‌VIEW IN BROWSER

‌Review the Latest Research in Critical Care

We know how busy you are caring for critically ill patients. That’s why, as a Select or Professional member, you receive Critical Pulse—a concise, curated update with the latest information and insights to help you stay current and deliver the highest-quality care.

Machine Learning Models Demonstrate Strong Performance for the Prediction of Outcomes in Patients With Spontaneous Intracerebral Hemorrhage

A systematic review and meta-analysis published in Brain and Behavior evaluated the performance of machine learning (ML) models in predicting key adverse outcomes in patients with spontaneous intracerebral hemorrhage (ICH). Eighty-three studies comprising at least 136,840 patients were included. Pooled concordance index (C-index), sensitivity, and specificity were calculated using a random-effects or bivariate model. Meta-analysis findings demonstrated that models integrating both clinical and radiomics features achieved the highest discriminative performance across key prognostic prediction tasks: predicting hematoma expansion (pooled C-index = 0.822; 95% CI, 0.789-0.855), poor functional outcome (C-index = 0.850; 95% CI, 0.830-0.869), and mortality (C-index = 0.860; 95% CI, 0.809-0.911). As true external validation remains sparse, further validation in diverse cohorts is needed.

Routine Intensive Glucose Control Does Not Improve Survival in ICU Patients Compared to Liberal Glucose Control

A systematic review and meta-analysis published in Nursing in Critical Care compared the benefits and risks of intensive versus liberal glucose control in ICU patients. Seventy RCTs comprising 36,502 patients were included. There was no significant difference between all-cause mortality after intensive and liberal glucose control in both adults and children. Intensive glucose control had a statistically significantly higher risk of severe hypoglycemia in both children (RR = 5.70; 95% CI, 2.60-12.51) and adults (RR = 3.55; 95% CI, 2.49-5.07). However, intensive glucose control had a statistically lower risk of infection in both children (RR = 0.83; 95% CI, 0.70-0.98) and adults (RR = 0.78; 95% CI, 0.63-0.97). These findings suggest that routine intensive glucose control does not improve survival and should be applied cautiously due to increased risk of hypoglycemia.

Evidence Shows No Significant Mortality Benefit for Prehospital Whole Blood Over Standard Blood-Component Therapy in Adult Patients With Traumatic Hemorrhagic Shock

A systematic review and meta-analysis published in The American Journal of Emergency Medicine evaluated the efficacy and safety of prehospital whole blood (WB) resuscitation compared with the standard care blood components (BCs) in adult patients with traumatic hemorrhagic shock. Three RCTs comprising 2,048 patients were included. Prehospital WB did not differ significantly from BCs in 24-hour all-cause mortality (OR = 1.12; 95% CI, 0.81-1.55; P = 0.49) or 28- to 30-day mortality (OR = 1.15; 95% CI, 0.90-1.47; P = 0.28). Massive transfusion within 24 hours (OR = 1.09; 95% CI, 0.80-1.50) and thromboembolic complications (deep-vein thrombosis, pulmonary embolism, and ischemic stroke) likewise showed no significant difference. Since only 3 trials of limited size and quality were included in the analysis, future RCTs are needed to confirm the findings.

Therapeutic Hypothermia May Be a Feasible, Safe, and Effective Intervention in Patients With Acute Traumatic Spinal Cord Injury

A systematic review and meta-analysis published in Archives of Academic Emergency Medicine evaluated the impact of systemic or local hypothermia on neurological outcomes, mortality, and ICU stay in patients with spinal cord injury (SCI). Six studies comprising 156 patients were included. Intervention methods included surface, and endovascular techniques to maintain body temperature at 32 to 34^oC for 24 to 72 hours, initiated between 1.6 to 70 hours after the injury. Pooled analyses showed decreased mortality with RR = 0.57 (95% CI, 0.05-5.88; P = 0.6883), improved Association Impairment Scale grade with RR = 2.96 (95% CI, 0.01-939.31; P = 0.3098), and decreased ICU length of stay with MD = ‒1.27 days (95% CI, ‒2.46 to ‒0.07; P = 0.9658) in SCI patients receiving hypothermia. Complications included pneumonia, hypotension, and bradycardia. No hypothermia-related deaths were reported. Early initiation (< 6 hours) was consistently linked with superior functional improvement.

Structured Nutritional Protocols Improve Caloric Adequacy in Critically Ill Children

A systematic review and meta-analysis published in Frontiers in Pediatrics evaluated the use of structured nutritional protocols to improve caloric adequacy in critically ill children. Nine studies comprising 1,992 children across 6 countries were included. Nutritional protocols were associated with a pooled MD of +21.98% in caloric adequacy (P < 0.001), with a substantial heterogeneity (I2 = 73.9%). Both nurse-led (MD, +19.16%) and non‒nurse-led protocols (MD, +23.95%) improved delivery without a significant between-group difference (P = 0.51). The findings support wider adoption of protocolized feeding as a standard of care in PICUs globally.

Sensory Stimulation May Improve Level of Consciousness, Reduce Incidence of Delirium, and Shorten Awakening Time in ICU Patients

A systematic review and meta-analysis in Dimensions of Critical Care Nursing aimed to evaluate the effects of sensory stimulation (SS) on the level of consciousness, incidence and duration of ICU delirium, awakening time, and duration of mechanical ventilation in ICU patients. Twenty-two RCTs comprising 1,522 patients were included. Compared with routine care, SS improved the level of consciousness (MD = 2.09; 95% CI, 1.50-2.68; P < 0.001) and reduced the incidence (OR = 0.33; 95% CI, 0.18-0.62; P < 0.001) and duration of delirium (MD = –2.63; 95% CI, ‒3.32 to ‒2.03; P < 0.001) in ICU patients and shortened the awakening time (MD = –7.39; 95% CI, –8.76 to –6.01; P < 0.001). Subgroup analyses suggest that SS delivered by family members is more effective than that delivered by nurses. Subgroup analyses also suggest that multisensory stimulation is more effective than single-modality stimulation, and an intervention period of at least 7 days is required to achieve a significant effect, with twice-daily SS appearing to be the optimal frequency.

‌This message was sent to: sccmcommunity@sccm.org

Your Member Type: Nonmember

Communications Preferences or Unsubscribe | Privacy Policy | Contact SCCM 

© Society of Critical Care Medicine. 500 Midway Drive Mount Prospect, IL 60056 USA