Janssen RME, Yasrebi-de Kom IAR, Klopotowska JE
… +8 more, van der Linden PD, de Keizer NF, Termorshuizen F, van der Hoeven JG, Hulscher MEJL, Atsma F, Schouten JA, SIMPLIFY study group
J Crit Care
· 2026 May · PMID 42191421
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BACKGROUND: Antibiotics are widely used in ICUs. This study aimed to examine ICU-level variation in antibiotic use across Dutch ICUs as a basis for quality improvement and antimicrobial stewardship efforts. METHODS: We c...BACKGROUND: Antibiotics are widely used in ICUs. This study aimed to examine ICU-level variation in antibiotic use across Dutch ICUs as a basis for quality improvement and antimicrobial stewardship efforts. METHODS: We conducted a retrospective observational study using routinely collected data from electronic health records and the National Intensive Care Evaluation Registry, including all admissions to 11 Dutch ICUs between 2016 and 2019. Systemic antibiotic use was measured using Defined Daily Doses (DDD), Days of Therapy (DOT), length of therapy, antibiotic free days, the Access, Watch, Reserve classification, and the Antibiotic Spectrum Index (ASI). Antibiotic use was assessed for three groups of ICU admissions: all admissions, those with pneumonia, and those with intra-abdominal sepsis. For the latter two groups, we quantified case-mix adjusted variation in DOT and ASI through indirect standardization and ICU fixed effect estimation. RESULTS: Of the 51,205 ICU admissions, 73% received at least one antibiotic. Average antibiotic use was 88.9 DDD and 91.1 DOT per 100 patient-days in the overall ICU cohort. Pneumonia and intra-abdominal sepsis were diagnosed in 3059 and 1094 admissions, respectively. After case-mix adjustment, significant variation in DOT and ASI between ICUs remained for both the pneumonia and intra-abdominal sepsis groups. Some ICUs with low DOTs, indicating lower overall antibiotic use, had less favorable ASI scores, suggesting use of broader-spectrum antibiotics, while others showed the opposite pattern. CONCLUSIONS: Antibiotic use varied significantly across ICUs, and case-mix did not explain these differences. The ASI provides important information in addition to the other antibiotic use metrics.
Waskowski J, Maggisano GMEA, Hahn M
… +3 more, Hofer DM, Faltys M, Pfortmueller CA
J Crit Care
· 2026 May · PMID 42177859
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BACKGROUND: Fluid accumulation is a known risk factor of adverse renal outcomes in critically ill patients. A substantial proportion of the fluid burden in intensive care unit (ICU) patients arises from maintenance fluid...BACKGROUND: Fluid accumulation is a known risk factor of adverse renal outcomes in critically ill patients. A substantial proportion of the fluid burden in intensive care unit (ICU) patients arises from maintenance fluids and fluid creep. Whether these non-resuscitation fluids affect renal outcomes remains uncertain. METHODS: Retrospective cohort study of adult ICU patients admitted to a tertiary care center in Switzerland between January 2014 and December 2017. The primary objective was the association of fluid creep/maintenance fluid intake with major adverse kidney events within 30 days (MAKE30). Secondary endpoints included the individual components of MAKE30: mortality, renal replacement therapy (RRT), and persistent renal dysfunction. Associations were analysed using multivariable logistic regression adjusted for typical confounders. RESULTS: 12,716 patients were included, of whom 1812 (14%) experienced MAKE30. The median total volume of fluid creep/maintenance fluids until ICU discharge was 716 mL (Interquartile range [IQR] 329; 2128), corresponding to a median daily intake of 8 mL/kg (IQR 4; 15). Each additional milliliter of fluid creep/maintenance fluids per kilogram body weight per day was associated with MAKE30 (adjusted odds ratio [aOR] 1.004, 95% confidence interval [CI] 1.001-1.008; p = 0.016) and all its components, including 30-day mortality, RRT, and persistent renal dysfunction. CONCLUSION: In a large mixed ICU cohort, higher exposure to fluid creep/ maintenance fluids was consistently associated with MAKE30 and its components. Fluid creep should be recognized as a modifiable component of fluid therapy. Future studies are needed to determine how reducing the dose of hidden fluids affects clinical outcomes.
J Crit Care
· 2026 May · PMID 42177858
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Ketamine has been shown to possess unique pharmacologic properties that make it an appealing adjunctive sedative for critically ill patients; however, its overall impact on key intensive care unit (ICU) outcomes remains...Ketamine has been shown to possess unique pharmacologic properties that make it an appealing adjunctive sedative for critically ill patients; however, its overall impact on key intensive care unit (ICU) outcomes remains uncertain. As such, this systematic review and meta-analysis was conducted to evaluate whether intravenous ketamine-based sedation improves mechanical ventilation duration (MVD), ICU length of stay (LOS), and delirium incidence in ICU patients compared with standard analgosedation. Following PRISMA guidelines, a comprehensive literature search was conducted across online databases through June 2025. Eligible studies included randomized or prospective controlled adult ICU trials comparing continuous intravenous ketamine or esketamine infusions with standard sedation regimens. Pooled mean differences (MDs) and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using random-effects models. Six studies comprising 903 ICU patients met inclusion criteria. MVD was reported in all six studies; ICU LOS was reported in five studies and delirium was reported in two studies. Ketamine-based sedation was associated with a significant reduction in ICU LOS and a significant decrease in delirium incidence (MD: -0.86; 95% CI: -1.51, -0.22 and OR: 0.55; 95% CI: 0.43-0.72, respectively). Although MVD trended shorter in the ketamine group, this difference did not reach statistical significance (MD: -0.30; 95% CI: -1.53, 0.92). These results support consideration of ketamine as an adjunct in multimodal ICU sedation strategies; however, the effect on ventilation duration remains uncertain. While this study's findings offer valuable comprehensive evaluations, further large-scale trials are needed to optimize dosing and confirm long-term benefits.
Hamblen MC, Petrilli AR, Khanna AK
… +2 more, Russell GB, Mahler SA
J Crit Care
· 2026 May · PMID 42167193
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OBJECTIVES: In patients presenting to the Emergency Department (ED) with infectious symptoms, ruling out sepsis is essential. Procalcitonin (PCT) and presepsin are inflammatory biomarkers suggested for the diagnosis and...OBJECTIVES: In patients presenting to the Emergency Department (ED) with infectious symptoms, ruling out sepsis is essential. Procalcitonin (PCT) and presepsin are inflammatory biomarkers suggested for the diagnosis and exclusion of sepsis. Our objective was to test whether these biomarkers, in combination or alone, can rule out sepsis. METHODS: We conducted a single site, prospective pilot observational cohort study of adult ED patients presenting with acute infectious symptoms. Patients were included if they had antibiotics ordered, identification of an infectious source on imaging or laboratory testing, or presence of systemic inflammatory response syndrome. Each participant had blood collected and analyzed on the Pathfast point-of-care analyzer (PHC Corporation, Tokyo, Japan) for presepsin and PCT. Presepsin and PCT results were classified into low-, moderate-, and high-risk based on established cut points. The clinical team was blinded to presepsin and PCT results. The primary outcome was a diagnosis of sepsis. Association of presepsin and PCT with sepsis was assessed using chi-square testing. Negative predictive values (NPV) of presepsin and PCT measures, alone and in combination, for sepsis were calculated with associated 95% confidence intervals. RESULTS: During the study period, 149 patients were accrued, of which 47.0% were female and 40.9% non-white, with a median age of 64. Among these patients 27.5% (41/149) were diagnosed with sepsis. In patients with low-risk presepsin measures, 5.1% (2/39) had sepsis compared to 35.5% (39/110) in patients with moderate- or high-risk presepsin measures (p < 0.0001). Of the 78 patients with a low-risk PCT, 9.2% (9/98) had sepsis vs 60.4% (29/48) in patients with a moderate- or high-risk PCT (p < 0.0001). In the 36 patients with low-risk measures of both presepsin and procalcitonin, 0% had sepsis compared to 34.5% (38/110) of patients without low-risk measures for both biomarkers (p < 0.0001). The NPV for sepsis was 94.9% (95% CI of 88.0%, 100%) for presepsin, 90.8% (95% CI of 85.1%, 96.5%) for PCT, and 100% (95% CI of 90.3%, 100%) for their combination. CONCLUSIONS: Use of presepsin yielded high negative predictive value for sepsis, especially when used in combination with PCT.
Wiseman JF, Wiseman VH, Jawa NA
… +2 more, Fei LYN, Boyd JG
J Crit Care
· 2026 May · PMID 42143789
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BACKGROUND: Central venous catheters have been historically preferred over peripheral venous catheters for the administration of vasoactive medications in critically ill patients to reduce the risk of extravasation. Peri...BACKGROUND: Central venous catheters have been historically preferred over peripheral venous catheters for the administration of vasoactive medications in critically ill patients to reduce the risk of extravasation. Peripheral vasopressor administration is gaining attention as a strategy to expedite initiation while avoiding the procedural risks of central venous catheter placement. Although prior systematic reviews have focused on anatomical site and peripheral venous catheter gauge, the impact of implementing a peripheral vasopressor protocol on the safety profile of peripheral vasopressor administration has not been systematically evaluated. OBJECTIVE: To determine whether a peripheral vasopressor protocol influences the safety profile of peripherally administered vasopressors in critically ill patients. STUDY DESIGN AND METHODS: A comprehensive search was conducted across MEDLINE (Ovid), Embase (Ovid), the Cochrane Central Register of Controlled Trials (Ovid), and PubMed, encompassing studies published since January 2000. Statistical analysis was conducted using R (v. 4.4.3; https://www.r-project.org/), with two-tailed significance set at p < 0.05. RESULTS: A total of 22 studies involving 10,983 adult patients (≥18 years) were identified. Median extravasation rates were similar between studies using a peripheral vasopressor protocol and those not (33.5 [12.3-53.0] vs. 31.2 [12.0-39.6] per 1000 patients), with no statistically significant difference (U = 68, p = 0.78). CONCLUSION: This review demonstrated that peripheral vasopressor protocols did not yield statistically significant reductions in extravasation rates among patients receiving peripheral vasopressor therapy.
Hiemstra FW, van Kekem MJ, Arbous MS
… +3 more, Schoones JW, van Westerloo DJ, Kervezee L
J Crit Care
· 2026 Aug · PMID 42139859
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INTRODUCTION: Disruption of sleep and circadian rhythms is highly prevalent in intensive care unit (ICU) patients and may be exacerbated by environmental noise. The specific impact of alarm sounds on patients' sleep and...INTRODUCTION: Disruption of sleep and circadian rhythms is highly prevalent in intensive care unit (ICU) patients and may be exacerbated by environmental noise. The specific impact of alarm sounds on patients' sleep and circadian rhythms in the ICU remains unclear. The aim of this scoping review was to systematically map the existing evidence on the impact of alarm sounds on sleep and circadian rhythms in ICU patients. METHODS: A systematic literature search across four databases (PubMed, Embase, Web of Science, CINAHL and Ovid Emcare) was conducted to identify studies examining the impact of alarm sounds on sleep and circadian rhythms in ICU patients. Data on study population, methodology, and main findings on alarm sound impact were extracted, summarized in tables, and narratively synthesized. RESULTS: The search yielded 429 unique publications, of which 24 met the inclusion criteria. Across studies, alarm sounds were consistently identified as a major source of sleep disruption, with 52% to 91% of ICU patients rating alarms as highly disturbing. Objective measures, though limited by small sample sizes, confirmed the significant role of alarms in disturbing sleep, often linking alarm sounds to arousals and awakenings, particularly at higher sound levels. No studies were identified that assessed effects on circadian rhythms or the impact of alarm management strategies. CONCLUSION: These findings underscore the substantial burden of alarm noise on ICU sleep, and highlight the lack of evidence regarding effects on circadian rhythms, as well as the need for effective alarm management strategies.
Rodriguez-Ruiz E, Hohenwallner A, Fuest K
… +8 more, Simon P, Ortiz Suñer A, Estany-Gestal A, Blanco Hortas A, Jung J, Campelo-Izquierdo M, Ortigueira España R, Michalsen A
J Crit Care
· 2026 Aug · PMID 42107347
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BACKGROUND: Healthsystem crises, for instance caused by wars, terrorist attacks, environmental disasters, or pandemics, may cause a considerable scarcity of resources, resulting in the need to prioritize care. This study...BACKGROUND: Healthsystem crises, for instance caused by wars, terrorist attacks, environmental disasters, or pandemics, may cause a considerable scarcity of resources, resulting in the need to prioritize care. This study aimed to assess how prioritisation processes have affected health care professionals (HCPs) in intensive care units in (ICUs) in Spain and Germany and how it will likely affect them in future scarcity scenarios. METHODS: A multicentre, observational, cross-sectional study design was used. Data were collected in ICUs across two Spanish and three German regions between November and December 2024. The questionnaire comprised 53 items and included work-related and sociodemographic characteristics, the Ethical Decision-Making Climate Questionnaire (EDMCQ) and items related to job strain, professional responsibility regarding healthcare costs, and the need to prioritize care in situations of resource scarcity. RESULTS: Two hundred and fifteen ICU HCPs participated in the study, 80 from Germany and 135 from Spain. German HCPs reported a more favourable perception of the ethical climate than their Spanish counterparts (p 〈0,001). A more positively perceived ethical climate correlated significantly with a lesser intention to leave one's job. Also, agreeing that clinicians should take prioritisation decisions caused lesser job strain than disagreeing (p < 0,05). CONCLUSIONS: Differences in the perception of the ethical climate may be partly attributable to variations in end-of-life practices. The ethical climate contributes significantly to the intention to leave one's job. Exposure to prioritisation processes during scarcity scenarios may likely result in moral distress, and rigid utilitarian prioritisation strategies may be perceived as burdensome to HCPs.
Chotalia M, Ali M, Chotalia R
… +3 more, Patel JM, Parekh D, Bangash MN
J Crit Care
· 2026 Aug · PMID 42105488
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BACKGROUND: The optimal parameter to assess cardiovascular function in sepsis is currently unknown. We investigated whether echocardiography-derived cardiac index offers superior haemodynamic monitoring and prognostic va...BACKGROUND: The optimal parameter to assess cardiovascular function in sepsis is currently unknown. We investigated whether echocardiography-derived cardiac index offers superior haemodynamic monitoring and prognostic value compared to left ventricular ejection fraction (LVEF) in ICU patients with sepsis. METHODS: We conducted a retrospective, single-centre cohort study in ICU patients with sepsis admitted between April 2016 and December 2021 that received a transthoracic echocardiogram (TTE) within seven days of sepsis onset. Correlation between CI and LVEF was assessed using the Spearman rank test. The 90-day mortality rates of normal, low and high CI and LVEF subgroups were compared. Multivariable logistic regression analysis was performed to determine the association of CI and LVEF phenotypes with mortality. RESULTS: 1731 patients were included and were aged 62 years (IQR 47-72), with 21% (n = 367) having septic shock. Ninety-day mortality was 32.5% (n = 561). Although CI and LVEF demonstrated moderate correlation (r = 0.51 (0.47-0.54), one-third of patients in a given CI subgroup were classified into a discordant LVEF subgroup. The 90-day mortality rates of low and high CI (54%, 54%) and low and high LVEF subgroups (43%, 59%) were broadly comparable and were higher than their normal CI (20%) and LVEF (23%) counterparts respectively. After regression analysis, low and high CI independently associated with mortality (OR 2.6 (1.8-3.7; p < 0.001), (OR 3.4 (2.7-4.4; p < 0.001), as did low and high LVEF subgroups (OR 1.6 (1.2-2.3; p = 0.004), OR 3.2 (2.4-4.3; p < 0.001). Stratifying CI subgroups into low, normal and high LVEF (and vice-versa) was associated with significantly different mortality rates. CONCLUSIONS: Although CI and LVEF were modestly correlated, this association weakened when either parameter was abnormal, highlighting their non-equivalence as haemodynamic parameters. While both markers exhibited comparable associations with mortality, their combination substantially improved prognostic accuracy.
J Crit Care
· 2026 Aug · PMID 42105487
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BACKGROUND/OBJECTIVE: This study evaluated the prognostic value and therapeutic modifiability of low-frequency pressure reactivity index (LPRx) in TBI patients, examining its dynamics related to 6-month clinical outcomes...BACKGROUND/OBJECTIVE: This study evaluated the prognostic value and therapeutic modifiability of low-frequency pressure reactivity index (LPRx) in TBI patients, examining its dynamics related to 6-month clinical outcomes (survival, Glasgow Outcome Scale Extended [GOSE]) and common neurocritical care interventions. METHODS: We conducted a retrospective analysis of 46 patients with moderate-to-severe traumatic brain injury (TBI) undergoing neurosurgery and intensive care unit (ICU) monitoring with minute-by-minute recordings at two Taiwanese university hospitals (2022-2024). LPRx (moving Pearson correlation of 1-min averaged arterial blood pressure and intracranial pressure (ICP)) and cerebral perfusion pressure (CPPopt) (nadir of LPRx-cerebral perfusion pressure curve) were calculated. Patients were stratified by 6-month survival and GOSE (favorable: GOSE 5-8; unfavorable: GOSE 1-4). LPRx relationships with outcomes, ICP, CPPopt, decompressive craniectomy, and osmotic therapy were analyzed using non-parametric tests and generalized estimating equations (GEE). RESULTS: In 46 patients (35 survivors, 11 with favorable outcomes), a higher median LPRx and a greater proportion of time with LPRx > thresholds (e.g., > 0.3) correlated with unfavorable outcomes. Early impaired LPRx (days 1, 3, 4) was associated with unfavorable function. LPRx showed a U-shaped ICP relationship (nadir ∼10 mmHg). CPPopt was derivable in only 32% of monitoring time, with no consistent LPRx relationship. Decompressive craniectomy and osmotherapy did not significantly alter LPRx (osmotherapy GEE: p = 0.786). CONCLUSION: Impaired cerebral autoregulation is associated with poor TBI outcomes. CPPopt has limited feasibility and inconsistent physiological correlation, which challenge its clinical utility. The responsiveness of LPRx to conventional therapies remains uncertain, warranting further investigation.
Pacini E, Alfaroli L, Asiller ÖÖ
… +7 more, Belletti A, Borello M, Fresilli S, Landoni G, De Backer D, Monti G, Air Embolism Group
J Crit Care
· 2026 Aug · PMID 42105486
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PURPOSE: Air embolism is a fatal complication of central venous catheter (CVC) manipulation. Its delayed occurrence after CVC removal is poorly understood and underrecognized. We conducted a systematic review to identify...PURPOSE: Air embolism is a fatal complication of central venous catheter (CVC) manipulation. Its delayed occurrence after CVC removal is poorly understood and underrecognized. We conducted a systematic review to identify all delayed air embolism following CVC removal. MATERIAL AND METHODS: We included case reports or case series that described venous or paradoxical air embolism occurring ≥10 min after CVC removal. Data extracted included patient demographics, catheter characteristics, removal technique, timing of symptoms onset, clinical presentation, diagnostic tools used, management or treatment and outcomes. RESULTS: Twenty-eight case reports were identified. Symptoms developed between ten minutes and one hour after removal of CVC in 54% of cases, between one and two hours in 14%, and after more than two hours in 32%. Neurological manifestations occurred in 92% of patients, oxygen desaturation in 90%, and cardiovascular instability in 47%; cardiac arrest was reported in only two cases. In 10 out of the 11 patients in which diagnostic tools were used to identify a cause, a transcutaneous channel was found. Ten patients were investigated for a patent foramen ovale (PFO), and six of them were negative. 18% had permanent neurological impairment and 32% died. CONCLUSIONS: Delayed air embolism after CVC removal is an uncommon but potentially severe complication associated with substantial morbidity and mortality. Persistent venous-to-atmospheric communication was identified by imaging techniques in >90% of cases. Increased vigilance during and after CVC removal is necessary to improve future clinical practice.
J Crit Care
· 2026 Aug · PMID 42092265
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PURPOSE: Understanding patients as persons is foundational to person-centred care, yet this is particularly challenging in intensive care units (ICUs), where patients are often unable to communicate. The Patient Dignity...PURPOSE: Understanding patients as persons is foundational to person-centred care, yet this is particularly challenging in intensive care units (ICUs), where patients are often unable to communicate. The Patient Dignity Question (PDQ)-"What do we need to know about you as a person in order to give you the best care possible?"-offers a brief means of eliciting personhood. This study qualitatively examined PDQ responses provided by family members of critically ill ICU patients to understand what families want clinicians to know about their loved ones. MATERIALS AND METHODS: Family members of critically ill adults admitted to four ICUs across three hospitals in Winnipeg, Canada, were recruited between July 2021 and August 2022. Following informed consent, participants completed brief PDQ-guided interviews conducted by trained researchers. Response summaries were verified with participants and analyzed using an interpretive description approach. Multiple coders iteratively identified themes describing patient personhood from the family perspective. RESULTS: PDQ responses from 33 family members revealed a central theme of Shared Narratives of Personal Identity, encompassing four interrelated themes: Patients at Their Core, Key Elements of the Person's Story, Illness Experience, and Messages from Family to Staff. Families highlighted personal qualities, relationships, values, roles, spirituality, life experiences, and the impact of illness. PDQs also conveyed practical care recommendations, gratitude, and hopes for comfort, dignity, and compassion. CONCLUSIONS: Family members provide rich insights into ICU patients' personhood. The PDQ is a feasible, low-resource tool for integrating personhood into ICU care and may support dignity-conserving, person-centred, and family-centred practice in high-acuity settings.
J Crit Care
· 2026 Aug · PMID 42085872
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BACKGROUND: Critically ill patients rapidly develop impairments in muscle quality during ICU stay, which are associated with poor recovery. Muscle ultrasound is a bedside tool to assess these changes, but the measurement...BACKGROUND: Critically ill patients rapidly develop impairments in muscle quality during ICU stay, which are associated with poor recovery. Muscle ultrasound is a bedside tool to assess these changes, but the measurement properties of visual grading scales such as the Heckmatt scale are not well established in this population. OBJECTIVE: To evaluate construct validity and inter-rater reliability of the Heckmatt scale. METHODS: Clinimetric study evaluating the construct validity and inter-rater reliability of the Heckmatt scale using peripheral muscle ultrasound in critically ill patients. Ultrasound images of the quadriceps (rectus femoris and vastus intermedius) and tibialis anterior were obtained on days 1, 3, and 7. Three blinded evaluators scored muscle quality using the Heckmatt scale. Echogenicity was quantified by grayscale analysis (0-255). Construct validity was assessed using Spearman correlations (rho) between Heckmatt scores and echogenicity. Inter-rater reliability was assessed using ICC(1, 2). RESULTS: On day 1, correlations were strong for rectus femoris (rho = 0.74, p < 0.001) and moderate for vastus intermedius and tibialis anterior (rho = 0.47-0.48, p < 0.001). On day 3, associations were weaker, with no significant correlation for vastus intermedius and tibialis anterior. On day 7, correlations were strong to very strong in the quadriceps (rho = 0.61-0.84, p < 0.001) and moderate in tibialis anterior (rho = 0.36, p = 0.01). Reliability was moderate to good on days 1-3 (ICC range 0.70-0.83) and decreased on day 7 (ICC range 0.48-0.50). CONCLUSION: The Heckmatt scale shows acceptable measurement properties for bedside assessment of muscle quality, particularly in larger muscles during early ICU stay.
Melo RH, Galantier J, Romano MLP
… +5 more, Romano ER, Felicio APV, da Hora Passos R, Gioli-Pereira L, de Azevedo LCP
J Crit Care
· 2026 Aug · PMID 42081873
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BACKGROUND AND AIMS: Septic shock is associated with high mortality, yet evidence supporting adjunctive therapies remains limited. Methylene blue (MB) has been proposed as a rescue therapy targeting catecholamine-resista...BACKGROUND AND AIMS: Septic shock is associated with high mortality, yet evidence supporting adjunctive therapies remains limited. Methylene blue (MB) has been proposed as a rescue therapy targeting catecholamine-resistant vasodilation, but its impact on clinically meaningful outcomes is uncertain. Oncologic patients represent a clinically distinct subgroup with high disease severity and are underrepresented in prior studies. We evaluated the association between MB and outcomes in oncologic patients with septic shock requiring multiple vasopressors. METHODS: We conducted a retrospective cohort study using the TriNetX Research Network, including adult oncologic patients with septic shock between January 1, 2015, and December 31, 2025. Septic shock requiring multiple vasopressors was defined as septic shock requiring norepinephrine plus at least one additional vasopressor (vasopressin or epinephrine). MB recipients were matched 1:1 with non-recipients using propensity score matching. The primary outcome was 30-day all-cause mortality. Secondary outcomes included acute kidney injury (AKI), renal replacement therapy (RRT), invasive mechanical ventilation, and vasopressor escalation within 7 days. RESULTS: Among 266 MB-treated patients and 10,163 controls, 262 balanced pairs were analyzed after matching. MB was associated with lower 30-day mortality (risk ratio [RR] 0.80, 95% CI 0.66-0.97). Favorable associations were observed for AKI and vasopressor escalation, whereas invasive mechanical ventilation did not differ between groups. CONCLUSIONS: In oncologic patients with septic shock requiring multiple vasopressors, MB use was associated with lower 30-day mortality; however, within the limitations of this retrospective study, these findings should be interpreted cautiously. Prospective randomized trials are warranted to clarify the role of MB in this high-risk population.
Deininger MM, Freund D, Jahnke L
… +5 more, Schumann-Stoiber KM, Haehn N, Hoffmann F, Regner F, Josuttis D
J Crit Care
· 2026 Aug · PMID 42068812
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BACKGROUND: Intensive care unit (ICU) demand is increasing, while healthcare professional shortages and turnover threaten capacity, care quality, and patient safety. This nationwide survey quantified intention to stay (I...BACKGROUND: Intensive care unit (ICU) demand is increasing, while healthcare professional shortages and turnover threaten capacity, care quality, and patient safety. This nationwide survey quantified intention to stay (ITS), leave (ITL), or being undecided among ICU professionals in Germany and assessed associated determinants. METHODS: An anonymous, nationwide, cross-sectional online survey of ICU physicians, registered nurses, and allied health professionals was conducted by the Young German Interdisciplinary Association of Critical Care and Emergency Medicine between December 2024 and February 2025. Primary outcome was ITS in the ICU for at least three years. Determinants were examined using multinomial logistic regression. RESULTS: Of 1524 questionnaires, 1243 were eligible; median ICU experience was 7 years. 51.1% of respondents were physicians, 39.1% registered nurses and 9.8% allied health professionals. Overall, 45.4% reported ITS, 23.2% ITL, and 31.2% were undecided. A 10-point higher job satisfaction was associated with greater ITS versus being undecided (OR 1.34, 95%-CI[1.24-1.45], p < 0.001) and ITL (OR 1.49, 95%-CI[1.37-1.62], p < 0.001). Similarly, higher perceived family-friendliness was associated with greater ITS versus ITL (OR 1.11, 95%-CI[1.02-1.20], p = 0.013). Rotating day-night shift work was associated with higher ITL (OR 0.56, 95%-CI[0.34-0.92], p = 0.021). Association of annual career development dialogues were attenuated after adjustment, consistent with indirect effects via job satisfaction. CONCLUSIONS: More than half of ICU professionals were at risk of leaving intensive care within three years. Job satisfaction and family-friendliness emerged as key correlates of retention. Prospective studies are needed to determine whether these aspects are potentially modifiable factors to improve retention.
Ihalainen V, Pölkki A, Moser A
… +8 more, Takala J, Jakob SM, Bendel S, Raj R, Pekkarinen PT, Koivisto T, Starkopf J, Reinikainen M
J Crit Care
· 2026 Aug · PMID 42066690
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BACKGROUND: The Glasgow Coma Scale-based score (GCS) is used to describe the level of consciousness in critically ill patients. In risk-prediction models, an abnormal GCS carries a heavy weight, without considering the c...BACKGROUND: The Glasgow Coma Scale-based score (GCS) is used to describe the level of consciousness in critically ill patients. In risk-prediction models, an abnormal GCS carries a heavy weight, without considering the cause of impaired consciousness. We assessed the association between low GCS and mortality across individual diagnoses. METHODS: In this retrospective register-based study, we examined 58,982 admissions to 20 ICUs in Finland, Estonia, and Switzerland between 2015 and 2017. We divided the patients into two categories using Acute Physiology And Chronic Health Evaluation (APACHE) III diagnoses: Neurologic and Other diagnoses. We used the lowest GCS recorded during the first 24 h after intensive care unit (ICU) admission. We defined GCS below 9 as low. We analysed the association between low GCS and the risk of death in each APACHE III diagnosis and in the Neurologic and Other diagnoses categories using hierarchical logistic regression. RESULTS: There were 17,275 (29%) patients in the Neurologic category and 41,707 (71%) in the Other diagnoses category. Low GCS was recorded in 4266 (25%) patients in the Neurologic category and 6078 (15%) in the Other diagnoses category. Low GCS was associated with increased risk of death in the Neurologic category [odds ratio (OR) 11.3, 95% confidence interval (CI) 8.0-15.9] and in the Other diagnoses category (OR 4.8, 95% CI 3.9-5.8). The impact of low GCS varied widely between individual diagnoses within both categories. CONCLUSION: Low GCS was a strong predictor of death, but its relative weight was highly dependent on the diagnosis.