Critical Care Medicine

Sudden cardiac arrest (SCA) remains one of the major challenges in clinical care. Although improvements in resuscitation quality have increased the likelihood of return of spontaneous circulation (ROSC), most patients still fail to survive to hospital discharge, and neurological injury is the leading determinant of poor outcome. Hypoxic-ischemic encephalopathy caused by global cerebral hypoxia during cardiac arrest is a key contributor to long-term disability, and even survivors often experience substantial functional impairment, placing a significant burden on families and society. Targeted temperature management (TTM) has long been regarded as a cornerstone neuroprotective strategy; however, TTM and TTM2 trials reported no significant neurological difference between lower and higher temperature targets. However, these studies predominantly enrolled patients with relatively mild illness severity, and multiple real-world observational cohorts suggest that, among more severely ill resuscitated patients, lower target temperatures may still confer benefit. Consequently, the optimal temperature strategy in higher-risk subgroups remains uncertain. Seizures are another common manifestation of brain injury after cardiac arrest, occurring in approximately 20-30% of resuscitated patients and contributing to secondary neurological damage. Earlier trials evaluating prophylactic anti-seizure medication (ASM) (thiopental or diazepam/magnesium) did not demonstrate neurological benefit; however, these studies primarily focused on neuroprotection rather than seizure prevention, leaving a substantial evidence gap. Patients with moderate to severe disease severity-those at the highest risk of both cerebral injury and seizure occurrence-have never been specifically studied to determine whether personalized temperature selection or early short-term prophylactic ASM (e.g., valproic acid or levetiracetam) may provide clinical benefit. Accordingly, identifying the most appropriate temperature target for higher-risk patients and determining whether short-term prophylactic antiepileptic therapy can reduce seizure-related injury represent important unresolved questions in post-resuscitation care. The aim of this study is to conduct a prospective, multicenter, randomized clinical trial to evaluate whether, among comatose patients with moderate to severe risk after ROSC, specific TTM temperature strategies combined with early short-term prophylactic ASM can reduce postresuscitation seizure incidence and improve neurological outcomes. By addressing a population underrepresented in prior clinical trials-those at highest risk and most likely to benefit-this study aims to generate clinically meaningful evidence to guide temperature selection and prophylactic ASM after cardiac arrest. Evaluating these interventions in combination may provide a more comprehensive understanding of whether they reduce seizure burden, mitigate brain injury, and improve functional recovery.

The goal of this observational study is to validate the generalization capability and predictive performance of the "Time-Series Electronic Health Record Foundation Model (EHR Foundation Model)", which was pre-trained on a large-scale critical care dataset, within the real-world clinical environment of the Intensive Care Unit (ICU) at Peking University People's Hospital. The main question it aims to answer is: · Based on the "pre-training + fine-tuning" paradigm, whether the EHR foundation model can effectively provide accurate and dynamic prognostic support information in real-world clinical scenarios. Participants who agree to take part in the research, in addition to completing the signed informed consent form, if the patient's hospital stay is too short, will be obtained information on prognostic outcomes (e.g., 28-day mortality) through telephone follow-up.

The goal of this prospective multicenter observational study is to characterize early trajectories of consciousness recovery following the first valid structured awakening trial in mechanically ventilated critically ill adults, a phase that is not captured by current weaning classifications. The main questions it aims to answer are: 1. What trajectories of consciousness recovery occur during the first 72 hours after the first valid structured awakening trial? 2. Are different early consciousness trajectories associated with clinically relevant outcomes, including successful liberation from mechanical ventilation, delirium, duration of mechanical ventilation, ventilator-free days, mortality, and long-term functional and cognitive outcomes? Participants will: 1. Undergo standardized serial assessments of consciousness during the first 72 hours after the first valid structured awakening trial using the Richmond Agitation-Sedation Scale (RASS) and a standardized motor command assessment. 2. Receive daily assessments for delirium and weaning-related outcomes during the ICU stay. 3. Be followed for clinical outcomes during hospitalization and for functional and cognitive recovery up to 1 year after ICU admission.

Persistent Critical Illness (PCI) is a condition that affects some patients who remain in the Intensive Care Unit (ICU) for a long time, usually more than 10-14 days. It is estimated to occur in 5-20% of critically ill patients. A recent Portuguese study found that more than 14% of ICU patients stayed longer than 14 days. PCI is often associated with ongoing need for life support, such as mechanical ventilation or medications to maintain blood pressure. However, patients may also experience severe muscle weakness, repeated infections, or other complications, which makes this group very diverse. One of the main risk factors for prolonged ICU stay is sepsis, a severe infection that affects the whole body. Other factors-such as prior health conditions, use of corticosteroids, sedation practices, early versus late mobilization, fluid and antibiotic management, and delirium treatment-may also influence the development and course of PCI. This study aims to identify different clinical patterns ("clusters") among critically ill patients who remain in the ICU for more than 10 days. Patients will be followed until hospital discharge, and up to one year if data are available. Understanding these different patterns will help develop more personalized and effective care strategies for each patient profile. The study is a multicenter retrospective cohort including adult patients (≥18 years) admitted to participating ICUs for more than 5 days between 2021 and 2023. Data collected will include demographic, clinical, and laboratory information, details of organ support (such as mechanical ventilation or vasopressors), medications, nutrition, and rehabilitation practices. Statistical and machine learning methods will be used to identify groups of patients with similar clinical trajectories and to assess how these groups are related to outcomes such as survival, recovery of organ function, or long-term disability. Expected results are the identification of distinct clinical clusters of PCI that combine clinical and laboratory data, and the development of tailored management strategies to improve recovery and outcomes for patients with PCI.

The aim is to establish a nationwide registry for pediatric intensive care transports in Germany. The project aims to describe and analyse the need for, and current practice of, specialised transports. These data could then be used for future demand planning.

The goal of this clinical trial is to determine whether the Endotracheal Tube Position Anomaly Alerting System (ETPAAS) effectively reduces the duration of endotracheal tube malposition in patients admitted to the intensive care unit (ICU). Additionally, the study will assess the clinical impact, usability, and user satisfaction of ETPAAS. The main questions it aims to answer are: * Does ETPAAS reduce the duration of endotracheal tube malposition? * What are healthcare workers' perspectives on the usability and satisfaction of ETPAAS? Participants will receive standard care, with or without ETPAAS, in the intensive care unit. Researchers will evaluate the duration of endotracheal tube malposition. Healthcare workers will complete a questionnaire assessing the usability and satisfaction of ETPAAS.