Journal of critical care
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Journal of critical care · Feb 2025
Cumulative impact of hypotension during intermittent hemodialysis on kidney recovery in critically ill patients with AKI-D.
Intermittent hemodialysis (IHD) is commonly implemented in patients with AKI-D, irrespective of the initial kidney replacement therapy (KRT) modality. However, concerns remain regarding the hemodynamic instability during IHD. This study aimed to assess the association between hypotensive episodes during IHD and kidney recovery in AKI-D patients. ⋯ Our study revealed that IHD-related hypotension during hospitalization has a cumulative negative impact on kidney recovery in AKI-D survivors.
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Journal of critical care · Feb 2025
Clinician assessment of kidney function from plasma creatinine values during critical illness: A scenario-based international multi-professional survey.
During critical illness interpretation of serum creatinine is affected by non-steady state conditions, reduced creatinine generation, and altered distribution. We evaluated healthcare professionals' ability to adjudicate underlying kidney function, based on simulated creatinine values. ⋯ Participants displayed marked variation in estimation of kidney function, suggesting difficulty in accounting for multiple confounders. There is need for alternative, unbiased measures of kidney function in critical illness to avoid misclassifying kidney disease.
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Journal of critical care · Feb 2025
Fever following extracorporeal membrane oxygenation decannulation: Infection, thrombosis or just physiology?
Fever is frequent after extracorporeal membrane oxygenation (ECMO) decannulation. We aimed to evaluate the incidence of post-decannulation fever and describe its causes. ⋯ Post-decannulation fever was common, and was mainly due to infections or thrombosis. Fever should therefore not be considered as a benign inflammatory reaction until proven otherwise.
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Journal of critical care · Feb 2025
Multicenter StudyIntensivists' ethical perceptions about decisions to withhold or withdraw treatment: A clinical ethics empirical investigation.
Intensive care professional societies have issued policy recommendations regarding decisions to withhold and/or withdraw treatment (Wh&Wd) that consistently classify them as ethically equivalent and ethically neutral. However, on the ground they are often perceived as "active" and morally problematic. Moreover, recent studies have highlighted personal "variability" in the way such decisions are made. Therefore, it seemed necessary to explore intensivists' different ethical perceptions about Wh&Wd decisions. ⋯ The study results allow for recognition of intensivists' moral distress about Wh&Wd decisions and open new perspectives to deal with their deep-rooted variability, most notably by working on the rationale and format of the collegial decision-making procedure.
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Journal of critical care · Feb 2025
Multicenter StudyPrognosis of major bleeding based on residual variables and machine learning for critical patients with upper gastrointestinal bleeding: A multicenter study.
Upper gastrointestinal bleeding (UGIB) is a significant cause of morbidity and mortality worldwide. This study investigates the use of residual variables and machine learning (ML) models for predicting major bleeding in patients with severe UGIB after their first intensive care unit (ICU) admission. ⋯ ML models using residuals improved the accuracy and interpretability in predicting major bleeding during ICU admission in patients with UGIB. These interpretable features may facilitate the early identification and management of high-risk patients, thereby improving hemodynamic stability and outcomes.