Hagiwara J, Hunt J, Hunt J
… +4 more, Liu Q, Michalek J, DellaVolpe JD, Sousse LE
Crit Care Med
· 2026 Apr · PMID 42023953
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BACKGROUND: Extracorporeal membrane oxygenation (ECMO) is crucial in the management of severe cardiopulmonary dysfunction. Although early rehabilitation in the ICU has been shown to reduce ICU-acquired weakness and impro...BACKGROUND: Extracorporeal membrane oxygenation (ECMO) is crucial in the management of severe cardiopulmonary dysfunction. Although early rehabilitation in the ICU has been shown to reduce ICU-acquired weakness and improve patient outcomes, there is limited evidence on structured rehabilitation programs for patients on ECMO. OBJECTIVES: We evaluated the safety, feasibility, and preliminary effectiveness of a standardized daily program combining mobility therapy and resistance training during ECMO support. DESIGN: The primary outcome was time on exercise training per day. Task performance, repetitions in resistance exercises, adverse events, hospital disposition, and body mass index (BMI) changes were documented. SETTING: Prospective single-center pilot study. SUBJECTS: Subjects on ECMO ( n = 20, 47 ± 15 years old, 80% male, 95% venovenous ECMO). INTERVENTIONS: Subjects received a protocolized regimen: morning mobility with physical/occupational therapy (PT/OT) using a tilt/verticalization bed, activities of daily living, and graded transitions (sitting, standing, ambulation), followed by afternoon resistance exercises with a clinical exercise physiologist (≥ 5 d/wk). MEASUREMENTS AND MAIN RESULTS: Two minor adverse events occurred, which both resolved immediately. Day-28 survival was 95%, and in-hospital survival was 85%. Among survivors, 56% were discharged home, and 44% experienced an increase in BMI from admission to discharge. Daily therapy times averaged 21 minutes for PT/OT (median: 20), 30 minutes for resistance sessions (median: 27), and 35 minutes of combined daily exercise (median: 35, maximum: 122). Longer session times correlated with faster supine-to-sitting transitions in PT/OT ( p = 0.002). In resistance trainings, longer session times were associated with significantly increased repetitions in bicep and triceps flexion and extensions, chest press, shoulder press, and hip/knee flexion ( p < 0.001). CONCLUSIONS: A structured daily program that combines mobility, verticalization, and resistance exercises during ECMO was feasible and safe. More time in sessions was associated with better functional performance. Larger controlled studies are needed to determine effects on recovery and long-term outcomes.
Chiang CJ, Bria KE, Chrysafi P
… +8 more, Falvello V, Sanfilippo KM, Schaefer JK, Bauer K, Patell R, Baumann Kreuziger L, Freese RL, Gutierrez Bernal A
Crit Care Med
· 2026 Jul · PMID 42023946
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OBJECTIVES: Evidence guiding the optimal timing of mechanical thrombectomy for patients presenting with intermediate-risk pulmonary embolism (PE) is limited. We aimed to evaluate whether the timing of mechanical thrombec...OBJECTIVES: Evidence guiding the optimal timing of mechanical thrombectomy for patients presenting with intermediate-risk pulmonary embolism (PE) is limited. We aimed to evaluate whether the timing of mechanical thrombectomy is associated with improved clinical outcomes in this patient population. DESIGN, SETTING, AND PATIENTS: This multicenter, retrospective cohort study was conducted at five large academic hospitals. In total, 290 patients presenting with intermediate-risk PE who were treated with mechanical thrombectomy were included for analysis. The primary outcome was in-hospital mortality. Using generalized estimated equation, we compared the odds of in-hospital mortality for patients undergoing early intervention (EI; mechanical thrombectomy < 12 hr after PE diagnosis) vs. those undergoing delayed intervention (DI; mechanical thrombectomy ≥ 12 hr after diagnosis) while comparing for PE severity and other confounders. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: EI was performed in 179 patients (61.7%), while 111 patients (38.3%) received DI. Unadjusted mortality did not differ significantly between groups (7.3% [13/179] vs. 10.8% [12/111]; p = 0.39). After adjusting for the Pulmonary Embolism Severity Index and Composite Pulmonary Embolism Shock scores, timing of intervention did not influence mortality (odds ratio, 1.80; 95% CI, 0.82-3.95; p = 0.14). However, patients in the EI group had greater reductions in in pulmonary artery systolic pressure (-25.8% [17.0] vs. -18.9% [17.1]; p = 0.020 and mean pulmonary artery pressure, -26.8% [17.7] vs. -20.2% [19.7]; p = 0.016) and lower rates of intubation (8.9% [16/179] vs. 18% [20/111]; p = 0.028). CONCLUSIONS: In patients presenting with intermediate-risk PE, timing of mechanical thrombectomy did not influence in-hospital mortality. EI may result in greater reductions in pulmonary artery pressures and decreased incidence of intubation compared with DI.
Fuentes AL, Ellberg CC, Parada H
… +4 more, Trieu M, LaBuzetta JN, Malhotra A, Owens RL
Crit Care Med
· 2026 Jun · PMID 41989178
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OBJECTIVES: Delirium is common in the ICU and is associated with devastating consequences. However, the accuracy of delirium detection tools has not been evaluated when patient-provider language discordance is present. T...OBJECTIVES: Delirium is common in the ICU and is associated with devastating consequences. However, the accuracy of delirium detection tools has not been evaluated when patient-provider language discordance is present. This study aimed to assess the accuracy of delirium screening practices in Spanish-speaking ICU patients, evaluate whether caregiver-administered tools improve detection amid language barriers, and examine language-based differences in delirium care. DESIGN: Prospective observational cohort study. SETTING: Two MICUs at the University of California, San Diego. PATIENTS: 142 ICU patients and 100 caregivers were enrolled between August 2024 and January 2025. INTERVENTIONS: Usual-Care (Confusion Assessment Method [CAM]-ICU completed by bedside providers), Reference-standard (English or Spanish-language CAM-ICU performed by research staff), and FAM-CAM (English or Spanish-language Family-CAM administered by caregivers). MEASUREMENTS AND MAIN RESULTS: Among 71 English-speakers, 34 female (47%), with a mean ( sd ) age of 62 years (16). Among 71 Spanish-speakers, 26 female (37%) and the mean age was 60 years (15). The prevalence of delirium was 39% overall, affecting 26 (37%) English-speakers and 32 (45%) Spanish-speakers. Agreement between Usual-Care and Reference-standard was higher in English-speakers than in Spanish-speakers (κ=0.71 vs. κ=0.11; z=-4.98, p < 0.01), with 72% of delirium missed in Spanish-speakers. Among Spanish-speakers, FAM-CAM showed higher agreement with Reference-standard than did Usual-Care (κ=0.68 vs. κ=0.11; z= -4.69, p < 0.05) and reduced the rate of missed delirium by 47%. Spanish-speakers were more deeply sedated (mean Richmond Agitation Sedation Scale -1.46 [ sd 1.38] vs. -0.77 [ sd 1.31]; mean difference 0.69; 95% CI, 0.24 to 1.14, p < 0.01) and had higher odds of restraint use (odds ratio 4.53; 95% CI 1.91 to 10.74; p < 0.01) than English-speakers. CONCLUSIONS: Usual-Care demonstrated poor accuracy in delirium detection among Spanish-speakers, who also experienced deeper sedation and more frequent restraint use than English-speakers. FAM-CAM improved delirium detection among Spanish-speakers and may help overcome language barriers to equitable delirium detection.
Crit Care Med
· 2026 Apr · PMID 41972863
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OBJECTIVES: This study aims to investigate the effect of culturally and linguistically diverse (CaLD) status on in-hospital mortality in patients admitted to ICUs with sepsis. We hypothesize that diverse cultural and eth...OBJECTIVES: This study aims to investigate the effect of culturally and linguistically diverse (CaLD) status on in-hospital mortality in patients admitted to ICUs with sepsis. We hypothesize that diverse cultural and ethnic backgrounds, combined with limited English proficiency, might contribute to increased mortality in these patients. DESIGN: Multicenter, retrospective cohort study. SETTING: Adult ICUs with in South Western Sydney Local Health District (SWSLHD), New South Wales, Australia. PATIENTS: All adult patients 18 years or older, admitted to ICUs within the SWSLHD with a diagnosis of sepsis between January 1, 2012, and December 31, 2022. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Primary outcome was in-hospital mortality. ICU and hospital length of stays (LOSs) and readmission within 90 days to the ICU were our secondary outcomes. To isolate the effect of CaLD status on outcomes, matching was used to balance background covariates between the CaLD and non-CaLD groups. The average marginal effect of CaLD status on in-hospital mortality was then estimated using the matched data. In the analysis, 5971 sepsis-coded admissions were included, of which 2792 (46.75%) were from patients with CaLD backgrounds. Sixteen percent (435/2792) of the CaLD patients died in hospital compared with 17% (532/3179) deaths in the non-CaLD group. In the adjusted analysis on the matched data, hospital mortality was 2.2 percentage points lower (risk difference [RD], -0.022; 95% CI, 0.044 to -0.0005; p = 0.05) in the CaLD group compared with the non-CaLD group, corresponding to a 12.4% (risk ratio, 0.876; 95% CI, 0.763-0.989; p < 0.001) reduction in relative risk. ICU LOS was shorter for the CaLD patients by 0.53 days (12.72 hr) (95% CI, -0.836 to -0.226; p < 0.001) compared with the non-CaLD group. CONCLUSIONS: Contrary to our hypothesis, in-hospital mortality after ICU admission with sepsis was lower in patients belonging to CaLD backgrounds. This effect was largely driven by patients from North African/Middle Eastern backgrounds, the largest CaLD subgroup.
Schaap CM, Raasveld SJ, Reizine F
… +41 more, Corentin B, Schenk J, de Bruin S, Reuland MC, van den Oord C, Flint AWJ, Hamid T, Piagnerelli M, Mahečić TT, Benes J, Russell L, Aguirre-Bermeo H, Triantafyllopoulou K, Chantziara V, Gurjar M, Myatra SN, Pota V, Elhadi M, Gawda R, Mourisco M, Lance M, Neskovic V, Podbregar M, Llau JV, Quintana-Diaz M, Cronhjort M, Pfortmueller CA, Yapici N, Nielsen N, Shah A, Bakker J, Cecconi M, Feldheiser A, Meier J, McQuilten Z, Müller MCA, Scheeren TWL, Aubron C, Vlaar APJ, de Grooth HJ, International Point Prevalence Study of ICU Transfusion Practices (InPUT) study group
Crit Care Med
· 2026 Jul · PMID 41949385
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OBJECTIVES: RBC transfusions are common in the ICU. Recent studies suggest that a restrictive transfusion policy is noninferior or superior to a liberal policy. However, few studies focus on the influence of age in trans...OBJECTIVES: RBC transfusions are common in the ICU. Recent studies suggest that a restrictive transfusion policy is noninferior or superior to a liberal policy. However, few studies focus on the influence of age in transfusion. In elderly ICU patients, reduced physiologic reserves may shift the perceived risk-benefit balance of transfusion, potentially leading to different transfusion practices. This study examines whether transfusion practices in ICU patients differ across patient age. DESIGN: This is a substudy of the International Point Prevalence Study of ICU Transfusion Practices (InPUT), a global, multicenter, prospective observational cohort study. SETTING: ICUs from 233 centers across 30 countries. Data were collected from March 2019 to October 2022 in prespecified weeks. PATIENTS: Adult ICU patients (≥ 18 yr) admitted during predefined study weeks. Patients were categorized by age (< 65, 65-75, 75-85, and > 85 yr). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A total of 3643 patients from 233 centers across 30 countries were included. Of these, 53% were younger than 65 years, 26% were 65-75 years, 17% were 75-85 years, and 4% were older than 85 years. RBC transfusion rates ranged from 23% to 26% across all age groups ( p = 0.91). Patients older than 85 years had higher stated hemoglobin thresholds (median, 10.0 g/dL) compared with younger patients (median, 8.0 g/dL; p < 0.001). "Age" and "improve general state" were more frequently cited as reasons for transfusion in patients older than 85 years. However, after adjustment, age was not associated with the probability of receiving an RBC transfusion. CONCLUSIONS: Different transfusion strategies are applied in patients older than 85 years old. These differences appear to be driven by age-related differences in physiology and diagnoses rather than motivated by older age itself.
Lijović L, Hilders P, Radočaj T
… +2 more, Širanović M, Elbers P
Crit Care Med
· 2026 Jul · PMID 41945715
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OBJECTIVES: Static thresholds for mechanical power (MP) may not prevent ventilator-induced lung injury because risk depends on exposure duration and the underlying respiratory compliance. We aimed to quantify how MP inte...OBJECTIVES: Static thresholds for mechanical power (MP) may not prevent ventilator-induced lung injury because risk depends on exposure duration and the underlying respiratory compliance. We aimed to quantify how MP intensity and exposure duration interact with respiratory compliance to predict oxygenation changes consistent with acute respiratory distress syndrome worsening or 14-day mortality. DESIGN: A retrospective analysis of 2 large intensive care datasets. SETTING: ICUs in the Netherlands and the United States from 2003 to 2016 and 2008 to 2019, respectively. PATIENTS: Mechanically ventilated adults with oxygenation levels consistent with moderate to severe acute respiratory distress syndrome. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Time-dependent Cox proportional hazards models stratified by respiratory compliance estimated the hour-specific associations of immediate exceedance and cumulative time above MP thresholds with the primary outcome. Estimated effects were integrated into a risk-adjusted mechanical-power score. Among 2150 mechanically ventilated acute respiratory distress syndrome patients risk from MP exposure was dictated by respiratory compliance: in higher-compliance lungs, risk followed a dose-response pattern, with immediate hazard beginning at 10 J/min (hazard ratio = 1.04) and cumulative harm amplifying significantly over time. Conversely, for low-compliance patients, risk was confined to a narrow power band (11-20 J/min) without evidence of cumulative harm. With risk-adjusted MP score as a predictor of outcome eXtreme Gradient Boosting yielded an area under the receiver operating characteristic curve of 0.863. CONCLUSIONS: A single "safe" MP threshold is insufficient for guiding ventilation; the risk of lung injury is governed by a dynamic interplay of power intensity, duration, and the patient's respiratory compliance. The risk-adjusted MP score unifies these factors into a time-varying, clinically interpretable metric that warrants prospective validation for personalized ventilator management.