---
title: "Critical Care Clinical Research Feed | MedicHelpline"
specialty: "Critical Care"
specialty_slug: "critical-care"
canonical_url: "https://medichelpline.com/clinical-feed/critical-care"
content_type: "clinical_feed_specialty"
page: 1
articles_in_batch: 30
generated_at: "2026-09-05T23:52:19.209Z"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Critical Care — Clinical Research Feed
## Specialty Overview: Critical Care
Latest peer-reviewed clinical trials, guidelines, and observational research in **Critical Care**, indexed and structured for clinical intelligence and AI reasoning.
## Latest Critical Care Publications
### 1. [High-Flow Nasal Cannula (HFNC) Outside PICU for Children >1 Year: Narrative Review Summary](https://medichelpline.com/clinical-feed/pubmed-42698348.md)
- **Source:** PubMed / NCBI | **Published:** 2026-09-05 | DOI: [10.1111/jpc.70572](https://doi.org/10.1111%2Fjpc.70572)
- **Detail Markdown URL:** [High-Flow Nasal Cannula (HFNC) Outside PICU for Children >1 Year: Narrative Review Summary](https://medichelpline.com/clinical-feed/pubmed-42698348.md)

> **Executive GIST:** - This narrative review examines evidence for **high-flow nasal cannula (HFNC)** therapy used outside paediatric intensive care units (PICUs) in children older than 12 months with acute respiratory distress. - The review addressed a literature search of PubMed, Scopus and Medline (OVID) up to October 2025 focused on emergency department and ward settings. - Eight studies met inclusion: six randomised controlled trials, one pilot RCT and one observational cohort. - Conditions covered included **asthma**, **pneumonia** and mixed hypoxaemic respiratory failure rather than bronchiolitis or neonatal populations. - Small trials demonstrated early physiological improvements with HFNC but did not show consistent benefits in hospital length of stay or PICU admission. - Flow rates used across studies were highly variable; several trials delivered flows below thresholds commonly considered necessary to achieve a true high-flow physiological effect. - The largest included trial reported longer hospital stay and higher PICU admission rates when **HFNC** was used early compared with conventional oxygen therapy. - Overall safety and tolerability of HFNC in these settings appeared acceptable in the included studies. - The authors conclude there is insufficient evidence to support routine first-line use of HFNC outside PICU in children over 1 year. - They emphasise the need for further prospective research to define which patient groups may benefit and recommend institution-level policies, clear escalation criteria and close monitoring where HFNC is used outside the PICU.

### 2. [Fulminant hyperammonemia during chemotherapy linked to occult partial OTC deficiency](https://medichelpline.com/clinical-feed/pubmed-42698052.md)
- **Source:** PubMed / NCBI | **Published:** 2026-09-05 | DOI: [10.1007/s12185-026-04271-6](https://doi.org/10.1007%2Fs12185-026-04271-6)
- **Detail Markdown URL:** [Fulminant hyperammonemia during chemotherapy linked to occult partial OTC deficiency](https://medichelpline.com/clinical-feed/pubmed-42698052.md)

> **Executive GIST:** - Reported is a case of a woman in her 40s with **acute myeloid leukemia (AML)** who developed fulminant nonhepatic **hyperammonemia** during high-dose cytarabine consolidation therapy. - On day 5 of consolidation she manifested rapidly progressive altered consciousness with markedly elevated serum ammonia despite preserved liver and kidney function and absence of active sepsis. - Brain MRI demonstrated cortical changes more consistent with **metabolic encephalopathy** than with cytarabine neurotoxicity or posterior reversible encephalopathy syndrome (PRES). - The clinical course progressed to rising ammonia levels, generalized seizures, diffuse cerebral edema, and death despite supportive care. - Metabolic workup suggested a **urea cycle disorder**; genetic testing identified a heterozygous pathogenic variant in the **ornithine transcarbamylase (OTC)** gene, indicating previously unrecognized partial OTC deficiency. - Adult cases of severe nonhepatic hyperammonemia in hematologic malignancy patients are often labeled idiopathic or infection-related; genetically proven urea cycle disorders in this context are rare. - This case broadens the recognized spectrum of chemotherapy-associated nonhepatic hyperammonemia by implicating an occult inherited metabolic predisposition as a potential contributor to pathogenesis. - The report emphasizes the need for early recognition and consideration of hyperammonemia in unexplained encephalopathy during intensive chemotherapy to enable timely metabolic evaluation and management.

### 3. [Multicentre European study of Moraxella blood isolates: epidemiology, susceptibility, and phylogen](https://medichelpline.com/clinical-feed/pubmed-42698036.md)
- **Source:** PubMed / NCBI | **Published:** 2026-09-05 | DOI: [10.1007/s10096-026-05640-z](https://doi.org/10.1007%2Fs10096-026-05640-z)
- **Detail Markdown URL:** [Multicentre European study of Moraxella blood isolates: epidemiology, susceptibility, and phylogen](https://medichelpline.com/clinical-feed/pubmed-42698036.md)

> **Executive GIST:** - The article titled “Moraxella species isolated from blood cultures in Europe (MORAXEu)” reports a **multicentre** investigation of **Moraxella** species recovered from **blood cultures** across European centres, with focus on **epidemiology**, **antimicrobial susceptibility**, and complementary **phylogenomic analysis** of publicly available genomes. - The study is published in Eur J Clin Microbiol Infect Dis (online ahead of print) with DOI 10.1007/s10096-026-05640-z and PubMed entry dated 2026 Sep 5. - The author list is large and multinational, with lead affiliations including the Department of Microbiology, University of Oslo and Oslo University Hospital, Norway, and numerous collaborating microbiology and clinical departments across Greece, Bulgaria, Croatia, Romania, Slovenia, Austria, Slovakia, Czech Republic, Poland, Sweden, France, Denmark, Germany and other European centres. - The project combined laboratory data from multiple European clinical microbiology centres with a complementary **phylogenomic analysis** using publicly available genomes; the title specifies both empirical antimicrobial susceptibility testing and genome-based phylogenetic work. - Specific methodological details (sample size, inclusion dates, antimicrobial panels, susceptibility results, resistance rates, genomic methods, phylogenomic findings, and clinical outcomes) are not reported in the provided source excerpt. - The source listing indicates the work is an online ahead-of-print article; full abstract, results, and conflict-of-interest statements are accessible in the full PubMed record but were not included in the provided text. - The collaborative network includes clinical microbiology, infectious diseases, paediatrics, and molecular microbiology departments, indicating an interdisciplinary approach to bloodstream Moraxella isolates across Europe. - Because the provided source text is largely bibliographic and authorship metadata, no study-specific quantitative findings or recommendations can be extracted from this excerpt.

### 4. [Inspiratory Flow and I:E Ratio Effects on Aerosol Deposition During Mechanical Ventilation](https://medichelpline.com/clinical-feed/pubmed-42537825.md)
- **Source:** PubMed / NCBI | **Published:** 2026-09-05 | DOI: [10.1016/j.ijpharm.2026.127242](https://doi.org/10.1016%2Fj.ijpharm.2026.127242)
- **Detail Markdown URL:** [Inspiratory Flow and I:E Ratio Effects on Aerosol Deposition During Mechanical Ventilation](https://medichelpline.com/clinical-feed/pubmed-42537825.md)

> **Executive GIST:** - The study examined how **inspiratory flow** and inspiratory-to-expiratory (I:E) ratio affect aerosol transport and respiratory tract deposition during controlled mechanical ventilation using two nebulizer technologies: a **vibrating mesh nebulizer (VMN)** and a **jet nebulizer (JN)**. - Experiments used a validated ex vivo porcine respiratory model under **volume-controlled ventilation** with active heated humidification; nebulizers were positioned 15 cm upstream of the Y-piece. - Inspiratory flow settings compared were **35 L/min vs 60 L/min**; I:E ratios compared were **1:2 vs 1:3**. - Aerosol deposition was quantified by **planar scintigraphy** with radiolabeled aerosol and a mass-balance approach. - VMN had significantly higher delivery efficiency than JN in all tested conditions. - With VMN, lower inspiratory flow (35 L/min) increased respiratory tract deposition (57% ± 8% vs 45% ± 5%; p = 0.022). - Prolonging the expiratory phase (I:E 1:3 vs 1:2) further improved deposition with VMN (60% ± 9% vs 45% ± 5%; p < 0.0001) and reduced losses in the inspiratory limb. - JN produced low output and showed no significant variation in deposition across the ventilatory settings evaluated. - The authors conclude that ventilatory parameters significantly influence aerosol deposition with **VMN** but not **JN** in this mechanical ventilation model; combining lower inspiratory flow and prolonged expiratory time increased deposition with VMN. - The study objective was to assess interaction between ventilatory parameters and aerosol generation technology, not to declare commercial-device superiority. - The authors note that further studies are needed to determine whether these preclinical findings translate into clinical benefit.

### 5. [Ciclesonide–Indacaterol Liposomes: Optimizing ICS/LABA Pulmonary Delivery for Asthma](https://medichelpline.com/clinical-feed/pubmed-42486206.md)
- **Source:** PubMed / NCBI | **Published:** 2026-09-05 | DOI: [10.1016/j.ijpharm.2026.127217](https://doi.org/10.1016%2Fj.ijpharm.2026.127217)
- **Detail Markdown URL:** [Ciclesonide–Indacaterol Liposomes: Optimizing ICS/LABA Pulmonary Delivery for Asthma](https://medichelpline.com/clinical-feed/pubmed-42486206.md)

> **Executive GIST:** - Combination inhaled corticosteroid–long-acting β2-agonist therapy is central to asthma care, but lung delivery is limited by **drug hydrophobicity**, mucus entrapment and macrophage clearance, which reduce target-site availability and force higher doses or more frequent administration. - The authors report systematic optimization of a **liposomal** co-delivery system for **ciclesonide (CIC)** and **indacaterol maleate (IND)** to overcome pulmonary barriers and improve efficacy. - Among PEGylated lipids tested, **DSPE-PEG** was selected because its amine function enhances IND encapsulation through amine–phosphate interactions and its 18-carbon chain showed better macrophage biocompatibility than C14 and C16 analogs. - A DSPE-PEG content of **15%** was used to balance mucopenetration and macrophage evasion, and this formulation improved the ex vivo relaxation effect of IND compared with the free drug solution. - **DLPC** was chosen as the main phospholipid because its double unsaturation (two double bonds) was required to achieve high encapsulation efficiency for both hydrophobic drugs, facilitate epithelial cell uptake in vitro, and enhance ex vivo potency of IND. - In an ovalbumin (OVA)-induced murine asthma model, the optimized liposomal formulation significantly attenuated **airway hyperresponsiveness** and suppressed the type 2 inflammatory cascade, including epithelial alarmins, downstream cytokines, and inflammatory cell recruitment. - Liposomal encapsulation provided a potential **dose-sparing** effect for both CIC and IND, indicating more efficient pulmonary delivery and a promising strategy for asthma and possibly other respiratory diseases. - The study emphasizes formulation-driven solutions (lipid choice and PEGylation level) to biological barriers rather than altering active agents; detailed quantitative metrics and some experimental parameters were reported in the original article but are not reproduced in full here.

### 6. [Seco-tanapartholide B activates PKM2 to reprogram glycolysis and reduce acute lung injury](https://medichelpline.com/clinical-feed/pubmed-42208465.md)
- **Source:** PubMed / NCBI | **Published:** 2026-09-05 | DOI: [10.1016/j.bioorg.2026.110040](https://doi.org/10.1016%2Fj.bioorg.2026.110040)
- **Detail Markdown URL:** [Seco-tanapartholide B activates PKM2 to reprogram glycolysis and reduce acute lung injury](https://medichelpline.com/clinical-feed/pubmed-42208465.md)

> **Executive GIST:** - The study reports that **seco-tanapartholide B (SB)**, a sesquiterpene lactone from Artemisia argyi, reduces inflammation and glycolysis in models of **acute lung injury (ALI)** induced by lipopolysaccharide (LPS). - SB was shown to directly bind and activate **PKM2**, identified using thermal proteome profiling (TPP), CETSA, DARTS, and BLI target-engagement assays. - LC-MS/MS mapping indicated a covalent modification of PKM2 at **Cys424** via SB’s α-methylene-γ-lactone moiety, which enhanced pyruvate kinase activity and promoted PKM2 tetramer formation. - Activation and tetramerization of PKM2 by SB correlated with suppression of **glycolysis** and downregulation of inflammation-associated signaling pathways, including NF-κB and STAT3, and reduced HIF-1α expression. - Genetic knockdown of PKM2 diminished SB’s anti-inflammatory and glycolysis-inhibitory effects in macrophages, supporting on-target activity. - The authors propose SB as a natural **PKM2 activator** that links metabolic reprogramming to anti-inflammatory effects and suggest PKM2 tetramerization as a therapeutic strategy for ALI/ARDS. - The work extends the potential application of PKM2 activators beyond oncology into inflammatory lung disease and provides biochemical evidence for covalent activation of PKM2 by a plant-derived compound. - Details on experimental models, dosing, quantitative outcomes, and safety data were not reported in the abstract and require consultation of the full text for specifics.

### 7. [Validation of the STUMBL Score vs ISS for Predicting Outcomes in Blunt Thoracic Trauma](https://medichelpline.com/clinical-feed/pubmed-42003070.md)
- **Source:** PubMed / NCBI | **Published:** 2026-09-05 | DOI: [10.5090/jcs.25.143](https://doi.org/10.5090%2Fjcs.25.143)
- **Detail Markdown URL:** [Validation of the STUMBL Score vs ISS for Predicting Outcomes in Blunt Thoracic Trauma](https://medichelpline.com/clinical-feed/pubmed-42003070.md)

> **Executive GIST:** - This prospective cohort study at Dr. Saiful Anwar General Hospital in Malang, Indonesia evaluated the performance of the **STUMBL score** versus the **Injury Severity Score (ISS)** for patients with blunt thoracic trauma. - Study period was February 2024 to April 2025 and included adult patients (≥18 years) with confirmed blunt thoracic trauma and a Glasgow Coma Scale of 14–15. - Demographic, clinical, and radiologic data were recorded at admission; both ISS and STUMBL scores were calculated on arrival. - Primary outcomes were prolonged hospitalization (≥7 days), intensive care unit (ICU) admission, and in-hospital mortality. - The cohort comprised 371 patients; 75.7% were male, median age was 43 years, and 69.5% of injuries resulted from road traffic accidents. - ICU admission occurred in 18.3% of patients and in-hospital mortality was 5.4%. - Both ISS and STUMBL were significantly higher in patients who experienced adverse outcomes (p 10.5 produced sensitivities of approximately 70.0–74.1% and specificities of 80.6–92.4% for the reported outcomes. - ISS showed lower discriminative performance with AUC values between 0.753 and 0.802. - The authors conclude that applying the **STUMBL score** may improve early risk stratification and clinical decision-making for blunt thoracic trauma in Indonesian tertiary hospitals.

### 8. [Integrated cell death networks and diet‑related small molecule modulation in sepsis‑associated AKI](https://medichelpline.com/clinical-feed/pubmed-42695405.md)
- **Source:** PubMed / NCBI | **Published:** 2026-09-04 | DOI: [10.3892/ijmm.2026.5974](https://doi.org/10.3892%2Fijmm.2026.5974)
- **Detail Markdown URL:** [Integrated cell death networks and diet‑related small molecule modulation in sepsis‑associated AKI](https://medichelpline.com/clinical-feed/pubmed-42695405.md)

> **Executive GIST:** - Sepsis‑associated acute kidney injury (SA‑AKI) arises from multiple interacting disturbances — inflammation, metabolic derangement, microcirculatory failure, mitochondrial dysfunction and programmed cell death — rather than a single dominant pathway. - Multiple programmed death modalities (including **apoptosis**, **pyroptosis**, **ferroptosis**, **necroptosis** and **autophagy**‑related responses) act as an integrated, heterogeneous network with extensive crosstalk, compensatory signaling and regulation that varies by disease stage. - The review reframes SA‑AKI through an integrated cell death network model, organizing evidence around shared regulatory nodes classified as upstream drivers, amplifiers/permissive states, context‑dependent modifiers and terminal execution mechanisms. - Key shared injury conditions highlighted include **mitochondrial dysfunction**, **redox‑iron imbalance**, **NF‑κB‑dependent inflammatory activation**, **inflammasome priming**, failures in **autophagy/mitophagy**, and **immunometabolic stress**. - Diet‑related small molecules are grouped into food‑derived phytochemicals, nutritional compounds, microbiota‑derived metabolites and ICU antioxidant/vitamin regimens; their potential benefit may stem from reshaping common upstream environments rather than selectively blocking single death pathways. - Major translational barriers are emphasized: limited bioavailability, unclear active metabolites, sepsis‑altered pharmacokinetics, disease‑stage specificity, renal target exposure and inter‑patient heterogeneity. - The authors propose an exposure‑aware and endotype‑guided framework to evaluate diet‑related small molecules in SA‑AKI, stressing the need to account for pharmacology, timing and patient subgroups rather than relying on single‑target strategies.

### 9. [Barriers and Facilitators to Medical Emergency Team (MET) Activation: Protocol for a Four‑Hospital](https://medichelpline.com/clinical-feed/medrxiv-3-barriers-and-facilitators-to-medical-emergency-team-activation-among-healthcare.md)
- **Source:** medRxiv (Clinical Preprints) | **Published:** 2026-09-04
- **Detail Markdown URL:** [Barriers and Facilitators to Medical Emergency Team (MET) Activation: Protocol for a Four‑Hospital](https://medichelpline.com/clinical-feed/medrxiv-3-barriers-and-facilitators-to-medical-emergency-team-activation-among-healthcare.md)

> **Executive GIST:** - This protocol describes a multicentre cross-sectional web survey of healthcare professionals in four Swiss hospitals to identify modifiable barriers and facilitators to timely **Medical Emergency Team (MET)** activation for deteriorating adult inpatients. - METs aim to provide early expert assessment and treatment, but activation sometimes occurs only after prolonged physiological deterioration; potential causes include uncertainty about activation criteria, professional hierarchy, departmental culture, perceived pressure to manage without help, fear of criticism, and concerns about professional reputation. - The survey will be sequentially implemented in two cantonal and two tertiary university hospitals. Eligible participants are physicians, nurses, nurses in training, physiotherapists, occupational therapists, and speech and language therapists working in areas where MET activation may occur; staff primarily in paediatrics, emergency medicine, anaesthesia, intensive care, operating theatres, recovery areas, outpatient care, and MET members are excluded. - The German-language questionnaire was compiled from existing MET and rapid response system survey items and mapped to the revised 14-domain **Theoretical Domains Framework (TDF v2)** to ensure comprehensive coverage of behavioural determinants. - Two physician investigators independently mapped items to TDF domains; disagreements were resolved by consensus. All 14 TDF domains were deemed potentially relevant and additional items were created where domain coverage was insufficient. The questionnaire was pilot tested with physicians and nurses. - Four prespecified primary outcomes are: a proximal self-reported behavioural indicator (non-activation despite fulfilment of MET criteria) and three determinants of timely activation — perceived pressure to avoid activation, concern that activation may reflect poorly on professional competence, and absence of a departmental culture supporting immediate activation. - The primary professional comparison is **physicians versus nurses**. Ordinal logistic regression will adjust for hospital, years of professional experience, clinical area, and previous personal MET activation. Secondary outcomes will be analysed descriptively and exploratorily. No analysis by MET maturity will be performed. - The project was classified as research outside the scope of the Swiss Human Research Act. Site-specific ethics determinations and institutional endorsements will be reported. Participation is voluntary and responses are confidential but not fully anonymous if optional contact details are provided. - Results will be disseminated via peer-reviewed publication, presentations, and aggregated feedback to participating hospitals. The questionnaire, statistical analysis plan, and supplementary materials will be publicly archived; de‑identified participant data will be available only as permitted by ethics and institutional policies. - Registration is described as a prospective registration of the pooled analysis because data collection had already been completed at one participating hospital at the time of registration. Competing interests and standard author ethical declarations are reported in the protocol.

### 10. [Decision aids for life-sustaining treatment and end-of-life care in emergency and intensive care:](https://medichelpline.com/clinical-feed/bmj-open-9-decision-aids-for-life-sustaining-treatment-including-withholding-or-withdrawal.md)
- **Source:** BMJ Open | **Published:** 2026-09-04
- **Detail Markdown URL:** [Decision aids for life-sustaining treatment and end-of-life care in emergency and intensive care:](https://medichelpline.com/clinical-feed/bmj-open-9-decision-aids-for-life-sustaining-treatment-including-withholding-or-withdrawal.md)

> **Executive GIST:** - This protocol outlines a scoping review to identify and map literature on **decision aids** and related interventions that support **shared decision-making (SDM)** about **life-sustaining treatment** and end-of-life care in **emergency** and **intensive care** settings. - The review responds to ethical and emotional complexity in these settings, including prognostic uncertainty, limited time for deliberation, and frequent patient incapacity requiring surrogate decision-makers. - The authors note decision aids are evidence-based tools presenting options, benefits and harms, and supporting values clarification, but their use in acute care for life-sustaining and end-of-life decisions is fragmented and not comprehensively mapped. - The scoping review will follow the **Joanna Briggs Institute (JBI)** methodology and will be reported using **PRISMA-ScR**. - Databases searched will include PubMed, Web of Science, CENTRAL, CINAHL and Ichushi-Web; eligible studies are those published in English or Japanese from January 2000 onward. - Included study designs: quantitative, qualitative, mixed-methods and descriptive studies that address decision aids or related interventions for adult patients, family members, surrogate decision-makers or healthcare professionals in emergency and intensive care settings. - Two reviewers will independently screen, assess eligibility and chart data. - Data synthesis will be descriptive and presented in narrative and tabular formats. - No ethics approval is required because only publicly available literature will be analyzed. - Planned dissemination includes publication in a peer-reviewed journal and presentation at scientific conferences.

### 11. [Enoxaparin 30 mg BID Often Fails in High-Risk Trauma: Anti-Xa Monitoring Reveals a Dosing Gap](https://medichelpline.com/clinical-feed/pubmed-42696445.md)
- **Source:** PubMed / NCBI | **Published:** 2026-09-04 | DOI: [10.1177/00031348261486938](https://doi.org/10.1177%2F00031348261486938)
- **Detail Markdown URL:** [Enoxaparin 30 mg BID Often Fails in High-Risk Trauma: Anti-Xa Monitoring Reveals a Dosing Gap](https://medichelpline.com/clinical-feed/pubmed-42696445.md)

> **Executive GIST:** - This retrospective cohort at a Level I trauma center (April 2022–October 2023) included 244 adult trauma patients who had at least one **anti-factor Xa (anti-Xa)** measurement while receiving enoxaparin for venous thromboembolism (VTE) prophylaxis. - The cohort had a median Injury Severity Score (ISS) of 22 and notable obesity burden: 43% had **BMI >40 kg/m2**. - Initial dosing: 80% received standard enoxaparin **30 mg twice daily (BID)**. - Target prophylactic anti-Xa range was defined as **0.2–<0.5 IU/mL**; only 42% of all patients achieved this target on their initial measurement. - Among those started on 30 mg BID, 34% required dose escalation; the mean adjusted dose approached approximately **40 mg BID**. - Of patients who underwent repeat anti-Xa testing after dose escalation, 68% achieved target levels, indicating dose adjustments can be effective when followed by monitoring. - However, only 22% of all patients who had dose adjustments received the recommended repeat anti-Xa monitoring — revealing a significant implementation gap. - Clinical outcomes in the cohort included VTE in 5% and bleeding in 7%. - Authors conclude standard enoxaparin dosing frequently under-anticoagulates high-risk trauma patients and that clinicians do escalate dosing, but inconsistent follow-up testing leaves the anti-Xa pathway incomplete. - The study was observational and was not designed to compare dosing strategies or evaluate a protocolized intervention. - The authors recommend standardized tracking protocols and automated electronic triggers to ensure follow-up anti-Xa monitoring and close the persistent dosing gap.

### 12. [Personalized Oxygen Saturation Targets vs. Observed Saturation in Mechanically Ventilated Adults](https://medichelpline.com/clinical-feed/pubmed-42696412.md)
- **Source:** PubMed / NCBI | **Published:** 2026-09-04 | DOI: [10.1093/annalsats/aaoag281](https://doi.org/10.1093%2Fannalsats%2Faaoag281)
- **Detail Markdown URL:** [Personalized Oxygen Saturation Targets vs. Observed Saturation in Mechanically Ventilated Adults](https://medichelpline.com/clinical-feed/pubmed-42696412.md)

> **Executive GIST:** - The article titled "Personalized Oxygen Saturation Targets Compared to the Oxygen Saturation Experienced in Care Among Mechanically Ventilated Adults" was published online ahead of print in Annals of the American Thoracic Society and is indexed as PMID 42696412 with DOI 10.1093/annalsats/aaoag281. - Authors represent multiple U.S. academic centers including Vanderbilt University Medical Center, University of Wisconsin–Madison, Rush University, Cleveland Clinic, University of Pittsburgh, and others; the work is associated with the Pragmatic Critical Care Research Group. - The study topic compares **personalized oxygen saturation** targets with the actual **oxygen saturation** values recorded during clinical care of **mechanically ventilated** adult patients. - The PubMed entry provides bibliographic metadata (title, authors, affiliations, journal, DOI, PMID, publication date) but does not include the abstract text, detailed methods, results, or conclusions in the provided source content. - Key clinical terms: **oxygen saturation**, **mechanically ventilated adults**, **personalized targets** are central to the study as reported in the citation metadata. - Because the abstract and full text details (study design, sample size, inclusion criteria, interventions, outcome measures, statistical analysis, numeric results, and authors' conclusions) were not included in the provided source excerpt, specific findings and recommendations could not be extracted from the source. - Interpretation, clinical implications, and recommendations cannot be summarized from the source without access to the article body or abstract; readers should consult the journal or DOI link for full study details.

### 13. [Liberation from Continuous KRT in Children: article metadata, keywords, and evidence gaps](https://medichelpline.com/clinical-feed/pubmed-42696387.md)
- **Source:** PubMed / NCBI | **Published:** 2026-09-04 | DOI: [10.2215/CJN.0000001229](https://doi.org/10.2215%2FCJN.0000001229)
- **Detail Markdown URL:** [Liberation from Continuous KRT in Children: article metadata, keywords, and evidence gaps](https://medichelpline.com/clinical-feed/pubmed-42696387.md)

> **Executive GIST:** - Article titled “Liberation from Continuous KRT in Children: Where Do the Wins Come from?” published online ahead of print in Clin J Am Soc Nephrol on 2026 Sep 4; DOI 10.2215/CJN.0000001229 and PubMed ID (PMID) 42696387. - Authors are Edoardo La Porta and Pasquale Esposito with affiliations in Genoa, Italy: Unit of Nephrology and Transplantation IRCCS Istituto Giannina Gaslini; Department of Internal Medicine (DIMI), University of Genoa; Unit of Nephrology, Dialysis and Transplantation, AOM IRCCS Ospedale Policlinico San Martino. - No abstract is available on the PubMed entry; the record lists keywords but does not provide study methods, results, or conclusions in the entry. - Listed keywords include **AKI**, CKD, ESKD, hemodialysis, renal fibrosis, renal function decline, fluid/electrolyte and acid–base disorders, apoptosis, and AKI in critical care contexts. - The PubMed entry provides a reference list (10 references visible in the record) with citations that include recent relevant literature on pediatric liberation from continuous kidney replacement therapy and adult/consensus guidance on stopping renal replacement therapy. - Representative cited works include a 2025 pediatric survey on provider practices; a 2019 commentary on stopping renal replacement therapy; a 2025 Delphi consensus on liberation from continuous renal replacement therapy; and WE-ROCK cohort analyses and methodology references relevant to hierarchical composite outcomes. - The PubMed record is limited to bibliographic metadata, keywords, author affiliations, DOI/PMID, and references; full text content, abstract, study design, patient populations, endpoints, and recommendations were not included in the source entry. - Any clinical interpretation, recommendations, or outcome data are not reported in this PubMed source and therefore cannot be summarized here.

### 14. [Oral ketamine as an adjunct during burn wound care to reduce opioid exposure](https://medichelpline.com/clinical-feed/pubmed-42696301.md)
- **Source:** PubMed / NCBI | **Published:** 2026-09-04 | DOI: [10.1093/jbcr/irag159](https://doi.org/10.1093%2Fjbcr%2Firag159)
- **Detail Markdown URL:** [Oral ketamine as an adjunct during burn wound care to reduce opioid exposure](https://medichelpline.com/clinical-feed/pubmed-42696301.md)

> **Executive GIST:** - This retrospective single-center cohort study (August 2022–2024) evaluated adult (≥18 years) burn intensive care unit patients who received **oral ketamine** as premedication for wound care. The study aimed to compare opioid and benzodiazepine requirements before and after initiation of oral ketamine. - The electronic medical record was queried to capture medications administered specifically during wound care procedures. Only procedural medication use was recorded; other medication exposures were not included. - Primary outcome was change in total opioid use measured as **oral morphine equivalents (OMEs)** during wound care before (pre) and after (post) starting oral ketamine. Descriptive statistics were used for analysis; statistical testing was reported for OME and midazolam comparisons. - Fifty-two patients met inclusion. Median percent total body surface area (**%TBSA**) burned was 31 (IQR 20–48), indicating a population with largely moderate-to-severe burns. - The median ketamine dose given during wound care was 100 mg (IQR 100–125). All patients received IV fentanyl as part of wound care; 47 of 52 patients (90%) received IV midazolam. - Median OMEs during wound care decreased from 225 mg (IQR 150–300) in the pre-ketamine period to 180 mg (IQR 120–240) in the post-ketamine period; this difference reached statistical significance (P = 0.008). - There was no significant difference in midazolam use during wound care before and after ketamine initiation (6 mg [IQR 4–8] vs 5 mg [IQR 3–8]; P = 0.21). - The authors conclude that **oral ketamine** may be an effective adjunct for wound care in burn patients and may reduce exposure to **opioids**. Detailed safety outcomes, adverse events, timing, duration of observation, and additional procedural or clinical variables were not reported in the abstract.

### 15. [Patient-reported outcome measures in European cohorts after severe injury: systematic review and m](https://medichelpline.com/clinical-feed/pubmed-42696117.md)
- **Source:** PubMed / NCBI | **Published:** 2026-09-04 | DOI: [10.1007/s00068-026-03325-y](https://doi.org/10.1007%2Fs00068-026-03325-y)
- **Detail Markdown URL:** [Patient-reported outcome measures in European cohorts after severe injury: systematic review and m](https://medichelpline.com/clinical-feed/pubmed-42696117.md)

> **Executive GIST:** - This systematic review and meta-analysis assessed use and outcomes of **patient-reported outcome measures (PROMs)** in European cohorts of severely injured patients using studies from 2000 through 14 October 2025. - The authors screened 2,479 records and included 119 studies describing European cohorts; inclusion criteria defined **severe injury** by ISS ≥ 16, GCS ≤ 8, ICU admission, spinal cord injury, traumatic amputation, or pelvic fracture. - Included studies originated most frequently from the Netherlands (26%), Norway (18%), and Germany (16%). - Study focus: 61% were general severely injured cohorts, 17% traumatic brain injury cohorts, and 15% spinal cord injury cohorts. - Across the included literature, 94 different PROMs were used and outcomes were reported at 277 distinct follow-up timepoints, demonstrating high heterogeneity in instrument selection and reporting. - Domains assessed most often were **health-related quality of life** (63% of PROM use), followed by anxiety/depression (14%), post-traumatic stress (9%), and social functioning (6%). - Meta-analysis (where ≥3 studies reported comparable PROMs at similar timepoints) found at one year a pooled **EuroQol-5D-3L** index score of 0.70 (95% CI 0.62–0.77) and a VAS score of 68 (95% CI 60–75), indicating persistent impairment compared with population norms. - The review concludes that severely injured patients experience lasting functional and psychosocial deficits with incomplete restoration of pre-injury functioning. - The authors highlight substantial heterogeneity in PROM selection and outcome reporting across European cohorts and call for standardised PROM assessment to improve comparability and outcome evaluation after severe injury. - Conflict of interest: authors declared no competing interests; ethics: review used previously published anonymised data and reported that original studies obtained ethical approvals and informed consent as required.

### 16. [Performance of Pre‑interventional Risk Scores for 30‑Day Mortality and ICU Admission in Gastrointe](https://medichelpline.com/clinical-feed/pubmed-42696100.md)
- **Source:** PubMed / NCBI | **Published:** 2026-09-04 | DOI: [10.1007/s11739-026-04519-3](https://doi.org/10.1007%2Fs11739-026-04519-3)
- **Detail Markdown URL:** [Performance of Pre‑interventional Risk Scores for 30‑Day Mortality and ICU Admission in Gastrointe](https://medichelpline.com/clinical-feed/pubmed-42696100.md)

> **Executive GIST:** - This retrospective single‑center cohort study compared 12 pre‑interventional prognostic scores for patients with **gastrointestinal bleeding (GIB)** presenting to the emergency department between January 2014 and March 2025. - The cohort included 2020 patients divided into upper GIB (UGIB; n = 1524) and lower GIB (LGIB; n = 496). - Evaluated scores: **Glasgow‑Blatchford Score (GBS)**, modified GBS (mGBS), **AIMS65**, Pre‑Rockall, ABC, Harbinger, T‑Score, Canuka, SHA2PE, Oakland, **NOBLADS**, and Modified Early Warning Score (MEWS). - Primary outcomes were **30‑day mortality** and **ICU admission**. Scores were assessed in an indication‑restricted analysis (each score applied only to its original bleeding location) and a comprehensive analysis (all scores applied to both UGIB and LGIB). - Discrimination was measured by area under the curve (AUC); pairwise comparisons used DeLong’s method. - For 30‑day mortality in UGIB, **AIMS65** showed the highest discrimination (AUC = 0.850) in both indication‑restricted and comprehensive analyses. AIMS65 outperformed NOBLADS, ABC, and Pre‑Rockall in the comprehensive UGIB analysis. - For 30‑day mortality in LGIB, **NOBLADS** ranked highest in the indication‑restricted analysis (AUC = 0.809); in the comprehensive LGIB analysis **GBS** had the highest AUC (0.851), followed by MEWS (0.841) and mGBS (0.832), with no significant differences among top scores. - For predicting **ICU admission**, top scores achieved only moderate discrimination (AUC ranges: 0.755–0.788 in UGIB; 0.746–0.768 in LGIB), and no score reliably predicted ICU admission. - The study highlights **AIMS65** as the strongest pre‑interventional predictor of 30‑day mortality in UGIB and suggests **NOBLADS** may have utility across bleeding locations as a location‑independent mortality predictor. - Authors report no competing interests; ethical approval and waiver of informed consent were obtained from Karadeniz Technical University ethics committee (approval number: 2025/26).

### 17. [Feeding Equipment for Enteral Delivery Systems (FEEDS) in the ICU: Observational Cohort Findings](https://medichelpline.com/clinical-feed/pubmed-42695968.md)
- **Source:** PubMed / NCBI | **Published:** 2026-09-04 | DOI: [10.1080/10376178.2026.2728389](https://doi.org/10.1080%2F10376178.2026.2728389)
- **Detail Markdown URL:** [Feeding Equipment for Enteral Delivery Systems (FEEDS) in the ICU: Observational Cohort Findings](https://medichelpline.com/clinical-feed/pubmed-42695968.md)

> **Executive GIST:** - This prospective non‑participant observational audit examined bedside practice for **enteral nutrition** (EN) delivery in an adult intensive care unit over six weeks. - Thirty consecutive patients receiving EN via enteral tubes were observed; 25 (83.3%) had nasogastric tubes (NGT) and 5 (16.7%) had naso‑jejunal tubes. - Observers recorded 110 observation events across 73 days in which EN giving sets (ENGS) were changed 80 times; ENGS were used from 2 to 59 hours (median 22.5 h, IQR 10). - Labelling of ENGS occurred in 58.5% of observations and documentation of EN practice in 60.6% of observations. - Time from tube insertion to start of EN was short: median 1 day (IQR 2, range 7) prior to EN commencement. - EN was most commonly administered for 4 days per patient episode (IQR 5, range 28). - Median prescribed or 'target' infusion rate was 40 mL/h (IQR 20); the median actual delivery rate observed was 35 mL/h (IQR 25), representing a 12.5% lower delivery than target. - Diarrhoea was the most frequent EN‑related adverse outcome, affecting 12 patients (40%). - Study authors conclude observed practice often did not follow manufacturers' recommendations for ENGS replacement and highlight a lack of strong evidence and bedside guidance for nursing management of EN in the ICU. - The study identifies potential for inconsistent, experience‑dependent care and calls attention to the need for evidence‑based protocols that include nursing responsibilities for ongoing EN management.

### 18. [Proteomics of Sepsis: Protein Regulators of Metabolic Alterations in Fluids, Immune Cells, and Org](https://medichelpline.com/clinical-feed/pubmed-42695867.md)
- **Source:** PubMed / NCBI | **Published:** 2026-09-04 | DOI: [10.1021/acs.jproteome.6c00386](https://doi.org/10.1021%2Facs.jproteome.6c00386)
- **Detail Markdown URL:** [Proteomics of Sepsis: Protein Regulators of Metabolic Alterations in Fluids, Immune Cells, and Org](https://medichelpline.com/clinical-feed/pubmed-42695867.md)

> **Executive GIST:** - Sepsis is a life‑threatening syndrome driven by a dysregulated host response to infection and prominent metabolic alterations that contribute to immune dysfunction and organ failure. - This Review synthesizes proteomic evidence on proteins involved in metabolic pathways across circulating biofluids (plasma, urine), immune cells (monocytes, neutrophils), and organs. - In biofluids, proteomic studies report disturbances in **lipoprotein-associated pathways**, redox homeostasis, mitochondrial function, and substrate metabolism, indicating systemic and detectable protein signatures of metabolic dysregulation. - In immune cells, proteomics reveal a shift toward **glycolysis** with concurrent impairment of mitochondrial pathways and phenotype‑dependent differences in lipid and redox-related programs in monocytes and neutrophils. - Organ-level proteomic analyses show heterogeneous metabolic responses with distinct trajectories in kidney, heart, liver, lung, skeletal muscle, and brain rather than a single convergent metabolic state. - Proteomic data identify metabolism-associated proteins that associate with disease severity, clinical phenotypes, and biologically distinct patient subgroups, suggesting potential translational applications for stratification and targeting. - The current evidence is largely exploratory and context-dependent; proteomics offers a complementary framework to understand molecular regulation of sepsis-associated metabolic dysfunction, particularly when integrated with longitudinal sampling and multiomic data. - Keywords emphasized in the source include **immunometabolism**, **lipoproteins**, **mitochondria**, and **biomarkers**.

### 19. [Rethinking Gender Gaps in Critical Care Authorship: Article Overview and Key Metadata](https://medichelpline.com/clinical-feed/pubmed-42695759.md)
- **Source:** PubMed / NCBI | **Published:** 2026-09-04 | DOI: [10.1097/CCM.0000000000007347](https://doi.org/10.1097%2FCCM.0000000000007347)
- **Detail Markdown URL:** [Rethinking Gender Gaps in Critical Care Authorship: Article Overview and Key Metadata](https://medichelpline.com/clinical-feed/pubmed-42695759.md)

> **Executive GIST:** - This PubMed entry reports a commentary or article titled **Rethinking Where Gender Gaps in Critical Care Authorship Really Lie**, published online ahead of print in Crit Care Med on 2026 Sep 4 (DOI 10.1097/CCM.0000000000007347; PMID 42695759). - Authors listed are Fatima Sheikh and Kirsten M Fiest with multiple Canadian academic and clinical affiliations including McMaster University, Hamilton Health Sciences, University of Calgary, and Alberta Health Services. - No abstract is available in the PubMed record; the entry provides metadata only (title, authors, affiliations, keywords, conflicts of interest, references). - Keywords assigned to the record are **authorship**, **critical care**, **diversity**, **gender**, and **gender equity**, indicating the article focuses on gender representation in critical care academic authorship. - Conflict of interest disclosures: Dr. Fiest received support for related research from the Canadian Institutes of Health Research; Dr. Sheikh reported no potential conflicts. - The PubMed page lists references cited in the article; those references indicate prior work on gender disparity in critical care publications, conference speaker gender gaps, representation on editorial boards, society leadership, and workforce representation. - Because the abstract and article text are not included in the PubMed record provided, specific methods, results, conclusions, and recommendations from the article are not reported here. - Readers should consult the full article (Crit Care Med; DOI provided) for data, analysis, and the authors’ detailed arguments about where gender gaps in critical care authorship lie. - This summary preserves only information available in the PubMed entry and does not infer findings or outcomes beyond the recorded metadata and listed keywords.

### 20. [Pre-admission Healthcare Visits in the Week Before Pediatric Sepsis Hospitalization](https://medichelpline.com/clinical-feed/pubmed-42695757.md)
- **Source:** PubMed / NCBI | **Published:** 2026-09-04 | DOI: [10.1097/CCM.0000000000007336](https://doi.org/10.1097%2FCCM.0000000000007336)
- **Detail Markdown URL:** [Pre-admission Healthcare Visits in the Week Before Pediatric Sepsis Hospitalization](https://medichelpline.com/clinical-feed/pubmed-42695757.md)

> **Executive GIST:** - Study objective: quantify the proportion and characteristics of healthcare encounters in the 7 days before pediatric sepsis hospitalizations using claims data. - Design: retrospective observational cohort analysis using the Merative MarketScan administrative claims database covering employer-based and Medicaid claims across multiple states. - Population: children aged 0–18 years hospitalized with sepsis between January 1, 2016, and December 31, 2022, with ≥30 days continuous insurance enrollment before admission. - Primary outcome: any healthcare encounter (outpatient, emergency department, or inpatient) in the 7 days before the sepsis admission; secondary classification of encounters as **infection-related** when documented. - Cohort size: 6,928 pediatric sepsis hospitalizations identified. - Baseline characteristics: median age 10 years (IQR 3–15); 64.3% (4,452/6,928) had a complex chronic condition. - Pre-admission utilization: 53.5% (3,707/6,928) had at least one healthcare encounter within 7 days of admission. - Encounter types within 7 days: outpatient visits 33.7% (2,338/6,928), emergency department visits 28.2% (1,956/6,928), inpatient hospitalization 6.2% (431/6,928). - Infection-related encounters: among those with any pre-admission encounter, 38.9% (1,445/3,707) had an infection-related diagnosis at that encounter. - Outcomes by prior encounter: there was no difference in mechanical ventilation use, ICU use, or length of stay between patients with versus without a pre-sepsis healthcare encounter. - Conclusion: Over half of children hospitalized with sepsis had outpatient or ED evaluation in the week prior; about one in five were evaluated for infection. The authors suggest that understanding these encounters may permit earlier identification and possible prehospital intervention. - Data source and timeframe, study design, cohort criteria, and main numerical results are drawn from the article abstract; details beyond the abstract (e.g., statistical methods, granular subgroup analyses, limitations) were not reported in the provided source text.

### 21. [Peripheral IV versus Extended Dwell Catheter Longevity in the PICU: Single-Center Retrospective Co](https://medichelpline.com/clinical-feed/pubmed-42695754.md)
- **Source:** PubMed / NCBI | **Published:** 2026-09-04 | DOI: [10.1097/PCC.0000000000004044](https://doi.org/10.1097%2FPCC.0000000000004044)
- **Detail Markdown URL:** [Peripheral IV versus Extended Dwell Catheter Longevity in the PICU: Single-Center Retrospective Co](https://medichelpline.com/clinical-feed/pubmed-42695754.md)

> **Executive GIST:** - Objective: Compare the **longevity** (dwell time) of **extended dwell catheters (EDCs)** versus **peripheral IV catheters (PIVs)** in a pediatric intensive care unit (PICU) and identify factors associated with catheter duration. - Design and period: Single-center, retrospective cohort study covering September 2023 to August 2024. - Setting and population: Mixed cardiac and general PICU at an academic center in Ottawa, Canada; 400 vascular access catheters from 238 unique patients were analyzed (329 PIVs and 71 EDCs). - Primary measurement: Unadjusted median catheter dwell times reported as days with interquartile ranges (IQR). - Key unadjusted results: Median dwell time was 4.6 days (IQR 2.8–7.9) for EDCs and 2.3 days (IQR 1.2–4.1) for PIVs. - Adjusted analysis: In a mixed-effects multivariable regression, EDCs were associated with 62% greater longevity compared with PIVs (adjusted ratio 1.62; 95% CI, 1.10–2.37). - Other factors associated with increased catheter longevity included **upper limb** insertion site (adjusted ratio 1.49; 95% CI, 1.07–2.07) and combined **sedation with acute invasive mechanical ventilation** (adjusted ratio 2.12; 95% CI, 1.47–3.05). - Sensitivity analysis limited to failed devices did not identify a statistically significant difference for EDCs (adjusted ratio 1.38; 95% CI, 0.80–2.37), though the confidence interval did not exclude the possibility of a clinically meaningful increase. - Proportion of catheters still functional at removal did not differ significantly: PIV 26% (95% CI, 21–31%) vs EDC 30% (95% CI, 20–42%). - Conclusion: At this single center during 2023–2024, **EDCs** were associated with longer duration of use than PIVs, suggesting EDCs may be preferred for medium-term IV access in PICU patients not meeting criteria for central lines. The authors call for prospective studies to evaluate broader EDC use and optimal insertion practices. - Additional metadata: Study published online ahead of print in Pediatr Crit Care Med; PMID 42695754; DOI 10.1097/PCC.0000000000004044. Conflict of interest: none disclosed.

### 22. [Counting Sepsis: Epidemiology, Data Sources, and Measurement Challenges](https://medichelpline.com/clinical-feed/pubmed-42695749.md)
- **Source:** PubMed / NCBI | **Published:** 2026-09-04 | DOI: [10.1097/CCM.0000000000007352](https://doi.org/10.1097%2FCCM.0000000000007352)
- **Detail Markdown URL:** [Counting Sepsis: Epidemiology, Data Sources, and Measurement Challenges](https://medichelpline.com/clinical-feed/pubmed-42695749.md)

> **Executive GIST:** - Article metadata: Olaf L Cremer authored an editorial or commentary titled **Counting Sepsis: The Epidemiology of a Syndrome**, published online ahead of print in Crit Care Med (2026 Sep 4). DOI 10.1097/CCM.0000000000007352; PubMed PMID 42695749. - Affiliation: Author is affiliated with the Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, The Netherlands. - No abstract available on the PubMed record; full text details were not provided in the source record. - Keywords listed on the PubMed entry indicate the piece addresses **administrative data**, **case fatality**, **disease burden**, **epidemiology**, **mortality**, and **sepsis**. - The PubMed entry notes the author has disclosed no potential conflicts of interest. - The reference list cited classic and contemporary sepsis epidemiology and methods papers, including works on long‑term trends, national inpatient sampling, and comparisons of administrative claims versus objective clinical data; specific reference details are provided in the PubMed record. - The record signals topical concerns commonly raised in sepsis epidemiology: changing incidence, mortality trends, coding and denominator issues, and interpretation of administrative datasets — though specific conclusions or data from the article itself are not reported in the source. - Details such as study design, results, numerical estimates, and specific recommendations were not reported in the PubMed abstract page and therefore cannot be restated here.

### 23. [Noninvasive Postoperative Blood Pressure Monitoring Is Safe and Feasible in Osteogenesis Imperfecta](https://medichelpline.com/clinical-feed/pubmed-42695678.md)
- **Source:** PubMed / NCBI | **Published:** 2026-09-04 | DOI: [10.5435/JAAOS-D-26-00397](https://doi.org/10.5435%2FJAAOS-D-26-00397)
- **Detail Markdown URL:** [Noninvasive Postoperative Blood Pressure Monitoring Is Safe and Feasible in Osteogenesis Imperfecta](https://medichelpline.com/clinical-feed/pubmed-42695678.md)

> **Executive GIST:** - This prospective study evaluated postoperative **noninvasive blood pressure (NIBP)** monitoring in patients with **osteogenesis imperfecta (OI)** undergoing spine or extremity surgery. - Inclusion required orthopaedic surgeon approval, age 1–35 years, and non-ICU postoperative admission; the study was conducted within a high-volume OI care system with OI-specialized surgeons screening patients. - The protocol limited maximum cuff inflation pressures to reduce fracture risk: neonatal/infant/pediatric cuffs up to **120 mmHg** and adult cuffs up to **140 mmHg**. - Postoperative BP measurement schedule followed institutional standards: no more than every 4 hours for the first 24 hours, then every 8 hours or less thereafter. - Upper-extremity BP was measured manually by registered nurses who inspected the limb and asked about pain with palpation and bruising before and after each measurement to monitor for fractures. - Fifty participants were enrolled (median age 12.5 years; 25 girls), with most categorized as moderate (48%) or severe (42%) OI; 28 had extremity surgery and 22 had spine surgery. - Thirty-three percent of humeri used for measurements were rodded. Participants had an average of 9.5 postoperative BP measurements. - Clinical assessment found no fractures attributable to cuff use. Two participants (4%) withdrew for reasons unrelated to BP cuff complications. - Investigators conclude that manual **cuff** NIBP monitoring with careful fracture surveillance can be performed safely in the postoperative period for patients with OI within the study’s setting and limitations. - The authors recommend this approach to potentially avoid postoperative arterial catheters and ICU admission and to facilitate preventive cardiovascular care, while noting limitations including single-system expertise and surgeon screening.

### 24. [Fluid Overload and Risk of Pressure Injuries in ICU Patients With Sepsis](https://medichelpline.com/clinical-feed/pubmed-42695538.md)
- **Source:** PubMed / NCBI | **Published:** 2026-09-04 | DOI: [10.1111/jocn.70538](https://doi.org/10.1111%2Fjocn.70538)
- **Detail Markdown URL:** [Fluid Overload and Risk of Pressure Injuries in ICU Patients With Sepsis](https://medichelpline.com/clinical-feed/pubmed-42695538.md)

> **Executive GIST:** - Study type: retrospective cohort analysis of ICU patients with sepsis using the Medical Information Mart for Intensive Care-IV (MIMIC‑IV) 3.0 database, reported following STROBE guidance. - Population: 10,669 patients with sepsis admitted to the ICU; 2,346 (22.0%) developed **pressure injuries** during the ICU stay. - Exposure classification: cumulative fluid balance percentage over the first days of ICU admission categorized as **fluid negative** ( 10%). - Main finding: higher cumulative fluid balance in the first 3 days among patients who developed pressure injuries compared with those who did not. - Multivariable analysis: **fluid overload** on ICU Days 1, 2, and 3 was independently associated with greater hazard of pressure injury occurrence, with hazard ratios (HRs) of 1.30, 1.30, and 1.39, respectively, from Cox proportional hazards models. - Incidence: by Day 3 of ICU admission, **fluid overload** was present in 21.7% of patients with sepsis. - Statistical approach: Cox proportional hazards regression used to assess associations between fluid balance categories and time to pressure injury occurrence. - Clinical implication: integrating **fluid management** into ICU nursing practice may aid earlier identification and prevention of pressure injuries in patients with **sepsis**. - Trial registration and data source: retrospective analysis of a publicly available database; no trial registration required; data from MIMIC‑IV 3.0. - Reported impact: results aim to inform ICU nursing practice and pressure injury prevention strategies by highlighting an independent association between cumulative fluid balance and pressure injury risk.

### 25. [Nimodipine-Induced Refractory Vasoplegia After Aneurysmal SAH: Case Series and Management Insights](https://medichelpline.com/clinical-feed/pubmed-42695493.md)
- **Source:** PubMed / NCBI | **Published:** 2026-09-04 | DOI: [10.1177/08971900261486909](https://doi.org/10.1177%2F08971900261486909)
- **Detail Markdown URL:** [Nimodipine-Induced Refractory Vasoplegia After Aneurysmal SAH: Case Series and Management Insights](https://medichelpline.com/clinical-feed/pubmed-42695493.md)

> **Executive GIST:** - Following aneurysmal subarachnoid hemorrhage (aSAH), about **30%** of patients develop delayed cerebral ischemia (**DCI**); **nimodipine** reduces this risk but can cause hypotension or bradycardia in fewer than 5% of patients. - This retrospective case series from a Neurosciences ICU describes four patients who developed **nimodipine-induced refractory vasoplegia** after aSAH. - The authors reviewed vasopressor use, interventions for hypotension and bradycardia, patient demographics, and comorbidities to identify risk factors for vasoplegia. - Patients required, on average, **6.5 medications** to manage vasoplegia and were weaned slowly from vasopressors; mean duration of vasoplegia was **18 hours**. - Two patients required **transvenous pacing and intubation** due to cardiovascular compromise. - The review identified **liver and kidney disease** as potential risk factors and suggested that **nimodipine formulation** may contribute to vasoplegia. - The authors note that **dose adjustments** of nimodipine could increase the risk of DCI, so altering doses carries potential harm. - For refractory vasoplegia causing cardiovascular collapse, the authors recommend stopping nimodipine and treating as **calcium channel blocker toxicity**, including consideration of **nitric oxide scavengers** given the drug’s mechanism and the pathophysiology of vasoplegia. - Overall, nimodipine remains generally well tolerated and effective at reducing DCI, but clinicians should anticipate mild to moderate hypotension that may require vasopressor support and be prepared for rare, severe vasoplegia.

### 26. [Combined trajectories of serum sodium and urine output predict 30-day mortality in sepsis (MIMIC‑I](https://medichelpline.com/clinical-feed/pubmed-42695367.md)
- **Source:** PubMed / NCBI | **Published:** 2026-09-04 | DOI: [10.7189/jogh.16.04308](https://doi.org/10.7189%2Fjogh.16.04308)
- **Detail Markdown URL:** [Combined trajectories of serum sodium and urine output predict 30-day mortality in sepsis (MIMIC‑I](https://medichelpline.com/clinical-feed/pubmed-42695367.md)

> **Executive GIST:** - This retrospective cohort study used the **MIMIC‑IV** database to examine combined longitudinal patterns of **serum sodium** and **urine output (UO)** during the first 96 hours after ICU admission in patients with **sepsis**. - Group‑based multi‑trajectory modelling identified five distinct combined trajectory subtypes across four consecutive 24‑hour periods (first 96 hours). - Subtype 1 showed a mild early decline in serum sodium with recovery and a gradual increase in UO and was associated with the most favorable prognosis (reference group). - Subtype 2 showed mildly increasing serum sodium and gradually decreasing UO and had the highest adjusted risk of **30‑day mortality** (HR 1.85; 95% CI 1.56–2.19; P < 0.001) versus subtype 1. - Subtype 3 had relatively stable serum sodium with UO that rose then fell and had higher 30‑day mortality (HR 1.22; 95% CI 1.03–1.46; P = 0.026). - Subtype 4 was characterized by gradually increasing serum sodium and UO that rose then levelled off; it had increased 30‑day mortality (HR 1.31; 95% CI 1.10–1.56; P = 0.003). - Subtype 5 exhibited gradually decreasing serum sodium and UO that rose then levelled off and carried elevated 30‑day mortality (HR 1.53; 95% CI 1.29–1.82; P < 0.001). - Cox regression models adjusted for covariates were used to assess associations; subgroup and sensitivity analyses generally supported the main results. - The authors conclude that early combined trajectories of **serum sodium** and **UO** may help prognostic risk stratification in sepsis, but emphasize that causal inferences cannot be drawn from this observational analysis. - Key study identifiers reported: sample size 7,127 patients, PMID 42695367, DOI 10.7189/jogh.16.04308.

### 27. [Automated Protein Quantification Platforms for Critical Care Precision Medicine Trials](https://medichelpline.com/clinical-feed/pubmed-42695277.md)
- **Source:** PubMed / NCBI | **Published:** 2026-09-04 | DOI: [10.1097/CCE.0000000000001477](https://doi.org/10.1097%2FCCE.0000000000001477)
- **Detail Markdown URL:** [Automated Protein Quantification Platforms for Critical Care Precision Medicine Trials](https://medichelpline.com/clinical-feed/pubmed-42695277.md)

> **Executive GIST:** - This scoping review mapped commercially available **automated platforms** for quantitative measurement of human **protein biomarkers** in blood, serum, or plasma to inform critical care precision medicine trials. - Evidence sources comprised 228 items: 211 publication reports, 14 patent reports, and 3 company correspondence reports. - Publication-derived data produced 256 device records representing 74 distinct device models from 34 manufacturers. - The most frequently reported devices were **Ella** (48 records), **LUMIPULSE G1200** (25), **LUMIPULSE G600II** (17), **cobas e 411** (13), and **Simoa HD-X** (12). - Multiplex capability was reported for eight devices in publications, with two further multiplex-capable platforms identified via company correspondence, indicating limited **multiplex** availability across platforms. - Inflammatory and neurologic biomarkers dominated reported analytes. Top inflammatory markers: procalcitonin (36 records), interleukin-6 (IL-6, 35), tumor necrosis factor-α (TNF-α, 22), and IL-10 (14). - Top neurologic markers: neurofilament light chain (34), p-tau217 (31), Aβ42 (29), Aβ40 (27), and p-tau181 (27). - The review highlights heterogeneity in device reporting and recommends more standardized, device-level reporting to aid platform selection for biomarker-enabled trials and clinical implementation. - Keywords emphasized by authors include **automation**, **immunoassay**, **multiplex**, **point-of-care testing**, and **precision medicine**.

### 28. [ICU Practices for Sedation, Analgesia and Delirium in Mechanically Ventilated Patients: Multicente](https://medichelpline.com/clinical-feed/pubmed-42695271.md)
- **Source:** PubMed / NCBI | **Published:** 2026-09-04 | DOI: [10.1097/CCE.0000000000001479](https://doi.org/10.1097%2FCCE.0000000000001479)
- **Detail Markdown URL:** [ICU Practices for Sedation, Analgesia and Delirium in Mechanically Ventilated Patients: Multicente](https://medichelpline.com/clinical-feed/pubmed-42695271.md)

> **Executive GIST:** - This PubMed record describes a multicenter study titled “Characteristics and Reported Practices of ICUs Participating in the Sedation, Analgesia and Delirium Management International Study: Variability in Site-Level Management of Mechanically Ventilated Patients.” - Publication: Crit Care Explor, volume 8, issue 9, e1479, eCollection 2026 Sep 1; cited date 2026 Sep 4. DOI 10.1097/CCE.0000000000001479; PMID 42695271. - Study type reported in the citation: Multicenter study. The title indicates the study assessed **sedation**, **analgesia**, and **delirium** management practices and variability across sites caring for **mechanically ventilated** patients. - Lead and corresponding authorship includes Sangeeta Mehta and a multidisciplinary, international group of investigators (SAnDMAN Investigators) with affiliations spanning Canada, the United States, Europe, Brazil, and other centers. - Listed authors represent critical care, anesthesia, pharmacy, perioperative medicine, neuroscience and epidemiology disciplines and include institutional affiliations such as Sinai Health (Toronto), University of Toronto, Sciensano (Brussels), Mayo Clinic (Rochester), Karolinska (Stockholm), University of Leuven, and others. - The PubMed page includes standard bibliographic and administrative elements (author list, affiliations, DOI, PMID) but the provided source text does not include an abstract or detailed study methods, results, outcomes, or conclusions. - Because the supplied page excerpt lacks the article abstract and full text content, specific findings, numerical results, methodology, sample size, participating ICU characteristics, and reported site-level practice details were not reported in the source provided here. - For full clinical details (methods, outcomes, site-level variability metrics, and clinical implications), readers should consult the full article via the DOI or the journal’s website; those details are not available in the supplied source content.

### 29. [Digital-driven cardiac rehabilitation improves functional recovery and shortens stay after TAVR](https://medichelpline.com/clinical-feed/pubmed-42695202.md)
- **Source:** PubMed / NCBI | **Published:** 2026-09-04 | DOI: [10.3724/zdxbyxb-2026-0179](https://doi.org/10.3724%2Fzdxbyxb-2026-0179)
- **Detail Markdown URL:** [Digital-driven cardiac rehabilitation improves functional recovery and shortens stay after TAVR](https://medichelpline.com/clinical-feed/pubmed-42695202.md)

> **Executive GIST:** - This retrospective study evaluated the impact of a **digital-driven cardiac rehabilitation** program on clinical and functional outcomes after transcatheter aortic valve replacement (**TAVR**). - Data from 1,012 consecutive TAVR patients treated at a single center (Second Affiliated Hospital, Zhejiang University School of Medicine) between March 2013 and January 2023 were analyzed. - Patients who received conventional rehabilitation comprised the control group; those enrolled in a digital-driven rehabilitation pathway comprised the intervention group. The digital program included preoperative screening and functional preparation, intraoperative eligibility assessment, postoperative stepwise rehabilitation management, and intelligent home-based rehabilitation. - Propensity score matching was applied to adjust for baseline confounders; after matching, 251 patients were included in each group. - Primary comparisons included postoperative ICU stay and total postoperative hospital stay, incidence of cardiovascular and cerebrovascular adverse events at 30 days, 1 year, and 2 years, and functional measures (5-meter walk test, 6-minute walk test, Katz Index). - The intervention group had significantly shorter postoperative ICU and hospital stays than controls (ICU stay median 0 [0,0] h vs 0 [0,1] h; hospital stay median 3 [1,7] days vs 8 [7,11] days; both P 0.05). - The authors conclude that the digital-driven cardiac rehabilitation pathway may shorten hospitalization and improve selected functional outcomes after TAVR without increasing postoperative cardiovascular or cerebrovascular adverse events. - The study is registered on ClinicalTrials.gov (NCT02803294).

### 30. [Short-term ambient PM2.5 exposure and respiratory healthcare use in older adults near an industria](https://medichelpline.com/clinical-feed/pubmed-42693905.md)
- **Source:** PubMed / NCBI | **Published:** 2026-09-04 | DOI: [10.7189/jogh.16.04269](https://doi.org/10.7189%2Fjogh.16.04269)
- **Detail Markdown URL:** [Short-term ambient PM2.5 exposure and respiratory healthcare use in older adults near an industria](https://medichelpline.com/clinical-feed/pubmed-42693905.md)

> **Executive GIST:** - Study examined short-term associations between ambient **PM2.5** and respiratory healthcare utilisation among adults aged ≥60 living within 5 km of a newly industrialising area in central Thailand. - Time-series design using daily counts of respiratory visits (ICD-10 J00–J99) from a local secondary hospital from November 2023 to March 2024. - Daily **PM2.5** concentrations and meteorological data were obtained from the nearest governmental air-quality monitoring station. - Analysis employed negative binomial regression to estimate incidence rate ratios (IRRs) per 10 μg/m3 increase in PM2.5, with single-lag and moving-average models to assess delayed effects. - Models adjusted for temperature, relative humidity, wind speed, day of the week, and temporal trends. - There were 924 respiratory healthcare visits (mean 6.37 visits/day) during the study window. Mean daily PM2.5 was 42.43 μg/m3 (SD 15.12), exceeding the **WHO** guideline. - Positive associations between PM2.5 and respiratory visits were reported across several lag days; the largest point estimate occurred at lag 4. - A 10 μg/m3 increase in PM2.5 at lag 4 corresponded to a 5.5% increase in respiratory visits (IRR = 1.055), but the 95% confidence interval (0.995–1.119) did not reach statistical significance. - Subgroup estimates were numerically larger for females and for those aged 60–69 years, but interaction tests were not statistically significant. - Authors conclude a positive but non-significant short-term association and recommend continuing air quality improvement and protection of vulnerable populations to reduce pollution-related respiratory burden.

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