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...

BackgroundThe role of arterial blood gas (ABG) testing in the intensive care unit (ICU) remains debated within the "less is more" paradigm. While unnecessary testing may pose risks without benefit, timely ABGs provide critical information in unstable patients. Institutional variation in early ABG utilization and its association with outcomes remains unclear. MethodsWe conducted a multicenter retrospective cohort study using the Japanese Intensive Care PAtient Database (JIPAD) between April 2015...

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...

ObjectiveTo assess whether focal and non-focal COVID-19 ARDS exhibit different respiratory mechanics and arterial blood gas (ABG) trajectories during the first extended prone positioning (PP) session. DesignPost-hoc analysis of a previously published retrospective monocentric cohort study. SettingA university-affiliated intensive care unit in Paris (France) between March 2020 and April 2021. PatientsSeventy-four adult patients with moderate-to-severe COVID-19 ARDS who underwent extended prone...

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 ...

RationalePatients receiving prolonged mechanical ventilation are often discharged to long-term acute care hospitals (LTACHs) with hopes of recovery and ultimately return to the community. Among those who survive and undergo tracheostomy, little is known about their quality of life and social outcomes after LTACH discharge. ObjectiveMeasure health related quality of life in a cohort of critical illness survivors who underwent tracheostomy and an LTACH stay MethodsSingle center, prospective obse...

Purposeto describe HRV metrics in Covid-19 patients at admission in the ICU and its relationship with mortality and invasive mechanical ventilation (IMV). Heart rate variability (HRV) in sitting position in critically ill patients has not been explored. Methodswe conducted a prospective single-centre observational study. Adult patients admitted in the ICU with respiratory failure due to RT-PCR-confirmed SARS-CoV-2 but not under IMV were included. Electrocardiogram was recorded at least for 15 m...

BackgroundIn-hospital cardiac arrest (IHCA) survival has improved over the past two decades, resulting from better acute resuscitation survival. Post-resuscitation care is a key link in the IHCA chain-of-survival, yet post-resuscitation survival has remained stagnant over time. HypothesisWe hypothesized substantial hospital-to-hospital variation exists in risk-standardized post-resuscitation survival rate (RSSR) and hospital-area social deprivation is associated with worse RSSR. MethodsWe perf...

IntroductionReliable estimation of mortality among critically ill patients is crucial for guiding clinical decisions and optimizing ICU performance. Traditional scoring systems such as APACHE, SOFA, and SAPS are commonly applied, though their predictive capacity is constrained by their reliance on static structures and linear modeling assumptions. Artificial intelligence-based models provide flexible, data-oriented prediction strategies, yet their comparative accuracy remains unclear. This study...

BackgroundPatients with acute respiratory failure requiring non-invasive respiratory support are at high risk of deterioration. Different advanced monitoring instruments are available that can provide objective measurements. However, there is currently no evidence synthesis on these instruments. The aim of this project is to systematically synthetise data identifying the advanced monitoring instruments used and their effectiveness. MethodsWe conducted a systematic search of MEDLINE (via Pubmed)...

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...

IntroductionHyperferritinemia is a prognostic marker in critical illness, but its role in postoperative outcomes of pediatric congenital heart defects remains poorly defined, especially in resource-limited settings. This study evaluated early serum ferritin as a predictor of outcomes after congenital heart surgery and its association with the PIM 3 score. MethodsA single-center, prospective cohort study was conducted from April 2023 to October 2024 at a tertiary referral center in southeastern ...

BackgroundMedication-related morbidity due to inappropriate prescribing, delays in appropriate treatment, and adverse drug events are major contributors to mortality in acutely hospitalized adults. Comprehensive medication management (CMM) is a standard for medication therapy care provided by pharmacists in collaboration with the interprofessional rounding team. Optimization of CMM via appropriate pharmacist staffing practices may reduce mortality. MethodsAdults admitted to an intensive care un...