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

Propofol-Based Sedation Is Associated With Significant Reduction in MAP in Patients Receiving Invasive Mechanical Ventilation

A retrospective cohort study in Critical Care Explorations quantified MAP changes following propofol sedation in 16,418 patients receiving invasive mechanical ventilation and identified risk factors for hemodynamic instability. Propofol-based sedation was associated with a MAP reduction within the first 30 minutes (−6.58 mm Hg; 95% CI, −6.85 to −6.32; P < 0.001). There was substantial interpatient variability in both baseline MAP, and MAP decline after sedation (9.5 and 40.9% between-patient differences, respectively). Higher SOFA scores (−0.31 mm Hg/point), older age (−0.04 mm Hg/yr), and male sex (−0.47 mm Hg) were associated with lower MAP. Patients with higher illness severity experienced progressively greater MAP decline over time (−0.20 mm Hg/hr/SOFA point; P < 0.001). The interpatient variability in MAP responses suggests the importance of personalized management approaches, including risk stratification based on age, sex, and illness severity.

Beta-Blocker Therapy for MI Was Associated With Evidence of Harm in Women

An RCT of 8438 patients, published in European Heart Journal, evaluated the effect of beta-blockers after acute MI with LVEF < 40%. A sex-specific subgroup analysis was performed. During a median follow-up of 3.7 years, women had overall higher rates of death, MI, or heart failure hospitalization than men. The incidence rate of the primary endpoint in women was 30.4 and 21.0/1000 patient-years in the beta-blocker group and no beta-blocker group, respectively (hazard ratio 1.45, 95% CI, 1.04-2.03). No significant differences were observed in men (hazard ratio .94; 95% CI, 79-1.13; P for interaction = .026). Women with preserved LVEF who received higher beta-blocker doses were at greater risk of harm, an effect not found in men.

Drawing and Storytelling Reduce Anxiety and Improve Emotional Well-Being in Children Hospitalized in PICUs

An RCT of 70 children (aged 7-12 years), published in European Journal of Pediatrics, evaluated the effectiveness of drawing and mutual storytelling techniques in reducing anxiety and improving emotional well-being. The intervention group received therapeutic communication sessions involving drawing and mutual storytelling techniques, delivered by a trained researcher over 2 consecutive days, while the control group received standard care. After the intervention, the mean anxiety score significantly decreased in the intervention group (36.84 ± 9.6) compared to the control group (43.84 ± 8.3; P = 0.002, Cohen's d = 0.78). According to Koppitz test results, feelings of insecurity and inadequacy were significantly lower in the intervention group (36.7%) than in the control group (70.0%; P = 0.010). Integrating these interventions into routine nursing care may enhance pediatric patient outcomes.

Early Hyperferritinemia Predicts Adverse Outcomes in Polytrauma Patients Reflecting Systemic Inflammation and Organ Failure

A multicenter, prospective observational study in Inflammation Research investigated the temporal dynamics of serum ferritin in 1475 polytrauma patients and its association with systemic inflammation, organ dysfunction, and mortality. Hyperferritinemia (≥ 500 ng/mL) occurred in 39.3% of patients, with mortality rising from 9.2% (ferritin < 500 ng/mL) to 66.7% (ferritin ≥ 3000 ng/mL) (P < 0.001). Ferritin > 1000 ng/mL was an independent mortality risk factor (OR = 1.91, P = 0.004), correlating with elevated inflammatory hyperferritinemia markers (IL-6, CRP), hepatic/renal dysfunction (AST↑, eGFR↓), and coagulopathy (INR↑). Survivors exhibited a steeper ferritin decline (−233 vs. −146 ng/mL, P < 0.001), while nonsurvivors sustained hyperferritinemia. Serial ferritin monitoring post-injury may enhance risk stratification, serving as a pragmatic biomarker for guiding intensive care and targeted interventions.

Blood Pressure Response Index is a Powerful Predictor for In-hospital Mortality Among Patients With Cardiogenic Shock Admitted to the ICU

A multicenter, prospective study in Journal of the American Heart Association explored the relationship between the blood pressure response index (BPRI) and outcomes in 1842 patients with cardiogenic shock (CS). Clinical data of patients with CS admitted to the ICU from the MIMIC-IV (v3.1) database and the eICU Collaborative Research Database (eICU-CRD) was extracted. BPRI had a better AUROC for predicting in-hospital mortality than SOFA scores and BOS, MA2 risk score in both the MIMIC-IV and eICU-CRD cohorts. An L-shaped association between BPRI and in-hospital mortality (P for nonlinear <0.001), with the cutoff values at 2.4 in both cohorts, was found. The newly developed model utilizing BPRI demonstrated a good predictive ability for in-hospital mortality among patients with CS (AUC 0.799). The application of BPRI can help clinicians achieve early warning of mortality risk and early decision-making, guide the use of vasoactive drugs, and assist with risk stratification.

Sepsis Survivors Incur High Healthcare Costs That Can Persist for Years After Discharge From Initial Hospitalization

A systematic review of 20 observational studies in Critical Care aimed to describe the post-hospitalization healthcare costs among adults in developed nations who survived an episode of sepsis. Across studies, the median total healthcare cost among sepsis survivors in year 1 after discharge was $28,719 (IQR $21,715) and the median total healthcare cost in year 2 after discharge was $22,460 (IQR $14,407). The median cost of a readmission for sepsis survivors was $20,320 (IQR $4,889). These findings emphasize the long-term economic burden of sepsis, suggesting that sepsis is an important target for policy and practice interventions that could improve health outcomes and reduce costs. 

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