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Prediction of Readmission Following Sepsis Using Social Determinants of Health. 利用健康的社会决定因素预测败血症后的再入院情况。
Q4 Medicine Pub Date : 2024-05-24 eCollection Date: 2024-06-01 DOI: 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.

目的与传统的临床变量相比,确定健康的社会决定因素(SDoH)变量对脓毒症住院后 30 天再入院的预测价值:多中心回顾性队列研究,使用患者层面的数据,包括人口统计学、临床和调查数据:2017年至2021年,全美35家医院:干预措施:无:干预措施:无:非计划 30 天再入院。在确定与 30 天再入院相关的变量时,建立了多项式逻辑回归模型以考虑生存率,并以调整后的几率(aORs)表示。在我们队列中的 8909 名脓毒症患者中,21% 的患者在 30 天内发生了计划外再入院。中位年龄(四分位数间距)为 54 岁(41-65 岁),女性 4762 人(53.4%),自述黑人 1612 人(18.09%),西班牙裔 2271 人(25.49%),白人 4642 人(52.1%)。在考虑生存率的多项式逻辑回归模型中,我们发现,由于经济原因(aOR,2.55 [2.35-2.74])而改用非医生医疗服务提供者类型、由于交通不便而延迟接受医疗护理(aOR,1.68 [1.62-1.74])以及无法负担流动医疗护理(aOR,1.59 [1.52-1.66]),在考虑生存率的情况下,与 30 天再入院密切且独立相关。居住在贫困和没有医疗保险的患者比例较高的邮政编码内的患者也更有可能在 30 天内再次入院(aOR,分别为 1.26 [1.22-1.29] 和 aOR,1.28 [1.26-1.29])。最后,我们发现拥有初级保健提供者和医疗保险与30天内非计划再入院的低几率相关:在这个多中心回顾性队列中,几个 SDoH 变量与 30 天非计划再入院密切相关。在传统临床变量的基础上增加 SDoH 因素,可能会对预测脓毒症住院后再入院的模型有所帮助。
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引用次数: 0
Physical Rehabilitation and Mobilization in Patients Receiving Extracorporeal Life Support: A Systematic Review. 体外生命支持患者的身体康复和移动:系统回顾。
Q4 Medicine Pub Date : 2024-05-24 eCollection Date: 2024-06-01 DOI: 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。
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引用次数: 0
Noninvasive Positive Pressure Ventilation Use and In-Hospital Cardiac Arrest in Bronchiolitis. 支气管炎患者使用无创正压通气与院内心脏骤停。
Q4 Medicine Pub Date : 2024-05-15 eCollection Date: 2024-05-01 DOI: 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。
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引用次数: 0
National Emergency Tele-Critical Care in a Pandemic: Barriers and Solutions. 大流行病中的国家紧急远程重症监护:障碍与解决方案。
Q4 Medicine Pub Date : 2024-05-13 eCollection Date: 2024-05-01 DOI: 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.

COVID-19 大流行对美国医疗系统造成了巨大的破坏,在病人大量涌入时,一些医院几乎瘫痪。全国各地有限的重症监护病房床位进一步加剧了这些挑战。远程医疗,特别是远程重症监护 (TCC),可以通过远程专业技术扩展医院的临床能力,并通过将一些监护工作转移到远程团队来提高医疗能力。遗憾的是,远程医疗尤其是远程重症监护的快速部署受到多重障碍的制约。2020 年夏天,为了支持国家紧急远程重症监护网络(NETCCN)的部署,50 多名将远程医疗技术应用于重症监护的国家领导者聚集一堂,就实施国家紧急远程重症监护网络的障碍和克服这些障碍的策略发表了自己的看法。在达成共识后,这些专家编写了白皮书,并以此为基础撰写了本文。在本文中,作者分享了他们的经验,并针对法律、地方政策和文化以及个人观点所带来的障碍,按照最低、较好、最佳的模式,提出了在国家灾难背景下提供远程医疗的多种解决方案。跨州许可和虚拟专家的地方特权被认为是快速部署服务的最大障碍,而完善 TCC 模式以实现最佳结果和定义最佳财务模式则是长期成功的最重要因素。最终,我们得出结论,快速部署全国远程医疗响应系统是可以实现的。
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引用次数: 0
Physiologic Determinants of Near-Infrared Spectroscopy-Derived Cerebral and Tissue Oxygen Saturation Measurements in Critically Ill Patients. 重症患者近红外光谱法得出的大脑和组织血氧饱和度测量值的生理决定因素
Q4 Medicine Pub Date : 2024-05-10 eCollection Date: 2024-05-01 DOI: 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.

目的:近红外光谱(NIRS)是监测重症患者脑部和其他组织供氧是否充足的一种有潜在价值的方法,但人们对 NIRS 导出的组织氧饱和度的生理决定因素知之甚少。本研究的目的是评估常规测量的生理参数对 NIRS 测量的组织氧饱和度的贡献:设计:对参加复苏后积极去复苏作用-2(RADAR-2)随机可行性试验的患者进行观察性子研究:地点:英国两家重症监护室:RADAR-2研究比较了液体疗法和复苏的保守方法与常规护理。参与该子研究的患者接受了连续的近红外血氧饱和度(SctO2)和股四头肌组织饱和度(SmtO2)监测:干预措施:在记录 NIRS 数据的同时,同步连续记录平均动脉压 (MAP)、心率 (HR) 和脉搏血氧仪(血氧饱和度,Spo2)的测量值。每 12 小时记录一次动脉 Paco2、Pao2 和血红蛋白浓度。线性混合效应模型用于研究这些生理变量与大脑和肌肉组织血氧饱和度之间的关系:有 66 名患者参与了分析。线性混合模型显示,Paco2、Spo2、MAP 和 HR 与 SctO2 的关系较弱,但只能解释总变化的 7.1%。Spo2 和 MAP 与 SmtO2 相关,但二者只能解释其总变化的 0.8%。其余的变异主要是由受试者之间的差异造成的:我们的研究结果表明,常规测量的生理变量只能解释一小部分 NIRS 导出的大脑和组织血氧测量的变异性。我们的结论是,要使近红外成像技术成为重症监护中一种有用的监测模式,还需要进行大量的进一步研究,以了解生理决定因素和预后意义。
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引用次数: 0
Randomized Controlled Trial of Telementoring During Resource-Limited Patient Care Simulation Improves Caregiver Performance and Patient Survival. 在资源有限的患者护理模拟过程中进行指导的随机对照试验可提高护理人员的工作表现和患者存活率。
Q4 Medicine Pub Date : 2024-05-09 eCollection Date: 2024-05-01 DOI: 10.1097/CCE.0000000000001090
Jeremy C Pamplin, Sena R Veazey, Stacie Barczak, Stephanie J Fonda, Maria L Serio-Melvin, Kevin S Ross, Christopher J Colombo

Objectives: To determine the impact of telementoring on caregiver performance during a high-fidelity medical simulation model (HFMSM) of a critically ill patient in a resource-limited setting.

Design: A two-center, randomized, controlled study using a HFMSM of a patient with community-acquired pneumonia complicated by acute respiratory distress syndrome.

Setting: A notional clinic in a remote location staffed by a single clinician and nonmedical assistant.

Participants: Clinicians with limited experience managing critically ill patients.

Interventions: Telemedicine (TM) support.

Measurements: The primary outcome was clinical performance as measured by accuracy, reliability, and efficiency of care. Secondary outcomes were patient survival, procedural quality, subjective assessment of the HFMSM, and perceived workload.

Main results: TM participants (N = 11) performed better than non-TM (NTM, N = 12) in providing expected care (accuracy), delivering care more consistently (reliability), and without consistent differences in efficiency (timeliness of care). Accuracy: TM completed 91% and NTM 42% of expected tasks and procedures. Efficiency: groups did not differ in the mean (± sd) minutes it took to obtain an advanced airway successfully (TM 15.2 ± 10.5 vs. NTM 22.8 ± 8.4, p = 0.10) or decompress a tension pneumothorax with a needle (TM 0.7 ± 0.5 vs. NTM 0.6 ± 0.9, p = 0.65). TM was slower than NTM in completing thoracostomy (22.3 ± 10.2 vs. 12.3 ± 4.8, p = 0.03). Reliability: TM performed 13 of 17 (76%) tasks with more consistent timing than NTM. TM completed 68% and NTM 29% of procedural quality metrics. Eighty-two percent of the TM participants versus 17% of the NTM participants simulated patients survived (p = 0.003). The groups similarly perceived the HFMSM as realistic, managed their patients with personal ownership, and experienced comparable workload and stress.

Conclusions: Remote expertise provided with TM to caregivers in resource-limited settings improves caregiver performance, quality of care, and potentially real patient survival. HFMSM can be used to study interventions in ways not possible with real patients.

目的:确定在资源有限的环境中,高仿真医学模拟模型(HFMSM)中的辅导对护理人员工作表现的影响:在资源有限的环境中,确定在重症患者的高保真医学模拟模型(HFMSM)中,辅导对护理人员表现的影响:设计:一项由两个中心进行的随机对照研究,研究对象为社区获得性肺炎并发急性呼吸窘迫综合征患者:地点:偏远地区的一个名义诊所,由一名临床医生和一名非医疗助理组成:干预措施:远程医疗(TM):干预措施:远程医疗(TM)支持:主要结果是临床表现,以护理的准确性、可靠性和效率来衡量。次要结果为患者存活率、程序质量、对高频医疗管理系统的主观评估以及感知工作量:在提供预期护理(准确性)、更一致地提供护理(可靠性)以及效率(护理的及时性)方面,TM 参与者(N = 11)的表现优于非 TM 参与者(NTM,N = 12)。准确性:TM 完成了 91% 的预期任务和程序,NTM 完成了 42% 的预期任务和程序。效率:在成功获得先进气道(TM 15.2 ± 10.5 vs. NTM 22.8 ± 8.4,p = 0.10)或用针为张力性气胸减压(TM 0.7 ± 0.5 vs. NTM 0.6 ± 0.9,p = 0.65)的平均(± sd)分钟数上,两组没有差异。在完成胸腔造口术方面,TM 比 NTM 慢(22.3 ± 10.2 vs. 12.3 ± 4.8,p = 0.03)。可靠性:在 17 项任务中,TM 完成了 13 项(76%),时间一致性高于 NTM。在程序质量指标方面,TM 完成了 68%,NTM 完成了 29%。82% 的 TM 参与者和 17% 的 NTM 参与者模拟了患者的存活率(P = 0.003)。这两组人都同样认为高频医疗管理系统是现实的,他们都以个人主人翁的态度管理病人,并经历了相似的工作量和压力:结论:在资源有限的环境中,向护理人员提供远程专业技术可提高护理人员的工作绩效和护理质量,并有可能提高患者的实际存活率。高频医疗管理系统可用于研究干预措施,这是真实病人无法做到的。
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引用次数: 0
The Presence of Blood in a Strain Gauge Pressure Transducer Has a Clinical Effect on the Accuracy of Intracranial Pressure Readings. 应变片压力传感器中的血液对颅内压读数的准确性有临床影响。
Q4 Medicine Pub Date : 2024-05-09 eCollection Date: 2024-05-01 DOI: 10.1097/CCE.0000000000001089
Emerson B Nairon, Jeslin Joseph, Abdulkadir Kamal, David R Busch, DaiWai M Olson

Importance: Patients admitted with cerebral hemorrhage or cerebral edema often undergo external ventricular drain (EVD) placement to monitor and manage intracranial pressure (ICP). A strain gauge transducer accompanies the EVD to convert a pressure signal to an electrical waveform and assign a numeric value to the ICP.

Objectives: This study explored ICP accuracy in the presence of blood and other viscous fluid contaminates in the transducer.

Design: Preclinical comparative design study.

Setting: Laboratory setting using two Natus EVDs, two strain gauge transducers, and a sealed pressure chamber.

Participants: No human subjects or animal models were used.

Interventions: A control transducer primed with saline was compared with an investigational transducer primed with blood or with saline/glycerol mixtures in mass:mass ratios of 25%, 50%, 75%, and 100% glycerol. Volume in a sealed chamber was manipulated to reflect changes in ICP to explore the impact of contaminates on pressure measurement.

Measurements and main results: From 90 paired observations, ICP readings were statistically significantly different between the control (saline) and experimental (glycerol or blood) transducers. The time to a stable pressure reading was significantly different for saline vs. 25% glycerol (< 0.0005), 50% glycerol (< 0.005), 75% glycerol (< 0.0001), 100% glycerol (< 0.0005), and blood (< 0.0005). A difference in resting stable pressure was observed for saline vs. blood primed transducers (0.041).

Conclusions and relevance: There are statistically significant and clinically relevant differences in time to a stable pressure reading when contaminates are introduced into a closed drainage system. Changing a transducer based on the presence of blood contaminate should be considered to improve accuracy but must be weighed against the risk of introducing infection.

重要性:因脑出血或脑水肿入院的患者通常需要接受脑室外引流管(EVD)置入术,以监测和管理颅内压(ICP)。EVD 配有应变计传感器,可将压力信号转换为电波,并为 ICP 赋值:本研究探讨了在传感器中存在血液和其他粘性液体污染物的情况下 ICP 的准确性:临床前比较设计研究:实验室环境:使用两台 Natus EVD、两个应变计传感器和一个密封压力室:干预措施:干预措施:使用生理盐水的对照传感器与使用血液或质量比为 25%、50%、75% 和 100% 甘油的生理盐水/甘油混合物的研究型传感器进行比较。通过调节密封舱的容积来反映 ICP 的变化,以探索污染物对压力测量的影响:在 90 次配对观察中,对照组(生理盐水)和实验组(甘油或血液)传感器的 ICP 读数在统计学上有显著差异。生理盐水与 25% 甘油(< 0.0005)、50% 甘油(< 0.005)、75% 甘油(< 0.0001)、100% 甘油(< 0.0005)和血液(< 0.0005)相比,获得稳定压力读数的时间有显著差异。观察到生理盐水与血液引流传感器的静息稳定压存在差异(0.041):当污染物进入密闭引流系统时,在获得稳定压力读数的时间上存在明显的统计学差异和临床相关性。应考虑根据血液污染物的存在更换传感器,以提高准确性,但必须权衡引入感染的风险。
{"title":"The Presence of Blood in a Strain Gauge Pressure Transducer Has a Clinical Effect on the Accuracy of Intracranial Pressure Readings.","authors":"Emerson B Nairon, Jeslin Joseph, Abdulkadir Kamal, David R Busch, DaiWai M Olson","doi":"10.1097/CCE.0000000000001089","DOIUrl":"10.1097/CCE.0000000000001089","url":null,"abstract":"<p><strong>Importance: </strong>Patients admitted with cerebral hemorrhage or cerebral edema often undergo external ventricular drain (EVD) placement to monitor and manage intracranial pressure (ICP). A strain gauge transducer accompanies the EVD to convert a pressure signal to an electrical waveform and assign a numeric value to the ICP.</p><p><strong>Objectives: </strong>This study explored ICP accuracy in the presence of blood and other viscous fluid contaminates in the transducer.</p><p><strong>Design: </strong>Preclinical comparative design study.</p><p><strong>Setting: </strong>Laboratory setting using two Natus EVDs, two strain gauge transducers, and a sealed pressure chamber.</p><p><strong>Participants: </strong>No human subjects or animal models were used.</p><p><strong>Interventions: </strong>A control transducer primed with saline was compared with an investigational transducer primed with blood or with saline/glycerol mixtures in mass:mass ratios of 25%, 50%, 75%, and 100% glycerol. Volume in a sealed chamber was manipulated to reflect changes in ICP to explore the impact of contaminates on pressure measurement.</p><p><strong>Measurements and main results: </strong>From 90 paired observations, ICP readings were statistically significantly different between the control (saline) and experimental (glycerol or blood) transducers. The time to a stable pressure reading was significantly different for saline vs. 25% glycerol (< 0.0005), 50% glycerol (< 0.005), 75% glycerol (< 0.0001), 100% glycerol (< 0.0005), and blood (< 0.0005). A difference in resting stable pressure was observed for saline vs. blood primed transducers (0.041).</p><p><strong>Conclusions and relevance: </strong>There are statistically significant and clinically relevant differences in time to a stable pressure reading when contaminates are introduced into a closed drainage system. Changing a transducer based on the presence of blood contaminate should be considered to improve accuracy but must be weighed against the risk of introducing infection.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11086962/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140900631","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}
引用次数: 0
Cortisol Levels During First Admission Day Are Associated With Clinical Outcomes in Surgical Critically Ill Patients. 入院首日的皮质醇水平与外科重症患者的临床疗效有关。
Q4 Medicine Pub Date : 2024-05-08 eCollection Date: 2024-05-01 DOI: 10.1097/CCE.0000000000001086
Noam Goder, Fabian Gerstenhaber, Amir Gal Oz, Dekel Stavi, Yoel Angel, Asaph Nini, Yael Lichter, Oded Sold

Importance: To explore the correlation between cortisol levels during first admission day and clinical outcomes.

Objectives: Although most patients exhibit a surge in cortisol levels in response to stress, some suffer from critical illness-related corticosteroid insufficiency (CIRCI). Literature remains inconclusive as to which of these patients are at greater risk of poor outcomes.

Design: A retrospective study.

Setting: A surgical ICU (SICU) in a tertiary medical center.

Participants: Critically ill patients admitted to the SICU who were not treated with steroids.

Main outcomes and measures: Levels of cortisol taken within 24 hours of admission (day 1 [D1] cortisol) in 1412 eligible patients were collected and analyzed. Results were categorized into four groups: low (0-10 µg/dL), normal (10-25 µg/dL), high (25-50 µg/dL), and very high (above 50 µg/dL) cortisol levels. Primary endpoint was 90-day mortality. Secondary endpoints were the need for organ support (use of vasopressors and mechanical ventilation [MV]), ICU length of stay (LOS), and duration of MV.

Results: The majority of patients (63%) had high or very high D1 cortisol levels, whereas 7.6% had low levels and thus could be diagnosed with CIRCI. There were statistically significant differences in 90-day mortality between the four groups and very high levels were found to be an independent risk factor for mortality, primarily in patients with Sequential Organ Failure Assessment (SOFA) less than or equal to 3 or SOFA greater than or equal to 7. Higher cortisol levels were associated with all secondary endpoints. CIRCI was associated with favorable outcomes.

Conclusions and relevance: In critically ill surgical patients D1 cortisol levels above 50 mcg/dL were associated with mortality, need for organ support, longer ICU LOS, and duration of MV, whereas low levels correlated with good clinical outcomes even though untreated. D1 cortisol level greater than 50 mcg/dL can help discriminate nonsurvivors from survivors when SOFA less than or equal to 3 or SOFA greater than or equal to 7.

重要性目的:探讨入院首日皮质醇水平与临床结果之间的相关性:尽管大多数患者在应激时皮质醇水平会激增,但也有一些患者会出现与危重疾病相关的皮质类固醇不足(CIRCI)。关于这些患者中哪些人出现不良预后的风险更大,目前尚无定论:设计:回顾性研究:地点:一家三级医疗中心的外科重症监护病房(SICU):主要结果和测量指标:收集并分析了 1412 名符合条件的患者入院后 24 小时内的皮质醇水平(第 1 天 [D1] 皮质醇)。结果分为四组:皮质醇水平低(0-10 µg/dL)、正常(10-25 µg/dL)、高(25-50 µg/dL)和极高(50 µg/dL以上)。主要终点是 90 天死亡率。次要终点是器官支持需求(使用血管加压药和机械通气[MV])、重症监护室住院时间(LOS)和机械通气持续时间:大多数患者(63%)的 D1 皮质醇水平较高或很高,而 7.6% 的患者水平较低,因此可诊断为 CIRCI。四组患者的 90 天死亡率在统计学上有显著差异,高水平皮质醇是死亡率的一个独立风险因素,主要是在器官功能衰竭序列评估(SOFA)小于或等于 3 或 SOFA 大于或等于 7 的患者中。 较高的皮质醇水平与所有次要终点相关。CIRCI与良好的预后相关:在重症手术患者中,D1 皮质醇水平高于 50 毫微克/分升与死亡率、器官支持需求、ICU LOS 延长和 MV 持续时间有关,而低水平则与良好的临床预后相关,即使未经治疗也是如此。当 SOFA 小于或等于 3 或 SOFA 大于或等于 7 时,D1 皮质醇水平高于 50 毫微克/分升有助于区分非存活者和存活者。
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引用次数: 0
High-Flow Nasal Cannula Versus Noninvasive Ventilation as Initial Treatment in Acute Hypoxia: A Propensity Score-Matched Study. 高流量鼻导管与无创通气作为急性缺氧的初始治疗方法:倾向评分匹配研究。
Q4 Medicine Pub Date : 2024-05-08 eCollection Date: 2024-05-01 DOI: 10.1097/CCE.0000000000001092
Elizabeth S Munroe, Ina Prevalska, Madison Hyer, William J Meurer, Jarrod M Mosier, Mark A Tidswell, Hallie C Prescott, Lai Wei, Henry Wang, Christopher M Fung

Importance: Patients presenting to the emergency department (ED) with hypoxemia often have mixed or uncertain causes of respiratory failure. The optimal treatment for such patients is unclear. Both high-flow nasal cannula (HFNC) and noninvasive ventilation (NIV) are used.

Objectives: We sought to compare the effectiveness of initial treatment with HFNC versus NIV for acute hypoxemic respiratory failure.

Design setting and participants: We conducted a retrospective cohort study of patients with acute hypoxemic respiratory failure treated with HFNC or NIV within 24 hours of arrival to the University of Michigan adult ED from January 2018 to December 2022. We matched patients 1:1 using a propensity score for odds of receiving NIV.

Main outcomes and measures: The primary outcome was major adverse pulmonary events (28-d mortality, ventilator-free days, noninvasive respiratory support hours) calculated using a win ratio.

Results: A total of 1154 patients were included. Seven hundred twenty-six (62.9%) received HFNC and 428 (37.1%) received NIV. We propensity score matched 668 of 1154 (57.9%) patients. Patients on NIV versus HFNC had lower 28-day mortality (16.5% vs. 23.4%, p = 0.033) and required noninvasive treatment for fewer hours (median 7.5 vs. 13.5, p < 0.001), but had no difference in ventilator-free days (median [interquartile range]: 28 [26, 28] vs. 28 [10.5, 28], p = 0.199). Win ratio for composite major adverse pulmonary events favored NIV (1.38; 95% CI, 1.15-1.65; p < 0.001).

Conclusions and relevance: In this observational study of patients with acute hypoxemic respiratory failure, initial treatment with NIV compared with HFNC was associated with lower mortality and fewer composite major pulmonary adverse events calculated using a win ratio. These findings underscore the need for randomized controlled trials to further understand the impact of noninvasive respiratory support strategies.

重要性:因低氧血症到急诊科(ED)就诊的患者通常有混合或不确定的呼吸衰竭原因。此类患者的最佳治疗方法尚不明确。高流量鼻插管(HFNC)和无创通气(NIV)均可使用:我们试图比较高流量鼻插管与无创通气对急性低氧血症呼吸衰竭的初始治疗效果:我们对 2018 年 1 月至 2022 年 12 月期间抵达密歇根大学成人急诊室 24 小时内接受 HFNC 或 NIV 治疗的急性低氧血症呼吸衰竭患者进行了一项回顾性队列研究。我们使用倾向评分对患者接受 NIV 的几率进行了 1:1 匹配:主要结果为主要肺部不良事件(28 天死亡率、无呼吸机天数、无创呼吸支持小时数),采用胜率计算:共纳入 1154 名患者。其中 726 人(62.9%)接受了高频NC,428 人(37.1%)接受了 NIV。我们对 1154 例患者中的 668 例(57.9%)进行了倾向评分匹配。NIV 与 HFNC 患者的 28 天死亡率较低(16.5% vs. 23.4%,p = 0.033),需要无创治疗的时间较少(中位数 7.5 vs. 13.5,p < 0.001),但无呼吸机天数没有差异(中位数[四分位间范围]:28 [26, 28] vs. 28 [10.5, 28],p = 0.199)。综合主要肺部不良事件的Win ratio倾向于NIV(1.38;95% CI,1.15-1.65;P < 0.001):在这项针对急性低氧血症呼吸衰竭患者的观察性研究中,与高频NC相比,NIV的初始治疗与较低的死亡率和较少的综合主要肺部不良事件相关。这些发现强调了进行随机对照试验的必要性,以进一步了解无创呼吸支持策略的影响。
{"title":"High-Flow Nasal Cannula Versus Noninvasive Ventilation as Initial Treatment in Acute Hypoxia: A Propensity Score-Matched Study.","authors":"Elizabeth S Munroe, Ina Prevalska, Madison Hyer, William J Meurer, Jarrod M Mosier, Mark A Tidswell, Hallie C Prescott, Lai Wei, Henry Wang, Christopher M Fung","doi":"10.1097/CCE.0000000000001092","DOIUrl":"10.1097/CCE.0000000000001092","url":null,"abstract":"<p><strong>Importance: </strong>Patients presenting to the emergency department (ED) with hypoxemia often have mixed or uncertain causes of respiratory failure. The optimal treatment for such patients is unclear. Both high-flow nasal cannula (HFNC) and noninvasive ventilation (NIV) are used.</p><p><strong>Objectives: </strong>We sought to compare the effectiveness of initial treatment with HFNC versus NIV for acute hypoxemic respiratory failure.</p><p><strong>Design setting and participants: </strong>We conducted a retrospective cohort study of patients with acute hypoxemic respiratory failure treated with HFNC or NIV within 24 hours of arrival to the University of Michigan adult ED from January 2018 to December 2022. We matched patients 1:1 using a propensity score for odds of receiving NIV.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was major adverse pulmonary events (28-d mortality, ventilator-free days, noninvasive respiratory support hours) calculated using a win ratio.</p><p><strong>Results: </strong>A total of 1154 patients were included. Seven hundred twenty-six (62.9%) received HFNC and 428 (37.1%) received NIV. We propensity score matched 668 of 1154 (57.9%) patients. Patients on NIV versus HFNC had lower 28-day mortality (16.5% vs. 23.4%, <i>p</i> = 0.033) and required noninvasive treatment for fewer hours (median 7.5 vs. 13.5, <i>p</i> < 0.001), but had no difference in ventilator-free days (median [interquartile range]: 28 [26, 28] vs. 28 [10.5, 28], <i>p</i> = 0.199). Win ratio for composite major adverse pulmonary events favored NIV (1.38; 95% CI, 1.15-1.65; <i>p</i> < 0.001).</p><p><strong>Conclusions and relevance: </strong>In this observational study of patients with acute hypoxemic respiratory failure, initial treatment with NIV compared with HFNC was associated with lower mortality and fewer composite major pulmonary adverse events calculated using a win ratio. These findings underscore the need for randomized controlled trials to further understand the impact of noninvasive respiratory support strategies.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11081605/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140900610","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}
引用次数: 0
Patterns of Multiple Organ Dysfunction and Renal Recovery in Critically Ill Children and Young Adults Receiving Continuous Renal Replacement Therapy. 接受持续肾脏替代疗法的重症儿童和青少年的多器官功能障碍和肾功能恢复模式。
Q4 Medicine Pub Date : 2024-05-06 eCollection Date: 2024-05-01 DOI: 10.1097/CCE.0000000000001084
Sameer Thadani, Dana Fuhrman, Claire Hanson, Hyun Jung Park, Joseph Angelo, Poyyapakkam Srivaths, Katri Typpo, Michael J Bell, Katja M Gist, Joseph Carcillo, Ayse Akcan-Arikan

Objectives: Acute kidney injury requiring dialysis (AKI-D) commonly occurs in the setting of multiple organ dysfunction syndrome (MODS). Continuous renal replacement therapy (CRRT) is the modality of choice for AKI-D. Mid-term outcomes of pediatric AKI-D supported with CRRT are unknown. We aimed to describe the pattern and impact of organ dysfunction on renal outcomes in critically ill children and young adults with AKI-D.

Design: Retrospective cohort.

Setting: Two large quarternary care pediatric hospitals.

Patients: Patients 26 y old or younger who received CRRT from 2014 to 2020, excluding patients with chronic kidney disease.

Interventions: None.

Measurements and main results: Organ dysfunction was assessed using the Pediatric Logistic Organ Dysfunction-2 (PELOD-2) score. MODS was defined as greater than or equal to two organ dysfunctions. The primary outcome was major adverse kidney events at 30 days (MAKE30) (decrease in estimated glomerular filtration rate greater than or equal to 25% from baseline, need for renal replacement therapy, and death). Three hundred seventy-three patients, 50% female, with a median age of 84 mo (interquartile range [IQR] 16-172) were analyzed. PELOD-2 increased from 6 (IQR 3-9) to 9 (IQR 7-12) between ICU admission and CRRT initiation. Ninety-seven percent of patients developed MODS at CRRT start and 266 patients (71%) had MAKE30. Acute kidney injury (adjusted odds ratio [aOR] 3.55 [IQR 2.13-5.90]), neurologic (aOR 2.07 [IQR 1.15-3.74]), hematologic/oncologic dysfunction (aOR 2.27 [IQR 1.32-3.91]) at CRRT start, and progressive MODS (aOR 1.11 [IQR 1.03-1.19]) were independently associated with MAKE30.

Conclusions: Ninety percent of critically ill children and young adults with AKI-D develop MODS by the start of CRRT. Lack of renal recovery is associated with specific extrarenal organ dysfunction and progressive multiple organ dysfunction. Currently available extrarenal organ support strategies, such as therapeutic plasma exchange lung-protective ventilation, and other modifiable risk factors, should be incorporated into clinical trial design when investigating renal recovery.

目的:需要透析的急性肾损伤(AKI-D)通常发生在多器官功能障碍综合征(MODS)的情况下。连续性肾脏替代疗法(CRRT)是治疗急性肾损伤透析的首选方法。使用 CRRT 治疗小儿 AKI-D 的中期效果尚不清楚。我们旨在描述重症儿童和年轻成人 AKI-D 患者器官功能障碍的模式及其对肾脏预后的影响:设计:回顾性队列:两家大型儿科医院:干预措施:无:测量和主要结果使用儿科逻辑器官功能障碍-2(PELOD-2)评分评估器官功能障碍。MODS定义为大于或等于两个器官功能障碍。主要结果是 30 天内的主要肾脏不良事件(MAKE30)(估计肾小球滤过率从基线下降大于或等于 25%、需要肾脏替代疗法和死亡)。接受分析的 373 名患者中,50% 为女性,中位年龄为 84 个月(四分位数间距 [IQR] 16-172)。从入住 ICU 到开始使用 CRRT,PELOD-2 从 6(IQR 3-9)升至 9(IQR 7-12)。97%的患者在 CRRT 开始时出现 MODS,266 名患者(71%)出现 MAKE30。CRRT开始时的急性肾损伤(调整赔率[aOR]3.55 [IQR 2.13-5.90])、神经系统(aOR 2.07 [IQR 1.15-3.74])、血液学/肿瘤学功能障碍(aOR 2.27 [IQR 1.32-3.91])和进行性MODS(aOR 1.11 [IQR 1.03-1.19])与MAKE30独立相关:结论:90%患有AKI-D的重症儿童和年轻成人在开始CRRT时会出现MODS。肾功能无法恢复与特定的肾外器官功能障碍和进行性多器官功能障碍有关。在研究肾功能恢复时,应将目前可用的肾外器官支持策略(如治疗性血浆置换、肺保护性通气)和其他可改变的风险因素纳入临床试验设计中。
{"title":"Patterns of Multiple Organ Dysfunction and Renal Recovery in Critically Ill Children and Young Adults Receiving Continuous Renal Replacement Therapy.","authors":"Sameer Thadani, Dana Fuhrman, Claire Hanson, Hyun Jung Park, Joseph Angelo, Poyyapakkam Srivaths, Katri Typpo, Michael J Bell, Katja M Gist, Joseph Carcillo, Ayse Akcan-Arikan","doi":"10.1097/CCE.0000000000001084","DOIUrl":"10.1097/CCE.0000000000001084","url":null,"abstract":"<p><strong>Objectives: </strong>Acute kidney injury requiring dialysis (AKI-D) commonly occurs in the setting of multiple organ dysfunction syndrome (MODS). Continuous renal replacement therapy (CRRT) is the modality of choice for AKI-D. Mid-term outcomes of pediatric AKI-D supported with CRRT are unknown. We aimed to describe the pattern and impact of organ dysfunction on renal outcomes in critically ill children and young adults with AKI-D.</p><p><strong>Design: </strong>Retrospective cohort.</p><p><strong>Setting: </strong>Two large quarternary care pediatric hospitals.</p><p><strong>Patients: </strong>Patients 26 y old or younger who received CRRT from 2014 to 2020, excluding patients with chronic kidney disease.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Organ dysfunction was assessed using the Pediatric Logistic Organ Dysfunction-2 (PELOD-2) score. MODS was defined as greater than or equal to two organ dysfunctions. The primary outcome was major adverse kidney events at 30 days (MAKE30) (decrease in estimated glomerular filtration rate greater than or equal to 25% from baseline, need for renal replacement therapy, and death). Three hundred seventy-three patients, 50% female, with a median age of 84 mo (interquartile range [IQR] 16-172) were analyzed. PELOD-2 increased from 6 (IQR 3-9) to 9 (IQR 7-12) between ICU admission and CRRT initiation. Ninety-seven percent of patients developed MODS at CRRT start and 266 patients (71%) had MAKE30. Acute kidney injury (adjusted odds ratio [aOR] 3.55 [IQR 2.13-5.90]), neurologic (aOR 2.07 [IQR 1.15-3.74]), hematologic/oncologic dysfunction (aOR 2.27 [IQR 1.32-3.91]) at CRRT start, and progressive MODS (aOR 1.11 [IQR 1.03-1.19]) were independently associated with MAKE30.</p><p><strong>Conclusions: </strong>Ninety percent of critically ill children and young adults with AKI-D develop MODS by the start of CRRT. Lack of renal recovery is associated with specific extrarenal organ dysfunction and progressive multiple organ dysfunction. Currently available extrarenal organ support strategies, such as therapeutic plasma exchange lung-protective ventilation, and other modifiable risk factors, should be incorporated into clinical trial design when investigating renal recovery.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11075942/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140868470","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}
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Critical care explorations
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