Critical Care最新文献

{"title":"Lower limits of CRRT dose-intensity: what does the evidence support?","authors":"Nuttha Lumlertgul, Sean M Bagshaw","doi":"10.1186/s13054-026-06352-8","DOIUrl":"10.1186/s13054-026-06352-8","url":null,"abstract":"","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"30 1","pages":""},"PeriodicalIF":11.4,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13617841/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149073772","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":"Fluid-intolerance signals as bedside safety limits during early septic shock resuscitation: a multicenter randomized trial","authors":"Paulo Melo,Macarena Amthauer,Giorgio Ferri,Roberto Contreras,Juan Pablo Valdivia,César Santis,Vanessa Oviedo,Sofía Valenzuela,Sebastian Morales,Matías Olmos,Roque Basoalto,Carolina S. Goic,Henrique Mendes,Rafael Hortêncio Melo,Philippe Rola,Ross Prager,John Basmaji,Pedro D. Wendel-Garcia,Ricardo Castro,Glenn Hernandez,Eduardo Kattan","doi":"10.1186/s13054-026-06316-y","DOIUrl":"https://doi.org/10.1186/s13054-026-06316-y","url":null,"abstract":"","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"30 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149049113","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":"Palliative and end-of-life care on the battlefield: a scoping review","authors":"C. Matray,O. Duranteau,A. Bercal,P. Hebrard de Veyrinas,M. David,P. Pasquier,F. Gzil,A. Lamblin","doi":"10.1186/s13054-026-06359-1","DOIUrl":"https://doi.org/10.1186/s13054-026-06359-1","url":null,"abstract":"Abstract Background Modern conflicts have brought about a paradigm shift in military medicine. In Prolonged Field Care, recommendations have so far focused on damage control and care aimed at ensuring survival. But, particularly in large scale combat operation, not all patients will survive, and despite the development of palliative care in the civilian sector, no extension of this approach has yet been envisaged for military medicine. This review aims to identify knowledge gaps in palliative and supportive care in combat situations. Methods We conducted a literature review in PubMed, CAIRN, Scopus and Embase, with the last search carried out on 31 December 2025, using triangulation at each stage of the screening process. Studies published since 1900 focusing on frontline palliative and end-of-life care for combatants were included. Results Of 3,629 unique records, 35 articles were included, ranging from World War II-era accounts to current prolonged field care guidelines. Pain management was the most extensively documented topic. Morphine, a historical mainstay, has been increasingly supplemented by oral transmucosal fentanyl citrate and ketamine. Ketamine was favored in austere settings for its hemodynamic stability and multi-route administration. Other analgesics, such as paracetamol and NSAIDs, were also briefly described. Regional anesthesia was recognized as an analgesic force multiplier, though never described in an explicitly palliative context. For expectant and dying casualties, a limited but consistent body of literature addressed opioid titration and palliative sedation, notably via continuous midazolam infusion. Diverse end-of-life-related symptoms were addressed, including nausea, dyspnea, secretions, and delirium. Non-pharmacological measures, such as thermal regulation, mouth care, disarming, and comfort items, were described as accessible across provider levels. Spiritual care and family communication, though addressed in few sources, emerged as important but under-formalized components. Overall, evidence specific to palliative and end-of-life battlefield care remains sparse and largely extrapolated from curative-care literature. Conclusion Pain management in combat is a well-researched field, but one that is rarely examined in the specific context of end-of-life care. Similarly, there is a notable gap in the literature regarding palliative care in a combat context. Where such topics are addressed, they are often simply a transposition of civilian data. The lack of training and doctrinal guidance prevents the proper integration of this specialized care, which aims to ensure dignity for dying combatants and to reflect the values upon which military medicine is founded. Clinical trial number The protocol was pre-registered on the Open Science Framework (OSF) on 8 December 2025 (DOI: 10.17605/OSF.IO/U9RSG). Take-home message As future conflicts threaten to bring mass casualties on a scale that counterinsurgency warfare never approac","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"106 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149049114","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":"Increased ureagenesis revealing metabolic intolerance to enhanced nutrition in the PICU: a secondary analysis of the PEPaNIC RCT","authors":"Ilse Vanhorebeek,Nazlı Umman Serin,Sascha C. A. T. Verbruggen,Koen F. M. Joosten,Greet Van den Berghe,Jan Gunst","doi":"10.1186/s13054-026-06345-7","DOIUrl":"https://doi.org/10.1186/s13054-026-06345-7","url":null,"abstract":"","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"94 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149049116","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":"Reply to: Organ donation after ECPR: ethical challenges and clinical implications","authors":"Sasa Rajsic,Eduard Argudo,Sylvia Maria Belda Hofheinz,María Martínez Martínez,Ana Delgado,Marta Velia Antonini,Jonah Rubin,Robert Breitkopf","doi":"10.1186/s13054-026-06349-3","DOIUrl":"https://doi.org/10.1186/s13054-026-06349-3","url":null,"abstract":"","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"12 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149049117","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":"Transpulmonary pressures and EIT-derived alveolar collapse and overdistension in ARDS: association and comparison of two PEEP titration strategies","authors":"Clément Brault,Yoann Zerbib,Romain Vallee,Rosalie Schoux,Alexis Lambour,Benjamin Swinyard,Valentin Dambrine,Julien Demaiter,Loay Kontar,Julien Maizel,Michel Slama","doi":"10.1186/s13054-026-06356-4","DOIUrl":"https://doi.org/10.1186/s13054-026-06356-4","url":null,"abstract":"","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"19 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149049118","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":"Reply to: \"From derived signals to clinical stratification: interpreting EIT pulsatility in pulmonary embolism\".","authors":"Shaofei Xu, Jiazheng Li, Ziqi Li, Yuxuan Cai, Junlai Zhao, Rongrong Zhu, Maokun Li, Weiwei Wu","doi":"10.1186/s13054-026-06343-9","DOIUrl":"10.1186/s13054-026-06343-9","url":null,"abstract":"","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"30 1","pages":""},"PeriodicalIF":11.4,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13602698/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149036802","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":"Dosing of anti-infective drugs in patients undergoing therapeutic plasma exchange - considerations for practical application: a narrative review.","authors":"Maj-Britt Nachtigall, J J Schmidt, S Scherneck, J Flechtner, S David, J T Kielstein","doi":"10.1186/s13054-026-06306-0","DOIUrl":"10.1186/s13054-026-06306-0","url":null,"abstract":"<p><strong>Background: </strong>Therapeutic plasma exchange (TPE) is used in a wide range of indications and patient populations. The current guidelines of the American Society for Apheresis on the use of therapeutic apheresis in clinical practice list 166 graded indications for TPE. Many indications are related to the treatment of critically ill patients. Indeed, two multicenter trials are currently investigating the role of TPE in the treatment of early septic shock.</p><p><strong>Main body: </strong>During TPE, usually 1.0-1.5 times the calculated plasma volume is exchanged using albumin solution or fresh frozen plasma as replacement fluid, although considerable deviations from this recommended exchange volume have been reported. Depending on the TPE modality (membrane-based or centrifugal), the duration of the procedure ranges between 90 and 140 min. TPE removes not only unwanted substances such as inflammatory mediators or pathological antibodies but may also remove drugs that are essential for the treatment of the underlying disease. Furthermore, changes in plasma protein concentrations due to TPE may affect the volume of distribution (Vd) and the concentrations of protein-bound drugs. The objective of the current narrative review is to introduce general principles of TPE-associated drug removal as well as the current literature on the dosing of anti-infectives in patients undergoing TPE.</p><p><strong>Conclusion: </strong>Pharmacokinetic characteristics, including volume of distribution, plasma protein binding, endogenous clearance, and redistribution kinetics, have been demonstrated to influence the susceptibility of a drug to TPE-associated removal. TPE may substantially affect plasma levels of drugs with low volume of distribution and high protein binding, including aminoglycosides and glycopeptides. Further studies are needed because direct evidence on the pharmacokinetics of anti-infective drugs undergoing TPE in sepsis remains limited. Specific timing or dosing strategies are therefore not supported by sufficient evidence and should be individualized according to drug-specific pharmacokinetics, TPE characteristics, and clinical situation.</p>","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"30 1","pages":""},"PeriodicalIF":11.4,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13613798/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149036816","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":"Eligibility criteria in sepsis-associated AKI trials preferentially exclude patients at risk to develop adverse kidney outcomes","authors":"Kevin Vanneck Kamdem,Fanny Vardon,Stein Silva,Stanislas Faguer","doi":"10.1186/s13054-026-06348-4","DOIUrl":"https://doi.org/10.1186/s13054-026-06348-4","url":null,"abstract":"","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"1 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149020711","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":"Beyond macrocirculatory targets: a multimodal framework for microcirculatory and organ perfusion monitoring in sepsis","authors":"Xuebin Yin,Haowen Guan,Ming Zhou,Lisha Fan,Qiuxia Liu,Ruping Zhou,Gefan Wu,Man Chen,Wei Fang","doi":"10.1186/s13054-026-06353-7","DOIUrl":"https://doi.org/10.1186/s13054-026-06353-7","url":null,"abstract":"","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"2 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149020710","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}