Critical Care最新文献

{"title":"Correction: Electrical impedance tomography-guided the optimal awake prone position in a moderate ARDS patient","authors":"Yongzhen Sun, Jiale Tao, Jinjun Jiang, Shujing Chen","doi":"10.1186/s13054-025-05584-4","DOIUrl":"https://doi.org/10.1186/s13054-025-05584-4","url":null,"abstract":"<p><b>Correction: Crit Care (2025) 29:95</b> <b>https://doi.org/10.1186/s13054-025-05332-8</b></p><p>Following publication of the original article [1], the authors identified an error in Fig. 1F. Thinker’s position should be 320, however it appeared as 20. Both the incorrect and correct Fig. 1 is given hereafter.</p><p>The incorrect Fig. 1:</p><figure><picture><source srcset=\"//media.springernature.com/lw685/springer-static/image/art%3A10.1186%2Fs13054-025-05584-4/MediaObjects/13054_2025_5584_Figa_HTML.png?as=webp\" type=\"image/webp\"/><img alt=\"figure a\" aria-describedby=\"Figa\" height=\"760\" loading=\"lazy\" src=\"//media.springernature.com/lw685/springer-static/image/art%3A10.1186%2Fs13054-025-05584-4/MediaObjects/13054_2025_5584_Figa_HTML.png\" width=\"685\"/></picture></figure><p><b>Fig. 1</b> Changes in lung ventilation status and S/F, RR, and ROX of the patient in different positions under EIT monitoring. <b>A</b> shows the EIT images from the first day to the third day. The images in each panel from top to bottom are: global impedance waveforms, tidal impedance variation distribution (RVD: region ventilation delay, in yellow), difference image (CW: compliance win, in turquoise; CL: compliance loss, in orange), and data trend chart. (I), (II), (III), and (IV) in Figure A represent the supine position, semi-recumbent position, “Thinker’s position”, and prone position respectively, and each position was maintained for 10 min. <b>B</b> shows the changes in the global inhomogeneity index (GI) of the lungs in different positions monitored by EIT on the first and second days.<b> C</b> shows the changes in the ventilation center (CoV) of the lungs in different positions monitored by EIT on the first and second days.<b> D </b>shows the changes in GI and CoV of the lungs in different positions monitored by EIT on the third day. E shows the changes in the patient’s respiratory rate and ROX index during the 2-h maintenance of the“Thinker’s position (TP)”. F shows the changes in S/F, RR, and ROX of the patient in different positions from the first day to the third day</p><p>The correct Fig. 1:</p><figure><figcaption><b data-test=\"figure-caption-text\">Fig. 1</b></figcaption><picture><source srcset=\"//media.springernature.com/lw685/springer-static/image/art%3A10.1186%2Fs13054-025-05584-4/MediaObjects/13054_2025_5584_Fig1_HTML.png?as=webp\" type=\"image/webp\"/><img alt=\"figure 1\" aria-describedby=\"Fig1\" height=\"852\" loading=\"lazy\" src=\"//media.springernature.com/lw685/springer-static/image/art%3A10.1186%2Fs13054-025-05584-4/MediaObjects/13054_2025_5584_Fig1_HTML.png\" width=\"685\"/></picture><p>Changes in lung ventilation status and S/F, RR, and ROX of the patient in different positions under EIT monitoring. <b>A</b> shows the EIT images from the first day to the third day. The images in each panel from top to bottom are: global impedance waveforms, tidal impedance variation distribution (RVD: region ventilation delay, in yellow), difference image (CW: compliance win,","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"15 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144763327","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":"Targeting high circulating dipeptidyl peptidase 3 in circulatory failure","authors":"Adrien Picod, Feriel Azibani, Veli-Pekka Harjola, Mahir Karakas, Antoine Kimmoun, Bruno Levy, Peter Pickkers, Holger Thiele, Uwe Zeymer, Karine Santos, Alexandre Mebazaa","doi":"10.1186/s13054-025-05545-x","DOIUrl":"https://doi.org/10.1186/s13054-025-05545-x","url":null,"abstract":"Circulating dipeptidyl peptidase 3 is a new biomarker linked to circulatory failure prognosis and pathophysiology and is a potential actionable therapeutic target. In this short review intended for the clinician, a question-and-answer format provides key insights on the nature of this biomarker and the therapeutical potential of its targeted inhibition in critically ill patients.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"26 1","pages":"340"},"PeriodicalIF":15.1,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144756373","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":"Correction: Peri‑intubation complications in critically ill obese patients: a secondary analysis of the international INTUBE cohort","authors":"Vincenzo Russotto, John G. Laffey, Elena Tassistro, Sheila N. Myatra, Emanuele Rezoagli, Giuseppe Foti, Laura Antolini, Maria Grazia Valsecchi, Philippe R. Bauer, Konstanty Szułdrzyński, Luigi Camporota, Robert Greif, Andy Higgs, Matteo Parotto, Roberto Fumagalli, Massimiliano Sorbello, Chiara Robba, Giacomo Grasselli, Giacomo Bellani, Pietro Caironi, Jean Baptiste Lascarrou","doi":"10.1186/s13054-025-05475-8","DOIUrl":"https://doi.org/10.1186/s13054-025-05475-8","url":null,"abstract":"<p><b>Correction: Critical Care (2025) 29:192</b> <b>https://doi.org/10.1186/s13054-025-05419-2</b></p><p>Following the publication of the original article [1], the author reported that due to an error the institutional author group was not indicated on the title page and therefore the institutional authors were not visible as being part of the INTUBE Study Investigators. The institutional author names given in the additional file 1 of the original article [1] have been added to the INTUBE Study Investigators institutional author group.</p><p>The title page and the institutional author group has been updated in this correction article and the original article [1] has been corrected.</p><ol data-track-component=\"outbound reference\" data-track-context=\"references section\"><li data-counter=\"1.\"><p>Russotto V, Laffey JG, Tassistro E, et al. Peri-intubation complications in critically ill obese patients: a secondary analysis of the international INTUBE cohort. Crit Care. 2025;29:192. https://doi.org/10.1186/s13054-025-05419-2.</p><p>Article Google Scholar </p></li></ol><p>Download references<svg aria-hidden=\"true\" focusable=\"false\" height=\"16\" role=\"img\" width=\"16\"><use xlink:href=\"#icon-eds-i-download-medium\" xmlns:xlink=\"http://www.w3.org/1999/xlink\"></use></svg></p><h3>Authors and Affiliations</h3><ol><li><p>Department of Oncology, University of Turin, Turin, Italy</p><p>Vincenzo Russotto & Pietro Caironi</p></li><li><p>Department of Anesthesia and Intensive Care, University Hospital San Luigi Gonzaga, Orbassano, Turin, Italy</p><p>Vincenzo Russotto & Pietro Caironi</p></li><li><p>Anesthesia and Intensive Care Medicine, School of Medicine, University of Galway, Galway, Ireland</p><p>John G. Laffey</p></li><li><p>Department of Anesthesia and Intensive Care Medicine, University Hospital Galway, Galway, Ireland</p><p>John G. Laffey</p></li><li><p>Biostatistics and Clinical Epidemiology, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy</p><p>Elena Tassistro & Maria Grazia Valsecchi</p></li><li><p>Bicocca Center of Bioinformatics, Biostatistics and Bioimaging (B4 Center), School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy</p><p>Elena Tassistro, Laura Antolini & Maria Grazia Valsecchi</p></li><li><p>Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India</p><p>Sheila N. Myatra</p></li><li><p>Department of Emergency and Intensive Care, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy</p><p>Emanuele Rezoagli & Giuseppe Foti</p></li><li><p>School of Medicine and Surgery, University of Milano Bicocca, Monza, Italy</p><p>Emanuele Rezoagli, Giuseppe Foti & Roberto Fumagalli</p></li><li><p>Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, USA</p><p>Philippe R. Bauer</p></li><li><p>Department of Anesthesiology and Intensive Care, National Medical Institute of the Ministry of Interior and Administration, Warsaw, ","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"15 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144747066","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":"Assessing inspiratory drive and effort in critically ill patients at the bedside","authors":"Roberto Tonelli, Alessandro Protti, Elena Spinelli, Domenico Luca Grieco, Takeshi Yoshida, Annemijn H. Jonkman, Evangelia Akoumianaki, Irene Telias, Mattia Docci, Antenor Rodrigues, Joaquin Perez, Lise Piquilloud, Jeremy Beitler, Ling Liu, Oriol Roca, Lara Pisani, Ewan Goligher, Guillaume Carteaux, Giacomo Bellani, Enrico Clini, Jian-Xin Zhou, Giacomo Grasselli, Samir Jaber, Alexandre Demoule, Daniel Talmor, Leo Heunks, Laurent Brochard, Tommaso Mauri","doi":"10.1186/s13054-025-05526-0","DOIUrl":"https://doi.org/10.1186/s13054-025-05526-0","url":null,"abstract":"Monitoring inspiratory drive and effort may aid proper selection and setting of respiratory support in patients with acute respiratory failure (ARF), whether they are intubated or not. Although diaphragmatic electrical activity (EAdi) and esophageal manometry can be considered the reference methods for assessing respiratory drive and inspiratory effort, respectively, various alternative techniques exist, each with distinct advantages and limitations. This narrative review provides a comprehensive overview of bedside methods to assess respiratory drive and effort, with a primary focus on patients with ARF. First, EAdi and esophageal manometry are described and discussed as reference techniques. Then, alternative methods are categorized along the neuromechanical pathway from inspiratory drive to muscular effort into three groups: (1) techniques assessing the respiratory drive: airway occlusion pressure (P0.1), mean inspiratory flow (Vt/Ti) and respiratory muscle surface electromyography (sEMG); (2) techniques assessing the respiratory muscle effort: whole-breath occlusion pressure (ΔPocc), pressure-muscle index (PMI), nasal pressure swing (ΔPnose), diaphragm ultrasonography (USdi), central venous pressure swing (ΔCVP), breathing effort (BREF) models, and flow index; (3) techniques and clinical parameters assessing the consequences of effort: tidal volume (Vt), electrical impedance tomography (EIT), dyspnea. For each, we summarize the physiological rationale, measurement methodology, interpretation of results, and key limitations.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"137 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144747288","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":"Effect of a generalized early mobilization and rehabilitation protocol on outcomes in trauma patients admitted to the intensive care unit: a retrospective pre–post study","authors":"Tsuyoshi Ichikawa, Asuka Tsuchiya, Yusuke Tsutsumi, Tatsuya Okawa, Daisuke Kubo, Yu Horimizu, Ryo Tsutsui, Hina Shukumine, Kento Noda, Katsuhiro Mizuno","doi":"10.1186/s13054-025-05570-w","DOIUrl":"https://doi.org/10.1186/s13054-025-05570-w","url":null,"abstract":"The impact of early mobilization and rehabilitation protocol (EMRP) on trauma patients admitted to the intensive care unit (ICU) remains unclear owing to limited randomized controlled trials and methodological limitations in observational studies. This study aimed to compare the clinical outcomes of trauma patients admitted to the ICU before and after EMRP implementation. A retrospective pre–post study was conducted on adult trauma patients having an Injury Severity Score ≥ 9 who were admitted to the ICU of a university hospital. Patients admitted from July 2021 to June 2022 comprised the pre-EMRP group, whereas those admitted from July 2022 to August 2023 comprised the post-EMRP group. Outcomes were compared between these two groups using propensity score matching to adjust for confounders. The primary outcome was the proportion of home discharge. The secondary outcomes were the Barthel Index score at hospital discharge, length of stay (LOS) in the ICU and hospital; Functional Status Score for the ICU at ICU discharge; and cumulative rate of patients reaching ICU Mobility Scale (IMS) levels ≥ 3, ≥4, and ≥ 7 within 28 days after ICU admission. Among 552 eligible patients, 254 and 298 were admitted during the pre-EMRP and post-EMRP phases, respectively. In the propensity score-matched cohort, the post-EMRP group showed a higher proportion of home discharge (52.1% vs. 41.1%, difference: 11.0%, 95% confidence interval [CI]: 1.7–20.2%), higher Barthel Index score at hospital discharge (95.0 [55.0–100.0] vs. 80.0 [40.0–100.0], P = 0.007), and shorter LOS in the ICU (5.0 [3.0–11.0] vs. 7.0 [4.0–11.0] days, P = 0.03) than the pre-EMRP group. EMRP was associated with a higher rate of patients reaching IMS levels ≥ 3 (hazard ratio [HR]: 1.29, 95% CI: 1.06–1.57), ≥ 4 (HR: 1.27, 95% CI: 1.03–1.56), and ≥ 7 (HR: 1.36, 95% CI: 1.08–1.70). Compared with pre-EMRP implementation, EMRP for adult trauma patients was associated with a higher proportion of home discharge, an improved Barthel Index score at hospital discharge, and a shorter LOS in the ICU. These findings indicate that EMRP may facilitate returning home by improved physical function.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"49 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144737634","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":"Not all pulse contour algorithms are created equal","authors":"Frederic Michard, Stefano Romagnoli","doi":"10.1186/s13054-025-05589-z","DOIUrl":"https://doi.org/10.1186/s13054-025-05589-z","url":null,"abstract":"<p>We read with interest the article by Lamarche-Fontaneto et al. [1] on cardiac output (CO) monitors in septic shock. We fully agree that pulmonary artery catheterization and transpulmonary thermodilution have value in this context, not only for measuring CO but also for gaining additional insights, such as pulmonary artery pressures or extravascular lung water. However, we felt that pulse contour techniques were dismissed too quickly, without considering the differences between the underlying algorithms.</p><p>Pulse contour techniques are generally classified as either calibrated or non-calibrated, with the common belief that calibrated ones are more accurate and precise. It is important to note that the algorithms may be identical. For example, the PiCCO and the ProAQT systems (Getinge, Sweden) use the same pulse contour algorithm. Similarly, the LiDCOplus and LiDCOrapid systems rely on the same PulseCO algorithm (Masimo, USA). The former are simply calibrated or reset periodically using dilution methods, while the latter are not. Consequently, calibrated methods are seen as more accurate, not because they have superior algorithms, but primarily because they are regularly reset to reference values.</p><p>Regarding uncalibrated pulse contour analysis, it is unclear why Lamarche-Fontaneto et al. [1] mentioned that “PRAM is not plug-and-play and waveform quality must be continuously verified and optimized.” Unlike the FloTrac and ProAQT algorithms, which require specific pressure transducers, the PRAM algorithm can analyze arterial pressure waveforms recorded with any standard pressure transducer. Therefore, it is easier to set up. This feature, shared with other algorithms (e.g., the MBA algorithm from Retia, USA), also offers the advantage of improving the sustainability and reducing the cost of CO monitoring [2]. Additionally, all algorithms that analyze waveform characteristics are affected by artifacts and damping phenomena, and we are not aware of any studies comparing how abnormal waveforms impact the performance of existing pulse contour algorithms. Notably, the PRAM algorithm now incorporates an electronic filter specifically designed to detect and correct underdamping phenomena [3], which may offer an advantage over other pulse contour methods. Regardless of the algorithm used, clinicians need to inspect the arterial pressure waveform for abnormalities and address them promptly. Failure to do so can lead to inaccurate blood pressure and CO measurements.</p><p>Clinical studies have reported significant variability in the performance of uncalibrated pulse contour algorithms. This variability likely stems from differences in clinical settings (operating room vs. ICU) and patient conditions (hemodynamic stability vs. instability). The heterogeneity of validation studies complicates any direct comparison between algorithms. However, a few studies [4,5,6,7,8] have directly compared several pulse contour algorithms against a reference CO measu","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"25 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144737747","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":"Climate change impacts: survival on, and of, intensive care","authors":"Hugh Montgomery","doi":"10.1186/s13054-025-05565-7","DOIUrl":"https://doi.org/10.1186/s13054-025-05565-7","url":null,"abstract":"<p>‘Greenhouse gases’ [GHG] such as carbon dioxide (CO<sub>2</sub>) transmit shortwave solar radiation, but trap heat energy. We are adding vast and ever-increasing quantities to our atmosphere - the equivalent of 57 billion tonnes of CO<sub>2</sub> (3 × 10<sup>25</sup> litres) in 2024 alone [1]. Their concentrations are rising faster every year- CO<sub>2</sub> by 2.6 ppm/year, to a concentration of > 427 ppm (from a preindustrial baseline of 280ppm), now trapping the energy equivalent of 8 Hiroshima Bomb’s/hour.</p><p>The oceans are gaining heat- in 2024, a (record) 16 × 10<sup>21</sup> Joules was added to its top 2 km- enough to take 15 billion Olympic swimming pools from 0 <sup>o</sup>C to 100 <sup>o</sup>C [2]. The gaseous atmosphere is heating- to 1.6 <sup>o</sup>C above preindustrial levels in 2024- at an accelerating rate [3]. Ice melt- 28 trillion tonnes lost between 1994 and 2017- is accelerating, rising 57% (from 0.8 to 1.2 trillion tonnes/year) since the 1990 s [4]. Sea level rise, now nearly 1 cm every 2 years from land ice melt and thermal ocean expansion, has accelerated, its rate doubling in recent decades [5].</p><p>We now face ‘acceleration of these accelerations’ from interacting positive feedback loops. Snow and ice melt means less to reflect light back into space, and more exposed dark soil/ocean to absorb heat. This adds an energy gain equivalent of an extra 100ppm atmospheric CO<sub>2</sub>. Emissions of methane (83x as potent a GHG as CO<sub>2</sub> over its first 20 years) from (rebranded) ‘Natural Gas’, belching cows, rubbish tips and more, is now supplemented by release from melting permafrost, heated carbonate rocks and wetland fermentation, and its atmospheric clearance reduced by fires (tree bark microbiomes break it down; carbon monoxide extends its atmospheric half-life). Wildfires release (GHG) CO<sub>2</sub>, and (atmospheric heating/glacier melting) black soot. Water vapour from ocean evaporation is a high-altitude GHG, and tundra/rainforest heating is leading to both becoming net CO<sub>2</sub> emitters [6]. Finally, the full force of global heating is being revealed as loss of (reflective) low-altitude cloud occurs (reviewed in [7]).</p><p>Abrupt and catastrophic changes are occurring to global weather systems. Polar heating (<i>≤</i> 4x faster than the global average) is accelerating and moving the Northern Jet Stream, worsening Iberian droughts and Northern European flooding, and bringing even more extreme weather events. Collapse or severe slowing of the Atlantic Meridional Overturning Circulation (AMOC, transporting massive heat loads around the N hemisphere) is imminent. Massive sudden Arctic heating may soon accelerate these impacts and those on sea level (reviewed in [7]).</p><p>None can have failed to notice the increasingly frequent and severe extreme weather events (storms, heatwaves, droughts, floods, fires): up 83% between 1980 and 1999 and 2000–2019 [7]. Heatwave exposure is rising [8]. The land","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"13 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144737635","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":"Vasopressin and its analogues in patients with septic shock: holy Grail or unfulfilled promise?","authors":"Quentin Lajoye, Arthur Orieux, Alexandre Boyer, Renaud Prevel, Mathieu Jozwiak","doi":"10.1186/s13054-025-05540-2","DOIUrl":"https://doi.org/10.1186/s13054-025-05540-2","url":null,"abstract":"The Surviving Sepsis Campaign (SSC) recommends norepinephrine as first-line vasopressor in patients with septic shock. For many years, there has been growing evidence that high doses of norepinephrine might have cardiac and immunological adverse effects and be associated with poorer outcomes. Current SSC guidelines therefore suggest adding vasopressin, a non-catecholaminergic vasopressor, as a second-line vasopressor rather than increasing the norepinephrine dose in patients requiring doses of norepinephrine base > 0.25–0.50 µg/kg/min, after excluding persistent hypovolemia and cardiac dysfunction. Vasopressin is a peptide hormone that causes vasoconstriction through its specific receptor, the arginine vasopressin receptor V1. Up to one-third of patients with septic shock may have vasopressin deficiency, which contributes to refractory septic shock. Vasopressin use is associated with a norepinephrine-sparing effect, which may in turn reduce the complications induced by high-doses of norepinephrine, by decreasing the vasopressor load: this is the concept of decatecholaminization. Nevertheless, the use of vasopressin in patients with septic shock has not yet demonstrated clear benefits in terms of patient outcomes, such as less cardiotoxicity, reduced use of renal replacement therapy or decreased mortality. The heterogeneity in the use of vasopressin and the definition of early vasopressin administration between different studies as well as many unresolved issues regarding the use of vasopressin in patients with septic shock could explain the absence of clear and relevant clinical benefits. Thus, the identification of subgroups of patients likely to benefit the most from vasopressin, the management of vasopressin administration (time to initiation, optimal doses, weaning strategy) and a better understanding of the interactions between vasopressin and corticosteroids represent major areas of research for future studies. ","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"14 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144719520","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":"Use of extracorporeal membrane oxygenation in adult trauma patients with refractory acute cardiopulmonary failure: guideline from the Chinese society of extracorporeal life support 2025","authors":"Hua Wang, Zhongran Cen, Xingxing Liu, Zhanguo Liu, Xiaotong Hou, Xiangdong Guan, Jianfeng Wu, Yimin Li, Yonghao Xu, Chengbin Zhou, Zhiyong Peng, Fachun Zhou, Tongwen Sun, Bingyu Qin, Jiandong Lin, Lina Zhang, Jinghui Li, You Shang, Songqiao Liu, Zhenhua Zeng, Xiaowu Wang, Qunqing Chen, Yanwu Guo, Changbiao Peng, Yang Wang, Songjian Li, Chunyao Wang, Shulin Xiang, Zhou Cheng, Peihua Cao, Jie Jiang, Yihao Chen, Duoduo Yu, Wenzhan Liao, Ye Liao, Xiaoqin Cheng, Limei Chen, Yuxuan He, Jie He, Qingling Guo, Zenghui Yue, Ke Deng, Ying Tang, Bo Huang, Cuiping Liu, Sheng Peng, Jing Cai, Yaru Zhu, Kai Wang, Yangyang Wang, Qianwen Wang, Jingjing Yang, Maoyou Shichen, Zhuo Li, Manli Guo, Xueshan Luo","doi":"10.1186/s13054-025-05504-6","DOIUrl":"https://doi.org/10.1186/s13054-025-05504-6","url":null,"abstract":"Adult trauma patients with refractory acute cardiopulmonary failure suffer from high morbidity and mortality. In the past decade, a growing body of researches has shown survival benefits of extracorporeal membrane oxygenation (ECMO) in trauma patients who fail to respond to optimal damage control resuscitation (DCR), and there is an opportunity to formulate clinical practice guidelines to guide clinicians in implementing trauma ECMO at the bedside. The Chinese Society of Extracorporeal Life Support (CSECLS) convened a domestic panel of interdisciplinary experts to develop this guideline, adhering to the principles of the World Health Organization (WHO) Manual for Guideline Development and the policy of conflict of interest. Clinical key questions pertaining to trauma ECMO use were informed from expert interviews and literature reviews, and formulated as PICO (Population/Intervention/Comparison/Outcome) format for literature retrieval of original studies supporting the question. Then, panelists were assigned to address specific clinical questions, synthesize evidence, formulate recommendations and determine their strength, following the Recommendations Assessment, Development and Evaluation (GRADE) framework. The guideline steering committee and stakeholders approved the final document. Eleven recommendations regarding trauma ECMO use in adult patients were formulated, focusing on the following topics: (1) indications; (2) patient screening; (3) timing of initiation; (4) multidisciplinary approach; (5) trauma ECMO management; and (6) complication prevention. Supporting evidences are elaborated in detail, and expert opinions on clinical application and future research provided. Although the quality of the body of evidence is low to very-low, most researches have shown that ECMO improves the survival of adult trauma patients with varied injury mechanisms. However, decision-making should consider the individual characteristics, benefits and potential harms, patients’ values and preferences, and long-term outcomes. ","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"26 1","pages":"334"},"PeriodicalIF":15.1,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144737746","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":"Candida auris infections in ICU patients: risk factors, outcomes, and antifungal resistance patterns","authors":"Satyajit Choudhury, Kalpana Majhi, Pragati Jena, Sritam Mohanty, Yallawar Nipun Narayan, Pragnya Paramita Jena, Shakti Bedanta Mishra, Sagarika Panda","doi":"10.1186/s13054-025-05544-y","DOIUrl":"https://doi.org/10.1186/s13054-025-05544-y","url":null,"abstract":"Candida auris has emerged as a major nosocomial pathogen in intensive care units worldwide due to its multidrug resistance, environmental persistence, and high transmission potential. While several outbreak reports exist, there remains limited comparative data on clinical features, resistance profiles, and outcomes between Candida auris and non-auris Candida candidemia, particularly in Indian ICU settings. This study aimed to evaluate the incidence, risk factors, antifungal resistance, and clinical outcomes of Candida auris bloodstream infections in comparison to non-auris Candida infections among ICU patients. This retrospective cohort study was conducted over four years (January 2020–December 2023) in the ICU of a tertiary care hospital in eastern India. Adult patients (≥ 18 years) with culture-confirmed candidemia were included and stratified into Candida auris and non-auris groups. Demographic, clinical, therapeutic, and microbiological data were extracted. Antifungal susceptibility testing was performed as per CLSI and CDC guidelines. Multivariate logistic regression identified risk factors associated with Candida auris infection. Survival analysis were compared using Kaplan–Meier and Cox regression analysis. Of 267 ICU patients with candidemia, 38 (14.2%) had Candida auris infection. Candida auris patients were older (median age 60 vs. 53 years) and had lower SOFA scores at admission (median 7 vs. 8; p = 0.02). On multivariate analysis, increasing age (OR 1.10, p = 0.0003) and female sex (OR 16.35, p = 0.012) were independently associated with Candida auris infection. Fluconazole resistance was 94.7% in Candida auris isolates, with amphotericin B and echinocandin resistance in 39.5% and 7.9%, respectively. ICU mortality did not differ significantly between Candida auris and non-auris groups (31.6% vs. 34.5%; p = 0.854), and survival analysis showed no statistically significant difference (log-rank p = 0.07). This study highlights the growing burden of Candida auris in intensive care unit settings, demonstrating a substantial incidence without increased mortality compared to non-auris Candida species. Advancing age and female sex emerged as significant independent risk factors, emphasizing the need for continued surveillance and targeted risk assessment in regions where Candida auris is endemic.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"12 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144719521","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}