Critical Care最新文献

{"title":"The role of the Corsano CardioWatch in continuous vital sign monitoring for early sepsis detection","authors":"Sven-Olaf Kuhn, Sebastian Gibb, Matthias Gründling","doi":"10.1186/s13054-025-05365-z","DOIUrl":"https://doi.org/10.1186/s13054-025-05365-z","url":null,"abstract":"<p>Sepsis is a critical medical emergency frequently associated with significant organ failure and high mortality rates. Early detection is crucial, as delays in treatment substantially increase the risk of fatal outcomes with each passing hour. However, no specific molecular marker or definitive blood test for sepsis detection exists.</p><p>Early warning scores (EWS), such as the National Early Warning Score (NEWS), are widely used in hospitals to identify clinical deterioration. In general hospital wards, sepsis detection relies primarily on intermittent vital sign measurements, including heart rate (HR), blood pressure (BP), and body temperature, with less frequent monitoring of oxygen saturation (SpO<sub>2</sub>) and respiratory rate (RR). However, these measurements are typically taken only a few times daily, creating a gap where early signs of deterioration may go unnoticed—especially at night or in outpatient settings.</p><p>A recent study demonstrated that an electronic alert system integrating qSOFA components, refreshing electronic medical records (EMRs) every four hours, significantly reduced 90-day in-hospital mortality [1]. This underscores the potential of continuous sepsis screening via biosensors as a valuable strategy for improving patient safety and reducing sepsis-related mortality.</p><h3>The emergence of wearable biosensors for sepsis detection</h3><p>Advancements in wearable and wireless sensors now allow real-time, continuous monitoring of vital signs. These cost-effective solutions enhance patient observation and facilitate early intervention by triggering alarms when physiological parameters indicate potential deterioration. However, ensuring high data quality, system interoperability, and intelligent alerting remains challenging.</p><p>Several wearable biosensors have shown promising results. Most available devices are still limited in how many parameters they can measure accurately. Additionally, many devices require adhesive electrodes on the chest or additional sensors for measuring temperature in the armpit or SpO<sub>2</sub> at the fingertip. These features often reduce patient comfort and adherence to continuous monitoring.</p><p>Biosensors must be minimally invasive and comfortable to wear for extended periods for optimal patient acceptance. Current wrist-worn biosensors offer a promising solution by providing high-quality data on vital parameters necessary for calculating the NEWS2 score, which the British NHS endorses as an improvement over the original NEWS. This score helps assess the severity of a patient's condition and ensures timely critical care interventions.</p><h3>Pilot study: feasibility of remote wireless monitoring</h3><p>In a pilot study, we assessed the feasibility of wireless remote monitoring in general hospital wards using a smart, cable-free wrist device (Corsano CardioWatch 287-2) designed for continuous vital sign measurement in long-term hospitalized patients (Fig. 1). The primary goal was ","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"8 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744825","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":"Response to comments from Dr Vahedian-Azim related to our recent article Understanding and addressing a ‘difficult’ family in ICU","authors":"Victoria Metaxa, Flavio E. Nacul, Anna Conway Morris","doi":"10.1186/s13054-025-05337-3","DOIUrl":"https://doi.org/10.1186/s13054-025-05337-3","url":null,"abstract":"<p>We thank Dr Vahedian-Azim for taking the time to respond [1] to our commentary [2]. We aimed to discuss mentalisation, a process already known to psychotherapists but less so to critical care clinicians [3]. The main point of our commentary was to explore the possible role of mentalisation in the highly emotive environment of ICU, as a tool in conflict prevention and resolution. You are very right to point out that the actual impact of the process on outcomes is far from evidenced-based; however, being curious about one’s own reactions and endeavouring to understand the reactions of others is an attitude with strong face validity and hence conceptually attractive. Yet, robust scientific evaluation is needed to ensure that the anticipated benefits materialise and are not offset by unanticipated consequences.</p><p>We completely agree with your second comment on the importance of culturally competent communication in ICU. Indeed, in an increasingly diverse world, ICU patient and family communication must incorporate skills that accommodate the language, ethnicity and religious differences that exist. Logically, the capacity to understand other people’s intentional or inner mental states while acknowledging one’s own (mentalisation) would improve with increased cross-cultural awareness. Despite the implicit link, this positive association between cultural competence and improved patient/ family outcomes is also lacking [4]. It is obvious that the impact of such educational interventions (cultural competence, mentalisation techniques) requires better quality studies in order to provide robust conclusions about their effectiveness.</p><p>No datasets were generated or analysed during the current study.</p><ol data-track-component=\"outbound reference\" data-track-context=\"references section\"><li data-counter=\"1.\"><p>Vahedian-Azimi A. Enhancing cultural competence and communication in ICU: addressing family conflicts. Crit Care. 2025;29:53. https://doi.org/10.1186/s13054-025-05298-7.</p><p>Article PubMed PubMed Central Google Scholar </p></li><li data-counter=\"2.\"><p>Metaxa V, Nacul FE, Morris AC. Understanding and addressing a ‘difficult’ family in ICU. Crit Care. 2025;29:22. https://doi.org/10.1186/s13054-024-05244-z.</p><p>Article PubMed PubMed Central Google Scholar </p></li><li data-counter=\"3.\"><p>Lüdemann J, Rabung S, Andreas S. Systematic review on mentalization as key factor in psychotherapy. Int J Environ Res Public Health. 2021;18(17):9161. https://doi.org/10.3390/ijerph18179161.</p><p>Article PubMed PubMed Central Google Scholar </p></li><li data-counter=\"4.\"><p>Lie DA, Lee-Rey E, Gomez A, et al. Does cultural competency training of health professionals improve patient outcomes? A systematic review and proposed algorithm for future research. J Gen Intern Med. 2011;26:317–25. https://doi.org/10.1007/s11606-010-1529-0.</p><p>Article PubMed Google Scholar </p></li></ol><p>Download references<svg aria-hidden=\"true\" focusable=\"false\" height=\"16\"","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"13 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744824","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":"Further considerations on the clinical applicability of time to positivity as a prognostic tool for catheter-related Pseudomonas aeruginosa bloodstream infections","authors":"Daniel N. Marco, Àlex Soriano, Sabina Herrera","doi":"10.1186/s13054-025-05370-2","DOIUrl":"https://doi.org/10.1186/s13054-025-05370-2","url":null,"abstract":"<p>To the Editor,</p><p>We appreciate the thoughtful comments by Liao et al. [1] regarding our study [2] on “Time to positivity (TTP) as a predictor of catheter-related bacteremia and mortality in <i>Pseudomonas aeruginosa</i> bloodstream infections (PAE-BSI)”. Their insights highlight important aspects that warrant further discussion, particularly regarding additional variables that could influence the TTP, and about long-term outcome.</p><p>In response to the first point, we acknowledge the potential influence of resistance on TTP. We found that susceptible <i>P. aeruginosa</i> strains had a significantly shorter TTP (Table 1). Moreover, this property was consistent across all antibiotic families. Since no clinically relevant TTP cut-off for predicting resistance was identified, this data was not included in the main article due to length limitation. This finding supports that resistant strains may decelerate their replication rates because resistance mechanisms affect one or more metabolic pathways involved in bacterial replication. A previous study in <i>Staphylococcus aureus</i> bacteremia also demonstrated shorter TTP for methicillin-susceptible strains compared to methicillin-resistant ones [3]. However, we have to recognize that other studies focused in Enterobacterales and other non-fermenting gram-negative bacilli have shown contradictory results [4, 5].</p><figure><figcaption><b data-test=\"table-caption\">Table 1 Factors associated with shorter TTP. Univariate and multivariate analysis.</b></figcaption><span>Full size table</span><svg aria-hidden=\"true\" focusable=\"false\" height=\"16\" role=\"img\" width=\"16\"><use xlink:href=\"#icon-eds-i-chevron-right-small\" xmlns:xlink=\"http://www.w3.org/1999/xlink\"></use></svg></figure><p>The authors raise another point regarding immune suppression and comorbidities as potential modifiers of TTP. Although the role of host immunity seems reasonable, our data (Table 1) did not support this statement. In the univariable analysis, chronic kidney disease (CKD) in hemodialysis, neutropenia and corticosteroid therapy were significantly associated with shorter TTP. However, no one was finally included in the multivariable analysis. In the case of CKD in hemodialysis the reason to be excluded is that the majority of these cases were catheter-related bacteremia that is a significant determinant of shorter TTP. Neutropenia reduces the host capacity to clear bacteria from infected tissue resulting in higher bacterial loads in the bloodstream and corticosteroid therapy impair the reticuloendothelial system located at the liver and the spleen, both responsible of rapid bacterial clearance from the blood [6, 7]. Therefore, weak immune system increases the inoculum at the infectious foci and that is the variable superior in the multivariable analysis. According to our findings, we have summarized the main determinants of TTP in Fig. 1.</p><figure><figcaption><b data-test=\"figure-caption-text\">Fig. 1</b></figcaption><pictu","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"39 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744826","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":"Incidence and risk factors of weaning-induced pulmonary oedema: results from a multicentre, observational study","authors":"Rui Shi, Soufia Ayed, Marion Beuzelin, Romain Persichini, Marie Legouge, Nello D. E. Vita, Bruno Levy, Alexandra Beurton, Kishore Mangal, Thomas Hullin, Vincent Labbe, Max Guillot, Anatole Harrois, Maurizio Cecconi, Nadia Anguel, David Osman, Francesca Moretto, Christopher Lai, Tài Pham, Jean-Louis Teboul, Xavier Monnet","doi":"10.1186/s13054-025-05350-6","DOIUrl":"https://doi.org/10.1186/s13054-025-05350-6","url":null,"abstract":"During the weaning process, the transition from positive to negative pressure ventilation may induce cardiac dysfunction, which may lead to pulmonary oedema. The incidence of weaning-induced pulmonary oedema (WIPO) is poorly documented and shows huge variations. Our study aims to investigate the incidence and risk factors for WIPO during weaning from mechanical ventilation in general critically ill patients. This multicentre study was conducted in France, Italy, and India. Adult critically ill patients receiving invasive ventilation were included once a spontaneous breathing trial (SBT) was performed. The SBT technique could be either T-piece or pressure support mode with (PSV-PEEP) or without positive end expiratory pressure (PEEP) (PSV-ZEEP). A consensual diagnosis of WIPO was made a posteriori by five experts who analysed changes observed during the SBT that were retrospectively recorded. From July 2019 to February 2021, 634 SBTs were performed in 500 patients from 13 ICUs. Weaning success occurred in 417 patients (66%) and weaning failure in 217 (34%). Weaning was short in 414 (83%) of SBTs, difficult in 47 (9%) SBTs, and prolonged in 39 (8%) SBTs. WIPO was diagnosed in 79 (12%) cases, which accounted for 36% of the 217 weaning failures. WIPO occurred in 54/358 (15%) of T-piece SBT, in 7/84 (8%) of PSV-PEEP SBT (p = 0.072 vs. T-piece), and in 18/192 (9%) of PSV-ZEEP SBT (p = 0.002 vs. T-piece). In multilevel logistic regression analysis including 202 weaning failures from 149 different patients, COPD, and previous cardiomyopathy were identified as independent risk factors associated with WIPO. In general ICU patients, WIPO accounts for 36% of weaning failure cases. Previous heart disease and COPD are two independent risk factors for developing WIPO during the weaning process. ClinicalTrials.gov identifier (retrospectively registered on 2022-03-31): NCT05318261.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"58 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143736632","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":"Presence of psychologists in the French intensive care units: a gap between requirements and practice","authors":"Emilie Marty-Petit, Emilie Aebischer, Cathy Gonzales, Jean-Philippe Rigaud, Gaelle Freitas-Terzi, Anne Renault, Charlotte Garret, Anne-Françoise Rousseau, Guillaume Thiéry","doi":"10.1186/s13054-025-05373-z","DOIUrl":"https://doi.org/10.1186/s13054-025-05373-z","url":null,"abstract":"<p>Experiencing a stay in an intensive care unit (ICU) can be traumatic for critically ill patients who are exposed to a technical environment and the fear of dying. At least one third of the survivors develop psychological disorder, including anxiety, depression or post-traumatic stress disorder [1]. There is also evidence that the relatives can suffer from emotional distress during and after the ICU stay of their loved one, leading to the so-called post-intensive care syndrome-family [2]. The burden is also considerable for relatives of patients who die in ICU, leading potentially to a complicated bereavement.</p><p>Patient- and family-cantered care in ICU is a holistic model of health care recognizing the importance of a humanized environment to improve recovery, in which psychologists may play a key role [3]. In 2021, the French government asked the scientific societies to draw up an overview of the presence of psychologists in ICUs. A national decree was also published in April 26th, 2022, recommanding the presence of psychologists in French ICUs (https://www.legifrance.gouv.fr/eli/decret/2022/4/26/SSAH2206984D/jo/texte). However, how this decree is translated into practice is unknown. (https://igas.gouv.fr/L-offre-de-soins-critiques-reponse-au-besoin-courant-et-aux-situations). In this context, the aim of the present study was to describe the presence of psychologists in French ICUs and to identify the potential obstacles to their effective integration in ICU teams.</p><p>A questionnaire was designed by the Patients and Relatives Working Group of the French Society of Intensive Care Medicine (SRLF). The first question was <i>“Does your ICU team include a dedicated psychologist caring for patients and relatives?”</i>. In case of positive answer, the next question was <i>“What proportion of his working time is dedicated to ICU?”</i>. In case of negative answer, two further questions were asked: “<i>Do you have access to psychologists from other departments in your hospital?”</i> and <i>“What are the main barriers preventing the inclusion of a psychologist in your ICU team?”.</i> The following barriers were explored: 1) no financial resources, 2) hospital management decision, 3) no interest.\u0000</p><p>The survey was conducted between January and December 2023. A total of 322 ICUs were identified, representing approximately 90% of all the ICUs in the country. The medical director and/or the head nurse of each ICU were contacted by telephone or email. Twenty ICUs did not respond (response rate: 302/322, 97%). The characteristics of the participating ICUs are described in Table 1. The presence of a dedicated psychologist was confirmed in half of the participating ICUs (156/302, 51.6%), committing 0.5 (0.3–0.75) working time equivalent (WTE) to this function. In these ICUs the psychologist-to-bed ratio was 1/40. ICUs located in university hospitals were more likely to have a psychologist (79/109, 72%) than the other ICUs (77/193, 39%) (<i>p</i> < ","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"25 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744886","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":"Unlocking the potential of high-resolution multimodality neuromonitoring for traumatic brain injury management: lessons and insights from cases, events, and patterns","authors":"Stefan Yu Bögli, Erta Beqiri, Ihsane Olakorede, Marina Sandra Cherchi, Claudia Ann Smith, Xuhang Chen, Guido Di Tommaso, Tommaso Rochat, Masumi Tanaka Gutiez, Giada Cucciolini, Virginia Motroni, Adel Helmy, Peter Hutchinson, Andrea Lavinio, Virginia F. J. Newcombe, Peter Smielewski","doi":"10.1186/s13054-025-05360-4","DOIUrl":"https://doi.org/10.1186/s13054-025-05360-4","url":null,"abstract":"Multimodality neuromonitoring represents a crucial cornerstone for patient management after acute brain injury. Despite the potential of multimodality neuromonitoring (particularly high-resolution neuromonitoring data) to transform care, its full benefits are not yet universally realized. There remains a critical need to integrate the interpretation of complex patterns and indices into the real-time clinical decision-making processes. This requires a multidisciplinary approach, to evaluate and discuss the implications of observed patterns in a timely manner, ideally in close temporal proximity to their occurrence. Such a collaborative effort could enable clinicians to harness the full potential of multimodal data. In this educational case-based scoping review, we aim to provide clinicians, researchers, and healthcare professionals with detailed, compelling examples of potential applications of multimodality neuromonitoring, focused on high-resolution modalities within the field of traumatic brain injury. This case series showcases how neuromonitoring modalities such as intracranial pressure, brain tissue oxygenation, near-infrared spectroscopy, and transcranial Doppler can be integrated with cerebral microdialysis, neuroimaging and systemic physiology monitoring. The aim is to demonstrate the value of a multimodal approach based on high-resolution data and derived indices integrated in one monitoring tool, allowing for the improvement of diagnosis, monitoring, and treatment of patients with traumatic brain injury. For this purpose, key concepts are covered, and various cases have been described to illustrate how to make the most of this advanced monitoring technology.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"38 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143736630","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":"Structural and functional alteration of the gut microbiomes in ICU staff: a cross-sectional analysis","authors":"Bing Xie, Chenyang Dong, Xin Zhao, Lianlian Qu, Yongling Lv, Hong Liu, Jiaxin Xu, Zhizhong Yu, Hexiao Shen, You Shang, Xing Zhao, Jiancheng Zhang","doi":"10.1186/s13054-025-05379-7","DOIUrl":"https://doi.org/10.1186/s13054-025-05379-7","url":null,"abstract":"16S rRNA sequencing has revealed structural alterations in the gut microbiomes of medical workers, particularly those working in intensive care unit (ICU). This study aims to further compare the taxonomic and functional characteristics of gut microbiomes between ICU staff and non-medical individuals using metagenomic sequencing. A prospective cross-sectional cohort study was conducted, fecal samples from 39 individuals in each group—ICU staff and non-medical subjects were analyzed using metagenomic sequencing. PERMANOVA (using the adonis function) was employed to analyze the genus-level profiles and assess the impact of individual parameters on the gut microbiome. Multiple databases were utilized to annotate and compare the functional differences in gut microbiomes between the two groups. We observed that ICU staff exhibited a significant decrease in gut microbiome diversity, characterized by a marked decline in Actinobacteria and a substantial increase in Bacteroides and Bacteroidaceae. CAZy annotation revealed a notable increase in carbohydrate-active enzymes within the ICU staff cohort. Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis further indicated an elevated risk of endocrine and metabolic disorders, along with enhanced glycan biosynthesis and metabolism. Additionally, KEGG pathway enrichment analysis highlighted significant enrichment in cancer-related pathways. Analysis using the Virulence Factor Database (VFDB) showed a higher abundance of virulence factors associated with immune modulation, invasion, and antimicrobial activity/competitive advantage among ICU staff. Notably, no discernible difference in the presence of antibiotic resistance genes within the gut microbiomes was observed between the two groups. Importantly, all aforementioned differences demonstrated clear gender disparities. Our findings indicated that ICU staff exhibited a reduction in gut microbiome diversity which was associated with an increase in virulence factors and carbohydrate-active enzymes, as well as with a heightened susceptibility to endocrine and metabolic diseases and cancers.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"96 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744823","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":"Adjuvant therapies for management of hemorrhagic shock: a narrative review","authors":"Yann Daniel, Frédérique Dufour-Gaume, Amandine Vergnaud, Manon Denis, Louise Giaume, Bertrand Rozec, Nicolas Prat, Benjamin Lauzier","doi":"10.1186/s13054-025-05368-w","DOIUrl":"https://doi.org/10.1186/s13054-025-05368-w","url":null,"abstract":"Severe bleeding remains a leading cause of death in patients with major trauma, despite improvements in care during the acute phase, especially the application of damage control concepts. Death from hemorrhage occurs rapidly after the initial trauma, in most cases before the patient has had a chance to reach a hospital. Thus, the development of adjuvant drugs that would increase the survival of injured patients is necessary. Among the many avenues of research in this area, one is to improve cell survival during tissue hypoxia. During hemorrhagic shock, oxygen delivery to cells decreases and, despite increased oxygen extraction, anaerobic metabolism occurs, leading to acidosis, coagulopathy, apoptosis, and organ dysfunction. We selected six treatments that may help cells cope with this situation and could be used as adjuvant therapies during the initial resuscitation of severe trauma patients, including out-of-hospital settings: niacin, thiazolidinediones, prolyl hydroxylase domain inhibitors, O-GlcNAcylation stimulation, histone deacetylase inhibitors, and adenosine–lidocaine–magnesium solution. For each treatment, the biological mechanism involved and a systematic review of its interest in hemorrhagic shock (preclinical data and human clinical trials) are presented. Promising molecules, some of which are already used in humans for other indications, give us hope for human clinical trials in the field of hemorrhagic shock in the near future.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"11 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143734011","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":"Association between mean hemodynamic variables during the first 24 h and outcomes in cardiogenic shock: identification of clinically relevant thresholds","authors":"Bruno Levy, Anais Curtiaud, Kevin Duarte, Clément Delmas, Julien Demiselle, Nicolas Girerd, Caroline Eva Gebhard, Julie Helms, Ferhat Meziani, Antoine Kimmoun, Hamid Merdji","doi":"10.1186/s13054-025-05356-0","DOIUrl":"https://doi.org/10.1186/s13054-025-05356-0","url":null,"abstract":"Cardiogenic shock (CS) remains a critical condition with high mortality rates despite advances in treatment. This study aims to comprehensively evaluate both macrocirculatory and tissue perfusion variables over the initial 24 h post-admission to determine their impact on patient prognosis and identify potential hemodynamic thresholds for optimal outcomes. Secondary aims were to explore the correlation between macrocirculatory and tissue perfusion variables. This is a post hoc analysis of data from two prospective studies, OptimaCC (NCT01367743) and MicroShock (NCT03436641), involving only patients with CS. Both studies applied regular assessment of hemodynamic variables at specific time points (admission, 6, 12, and 24 h) to ensure consistency in data collection, enrolling 118 patients between September 2011 and July 2021, with similar inclusion criteria and care processes. The median age of the cohort was 69 years, 59% being male. The primary outcome, 30-day mortality, occurred in 37% of patients. Average macrocirculation variables over the first 24 h of CS such as mean arterial pressure (MAP), cardiac output (CO), cardiac index (CI), and cardiac power index (CPI) were significantly lower in patients meeting the primary outcome. Accordingly, average tissue perfusion variables (ΔPCO2 and ΔPCO2/C(a-v)O2) over the first 24 h of CS were also consistently impaired in patients meeting the primary outcome. The optimal clinically relevant thresholds of the first 24 h time course for poor outcomes, closely approximating the optimal values identified in the analysis, were: mean SAP < 95 mmHg, MAP < 70 mmHg, CO < 3.5 L/min, CI ≤ 1.8 L/min/m2, CPI < 0.27 W/m2, ScvO2 < 70%, ΔPCO2 ≥ 9 mmHg, and ΔPCO2/C(a-v)O2 ≥ 1.5 mmHg/mL. This study is the first to identify critical hemodynamic thresholds, encompassing both macrocirculatory and tissue perfusion variables, within the initial 24 h of CS that are associated with adverse outcomes. The identified thresholds suggest specific hemodynamic targets that may guide resuscitation strategies.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"18 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712784","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":"Complementary role of transcriptomic endotyping and protein-based biomarkers for risk stratification in sepsis-associated acute kidney injury","authors":"Bengi S. Tavris, Christian Morath, Christoph Rupp, Roman Szudarek, Florian Uhle, Timothy E. Sweeney, Oliver Liesenfeld, Mascha O. Fiedler-Kalenka, Simon Dubler, Martin Zeier, Felix C. F. Schmitt, Markus A. Weigand, Thorsten Brenner, Christian Nusshag","doi":"10.1186/s13054-025-05361-3","DOIUrl":"https://doi.org/10.1186/s13054-025-05361-3","url":null,"abstract":"Sepsis-associated acute kidney injury (SA-AKI) is a prevalent and severe complication in critically ill patients. However, diagnostic and therapeutic advancements have been hindered by the biological heterogeneity underlying the disease. Both transcriptomic endotyping and biomarker profiling have been proposed individually to identify molecular subtypes of sepsis and may enhance risk stratification. This study aimed to evaluate the utility of combining transcriptomic endotyping with protein-based biomarkers for improving risk stratification in SA-AKI. This secondary analysis of the PredARRT-Sep-Trial included 167 critically ill patients who met Sepsis-3 criteria. Patients were stratified into three transcriptomic endotypes—inflammopathic (IE), adaptive (AE), and coagulopathic (CE)—using a validated whole-blood gene expression classifier. Eight protein-based biomarkers encompassing kidney function, vascular integrity, and immune response were measured. Predictive performance for the primary endpoint kidney replacement therapy or death was assessed using receiver operating characteristic curve analysis and logistic regression models. Stratification into transcriptomic endotypes assigned 33% of patients to IE, 42% to AE, and 24% to CE. Patients classified as IE exhibited the highest disease severity and were most likely to meet the primary endpoint (30%), compared to AE and CE (17% and 10%, respectively). Kidney function biomarkers showed stepwise increases with AKI severity across all endotypes, whereas non-functional biomarkers (neutrophil gelatinase-associated lipocalin [NGAL], soluble urokinase plasminogen activator receptor [suPAR], and bioactive adrenomedullin [bio-ADM]) exhibited endotype-specific differences independent of AKI severity. NGAL and suPAR levels were disproportionately elevated in the IE group, suggesting a dominant role of innate immune dysregulation in this endotype. In contrast, bio-ADM, a marker of endothelial dysfunction, was the strongest risk-predictor of outcomes in CE. The combination of transcriptomic endotyping with protein-based biomarkers enhanced predictive accuracy for the primary endpoint and 7-day mortality, with the highest area under the receiver operating characteristic curve of 0.80 (95% CI 0.72–0.88) for endotyping + bio-ADM and 0.85 (95% CI 0.78–0.93) for endotyping and suPAR, respectively. Combinations of endotyping with functional and non-functional biomarkers particularly improved mortality-related risk stratification. Combining transcriptomic endotyping with protein-based biomarker profiling enhances risk-stratification in SA-AKI, offering a promising strategy for personalized treatment and trial enrichment in the future. Further research should validate these findings and explore therapeutic applications.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"94 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712785","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}