Coppola S, Pelliccia M, Pozzi T
… +5 more, Catozzi G, Rocco C, Monte A, Besana G, Chiumello D
Crit Care Med
· 2026 Jun · PMID 41925582
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HEADINGS: The effects of high-flow nasal cannula (HFNC) and continuous positive airway pressure (CPAP) in patients with acute hypoxemic respiratory failure (AHRF) on respiratory mechanics and inspiratory efforts are not...HEADINGS: The effects of high-flow nasal cannula (HFNC) and continuous positive airway pressure (CPAP) in patients with acute hypoxemic respiratory failure (AHRF) on respiratory mechanics and inspiratory efforts are not entirely understood. OBJECTIVES: To compare the physiologic effects of HFNC and helmet CPAP with respect to conventional oxygen therapy (COT) in terms of respiratory mechanics, inspiratory effort, gas exchange, and hemodynamics during AHRF. DESIGN: Crossover study. SETTING: General surgical-medical ICU of San Paolo University Hospital, Milan, Italy. PATIENTS: Thirty-three adult patients with AHRF, defined as an Pa o2 less than 60 mm Hg or an Pa o2 /F io2 less than 300 with a positive end-expiratory pressure (PEEP) level greater than or equal to 5 cm H 2 O, along with an Pa co2 less than 45 mm Hg. INTERVENTIONS: After support with COT, three types of respiratory support were applied in random order: HFNC with 60 L/min of flow and helmet CPAP with 5 or 10 cm H 2 O of PEEP. MEASUREMENTS AND MAIN RESULTS: Tidal volume, respiratory rate, inspiratory esophageal (ΔPes), and airway pressure swings were measured and an arterial blood gas analysis, along with hemodynamic data, was obtained after 20 minutes from the application of each respiratory support device. The application of HFNC and helmet CPAP at both 5 and 10 cm H 2 O of PEEP reduced minute ventilation (9.2 ± 3.2, 8.8 ± 2.3, and 9.3 ± 2.7 vs. 10.9 ± 3.3 L/min; p < 0.001) and ΔPes (-6.0 cm H 2 O [-7.8 to -4.0 cm H 2 O], -5.8 cm H 2 O [-7.2 to -4.5 cm H 2 O], and -5.9 cm H 2 O [-8.0 to -4.0 cm H 2 O] vs. -7.5 cm H 2 O [-10.8 to -6.5 cm H 2 O]; p < 0.001) while increasing Pa o2 /F io2 (188 ± 57, 208 ± 62, and 213 ± 69 vs. 129 ± 32; p < 0.001) with respect to COT; the application of 10 cm H 2 O of PEEP with helmet CPAP did not reduce inspiratory effort indices or increased oxygenation, but worsened mechanical power compared with HFNC and helmet CPAP with 5 cm H 2 O of PEEP. CONCLUSIONS: In patients with mild and moderate AHRF, HFNC and helmet CPAP ameliorated minute ventilation and respiratory rate, reduced inspiratory effort, and increased oxygenation compared with COT; the application of 10 cm H 2 O of PEEP during CPAP support worsened mechanical power.
Crit Care Med
· 2026 Jun · PMID 41925536
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OBJECTIVES: During organ donation after death determination by circulatory criteria (DCC), It is thought that graft oxygenation becomes impacted under certain thresholds of blood pressure or oxygen. Prolongation of funct...OBJECTIVES: During organ donation after death determination by circulatory criteria (DCC), It is thought that graft oxygenation becomes impacted under certain thresholds of blood pressure or oxygen. Prolongation of functional donor warm ischemic time (fdWIT) is a risk for complications, but threshold criteria for when to initiate fdWIT vary. We aimed to assess hemodynamic and potential ischemic variation of fdWIT in patients undergoing withdrawal of life support measures. DESIGN: This was a planned post hoc analysis of clinical and biomarker data collected from patients enrolled in a prospective cohort study of the physiology of death after circulatory arrest. PATIENTS: Patients undergoing withdrawal of life support measures were eligible for recruitment. SETTING: ICU. INTERVENTIONS: Detailed physiologic and biomarker assessment, and a mathematical method termed the DCC Ischemic Index (DII) to quantify hemodynamic variation. MEASUREMENTS AND MAIN RESULTS: We demonstrate that following withdrawal, oxygen saturation (Sp o2 ) and blood pressure thresholds for fdWIT are met sequentially in a predictable manner; thresholds using Sp o2 criteria were met first, followed by those using blood pressure criteria. We demonstrate that DII methodology can capture hemodynamic fluctuations, potentially providing an improved method to quantify ischemic graft injury. Lastly, we demonstrate that release of inflammatory cytokines may be more correlated with measures of DII as opposed to fdWIT. CONCLUSIONS: Our findings suggest fdWIT criteria may not be equivalent, and that fdWITs alone may not sufficiently reflect physiologic processes that could lead to graft injury.
Crit Care Med
· 2026 Jun · PMID 41925519
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OBJECTIVES: There are no established criteria to define the resolution of acute respiratory distress syndrome (ARDS). We aimed to develop an expert consensus definition of ARDS resolution. DESIGN: Modified Delphi consens...OBJECTIVES: There are no established criteria to define the resolution of acute respiratory distress syndrome (ARDS). We aimed to develop an expert consensus definition of ARDS resolution. DESIGN: Modified Delphi consensus study with three iterative rounds. SETTING: Electronic surveys. SUBJECTS: A panel of 19 ARDS experts participated in the Delphi process. Experts were identified using prespecified criteria. INTERVENTIONS: The Delphi process was conducted over three rounds. Item generation was performed in round 1 with all panelists invited to suggest defining characteristics for resolution of ARDS with corresponding operational definitions, which were then voted on by the panel. Item refinement in rounds 2 and 3. Thresholds for agreement were specified a priori and set at 70%. MEASUREMENTS AND MAIN RESULTS: Nineteen panelists submitted complete responses to the first round with 16 panelists contributing to the final definition that met a priori consensus criteria after the third round questionnaire. The panel agreed on the following elements: 1) resolution of hypoxemia, defined as ratio of Pa o2 /F io2 greater than 300 (or ratio of oxygen saturation to F io2 > 315) for more than 24 hours and 2) normalization of level of respiratory support, defined as "if still intubated, this is for primarily nonrespiratory reasons (e.g. altered mental state, ICU-acquired weakness) and ventilatory assistance is minimal (i.e., positive end-expiratory pressure less than or equal to 5 cm H 2 O, and no adjunctive interventions); if maximal respiratory support was continuous positive airway pressure (CPAP) or noninvasive ventilation (NIV), then no longer requiring CPAP or NIV; if maximal respiratory support was oxygen via high-flow nasal cannula (HFNC), then no longer requiring HFNC; and if maximal respiratory support was standard oxygen, then longer receiving oxygen." CONCLUSIONS: A high level of consensus was achieved on criteria defining the resolution of ARDS. Future work is required to explore the epidemiology and performance characteristics of this definition.
Caroli A, Algera AG, van Meenen D
… +4 more, Schultz MJ, Paulus F, Neto AS, REstricted vs. Liberal positive end-expiratory pressure in patients without Acute Respiratory Distress Syndrome (RELAx)—investigators and the PRotective Ventilation (PROVE) Network
Crit Care Med
· 2026 Jun · PMID 41914828
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OBJECTIVE: The "REstricted vs. Liberal positive end-expiratory pressure in patients without Acute Respiratory Distress Syndrome (ARDS)" (RELAx) trial compared lower vs. higher positive end-expiratory pressures (PEEP) in...OBJECTIVE: The "REstricted vs. Liberal positive end-expiratory pressure in patients without Acute Respiratory Distress Syndrome (ARDS)" (RELAx) trial compared lower vs. higher positive end-expiratory pressures (PEEP) in invasively ventilated critically ill patients without ARDS, concluding non-inferiority of lower PEEP in frequentist analysis. This study aimed to perform a Bayesian re-analysis of RELAx to assess probabilities of clinically meaningful differences between lower and higher PEEP. DESIGN: A post hoc Bayesian analysis of RELAx data. SETTING: RELAx was a non-inferiority multicenter trial conducted between October 2017 and March 2019 in eight ICUs. PATIENTS: The trial included 980 ICU patients expected to require invasive mechanical ventilation greater than or equal to 24 hours for reasons other than ARDS. All patients included in the original analysis entered the Bayesian re-analysis. INTERVENTIONS: Participants were randomized to the lowest possible PEEP between 0 and 5 cm H 2 O or to a higher PEEP of 8 cm H 2 O. MEASUREMENTS AND MAIN RESULTS: The primary outcome was ventilator-free days at day 28 (VFD-28). Secondary outcomes were 28-day mortality and ventilation duration. The odds ratio for higher VFD-28 with lower PEEP was 1.08 (95% credible intervals, 0.87-1.35), with consistent estimates across priors and with a probability of superiority ranging from 75% to 78%. For 28-day mortality and duration of ventilation, the probability of benefit of the lower-PEEP strategy ranged from 72% to 89%, and from 11% to 28%, respectively. In patients admitted for other reasons than cardiac arrest or intubated for other reasons than respiratory failure, probabilities of benefit with lower PEEP exceeded 90%. CONCLUSIONS: Although the probability of benefit in the overall population was modest, the analysis suggested a higher probability of benefit in selected subgroups, particularly patients admitted for other reasons than cardiac arrest or intubated for other reasons than respiratory failure. These findings highlight potential heterogeneity of treatment effect and support further investigations.
Crit Care Med
· 2026 Jul · PMID 41914827
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OBJECTIVES: To determine whether the implementation of the Life-Sustaining Treatment Decision Act (LSTDA) in South Korea affected the age-standardized incidence rate (ASIR) of in-hospital cardiac arrest (IHCA) and in-hos...OBJECTIVES: To determine whether the implementation of the Life-Sustaining Treatment Decision Act (LSTDA) in South Korea affected the age-standardized incidence rate (ASIR) of in-hospital cardiac arrest (IHCA) and in-hospital mortality. DESIGN: Retrospective, population-based cohort study. SETTING: Nationwide administrative health database in South Korea. PATIENTS: A total of 380,488 adult patients (≥ 18 yr) who underwent in-hospital cardiopulmonary resuscitation between January 2013 and December 2023. Cases from the implementation year (2018) were excluded to minimize transitional bias. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The primary outcomes were the annual ASIR of IHCA and in-hospital mortality. The study population was divided into pre-LSTDA (2013-2017; n = 147,385) and post-LSTDA (2019-2023; n = 233,103) periods. Multivariable logistic regression revealed that the post-LSTDA period was associated with significantly lower in-hospital mortality compared with the pre-LSTDA period (adjusted odds ratio, 0.90; 95% CI, 0.88-0.92; p < 0.001). Regarding incidence, segmented linear regression analysis showed that before the LSTDA, the ASIR increased significantly by 6.5 cases per 100,000 population per year (95% CI, 1.6-11.4; p < 0.001). After implementation, the upward trend decelerated (slope change, -5.4; 95% CI, -12.8 to 1.5; p = 0.177), indicating a shift toward a decline in the growth of IHCA events. CONCLUSIONS: The enactment of the LSTDA was associated with a significant improvement in survival outcomes and a deceleration in the rising incidence of IHCA. These findings suggest that the legal framework for end-of-life decision-making effectively facilitates the withholding of medically nonbeneficial resuscitation, thereby optimizing the allocation of critical care resources toward patients with better reversible potential.
Urner M, Rojas-Saunero LP, Buyck K
… +8 more, Douflé G, Amaral AC, Adhikari NKJ, Jüni P, Hansen B, Ferguson ND, Fan E, Mehta S
Crit Care Med
· 2026 Mar · PMID 41914820
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OBJECTIVES: Previous work reported that critically ill female patients received higher tidal volumes per predicted body weight (PBW) than male patients during the first 24 hours of mechanical ventilation, which might be...OBJECTIVES: Previous work reported that critically ill female patients received higher tidal volumes per predicted body weight (PBW) than male patients during the first 24 hours of mechanical ventilation, which might be associated with higher mortality. We investigated if sex inequity in daily tidal volumes during mechanical ventilation persisted beyond the first 24 hours and remained associated with mortality. Also, we examined if the association was mainly explained by baseline factors that differed between female and male patients. DESIGN: In this registry-based cohort study, Bayesian joint models were used to estimate indirect (through tidal volumes) and direct effects of sex on mortality using data recorded in the Toronto Intensive Care Observational Registry between April 2014 and December 2022. PATIENTS: Adult patients (18 yr old or older), mechanically ventilated for greater than or equal to 24 hours. SETTING: Nine ICUs from six University of Toronto-affiliated hospitals. INTERVENTION: None. MEASUREMENTS AND MAIN RESULTS: Of 20,351 eligible patients, 7,635 (38%) were female. Unadjusted mortality was 18% for female (1,384/7,635) and 17% for male (2,113/12,716) patients. We noticed that 2820 female (37%) and 4335 male patients (34%) underwent mechanical ventilation without recordings for body height. Every increase in daily tidal volumes (1 mL/kg PBW) was associated with higher mortality (hazard ratio: 1.10, 95% credible intervals [CrIs], 1.07-1.13), adjusted for severity of illness changing over time. Female patients had on average a lower height and consistently received higher daily tidal volumes (+0.6 mL/kg PBW, 95% CrI, +0.6 to +0.7 mL/kg PBW) and driving pressures (+1 cm H2O; 95% CI, 1-1 cm H2O) compared with male patients, suggesting an indirect effect of sex on mortality mediated by ventilator management. No direct effect of sex on mortality was observed. CONCLUSIONS: Measurement of height and daily adjustments of tidal volumes and driving pressures may reduce mortality, particularly for female patients with lower height.
Loaec M, Patterson E, Reeder R
… +8 more, Graham K, Donoghue M, Sawhney S, Pradhan A, Topjian AA, Sutton RM, Berg RA, Morgan RW
Crit Care Med
· 2026 Jun · PMID 41914811
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OBJECTIVES: Pediatric resuscitation guidelines support using diastolic blood pressure (DBP) as a marker of cardiopulmonary resuscitation (CPR) quality. Thresholds of greater than or equal to 25 mm Hg in infants and great...OBJECTIVES: Pediatric resuscitation guidelines support using diastolic blood pressure (DBP) as a marker of cardiopulmonary resuscitation (CPR) quality. Thresholds of greater than or equal to 25 mm Hg in infants and greater than or equal to 30 mm Hg in children were derived from data limited to the first 10 minutes of CPR, regardless of event duration. We aimed to describe DBP trajectories throughout in-hospital cardiac arrest and evaluate associations between DBP thresholds and return of spontaneous circulation (ROSC) in prolonged CPR (≥ 10 min). DESIGN: Single-center retrospective cohort study (2017-2023). SETTING: PICU and CICU. PATIENTS: Pediatric IHCA with invasive arterial BP monitoring. SETTING AND PATIENTS: Pediatric IHCAs with invasive arterial BP monitoring. INTERVENTIONS: None. MEASUREMENT AND MAIN RESULTS: Events with greater than or equal to 1 minute of evaluable DBP data were included in trend analyses; those with greater than or equal to 1 minute of evaluable DBP data after 10 minutes of CPR were included in prolonged CPR analyses. Linear and mixed-effects regression assessed DBP trends; univariate logistic regression evaluated associations between DBP thresholds and ROSC. Among 118 events (median age 0.4 yr; 69% with congenital heart disease), DBP rose early and plateaued above guideline thresholds. Early ROSC was associated with higher average DBP ( p = 0.02) and steeper early DBP rise ( p < 0.001). In 46 prolonged events, 80% had mean DBP above guideline thresholds. In prolonged CPR, an upward DBP trend was associated with ROSC ( p < 0.001). In prolonged CPR, meeting current DBP thresholds was not significantly associated with ROSC, but achieving higher thresholds (≥ 30 mm Hg in infants and ≥ 35 mm Hg in children) later in CPR was associated with ROSC (odds ratio 7.14; 95% CI, 1.58-51.35; p = 0.009). CONCLUSIONS: DBP can be sustained above current thresholds during prolonged CPR. Larger cohort studies are needed to determine if higher, patient-specific, and time-dependent DBP targets are required to achieve ROSC in prolonged CPR.
Vavilala MS, Lujan S, Velonjara J
… +7 more, Bell MJ, Guadagnoli N, Wang J, Mock C, Weiner BJ, Petroni G, Pediatric Guideline Adherence and Outcomes (PEGASUS) Argentina study group
Crit Care Med
· 2026 Jun · PMID 41891786
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OBJECTIVES: High-quality approaches to increase evidence-based severe traumatic brain injury (TBI) practice is lacking. We examined whether a facilitated, multilevel program improves TBI guideline adherence in children w...OBJECTIVES: High-quality approaches to increase evidence-based severe traumatic brain injury (TBI) practice is lacking. We examined whether a facilitated, multilevel program improves TBI guideline adherence in children with severe TBI, including extracranial injury patients. The primary outcome was first 3-day cumulative ICU TBI guideline adherence rate for all and stratified by extracranial injury. DESIGN: This was an open-label, pragmatic, multicenter, phase 3, superiority, parallel cluster randomized controlled trial. Unadjusted and adjusted percent differences were based on intention-to-treat. SETTING: Sixteen South American hospitals (14 Argentina, one Chile, and one Paraguay) regularly treating pediatric patients with severe TBI participated. PATIENTS: Patient inclusion criteria were younger than 18 years, severe TBI (Glasgow Coma Scale [GCS] score ≤ 8 or, if intubated, motor GCS ≤ 5), and ICU admission. INTERVENTIONS: Sites provided usual care ( n = 8) or the Pediatric Guideline Adherence and Outcomes (PEGASUS) intervention ( n = 8) to participating patients. The PEGASUS intervention included checklists, case reviews, and other components designed to improve adherence to Brain Trauma Foundation pediatric guidelines. MEASUREMENTS AND MAIN RESULTS: Three hundred eighty-nine patients were enrolled (208 control and 181 intervention). Control patients had less extracranial injury than intervention patients (70.7% vs. 82.9%; p = 0.005). TBI guideline adherence rates were 83.7% for control and 84.4% for intervention arms. There was no overall difference in adjusted first 3-day cumulative guideline adherence rate between arms (0.1% [-3.3% to 3.5%]). Intervention sites achieved higher guideline adherence rates than control sites in patients with isolated severe TBI (7.9% [1.9-13.8%]; p = 0.01). CONCLUSIONS: Implementing an evidence-based TBI program was not superior to usual care in increasing first 3-day cumulative ICU TBI guideline adherence rates in all children with severe TBI. However, implementation increased adherence rates in children with isolated severe TBI.
Mellett-Smith A, Caunt M, Buckle A
… +8 more, Devitt P, Osmani Z, Worley D, Johnson S, Harris B, Brown T, Fothergill R, Couper K
Crit Care Med
· 2026 Jul · PMID 41885565
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OBJECTIVES: To determine the population-based incidence of out-of-hospital cardiac arrest involving children. DATA SOURCES: We searched MEDLINE, Embase, CINAHL, and gray literature sources, from inception to March 12, 20...OBJECTIVES: To determine the population-based incidence of out-of-hospital cardiac arrest involving children. DATA SOURCES: We searched MEDLINE, Embase, CINAHL, and gray literature sources, from inception to March 12, 2025. STUDY SELECTION: We included studies and reports describing the population-based incidence of emergency medical service treated out-of-hospital cardiac arrest in children. DATA EXTRACTION: Two reviewers independently screened studies for eligibility and extracted data. Risk of bias was assessed using the JBI Critical Appraisal Checklist for Prevalence Studies. DATA SYNTHESIS: We summarized incidence rates in the overall population and in our prespecified subgroups in a meta-analysis using a random-effects model. Four thousand seven hundred eleven studies were screened with 50 finally included in our analysis including data from 18 countries (17 high-income and one upper-middle-income). Thirty-seven thousand six hundred eighty-one cardiac arrest incidents, across a total follow-up time of 547,267,107 person-years, were included in our primary analysis. Meta-analysis generated a pooled incidence rate estimate of 5.56 out-of-hospital cardiac arrest incidents in all children in the included populations, per 100,000 person-years (95% CI, 4.54-6.58; I2 = 100%). We identified substantial variation in incidence across prespecified subgroups of etiology, presenting rhythm, and age. Included studies had an unclear overall risk of bias due to the diagnostic criteria for out-of-hospital cardiac not being commonly reported. CONCLUSIONS: Out-of-hospital cardiac arrest incidents affecting children reported in high-income countries are rare and the incidence is influenced by factors such as age and etiology. The lack of available data from low-middle-income countries, and the inconsistent reporting of these incidents, are limitations of this review. An international focus on standardized reporting of out-of-hospital cardiac arrest in children is required.
Killien EY, Carlton EF, Pierce RW
… +5 more, Heneghan JA, Karam O, Typpo K, Bhalla A, Pathways to Independence Special Interest Group of the Pediatric Acute Lung Injury and Sepsis Investigators Network
Crit Care Med
· 2026 Jul · PMID 41885544
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OBJECTIVES: Advancement of medical science is dependent on the development of clinician-scientists; however, the factors contributing to a successful transition to research independence remain unknown, especially in crit...OBJECTIVES: Advancement of medical science is dependent on the development of clinician-scientists; however, the factors contributing to a successful transition to research independence remain unknown, especially in critical care. We aimed to determine factors associated with submission of a National Institutes of Health (NIH) R01-level award among pediatric critical care medicine (PCCM) physicians. DESIGN: Cross-sectional survey. SETTING: Web-based survey administered from September 2024 to November 2024 in academic pediatric critical care divisions. SUBJECTS: PCCM physicians who received an NIH career development award (K award; either institutional [K12, KL2] or individual [K08, K23, K99/R00]) between 2014 and 2023. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Participants were asked about award, recipient, and institutional characteristics and work hours. We used multivariable generalized linear regression to identify factors associated with R01 submission. Among 122 PCCM K award recipients, 102 (83.6%) completed the survey. Among 76 respondents who had completed or were within 1 year of completing K award funding, 53 (69.7%) had submitted an R01. Factors independently associated with higher likelihood of R01 submission were: 1) receipt of an individual K award (adjusted relative risk [aRR], 2.38; 95% CI, 1.30-4.38) or an institutional followed by an individual K award (aRR, 2.13; 95% CI, 1.19-3.83) relative to an institutional award only; 2) conducting basic science research (aRR, 1.45; 95% CI, 1.11-1.89); 3) receiving an NIH Loan Repayment Program award (aRR, 1.63; 95% CI, 1.21-2.19); 4) having fewer other K award recipients in the PCCM division (aRR, 2.33 for 0 vs. 3 or more; 95% CI, 1.45-3.76); and 5) working fewer nightshift hours (aRR, 1.89 for first vs. fourth quartile; 95% CI, 1.17-3.06). CONCLUSIONS: Among over 100 PCCM K award recipients, both individual and institutional factors were associated with R01 submission, suggesting potential targets for efforts to support the transition to independence for K award recipients and bolster growth of the clinician-scientist workforce.
Yumoto T, Naito H, Hayakawa M
… +22 more, Yokobori S, Nishiyama K, Atsumi T, Tasaki O, Tsurukiri J, Hayamizu M, Murahashi S, Hayashi M, Nishimura T, Goto Y, Narumiya H, Mizutani A, Miyajima M, Shimazaki J, Miura T, Shima N, Deuchi K, Nakayasu H, Kano H, Yorifuji T, Nakao A, Japan Comprehensive Process for End-of-Life Care and Organ Donation after Brain Death (J-RESPECT) study group
Crit Care Med
· 2026 Jun · PMID 41885543
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OBJECTIVES: To determine whether key institutional and clinical differences exist between highly and moderately active hospitals in Japan with respect to brain-dead organ donation practices. DESIGN: Retrospective multice...OBJECTIVES: To determine whether key institutional and clinical differences exist between highly and moderately active hospitals in Japan with respect to brain-dead organ donation practices. DESIGN: Retrospective multicenter cohort study. SETTING: Sixteen tertiary emergency and critical care centers across Japan. PATIENTS: All brain-dead organ donors from participating institutions who had at least one organ procured and transplanted between July 17, 2010, and December 31, 2023. Hospitals were categorized as highly active (≥ 14 donations) or moderately active (≤ 13 donations) during the study period. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Institutional donation practices were compared, including donor management strategies, use of vasopressors and corticosteroids, time intervals in the donation process, and frequency of multidisciplinary team meetings. A total of 204 donors were included; the median age was 47 years (interquartile range, 37-56), and 92 (45.1%) were female. Donor characteristics were similar between groups. Vasopressin was used in nearly all donors, though dosing protocols varied. Corticosteroid use was significantly higher in highly active hospitals compared with moderately active ones (58.3% vs. 38.0%; p = 0.004). Time from admission to coordinator notification was similar; however, time to family consent (median, 8 vs. 5 d; p < 0.001) and time to organ procurement (median, 12 vs. 9 d; p = 0.006) were longer in highly active hospitals. These hospitals also conducted more multidisciplinary meetings during donor management (median, 2 vs. 0; p < 0.001). CONCLUSIONS: Highly active hospitals demonstrated more intensive donor management practices, longer timeframes for key donation steps, and greater multidisciplinary engagement. Standardization of donation practices may enhance efficiency and support broader dissemination of effective institutional strategies to improve brain-dead organ donation rates in Japan.
Zheng H, Wang W, Liu X
… +13 more, Wang X, Zhang S, Wang Z, Li L, Xing G, Lv Y, Jiang S, Xu S, Zheng Y, Yu J, Wen C, Tong Y, Liang P
Crit Care Med
· 2026 Jun · PMID 41879382
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OBJECTIVES: To assess critical care ultrasound (CCUS) utilization, training coverage, and barriers to implementation among ICU clinicians across economically diverse regions in China. DESIGN: An online cross-sectional su...OBJECTIVES: To assess critical care ultrasound (CCUS) utilization, training coverage, and barriers to implementation among ICU clinicians across economically diverse regions in China. DESIGN: An online cross-sectional survey with chi-square tests, Mann-Whitney U tests, multivariate logistic regression, and principal component analysis (PCA)-based clustering. SETTING: ICU clinicians from all 31 provincial-level regions in mainland China, classified into high- and low-gross domestic product (GDP) groups by per capita GDP relative to the national average. SUBJECTS: Six hundred fifty-five ICU clinicians who completed the survey. INTERVENTIONS: The survey included demographics, CCUS training experience, equipment availability, clinical usage frequency, and perceived implementation barriers. MEASUREMENTS AND MAIN RESULTS: A total of 61.4% of respondents reported receiving CCUS training, with similar coverage between high- and low-GDP regions (61.9% vs. 60.8%; p = 0.769). Clinicians from high-GDP areas reported significantly higher self-assessed ultrasound proficiency ( p = 0.008). Dedicated ultrasound equipment was unavailable in approximately one-third of ICUs, slightly more common in low-GDP regions (37.7% vs. 31.4%; p = 0.094). Major barriers included insufficient expert support (36.9%), lack of ultrasound consultants (31.3%), and difficulties in image interpretation (31.1%). Logistic regression analysis showed structured training significantly reduced the odds of encountering equipment-related barriers (odds ratio, 0.57; 95% CI, 0.34-0.97; p = 0.036). PCA-based clustering identified three clinician profiles: frequent users (high training and usage, predominantly from high-GDP areas), moderate users, and infrequent users (limited training and primarily from low-GDP regions). CONCLUSIONS: Structured CCUS training significantly enhances utilization and clinician expertise, irrespective of regional economic conditions. Policies promoting standardized training, equitable equipment distribution, and sustainable expert support are essential for broader CCUS integration in critical care settings across China.