Critical Care最新文献

{"title":"Imaging in animal models: bridging experimental findings and human pathophysiology","authors":"Lucas Rodrigues Moraes, Amanda Costa Cotias, Marco Aurélio Martins, Martin Scharffenberg, Christian Schnabel, Robert Huhle, Patricia Rieken Macedo Rocco, Pedro Leme Silva","doi":"10.1186/s13054-025-05574-6","DOIUrl":"https://doi.org/10.1186/s13054-025-05574-6","url":null,"abstract":"Acute respiratory distress syndrome (ARDS), chronic obstructive pulmonary disease (COPD), and pulmonary fibrosis are major respiratory conditions associated with significant morbidity and, in some cases, high mortality. A variety of animals models have been established to study these disorders, primarily focusing on histologic alterations, cellular signalling pathways, inflammatory responses, lung perfusion, gas-exchange abnormalities, and response to emerging therapies. Imaging techniques play a crucial role in these investigations, enabling in vivo assessment of lung structure and function. The most widely used imaging modalities include computed tomography (CT), positron emission tomography (PET), and electrical impedance tomography (EIT). While CT and, to a variable extent, PET involve ionizing radiation, EIT is a radiation-free technique. Despite anatomical differences between species, many imaging and physiological findings observed in animal models are consistent with those seen in critically ill patients, enhancing their translational relevance. This narrative review provides a comprehensive overview of the applicability of these imaging techniques in animal models and explores their relevance to human pathophysiology and clinical management.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"68 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144712319","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":"Urinary urea excretion index to guide weaning from renal replacement therapy in patients with acute kidney injury: Still haven’t found what i’m weaning for","authors":"Khalil Chaïbi, Stéphane Gaudry","doi":"10.1186/s13054-025-05581-7","DOIUrl":"https://doi.org/10.1186/s13054-025-05581-7","url":null,"abstract":"<p>To the Editor,</p><p>We acknowledge the effort by Bodot et al. to explore the under-addressed topic of renal replacement therapy (RRT) discontinuation in critically ill patients with acute kidney injury (AKI) [1]. The study addresses a relevant issue and, in its introduction, rightly refers to the hypothesis that RRT itself may contribute to ongoing kidney injury through hemodynamic instability and other mechanisms. However, we believe that certain methodological and conceptual aspects, beginning with the underlying rationale, could benefit from further refinement, which may enhance the robustness of the conclusions and support broader applicability of the proposed approach in routine practice.</p><p>While the authors do not explicitly frame their study in these terms, their approach reflects an increasingly common tendency to define RRT discontinuation through structured protocols and fixed variable thresholds, in a manner reminiscent of mechanical ventilation (MV) weaning [2]. However, the process of MV weaning is critical because premature extubation can result in emergency reintubation, and increased mortality [3]. By contrast, stopping RRT too early typically leads only to the resumption of RRT (with need for catheter reinsertion in some instances) which is rarely associated with significant harm. The authors suggest that stopping RRT too early could result in fluid accumulation, delayed MV weaning, prolonged ICU stays, and increased mortality. This contention is not convincingly supported by the existing literature. In fact, emerging data, suggest that an overly aggressive approach to fluid removal in the early phase of AKI might actually worsen outcomes [4]. Then, the potential harms of RRT continuation, including hemodynamic instability and catheter-related complications, may outweigh the speculative risks of early cessation. The emphasis should therefore shift from the fear of stopping too soon to a more nuanced assessment of when further sessions are truly beneficial. From this perspective, the risk associated with early discontinuation of RRT is modest. It is therefore debatable whether the search for strict RRT weaning criteria is justified. In other words, the more relevant clinical question may not be “when to stop RRT” based on a predefined threshold, but rather “whether to continue” on a given day, depending on the patient’s evolving condition and ongoing indication for RRT. In this view, the focus shifts from a binary decision based on fixed criteria to a continuous clinical judgement aiming not only to avoid premature discontinuation, but also to recognize when further RRT sessions are no longer necessary [5].</p><p>Beyond this, the methodological framework chosen by the authors raises additional concerns. The primary endpoint, catheter-free days at day 28, relies on a clinician-driven decision and, while it captures a relevant process of care, it remains a surrogate outcome that does not directly measure total RRT duration, ","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"68 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144710702","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":"CPAP improves regional lung strain rate and diaphragm velocity of relaxation in experimental self-inflicted lung injury","authors":"Agustín Pérez, Benjamín Erranz, Sonia Reveco, Carlos González, Nibaldo Avilés-Rojas, Daniel E. Hurtado, Pablo Cruces","doi":"10.1186/s13054-025-05536-y","DOIUrl":"https://doi.org/10.1186/s13054-025-05536-y","url":null,"abstract":"Strenuous respiratory effort has been proposed as a second hit in severe acute lung injury (ALI), introducing the concept of “patient self-inflicted lung injury” (P-SILI). In an experimental setting, noninvasive continuous positive airway pressure (CPAP) attenuates lung and diaphragmatic injury, but the underlying mechanisms remains elusive. Here we investigate the effects of noninvasive CPAP on global and regional lung strain and diaphragm velocity of contraction and relaxation in an experimental P-SILI model. Lung injury was induced in Sprague Dawley rats through surfactant depletion followed by either three hours of standard oxygen therapy (Control group) or CPAP support (CPAP group). Subjects were assessed through inspiratory and expiratory muscle activation. Regional lung and diaphragmatic deformation amplitude (strain) and the rate of change (strain rate) maps were developed using a micro-computed tomography (µCT) scan. Morphometric tissue assessment was carried out to study biological damage. Compared with the Control group, the CPAP group resulted in: (1) higher SpO2 and lower respiratory rate, nasal flaring, inspiratory and expiratory muscle activation, and minute ventilation at the end of the study; (2) lower global and regional tidal ventilation at the beginning of the study; (3) lower regional inspiratory and expiratory lung strain rate over time; and (4) higher muscle area in the diaphragm morphometric analysis. Furthermore, intragroup analysis showed that only the CPAP group reduced the inspiratory and expiratory muscle activation, the global and regional expiratory lung strain rate and the regional velocity of relaxation of the diaphragm over time. Standard oxygen therapy resulted in worse patterns of lung strain rate and diaphragm velocity of relaxation, consistent with P-SILI and load-induced diaphragm injury. CPAP resulted in improved lung function, decreased lung strain rate, and diaphragmatic relaxation velocity throughout the respiratory cycle. We conclude that CPAP promotes biomechanical protection in injured lungs and diaphragm, more noticeably during the expiratory phase.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"115 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144694053","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":"Extracellular vesicles as a biomarkers in traumatic brain injury: a systematic review of animal and clinical studies","authors":"Nekane Romero-García, Alberto Ruiz-Pacheco, Javier Huete-Acevedo, Berta Monleón, Antoni Vicente, Cristina Mas-Bargues, Jorge Sanz-Ros, Maria Luisa García-Pérez, Andrea Gutiérrez, Jose Carbonell, Gerardo Aguilar, Fabio Tarantino, Consuelo Borrás, Chiara Robba, Rafael Badenes","doi":"10.1186/s13054-025-05477-6","DOIUrl":"https://doi.org/10.1186/s13054-025-05477-6","url":null,"abstract":"Traumatic brain injury (TBI) is one of the leading causes of disability worldwide. Clinical or imaging scales are currently used to stratify severity, but they show a limited correlation with clinical prognosis, which has raised interest in biomarkers. Extracellular vesicles (EV)-based biomarkers may be superior to soluble biomarkers because of their stability, resistance to degradation and unique signature according to tissue of origin. Identification of EV-associated TBI biomarkers remains challenging due to the significant heterogeneity in experimental design, exosome isolation methods and study populations. This systematic review aims to analyze the role of EVs as biomarkers in TBI across both animal and clinical models, with particular focus on their association with prognosis. A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Four electronic databases were searched from inception to December 31st, 2024, using the terms “traumatic brain injury”, “extracellular vesicles” and “biomarkers”. Animal studies and human cohort, case control, and case series studies were included; previous reviews, congress abstracts, and non-peer-reviewed works were excluded. Studies conducted on adult individuals or in experimental models of acute TBI, regardless of the mechanism and severity, and which studied biomarkers within the first week of injury, were included. The primary outcome was the EV-based biomarker identified by each study and its diagnostic accuracy when provided. Secondary outcomes were sample type for EV isolation, origin of EVs and methods for isolation and characterization. A total of 18 animal and 19 human studies were included. miRNAs were the most frequently identified biomarker in animal studies, while proteins were most common in human studies. The most commonly identified proteins in EVs were GFAP, UCH-L1, and Tau, with miRNA-124-3p also being repeatedly found. EVs were most frequently obtained from plasma, followed by brain tissue lysates in animals and cerebrospinal fluid or saliva in humans. Most studies used ultracentrifugation or polymer-based precipitation for EV isolation, with western blotting and electron microscopy for characterization. Few studies provided a measure of accuracy for the studied biomarkers; the highest diagnostic performance has been achieved with neural EV-based miRNA panels. While several studies explored diagnostic applications, only a limited number investigated prognostic utility, with few using scales such as GOS-E or evaluating long-term neurocognitive complications. This review highlights the potential of EV-based biomarkers in TBI, emphasizing their stability and tissue-specific signatures. Standardized protocols for EV isolation and characterization are needed for consistency across studies. While diagnostic applications have been explored, more research is required on the prognostic value of EV biomarkers, particu","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"19 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144694010","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":"Value of cDPP3 as a short-term prognostic biomarker in all-comers critically ill patients in the emergency department","authors":"Giacomo Fidelio, Maria Pia Ruggieri, Luca Crisanti, Gabriele Valli, Francesca De Marco, Andreas Bergman, Karine Santos, Oliver Hartman, Salvatore Di Somma","doi":"10.1186/s13054-025-05578-2","DOIUrl":"https://doi.org/10.1186/s13054-025-05578-2","url":null,"abstract":"<p>Early and accurate risk stratification of critically ill patients in the Emergency Department (ED) remains a cornerstone of modern acute care medicine. Timely decisions regarding resource allocation, Intensive Care Unit (ICU) admission, and targeted therapies rely on tools that can identify patients at risk of rapid deterioration, preferably before overt clinical signs emerge.</p><p>Traditional clinical scoring systems, such as the Modified Early Warning Score (MEWS), the quick Sequential Organ Failure Assessment (qSOFA), and the Shock Index (SI), are widely used for initial triage and prognosis [1]. However, these scores often detect deterioration only after organ damage has already begun.</p><p>Recent literature has identified circulating dipeptidyl peptidase 3 (cDPP3), a cytosolic metalloprotease released into the bloodstream during cellular injury, as a promising biomarker associated with poor outcomes in patients with septic, cardiogenic, or vasoplegic shock admitted to the ICU [2,3,4,5]. By degrading angiotensin II and enkephalins, cDPP3 may directly contribute to hemodynamic instability, myocardial depression, and multi-organ failure. Despite these insights, the utility of cDPP3 as an early biomarker in the ED setting has not been fully explored.</p><p>We conducted a prospective observational study at the ED of San Giovanni Addolorata Hospital in Rome, Italy. A total of 336 consecutive patients classified as triage code 1 (critical) and presenting with at least one abnormal clinical score (MEWS &gt; 3, qSOFA ≥ 2, or SI &gt; 1) were enrolled. Exclusion criteria included pre-hospital cardiac arrest, trauma, and refusal of consent.</p><p>Following informed consent, all patients underwent point-of-care (POC) testing for cDPP3 on ED admission using the IB10 sphingotest^® cDPP3 in the Nexus IB10 POC system (4TEEN4 Pharmaceuticals GmbH, Hennigsdorf-Berlin, Germany). The primary endpoint was in-hospital and 28-day all-cause mortality.</p><p>The median age in our cohort was 77 (61–86) years, with a slight male prevalence (60.4%). A total of 9 patients (2.7%) died in the ED within the first 24 h, with increasing mortality over the following days to a 28-day mortality of 15.8% (<i>n</i> = 53). No patient was lost at the 28-day follow-up.</p><p>Our findings suggest that elevated cDPP3 levels on arrival are significantly associated with short-term mortality. Median cDPP3 concentrations were higher in non-survivors compared to survivors (43.96 [31.95–70.66] ng/mL vs. 35.18 [21.74–58.32] ng/mL, <i>p</i> &lt; 0.006). Using a cutoff of 40 ng/mL, consistent with thresholds identified in previous ICU studies, patients with a cDPP3 above this level had a twofold increased risk of 28-day mortality (HR 2.06, 95% CI 1.19–3.56). Importantly, cDPP3 demonstrated stronger predictive power for early mortality, with an AUC of 0.83 for 24-hour mortality and a C-index of 0.618 (95% CI: 0.547–0.689) for 28-day mortality.</p><p>The MEWS had the highest overal","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"25 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144694051","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":"Research without prior consent procedure and intervention effect on mortality in critical care: a meta-epidemiological study of randomized controlled trials","authors":"Geoffroy Hariri, Jacqueline Louie, Aqsa Khan, Peggy Tahir, Guillaume L. Martin, Agnès Dechartres, Matthieu Legrand","doi":"10.1186/s13054-025-05480-x","DOIUrl":"https://doi.org/10.1186/s13054-025-05480-x","url":null,"abstract":"In critical care randomized controlled trials (RCTs), obtaining informed consent from patients or proxies can be challenging and may delay randomization, potentially affecting intervention efficacy. Research without prior consent (RWPC) procedures are increasingly used to facilitate timely inclusion but their impact on trial outcomes remains uncertain. We aimed to assess whether RWPC procedures are associated with differences in intervention effects on mortality in critical care RCTs. We searched PubMed and the Cochrane Database of Systematic Reviews from inception to August 1, 2024. We included meta-analyses of RCTs evaluating therapeutic interventions in critically ill adults, reporting mortality as a primary or secondary outcome. We conducted a meta-epidemiological study using a two-step approach. First, we calculated the ratio of odds ratios (ROR) within each meta-analysis to compare the effect of interventions on mortality between RCTs using RWPC and those using standard consent. Second, we pooled these RORs across meta-analyses using a random-effects model. Secondary outcomes included the delay from eligibility to randomization and the recruitment rate. We included 42 meta-analyses comprising 323 RCTs and 103,011 patients, of which 59 RCTs (18%) used a RWPC procedure. Trials using RWPC were more recent (median year: 2015 [2008–2019] vs. 2012 [2007–2017]; p < 0.01), larger (sample size: 203 [101–605] vs. 72 [40–162]; p < 0.01), more frequently multicenter (80% vs. 43%; p < 0.01), and had lower overall risk of bias. There was no significant difference in intervention effect on mortality between trials with and without RWPC (pooled ROR, 1.05 [95% CI 0.83–1.34]; I²=71.7%). RWPC was associated with shorter time to randomization (3 [1−9] vs. 11 [4−23] hours; p < 0.01) and higher recruitment rates (9.6 [4.7–18.7] vs. 4.5 [1.9–8.6] patients/month; p = 0.01). In critical care RCTs, RWPC procedures were not associated with differences in intervention effect on mortality but were linked to shorter time to randomization and higher recruitment rates.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"53 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144694083","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":"Development and validation of a dynamic early warning system with time-varying machine learning models for predicting hemodynamic instability in critical care: a multicohort study","authors":"Dung-Hung Chiang, Zeyu Jiang, Cong Tian, Chien-Ying Wang","doi":"10.1186/s13054-025-05553-x","DOIUrl":"https://doi.org/10.1186/s13054-025-05553-x","url":null,"abstract":"Hemodynamic instability, a life-threatening condition marked by circulatory failure, presents a significant challenge in intensive care unit (ICU) settings, often leading to poor patient outcomes. Traditional monitoring methods that rely on single parameters may delay diagnosis. Machine learning models offer a solution by integrating multiple clinical parameters to more dynamically and accurately predict instability. We developed the Time-varying Hemodynamic Early Warning Score (TvHEWS), an AI-assisted model used to predict hemodynamic instability in intensive care unit (ICU) patients. The model was trained and internally validated via retrospective data from the VGHTPE 2010 cohort (2010–2021) at Taipei Veteran General Hospital. It was further validated with prospective data from the VGHTPE 2022 cohort and external data from the MIMIC IV cohort. TvHEWS includes hourly updating models, providing continuous risk assessments. TvHEWS showed strong predictive performance. In the VGHTPE 2010 cohort, the AUROC was 0.93, with a precision of 0.94 and a recall of 0.77. In the VGHTPE 2022 cohort, the AUROC was 0.92, with precision and recall balanced at 0.74 and 0.76, respectively. The MIMIC IV cohort had a slightly lower AUROC of 0.82, with a precision of 0.72 and a recall of 0.36. The calibration plots showed good alignment between the predicted and observed risks, with Brier scores of 0.082, 0.085, and 0.116 for the VGHTPE 2010, VGHTPE 2022, and MIMIC IV cohorts, respectively. TvHEWS predicted hemodynamic instability for up to 7 h before intervention in the VGHTPE 2010 cohort, 8.6 h in the VGHTPE 2022 cohort, and 21 h in the MIMIC IV cohort, with low false alarm rates. TvHEWS addresses the challenge of early detection of hemodynamic instability by integrating multiple clinical parameters and offering continuous, dynamic risk assessments. It enhances the ability to anticipate and manage critical circulatory issues, potentially improving patient outcomes through earlier interventions. Further prospective validation in other hospitals is needed to confirm its robustness across diverse settings.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"90 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144684741","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":"Rinaldo Bellomo – An Intensive Care Medicine Icon","authors":"Anthony McLean, Geoffery Dobb","doi":"10.1186/s13054-025-05481-w","DOIUrl":"https://doi.org/10.1186/s13054-025-05481-w","url":null,"abstract":"<p>An exceptional figure in the international intensive care community, Professor Rinaldo Bellomo, has died following a short illness. Based in Melbourne australia, Rinaldo became internationally renowned for his prodigious research output in intensive care medicine. Although a giant in the field of managing acute renal injury in the critically ill patient, the breadth and depth of his contributions extended into many fields of medicine. He was the preeminent intensive care researcher in Australia and has an extraordinary legacy having authored more than 1800 publications. He was recognised by being appointed an officer of the order of Australia in 2018, the highest honour that can be bestowed in the country.</p><p>Rinaldo was a true clinician researcher. He was the founding chair of the ANZICS clinical trials group, a collection of clinical researchers who came together in the 1990s to produce groundbreaking multicentre studies that changed intensive care practice. Yet his research interests were much broader than that. He was a true scientist, working with laboratory based researchers and developing pre-clinical studies. He was also a compassionate, supportive supervisor and mentor to many Phd students from around the Globe who have spread the lessons from working with him.</p><p>For over 30 years that we have known Rinaldo he never lost his infectious enthusiasm, wherever he was encountered around the globe whether it be Europe, Australia, Asia or elsewhere. His work ethic was truly amazing, balancing never ending invitations to present at international meetings with his clinical and academic commitments. His contribution to a number of medical journals as an Editor and a reviewer was outstanding. It was rare for a manuscript not to be substantially improved by his input. Notable too was his longterm input to the Editorial Board of <i>Critical Care.</i></p><p>He brought his cheerfulness and warmth of character with him. He was a gifted communicator, whether it be when providing a critique of his own and others research, reviewing our current clinical practice or as a passionate advocate for Intensive Care as a researchbased specialty. Beginning his professional life as a physician he remained clinically active throughout his career, blending real patient experience with research that could improve the lives of individual patients.</p><p>It is impossible to list all of Rinaldo’s achievements but suffice to say he was the leading Australasian Critical Care clinician scientist who many counted as their colleague, mentor and friend. Our deepest sympathies are extended to his wife Debbie and daughter Hilary, whom Rinaldo often mentioned in conversations in the most loving terms.</p><p>Anthony McLean – Blue Mountains, Australia.</p><p>Geoffery Dobb – Perth, Australia.</p><figure><picture><source srcset=\"//media.springernature.com/lw685/springer-static/image/art%3A10.1186%2Fs13054-025-05481-w/MediaObjects/13054_2025_5481_Figa_HTML.png?as=webp\" type=\"","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"14 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144684740","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":"Commentary: refining patient stratification for haemoadsorption in cardiac surgery: comparative reflections on RECCAS, REMOVE, and SIRAKI02","authors":"Andreas Hohn, Nathalie M. Malewicz-Oeck, Dirk Buchwald, Thorsten Annecke, Peter K. Zahn, Andreas Baumann","doi":"10.1186/s13054-025-05525-1","DOIUrl":"https://doi.org/10.1186/s13054-025-05525-1","url":null,"abstract":"&lt;p&gt;&lt;b&gt;Clinical Registration:&lt;/b&gt; The RECCAS trial was prospectively registered (Clinical Trial Number DRKS00007928, https://drks.de/search/en/trial/DRKS00007928 on 3rd August 2015 with the Clinical Trial Registry and published under: Baumann A, Buchwald D, Annecke T, Hellmich M, Zahn PK, Hohn A. RECCAS - REmoval of Cytokines during Cardiac Surgery: study protocol for a randomised controlled trial. Trials. 2016;17: 137.&lt;/p&gt;&lt;br/&gt;&lt;p&gt;Haemoadsorption (HA) to modulate inflammation after cardiac surgery via extracorporeal cytokine removal has theoretical benefits, with divergent study results and clinical outcomes. These findings fuel debate on HA’s clinical relevance in cardiac surgery [1,2,3] during cardiopulmonary bypass (CPB). This commentary reflects on the findings of the RECCAS trial, a prospective, randomised trial investigating intraoperative haemoadsorption (HA) in elective cardiac surgery [4]. While HA lowered certain cytokines during surgery and improved cardiac index, fluid, and fibrinogen needs, it did not affect IL-6 at ICU nor organ function. We contextualise RECCAS findings by comparing with the REMOVE and SIRAKI02 trials [5, 6], and derive implications for patient stratification and future trial design. Among available trials, REMOVE and SIRAKI02 provide recent and relevant trials due to their prospective, randomised design and focus on HA in cardiac surgery. Despite differences in patient populations and devices, these trials allow a comparative evaluation of methodologies and directionality of outcomes.&lt;/p&gt;&lt;p&gt;Notably, 30.5% of cardiac procedures are performed in patients aged 70–79 years [5]. The RECCAS trial included patients aged ≥ 65 years reflecting the typical demographic undergoing elective cardiac surgery. While this focus enhances relevance for the typical older cardiac surgery population, it may limit applicability to less frequently encountered groups such as younger patients. Broader inclusion criteria could enhance generalisability but may introduce heterogeneity. Although older patients show a less pronounced inflammatory response, it still contributes to complications.&lt;/p&gt;&lt;p&gt;In contrast, the REMOVE trial enrolled patients with infective endocarditis and a high inflammatory burden, whereas SIRAKI02 targeted on individuals with lower preoperative risk profiles. Future studies should investigate age-related differences across broader populations and focus on subgroup analyses, particularly in patients with pronounced inflammatory activity.&lt;/p&gt;&lt;p&gt;The RECCAS cohort included isolated coronary artery bypass grafting (CABG) and valve surgeries but also complex combined procedures (Supplement 1), reflecting the diversity of real-world surgical practices [5,6,7]. Although full blinding was not possible, restricted visibility for surgeons and concealed group allocation reduced performance bias. Comparable intraoperative times and full ICU blinding confirm objective outcome assessment.&lt;/p&gt;&lt;h3&gt;Inflammatory monitoring and outcome ass","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"696 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144685051","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":"Oral care for intubated patients in the intensive care unit: examination of bacterial count and microbiota","authors":"Daisuke Kanamori, Tadashi Fujii, Mitsuyoshi Yoshida, Risa Ito, Ayu Sakai, Hideaki Takahashi, Kento Kuramitsu, Kohei Funasaka, Eizaburo Ohno, Yoshiki Hirooka, Takumi Tochio","doi":"10.1186/s13054-025-05576-4","DOIUrl":"https://doi.org/10.1186/s13054-025-05576-4","url":null,"abstract":"Ventilator-associated pneumonia (VAP) after tracheal intubation is a major infectious complication in patients in the intensive care unit (ICU), with an incidence of 8–28%. Oral care in the ICU is essential; however, the presence of an intubation tube and restricted mouth opening cause complications. A healthy commensal microflora in the oral cavity resists colonization by respiratory pathogens, and poor oral hygiene may increase the risk for VAP. In this study, we examined the effectiveness of oral care on oral bacterial counts and microbial diversity in patients admitted to the ICU. Fifteen ICU patients were included in this study. Oral microbiome samples were collected by swabbing the surface of the tongue. Oral bacterial counts were measured at four time points: before and after oral care, both pre- and post-extubation. Additionally, microbiome analysis was conducted twice: once before oral care pre-extubation, and once before oral care post-extubation. Oral bacterial counts were assessed using a bacterial counter, and microbiome analysis was performed through 16S rRNA gene amplicon sequencing. Oral bacterial counts significantly decreased after oral care at both pre- and post-extubation time points. Microbiome analysis revealed significant differences in alpha diversity pre- and post-extubation samples. Samples post extubation were less diverse. This study demonstrates that oral care effectively reduces bacterial counts in ICU patients, both pre- and post-extubation. Microbiome analysis revealed shifts in microbial diversity, suggesting that the oral microbiota was disrupted during intubation. Given the risk of VAP, oral care may play an important role to prevent VAP in ICU settings.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"32 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144684739","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}