Critical Care最新文献

{"title":"Elevated antibiotic resistance gene abundance of ICU healthcare workers, a multicentre, cross-sectional study","authors":"Lingtong Huang, Kangchen Li, Chen Peng, Silan Gu, Xiaohan Huang, Chunhua Gao, Xindie Ren, Minghui Cheng, Guojun He, Yinghe Xu, Yongpo Jiang, Hongyu Wang, Mingqiang Wang, Peng Shen, Qianqian Wang, Xuwei He, Lin Zhong, Shengfeng Wang, Nan Wang, Gensheng Zhang, Hongliu Cai, Chao Jiang","doi":"10.1186/s13054-025-05408-5","DOIUrl":"https://doi.org/10.1186/s13054-025-05408-5","url":null,"abstract":"Studies suggest that the colonization of multidrug-resistant organism in the gut of healthcare workers is similar to that of healthy individuals. However, due to exposure to medical environments, is the abundance of antibiotic resistance genes (ARG) in the gut of ICU healthcare workers higher than that of healthy individuals? Prospective, multicentre, cross-sectional study. Eight medical centers in China, recruiting from January 2024 to February 2024. 303 Healthy people (201 ICU healthcare workers and 103 healthy controls) were screened and 290 Healthy people (191 ICU healthcare workers and 99 healthy controls) were included in analysis. Fecal samples were collected and subjected to metagenomic sequencing. We compared the total ARG abundance, ARG diversity, and gut microbiome composition between the two groups. After adjusting for age, sex, and body mass index, ICU healthcare workers exhibited a significantly higher total ARG abundance compared to healthy controls (fold change = 1.22, 95% CI: 1.12–1.34, p < 0.001). The β-diversity of ARG between the two groups differed significantly (p = 0.001). No significant linear or nonlinear relationship was observed between the duration of ICU occupational exposure and ARG abundance (p for overall = 0.96, p for nonlinear = 0.84). In this prospective, multicenter study, we found that ICU healthcare workers exhibit significantly higher gut ARGs abundance compared to healthy controls. Meanwhile, ICU healthcare workers, including physicians, nurses, and nursing assistants, have a different composition of gut ARGs compared to healthy individuals. Trial registration: NCT06228248.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"46 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143889625","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":"Regional barriers in POCUS training","authors":"Vasiliki Tsolaki, Maria Theodorakopoulou, Epaminondas Zakynthinos","doi":"10.1186/s13054-025-05394-8","DOIUrl":"https://doi.org/10.1186/s13054-025-05394-8","url":null,"abstract":"&lt;p&gt;Point-of-Care Ultrasonography (POCUS) has become part of the daily clinical practice of physicians dealing with emergencies in almost all European countries. This involves intensivists, emergency physicians, anesthesiologists, and generally physicians treating patients who require immediate clinical decision making, emergency care and proper monitoring improving safety of critically ill patients.&lt;/p&gt;&lt;p&gt;In Greece, instead of rewarding physicians who use POCUS—and even strive to pass on their knowledge and experience to younger colleagues—on the contrary, obstacles are created by physician associations (such as the Radiology Society) that attempt to block any effort for POCUS training and modernization in Intensive Care Units (ICUs). The objections are based on outdated Greek laws and the mistaken belief that their professional rights are being undermined. It should be noted that a significant part of POCUS (brain, transcranial Doppler, thorax: lung and diaphragm) is not included in the training of Radiologists in Greece, while there is resistance from Radiologists in providing basic training in POCUS to physicians outside their specialty. These barriers were met around 20 years previously in Europe and North America, when POCUS was being introduced in the ICUs; intensivists had to develop informal working and teaching relationships in a non-competitive and low-keyed manner with other frontline intensivists who understood the value and utility of POCUS. The obstacles were overcome with the publications of landmark papers [1, 2] that defined the competencies in POCUS and the operationalization of recommendations into the curriculum and training programmes by the national societies [3].&lt;/p&gt;&lt;p&gt;Point-of-care ultrasonography is defined as the acquisition, interpretation and immediate clinical integration of ultrasonographic imaging performed by a treating clinician at the patient’s bedside rather than by a radiologist or cardiologist. POCUS is an inclusive term not limited to any specialty, protocol, or organ system [4]. Sound evidence supports that non-radiologists and non-cardiologists can become competent in the performance of POCUS. This has resulted in the expanded use in many practice settings and in all phases of care—from screening and diagnosis to procedural guidance and monitoring. POCUS use has been associated with changes in clinical decision making in medical practice [5, 6].&lt;/p&gt;&lt;p&gt;Especially in the ICU, POCUS complements clinical examination as a new “functional stethoscope”. Lung Ultrasonography (LUS) is more accurate than X-rays in distinguishing atelectasis, consolidation, or pleural effusion, pneumothorax and interstitial syndrome in ICU patients [7]. Additionally, LUS criteria fulfill the imaging requirements for ARDS diagnosis [8], and diaphragm ultrasonography can guide and monitor patient-ventilator interaction, preventing asynchrony and ventilator-induced diaphragmatic dysfunction [9, 10]. Brain ultrasonography aids the monitor","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"37 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143880378","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":"Health-related quality of life correlates with patient-reported and proxy-reported disability in critical illness survivors: a secondary analysis of the ERIC trial","authors":"Elena Ribet Buse, Julius J. Grunow, Claudia D. Spies, Björn Weiss, Nicolas Paul","doi":"10.1186/s13054-025-05399-3","DOIUrl":"https://doi.org/10.1186/s13054-025-05399-3","url":null,"abstract":"Expanding follow-up services for survivors of critical illness requires short and reliable instrument sets. The WHO Disability Assessment Schedule (WHODAS) 2.0 and the EuroQol 5-Dimensions 5-Level (EQ-5D-5L) are recommended to assess disability and health-related quality of life (HrQoL), respectively. As they may measure partially overlapping constructs, we assessed their relationship. We conducted a secondary analysis of the multicenter cluster-randomized controlled Enhanced Recovery after Intensive Care (ERIC) trial (ClinicalTrials.gov: NCT03671447). At follow-ups scheduled 6 months after ICU discharge, critical illness survivors and caregivers completed the EQ-5D-5L, the patient-reported and the proxy-reported 12-item WHODAS 2.0. We employed local polynomial regressions, correlation coefficients, and linear regressions to analyze the global and domain-specific relationships between the EQ-5D-5L and the WHODAS 2.0. We analyzed 700 patients with a median EQ-5D-5L index value of 0.81 [IQR 0.52 to 0.94], a median patient-reported WHODAS 2.0 sum score of 11 [IQR 3 to 23], and a median proxy-reported WHODAS 2.0 sum score of 16 [IQR 6 to 28]. The EQ-5D-5L index value highly correlated with patient-reported (Spearman: − 0.84 [95% CI − 0.86 to − 0.82]) and proxy-reported (Spearman: − 0.70 [− 0.76 to − 0.64]) WHODAS 2.0 sum scores. Corresponding domains were also highly correlated, with the patient-reported WHODAS 2.0 aligning more closely with the EQ-5D-5L than the proxy-reported WHODAS 2.0. We found ceiling and floor effects for both instruments, indicating limitations for detecting mild disabilities and high HrQoL. In multivariable linear regressions, the patient-reported and proxy-reported WHODAS 2.0 sum scores (both − 0.02 [95% CI − 0.02 to − 0.02], p < 0.01) and WHODAS 2.0 domain scores for mobility, self-care, and life activities were predictors of the EQ-5D-5L index value and respective EQ-5D-5L domain scores. Our results suggest a high correlation between the patient-reported and proxy-reported WHODAS 2.0 and the EQ-5D-5L, particularly in their corresponding domains. To economize post-ICU assessments, there may be no need to use both instruments simultaneously.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"108 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143862763","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 impact of different rates of sodium reduction on the central nervous system in acute hypernatremia in rabbits","authors":"Geng Xue, Hongyu Wu, Ruidong Feng, Ling Ma, Rui Cao, Rongli Yang, Shuo Wu","doi":"10.1186/s13054-025-05377-9","DOIUrl":"https://doi.org/10.1186/s13054-025-05377-9","url":null,"abstract":"Acute hypernatremia is a prevalent electrolyte imbalance in the intensive care unit (ICU), closely associated with the severity of patients’ conditions. This study employs animal experimentation to investigate the effects of varying sodium reduction rates on the central nervous system in acute hypernatremia, aiming to identify the optimal rate of sodium reduction. A stepwise sodium titration approach was used to establish an acute hypernatremia model, targeting a sodium increase of 0.5 mEq/L per hour (target serum sodium: a rise of 15 mEq/L within 48 h from baseline). Subsequently, a stepwise sodium decrement method was applied to reduce sodium levels to baseline. The study included four groups with different target sodium reduction rates: 1 mEq/L/h (Slow group), 2 mEq/L/h (Middle group), 3 mEq/L/h (Fast group), and Sham surgery group. Blood sodium and potassium levels, as well as urine sodium and potassium, were measured at various time points; central venous pressure (CVP) and intracranial pressure (ICP) were monitored; fluid intake and output were recorded to calculate fluid balance. After sodium reduction, brain tissue was extracted for pathological examination. Twenty adult, healthy male rabbits were randomly assigned to four groups (five rabbits per group). Before and after sodium reduction, the ICP significantly increased in the Fast group from 7.00 ± 0.71 to 13.20 ± 2.95 and in the Middle group from 6.80 ± 0.45 to 11.40 ± 0.89 (p = 0.015 and p = 0.000, respectively); the Slow group showed no significant change in ICP. Pathological findings revealed edema and disorganized brain tissue in the cerebral cortex and brainstem in the Fast and Middle groups, with statistically significant differences compared to the sham-operated group in semi-quantitative analysis. For acute hypernatremia that develops within 48 h, sodium reduction rates exceeding 1 mEq/L/h are associated with greater increases in ICP and more severe brain edema. Therefore, for managing acute hypernatremia,our result prompted that sodium reduction rates might not exceed 1 mEq/L/h.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"6 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143862745","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":"Letter to the editor regarding “Structural and functional alteration of the gut microbiomes in ICU staff: a cross-sectional analysis”","authors":"Wenxiao Zhang","doi":"10.1186/s13054-025-05418-3","DOIUrl":"https://doi.org/10.1186/s13054-025-05418-3","url":null,"abstract":"&lt;p&gt;Dear Editor,&lt;/p&gt;&lt;p&gt;I read with great interest the study by Xie et al. published in Critical Care and carefully reviewed their clinical trial registration details (NCT06524765) [1]. Although this study holds significant clinical value, there are still certain issues that need to be addressed.&lt;/p&gt;&lt;p&gt;First, it appears that there may be some deviations from the clinical trial protocol provided (NCT06524765). According to the study protocol, the primary outcome was defined as the difference in ARGs abundance; however, this outcome does not seem to have been fully addressed in the study. Additionally, several secondary outcomes were not presented. Specifically, important metrics related to quality-of-life assessments, including the Patient Health Questionnaire (PHQ-9) score, Symptom Checklist 90 (SCL-90) score, Perceived Stress Scale (PSS) score, International Physical Activity Questionnaire (IPAQ) score, and Pittsburgh Sleep Quality Index (PSQI) score, appear to be missing. These omissions raise some questions regarding the completeness of the study’s findings.&lt;/p&gt;&lt;p&gt;Second, the authors claim that gender is the factor influencing microbiome differences among healthcare workers. Given that the majority of nurses in China are female, the observed differences could potentially be attributed to occupational characteristics rather than solely to gender. It would be helpful if the authors could provide additional details on the occupational categories of male and female healthcare workers to further clarify this issue.&lt;/p&gt;&lt;p&gt;Finally, the authors did not make any multiple corrections to the &lt;i&gt;P&lt;/i&gt;-value in this study. In microbiome research, multiple testing corrections for p-values should be applied to decrease the probability of false positives, making the final conclusions more reliable. Besides, it seems that a sample size calculation based on the primary outcome was not conducted. Considering that a sample size of 40 is relatively small for a microbiome study, this may have an impact on the statistical robustness of the results. For instance, while the authors suggest that there is no statistically significant difference in ARGs between healthcare workers and healthy individuals, this result could potentially be influenced by the sample size, which may not be sufficient to detect such differences.&lt;/p&gt;&lt;p&gt;I hope the authors can take these issues into careful consideration.&lt;/p&gt;&lt;p&gt;None&lt;/p&gt;&lt;ol data-track-component=\"outbound reference\" data-track-context=\"references section\"&gt;&lt;li data-counter=\"1.\"&gt;&lt;p&gt;Xie B, Dong C, Zhao X, et al. Structural and functional alteration of the gut microbiomes in ICU staff: a cross-sectional analysis. Crit Care. 2025;29:141.&lt;/p&gt;&lt;p&gt;Article PubMed PubMed Central Google Scholar &lt;/p&gt;&lt;/li&gt;&lt;/ol&gt;&lt;p&gt;Download references&lt;svg aria-hidden=\"true\" focusable=\"false\" height=\"16\" role=\"img\" width=\"16\"&gt;&lt;use xlink:href=\"#icon-eds-i-download-medium\" xmlns:xlink=\"http://www.w3.org/1999/xlink\"&gt;&lt;/use&gt;&lt;/svg&gt;&lt;/p&gt;&lt;p&gt;None.&lt;/p&gt;&lt;h3&gt;Authors and Affiliation","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"32 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143862749","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":"Pyroptosis in sepsis-associated acute kidney injury: mechanisms and therapeutic perspectives","authors":"Wenyu Wu, Wanning Lan, Xin Jiao, Kai Wang, Yawen Deng, Rui Chen, Ruifeng Zeng, Jun Li","doi":"10.1186/s13054-025-05329-3","DOIUrl":"https://doi.org/10.1186/s13054-025-05329-3","url":null,"abstract":"Sepsis-associated acute kidney injury (S-AKI) is a severe complication characterized by high morbidity and mortality, driven by multi-organ dysfunction. Recent evidence suggests that pyroptosis, a form of programmed cell death distinct from apoptosis and necrosis, plays a critical role in the pathophysiology of S-AKI. This review examines the mechanisms of pyroptosis, focusing on inflammasome activation (e.g., NLRP3), caspase-mediated processes, and the role of Gasdermin D in renal tubular damage. We also discuss the contributions of inflammatory mediators, oxidative stress, and potential therapeutic strategies targeting pyroptosis, including inflammasome inhibitors, caspase inhibitors, and anti-inflammatory therapies. Lastly, we highlight the clinical implications and challenges in translating these findings into effective treatments, underscoring the need for personalized medicine approaches in managing S-AKI. ","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"7 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143866755","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 rapid chest compression technique on intracranial and cerebral perfusion pressures in acute neurocritical patients: a randomized controlled trial","authors":"Ricardo Miguel Rodrigues-Gomes, Ángela Prieto Campo, Rosa Martinez Rolán, Miguel Gelabert-González","doi":"10.1186/s13054-025-05405-8","DOIUrl":"https://doi.org/10.1186/s13054-025-05405-8","url":null,"abstract":"Some studies refer to the increase in intracranial pressure (ICP) with chest physiotherapy techniques but without any randomized controlled trials that evaluate the safety of the manual rapid chest compression technique in patients with severe acute brain injuries on invasive mechanical ventilation. Our research question examines whether intracranial and cerebral perfusion pressures significantly change during rapid chest compression technique. A prospective, randomized, single-blinded controlled trial of acute neurocritical patients under mechanical ventilation was performed. The intervention group was subjected to rapid chest compression, and the control group received mechanical passive inferior limbs mobilization. The outcomes were intracranial pressure, cerebral perfusion pressure, blood partial pressure of oxygen and carbon dioxide, and inspiratory and expiratory peak flows. Between May 2021 and December 2023, 50 patients (aged 56.3 years), 66% females, were randomized into two groups (25 controls and 25 interventions). The ICP and cerebral perfusion pressure (CPP) did not significantly differ between the groups at any of the studied times. Intragroup analysis revealed significant decreases in the ICP and CPP in the intervention group, with posterior recovery in both groups. The CPP significantly decreased in the control group but did not reach the preintervention values at the last measurement time. PaCO2 was significantly lower in the intervention group than in the control group at the end of the study. The rapid chest compression technique did not increase the ICP during its application or even 30 min after it. The ICP showed a slight significant decrease during the application of the rapid chest compression technique but reached the previous values in the posterior 30 min. CPP had a similar behavior but did not completely recover in both groups. Trial registration: NCT03609866. Registered on 08/01/2018.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"1 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143862762","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":"Cardiovascular effects of lactate in healthy adults: d-lactate, the forgotten enantiomer—authors' reply","authors":"Kristoffer Berg-Hansen, Mette Glavind Bülow Pedersen, Nigopan Gopalasingam, Nikolaj Rittig, Esben Søndergaard, Niels Møller, Roni Nielsen","doi":"10.1186/s13054-025-05407-6","DOIUrl":"https://doi.org/10.1186/s13054-025-05407-6","url":null,"abstract":"&lt;p&gt;To the Editor,&lt;/p&gt;&lt;p&gt;We thank Drs. Stevic, Argaud, and Cour for their interest in our recent article entitled &lt;i&gt;Cardiovascular Effects of Lactate in Healthy Adults&lt;/i&gt; [1]. Indeed, utilizing a racemic hypertonic sodium lactate (HSL) solution, the composition of the enantiomers &lt;span&gt;l&lt;/span&gt;- and &lt;span&gt;d&lt;/span&gt;-lactate is balanced, and we agree that recognition of chirality is essential to further comprehend our results. However, additional important aspects must be considered to fully explain the potential hemodynamic benefits of HSL treatment.&lt;/p&gt;&lt;p&gt;The commentary by Stevic et al. [2] raises concerns regarding potential toxicity from &lt;span&gt;d&lt;/span&gt;-lactate accumulation, particularly in critically ill patients. While it is true that &lt;span&gt;d&lt;/span&gt;-lactate is metabolized less efficiently than &lt;span&gt;l&lt;/span&gt;-lactate [3], the clinical relevance of this remains unclear. In healthy individuals, &lt;span&gt;d&lt;/span&gt;-lactate is present at negligible concentrations and is readily excreted in the urine [4]. In our study, we only measured circulating &lt;span&gt;l&lt;/span&gt;-lactate, and thus, we can only speculate on the levels of &lt;span&gt;d&lt;/span&gt;-lactate [1]. Interestingly, a prior study of healthy participants utilizing a similar infusion regimen to ours demonstrated comparable circulating levels of &lt;span&gt;l&lt;/span&gt;-lactate (2.8–4.0 mmol/L), with slightly lower levels of &lt;span&gt;d&lt;/span&gt;-lactate (1.7–3.0 mmol/L) [4]. This difference was attributed to lower endogenous &lt;span&gt;d&lt;/span&gt;-lactate production. Importantly, metabolic clearance of &lt;span&gt;d&lt;/span&gt;-lactate appeared to be efficient, despite preferential utilization of &lt;span&gt;l&lt;/span&gt;-lactate. While &lt;span&gt;l&lt;/span&gt;-lactate is typically converted to pyruvate via &lt;span&gt;l&lt;/span&gt;-lactate dehydrogenase (L-LDH), &lt;span&gt;d&lt;/span&gt;-lactate may also be converted to pyruvate through D-LDH, an enzyme enriched in the liver and kidneys [5]. These findings suggest that &lt;span&gt;d&lt;/span&gt;-lactate, although less abundant in the bloodstream, may still undergo metabolic processes.&lt;/p&gt;&lt;p&gt;Despite concerns regarding potential &lt;span&gt;d&lt;/span&gt;-lactate toxicity, no studies to date have demonstrated clinically relevant adverse effects following exogenous administration in humans at doses comparable to those used in our study. Notably, endogenous accumulation of both &lt;span&gt;l&lt;/span&gt;- and &lt;span&gt;d&lt;/span&gt;-lactate can contribute to lactic acidosis [6]. While &lt;span&gt;l&lt;/span&gt;-lactic acidosis is commonly observed in clinical settings, &lt;span&gt;d&lt;/span&gt;-lactic acidosis is rare and often associated with short-bowel syndrome, where excessive &lt;span&gt;d&lt;/span&gt;-lactate is produced and absorbed from the gastrointestinal tract [7]. Furthermore, although &lt;span&gt;d&lt;/span&gt;-lactate accumulation has been linked to neurological symptoms in patients with mutations affecting D-LDH function, these conditions are often accompanied by the accumulation of multiple organic acids, complicating the interpretation of &lt;span&gt;d&lt;/span&gt;-lactate toxicity [8]. Importantly, no side effects resembling ","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"1 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143862744","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":"Haloperidol is not the “one drug fits all” solution in the treatment of delirium","authors":"Johannes Ehler, Axel Petzold","doi":"10.1186/s13054-025-05413-8","DOIUrl":"https://doi.org/10.1186/s13054-025-05413-8","url":null,"abstract":"&lt;p&gt;Dear Editor,&lt;/p&gt;&lt;p&gt;We read with great interest the recent publication by Cheng et al., investigating the role of haloperidol in delirium [1]. We acknowledge the authors’ diligent selection of studies for comparison, but wonder that landmark studies came to a diametrically opposed conclusion [2, 3]. There is need for a balanced interpretation of the presumed meta-analytical benefits of haloperidol regarding survival and delirium duration, with the interpretation of presumably fewer serious adverse events (SAEs) [1,2,3]. There are three key questions on which we would like to learn the authors’ opinion.&lt;/p&gt;&lt;p&gt;Firstly, the consistent comparison of haloperidol against placebo, while providing a baseline, overlooks the significant evolution towards a multimodal approach in delirium therapy. Current best practices emphasize a holistic strategy integrating non-pharmacological interventions for both prevention and treatment, with pharmacological agents reserved for specific indications [4]. The study does not address the contemporary core delirium care, particularly the extent to which non-pharmacological strategies were implemented. This omission is critical, given the increasing emphasis on non-pharmacological recommendations by leading societies such as the European Society of Anaesthesiology and Intensive Care (ESAIC) [4]. Does focusing solely on pharmacological intervention risks not present an incomplete and potentially biased perspective on delirium management?&lt;/p&gt;&lt;p&gt;Secondly, the observation of a reduced number of rescue benzodiazepine treatments through application of haloperidol warrants further scrutiny. Do benzodiazepines itself not have a pro-delirogenic potential and are therefore discouraged for treatment of delirium [4]?&lt;/p&gt;&lt;p&gt;Thirdly, the lack of a significant effect on duration of ventilation raises important questions, particularly concerning the broader context of ICU management. Prolonged ventilation is a multifactorial issue. Does attributing it solely to delirium not overlook the potential influence of sedative medication dosages, paradoxically including haloperidol itself?&lt;/p&gt;&lt;p&gt;Furthermore, we have concerns regarding the presentation of data in Table 2 on prevention of delirium [1]. The presentation of \"benefits (%)\" might be misleading when the Risk Ratio lacks significance. Similarly, the \"any benefit\" descriptor in Table 1 [1], while highlighting potential advantages, could be misinterpreted as a definitive recommendation for universal haloperidol use. In clinical practice there will be no “one drug fits all solution”.&lt;/p&gt;&lt;p&gt;In conclusion, we believe that while the study provides valuable data on the efficacy of haloperidol compared to placebo [1], a balanced interpretation should also include:&lt;/p&gt;&lt;ul&gt;\u0000&lt;li&gt;\u0000&lt;p&gt;Current guidelines increasingly support non-pharmacological strategies as the cornerstone of delirium management [4], moving away from a \"one drug fits all\" approach.&lt;/p&gt;\u0000&lt;/li&gt;\u0000&lt;li&gt;\u0000&lt;p&gt;Haloperidol carries a risk of QT","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"17 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143862747","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 administration of vitamin C in patients with sepsis or septic shock in emergency departments: a multicenter, double-blind, randomized controlled trial: the C-EASIE trial","authors":"Stefanie Vandervelden, Bente Cortens, Steffen Fieuws, Wilma Eegdeman, Stefano Malinverni, Philippe Vanhove, Koen Monsieurs, Jan Breuls, Ives Hubloue, François Stifkens, Jacques Creteur, Lina Wauters, Didier Desruelles","doi":"10.1186/s13054-025-05383-x","DOIUrl":"https://doi.org/10.1186/s13054-025-05383-x","url":null,"abstract":"Sepsis and septic shock are associated with high mortality and morbidity despite adequate standard care. Vitamin C deficiency is a common, potentially reversible, contributor to morbidity and mortality in sepsis. Previous studies have shown mixed and conflicting results. Our study aimed to determine the potential benefit of early administration (within 6 h after admission) of vitamin C in patients with sepsis or septic shock. This was a phase 3b prospective, multicenter, double-blinded, randomized placebo-controlled trial. Participants were enrolled in the Emergency Departments of 8 hospitals throughout Belgium. Patients were randomized to receive 1.5 g of vitamin C, or matching placebo, every 6 h for 4 days. The primary outcome was the average post-baseline patient Sequential Organ Failure Assessment (SOFA) score on day 2 to 5. Key secondary outcomes were the maximum SOFA score, 28-day mortality and length of ICU and hospital stay. A total of 300 patients were recruited between June 4th, 2021, and August 19th, 2023. 292 patients, of which 147 were assigned to the vitamin C and 145 to the placebo group, completed the trial and were included in the analysis. The primary outcome (vitamin C, 1.98; placebo, 2.19) was 8.7% lower in the vitamin C group, but not significantly (ratio 0.91, 95% CI 0.77 to 1.08, P = 0.30). In a planned subgroup analysis, patients with a baseline SOFA score of 6 or above had a significant lower average post-baseline SOFA score in the vitamin C group (ratio 0.76, 95% CI 0.86 to 0.99, P = 0.042). Findings were similar in the two groups regarding secondary outcomes and adverse events, except for a lower probability of being on renal replacement therapy in the vitamin C group of the per protocol analysis (ratio 0.28, 95% CI 0.078 to 1.0, P = 0.05). Early treatment with vitamin C did not result in a statistically significant reduction in organ dysfunction. Therefore, this study does not support the use of vitamin C in sepsis patients. Trial registration: ClinicalTrials.gov Identifier: NCT04747795 . Registered 4 February 2021. Question Does early treatment with vitamin C lead to a less severe disease course in patients with sepsis or septic shock? Findings In this randomized clinical trial that included 292 patients, treatment with intravenous vitamin C compared to placebo did not result in a lower average post-baseline patient Sequential Organ Failure Assessment (SOFA) score on day 2 to 5 (1.98 vs 2.19), except for a subgroup of patients with a baseline SOFA score of 6 or above. Meaning Early treatment with vitamin C did not result in a significant improvement of the disease course.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"3 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143862750","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}