Kumar SS, Kumar U, Karunanantham J
… +2 more, Sitaranjan D, Farid S
J Crit Care
· 2026 Jun · PMID 41628584
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PURPOSE: To evaluate the clinical impact of cardiac surgery-associated acute kidney injury requiring continuous venovenous haemofiltration by assessing its impact on short- and long-term outcomes. METHODS: Data for all a...PURPOSE: To evaluate the clinical impact of cardiac surgery-associated acute kidney injury requiring continuous venovenous haemofiltration by assessing its impact on short- and long-term outcomes. METHODS: Data for all adult cardiac surgeries performed between 2015 and 2024 were retrieved from our institutional database. 1:2 propensity-score matching of patients requiring postoperative haemofiltration and those not requiring haemofiltration was performed based on the EuroSCORE II covariates. In-hospital outcomes (mortality, postoperative complications, postoperative hospitalisation duration) and long-term survival were evaluated. RESULTS: After excluding patients requiring renal replacement therapy preoperatively, 16,681 patients were included. Propensity matching yielded Group H (postoperative haemofiltration, n = 510) and Group C (controls, n = 1020). Groups had generally similar demographics and preoperative clinical characteristics. Group H exhibited worse in-hospital outcomes compared to Group C. Hospital mortality was significantly higher in Group H (23.1% vs 6.2%, p < 0.001), with higher mortality up to five years and poorer long-term survival (HR =1.81 (95% CI: 1.50-2.18), p < 0.001). Conditional survival analyses demonstrated that among patients who survived past hospital discharge, long-term survival was comparable between groups (HR 1.23, 95% CI 0.95-1.58, p = 0.115). CONCLUSIONS: Postoperative AKI requiring haemofiltration is associated with poor outcomes following cardiac surgery. However, in patients surviving the acute postoperative phase, there was no significant difference in long-term survival compared to those who did not require haemofiltration. These findings underscore the importance of early recognition and management of acute kidney injury after cardiac surgery whilst offering a more nuanced understanding of long-term prognosis.
Zerem Y, Einav S, Weiniger CF
… +3 more, Schvartz R, Sela HY, Finkelstein A
J Crit Care
· 2026 Jun · PMID 41621293
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BACKGROUND: Intensive care unit (ICU) admission of obstetric patients during pregnancy or postpartum is not uncommon. The long-term physical and emotional implications of such admissions require elucidation. AIM: To desc...BACKGROUND: Intensive care unit (ICU) admission of obstetric patients during pregnancy or postpartum is not uncommon. The long-term physical and emotional implications of such admissions require elucidation. AIM: To describe obstetric patients' long-term perspectives on ICU admission and recovery. METHODS: A phenomenological approach was undertaken. All consecutive obstetric patients admitted to the ICU during 2016-2021 were invited to participate in a semi-structured interview after hospital discharge. Interviews were conducted from 12/2020 to 06/2022, and the transcripts were analyzed using Braun and Clarke's six-phase approach to reflexive thematic analysis. RESULTS: A total of 59 women aged 20-34 years admitted to an ICU during pregnancy or postpartum were interviewed. Qualitative inductive analysis of the interview transcripts generated three themes: the illness experience, an atypical patient, and recovery. Repetitive topics were a sense of disorientation, feeling distressed and scared, the importance of remaining in contact with and informed on the neonate, the importance of partner and family support, the challenges of being an atypical ICU patient, the difficulties in returning to normal life, and coping strategies. CONCLUSIONS: This study sheds new light on the experiences of obstetric patients admitted to an ICU. It highlights missed opportunities for maternal‑neonatal bonding, the importance of family support, unique needs that often remain unmet, the need for effective communication with the ICU staff, and the physical and emotional long-term adverse effects of the experience. The patient's narrative can contribute to our understanding of the ICU experience as a whole and its outcomes.
J Crit Care
· 2026 Jun · PMID 41619711
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BACKGROUND: Acute respiratory distress syndrome (ARDS) is a heterogeneous syndrome with high mortality. Subphenotyping may identify more homogeneous groups for prognostic enrichment and precision therapies. METHODS: We c...BACKGROUND: Acute respiratory distress syndrome (ARDS) is a heterogeneous syndrome with high mortality. Subphenotyping may identify more homogeneous groups for prognostic enrichment and precision therapies. METHODS: We conducted a scoping review (January 2013-December 31, 2025) in PubMed, Embase, and the Cochrane Library, complemented by reference screening. We included original adult studies deriving, applying, or validating ARDS phenotypes/subphenotypes and excluded pediatric, preclinical, review/editorial, and abstract-only reports. RESULTS: Sixty studies met eligibility criteria. Subphenotypes were reported across clinical, biological, computational, imaging, omics, and artificial intelligence (AI) domains, with uneven evidence maturity; reproducibility and validation were strongest in biological and computational frameworks, whereas imaging and omics evidence was more heterogeneous and less frequently externally validated. The most robust distinction separated hyperinflammatory and hypoinflammatory groups, differing in mortality, ventilator-free days, and organ failure, and showing heterogeneity of treatment effect in secondary analyses of randomized trials (fluid management, statins, corticosteroids, and recruitment manoeuvres). Clinical and computational approaches provided parsimonious classifiers for near real-time assignment, while biological studies implicated inflammatory, epithelial, and endothelial injury markers. AI models integrated multimodal data and reproduced known phenotypes, but external validation and interpretability were inconsistent. CONCLUSIONS: ARDS subphenotypes-particularly hyperinflammatory and hypoinflammatory classes-are prognostically meaningful and associated with heterogeneity of treatment effect. Parsimonious clinical and computational classifiers appear closest to bedside translation. Future research should prioritise prospective phenotype-stratified/adaptive trials using standardized, transparent algorithms in diverse international cohorts.
Batchelor RJ, Hodgson CL, Lankaputhra M
… +10 more, Burrell A, Orosz J, Coull J, Pellegrino V, Antsey J, Lefkovits J, Taylor AJ, Kaye DM, Stub D, EXCEL coinvestigators
J Crit Care
· 2026 Jun · PMID 41616607
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BACKGROUND: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly utilised in critically ill patients with severe cardiac failure and cardiac arrest, yet sex-specific differences in presentation, uti...BACKGROUND: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly utilised in critically ill patients with severe cardiac failure and cardiac arrest, yet sex-specific differences in presentation, utilisation, and clinical outcomes are not well understood. METHODS: The EXCEL registry is a binational registry capturing data on patients requiring ECMO in Australia and New Zealand. Data were collected on adult patients supported with VA-ECMO in Australia from February 2019 to December 2024. Patients were stratified by sex to assess differences in demographics, clinical characteristics, ECMO indications, complications, and outcomes. Multivariable logistic regression analyses conditional on several baseline covariates assessed associations between sex, in-hospital mortality, and major bleeding. RESULTS: Among 1443 patients undergoing VA-ECMO, 32.7% female and 67.3% were male. Females were younger, had lower APACHE IV scores, and more commonly required ECMO for myocarditis, pulmonary embolism, and advanced pulmonary hypertension. Conversely, males predominantly presented with acute myocardial infarction and more frequently had cardiac arrest with a shockable rhythm. Unadjusted in-hospital mortality was comparable between sexes; however, following adjustment, female sex independently predicted higher in-hospital mortality (OR 1.41, 95% CI 1.07-1.87; p = 0.015) and major bleeding (OR 1.40, 95% CI 1.03-1.91; p = 0.033). CONCLUSION: Female patients represent one third of the VA-ECMO population and are a distinct cohort to male patients. Despite younger age and fewer traditional risk factors, female sex is associated with increased adjusted risk of in-hospital mortality and bleeding in VA-ECMO patients. These findings should be interpreted as an adjusted association that is contingent on the completeness of covariate adjustment.
Mattedi FZ, Ribeiro HS, Busatto GF
… +4 more, Carvalho CRR, Zanetta DMT, Burdmann EA, HCFMUSP COVID-19 Study Group
J Crit Care
· 2026 Jun · PMID 41605062
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INTRODUCTION: The incidence of acute kidney injury (AKI) in patients with acute respiratory distress syndrome (ARDS) is high; nonetheless, the lung-kidney crosstalk remains unclear. OBJECTIVE: Describe the association be...INTRODUCTION: The incidence of acute kidney injury (AKI) in patients with acute respiratory distress syndrome (ARDS) is high; nonetheless, the lung-kidney crosstalk remains unclear. OBJECTIVE: Describe the association between ARDS and AKI in critically ill patients. METHODS: This scoping review was conducted according to the JBI and PRISM-ScR and included studies that investigated critically ill patients with ARDS (Participants), described AKI-related outcomes (Concept), and were conducted in hospitals (Context). MEDLINE, Embase, and LILACS databases were searched for articles published up to January 2024. Only observational studies were considered. Data on the diagnosis of ARDS-AKI and other kidney-related outcomes were extracted. RESULTS: A total of 2943 studies were screened, of which 28 were included in this review. Most studies were prospective and the majority originated from Europe. AKI was diagnosed using the KDIGO criteria in most studies and the pooled overall rate of AKI development across the studies was 46.8% (95% CI: 40.8-52.8). Two reports identified ARDS as an independent risk factor for AKI. Kidney replacement therapy was described in 17 studies. AKI recovery was described in only three studies. Seventeen studies evaluated hospital mortality, specifically in patients with ARDS-AKI, and found a greater mortality risk as compared to only ARDS. CONCLUSIONS: This scoping review emphasizes the variability of the evidence, which hinders definitive conclusions about the association between ARDS and AKI, despite their common occurrence in critically ill patients. Therefore, a significant gap remains in our understanding of this lung-kidney interaction.
J Crit Care
· 2026 Jun · PMID 41579506
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BACKGROUND: Timely identification and transfer of critically ill patients to intensive care units (ICUs) are crucial to reducing morbidity and mortality. Delayed ICU admission is linked to higher mortality, emphasizing t...BACKGROUND: Timely identification and transfer of critically ill patients to intensive care units (ICUs) are crucial to reducing morbidity and mortality. Delayed ICU admission is linked to higher mortality, emphasizing the need for efficient prediction systems. Artificial intelligence (AI) has shown promise in enhancing clinical decision-making. This study evaluates the efficacy of ChatGPT and Gemini AI models in predicting ICU admission needs. METHODS: This retrospective observational study analyzed data from 8043 ICU consultation cases in a tertiary hospital between January 2020 and June 2024. Clinical parameters included medication use, consultation details, ECG findings, imaging results, comorbidities, and laboratory values. Preprocessed and anonymized data were analyzed using ChatGPT and Gemini, with performance assessed through accuracy, Kappa statistic, Pearson Chi-square, and logistic regression. RESULTS: ChatGPT demonstrated strong predictive performance, achieving an accuracy of 93.8% and a Kappa statistic of 0.802, indicating substantial agreement with anesthesiologists' ICU decisions. Its predictions showed a highly significant association with actual clinical outcomes (Pearson Chi-Square = 5293.310, p < 0.001). Sensitivity and specificity analyses further confirmed ChatGPT's balanced performance in identifying both ICU and non-ICU patients. In contrast, Gemini showed more modest agreement with clinical decisions, with a Kappa value of 0.396, reflecting lower consistency despite producing correct classifications in a portion of cases. CONCLUSION: ChatGPT demonstrated superior accuracy and reliability in predicting ICU needs compared to Gemini. Early identification of critically ill patients enables timely interventions, potentially reducing morbidity and mortality. Future studies should explore real-time AI integration into clinical workflows and validate findings through prospective research.