Critical Care Medicine最新文献

{"title":"Association of Breathing Effort With Survival in Patients With Acute Respiratory Distress Syndrome.","authors":"Francisco José Parrilla-Gómez, Andrea Castellví-Font, Víctor Boutonnet, Andrés Parrilla-Gómez, Marta Antolín Terreros, Cristina Mestre Somoza, Marina Blanes Bravo, Paola Pratsobrerroca de la Rubia, Eva Martín-López, Santiago Marco, Olimpia Festa, Laurent J Brochard, Ewan C Goligher, Joan Ramon Masclans Enviz","doi":"10.1097/CCM.0000000000006797","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006797","url":null,"abstract":"<p><strong>Objectives: </strong>Invasive mechanical ventilation (IMV) is crucial for acute respiratory distress syndrome (ARDS) management, but mortality remains high. While spontaneous breathing is key to weaning, excessive respiratory effort may injure the lung and diaphragm. Most existing data on respiratory effort during IMV are based on brief periods of observation, potentially underestimating the burden of inappropriate efforts. This study aims to characterize the evolution of respiratory effort over time in ARDS patients and its relation to survival. We hypothesized that nonsurvivors would spend a greater proportion of time in the high-effort range during the active breathing phase compared with survivors.</p><p><strong>Design, setting, and patients: </strong>In this prospective cohort study, we continuously recorded airway pressure, flow, esophageal, and gastric pressures in ARDS patients on mechanical ventilation during 7 days after the onset of spontaneous breathing. We analyzed physiologic respiratory effort variables, focusing on the proportion of time spent within defined effort ranges, and compared these data between ICU survivors and nonsurvivors. Statistical analysis was conducted using variance weighted methods to account for variability in the number of respiratory cycles analyzed per patient. This study is registered at ClinicalTrials.gov under identifier NCT06490523.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>A total of 1,485,405 respiratory cycles were analyzed from 26 ARDS patients (19 survivors, seven nonsurvivors). Nonsurvivors spent significantly more time in high effort (12% vs. 3%; p = 0.006). In contrast, survivors spent more time in the moderate-effort range (50% vs. 5%; p < 0.001). The time spend with high dynamic transpulmonary driving pressure (> 25 cm H2O) was also significantly different between groups (32% survivors vs. 74% nonsurvivors; p = 0.001).</p><p><strong>Conclusions: </strong>Patients who die of ARDS are more likely to be exposed to high respiratory effort for prolonged periods of time compared with survivors.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144774848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decreased Clearance of Low-Density Lipoprotein Cholesterol is Causally Associate With Increased Mortality of Septic Shock.","authors":"Nozomi Takahashi, Kyle R Campbell, Taka-Aki Nakada, Keith R Walley","doi":"10.1097/CCM.0000000000006809","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006809","url":null,"abstract":"<p><strong>Objective: </strong>To determine whether low-density lipoprotein cholesterol (LDL-C) levels, set by the balance of clearance and production, causally contribute to septic shock 28-day mortality.</p><p><strong>Design: </strong>We measured LDL-C levels and genotypes in patients with septic shock. Using Genotyping and Genome-Wide Association Study summary statistics from over 150,000 Japanese participants, we genetically predicted pre-infection LDL-C levels. Two-sample Mendelian randomization was used to assess the causal relationship between predicted pre-infection LDL-C levels and 28-day mortality. We analyzed PCSK9 and 3-hydroxy-3-methylglutaryl-CoA reductase (HMGCR) genotypes to determine if LDL-C clearance or production was the underlying mechanism.</p><p><strong>Setting: </strong>Multicenter ICUs in Japan.</p><p><strong>Patients: </strong>Genotyped septic shock patients (n = 614).</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Predicted pre-infection LDL-C levels were much higher than directly measured LDL-C levels at the onset of septic shock (141 mg/dL vs. 40 mg/dL, p < 0.001). Two-sample Mendelian randomization revealed that high predicted pre-infection LDL-C levels were causally associated with increased septic shock 28-day mortality (hazard ratio, 2.78; p = 0.039). PCSK9 genetic variants that increase LDL-C clearance via the LDL receptor (genetically proxied PCSK9 inhibitor treatment) were associated with decreased mortality (p = 0.003) while HMGCR genetic variants that decrease LDL-C production (genetically proxied statin treatment) were not associated with decreased septic shock mortality (indeed the opposite effect was observed, p = 0.039). The two main genetic variants driving the association between high predicted pre-infection LDL-C levels and increased mortality were in apolipoprotein genes (ApoB100-rs13306206 and ApoE-rs7412), apolipoproteins involved in LDL-C binding to the LDL receptor.</p><p><strong>Conclusions: </strong>Low LDL-C clearance explains the causal association between high genetically predicted pre-infection LDL-C levels and increased septic shock mortality. PCSK9, ApoB, and ApoE variants were identified as causal, all related to the LDL receptor or its interaction with LDL-C. Enhancing LDL receptor-mediated clearance of pathogen lipid toxins may improve septic shock outcomes.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144774849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reconsidering the Evidence for Delayed Renal Replacement Therapy Initiation.","authors":"Yang Xu, Wei Hu, Wei Lin","doi":"10.1097/CCM.0000000000006704","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006704","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":"53 8","pages":"e1705-e1706"},"PeriodicalIF":6.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144783688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reflection on the Decision-Making Framework in ICU RBC Transfusions.","authors":"Song Zhou, Yunlai Zhao, Lianxiang Li, Bo Song","doi":"10.1097/CCM.0000000000006708","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006708","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":"53 8","pages":"e1696-e1697"},"PeriodicalIF":6.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144783690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Hoax of the Obesity Paradox Is Back.","authors":"Maya Guglin","doi":"10.1097/CCM.0000000000006676","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006676","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":"53 8","pages":"e1682"},"PeriodicalIF":6.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144783697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiology of Septic Shock Associated Acute Kidney Injury: A National Retrospective Cohort Study.","authors":"Asad E Patanwala, Brian L Erstad","doi":"10.1097/CCM.0000000000006735","DOIUrl":"10.1097/CCM.0000000000006735","url":null,"abstract":"<p><strong>Objectives: </strong>Septic shock is the most severe and final stage of sepsis. These patients may have a higher risk for sepsis-associated acute kidney injury (AKI). The purpose of this study is to determine the frequency of AKI, major adverse kidney events at 30 days (MAKE-30), and use of renal replacement therapy (RRT) in patients with septic shock. We also aim to determine the association between stage of AKI and in-hospital mortality.</p><p><strong>Design: </strong>Retrospective, multicenter, cohort study.</p><p><strong>Setting: </strong>This was conducted in 220 geographically diverse community and teaching hospitals across the United States.</p><p><strong>Patients: </strong>Adult patients were included if they had septic shock on hospital admission.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Measurements include stage 1, 2, and 3 AKI, RRT, and MAKE-30. Of the 21,803 patients included in the final cohort, 92.8% had AKI during hospital admission. Patients had a mean ( sd ) age of 66.0 years (15.1 yr), 48.6% were female, 29.5% had chronic kidney disease, and mean ( sd ) estimated glomerular filtration rate was 35.8 mL/min/1.73 m 2 (24.3 mL/min/1.73 m 2 ). The maximum stage of AKI during hospitalization was none (7.2%), stage 1 (22.9%), stage 2 (27.3%), or stage 3 (42.7%). The proportion of patients who received RRT was 6.4%. MAKE-30 occurred in 42.0% and 30.9% died. There was no significant association between stage 1 (odds ratio [OR], 1.12; 95% CI, 0.97-1.29; p = 0.109), but there was a significant association between stage 2 (OR, 1.25; 95% CI, 1.09-1.43; p = 0.001), and stage 3 AKI (OR, 1.66; 95% CI, 1.46-1.89; p < 0.001) and mortality.</p><p><strong>Conclusions: </strong>Among hospitalized patients with septic shock, most patients have AKI, and stage 3 AKI is associated with the highest risk of mortality.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e1601-e1609"},"PeriodicalIF":6.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144282780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early Use of a Risk-Adjusted Mechanical Ventilation Digital Quality Measure Bundle in a Large Health System.","authors":"Christopher M Horvat, Jesse Klug, Ruoting Li, Jesse Raffa, Thomas Pollard, Leo Celi, McKenzie Plovock, Kimberly Emanuele, Michael Garver, Harry Hochheiser, Robert Clark, Rachel Sackrowitz, Derek Angus, Chenell Donadee, Aimee Boeltz","doi":"10.1097/CCM.0000000000006740","DOIUrl":"10.1097/CCM.0000000000006740","url":null,"abstract":"<p><strong>Objectives: </strong>To describe the development, validation, and deployment of a risk-adjusted digital quality measure (dQM) bundle for spontaneous awakening trials (SATs), spontaneous breathing trials (SBTs), and low-tidal volume ventilation (LTVV) as part of a quality improvement (QI) program in a large health system.</p><p><strong>Design: </strong>Quasi-experimental before-after study.</p><p><strong>Setting: </strong>Thirty-seven ICUs across 14 hospitals in the United States.</p><p><strong>Patients: </strong>Mechanically ventilated patients older than 16 years.</p><p><strong>Interventions: </strong>An available, open-source, hospital mortality model, a new gradient-boosted ICU mortality model, and four new, heterogenous, stacked ensemble predicted duration of mechanical ventilation (DMV) models (one model predicting up to 14 d of ventilation [14-d DMV model] and three multiple classifier models predicting up to 6 d of ventilation) were created. A regularly refreshing dashboard displaying risk-adjusted information was coupled with audit and feedback sessions for ICU leadership beginning in September 2020.</p><p><strong>Measurements and main results: </strong>Risk model performance was evaluated, as appropriate, with C-statistics, mean se (MSE), concordance correlation coefficients (CCCs), and F1-scores. Across all ICUs, compliance with SBTs improved from 81 to 97%, LTVV 80 to 90%, and SATs 27 to 65%. Both hospital and ICU mortality models had robust performance, with C-statistics of 0.85 (95% CI, 0.84-0.85) and 0.94 (0.93-0.94), respectively. The 14-day DMV model MSE was 0.63 and CCC was 0.97, whereas the multiple classifier DMV models F1-scores ranged from 0.42 to 0.59. Unadjusted DMV was greater post-implementation (4.32 ± 3.99 d) vs. pre-implementation (3.76 ± 3.66 d). Actual vs. predicted ventilator days were stable pre-implementation vs. post-implementation when assessed with the multiple classifier models and decreased in the post-implementation period when assessed with the 14-day model. Risk-adjusted mortality remained stable.</p><p><strong>Conclusions: </strong>A dQM bundle proved useful for efficiently tracking process measures related to a ventilator management QI program in a large health system, although risk-adjusted information differed depending on model constructs. Future work should focus on developing and validating generalizable and interoperable dQM bundles.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e1630-e1640"},"PeriodicalIF":6.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144282757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes, Characteristics, and Physiology of In-Hospital Cardiac Arrest in Children With Sepsis.","authors":"Ryan W Morgan, Ron W Reeder, Joseph A Carcillo, Todd C Carpenter, Julie C Fitzgerald, Kathryn Graham, Todd J Kilbaugh, Kathleen L Meert, Vinay M Nadkarni, Chella A Palmer, Matthew P Sharron, Scott L Weiss, Heather A Wolfe, Tageldin Ahmed, Michael J Bell, Robert Bishop, Candice Burns, J Wesley Diddle, Ericka L Fink, Deborah Franzon, Aisha H Frazier, Stuart H Friess, David A Hehir, Christopher M Horvat, Leanna L Huard, Tensing Maa, Patrick S McQuillen, Peter M Mourani, Maryam Y Naim, Murray M Pollack, Anil Sapru, Neeraj Srivastava, Andrew R Yates, Robert A Berg, Robert M Sutton","doi":"10.1097/CCM.0000000000006739","DOIUrl":"10.1097/CCM.0000000000006739","url":null,"abstract":"<p><strong>Objectives: </strong>Prearrest sepsis has been associated with particularly poor outcomes among children who suffer in-hospital cardiac arrest (IHCA), but there is a paucity of dedicated studies on the topic. In this study of children receiving cardiopulmonary resuscitation (CPR) in the ICU, our objective was to determine the associations of sepsis with IHCA outcomes and intraarrest physiology.</p><p><strong>Design: </strong>Prospectively designed secondary analysis of the ICU Resuscitation Project clinical trial (NCT02837497).</p><p><strong>Setting: </strong>The 18 pediatric and pediatric cardiac ICUs at ten children's hospitals in the United States.</p><p><strong>Patients: </strong>Children (≤ 18 yr) with an index IHCA event.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>The primary exposure was a prearrest diagnosis of sepsis. The primary survival outcome was survival to hospital discharge with favorable neurologic outcome (Pediatric Cerebral Performance Category score 1-3 or unchanged from baseline). The primary physiologic outcome was average diastolic blood pressure (DBP) during CPR. Multivariable regression models controlling for a priori covariates assessed the relationship between sepsis and outcomes. Of 1129 children with index IHCAs, 184 (16.3%) had prearrest sepsis. Patients with sepsis had greater prearrest comorbidities, higher prearrest severity of illness, and higher Vasoactive-Inotropic Scores than patients without sepsis. They more frequently had hypotension as the cause of IHCA, had longer durations of CPR, and more frequently received epinephrine and sodium bicarbonate during CPR. They less frequently achieved survival with favorable neurologic outcome (52/184 [28.3%] vs. 552/945 [58.4%]; p < 0.001; adjusted relative risk, 0.54; 95% CI, 0.43-0.68; p < 0.001). Intraarrest DBPs did not differ between patients with vs. without sepsis. Following IHCA, event survivors with sepsis had higher vasoactive requirements, more frequently experienced hypotension, and continued to have greater mortality rates through 48 hours postarrest.</p><p><strong>Conclusions: </strong>Children with prearrest sepsis had worse survival outcomes, similar intraarrest DBPs, and greater pre and postarrest severity of illness than children without sepsis.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e1529-e1541"},"PeriodicalIF":6.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12286578/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144483439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lactate Values and Mortality in Patients With Cardiogenic Shock: Insights From the Altshock-2 Registry.","authors":"Matteo Pagnesi, Mauro Riccardi, Alice Sacco, Giovanna Viola, Fabrizio Oliva, Simone Frea, Martina Briani, Letizia Fausta Bertoldi, Maurizio Bertaina, Luciano Potena, Serafina Valente, Marco Marini, Gaetano Maria De Ferrari, Nicoletta D'Ettore, Astrid Cardinale, Rita Camporotondo, Matteo Rota, Guido Tavazzi, Nuccia Morici, Federico Pappalardo, Marco Metra","doi":"10.1097/CCM.0000000000006738","DOIUrl":"10.1097/CCM.0000000000006738","url":null,"abstract":"<p><strong>Objectives: </strong>We aimed to evaluate the prognostic role of baseline and 24-hour plasma lactates in patients with cardiogenic shock (CS).</p><p><strong>Design: </strong>Multicenter, observational, prospective Altshock-2 Registry (NCT04295252) enrolling patients with CS since March 2020.</p><p><strong>Setting: </strong>Multicenter Italian Registry (12 centers).</p><p><strong>Patients: </strong>Six hundred fifty-one consecutive patients with CS and available data on lactate values.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>The association of baseline and 24-hour lactates with in-hospital mortality (primary endpoint) was evaluated. The optimal lactate cutoff points for predicting outcomes were identified in the overall cohort and among patients treated with mechanical circulatory support (MCS). Among the 651 included patients with CS, the mean age was 64 ± 14 years and 76% were male. On admission, patients with lactates less than 2.0, 2.1-4.0, and greater than 4.0 mmol/L were 248 (38.1%), 172 (26.4%), and 231 (35.5%), respectively. An improvement in lactate values at 24 hours was observed in 76.5% of patients. Baseline and 24-hour lactates were both independently associated with increased mortality (adjusted odds ratios for each 1-mmol/L increase: 1.08 [95% CI, 1.02-1.14] for baseline lactate; and 1.37 [95% CI, 1.15-1.63] for 24-hr lactate), but 24-hour lactates had a higher predictive accuracy than baseline lactates (area under the curve 0.702 vs. 0.648). The optimal baseline and 24-hour lactate cutoffs for predicting mortality were 3.2 mmol/L and 1.7 mmol/L, respectively, and varied in patients treated with MCS at different time points.</p><p><strong>Conclusions: </strong>Higher baseline and 24-hour lactates were both independently associated with increased in-hospital mortality in patients with CS, although the 24-hour value had a higher predictive accuracy. Optimal lactate cutoffs for predicting mortality varied between admission and 24 hours and according to the MCS strategies.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e1620-e1629"},"PeriodicalIF":6.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144282783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Sevoflurane Inhalation on Pulmonary Hemodynamics in Moderate to Severe Acute Respiratory Distress Syndrome Patients With Septic Shock: A Prospective Cohort Study.","authors":"Giovanni Bousquet, Gabriel Parzy, Damien Barrau, Ines Gragueb-Chatti, Florence Daviet, Mélanie Adda, Saida Salmi, Geoffray Agard, Jean-Marie Forel, Antoine Roch, Laurent Papazian, Sami Hraiech, Christophe Guervilly","doi":"10.1097/CCM.0000000000006744","DOIUrl":"10.1097/CCM.0000000000006744","url":null,"abstract":"<p><strong>Objectives: </strong>Our study aimed to investigate the effects of sevoflurane inhalation on mean pulmonary arterial pressure (mPAP) and pulmonary vascular resistances (PVRs) in acute respiratory distress syndrome (ARDS) patients during lung protective ventilation.</p><p><strong>Design: </strong>Prospective cohort study.</p><p><strong>Setting: </strong>Medical ICU of a university teaching hospital.</p><p><strong>Patients: </strong>Deeply sedated, intubated adult patients with moderate to severe ARDS with Pa o2 /F io2 less than 150 mm Hg, with a positive end-expiratory pressure of greater than or equal to 5 cm H 2 O and septic shock monitored with a pulmonary arterial catheter.</p><p><strong>Interventions: </strong>Sedation was switched from IV midazolam to sevoflurane inhalation.</p><p><strong>Measurements and main results: </strong>Main objective was the change in mPAP between before (T0) and 1 hour (H + 1) after sevoflurane inhalation. Main secondary outcomes were mPAP 12-18 hours (H + 12-18) after inclusion, PVR indexed (PVRI), cardiac index, Pa o2 /F io2 , pulmonary shunt at H + 1, and H + 12-18 after inclusion. The H + 12-18 measurements were performed either in supine position (SP) or in prone position (PP), if Pa o2 /F io2 ratio was less than 150 mm Hg at H + 1. Fifteen patients were included in interim analysis. mPAP was 24 ± 4 mm Hg at inclusion and remained unchanged after 1 hour (24 ± 5 mm Hg) and 12-18 hours (23 ± 6 mm Hg) of sevoflurane inhalation. The mean expired fraction of sevoflurane was 0.75% ± 0.25% at H + 1 and 0.71% ± 0.25% at H + 12-18. No significant variations in PVRI, cardiac index, mean arterial pressure, pulmonary shunt were observed at H + 1 and H + 12-18. An improvement of Pa o2 /F io2 was observed at H + 12-18 in patients who remained in SP (from 158 ± 49 to 249 ± 86 mm Hg; p = 0.015) and in those turned prone (from 134 ± 36 to 241 ± 109 mm Hg; p = 0.018).</p><p><strong>Conclusions: </strong>In mechanically ventilated moderate to severe ARDS patients receiving lung protective ventilation, sevoflurane inhalation was not associated with decreases in mPAPs and PVRs. However, the smaller than planned sample size does not allow definitive conclusions.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e1659-e1665"},"PeriodicalIF":6.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144301304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}