Badell CS, Lizarazo Jimenez M, Lopez Jesus AI
… +10 more, Rojas T, Soares F, Solorzano-Salazar DM, Figueroa LA, Wilson G, Palomino LE, Fung KK, Chyn ETY, Ruiz EF, Ponce-Ponte OJ
J Crit Care
· 2026 Aug · PMID 41933548
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PURPOSE: Intensive care unit (ICU) admissions among older adults with dementia have more than doubled in the past two decades, now representing over 15% of ICU admissions. This population is particularly vulnerable to fu...PURPOSE: Intensive care unit (ICU) admissions among older adults with dementia have more than doubled in the past two decades, now representing over 15% of ICU admissions. This population is particularly vulnerable to functional decline and complications following critical illness. This study systematically reviewed evidence on ICU utilization and outcomes among older adults with dementia compared with those without dementia. METHODS: We conducted a systematic review and random-effects meta-analysis of cohort studies (2003-2023) identified in MEDLINE, EMBASE, SCOPUS, and Web of Science. Pooled odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated. RESULTS: Fifteen studies from six countries including 1,738,285 patients (173,107 with dementia) met inclusion criteria. Adjusted analyses showed no difference in ICU mortality (OR 1.05,95%CI 1.00-1.11;n = 1). However, dementia was associated with higher 30-day (OR 1.54,95%CI 1.47-1.62;n = 1) and 12-month mortality (OR 1.95,95%CI 1.88-2.02;n = 1). Patients with dementia also had lower odds of receiving mechanical ventilation (OR 0.69,95%CI 0.60-0.80;n = 3) and higher odds of developing delirium (OR 4.80, 95%CI 1.81-12.72;n = 1). CONCLUSIONS: Older adults with dementia admitted to ICUs experience similar ICU mortality but higher long-term mortality, more delirium, and lower odds of mechanical ventilation. These findings highlight the need for prospective studies to guide patient-centered ICU care in this population.
J Crit Care
· 2026 Aug · PMID 41932217
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Delirium is a frequent and serious complication among critically ill patients requiring mechanical ventilation. In response to the recent study by Prendergast et al., this correspondence highlights important consideratio...Delirium is a frequent and serious complication among critically ill patients requiring mechanical ventilation. In response to the recent study by Prendergast et al., this correspondence highlights important considerations regarding prediction models for sedative-associated delirium during acute respiratory failure. Particular attention is given to the complex pathophysiology of delirium, the influence of non-pharmacologic risk factors and the potential role of emerging biomarker-based approaches. These perspectives aim to support continued refinement of delirium prediction strategies and stimulate further research to improve neurological outcomes in critically ill populations.
Subramaniam A, Wong J, Ku D
… +14 more, Carr C, Gupta S, Ku SC, Kuroda Y, Yunos NM, Nhan LD, Pradian E, Rimal A, Rungruanghiranya S, Ryu HG, Sainbayar A, See KC, Woon CY, Hong SLC
J Crit Care
· 2026 Aug · PMID 41932216
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OBJECTIVE: To summarise the proceedings of the third Asia Pacific Critical Care Societies Summit and identify regionally aligned priorities for the "Future of Your ICU" across diverse health systems. DESIGN: Structured r...OBJECTIVE: To summarise the proceedings of the third Asia Pacific Critical Care Societies Summit and identify regionally aligned priorities for the "Future of Your ICU" across diverse health systems. DESIGN: Structured regional priority-mapping summit report and thematic synthesis of society presentations, informed by comparative evidence and contextual analysis. SETTING: Satellite meeting of the Asia Pacific Intensive Care Symposium, convened in Singapore on 17 August 2025, 14 Asia Pacific Critical Care Societies participated in the summit report. MAIN OUTCOME MEASURES: Qualitative thematic analysis and prioritisation of strategic domains across staged time horizons. RESULTS: Analysis of society presentations identified shared and divergent priorities, which were synthesized into a staged regional framework. Four overarching domains emerged: (1) Workforce, Education, and Wellbeing; (2) Infrastructure, Access, and Equity; (3) Technology, Innovation, and Data; and (4)) Population Health, Research, and Ethics. Short-term priorities (0-3 years) focused on addressing workforce shortages and infrastructure deficits. Medium-term priorities (3-6 years) emphasised digital integration, including tele-ICU and selective use of artificial intelligence and embedding ethical governance. Long-term goals (7-10 years) included advancing equity, and strengthening research capacity, particularly for digital health technologies. Notable heterogeneity was observed, with high-income countries prioritising digital maturity and precision care, while low- and middle-income countries focused on workforce expansion and ICU bed capacity. CONCLUSIONS: The "Future of Your ICU" in the Asia Pacific region requires a staged, context-sensitive approach. Aligning immediate investment in human and physical capacity with medium-term digital innovation and long-term research and ethical frameworks offers a pragmatic pathway toward sustainable, equitable, and human-centred critical care systems. X/TWITTER MESSAGE: The #APICS2025 Summit set a roadmap for the Future of Your ICU: A vision for resilient, sustainable, human-centered critical care by 2035. #CriticalCare #APICS, #APCCS.
Maji C, Kokiwar PR, Biradar A
… +1 more, Jauhari R
J Crit Care
· 2026 Aug · PMID 41932215
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We read with interest the recent multicenter post hoc cohort study evaluating serum urea nitrogen-to-creatinine ratio (UCR) trajectories in patients with acute kidney injury receiving continuous renal replacement therapy...We read with interest the recent multicenter post hoc cohort study evaluating serum urea nitrogen-to-creatinine ratio (UCR) trajectories in patients with acute kidney injury receiving continuous renal replacement therapy (CRRT). The authors identified three groups using group-based multitrajectory modeling and reported higher mortality in patients with elevated UCR or lactate. While the study addresses an important question in critical care risk stratification, several methodological and interpretive issues merit clarification. First, the identified classes appear to be driven primarily by baseline differences in UCR and lactate rather than clearly distinct longitudinal trajectories, raising the possibility that the findings reflect baseline prognostic stratification rather than true temporal phenotypes. Comparison with simpler baseline models incorporating day-1 variables would help determine the added value of the trajectory approach. Second, the requirement for at least two days of CRRT and the use of data up to day 3 for classification may introduce survivor or guarantee-time bias, as phenotype assignment depends on continued survival and treatment exposure. Analytical approaches such as landmark analysis or time-to-event modeling from a uniform baseline could improve validity. Third, UCR may be influenced by CRRT related factors, including modality, effluent dose, and nutritional support, complicating its biological interpretation as a marker of catabolism or illness severity. Adjustment for these variables would help distinguish treatment effects from underlying pathophysiology. Addressing these issues would strengthen the clinical applicability of UCR in risk stratification during CRRT.
J Crit Care
· 2026 Aug · PMID 41915953
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This letter evaluates Rousseau et al.'s recent study on post-intensive care unit dyslipidemia. While commending their focus on metabolic sequelae, we propose three clinical refinements. First, defining "de novo" hypertri...This letter evaluates Rousseau et al.'s recent study on post-intensive care unit dyslipidemia. While commending their focus on metabolic sequelae, we propose three clinical refinements. First, defining "de novo" hypertriglyceridemia using acute-phase ICU lipid troughs risks overestimating its true incidence, as these values represent pathological stress rather than physiological baselines. Second, profound post-discharge lifestyle transitions, particularly severe physical inactivity and ad libitum diets, must be considered alongside systemic inflammation as primary drivers. Finally, stratifying the cohort's diverse admission etiologies is essential to avoid diluting distinct metabolic phenotypes and improve targeted post-ICU care.
J Crit Care
· 2026 Aug · PMID 41905173
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We read with great interest the article by Kitisin et al. published in the Journal of Critical Care. In our letter, we focus on raising a key methodological concern: when "persistent AKI" is defined as "lasting more than...We read with great interest the article by Kitisin et al. published in the Journal of Critical Care. In our letter, we focus on raising a key methodological concern: when "persistent AKI" is defined as "lasting more than 48 hours from AKI onset," and serum creatinine and urine output are only specified as "at least twice daily" assessments, the heterogeneity in monitoring intensity among different patients may influence outcome determination. Variable sampling frequencies (potentially related to disease severity or influenced by clinicians' awareness of uACR results) alter the capture of AKI onset and recovery time points, leading to outcome misclassification near the 48-h threshold and potentially weakening (underestimating) the true association between uACR and persistent AKI in the present study.
Víðisson K, Kander T, Lengquist M
… +3 more, Mellhammar L, Linder A, Nilsson CU
J Crit Care
· 2026 Aug · PMID 41903245
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BACKGROUND: Sepsis-induced coagulopathy (SIC) is a scoring system developed for early detection of coagulopathy in sepsis and selection of patients for interventional studies. Our aim was to define the prevalence of SIC...BACKGROUND: Sepsis-induced coagulopathy (SIC) is a scoring system developed for early detection of coagulopathy in sepsis and selection of patients for interventional studies. Our aim was to define the prevalence of SIC in a critically ill population and investigate if SIC at intensive care unit (ICU) admission is associated with morbidity and mortality. METHODS: Patients admitted with septic shock between 2011, and March 2024 were propensity matched into 2 groups (control and SIC). Primary outcome was 28-day mortality. Other outcomes were 90-, 180-day and ICU-mortality, days alive and free of vasopressors, mechanical ventilation and renal replacement therapy (RRT) along with the use of RRT, number of critical bleeding events and red blood cell transfusion. RESULTS: 1367 patients with septic shock were identified, 422 (31%) had SIC at ICU admission. Propensity matching resulted in 340 patients in each group. SIC was not associated with higher 28-day mortality (44% versus 37%, p = 0.091). ICU-mortality was higher in the SIC group (30% versus 22%, p = 0.016) and it had fewer median days alive and free of vasopressors (20 versus 22, p = 0.046). Incidence of critical bleeding events was higher in the SIC group (17% versus 10%, p = 0.009). More patients in the SIC group required red blood cell transfusion (63% versus 53%, p = 0.009). There was no significant difference in other outcomes. CONCLUSION: SIC was prevalent in 31% of patients at ICU admission and was associated with higher ICU-mortality, fewer days alive and free of vasopressors, more critical bleeding events and more red blood cell transfusions.