Critical Care最新文献

{"title":"Fluid balance and outcome in cardiac arrest patients admitted to intensive care unit","authors":"Marie Renaudier, Jean-Baptiste Lascarrou, Jonathan Chelly, Olivier Lesieur, Jérémy Bourenne, Paul Jaubert, Marine Paul, Grégoire Muller, Pierre Leprovost, Thomas Klein, Mélany Yansli, Cédric Daubin, Matthieu Petit, Nicolas Pichon, Martin Cour, Ghada Sboui, Guillaume Geri, Alain Cariou, Wulfran Bougouin","doi":"10.1186/s13054-025-05391-x","DOIUrl":"https://doi.org/10.1186/s13054-025-05391-x","url":null,"abstract":"Although shock following cardiac arrest is common and contributes significantly to mortality, the influence of the modalities used to manage the hemodynamic situation, particularly with regard to fluid balance, remains unclear. We evaluated the association between positive fluid balance and outcome after out-of-hospital cardiac arrest (OHCA). We conducted a multicenter study from August 2020 to June 2022, which consecutively enrolled adult OHCA patients in 17 intensive care units. The primary endpoint was 90-day survival. Multivariate Cox analysis, propensity score matching and landmark analysis were performed, along with several sensitivity analyses. Of the 816 patients included in our study, 74% had a positive fluid balance, and 291 of 816 patients (36%) were alive at 90-day. A positive fluid balance was associated with mortality after adjusted multivariate analysis (HR = 1.8 [1.3 – 2.3], p < 0.001), after propensity score matching (n = 193 matched patient pairs, HR = 1.6 [1.1 – 2.1], p = 0.005) and after landmark analysis. We reported a dose-dependent association between fluid balance and mortality. Patients with a positive fluid balance were more likely to need renal replacement therapy (10% vs. 2%, p = 0.001) and had a lower minimum PaO2/FiO2 ratio in the first seven days (158 vs. 180, p < 0.001). After cardiac arrest, a positive fluid balance is consistently associated with a worse outcome. Pending further data, a restrictive fluid therapy strategy may be beneficial in post-OHCA patients. Trial registration: ClinicalTrial.gov cohort AfterROSC-1 NCT04167891 registered November 13th, 2019, ethics committees 2019-A01378-49 and CPP-SMIV 190901. ","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"37 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143831803","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":"Hallucinations in critically ill patients: understanding the unreal","authors":"Romain Sonneville","doi":"10.1186/s13054-025-05372-0","DOIUrl":"https://doi.org/10.1186/s13054-025-05372-0","url":null,"abstract":"&lt;p&gt;Hallucinations are perceptual experiences that occur in the absence of an external stimulus and can involve any of the five sensory modalities: visual, auditory, olfactory, gustatory, or tactile. Auditory and visual hallucinations are the most common forms encountered clinically. These phenomena may manifest as hearing voices, seeing images, or perceiving sensations that do not correspond with any external reality. Hallucinations are frequently associated with psychiatric disorders such as schizophrenia, neurological disorders such as Parkinson disease, severe sleep deprivation, or substance intoxication and withdrawal. They may also occur in individuals with sensory impairments, such as hearing or vision loss, where the brain may generate internal stimuli in response to the sensory deficit. The content of hallucinations can vary significantly, from benign to distressing or threatening, and may cause substantial psychological distress to the patient. The pathophysiology underlying hallucinations is not fully understood but is believed to involve dysregulation of neurotransmitters, particularly dopamine, and abnormal activity in brain regions responsible for sensory processing. Common risk factors or hallucinations are presented in the Table 1.&lt;/p&gt;&lt;figure&gt;&lt;figcaption&gt;&lt;b data-test=\"table-caption\"&gt;Table 1 Risk factors for hallucinations&lt;/b&gt;&lt;/figcaption&gt;&lt;span&gt;Full size table&lt;/span&gt;&lt;svg aria-hidden=\"true\" focusable=\"false\" height=\"16\" role=\"img\" width=\"16\"&gt;&lt;use xlink:href=\"#icon-eds-i-chevron-right-small\" xmlns:xlink=\"http://www.w3.org/1999/xlink\"&gt;&lt;/use&gt;&lt;/svg&gt;&lt;/figure&gt;&lt;p&gt;The ICU environment likely increases the risk of hallucinations due to multiple factors that disrupt normal cognitive function. Sleep deprivation is common in ICU patients, caused by frequent interruptions, noise, and continuous light exposure, which can precipitate delirium and hallucinations. Sensory overload from persistent alarms, machinery noise, and healthcare staff activity can overwhelm the sensory processing of patients, leading to perceptual distortions. Social and physical isolation in the ICU contributes to psychological stress and anxiety, further predisposing patients to hallucinations. Medications frequently administered in the ICU, including sedatives, analgesics, and anticholinergics, are known to have neuropsychiatric side effects, including hallucinations. Additionally, severe infections and metabolic disturbances, can impair cognitive function and contribute to delirium and associated hallucinations. The disorienting nature of the ICU—characterized by unfamiliar surroundings, lack of natural light, and frequent staff changes—further challenges patients’ ability to distinguish between reality and hallucinations [1].&lt;/p&gt;&lt;p&gt;The diagnosis of hallucinations remains challenging in the ICU, as no specific tool has been designed to quantify this symptom at the bedside. Among commonly used scales, the Intensive Care Delirium Screening Checklist (ICDSC) includes a qualita","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"6 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143827700","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":"A randomized controlled trial of catheters with different tips and lengths for patients requiring continuous renal replacement therapy in intensive care unit","authors":"Zhifeng Zhou, Chen Liu, Peiyun Li, Yingying Yang, Fang Wang, Qing Xu, Lu Jin, Ling Zhang, Ping Fu","doi":"10.1186/s13054-025-05389-5","DOIUrl":"https://doi.org/10.1186/s13054-025-05389-5","url":null,"abstract":"The tip design and length of catheter impact catheter function. Two types of catheters with different tips, side-hole catheters and step-tip catheters, are commonly used during continuous renal replacement therapy (CRRT). However, there is insufficient evidence comparing their efficacy and safety in CRRT. In addition, whether the insertion of a longer catheter could enhance catheter function remains poorly studied and controversial. In this open-label, three-arm, randomized trial, critically ill patients receiving CRRT were randomized to three groups. Group A received 20 cm side-hole catheters (GDHK‐1120), group B received 20 cm step-tip catheters (GDHK‐1320) and group C received 25 cm step-tip catheters (GDHK‐1325). The primary outcomes were the incidence of catheter dysfunction and catheter survival time. A total of 351 patients were enrolled, with 116 in group A, 117 in group B, and 118 in group C. The incidence of catheter dysfunction in group A (35.7%, 51/143) was significantly higher than that in group B (17.7%, 22/124) (P = 0.001). However, there was no difference between group B and group C (15.6%, 23/147) (P = 0.744). The catheter survival time was comparable between group A (5.5 days, IQR 2.5–9.3) and group B (5.0 days, IQR 3.0–10.0) (P = 0.626). In contrast, group C (6.4 days, IQR 3.9–12.0) demonstrated a significantly longer catheter survival time compared to group B (P = 0.019). Cox regression analysis identified BMI (HR 1.052, 95% CI 1.003–1.103, P = 0.036) as an independent risk factor for catheter dysfunction. Results were not consistent across BMI tertiles, with similar results observed only in patients with a lower BMI (BMI < 24.2) (chi-square 13.65, P = 0.001). There was also a trend that patients in group C have a longer filter lifespan (36.5 h, IQR 16.9–68.1, P = 0.001) and a lower incidence of catheter-related thrombosis (10.40 per 1000 catheter-days, 95% CI 5.93, 17.83, P = 0.019). Other secondary outcomes were not significantly different among groups. Step-tip catheters may be preferable for CRRT, particularly for patients in the lower BMI tercile. Longer femoral vein catheterization demonstrated enhanced benefits in CRRT, especially among obese patients. Further high-quality, multicenter RCTs are essential to strengthen the evidence guiding catheter selection during CRRT. Trial registration: ChiCTR2300075107. Registered 25 August 2023.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"60 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143819421","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":"Multimodal assessment of favorable neurological outcome using NSE levels and kinetics, EEG and SSEP in comatose patients after cardiac arrest","authors":"Aurélie Besnard, Juliette Pelle, Estelle Pruvost-Robieux, Antonin Ginguay, Clara Vigneron, Frédéric Pène, Jean-Paul Mira, Alain Cariou, Sarah Benghanem","doi":"10.1186/s13054-025-05378-8","DOIUrl":"https://doi.org/10.1186/s13054-025-05378-8","url":null,"abstract":"Prognostic markers of good neurological outcome after cardiac arrest (CA) remain limited. We aimed to evaluate the prognostic value of neuron-specific enolase (NSE), electroencephalogram (EEG) and somatosensory evoked potentials (SSEP) in predicting good outcome, assessed separately and in combination. A retrospective study was conducted in a tertiary CA center, using a prospective registry. We included all patients comatose after discontinuation of sedation and with one EEG and NSE blood measurement at 24, 48 or/and 72 h after CA. The primary outcome was favorable neurological outcome at three months, a Cerebral Performance Categories (CPC) scale 1–2 defining a good outcome. Between January 2017 and April 2024, 215 patients were included. Participants were 63 years old (IQR [52–73]), and 73% were male. At 3 months, 54 patients (25.1%) had a good outcome. Compared to the poor outcome group, NSE blood levels were significantly lower in the good outcome group at 24 h (39 IQR[27–45] vs 54 IQR[37–82]µg/L, p < 0.001), 48 h (26 [18–43] vs 107 [54–227]µg/L, p < 0.001) and 72 h (20 µg/L IQR [15–30] vs 184 µg/l IQR [60–300], p < 0,001). Normal NSE (i.e., < 17 µg/L) at 24 h was highly predictive of good outcome, with a predictive positive value (PPV) of 71% despite a sensitivity (Se) of 9%. The best cut-off values for NSE at 24, 48 and 72 h were below 45.5, 51.5 and 41.5 µg/L, yielding PPV of 64%, 80% and 83% and sensitivities of 74%, 93% and 90%, respectively. A decreasing trend in NSE levels between 24 and 72 h was also highly predictive of good outcome (PPV 82%, Se 81%). A benign EEG pattern was more frequently observed in the good outcome group (87.1 vs 14.9%, p < 0.001) and predicted a good outcome with a PPV of 72% and a Se of 94%. Regarding SSEPs, a bilateral N20-baseline amplitude > 0.85 µV was predictive of good outcome (PPV 75%, Se 100%). The combination of NSE < 51.5 µg/l at 48 h, a decreasing NSE trend between 24 and 72 h and a benign EEG showed the best predictive value (PPV 96%, Se 76%). In comatose patients after CA, a low NSE levels at 24, 48 h or 72 h, a decreasing trend in NSE over time, a benign EEG and a high N20 amplitude are robust markers of favorable outcome, reducing prognosis uncertainty. ","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"39 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143822850","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":"Monitoring patients with acute respiratory failure during non-invasive respiratory support to minimize harm and identify treatment failure","authors":"Joaquín Perez, Luciano Brandan, Irene Telias","doi":"10.1186/s13054-025-05369-9","DOIUrl":"https://doi.org/10.1186/s13054-025-05369-9","url":null,"abstract":"Non-invasive respiratory support (NRS), including high flow nasal oxygen therapy, continuous positive airway pressure and non-invasive ventilation, is a cornerstone in the management of critically ill patients who develop acute respiratory failure (ARF). Overall, NRS reduces the work of breathing and relieves dyspnea in many patients with ARF, sometimes avoiding the need for intubation and invasive mechanical ventilation with variable efficacy across diverse clinical scenarios. Nonetheless, prolonged exposure to NRS in the presence of sustained high respiratory drive and effort can result in respiratory muscle fatigue, cardiovascular collapse, and impaired oxygen delivery to vital organs, leading to poor outcomes in patients who ultimately fail NRS and require intubation. Assessment of patients’ baseline characteristics before starting NRS, close physiological monitoring to evaluate patients’ response to respiratory support, adjustment of device settings and interface, and, most importantly, early identification of failure or of paramount importance to avoid the negative consequences of delayed intubation. This review highlights the role of respiratory monitoring across various modalities of NRS in patients with ARF including dyspnea, general respiratory parameters, measures of drive and effort, and lung imaging. It includes technical specificities related to the target population and emphasizes the importance of clinicians’ physiological understanding and tailoring clinical decisions to individual patients’ needs.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"27 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143805774","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":"Prognosis of liver abscess in the intensive care unit (POLAIR), a multicentre observational study","authors":"Marie Le Goff, Frédéric Martino, Geoffrey Rossi, Aurélia Toussaint, Elsa Moncomble, Danielle Reuter, Charlotte Garret, Maxence Decavèle, Megan Fraissé, Antoine Herault, Laurent Argaud, Pierre Garçon, Clément Saccheri, Juliette Meunier, Guillaume Voriot, Cyril Cadoz, Élise Yvin, Virginie Laurent, Laure Calvet, Etienne de Montmollin, Julien Schmidt, Nahema Issa, Maxime Leclerc, Vincent Das, Virginie Lemiale, Éric Mariotte","doi":"10.1186/s13054-025-05376-w","DOIUrl":"https://doi.org/10.1186/s13054-025-05376-w","url":null,"abstract":"Liver abscess (LA) is a rare but potentially serious condition with a high mortality rate. Current epidemiological data of LA patients requiring intensive care unit (ICU) admission are limited. This multicentre retrospective study included adults admitted to 24 ICUs in France between January 2010 and December 2020. Risk factors for mortality were identified by multivariate analysis. A propensity score was used to adjust for confounders related to the presence of portal vein thrombosis. 335 patients were enrolled. The median age was 66 years [53–73] and 68% were male. Commons comorbidities included diabetes (29.9%) and cancer or haematological disease. Septic shock was the main reason for admission (58%). The median SAPS2 score at ICU admission was 42 [31–53] and the SOFA score was 6 [3–9]. The putative origin of LA was biliary (31%), while 40% were cryptogenic. Most patients (60%) had a solitary LA, involving the right lobe (38.8%), with a median diameter of 67 mm [47–91]. Associated portal vein thrombosis (PVT) was present in 13.4% of cases. Microbiological documentation was obtained in 82% of patients, showing gram-negative bacilli (59.7%), mainly Escherichia coli (19.6%) and Klebsiella spp. (19.1%), and gram-positive cocci (29.6%), mainly Streptococcus spp. (17.1%). Drainage was performed in 62% of cases, 40% within 48 h. The median duration of antibiotic therapy was 35 days [21–42]. During hospitalisation, 62% of patients required vasopressors and 29% required mechanical ventilation. In-ICU mortality was 11.6%. Multivariate analysis showed that organ dysfunction illustrated by SOFA score (HR 3.45 [1.95–6.09], p < 0.001) and PVT (HR 3.14 [1.54–6.39], p = 0.001) were significant risk factors for mortality. Drainage was not associated with improved short-term survival (HR 1.22 [0.65–2.72], p = 0.52). In the population matched for PVT confounders, a higher sofa score was the only factor associated with mortality (HR 3.11 [1.76–5.49] IC95%, p = 0.001). This multicentre study illustrates the severity of LA in French intensive care units and identifies organ dysfunction (SOFA score) and portal vein thrombosis as major risk factors for mortality. Prospective studies are needed to improve management strategies, as the survival benefit of drainage is unclear.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"63 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143790155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The 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":"&lt;p&gt;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.&lt;/p&gt;&lt;p&gt;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&lt;sub&gt;2&lt;/sub&gt;) 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.&lt;/p&gt;&lt;p&gt;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.&lt;/p&gt;&lt;h3&gt;The emergence of wearable biosensors for sepsis detection&lt;/h3&gt;&lt;p&gt;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.&lt;/p&gt;&lt;p&gt;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&lt;sub&gt;2&lt;/sub&gt; at the fingertip. These features often reduce patient comfort and adherence to continuous monitoring.&lt;/p&gt;&lt;p&gt;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.&lt;/p&gt;&lt;h3&gt;Pilot study: feasibility of remote wireless monitoring&lt;/h3&gt;&lt;p&gt;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":"&lt;p&gt;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.&lt;/p&gt;&lt;p&gt;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.&lt;/p&gt;&lt;p&gt;No datasets were generated or analysed during the current study.&lt;/p&gt;&lt;ol data-track-component=\"outbound reference\" data-track-context=\"references section\"&gt;&lt;li data-counter=\"1.\"&gt;&lt;p&gt;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.&lt;/p&gt;&lt;p&gt;Article PubMed PubMed Central Google Scholar &lt;/p&gt;&lt;/li&gt;&lt;li data-counter=\"2.\"&gt;&lt;p&gt;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.&lt;/p&gt;&lt;p&gt;Article PubMed PubMed Central Google Scholar &lt;/p&gt;&lt;/li&gt;&lt;li data-counter=\"3.\"&gt;&lt;p&gt;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.&lt;/p&gt;&lt;p&gt;Article PubMed PubMed Central Google Scholar &lt;/p&gt;&lt;/li&gt;&lt;li data-counter=\"4.\"&gt;&lt;p&gt;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.&lt;/p&gt;&lt;p&gt;Article PubMed Google Scholar &lt;/p&gt;&lt;/li&gt;&lt;/ol&gt;&lt;p&gt;Download references&lt;svg aria-hidden=\"true\" focusable=\"false\" height=\"16\"","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":"&lt;p&gt;To the Editor,&lt;/p&gt;&lt;p&gt;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 &lt;i&gt;Pseudomonas aeruginosa&lt;/i&gt; 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.&lt;/p&gt;&lt;p&gt;In response to the first point, we acknowledge the potential influence of resistance on TTP. We found that susceptible &lt;i&gt;P. aeruginosa&lt;/i&gt; 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 &lt;i&gt;Staphylococcus aureus&lt;/i&gt; 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].&lt;/p&gt;&lt;figure&gt;&lt;figcaption&gt;&lt;b data-test=\"table-caption\"&gt;Table 1 Factors associated with shorter TTP. Univariate and multivariate analysis.&lt;/b&gt;&lt;/figcaption&gt;&lt;span&gt;Full size table&lt;/span&gt;&lt;svg aria-hidden=\"true\" focusable=\"false\" height=\"16\" role=\"img\" width=\"16\"&gt;&lt;use xlink:href=\"#icon-eds-i-chevron-right-small\" xmlns:xlink=\"http://www.w3.org/1999/xlink\"&gt;&lt;/use&gt;&lt;/svg&gt;&lt;/figure&gt;&lt;p&gt;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.&lt;/p&gt;&lt;figure&gt;&lt;figcaption&gt;&lt;b data-test=\"figure-caption-text\"&gt;Fig. 1&lt;/b&gt;&lt;/figcaption&gt;&lt;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}