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Background: Mechanical power (MP) serves as a crucial predictive indicator for ventilator-induced lung injury and plays a pivotal role in tailoring the management of mechanical ventilation. However, its application across different diseases and stages remains nuanced., Methods: Using AmsterdamUMCdb, we conducted a retrospective study to analyze the causal relationship between MP and outcomes of invasive mechanical ventilation, specifically SpO 2 /FiO 2 ratio (P/F) and ventilator-free days at day 28 (VFD28). We employed causal inferential analysis with backdoor linear regression and double machine learning, guided by directed acyclic graphs, to estimate the average treatment effect (ATE) in the whole population and conditional average treatment effect (CATE) in the individual cohort. Additionally, to enhance interpretability and identify MP thresholds, we conducted a simulation analysis., Results: In the study, we included 11,110 unique admissions into analysis, of which 58.3% (6391) were surgical admissions. We revealed a negative and significant causal effect of median MP on VFD28, with estimated ATEs of -0.135 (95% confidence interval [CI]: -0.15 to -0.121). The similar effect was not observed in Maximal MP and minimal MP. The effect of MP was more pronounced in the medical subgroup, with a CATE of -0.173 (95% CI: -0.197 to -0.143) determined through backdoor linear regression. Patients with cardio, respiratory, and infection diagnoses, who required long-term intubation, sustained higher impact on CATEs across various admission diagnoses. Our simulations showed that there is no single MP threshold that can be applied to all patients, as the optimal threshold varies depending on the patient's condition., Conclusion: Our study underscores the importance of tailoring MP adjustments on an individualized basis in ventilator management. This approach opens up new avenues for personalized treatment strategies and provides fresh insights into the real-time impact of MP in diverse clinical scenarios. It highlights the significance of median MP while acknowledging the absence of universally applicable thresholds., Competing Interests: Declarations. Ethics approval and consent to participate: This study, involving de-identified human data retrieved from the Amsterdam UMC database. Consent to participate and adherence to the ethics guidelines were as per the guidelines set by AmsterdamUMCdb. More information is available at https://amsterdammedicaldatascience.nl/amsterdamumcdb/ . Consent for publication: Not applicable. Competing interests: The authors declare that they have no competing interests. Author JV is supported by National Heart, Lung, and Blood Institute of the National Institutes of Health (grant number T32HL155020)., (© 2025. The Author(s).)

Importance: Experimental data suggest that intravenous vitamin C may attenuate inflammation and vascular injury associated with sepsis and acute respiratory distress syndrome (ARDS)., Objective: To determine the effect of intravenous vitamin C infusion on organ failure scores and biological markers of inflammation and vascular injury in patients with sepsis and ARDS., Design, Setting, and Participants: The CITRIS-ALI trial was a randomized, double-blind, placebo-controlled, multicenter trial conducted in 7 medical intensive care units in the United States, enrolling patients (N = 167) with sepsis and ARDS present for less than 24 hours. The study was conducted from September 2014 to November 2017, and final follow-up was January 2018., Interventions: Patients were randomly assigned to receive intravenous infusion of vitamin C (50 mg/kg in dextrose 5% in water, n = 84) or placebo (dextrose 5% in water only, n = 83) every 6 hours for 96 hours., Main Outcomes and Measures: The primary outcomes were change in organ failure as assessed by a modified Sequential Organ Failure Assessment score (range, 0-20, with higher scores indicating more dysfunction) from baseline to 96 hours, and plasma biomarkers of inflammation (C-reactive protein levels) and vascular injury (thrombomodulin levels) measured at 0, 48, 96, and 168 hours., Results: Among 167 randomized patients (mean [SD] age, 54.8 years [16.7]; 90 men [54%]), 103 (62%) completed the study to day 60. There were no significant differences between the vitamin C and placebo groups in the primary end points of change in mean modified Sequential Organ Failure Assessment score from baseline to 96 hours (from 9.8 to 6.8 in the vitamin C group [3 points] and from 10.3 to 6.8 in the placebo group [3.5 points]; difference, -0.10; 95% CI, -1.23 to 1.03; P = .86) or in C-reactive protein levels (54.1 vs 46.1 μg/mL; difference, 7.94 μg/mL; 95% CI, -8.2 to 24.11; P = .33) and thrombomodulin levels (14.5 vs 13.8 ng/mL; difference, 0.69 ng/mL; 95% CI, -2.8 to 4.2; P = .70) at 168 hours., Conclusions and Relevance: In this preliminary study of patients with sepsis and ARDS, a 96-hour infusion of vitamin C compared with placebo did not significantly improve organ dysfunction scores or alter markers of inflammation and vascular injury. Further research is needed to evaluate the potential role of vitamin C for other outcomes in sepsis and ARDS., Trial Registration: ClinicalTrials.gov Identifier: NCT02106975.

Background: Readmissions or "bounce back" to the intensive care unit (ICU) following cardiac surgery is associated with an increased risk of morbidity and mortality. We sought to identify clinical and system-based factors associated with ICU bounce backs in order to generate a Bounce Back After Transfer (BATS) prediction score., Methods: We prospectively collected the clinical and financial records of all patients undergoing coronary artery bypass grafting (CABG) or surgical aortic valve replacement (AVR) between May 2013 and March 2014. Multivariable logistic regression was used to identify independent predictors of bounce backs to the ICU which served as the basis for our BATS score., Results: Of the 532 patients that underwent CABG or AVR during the study period, 35 (6.6%) were readmitted to the ICU. After risk adjustment, female sex, NYHA class III/IV, urgent or emergent operative status, and postoperative renal failure were the predictors of ICU bounce backs utilized to create the BATS score. Patients in the low (<5), moderate (5-10), and high-risk (>10) score cohorts experienced bounce back rates of 3.0%, 10.4%, and 42%, respectively. After adjusting for preoperative patient risk, ICU bounce back resulted in an increase in $68,030 to a patient's total hospital charges., Conclusions: A predictive model (BATS) can determine the risk of a bounce back to the ICU after transfer to the floor. We speculate that determination of a patient's BATS upon ICU transfer would allow targeted floor care and decrease bounce back rates, along with postoperative morbidity, mortality, and cost of care., (© 2015 Wiley Periodicals, Inc.)

Noise is a significant contributor to sleep disruption in the intensive care unit (ICU) that may result in increased patient morbidity such as delirium and prolonged length of stay in ICU. We conducted a pre-post intervention study in a 24-bed tertiary care academic medical ICU to reduce the mean noise levels. Baseline dosimeter recordings of ICU noise levels demonstrated a mean noise level of 54.2 A-weighted decibels (dBA) and peak noise levels of 109.9 dBA, well above the Environmental Protection Agency's recommended levels. There were 1735 episodes of "defects" (maximum noise levels > 60 dBA). Following implementation of multipronged interventions, although the mean noise levels did not change significantly between pre- and post-intervention (54.2 vs 53.8 dBA; p = 0.96), there was a significant reduction in the number of "defects" post-intervention (1735 vs 1289, p ≤ 0.000), and the providers felt that the patients were sleeping longer in the ICU post-intervention.

Aim: Delay in instituting neuroprotective measures after cardiac arrest increases death and decreases neuronal recovery. Current hypothermia methods are slow, ineffective, unreliable, or highly invasive. We report the feasibility of rapid hypothermia induction in swine through augmented heat extraction from the lungs., Methods: Twenty-four domestic crossbred pigs (weight, 50-55kg) were ventilated with room air. Intraparenchymal brain temperature and core temperatures from pulmonary artery, lower esophagus, bladder, rectum, nasopharynx, and tympanum were recorded. In eight animals, ventilation was switched to cooled helium-oxygen mixture (heliox) and perfluorocarbon (PFC) aerosol and continued for 90min or until target brain temperature of 32°C was reached. Eight animals received body-surface cooling with water-circulating blankets; eight control animals continued to be ventilated with room air., Results: Brain and core temperatures declined rapidly with cooled heliox-PFC ventilation. The brain reached target temperature within the study period (mean [SD], 66 [7.6]min) in only the transpulmonary cooling group. Cardiopulmonary functions and poststudy histopathological examination of the lungs were normal., Conclusion: Transpulmonary cooling is novel, rapid, minimally invasive, and an effective technique to induce therapeutic hypothermia. High thermal conductivity of helium and vaporization of PFC produces rapid cooling of alveolar gases. The thinness and large surface area of alveolar membrane facilitate rapid cooling of the pulmonary circulation. Because of differences in thermogenesis, blood flow, insulation, and exposure to the external environment, the brain cools at a different rate than other organs. Transpulmonary hypothermia was significantly faster than body surface cooling in reaching target brain temperature., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Background. Acute kidney injury (AKI) is a frequent complication of critically ill patients. The impact of different risk factors associated with this entity in the ICU setting is unknown. Objectives. The purpose of this research was to assess the risk factors associated with the development of AKI in critically ill patients by meta-analyses of observational studies. Data Extraction. Two reviewers independently and in duplicate used a standardized form to collect data from published reports. Authors were contacted for missing data. The Newcastle-Ottawa scale assessed study quality. Data Synthesis. Data from 31 diverse studies that enrolled 504,535 critically ill individuals from a wide variety of ICUs were included. Separate random-effects meta-analyses demonstrated a significantly increased risk of AKI with older age, diabetes, hypertension, higher baseline creatinine, heart failure, sepsis/systemic inflammatory response syndrome, use of nephrotoxic drugs, higher severity of disease scores, use of vasopressors/inotropes, high risk surgery, emergency surgery, use of intra-aortic balloon pump, and longer time in cardiopulmonary bypass pump. Conclusion. The best available evidence suggests an association of AKI with 13 different risk factors in subjects admitted to the ICU. Predictive models for identification of high risk individuals for developing AKI in all types of ICU are required.