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

Ethnicity and Socioeconomic Deprivation May Be Linked to Greater Risk of Certain Complications After Pediatric Cardiac Surgery

A retrospective analysis of a multicenter observational dataset in Critical Care Explorations aimed to describe social characteristics and explore links with postoperative complications of heart surgery in children. Minoritized ethnic groups were strongly linked to indices of deprivation. Residence in neighborhoods with highest deprivation occurred with Bangladeshi, Black African, and Pakistani ethnicity, while lowest deprivation occurred with White ethnicities. Compared with White patients, patients from Asian backgrounds had a significantly higher risk of developing single vs. no complications (OR, 1.53; 95% CI, 1.00-2.32), and Black patients had a higher risk of developing multiple vs. no complications (OR, 2.19; 95% CI, 1.09-4.41). Among single complications, Asian children had a higher risk of developing feeding issues (OR, 2.07; 95% CI, 1.13-3.28).

CT-Assessed Skeletal Muscle Mass at the Lumbar Level May Serve as Prognostic Marker in Critically Ill Patients

A systematic review and meta-analysis of 35 studies in Critical Care explored the association between CT-derived skeletal muscle mass at the lumbar level and short- and long-term mortality in critically ill patients. Most of the studies were retrospective and included heterogeneous populations such as patients with sepsis, COVID-19, and trauma. Skeletal mass was mostly reported as the skeletal muscle index at the third lumbar vertebra. Meta-analyses showed that low skeletal muscle mass area and index were significantly associated with increased risks of both short-term mortality (OR, 2.33; 95% CI, 1.90-2.87, I² = 41.39%) and long-term mortality (OR, 2.67; 95% CI, 1.45-4.92, I² = 62.24%). The overall prevalence of low muscle mass was 42% (95% CI, 34-49%, I² = 98.2%). The study concluded that CT-assessed skeletal muscle mass at the lumbar level on admission to ICU is associated with both short- and long-term mortality.

Liberal Transfusion Strategies Safely Improve Neurologic Outcomes in Adults With ABI

A systematic review and meta-analysis in Journal of Clinical Medicine evaluated the efficacy and safety of a liberal transfusion strategy in adults with acute brain injury (ABI). Five RCTs (2385 patients) comparing liberal and restrictive transfusion strategies in 2385 adult patients admitted to ICUs with ABI were included. Liberal transfusion significantly reduced unfavorable neurologic outcomes (RR, 0.88; 95% CI, 0.82-0.95; P = 0.0009) without affecting mortality (RR, 0.97; 95% CI, 0.84-1.11; P = 0.66). A meta-analysis of two studies (1465 patients) showed improved functional independence with liberal strategies (MD, 6.70; 95% CI, 2.07-11.33; P = 0.005) but there was no difference in quality of life (P = 0.30). Sepsis or septic shock occurred less frequently in the liberal group (RR, 0.68; 95% CI, 0.50-0.92; P = 0.01). Improvement in neurologic outcomes was specifically found in patients with TBI. Further studies are needed in patients with subarachnoid hemorrhage.

Elevated Cystatin C Is an Early Biomarker of Kidney Dysfunction in Former Preterm Children and Adolescents

A systematic review and meta-analysis of 13 studies in Pediatric Nephrology evaluated kidney health outcomes in former very preterm (gestational age ≤ 32 weeks) children and adolescents compared to full-term peers. Very preterm children and adolescents had higher serum cystatin C (0.05 mg/L; 95% CI, 0.02-0.08), lower Cr-eGFR (–11.87 mL/min/1.73 m2; 95% CI, –22.44 to –1.31), and higher SBP (1.96 mm Hg; 95% CI, 0.21-3.71). Sensitivity analysis confirmed cystatin C findings but rendered Cr-eGFR and SBP differences nonsignificant. Insufficient data prevented the assessment of additional kidney function parameters. While differences in Cr-eGFR and SBP were insignificant after sensitivity analysis, these markers remain relevant for long-term follow-up in this vulnerable population.

Esketamine May Decrease Norepinephrine Dosage in Patients With Septic Shock Receiving Invasive Mechanical Ventilation

An RCT in Drug Design, Development and Therapy compared the hemodynamic effects and prognosis of esketamine and remifentanil in combination with propofol in patients with septic shock receiving invasive mechanical ventilation. Sixty patients were assigned to each group. The norepinephrine dosage in the esketamine group was less than that of the remifentanil group (P = 0.007). There were no significant differences between the two groups with respect to adverse event rate, intestinal dysfunction rate, propofol dosage, mechanical ventilation time, ICU length of stay, hospital length of stay, and hospital mortality (P > 0.05). Kaplan-Meier survival analysis showed no significant difference in 28-day survival rate between the two groups (P = 0.225). Esketamine is beneficial for stabilizing hemodynamics and appears to be an effective and safe agent for patients with septic shock requiring invasive mechanical ventilation.

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