van Gelder TG, Lalmohamed A, Egberts TCG
… +4 more, Slooter AJC, Zegers M, van den Boogaard M, van Diem-Zaal IJ
J Crit Care
· 2026 Aug · PMID 41962414
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OBJECTIVE: To assess whether exposure to interleukin-6 (IL-6) inhibitors as treatment for critically ill COVID-19 patients is associated with a lower prevalence of mental health problems one year after ICU admission. DES...OBJECTIVE: To assess whether exposure to interleukin-6 (IL-6) inhibitors as treatment for critically ill COVID-19 patients is associated with a lower prevalence of mental health problems one year after ICU admission. DESIGN: Retrospective cohort study using prospectively collected outcome data. SETTING: Two university medical centers in the Netherlands: University Medical Center Utrecht (UMCU) and Radboud University Medical Center (Radboudumc). PATIENTS: Adult ICU survivors admitted to the ICU for COVID-19 from September 1, 2020, to March 31, 2022, with available one-year follow-up data. EXPOSURE: IL-6 inhibitors (tocilizumab or sarilumab) as treatment for COVID-19. MEASUREMENTS AND MAIN RESULTS: Mental health problems were assessed using the Impact of Event Scale (IES-6 or IES-R) for post-traumatic stress disorder (PTSD) and the Hospital Anxiety and Depression Scale (HADS) for anxiety and depression. The primary outcome was a composite of PTSD, anxiety, and/or depression symptoms one year after ICU admission. Among 170 patients included in the primary analysis (119 exposed to IL-6 inhibitors, 51 unexposed), IL-6 inhibitor exposure was associated with a lower prevalence of mental health problems (adjusted odds ratio (aOR) 0.46, 95% confidence interval (CI) 0.22-0.93) and PTSD symptoms alone (aOR 0.45, 95% CI 0.20-0.97). No significant associations were found for anxiety (aOR 0.77, 95% CI 0.34-1.72) or depression (aOR 0.71, 95% CI 0.33-1.50) symptoms alone. CONCLUSIONS: Exposure to IL-6 inhibitors as treatment for critically ill COVID-19 patients was associated with a lower prevalence of mental health problems, primarily driven by a lower prevalence of PTSD symptoms, one year after ICU admission. These findings suggest a potential role for cytokine-targeted therapies in mitigating long-term mental health problems in ICU survivors, but further research is needed to establish causality. KEY POINTS: Question: Does treatment with interleukin-6 (IL-6) inhibitors during ICU admission for COVID-19 reduce the prevalence of mental health problems one year later? FINDINGS: In this multicenter cohort study of 170 COVID-19 ICU survivors, IL-6 inhibitor exposure was associated with a significantly lower prevalence of PTSD and of the composite outcome of PTSD, anxiety, or depression symptoms one year after ICU admission. Meaning: These findings suggest that IL-6 inhibition during critical illness may help mitigate long-term psychological burden in ICU survivors.
J Crit Care
· 2026 Aug · PMID 41955922
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OBJECTIVE: Fluid overload contributes to extubation failure in mechanically ventilated patients. Point-of-care ultrasonography, particularly the Venous Excess Ultrasound Score (VExUS), enables noninvasive assessment of v...OBJECTIVE: Fluid overload contributes to extubation failure in mechanically ventilated patients. Point-of-care ultrasonography, particularly the Venous Excess Ultrasound Score (VExUS), enables noninvasive assessment of venous congestion. The effect of positive end-expiratory pressure (PEEP) on renal venous congestion is unclear. We aimed to explore the effect of PEEP titration on renal venous congestion metrics assessed by ultrasonography in mechanically ventilated patients. METHODS: We conducted a non-randomized crossover study in the ICU of a tertiary hospital, enrolling adults immediately prior to ventilator liberation. Each patient underwent renal Doppler ultrasonography at PEEP 5 and 10 cmH₂O, with crossover to the alternate setting separated by a one-hour interval. Intrarenal venous flow (IRVF) patterns, venous impedance index (VII), and renal resistive index (RRI) were assessed. IRVF was analyzed descriptively, while mixed-effects regression accounted for crossover design and cumulative fluid balance. RESULTS: Thirty-five patients (median age, 68 years; 62.9% male) were analyzed. IRVF patterns were stable across PEEP levels; however, three patients (8.6%) transitioned to a different IRVF pattern. VII increased significantly with higher PEEP (difference, 0.08; 95% CI, 0.01-0.14). RRI did not change significantly (difference, 0.005; 95% CI, -0.012 to 0.022). CONCLUSIONS: In this exploratory study, increasing PEEP from 5 to 10 cmH₂O was associated with a higher VII, while IRVF patterns and RRI showed minimal change. PEEP titration may contribute to variability in sonographic assessment of renal congestion. For patients approaching ventilator liberation, serial ultrasonography is best interpreted at the same or similar PEEP levels to ensure accurate fluid evaluation and VExUS scoring.
O'Grady HK, Marcella B, Patel P
… +19 more, Dolanjski B, Smith K, Chau C, Goligher E, Hays LMC, Hussaini A, Levi Z, Lother SA, Lucas B, Mahon N, Muscedere J, Nichol A, Pineau C, Santos M, Tolppa T, Marshall JC, Kho ME, Murthy S, Tsang JLY
J Crit Care
· 2026 Aug · PMID 41955921
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INTRODUCTION: There is increasing interest in patient and family-centered methods to improve research consent processes in the intensive care unit (ICU) environment. Because of the complexities of ICU care, measures of i...INTRODUCTION: There is increasing interest in patient and family-centered methods to improve research consent processes in the intensive care unit (ICU) environment. Because of the complexities of ICU care, measures of impact from multiple perspectives, including patients, substitute decision makers (SDMs) and research personnel, are required. OBJECTIVE: To determine what outcome measures have been used to assess the quality of informed consent for adult ICU-based research. METHODS: We conducted a scoping review of ICU-based clinical research, involving adult patients, SDMs, and/or research personnel, that reported any outcome measure assessing the quality of informed consent. Screening and data charting were completed in duplicate. Charted data included study, participant and outcome measure characteristics. We summarized characteristics using descriptive statistics and narrative summaries. RESULTS: We screened 18,164 unique citations, 102 full-texts, and included 9 studies. No studies used the same outcome measure. Most (n = 8, 89%) used a subjective questionnaire-based assessment of the consent process, while one (11%) measured quality by time to consent decision. We identified seven constructs assessed by outcomes: 1) consent discussion experience; 2) experience making consent decisions; 3) knowledge of parent study; 4) consent document experience; 5) perceived research risk; 6) experience of research, and 7) research processes. CONCLUSIONS: We identified a limited, heterogeneous body of literature assessing the quality of informed consent for ICU-based research. This highlights an important gap and an unmet need for the development and validation of comprehensive outcome measures to evaluate the quality of informed consent from the perspectives of patients, SDMs and research personnel.
Kotani Y, Karumai T, Yamamoto R
… +1 more, Hayashi Y
J Crit Care
· 2026 Aug · PMID 41950761
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BACKGROUND: The ratio of mean arterial pressure (MAP) to norepinephrine equivalent dose (NED) may better quantify the degree of hemodynamic instability by incorporating both patient response and intervention intensity. O...BACKGROUND: The ratio of mean arterial pressure (MAP) to norepinephrine equivalent dose (NED) may better quantify the degree of hemodynamic instability by incorporating both patient response and intervention intensity. OBJECTIVES: To evaluate the prognostic performance of the MAP/NED ratio for mortality. METHODS: This single-center retrospective cohort study consecutively included adult critically ill hypotensive patients who received norepinephrine infusion of at least 5 μg/min (in base formulation) within the first 24 h of intensive care unit (ICU) stay. The exposure of interest was the lowest MAP/NED ratio during the initial 24 h. The primary outcome was hospital mortality. We assessed the predictive validity of the lowest MAP/NED ratio for hospital mortality using logistic regression and area under the receiver operating characteristic curve (AUC). We compared the AUC of the lowest MAP/NED ratio with those of the lowest MAP and highest NED. RESULTS: Among 937 patients, hospital mortality was 29%. After adjustment for clinically relevant covariates, the lowest MAP/NED ratio remained independently associated with hospital mortality (adjusted odds ratio for the highest vs. lowest tertile, 0.60; 95% CI, 0.38-0.92). The AUC of the lowest MAP/NED ratio was 0.625, which was superior to that of the lowest MAP (0.562) and comparable to that of the highest NED (0.625). CONCLUSIONS: In adult patients receiving vasopressor infusion, the lowest MAP/NED ratio within 24 h of ICU admission was independently associated with hospital mortality. Its prognostic discrimination was slightly higher than that of the lowest MAP value and comparable to that of the highest NED.
van Beuningen FE, Visser M, van Munster BC
… +3 more, Ter Maaten JC, Bouma HR, Acutelines Investigators
J Crit Care
· 2026 Aug · PMID 41936233
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Hospital readmission after sepsis poses a substantial burden on the healthcare system. The aim of this study was to characterize hospital readmissions after sepsis in terms of risk factors, underlying causes, readmission...Hospital readmission after sepsis poses a substantial burden on the healthcare system. The aim of this study was to characterize hospital readmissions after sepsis in terms of risk factors, underlying causes, readmission timing and long-term outcome after readmission. We included patients from the Acutelines data- and biobank who were hospitalized with sepsis. The primary outcome was acute all-cause hospital readmission, with infection-related hospital readmission as secondary outcome. Among 851 patients with sepsis, 219 (26%) were readmitted within 90 days. 67% was readmitted due to an infectious reason. In 70% of cases, this infection was at the same site as the initial infection, and in 50% of the cases, it was also the same type of pathogen. Viral sepsis was associated with a higher risk of readmission than bacterial during the first month after discharge; after this time-point, the readmission risk after viral sepsis declined, while the risk after bacterial sepsis remained high. Risk factors associated with all-cause hospital readmission were malignancy, the use of immunosuppressants, the use of analgesics, and a higher SOFA score during admission, whereas haemoglobin at triage and sepsis due to SARS-CoV-2 were associated with lower risk for all-cause readmission. History of an organ transplantation and a bacterial and viral co-infection were associated with infection-related hospital readmission. Patients who were readmitted had higher long-term mortality rates than patients who were not readmitted. In conclusion, efforts to reduce readmission should focus on preventing infections, particularly in patients who are immunocompromised due to either comorbidities or medication use.