Critical Care最新文献

{"title":"Regional sepsis care in Catalonia: comparative insights from a secondary analysis of the European Sepsis Care Survey.","authors":"Adrian Ceccato, Christian S Scheer, Ricard Ferrer, Maria Luisa Martinez, Berta Cisteró, Juan Carlos Yébenes, Josep Trenado, Carol Lorencio, Adam Linder, Daniela Filipescu, Evgeny A Idelevich, Evangelos J Giamarellos-Bourboulis, Antonio Artigas","doi":"10.1186/s13054-025-05507-3","DOIUrl":"10.1186/s13054-025-05507-3","url":null,"abstract":"","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"29 1","pages":"367"},"PeriodicalIF":9.3,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12366016/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144882392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Heterogeneity in association of myocardial injury and mortality in sepsis or acute respiratory distress syndrome by subphenotype: a retrospective study.","authors":"Pablo Amador Sanchez, Sarah Obeidalla, V Eric Kerchberger, Andrew R Moore, Manoj V Maddali, Kirsten N Kangelaris, Carolyn M Hendrickson, Bruno Evrard, Kathleen D Liu, Julie A Bastarache, Michael A Matthay, Angela J Rogers, Carolyn S Calfee","doi":"10.1186/s13054-025-05613-2","DOIUrl":"10.1186/s13054-025-05613-2","url":null,"abstract":"<p><strong>Rationale: </strong>Myocardial injury is common in acute respiratory distress syndrome (ARDS) and sepsis and associated with increased mortality. Two latent class analysis derived subphenotypes are associated with differential risk of mortality in these populations, though the association of troponin-I with mortality within each subphenotype is unknown.</p><p><strong>Methods: </strong>The derivation (n = 597 in EARLI) and validation (n = 452 in VALID) cohorts consisted of patients with sepsis or ARDS admitted to the ICU and enrolled in two separate prospective observational studies. Patients with troponin-I measured between hospital presentation and within 24 h of ICU admission were included. A parsimonious classifier model using interleukin-8, soluble tumor necrosis factor receptor-1, and vasopressor use assigned patients to subphenotype. Association between peak troponin-I concentration and 60-day in-hospital mortality within each subphenotype was assessed through logistic regression adjusting for age, admission laboratory values, vasopressor use, invasive ventilation use, and cardiac comorbidities.</p><p><strong>Results: </strong>Median peak troponin-I was significantly higher in the hyperinflammatory vs hypoinflammatory subphenotype in both cohorts (0.07 vs 0.04 ng/mL and 0.17 vs 0.07 ng/mL, both p < 0.05). The association between peak troponin-I and mortality differed between inflammatory subphenotypes (p-interaction 0.004, EARLI). In EARLI, each doubling of peak troponin-I was associated with increased adjusted odds of 60-day mortality (aOR 1.14, 95% CI 1.02-1.28) in the hypoinflammatory subphenotype only. These findings were corroborated in VALID (aOR 1.11, 95% CI 1.03-1.21 in hypoinflammatory).</p><p><strong>Conclusions: </strong>Admission peak troponin-I is significantly associated with 60-day mortality in patients with sepsis or ARDS. This association was distinctly driven by the hypoinflammatory subphenotype.</p>","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"29 1","pages":"363"},"PeriodicalIF":9.3,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12363128/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144871866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: Real-time changes in pulse pressure during a 10-second end-expiratory occlusion test reliably detect preload responsiveness.","authors":"Francesco Gavelli, Nello De Vita, Christopher Lai, Danila Azzolina, Arthur Pavot, Mathieu Jozwiak, Rui Shi, Imane Adda, Alexandra Beurton, Jean-Louis Teboul, Xavier Monnet","doi":"10.1186/s13054-025-05609-y","DOIUrl":"10.1186/s13054-025-05609-y","url":null,"abstract":"","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"29 1","pages":"364"},"PeriodicalIF":9.3,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12366071/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144882389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of systemic autoimmune disorders on in-hospital outcomes of cardiac arrest: a United States national inpatient sample cross-sectional study.","authors":"Ruth Pius, Aditya Sunil Bhaskaran, Akanimo Antia, Favour Markson, Kenneth Ong","doi":"10.1186/s13054-025-05550-0","DOIUrl":"10.1186/s13054-025-05550-0","url":null,"abstract":"","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"29 1","pages":"365"},"PeriodicalIF":9.3,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12365998/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144882391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transforming sepsis management: AI-driven innovations in early detection and tailored therapies.","authors":"Praveen Papareddy, Thamar Jessurun Lobo, Michal Holub, Hjalmar Bouma, Jan Maca, Nils Strodthoff, Heiko Herwald","doi":"10.1186/s13054-025-05588-0","DOIUrl":"10.1186/s13054-025-05588-0","url":null,"abstract":"<p><p>Sepsis remains a leading cause of mortality worldwide, driven by its clinical complexity and delayed recognition. Artificial intelligence (AI) offers promising solutions to improve sepsis care through earlier detection, risk stratification, and personalized treatment strategies. Key applications include AI-driven early warning systems, subphenotyping based on clinical and biological data, and decision support tools that adapt to real-time patient information. The integration of diverse data types, such as structured clinical data, unstructured notes, waveform signals, and molecular biomarkers, enhances the precision and timeliness of interventions. However, challenges such as algorithmic bias, limited external validation, data quality issues, and ethical considerations continue to hinder clinical implementation. Future directions focus on real-time model adaptation, multi-omics integration, and the development of generalist medical AI capable of personalized recommendations. Successfully addressing these barriers is essential for AI to deliver on its potential to transform sepsis management and support the transition toward precision-driven critical care.</p>","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"29 1","pages":"366"},"PeriodicalIF":9.3,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12366378/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144882393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Liberal or restrictive transfusion for veno-arterial extracorporeal membrane oxygenation patients: a target trial emulation using the OBLEX study data.","authors":"Le Thi Phuong Thao, Hergen Buscher, Tri-Long Nguyen, Gennaro Martucci, Johannes Gratz, Georg Trummer, Matthieu Schmidt, Melchior Gautier, Alexis Serra, Koji Takeda, Jan-Steffen Pooth, Kevin Rahn, Florian Geismann, Matthias Lubnow, Andrew Retter, Priya Nair, Ruan Vlok, Maithri Siriwardena, James Winearls, James Walsham, David Gattas, Anders Aneman, Bentley Fulcher, Sally Newman, Claire Reynolds, Anthonio Arcadipane, Kiran Shekar, Carol Hodgson, Vincent Pellegrino, Thomas Mueller, Daniel Brodie, Zoe McQuilten","doi":"10.1186/s13054-025-05606-1","DOIUrl":"10.1186/s13054-025-05606-1","url":null,"abstract":"<p><strong>Background: </strong>The optimal transfusion threshold for patients undergoing venoarterial extracorporeal membrane oxygenation (VA-ECMO) remains uncertain.</p><p><strong>Methods: </strong>We used data from OBLEX (ClinicalTrials.gov: NCT03714048), an international, prospective, observational study conducted across 12 centres in Australia, Europe, and North America between 2019 and 2022. The study collected information on patient demographics, bleeding risk factors, transfusion practices during the first seven days of ECMO, and in-hospital mortality. Using these data, we emulated a target trial comparing the effects of liberal transfusion practice (transfusion initiated at Hb ≥ 90 g/L) and restrictive transfusion practice (transfusion initiated at Hb ≤ 70 g/L) on hospital mortality within seven days of ECMO initiation. Sequential trials approach was used to estimate the causal contrast.</p><p><strong>Results: </strong>A total of 534 patients were included, with 46% dying during hospitalisation. After accounting for potential confounders, the liberal transfusion practice demonstrated a modest survival benefit within the first two days of ECMO, with differences in survival probabilities of 12% (95% CI 3% to 21%) at day 2 and 13% (95% CI 2% to 25%) at day 3, corresponding to the number needed to treat (NNT) of 8 and 7 respectively. No differences in survival benefit were found after day 3. These results were consistent across sensitivity and exploratory analyses.</p><p><strong>Conclusion: </strong>This target trial emulation study suggests that a liberal transfusion threshold may provide a modest survival benefit during the early course of VA-ECMO, but no benefit afterwards. Prospective studies are needed to confirm these findings, assess clinical adoption, and investigate underlying mechanism.</p>","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"29 1","pages":"360"},"PeriodicalIF":9.3,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12359932/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144871867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neuroimaging for neurovascular complications of traumatic brain injury.","authors":"Laura Saitta, Martina Resaz, Chiara Robba, Giacomo Rebella, Claudia Rolla Bigliani, Giancarlo Salsano, Bruno Del Sette, Nicola Mavilio, Francesco Pasetti, Nicolò Patroniti, Lucio Castellan, Luca Roccatagliata","doi":"10.1186/s13054-025-05586-2","DOIUrl":"10.1186/s13054-025-05586-2","url":null,"abstract":"<p><strong>Background: </strong>Traumatic brain injury typically causes extra-axial and/or intra-axial bleeding including subarachnoid hemorrhage, intraparenchymal hemorrhage, subdural hematomas and epidural hematomas. Less commonly, trauma can cause cerebrovascular complications, which involve either the arterial or the venous side. Because of the rarity of these pathological conditions, guidelines and recommendations for their management are still controversial.</p><p><strong>Main body: </strong>The objective of this work is to describe the possible cerebrovascular complications of critically ill traumatic brain injured patients and to understand the most common underlying mechanisms and radiological features as well as their management. A variety of pathological entities will be addressed, such as post-traumatic aneurysms, carotid-cavernous fistula, arterial occlusion, arterial dissection (in potential association with brain ischemia), as well as arterial rupture/avulsion and post-traumatic venous thrombosis. Neurovascular complications of head trauma vary depending on the traumatic mechanism, on the site of impact and on the osseous structures involved. Early diagnosis is mostly based on Computed Tomography/Computed Tomography Angiography (CT/CTA) whose findings help guide patient management by detecting vascular lesions potentially leading to neurological deterioration. Magnetic resonance imaging may be useful in selected cases. Today Digital Subtraction Angiography (DSA) is mostly a diagnostic problem-solving tool when CTA findings are equivocal but advanced endovascular interventional techniques have improved the therapeutic possibilities in post-traumatic vascular complications.  CONCLUSIONS: Neurovascular complications are not common after head trauma but should not be overlooked because they might lead to severe and life-threatening consequences. Early diagnosis, and a multidisciplinary collaboration including neuroradiologists, neurosurgeons and neurointensivists is fundamental in order to prevent and minimize secondary brain damage in this population.</p>","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"29 1","pages":"362"},"PeriodicalIF":9.3,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12362949/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144871868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Composition and diversity of the pulmonary microbiome in acute respiratory distress syndrome: a systematic review.","authors":"Katrine Schneider, Johan Ulrich Ulrichsen, Amalie Nimand Westphal, Ulrik Winning Iepsen, Andreas Ronit, Ronni R Plovsing, Ronan M G Berg","doi":"10.1186/s13054-025-05548-8","DOIUrl":"10.1186/s13054-025-05548-8","url":null,"abstract":"<p><p>The pulmonary microbiome plays a crucial role in respiratory health and disease, with growing evidence suggesting its involvement in the pathophysiology of acute respiratory distress syndrome (ARDS). This systematic review synthesises current findings on primarily the composition of the lung microbiome in ARDS patients, and secondarily evaluates the microbial diversity, bacterial abundance and their potential clinical implications on disease severity, ventilator-free days and mortality. A comprehensive literature search identified 11 studies, including 660 patients, 466 of whom had ARDS, examining lung microbial alterations in ARDS using different sequencing technologies. While studies reported different, but consistent changes in microbial compositions, findings on diversity varied across studies. Trends suggest an increased prevalence of specific opportunistic pathogens, particularly members of the gut-associated Enterobacteriaceae family, which was also shown to be associated with fewer ventilator-free days and mortality, although differences in patient populations, study methodologies, and sequencing techniques influenced the results. The relationship between the pulmonary microbiome and clinical outcomes, remains an area of active investigation. Clinical trial Registration:the PROSPERO ID CRD42023467660.</p>","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"29 1","pages":"361"},"PeriodicalIF":9.3,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12359903/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144871865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"DPP4 inhibition curbs systemic inflammation","authors":"Katharina E. M. Hellenthal, Sebastian Kintrup, Timo Wirth, Laura Brabenec, Christina Cursiefen, Rebekka Beulen, Katharina Hollmann, Martin Lehmann, Philipp Burkard, Johannes Roth, Klaus Schughart, Luisa Klotz, Jan Rossaint, Patrick Meybohm, Nana-Maria Wagner","doi":"10.1186/s13054-025-05599-x","DOIUrl":"https://doi.org/10.1186/s13054-025-05599-x","url":null,"abstract":"Systemic inflammation is a critical clinical condition regularly observed in the context of surgery-induced trauma or infection. Systemic inflammation induces an ubiquitous activation of the vasculature and vascular dysfunction related to organ damage and adverse outcomes. The dipeptidyl peptidase-4 (DPP4) modulates the receptor preferences and activity of a multitude of humoral substrates mediating the systemic inflammatory response. We here determined whether DPP4 inhibition is a means to beneficially modulate systemic inflammatory responses affecting vascular and organ integrity. In cardiac surgery patients medicated with DPP4 inhibitors, we used a systems biology approach for in-depth characterization of the perioperative immune response and assessment of macro- and microvascular dynamics compared to control patients. In parallel, we mechanistically evaluated the efficacy of DPP4 inhibition on modulating immune responses, capillary leakage, vasoplegia and endothelial transcriptomic profiles in mice with severe systemic inflammation. Preoperative oral intake of the DPP4 inhibitor sitagliptin modulated innate and adaptive immune phenotypes and was associated with augmented microvascluar integrity, reduced vasoplegia and improved clinical parameters of capillary leakage in patients undergoing cardiac surgery. In mice, DPP4 inhibition curbed the inflammatory response to a polymicrobial sepsis resulting in a massive reduction in endothelial gene activation assoicated with preserved vascular barrier function, augmented vasopressor responses and organ integrity. We conclude that DPP4 inhibition may be a safe and potent means to curb immune responses to surgery or infection, resulting in a preservation of vascular integrity that translates into organ protection and improved clinical outcomes. https://www.clinicaltrials.gov ; Unique identifier: NCT05725798, study start: 2022-02-01. ","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"37 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144851311","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":"Clinical features and outcomes of peripartum obstetric patients admitted to the intensive care unit: A nationwide inpatient database in Japan","authors":"Satoshi Naruse, Mikio Nakajima, Yoshitaka Aoki, Daisuke Shigemi, Kyosuke Kamijo, Richard H. Kaszynski, Hiroyuki Ohbe, Yusuke Sasabuchi, Shotaro Aso, Hiroki Matsui, Kiyohide Fushimi, Yoshiki Nakajima, Hideo Yasunaga","doi":"10.1186/s13054-025-05597-z","DOIUrl":"https://doi.org/10.1186/s13054-025-05597-z","url":null,"abstract":"Pregnant and postpartum women face an increasing risk of severe complications due to pathophysiological changes, advanced maternal age, obesity, and reproductive technologies. Globally, maternal mortality remains a critical concern, with numerous critically ill obstetric patients requiring intensive care each year. However, comprehensive nationwide data on obstetric intensive care unit (ICU) admissions in Japan remain scarce. This study aimed to provide a detailed analysis of the clinical characteristics, causes of ICU admission, interventions, and outcomes of obstetric patients in Japan using a large, nationwide inpatient database. This retrospective observational study utilized the Japanese Diagnosis Procedure Combination inpatient database, which encompasses more than 90% of tertiary emergency hospitals, covering the period from July 2010 to March 2022. We included patients who were admitted to the ICU and delivered either during hospitalization or within one week before hospital admission. Patient demographics, comorbidities, causes of ICU admission, interventions, and clinical outcomes (e.g., in-hospital mortality) were analyzed. Comparative analyses were conducted between survivors and non-survivors to identify key differences in clinical presentation and outcomes. A total of 8,184 obstetric patients from 195 institutions were admitted to ICUs during the study period. The median age was 34 years (interquartile range, 30–38), and 53.2% underwent cesarean delivery. Hemorrhage was the most common cause of ICU admission (52.6%), followed by hypertensive disorders of pregnancy (16.7%). Major interventions included blood transfusions in 71.5% of patients, mechanical ventilation in 28.0%, and transcatheter arterial embolization in 18.0%. Overall in-hospital mortality was 1.1%. Compared with survivors, non-survivors had a lower proportion of hemorrhage-related cases but exhibited a higher prevalence of amniotic fluid embolism, cardiovascular and cerebrovascular disease, infection, pulmonary disease, trauma, and suicide. This nationwide study highlights hemorrhage as the primary cause of obstetric ICU admissions in Japan, with an all cause in-hospital mortality of 1.1%. These findings highlight the need for targeted interventions to enhance maternal care, optimize ICU resource allocation, and improve outcomes among critically ill obstetric patients. This was a retrospective observational study and was not registered prospectively as trial registration is not applicable to this type of study. ","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"12 1","pages":"358"},"PeriodicalIF":15.1,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144851438","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}