Pub Date : 2024-06-05eCollection Date: 2024-06-01DOI: 10.1097/CCE.0000000000001103
Syrus Razavi, Arjun Sharma, Cassidy Lavin, Ali Pourmand, Norma Smalls, Quincy K Tran
Objectives: The COVID-19 pandemic precipitated a significant transformation of scientific journals. Our aim was to determine how critical care (CC) journals and their impact may have evolved during the COVID-19 pandemic. We hypothesized that the impact, as measured by citations and publications, from the field of CC would increase.
Design: Observational study of journal publications, citations, and retractions status.
Setting: All work was done electronically and retrospectively.
Subjects: The top 18 CC journals broadly concerning CC, and the top 5 most productive CC journals on the SCImago list.
Interventions: None.
Measurements and main results: For the top 18 CC journals and specifically Critical Care Medicine (CCM), time series analysis was used to estimate the trends of total citations, citations per publication, and publications per year by using the best-fit curve. We used PubMed and Retraction Watch to determine the number of COVID-19 publications and retractions. The average total citations and citations per publication for all journals was an upward quadratic trend with inflection points in 2020, whereas publications per year spiked in 2020 before returning to prepandemic values in 2021. For CCM total publications trend downward while total citations and citations per publication generally trend up from 2017 onward. CCM had the lowest percentage of COVID-related publications (15.7%) during the pandemic and no reported retractions. Two COVID-19 retractions were noted in our top five journals.
Conclusions: Citation activity across top CC journals underwent a dramatic increase during the COVID-19 pandemic without significant retraction data. These trends suggest that the impact of CC has grown significantly since the onset of COVID-19 while maintaining adherence to a high-quality peer-review process.
{"title":"COVID-19 Pandemic and Impact on Research Publications in Critical Care.","authors":"Syrus Razavi, Arjun Sharma, Cassidy Lavin, Ali Pourmand, Norma Smalls, Quincy K Tran","doi":"10.1097/CCE.0000000000001103","DOIUrl":"10.1097/CCE.0000000000001103","url":null,"abstract":"<p><strong>Objectives: </strong>The COVID-19 pandemic precipitated a significant transformation of scientific journals. Our aim was to determine how critical care (CC) journals and their impact may have evolved during the COVID-19 pandemic. We hypothesized that the impact, as measured by citations and publications, from the field of CC would increase.</p><p><strong>Design: </strong>Observational study of journal publications, citations, and retractions status.</p><p><strong>Setting: </strong>All work was done electronically and retrospectively.</p><p><strong>Subjects: </strong>The top 18 CC journals broadly concerning CC, and the top 5 most productive CC journals on the SCImago list.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>For the top 18 CC journals and specifically <i>Critical Care Medicine</i> (CCM), time series analysis was used to estimate the trends of total citations, citations per publication, and publications per year by using the best-fit curve. We used PubMed and Retraction Watch to determine the number of COVID-19 publications and retractions. The average total citations and citations per publication for all journals was an upward quadratic trend with inflection points in 2020, whereas publications per year spiked in 2020 before returning to prepandemic values in 2021. For CCM total publications trend downward while total citations and citations per publication generally trend up from 2017 onward. CCM had the lowest percentage of COVID-related publications (15.7%) during the pandemic and no reported retractions. Two COVID-19 retractions were noted in our top five journals.</p><p><strong>Conclusions: </strong>Citation activity across top CC journals underwent a dramatic increase during the COVID-19 pandemic without significant retraction data. These trends suggest that the impact of CC has grown significantly since the onset of COVID-19 while maintaining adherence to a high-quality peer-review process.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"6 6","pages":"e1103"},"PeriodicalIF":0.0,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11155547/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141285626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-05eCollection Date: 2024-06-01DOI: 10.1097/CCE.0000000000001100
Megan A Watson, Marie Sandi, Johanna Bixby, Grace Perry, Patrick J Offner, Ellen L Burnham, Sarah E Jolley
Importance: Physical functional impairment is one of three components of postintensive care syndrome (PICS) that affects up to 60% of ICU survivors.
Objectives: To explore the prevalence of objective physical functional impairment among a diverse cohort of ICU survivors, both at discharge and longitudinally, and to highlight sociodemographic factors that might be associated with the presence of objective physical functional impairment.
Design, setting, and participants: This was a secondary analysis of 37 patients admitted to the ICU in New Orleans, Louisiana, and Denver, Colorado between 2016 and 2019 who survived with longitudinal follow-up data.
Main outcomes and measures: Our primary outcome of physical functional impairment was defined by handgrip strength and the short physical performance battery. We explored associations between functional impairment and sociodemographic factors that included race/ethnicity, sex, primary language, education status, and medical comorbidities.
Results: More than 75% of ICU survivors were affected by physical functional impairment at discharge and longitudinally at 3- to 6-month follow-up. We did not see a significant difference in the proportion of patients with physical functional impairment by race/ethnicity, primary language, or education status. Impairment was relatively higher in the follow-up period among women, compared with men, and those with comorbidities. Among 18 patients with scores at both time points, White patients demonstrated greater change in handgrip strength than non-White patients. Four non-White patients demonstrated diminished handgrip strength between discharge and follow-up.
Conclusions and relevance: In this exploratory analysis, we saw that the prevalence of objective physical functional impairment among ICU survivors was high and persisted after hospital discharge. Our findings suggest a possible relationship between race/ethnicity and physical functional impairment. These exploratory findings may inform future investigations to evaluate the impact of sociodemographic factors on functional recovery.
{"title":"An Exploratory Analysis of Sociodemographic Factors Associated With Physical Functional Impairment in ICU Survivors.","authors":"Megan A Watson, Marie Sandi, Johanna Bixby, Grace Perry, Patrick J Offner, Ellen L Burnham, Sarah E Jolley","doi":"10.1097/CCE.0000000000001100","DOIUrl":"10.1097/CCE.0000000000001100","url":null,"abstract":"<p><strong>Importance: </strong>Physical functional impairment is one of three components of postintensive care syndrome (PICS) that affects up to 60% of ICU survivors.</p><p><strong>Objectives: </strong>To explore the prevalence of objective physical functional impairment among a diverse cohort of ICU survivors, both at discharge and longitudinally, and to highlight sociodemographic factors that might be associated with the presence of objective physical functional impairment.</p><p><strong>Design, setting, and participants: </strong>This was a secondary analysis of 37 patients admitted to the ICU in New Orleans, Louisiana, and Denver, Colorado between 2016 and 2019 who survived with longitudinal follow-up data.</p><p><strong>Main outcomes and measures: </strong>Our primary outcome of physical functional impairment was defined by handgrip strength and the short physical performance battery. We explored associations between functional impairment and sociodemographic factors that included race/ethnicity, sex, primary language, education status, and medical comorbidities.</p><p><strong>Results: </strong>More than 75% of ICU survivors were affected by physical functional impairment at discharge and longitudinally at 3- to 6-month follow-up. We did not see a significant difference in the proportion of patients with physical functional impairment by race/ethnicity, primary language, or education status. Impairment was relatively higher in the follow-up period among women, compared with men, and those with comorbidities. Among 18 patients with scores at both time points, White patients demonstrated greater change in handgrip strength than non-White patients. Four non-White patients demonstrated diminished handgrip strength between discharge and follow-up.</p><p><strong>Conclusions and relevance: </strong>In this exploratory analysis, we saw that the prevalence of objective physical functional impairment among ICU survivors was high and persisted after hospital discharge. Our findings suggest a possible relationship between race/ethnicity and physical functional impairment. These exploratory findings may inform future investigations to evaluate the impact of sociodemographic factors on functional recovery.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"6 6","pages":"e1100"},"PeriodicalIF":0.0,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11155592/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141248949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-04eCollection Date: 2024-06-01DOI: 10.1097/CCE.0000000000001098
Christopher J Yarnell, Kali Barrett, Anna Heath, Margaret Herridge, Robert A Fowler, Lillian Sung, David M Naimark, George Tomlinson
Objectives: To estimate the expected value of undertaking a future randomized controlled trial of thresholds used to initiate invasive ventilation compared with usual care in hypoxemic respiratory failure.
Perspective: Publicly funded healthcare payer.
Setting: Critical care units capable of providing invasive ventilation and unconstrained by resource limitations during usual (nonpandemic) practice.
Methods: We performed a model-based cost-utility estimation with individual-level simulation and value-of-information analysis focused on adults, admitted to critical care, receiving noninvasive oxygen. In the primary scenario, we compared hypothetical threshold A to usual care, where threshold A resulted in increased use of invasive ventilation and improved survival compared with usual care. In the secondary scenario, we compared hypothetical threshold B to usual care, where threshold B resulted in decreased use of invasive ventilation and similar survival compared with usual care. We assumed a willingness-to-pay of 100,000 Canadian dollars (CADs) per quality-adjusted life year.
Results: In the primary scenario, threshold A was cost-effective compared with usual care due to improved hospital survival (78.1% vs. 75.1%), despite more use of invasive ventilation (62% vs. 30%) and higher lifetime costs (86,900 vs. 75,500 CAD). In the secondary scenario, threshold B was cost-effective compared with usual care due to similar survival (74.5% vs. 74.6%) with less use of invasive ventilation (20.2% vs. 27.6%) and lower lifetime costs (71,700 vs. 74,700 CAD). Value-of-information analysis showed that the expected value to Canadian society over 10 years of a 400-person randomized trial comparing a threshold for invasive ventilation to usual care in hypoxemic respiratory failure was 1.35 billion CAD or more in both scenarios.
Conclusions: It would be highly valuable to society to identify thresholds that, in comparison to usual care, either increase survival or reduce invasive ventilation without reducing survival.
目标: 对低氧血症呼吸衰竭患者启动有创通气的阈值与常规护理相比,估算未来开展随机对照试验的预期价值:估算未来开展随机对照试验的预期价值,该试验将对低氧血症呼吸衰竭患者启动有创通气的阈值与常规护理进行比较:背景:有能力提供有创通气的重症监护病房:环境:能够提供有创通气且在常规(非大流行)实践中不受资源限制的重症监护病房:我们进行了基于模型的成本效用估算,并进行了个体层面的模拟和信息价值分析,重点关注接受无创吸氧的重症监护成人。在主要方案中,我们将假设阈值 A 与常规护理进行了比较,与常规护理相比,阈值 A 导致有创通气的使用增加,并提高了存活率。在次要情景中,我们将假设阈值 B 与常规护理进行了比较,与常规护理相比,阈值 B 可减少有创通气的使用,并提高存活率。我们假设每个质量调整生命年的支付意愿为 100,000 加拿大元(CADs):在主要方案中,阈值 A 与常规护理相比具有成本效益,因为住院生存率提高(78.1% 对 75.1%),尽管有创通气使用率更高(62% 对 30%),终生成本更高(86,900 加元对 75,500 加元)。在次要方案中,阈值 B 与常规护理相比具有成本效益,因为两者的存活率相似(74.5% 对 74.6%),有创通气使用率较低(20.2% 对 27.6%),终生成本较低(7.17 万加元对 7.47 万加元)。信息价值分析表明,在两种情况下,对低氧血症呼吸衰竭患者进行有创通气阈值与常规护理比较的 400 人随机试验在 10 年内对加拿大社会的预期价值为 13.5 亿加元或更多:结论:与常规治疗相比,确定可提高存活率或在不降低存活率的情况下减少有创通气的阈值对社会极具价值。
{"title":"What Is the Potential Value of a Randomized Trial of Different Thresholds to Initiate Invasive Ventilation? A Health Economic Analysis.","authors":"Christopher J Yarnell, Kali Barrett, Anna Heath, Margaret Herridge, Robert A Fowler, Lillian Sung, David M Naimark, George Tomlinson","doi":"10.1097/CCE.0000000000001098","DOIUrl":"10.1097/CCE.0000000000001098","url":null,"abstract":"<p><strong>Objectives: </strong>To estimate the expected value of undertaking a future randomized controlled trial of thresholds used to initiate invasive ventilation compared with usual care in hypoxemic respiratory failure.</p><p><strong>Perspective: </strong>Publicly funded healthcare payer.</p><p><strong>Setting: </strong>Critical care units capable of providing invasive ventilation and unconstrained by resource limitations during usual (nonpandemic) practice.</p><p><strong>Methods: </strong>We performed a model-based cost-utility estimation with individual-level simulation and value-of-information analysis focused on adults, admitted to critical care, receiving noninvasive oxygen. In the primary scenario, we compared hypothetical threshold A to usual care, where threshold A resulted in increased use of invasive ventilation and improved survival compared with usual care. In the secondary scenario, we compared hypothetical threshold B to usual care, where threshold B resulted in decreased use of invasive ventilation and similar survival compared with usual care. We assumed a willingness-to-pay of 100,000 Canadian dollars (CADs) per quality-adjusted life year.</p><p><strong>Results: </strong>In the primary scenario, threshold A was cost-effective compared with usual care due to improved hospital survival (78.1% vs. 75.1%), despite more use of invasive ventilation (62% vs. 30%) and higher lifetime costs (86,900 vs. 75,500 CAD). In the secondary scenario, threshold B was cost-effective compared with usual care due to similar survival (74.5% vs. 74.6%) with less use of invasive ventilation (20.2% vs. 27.6%) and lower lifetime costs (71,700 vs. 74,700 CAD). Value-of-information analysis showed that the expected value to Canadian society over 10 years of a 400-person randomized trial comparing a threshold for invasive ventilation to usual care in hypoxemic respiratory failure was 1.35 billion CAD or more in both scenarios.</p><p><strong>Conclusions: </strong>It would be highly valuable to society to identify thresholds that, in comparison to usual care, either increase survival or reduce invasive ventilation without reducing survival.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"6 6","pages":"e1098"},"PeriodicalIF":0.0,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11152783/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141248952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-24eCollection Date: 2024-06-01DOI: 10.1097/CCE.0000000000001096
Daisuke Hasegawa, Ryota Sato, Abhijit Duggal, Mary Schleicher, Kazuki Nishida, Ashish K Khanna, Siddharth Dugar
Objectives: Measurement of blood pressure taken from different anatomical sites, are often perceived as interchangeable, despite them representing different parts of the systemic circulation. We aimed to perform a systematic review and meta-analysis on blood pressure differences between central and peripheral arterial cannulation in critically ill patients.
Data sources: We searched MEDLINE, Cochrane Central Register of Controlled Trials, and Embase from inception to December 26, 2023, using Medical Subject Headings (MeSH) terms and keywords.
Study selection: Observation study of adult patients in ICUs and operating rooms who underwent simultaneous central (femoral, axillary, or subclavian artery) and peripheral (radial, brachial, or dorsalis pedis artery) arterial catheter placement in ICUs and operating rooms.
Data extraction: We screened and extracted studies independently and in duplicate. We assessed risk of bias using the revised Quality Assessment for Studies of Diagnostic Accuracy tool.
Data synthesis: Twenty-four studies that enrolled 1598 patients in total were included. Central pressures (mean arterial pressure [MAP] and systolic blood pressure [SBP]) were found to be significantly higher than their peripheral counterparts, with mean gradients of 3.5 and 8.0 mm Hg, respectively. However, there was no statistically significant difference in central or peripheral diastolic blood pressure (DBP). Subgroup analysis further highlighted a higher MAP gradient during the on-cardiopulmonary bypass stage of cardiac surgery, reperfusion stage of liver transplant, and in nonsurgical critically ill patients. SBP or DBP gradient did not demonstrate any subgroup specific changes.
Conclusions: SBP and MAP obtained by central arterial cannulation were higher than peripheral arterial cannulation; however, clinical implication of a difference of 8.0 mm Hg in SBP and 3.5 mm Hg in MAP remains unclear. Our current clinical practices preferring peripheral arterial lines need not change.
{"title":"Comparison of Central and Peripheral Arterial Blood Pressure Gradients in Critically Ill Patients: A Systematic Review and Meta-Analysis.","authors":"Daisuke Hasegawa, Ryota Sato, Abhijit Duggal, Mary Schleicher, Kazuki Nishida, Ashish K Khanna, Siddharth Dugar","doi":"10.1097/CCE.0000000000001096","DOIUrl":"10.1097/CCE.0000000000001096","url":null,"abstract":"<p><strong>Objectives: </strong>Measurement of blood pressure taken from different anatomical sites, are often perceived as interchangeable, despite them representing different parts of the systemic circulation. We aimed to perform a systematic review and meta-analysis on blood pressure differences between central and peripheral arterial cannulation in critically ill patients.</p><p><strong>Data sources: </strong>We searched MEDLINE, Cochrane Central Register of Controlled Trials, and Embase from inception to December 26, 2023, using Medical Subject Headings (MeSH) terms and keywords.</p><p><strong>Study selection: </strong>Observation study of adult patients in ICUs and operating rooms who underwent simultaneous central (femoral, axillary, or subclavian artery) and peripheral (radial, brachial, or dorsalis pedis artery) arterial catheter placement in ICUs and operating rooms.</p><p><strong>Data extraction: </strong>We screened and extracted studies independently and in duplicate. We assessed risk of bias using the revised Quality Assessment for Studies of Diagnostic Accuracy tool.</p><p><strong>Data synthesis: </strong>Twenty-four studies that enrolled 1598 patients in total were included. Central pressures (mean arterial pressure [MAP] and systolic blood pressure [SBP]) were found to be significantly higher than their peripheral counterparts, with mean gradients of 3.5 and 8.0 mm Hg, respectively. However, there was no statistically significant difference in central or peripheral diastolic blood pressure (DBP). Subgroup analysis further highlighted a higher MAP gradient during the on-cardiopulmonary bypass stage of cardiac surgery, reperfusion stage of liver transplant, and in nonsurgical critically ill patients. SBP or DBP gradient did not demonstrate any subgroup specific changes.</p><p><strong>Conclusions: </strong>SBP and MAP obtained by central arterial cannulation were higher than peripheral arterial cannulation; however, clinical implication of a difference of 8.0 mm Hg in SBP and 3.5 mm Hg in MAP remains unclear. Our current clinical practices preferring peripheral arterial lines need not change.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"6 6","pages":"e1096"},"PeriodicalIF":0.0,"publicationDate":"2024-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11132324/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141089534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-24eCollection Date: 2024-06-01DOI: 10.1097/CCE.0000000000001093
Jan-Willem H L Boldingh, M Sesmu Arbous, Bart J Biemond, Nicole M A Blijlevens, Jasper van Bommel, Murielle G E C Hilkens, Nuray Kusadasi, Marcella C A Muller, Vera A de Vries, Ewout W Steyerberg, Walter M van den Bergh
Objectives: To develop and validate a prediction model for 1-year mortality in patients with a hematologic malignancy acutely admitted to the ICU.
Design: A retrospective cohort study.
Setting: Five university hospitals in the Netherlands between 2002 and 2015.
Patients: A total of 1097 consecutive patients with a hematologic malignancy were acutely admitted to the ICU for at least 24 h.
Interventions: None.
Measurements and main results: We created a 13-variable model from 22 potential predictors. Key predictors included active disease, age, previous hematopoietic stem cell transplantation, mechanical ventilation, lowest platelet count, acute kidney injury, maximum heart rate, and type of malignancy. A bootstrap procedure reduced overfitting and improved the model's generalizability. This involved estimating the optimism in the initial model and shrinking the regression coefficients accordingly in the final model. We assessed performance using internal-external cross-validation by center and compared it with the Acute Physiology and Chronic Health Evaluation II model. Additionally, we evaluated clinical usefulness through decision curve analysis. The overall 1-year mortality rate observed in the study was 62% (95% CI, 59-65). Our 13-variable prediction model demonstrated acceptable calibration and discrimination at internal-external validation across centers (C-statistic 0.70; 95% CI, 0.63-0.77), outperforming the Acute Physiology and Chronic Health Evaluation II model (C-statistic 0.61; 95% CI, 0.57-0.65). Decision curve analysis indicated overall net benefit within a clinically relevant threshold probability range of 60-100% predicted 1-year mortality.
Conclusions: Our newly developed 13-variable prediction model predicts 1-year mortality in hematologic malignancy patients admitted to the ICU more accurately than the Acute Physiology and Chronic Health Evaluation II model. This model may aid in shared decision-making regarding the continuation of ICU care and end-of-life considerations.
{"title":"Development and Validation of a Prediction Model for 1-Year Mortality in Patients With a Hematologic Malignancy Admitted to the ICU.","authors":"Jan-Willem H L Boldingh, M Sesmu Arbous, Bart J Biemond, Nicole M A Blijlevens, Jasper van Bommel, Murielle G E C Hilkens, Nuray Kusadasi, Marcella C A Muller, Vera A de Vries, Ewout W Steyerberg, Walter M van den Bergh","doi":"10.1097/CCE.0000000000001093","DOIUrl":"10.1097/CCE.0000000000001093","url":null,"abstract":"<p><strong>Objectives: </strong>To develop and validate a prediction model for 1-year mortality in patients with a hematologic malignancy acutely admitted to the ICU.</p><p><strong>Design: </strong>A retrospective cohort study.</p><p><strong>Setting: </strong>Five university hospitals in the Netherlands between 2002 and 2015.</p><p><strong>Patients: </strong>A total of 1097 consecutive patients with a hematologic malignancy were acutely admitted to the ICU for at least 24 h.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>We created a 13-variable model from 22 potential predictors. Key predictors included active disease, age, previous hematopoietic stem cell transplantation, mechanical ventilation, lowest platelet count, acute kidney injury, maximum heart rate, and type of malignancy. A bootstrap procedure reduced overfitting and improved the model's generalizability. This involved estimating the optimism in the initial model and shrinking the regression coefficients accordingly in the final model. We assessed performance using internal-external cross-validation by center and compared it with the Acute Physiology and Chronic Health Evaluation II model. Additionally, we evaluated clinical usefulness through decision curve analysis. The overall 1-year mortality rate observed in the study was 62% (95% CI, 59-65). Our 13-variable prediction model demonstrated acceptable calibration and discrimination at internal-external validation across centers (<i>C</i>-statistic 0.70; 95% CI, 0.63-0.77), outperforming the Acute Physiology and Chronic Health Evaluation II model (<i>C</i>-statistic 0.61; 95% CI, 0.57-0.65). Decision curve analysis indicated overall net benefit within a clinically relevant threshold probability range of 60-100% predicted 1-year mortality.</p><p><strong>Conclusions: </strong>Our newly developed 13-variable prediction model predicts 1-year mortality in hematologic malignancy patients admitted to the ICU more accurately than the Acute Physiology and Chronic Health Evaluation II model. This model may aid in shared decision-making regarding the continuation of ICU care and end-of-life considerations.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"6 6","pages":"e1093"},"PeriodicalIF":0.0,"publicationDate":"2024-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11132307/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141176138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-24eCollection Date: 2024-06-01DOI: 10.1097/CCE.0000000000001099
Fatemeh Amrollahi, Brent D Kennis, Supreeth Prajwal Shashikumar, Atul Malhotra, Stephanie Parks Taylor, James Ford, Arianna Rodriguez, Julia Weston, Romir Maheshwary, Shamim Nemati, Gabriel Wardi, Angela Meier
Objectives: To determine the predictive value of social determinants of health (SDoH) variables on 30-day readmission following a sepsis hospitalization as compared with traditional clinical variables.
Design: Multicenter retrospective cohort study using patient-level data, including demographic, clinical, and survey data.
Settings: Thirty-five hospitals across the United States from 2017 to 2021.
Patients: Two hundred seventy-one thousand four hundred twenty-eight individuals in the AllofUs initiative, of which 8909 had an index sepsis hospitalization.
Interventions: None.
Measurements and main results: Unplanned 30-day readmission to the hospital. Multinomial logistic regression models were constructed to account for survival in determination of variables associate with 30-day readmission and are presented as adjusted odds rations (aORs). Of the 8909 sepsis patients in our cohort, 21% had an unplanned hospital readmission within 30 days. Median age (interquartile range) was 54 years (41-65 yr), 4762 (53.4%) were female, and there were self-reported 1612 (18.09%) Black, 2271 (25.49%) Hispanic, and 4642 (52.1%) White individuals. In multinomial logistic regression models accounting for survival, we identified that change to nonphysician provider type due to economic reasons (aOR, 2.55 [2.35-2.74]), delay of receiving medical care due to lack of transportation (aOR, 1.68 [1.62-1.74]), and inability to afford flow-up care (aOR, 1.59 [1.52-1.66]) were strongly and independently associated with a 30-day readmission when adjusting for survival. Patients who lived in a ZIP code with a high percentage of patients in poverty and without health insurance were also more likely to be readmitted within 30 days (aOR, 1.26 [1.22-1.29] and aOR, 1.28 [1.26-1.29], respectively). Finally, we found that having a primary care provider and health insurance were associated with low odds of an unplanned 30-day readmission.
Conclusions: In this multicenter retrospective cohort, several SDoH variables were strongly associated with unplanned 30-day readmission. Models predicting readmission following sepsis hospitalization may benefit from the addition of SDoH factors to traditional clinical variables.
{"title":"Prediction of Readmission Following Sepsis Using Social Determinants of Health.","authors":"Fatemeh Amrollahi, Brent D Kennis, Supreeth Prajwal Shashikumar, Atul Malhotra, Stephanie Parks Taylor, James Ford, Arianna Rodriguez, Julia Weston, Romir Maheshwary, Shamim Nemati, Gabriel Wardi, Angela Meier","doi":"10.1097/CCE.0000000000001099","DOIUrl":"10.1097/CCE.0000000000001099","url":null,"abstract":"<p><strong>Objectives: </strong>To determine the predictive value of social determinants of health (SDoH) variables on 30-day readmission following a sepsis hospitalization as compared with traditional clinical variables.</p><p><strong>Design: </strong>Multicenter retrospective cohort study using patient-level data, including demographic, clinical, and survey data.</p><p><strong>Settings: </strong>Thirty-five hospitals across the United States from 2017 to 2021.</p><p><strong>Patients: </strong>Two hundred seventy-one thousand four hundred twenty-eight individuals in the AllofUs initiative, of which 8909 had an index sepsis hospitalization.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Unplanned 30-day readmission to the hospital. Multinomial logistic regression models were constructed to account for survival in determination of variables associate with 30-day readmission and are presented as adjusted odds rations (aORs). Of the 8909 sepsis patients in our cohort, 21% had an unplanned hospital readmission within 30 days. Median age (interquartile range) was 54 years (41-65 yr), 4762 (53.4%) were female, and there were self-reported 1612 (18.09%) Black, 2271 (25.49%) Hispanic, and 4642 (52.1%) White individuals. In multinomial logistic regression models accounting for survival, we identified that change to nonphysician provider type due to economic reasons (aOR, 2.55 [2.35-2.74]), delay of receiving medical care due to lack of transportation (aOR, 1.68 [1.62-1.74]), and inability to afford flow-up care (aOR, 1.59 [1.52-1.66]) were strongly and independently associated with a 30-day readmission when adjusting for survival. Patients who lived in a ZIP code with a high percentage of patients in poverty and without health insurance were also more likely to be readmitted within 30 days (aOR, 1.26 [1.22-1.29] and aOR, 1.28 [1.26-1.29], respectively). Finally, we found that having a primary care provider and health insurance were associated with low odds of an unplanned 30-day readmission.</p><p><strong>Conclusions: </strong>In this multicenter retrospective cohort, several SDoH variables were strongly associated with unplanned 30-day readmission. Models predicting readmission following sepsis hospitalization may benefit from the addition of SDoH factors to traditional clinical variables.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"6 6","pages":"e1099"},"PeriodicalIF":0.0,"publicationDate":"2024-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11132367/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141089545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-24eCollection Date: 2024-06-01DOI: 10.1097/CCE.0000000000001095
Julian D Rivera, Edward S Fox, Shannon M Fernando, Alexandre Tran, Daniel Brodie, Eddy Fan, Jo-Anne Fowles, Carol L Hodgson, Joseph E Tonna, Bram Rochwerg
Objectives: We planned to synthesize evidence examining the potential efficacy and safety of performing physical rehabilitation and/or mobilization (PR&M) in adult patients receiving extracorporeal life support (ECLS).
Data sources: We included any study that compared PR&M to no PR&M or among different PR&M strategies in adult patients receiving any ECLS for any indication and any cannulation. We searched seven electronic databases with no language limitations.
Study selection and data extraction: Two reviewers, independently and in duplicate, screened all citations for eligibility. We used the Cochrane Risk of Bias 2 and Cochrane Risk Of Bias In Non-randomized Studies of Interventions tools to assess individual study risk of bias. Although we had planned for meta-analysis, this was not possible due to insufficient data, so we used narrative and tabular data summaries for presenting results. We assessed the overall certainty of the evidence for each outcome using the Grading of Recommendations Assessment, Development, and Evaluation framework.
Data synthesis: We included 17 studies that enrolled 996 patients. Most studies examined venovenous extracorporeal membrane oxygenation (ECMO) and/or venoarterial ECMO as a bridge to recovery in the ICU. We found an uncertain effect of high-intensity/active PR&M on mortality, duration of mechanical ventilation, ICU length of stay, hospital length of stay, or quality of life compared with low-intensity/passive PR&M in patients receiving ECLS (very low certainty due to very serious imprecision). There was similarly an uncertain effect on safety events including clinically important bleeding, spontaneous intracerebral hemorrhage, limb ischemia, accidental decannulation, or ECLS circuit dysfunction (very low certainty due to very serious risk of bias and imprecision).
Conclusions: Based on the currently available summary of evidence, there is an uncertain effect of high-intensity/active PR&M on patient important outcomes or safety in patients receiving ECLS. Despite indirect data from other populations suggesting potential benefit of high-intensity PR&M in the ICU; further high-quality randomized trials evaluating the benefits and risks of physical therapy and/or mobilization in this population are needed.
目的: 我们计划对接受体外生命支持(ECLS)的成人患者进行物理康复和/或移动(PR&M)的潜在疗效和安全性的证据进行综合分析:我们计划综合研究对接受体外生命支持(ECLS)的成年患者进行物理康复和/或移动(PR&M)的潜在疗效和安全性的证据:我们纳入了所有对接受体外生命支持(ECLS)治疗的成年患者进行物理康复和/或移动(PR&M)与不进行物理康复和/或移动(PR&M)进行比较的研究,这些患者接受过任何适应症和任何插管。我们检索了七个无语言限制的电子数据库:两名审稿人分别独立并重复筛选了所有符合条件的引文。我们使用 Cochrane Risk of Bias 2 和 Cochrane Risk Of Bias In Non-randomized Studies of Interventions 工具来评估各项研究的偏倚风险。虽然我们曾计划进行荟萃分析,但由于数据不足而无法实现,因此我们采用了叙述式和表格式数据摘要来呈现结果。我们采用建议分级评估、发展和评价框架对每项结果的证据的整体确定性进行了评估:我们纳入了 17 项研究,共招募了 996 名患者。大多数研究将静脉体外膜肺氧合(ECMO)和/或静脉动脉 ECMO 作为重症监护病房康复的桥梁。我们发现,在接受 ECLS 的患者中,与低强度/被动 PR&M 相比,高强度/主动 PR&M 对死亡率、机械通气持续时间、重症监护室住院时间、住院时间或生活质量的影响并不确定(由于非常严重的不精确性,确定性很低)。同样,对临床重要出血、自发性脑出血、肢体缺血、意外拔管或 ECLS 电路功能障碍等安全事件的影响也不确定(由于存在非常严重的偏倚和不精确风险,因此确定性很低):根据目前可用的证据摘要,高强度/积极的 PR&M 对接受 ECLS 患者的重要预后或安全性的影响尚不确定。尽管来自其他人群的间接数据表明,在 ICU 中进行高强度 PR&M 可能会带来益处,但仍需进一步开展高质量的随机试验,评估物理治疗和/或动员对该人群的益处和风险。
{"title":"Physical Rehabilitation and Mobilization in Patients Receiving Extracorporeal Life Support: A Systematic Review.","authors":"Julian D Rivera, Edward S Fox, Shannon M Fernando, Alexandre Tran, Daniel Brodie, Eddy Fan, Jo-Anne Fowles, Carol L Hodgson, Joseph E Tonna, Bram Rochwerg","doi":"10.1097/CCE.0000000000001095","DOIUrl":"10.1097/CCE.0000000000001095","url":null,"abstract":"<p><strong>Objectives: </strong>We planned to synthesize evidence examining the potential efficacy and safety of performing physical rehabilitation and/or mobilization (PR&M) in adult patients receiving extracorporeal life support (ECLS).</p><p><strong>Data sources: </strong>We included any study that compared PR&M to no PR&M or among different PR&M strategies in adult patients receiving any ECLS for any indication and any cannulation. We searched seven electronic databases with no language limitations.</p><p><strong>Study selection and data extraction: </strong>Two reviewers, independently and in duplicate, screened all citations for eligibility. We used the Cochrane Risk of Bias 2 and Cochrane Risk Of Bias In Non-randomized Studies of Interventions tools to assess individual study risk of bias. Although we had planned for meta-analysis, this was not possible due to insufficient data, so we used narrative and tabular data summaries for presenting results. We assessed the overall certainty of the evidence for each outcome using the Grading of Recommendations Assessment, Development, and Evaluation framework.</p><p><strong>Data synthesis: </strong>We included 17 studies that enrolled 996 patients. Most studies examined venovenous extracorporeal membrane oxygenation (ECMO) and/or venoarterial ECMO as a bridge to recovery in the ICU. We found an uncertain effect of high-intensity/active PR&M on mortality, duration of mechanical ventilation, ICU length of stay, hospital length of stay, or quality of life compared with low-intensity/passive PR&M in patients receiving ECLS (very low certainty due to very serious imprecision). There was similarly an uncertain effect on safety events including clinically important bleeding, spontaneous intracerebral hemorrhage, limb ischemia, accidental decannulation, or ECLS circuit dysfunction (very low certainty due to very serious risk of bias and imprecision).</p><p><strong>Conclusions: </strong>Based on the currently available summary of evidence, there is an uncertain effect of high-intensity/active PR&M on patient important outcomes or safety in patients receiving ECLS. Despite indirect data from other populations suggesting potential benefit of high-intensity PR&M in the ICU; further high-quality randomized trials evaluating the benefits and risks of physical therapy and/or mobilization in this population are needed.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"6 6","pages":"e1095"},"PeriodicalIF":0.0,"publicationDate":"2024-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11132346/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141089540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-15eCollection Date: 2024-05-01DOI: 10.1097/CCE.0000000000001088
Lindsay N Shepard, Sanjiv Mehta, Kathryn Graham, Martha Kienzle, Amanda O'Halloran, Nadir Yehya, Ryan W Morgan, Garrett P Keim
Importance: A recent study showed an association between high hospital-level noninvasive positive pressure ventilation (NIPPV) use and in-hospital cardiac arrest (IHCA) in children with bronchiolitis.
Objectives: We aimed to determine if patient-level exposure to NIPPV in children with bronchiolitis was associated with IHCA.
Design, setting and participants: Retrospective cohort study at a single-center quaternary PICU in North America including children with International Classification of Diseases primary or secondary diagnoses of bronchiolitis in the Virtual Pediatric Systems database.
Main outcomes and measures: The primary exposure was NIPPV and the primary outcome was IHCA.
Measurements and main results: Of 4698 eligible ICU admissions with bronchiolitis diagnoses, IHCA occurred in 1.2% (57/4698). At IHCA onset, invasive mechanical ventilation (IMV) was the most frequent level of respiratory support (65%, 37/57), with 12% (7/57) receiving NIPPV. Patients with IHCA had higher Pediatric Risk of Mortality-III scores (3 [0-8] vs. 0 [0-2]; p < 0.001), more frequently had a complex chronic condition (94.7% vs. 46.2%; p < 0.001), and had higher mortality (21.1% vs. 1.0%; p < 0.001) compared with patients without IHCA. Return of spontaneous circulation (ROSC) was achieved in 93% (53/57) of IHCAs; 79% (45/57) survived to hospital discharge. All seven children without chronic medical conditions and with active bronchiolitis symptoms at the time of IHCA achieved ROSC, and 86% (6/7) survived to discharge. In multivariable analysis restricted to patients receiving NIPPV or IMV, NIPPV exposure was associated with lower odds of IHCA (adjusted odds ratio [aOR], 0.07; 95% CI, 0.03-0.18) compared with IMV. In secondary analysis evaluating categorical respiratory support in all patients, compared with IMV, NIPPV was associated with lower odds of IHCA (aOR, 0.35; 95% CI, 0.14-0.87), whereas no difference was found for minimal respiratory support (none/nasal cannula/humidified high-flow nasal cannula [aOR, 0.56; 95% CI, 0.23-1.36]).
Conclusions and relevance: Cardiac arrest in children with bronchiolitis is uncommon, occurring in 1.2% of bronchiolitis ICU admissions. NIPPV use in children with bronchiolitis was associated with lower odds of IHCA.
重要性:最近的一项研究表明,在患有支气管炎的儿童中,医院层面大量使用无创正压通气(NIPPV)与院内心脏骤停(IHCA)之间存在关联:我们旨在确定支气管炎患儿在患者层面接触无创正压通气是否与 IHCA 相关:在北美一家单中心四级 PICU 进行的回顾性队列研究,包括虚拟儿科系统数据库中国际疾病分类一级或二级诊断为支气管炎的儿童:主要暴露是NIPPV,主要结果是IHCA:在符合条件的 4698 例诊断为支气管炎的 ICU 入院患者中,1.2%(57/4698)发生了 IHCA。IHCA发生时,有创机械通气(IMV)是最常用的呼吸支持方式(65%,37/57),12%(7/57)接受NIPPV。与无 IHCA 的患者相比,IHCA 患者的儿科死亡风险-III 评分更高(3 [0-8] vs. 0 [0-2]; p < 0.001),患有复杂慢性疾病的比例更高(94.7% vs. 46.2%; p < 0.001),死亡率更高(21.1% vs. 1.0%; p < 0.001)。93%(53/57)的IHCA患者实现了自主循环(ROSC)恢复;79%(45/57)的患者存活至出院。七名无慢性疾病且在 IHCA 时有活动性支气管炎症状的患儿全部实现了 ROSC,86%(6/7)的患儿存活至出院。在仅限于接受 NIPPV 或 IMV 的患者的多变量分析中,与 IMV 相比,接受 NIPPV 的患者发生 IHCA 的几率较低(调整后的几率比 [aOR],0.07;95% CI,0.03-0.18)。在评估所有患者分类呼吸支持的二次分析中,与 IMV 相比,NIPPV 与较低的 IHCA 发生几率相关(aOR,0.35;95% CI,0.14-0.87),而最小呼吸支持(无/鼻插管/湿化高流量鼻插管 [aOR,0.56;95% CI,0.23-1.36])则无差异:支气管炎患儿心跳骤停的情况并不常见,仅占支气管炎重症监护病房收治人数的 1.2%。支气管炎患儿使用 NIPPV 可降低 IHCA 的发生几率。
{"title":"Noninvasive Positive Pressure Ventilation Use and In-Hospital Cardiac Arrest in Bronchiolitis.","authors":"Lindsay N Shepard, Sanjiv Mehta, Kathryn Graham, Martha Kienzle, Amanda O'Halloran, Nadir Yehya, Ryan W Morgan, Garrett P Keim","doi":"10.1097/CCE.0000000000001088","DOIUrl":"10.1097/CCE.0000000000001088","url":null,"abstract":"<p><strong>Importance: </strong>A recent study showed an association between high hospital-level noninvasive positive pressure ventilation (NIPPV) use and in-hospital cardiac arrest (IHCA) in children with bronchiolitis.</p><p><strong>Objectives: </strong>We aimed to determine if patient-level exposure to NIPPV in children with bronchiolitis was associated with IHCA.</p><p><strong>Design, setting and participants: </strong>Retrospective cohort study at a single-center quaternary PICU in North America including children with International Classification of Diseases primary or secondary diagnoses of bronchiolitis in the Virtual Pediatric Systems database.</p><p><strong>Main outcomes and measures: </strong>The primary exposure was NIPPV and the primary outcome was IHCA.</p><p><strong>Measurements and main results: </strong>Of 4698 eligible ICU admissions with bronchiolitis diagnoses, IHCA occurred in 1.2% (57/4698). At IHCA onset, invasive mechanical ventilation (IMV) was the most frequent level of respiratory support (65%, 37/57), with 12% (7/57) receiving NIPPV. Patients with IHCA had higher Pediatric Risk of Mortality-III scores (3 [0-8] vs. 0 [0-2]; p < 0.001), more frequently had a complex chronic condition (94.7% vs. 46.2%; p < 0.001), and had higher mortality (21.1% vs. 1.0%; p < 0.001) compared with patients without IHCA. Return of spontaneous circulation (ROSC) was achieved in 93% (53/57) of IHCAs; 79% (45/57) survived to hospital discharge. All seven children without chronic medical conditions and with active bronchiolitis symptoms at the time of IHCA achieved ROSC, and 86% (6/7) survived to discharge. In multivariable analysis restricted to patients receiving NIPPV or IMV, NIPPV exposure was associated with lower odds of IHCA (adjusted odds ratio [aOR], 0.07; 95% CI, 0.03-0.18) compared with IMV. In secondary analysis evaluating categorical respiratory support in all patients, compared with IMV, NIPPV was associated with lower odds of IHCA (aOR, 0.35; 95% CI, 0.14-0.87), whereas no difference was found for minimal respiratory support (none/nasal cannula/humidified high-flow nasal cannula [aOR, 0.56; 95% CI, 0.23-1.36]).</p><p><strong>Conclusions and relevance: </strong>Cardiac arrest in children with bronchiolitis is uncommon, occurring in 1.2% of bronchiolitis ICU admissions. NIPPV use in children with bronchiolitis was associated with lower odds of IHCA.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"6 5","pages":"e1088"},"PeriodicalIF":0.0,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11098256/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140924009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-13eCollection Date: 2024-05-01DOI: 10.1097/CCE.0000000000001091
Jeremy C Pamplin, Brooke Gray, Matthew T Quinn, Jeanette R Little, Christopher J Colombo, Sanjay Subramanian, Joseph C Farmer, Michael Ries, Benjamin Scott
The COVID-19 pandemic caused tremendous disruption to the U.S. healthcare system and nearly crippled some hospitals during large patient surges. Limited ICU beds across the country further exacerbated these challenges. Telemedicine, specifically tele-critical care (TCC), can expand a hospital's clinical capabilities through remote expertise and increase capacity by offloading some monitoring to remote teams. Unfortunately, the rapid deployment of telemedicine, especially TCC, is constrained by multiple barriers. In the summer of 2020, to support the National Emergency Tele-Critical Care Network (NETCCN) deployment, more than 50 national leaders in applying telemedicine technologies to critical care assembled to provide their opinions about barriers to NETCCN implementation and strategies to overcome them. Through consensus, these experts developed white papers that formed the basis of this article. Herein, the authors share their experience and propose multiple solutions to barriers presented by laws, local policies and cultures, and individual perspectives according to a minimum, better, best paradigm for TCC delivery in the setting of a national disaster. Cross-state licensure and local privileging of virtual experts were identified as the most significant barriers to rapid deployment of services, whereas refining the model of TCC to achieve the best outcomes and defining the best financial model is the most significant for long-term success. Ultimately, we conclude that a rapidly deployable national telemedicine response system is achievable.
{"title":"National Emergency Tele-Critical Care in a Pandemic: Barriers and Solutions.","authors":"Jeremy C Pamplin, Brooke Gray, Matthew T Quinn, Jeanette R Little, Christopher J Colombo, Sanjay Subramanian, Joseph C Farmer, Michael Ries, Benjamin Scott","doi":"10.1097/CCE.0000000000001091","DOIUrl":"10.1097/CCE.0000000000001091","url":null,"abstract":"<p><p>The COVID-19 pandemic caused tremendous disruption to the U.S. healthcare system and nearly crippled some hospitals during large patient surges. Limited ICU beds across the country further exacerbated these challenges. Telemedicine, specifically tele-critical care (TCC), can expand a hospital's clinical capabilities through remote expertise and increase capacity by offloading some monitoring to remote teams. Unfortunately, the rapid deployment of telemedicine, especially TCC, is constrained by multiple barriers. In the summer of 2020, to support the National Emergency Tele-Critical Care Network (NETCCN) deployment, more than 50 national leaders in applying telemedicine technologies to critical care assembled to provide their opinions about barriers to NETCCN implementation and strategies to overcome them. Through consensus, these experts developed white papers that formed the basis of this article. Herein, the authors share their experience and propose multiple solutions to barriers presented by laws, local policies and cultures, and individual perspectives according to a minimum, better, best paradigm for TCC delivery in the setting of a national disaster. Cross-state licensure and local privileging of virtual experts were identified as the most significant barriers to rapid deployment of services, whereas refining the model of TCC to achieve the best outcomes and defining the best financial model is the most significant for long-term success. Ultimately, we conclude that a rapidly deployable national telemedicine response system is achievable.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"6 5","pages":"e1091"},"PeriodicalIF":0.0,"publicationDate":"2024-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11093573/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140924008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-10eCollection Date: 2024-05-01DOI: 10.1097/CCE.0000000000001094
Neil Cody, Ian Bradbury, Ross R McMullan, Gerard Quinn, Aisling O'Neill, Kathryn Ward, Justine McCann, Daniel F McAuley, Jonathan A Silversides
Objectives: Near-infrared spectroscopy (NIRS) is a potentially valuable modality to monitor the adequacy of oxygen delivery to the brain and other tissues in critically ill patients, but little is known about the physiologic determinants of NIRS-derived tissue oxygen saturations. The purpose of this study was to assess the contribution of routinely measured physiologic parameters to tissue oxygen saturation measured by NIRS.
Design: An observational sub-study of patients enrolled in the Role of Active Deresuscitation After Resuscitation-2 (RADAR-2) randomized feasibility trial.
Setting: Two ICUs in the United Kingdom.
Patients: Patients were recruited for the RADAR-2 study, which compared a conservative approach to fluid therapy and deresuscitation with usual care. Those included in this sub-study underwent continuous NIRS monitoring of cerebral oxygen saturations (SctO2) and quadriceps muscle tissue saturations (SmtO2).
Intervention: Synchronized and continuous mean arterial pressure (MAP), heart rate (HR), and pulse oximetry (oxygen saturation, Spo2) measurements were recorded alongside NIRS data. Arterial Paco2, Pao2, and hemoglobin concentration were recorded 12 hourly. Linear mixed effect models were used to investigate the association between these physiologic variables and cerebral and muscle tissue oxygen saturations.
Measurements and main results: Sixty-six patients were included in the analysis. Linear mixed models demonstrated that Paco2, Spo2, MAP, and HR were weakly associated with SctO2 but only explained 7.1% of the total variation. Spo2 and MAP were associated with SmtO2, but together only explained 0.8% of its total variation. The remaining variability was predominantly accounted for by between-subject differences.
Conclusions: Our findings demonstrated that only a small proportion of variability in NIRS-derived cerebral and tissue oximetry measurements could be explained by routinely measured physiologic variables. We conclude that for NIRS to be a useful monitoring modality in critical care, considerable further research is required to understand physiologic determinants and prognostic significance.
{"title":"Physiologic Determinants of Near-Infrared Spectroscopy-Derived Cerebral and Tissue Oxygen Saturation Measurements in Critically Ill Patients.","authors":"Neil Cody, Ian Bradbury, Ross R McMullan, Gerard Quinn, Aisling O'Neill, Kathryn Ward, Justine McCann, Daniel F McAuley, Jonathan A Silversides","doi":"10.1097/CCE.0000000000001094","DOIUrl":"10.1097/CCE.0000000000001094","url":null,"abstract":"<p><strong>Objectives: </strong>Near-infrared spectroscopy (NIRS) is a potentially valuable modality to monitor the adequacy of oxygen delivery to the brain and other tissues in critically ill patients, but little is known about the physiologic determinants of NIRS-derived tissue oxygen saturations. The purpose of this study was to assess the contribution of routinely measured physiologic parameters to tissue oxygen saturation measured by NIRS.</p><p><strong>Design: </strong>An observational sub-study of patients enrolled in the Role of Active Deresuscitation After Resuscitation-2 (RADAR-2) randomized feasibility trial.</p><p><strong>Setting: </strong>Two ICUs in the United Kingdom.</p><p><strong>Patients: </strong>Patients were recruited for the RADAR-2 study, which compared a conservative approach to fluid therapy and deresuscitation with usual care. Those included in this sub-study underwent continuous NIRS monitoring of cerebral oxygen saturations (SctO2) and quadriceps muscle tissue saturations (SmtO2).</p><p><strong>Intervention: </strong>Synchronized and continuous mean arterial pressure (MAP), heart rate (HR), and pulse oximetry (oxygen saturation, Spo2) measurements were recorded alongside NIRS data. Arterial Paco2, Pao2, and hemoglobin concentration were recorded 12 hourly. Linear mixed effect models were used to investigate the association between these physiologic variables and cerebral and muscle tissue oxygen saturations.</p><p><strong>Measurements and main results: </strong>Sixty-six patients were included in the analysis. Linear mixed models demonstrated that Paco2, Spo2, MAP, and HR were weakly associated with SctO2 but only explained 7.1% of the total variation. Spo2 and MAP were associated with SmtO2, but together only explained 0.8% of its total variation. The remaining variability was predominantly accounted for by between-subject differences.</p><p><strong>Conclusions: </strong>Our findings demonstrated that only a small proportion of variability in NIRS-derived cerebral and tissue oximetry measurements could be explained by routinely measured physiologic variables. We conclude that for NIRS to be a useful monitoring modality in critical care, considerable further research is required to understand physiologic determinants and prognostic significance.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"6 5","pages":"e1094"},"PeriodicalIF":0.0,"publicationDate":"2024-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11090623/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140900619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}