Critical Care Explorations

BackgroundPulse oximeters are typically validated on cohorts of 200-500 subjects under controlled conditions. Whether these cohorts capture the demographic heterogeneity of national clinical practice -- and whether measurement error is associated with patient outcomes -- has not been established at scale. MethodsWe analyzed paired SpO2/SaO2 readings from three independent sources spanning 209 U.S. hospitals: MIMIC-IV (1 hospital; 12,934 ICU stays), eICU-CRD (208 hospitals; 55,178 stays), and th...

ObjectiveTo develop and validate a predictive model incorporating behavioral telemetry signals--documentation pattern anomalies derived from routine EHR charting--alongside clinical variables for ICU mortality prediction in patients with low acute physiologic derangement. Materials and MethodsRetrospective cohort study of 46,002 adult ICU stays from MIMIC-IV v3.1 (2008-2022) with SOFA scores 0-2, excluding neurological units. We extracted 66 variables spanning demographics, acuity, behavioral t...

RationaleAutonomic dysfunction is a hallmark of sepsis pathophysiology, yet its quantification remains challenging. Multiscale entropy (MSE) derived from heart rate variability (HRV) offers a dynamic measure of physiological complexity and may serve as a biomarker of early deterioration associated with subsequent organ failure, vasopressor escalation, or mortality. ObjectiveTo determine whether MSE computed across multiple temporal scales during the first 24 hours of Intensive Care Unit (ICU) a...

BackgroundQuality measurement in intensive care emphasizes task completion--whether assessments were documented and protocols followed. Electronic health record (EHR) systems capture these signals in real time, yet current metrics cannot distinguish task completion from cognitive clinical engagement. A prior analysis demonstrated that omission of orientation assessment predicted a 4.29-fold increase in hospital mortality among low-acuity ICU patients [1]. Whether combining this marker with routi...

Background: Severity scoring systems such as SOFA, NEWS2, and qSOFA effectively identify deteriorating ICU patients by aggregating physiological parameters into composite indices that trigger clinical alerts. However, these systems evaluate patient state at discrete time points and do not model the temporal dynamics of organ deterioration or the pharmacokinetic constraints that govern whether a given intervention can achieve therapeutic effect before an organ trajectory crosses an irreversible t...

BACKGROUNDDelirium is common in critically ill adults but often goes unrecognized and undertreated. Little is known about the perceptions of ICU nurse and physician leaders regarding ICU delirium detection and management and the potential role of objective continuous delirium monitoring to facilitate ICU delirium care. RESEARCH QUESTIONWhat are the perceptions of ICU leaders regarding the current challenges associated with delirium recognition and management and the potential benefits of contin...

BackgroundEarly lactate is widely used to risk-stratify septic shock, yet clinically actionable cut-offs for 28-day mortality remain uncertain. MethodsIn a single-centre study conducted across two intensive care units, we analysed 84 adults with septic shock identified within 24 hours of intensive care unit admission. The primary endpoint was 28-day mortality. Four lactate metrics obtained during the first 24 hours were evaluated: first (admission) lactate, last lactate, peak lactate, and lacta...

ObjectivesTo develop and validate pediatric adaptations of the Venous Excess Ultrasound Score (P-VExUS) for noninvasive estimation of central venous pressure (CVP) in critically ill children. DesignProspective observational study. SettingPICU of a tertiary-care teaching hospital. PatientsFifty-six mechanically ventilated children (median age 7.4 months, median weight 6.0 kg) with central venous catheters. InterventionsNone. Measurements and Main ResultsVenous Doppler ultrasonography of the ...

ObjectiveDespite substantial variability in the severity of post-anoxic encephalopathy, all comatose patients after cardiac arrest are usually treated according to the same standardized intensive care protocol, including sedation, mechanical ventilation, and targeted temperature management (TTM). We hypothesize that patients with a favourable EEG pattern (continuous EEG within 12 hours after cardiac arrest) may not benefit from prolonged sedation and TTM. We studied the feasibility and safety of...

BackgroundSepsis is a major public health challenge, and reliable biomarkers are essential for distinguishing sepsis from other conditions. Neutrophil Gelatinase-Associated Lipocalin (Neutrophil gelatinase-associated lipocalin (NGAL)) has shown promise as a diagnostic marker due to its role in the immune response. This study evaluates plasma NGAL as a diagnostic tool at the time of ICU admission. MethodsWe analysed plasma NGAL and C-reactive protein (CRP) levels in 4732 adult patients admitted ...

BackgroundBehavioral telemetry--the analysis of clinical actions NOT taken--may identify care process failures associated with adverse outcomes. While missed nursing care predicts outcomes in survey-based studies, objective EHR-derived measures are lacking. We hypothesized that missing routine cognitive assessment in ICU patients with low acute physiologic derangement would predict mortality independent of illness severity. MethodsRetrospective cohort study using MIMIC-IV (2008-2022, Beth Israe...

PurposeSepsis-associated immunothrombosis significantly contributes to high mortality, yet the role of N-glycosylation in this process remains poorly understood. This study aimed to comprehensively profile the plasma N-glycosylation landscape in sepsis and elucidate how its specific reprogramming in the complement and coagulation cascades influences immunothrombotic balance and patient outcomes. MethodsWe performed in-depth 4D-DIA proteomic and N-glycomic analyses on plasma from 43 sepsis patie...

The red cell distribution width (RDW) is a recognized prognostic marker in sepsis, yet its dynamic changes over time and their relationship with outcomes remain unexplored. This study aimed to identify distinct RDW trajectories during the early phase of sepsis and evaluate their association with mortality. We conducted a retrospective cohort study using data from the MIMIC-IV database (n=3,813) as the derivation cohort and from the First Affiliated Hospital of Kunming Medical University (n=467) ...

ImportanceRecent reports have highlighted an intense influenza activity related to the circulation of the influenza A(H3N2) subclade k variant. There is no data available on the impact of the emergence of H3N2 subclade k on the severity of the 2025-2026 epidemic or on the clinical phenotype of patients requiring admission to the intensive care unit (ICU). ObjectiveTo compare the clinical presentation, hospital mortality and virological characteristics of patients with laboratory-confirmed influ...

BackgroundNursing documentation patterns may reflect patient acuity and clinical deterioration, yet their prognostic value remains underexplored. We developed the Intensive Documentation Index (IDI), a novel framework quantifying temporal documentation rhythms, and evaluated its ability to enhance ICU mortality prediction.58 MethodsWe analyzed 26,153 ICU admissions of heart failure patients from the MIMIC-IV database (2008-2019). Nine IDI features capturing documentation rhythm, volume, and sur...

Emergency department (ED) triage decisions critically impact patient care and are standardized, yet ethnoracial disparities in triage assignment are well documented. We analyzed ethnoracial differences in triage assignments across four U.S. EDs (two adult, two pediatric), comprising 1.4 million encounters from 2011-2025. To better characterize these disparities, we developed an automated triage algorithm that replicates the Emergency Severity Index (ESI) criteria, the standard triage protocol us...

Machine learning adoption in clinical decision support systems remains limited by concerns about transparency and robustness. Causal structure learning (CSL) combined with expert knowledge may address these concerns by identifying potentially causal predictors, enabling more interpretable and clinically aligned models. In this study, we show that by integrating clinician expertise with CSL algorithms we can identify plausible causal drivers of acquired acute brain dysfunction (ABD) in the pediat...

BackgroundNeonatal jaundice management increasingly relies on transcutaneous bilirubinometry (TcB), yet discrepancies with serum bilirubin (TSB) have limited its clinical reliability. This study introduces Skin Residual Bilirubin Volume (SRBV) as a physiologically grounded framework to enhance TcB interpretation. ObjectiveTo evaluate SRBV as an explanation for TcB-TSB discordance and assess whether incorporating SRBV improves the interpretability and reliability of TcB measurements during diagn...

BackgroundPropofol dosing guidelines recommend age-based reductions because hypnotic sensitivity increases in older adults. Most real-world evaluations of induction practice, however, have relied on total weight-normalized dose (mg/kg) rather than estimating cerebral exposure using pharmacokinetic models. Because age-related pharmacokinetic changes alter the relationship between administered dose and peak effect-site concentration (Ce,max), mg/kg surrogates may misrepresent true age-dependent ex...

Sepsis is a complex condition with a time-dependent evolution. Longitudinal biomarker dynamics could help us to better characterise sepsis. We hypothesised that the kinetics of biomarkers are associated with sepsis and with the intensity of organ dysfunction, and may have predictive capacity for patient survival. This single-centre, prospective, observational study included adult patients presenting to the Emergency Department (ED) with suspected infection. Patients were included in the study i...