Nurse Practitioner
Audio Summaries

Clinical Criteria for the Definition of Refractory Septic Shock: A Joint Delphi Consensus from the Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM)

The authors aimed to establish a consensus on clinical criteria for defining refractory septic shock to improve diagnosis, management, and research in this severe condition. Through a Delphi process involving critical care experts, they identified 13 key criteria, including markers of organ dysfunction, tissue perfusion indicators, and specific treatment requirements, such as high doses of norepinephrine and the use of critical care ultrasound. This consensus provides a structured framework for recognizing and managing refractory septic shock in clinical practice.

Sepsis and Subsequent Psychiatric Morbidity: A Nationwide Population-Based Matched Cohort Study, 2008-2019

The authors aimed to quantify the risk of developing psychiatric morbidity following community-acquired sepsis and to determine if new chronic diseases mediated this association. Their findings indicate that patients with sepsis experienced a significantly higher incidence of psychiatric events compared to matched controls, with the elevated risk persisting for at least five years. This suggests that sepsis may have lasting effects on mental health, highlighting the need for preventive strategies in this population.

The Inherited Basis of Coronary Artery Disease

The authors investigate the genetic underpinnings of coronary artery disease (CAD) and how these insights can enhance risk prediction, prevention, and treatment strategies. They highlight the significance of both monogenic and polygenic factors in CAD, emphasizing the potential of polygenic risk scores to improve individual risk assessment. Key questions remain about the practical application, cost-effectiveness, and integration of these genetic insights into clinical practice.

Diagnosis and Management of Resistant Hypertension: A Review

The authors aim to address the diagnosis and management of resistant hypertension, which affects approximately 10% of patients despite treatment. They highlight the importance of excluding factors such as white-coat hypertension and medication nonadherence, and recommend lifestyle modifications, optimized pharmacologic therapy, and interventions like spironolactone and renal denervation to effectively lower blood pressure in these patients.

Effects of a Combined Lifestyle Intervention on Recovery of ICU Survivors: A Randomized Controlled Trial

The authors aimed to evaluate the effects of a combined lifestyle intervention, including exercise and dietary support, on perceived physical functioning (PF) and health-related quality of life (HRQoL) in ICU survivors. The study found that participants in the intervention group experienced a significant improvement in PF scores and increased protein intake compared to the control group, suggesting that such interventions may benefit recovery in this population.

Ready for Donation, Not for Death: A Qualitative Study of Families' Experience With Controlled Donation After Circulatory Determination of Death in Intensive Care

This qualitative study investigates the experiences and challenges faced by families of patients undergoing controlled donation after circulatory determination of death (cDCDD). Through in-depth interviews, the authors explore themes related to decision-making, the waiting period before death, and the controlled environment of the dying process, highlighting the need for better support for families during this time. The findings suggest that while families can engage meaningfully in the cDCDD process, proper preparation and emotional support are essential to mitigate distress.

National Estimates of Pediatric Sepsis in US Hospitals Using Clinical Data

The authors aimed to estimate the national incidence, mortality, and trends of pediatric sepsis in the U.S. using a Pediatric Sepsis Event (PSE) definition based on electronic health record (EHR) data, as traditional surveillance methods relying on administrative codes are often inaccurate. Their findings revealed a sepsis incidence of 1.3% among pediatric hospitalizations, with an in-hospital mortality rate of 10.1%, indicating that over 18,000 cases and 1,877 deaths occur annually, with no significant changes in incidence or mortality from 2016 to 2022. The PSE definition demonstrated strong validity, offering a more reliable method for identifying pediatric sepsis compared to existing administrative coding systems.

Gaps and Strategies for Management of Sepsis in Low-Resource Settings: Expert Consensus Statements Using a Delphi Method

The authors aimed to identify gaps in sepsis management and develop strategies tailored for low-resource settings (LRS), where the majority of sepsis cases occur but where resources are limited. Using a Delphi method, an international panel of experts reached consensus on 58 clinical practice statements focused on improving prevention, early recognition, and comprehensive management of sepsis in these settings. The findings highlight the need for further research to enhance sepsis care in LRS, while providing immediate guidance that complements existing international guidelines.

Society of Critical Care Medicine Guidelines on Caring for Older Adults in the ICU

The authors aimed to develop evidence-based guidelines for the care of older adults (65 years and older) in the ICU, addressing their unique needs during and after critical illness. The panel generated two conditional recommendations advocating for a geriatric model of care and advising against the use of antipsychotic medications for delirium prevention, while also identifying areas needing further research. Ultimately, the guidelines highlight the importance of tailored approaches to improve outcomes for older ICU patients.

The Frame of Survival for Sepsis: A Practical Systems Framework for Time-Sensitive Critical Illness in Low-Resource Settings

The authors aim to develop a practical framework, the "Sepsis Frame of Survival," to improve sepsis management in low-resource settings (LRS), addressing the high mortality rates associated with this time-sensitive condition. By conducting a targeted scoping review and engaging a multidisciplinary task force, they identify actionable strategies and prioritize feasible interventions that can be integrated into existing emergency and critical care systems. The framework emphasizes immediate, high-impact actions while recognizing the need for local evidence to inform ongoing quality improvement efforts.