‌Review the Latest Research in Critical Care

Exclusively for SCCM Select and Professional members, Critical Pulse contains late-breaking and important information to help your practice.

Urea-to-Creatinine Ratio Is an Emerging Biomarker in Critical Care

A scoping review and meta-analysis of 47 studies in Critical Care (London, England) assessed the role of the urea-to-creatinine ratio (UCR) in critical illness. UCR is inversely correlated to muscle cross-sectional area over time and associated with length of ICU stay, suggesting its potential role in identifying patients with ongoing protein catabolism. A UCR ≥ 80 mmol/L (BUN/Cr ≥ 20mg/dL) upon ICU admission, in comparison with a UCR < 80 mmol/L, was associated with a relative risk of 1.60 (95% CI, 1.27-2.00) and an adjusted hazard ratio of 1.29 (95% CI, 0.89-1.86) for in-hospital mortality. UCR elevations during critical illness could indicate muscle protein catabolism and progression to persistent critical illness. High UCR levels at ICU admission could be associated with mortality. UCR increments during an ICU stay may also indicate excessive exogenous dietary protein intake, overwhelming the body's ability to use it for whole-body or muscle protein synthesis.

AI/ML-Based Triage Models Hold Promise in Improving ED Efficiency and Patient Outcomes

A systematic review of 26 studies in Intensive Critical Care Nursing evaluated AI/ML-driven triage and risk stratification models in EDs, focusing on predictive performance, key predictors, clinical and operational outcomes, and implementation challenges. ML-based triage models consistently outperformed traditional tools, often achieving AUCs > 0.80 for high-acuity outcomes (e.g., hospital admission, ICU transfer). Key predictors included vital signs, age, arrival mode, and disease-specific markers. Incorporating free-text data via natural language processing enhances accuracy and sensitivity. Reported benefits included reduced ED overcrowding, improved resource allocation, fewer mistriaged patients, and potential patient outcome improvements. Integrating AI and ML into ED triage can enhance assessment accuracy and resource allocation.

Antiplatelet Therapy Lowers Risk of Short-Term Mortality in Patients With Sepsis

A systematic review and meta-analysis of 21 studies in PloS One assessed the potential benefits and risks of antiplatelet therapy in patients with sepsis. Antiplatelet therapy was associated with significantly lower risk of in-hospital mortality (RR, 0.76; 95% CI, 0.67-0.87), and mortality at 1-month (RR, 0.77; 95% CI, 0.66, 0.90) and 3-month (RR, 0.77; 95% CI, 0.66-0.90) follow-up. The risk of complications was comparable in all patients (RR, 1.01; 95% CI, 0.84-1.21). The duration of ICU or overall hospital stay was not impacted by antiplatelet therapy. The findings support the use of antiplatelet agents as a beneficial adjunctive therapy in sepsis management.

Prone Positioning During VV ECMO Is Linked to Lower Mortality in Patients With Acute Hypoxemic Respiratory Failure

A systematic review and meta-analysis in Intensive Care Medicine assessed the effects of prone positioning on mortality and other outcomes in patients receiving VV ECMO for acute hypoxemic respiratory failure. Two RCTs and 20 non-RCTs totaling 3465 patients were analyzed. Prone positioning was associated with lower 28-day (OR, 0.64; 95% CI, 0.42-0.98) and hospital (OR, 0.67; 95% CI, 0.54-0.83) mortality compared with no prone positioning despite fewer 28-day ventilator-free days and longer ECMO duration. However, these findings do not imply causation. Further research is needed to clarify the role of prone positioning in this population.

Clinician Lack of Knowledge and Communication Between Disciplines Are Barriers to Optimal Sepsis Care

A systematic review of 50 articles in BMC Health Services Research aimed to provide a qualitative synthesis of literature related to clinicians’ perspectives on sepsis care, emphasizing perceived barriers and facilitators to the care of patients with sepsis and sepsis survivors. Six domains were identified, related to the underlying disease, the patient, the clinician, the guidelines, the healthcare system, and the collaboration among clinicians. Clinicians’ level of knowledge and lack of communication between disciplines and/or sectors were reported as shortcomings in each phase of the care pathway. This review suggests that interventions that provide continuous clinician education as well as standard communication channels between disciplines (e.g., emergency medical services, resident physicians, ED nurses, and acute care physicians) have great potential to improve structural deficiencies in sepsis care.

Hyperoxemia Is Associated With Poor Neurologic Outcomes and Mortality in Patients With Acute Brain Injury

Updated meta-analyses of 66 studies in Critical Care (London, England) evaluated the association of arterial hyperoxemia with neurologic outcomes and mortality in adults with acute brain injury. A meta-analysis including 24 studies (16,635 patients) demonstrated that patients with hyperoxemia are more likely to develop poor neurologic outcomes (unadjusted OR, 1.295; 95% CI, 1.040-1.616) compared with those with no hyperoxemia, particularly in subarachnoid hemorrhage and ischemic stroke subgroups. A meta-analysis including 35 studies (98,207 patients) revealed that all-cause mortality is more likely (OR, 1.13; 95% CI, 1.002-1.282) in patients with hyperoxemia compared with no hyperoxemia. The results suggest the importance of carefully adjusting oxygenation strategies in neurocritical ICUs.

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