维生素C水平，确保试验设计的生物学合理性。除了临床研究之外，他还与弗洛里研究所（Florey Institute）合作，使用临床前绵羊败血症模型进行转化研究。这项合作揭示了脓毒性急性肾损伤的关键机制，并导致了大剂量抗坏血酸钠治疗的发展。该项目从概念验证发展到脓毒性休克的双盲随机试验，目前正在进行国家多中心Ib期和II期临床试验。雷纳尔多的遗产是由严谨的科学、指导和谦逊来定义的。他富有远见的、严谨的方法仍然是有影响力的研究的典范，并继续指导正在进行的努力，以提高对危重病人的护理。

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引用次数: 0

Honouring Rinaldo Bellomo’s tour de force in sepsis research 表彰里纳尔多·贝洛莫在败血症研究方面的杰出成就

IF 1.7 4区医学 Q3 CRITICAL CARE MEDICINE

Critical Care and Resuscitation

Pub Date : 2025-09-01 DOI: 10.1016/j.ccrj.2025.100139

S. Peake MD, PhD , A. Delaney MD, PhD , B. Venkatesh MD, PhD

This paper pays tribute to Rinaldo Bellomo’s unparallelled global legacy in sepsis research. As a clinician-scientist, Rinaldo’s unending quest was to improve the lives of our patients with sepsis and septic shock. The breadth of his work encompassed all facets of research methodology from basic science through to large-scale multicentre randomised trials. Seminal papers like the early goal-directed therapy and steroids in septic shock trials have been instrumental in informing international evidence-based sepsis guidelines and changing clinical practice. Above all, he was a pioneering, yet self-effacing, leader. He brought everyone who worked with him along on his journey. His infectious enthusiasm for the next new idea never failed to inspire our community, ensuring that his legacy in sepsis research will continue for many years to come.

本文向雷纳多·贝洛莫在败血症研究中无与伦比的全球遗产致敬。作为一名临床医生兼科学家，里纳尔多无止境的追求是改善脓毒症和感染性休克患者的生活。他的工作范围涵盖了从基础科学到大规模多中心随机试验的研究方法的各个方面。一些开创性的论文，如早期目标导向疗法和感染性休克试验中的类固醇，在告知国际循证败血症指南和改变临床实践方面发挥了重要作用。最重要的是，他是一位开拓性的、谦逊的领袖。他带着所有和他一起工作的人一起旅行。他对下一个新想法的传染性热情从未未能激励我们的社区，确保他在败血症研究方面的遗产将在未来许多年继续下去。

引用次数: 0

A gardener lost in spring 一个迷失在春天的园丁

IF 1.7 4区医学 Q3 CRITICAL CARE MEDICINE

Critical Care and Resuscitation

Pub Date : 2025-09-01 DOI: 10.1016/j.ccrj.2025.100125

Neil R. Orford MBBS, FCICM, FANZCA, PGDipEcho, PhD

引用次数: 0

Critical care nutrition and the legacy of Rinaldo Bellomo 重症监护营养和里纳尔多·贝洛莫的遗产

IF 1.7 4区医学 Q3 CRITICAL CARE MEDICINE

Critical Care and Resuscitation

Pub Date : 2025-09-01 DOI: 10.1016/j.ccrj.2025.100147

Adam M. Deane MBBS, PhD , Sandra L. Peake BMBS, PhD , Andrew R. Davies MBBS , Yasmine Ali Abdelhamid MBBS, PhD , Moritoki Egi MD, PhD , Marianne J. Chapman BMBS, PhD , Emma J. Ridley APD, PhD

We provide an overview of the monumental impact that Professor Rinaldo Bellomo made in the field of critical illness nutrition and metabolism. We reflect on research he conducted into energy delivery, refeeding hypophosphataemia, carbohydrate metabolism and glycaemia, protein delivery and impact of renal perfusion and nitrogen metabolism, and bowel management during nutritional therapy.

我们提供了一个巨大的影响，教授里纳尔多贝洛莫在危重疾病营养和代谢领域的概述。我们回顾了他在营养治疗期间的能量输送、再喂养低磷血症、碳水化合物代谢和血糖、蛋白质输送和肾灌注和氮代谢的影响、肠道管理等方面的研究。

引用次数: 0

The Australian and New Zealand Intensive Care Research Centre and Rinaldo Bellomo 澳大利亚和新西兰重症监护研究中心和里纳尔多·贝洛莫

IF 1.7 4区医学 Q3 CRITICAL CARE MEDICINE

Critical Care and Resuscitation

Pub Date : 2025-09-01 DOI: 10.1016/j.ccrj.2025.100129

D. Jamie Cooper AO, MD

引用次数: 0

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