Current Opinion in Critical Care最新文献

Patient-ventilator asynchronies beyond the waveform. 患者-呼吸机不同步超出波形。

IF 3.8 3区医学

Current Opinion in Critical Care Pub Date : 2026-10-12 DOI: 10.1097/MCC.0000000000001446

Candelaria de Haro, Eduardo Mireles-Cabodevila, Gerard Castells-Tortosa, Leonardo Sarlabous, Lluís Blanch

{"title":"Patient-ventilator asynchronies beyond the waveform.","authors":"Candelaria de Haro, Eduardo Mireles-Cabodevila, Gerard Castells-Tortosa, Leonardo Sarlabous, Lluís Blanch","doi":"10.1097/MCC.0000000000001446","DOIUrl":"https://doi.org/10.1097/MCC.0000000000001446","url":null,"abstract":"Purpose of review: Patient-ventilator asynchrony is commonly treated as a technical mismatch requiring correction, although asynchronous breaths are not uniformly harmful and apparent synchrony may conceal injurious effort. This review summarizes evidence from the past 18 months that redefines asynchrony through inspiratory effort, the transition to assisted breathing, and continuous waveform monitoring.Recent findings: Potential harm depends on effort magnitude and timing, breath stacking, ventilatory mode, lung and diaphragm vulnerability, dyspnea, and cumulative exposure. Double triggering, reverse triggering, and ineffective efforts may indicate injury, overassistance, or recovery depending on context. During transition, work shifts from ventilator to patient, exposing patients to both excessive and insufficient effort. Continuous analysis can identify burden, clustering, and physiological trajectories missed by intermittent inspection. Artificial-intelligence models increasingly estimate effort and dynamic driving pressure, but heterogeneous definitions, limited external validation, artifacts, and uncertain actionability constrain implementation.Summary: Management should move beyond eliminating individual events toward minimizing time outside individualized ranges of acceptable effort and assistance. Monitoring should integrate waveforms with effort, lung stress, diaphragm loading, dyspnea, ventilator settings, and temporal context. Artificial intelligence should support bedside reassessment rather than autonomous adjustment. Multicenter validation and physiology-guided trials must establish whether this approach improves patient-centered outcomes.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Lung protection in acute respiratory distress syndrome: moving from protective ventilation to precision respiratory support. 急性呼吸窘迫综合征的肺保护：从保护性通气到精确呼吸支持。

IF 3.8 3区医学

Current Opinion in Critical Care Pub Date : 2026-10-09 DOI: 10.1097/MCC.0000000000001447

Raffaele Merola, Denise Battaglini, Patricia R M Rocco

{"title":"Lung protection in acute respiratory distress syndrome: moving from protective ventilation to precision respiratory support.","authors":"Raffaele Merola, Denise Battaglini, Patricia R M Rocco","doi":"10.1097/MCC.0000000000001447","DOIUrl":"10.1097/MCC.0000000000001447","url":null,"abstract":"Purpose of review: Lung-protective ventilation focuses on limiting tidal volume and airway pressure to prevent ventilator-induced lung injury (VILI) in acute respiratory distress syndrome (ARDS). Nevertheless, patients exposed to similar ventilatory strategies often develop markedly different degrees of lung injury, indicating that conventional ventilatory targets alone do not fully account for VILI development. This review examines the evolving concept of lung protection, emphasizing load distribution, regional lung mechanics, respiratory effort, and host susceptibility.Recent findings: Mechanical ventilation delivers energy to a structurally heterogeneous lung, where the biological consequences of a given mechanical load depend not only on its magnitude but also on its regional distribution, patient-generated respiratory effort, and host susceptibility. Recent advances in physiological monitoring, bedside imaging, and computational modelling now allow these interactions to be assessed directly at the bedside, enabling physiology-guided ventilatory strategies.Summary: Conventional protective ventilatory targets remain the foundation of lung protection but do not fully explain why some lungs tolerate mechanical ventilation better than others. Effective ventilatory support requires ongoing adaptation to the evolving mechanical, physiological, and biological characteristics of the injured lung.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149126932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Severe infections in the ICU - a continuing and escalating challenge. 重症监护病房的严重感染——一个持续不断的挑战。

IF 3.8 3区医学

Current Opinion in Critical Care Pub Date : 2026-10-01 Epub Date: 2026-09-04 DOI: 10.1097/MCC.0000000000001405

Marin H Kollef

引用次数: 0

Optimizing the use of critical care echocardiography: from point-of-care tool to monitoring modality. 优化重症监护超声心动图的使用：从护理点工具到监测方式。

IF 3.8 3区医学

Current Opinion in Critical Care Pub Date : 2026-10-01 Epub Date: 2026-08-12 DOI: 10.1097/MCC.0000000000001423

Wincy Ng, Martin Balik, Michelle S Chew

{"title":"Optimizing the use of critical care echocardiography: from point-of-care tool to monitoring modality.","authors":"Wincy Ng, Martin Balik, Michelle S Chew","doi":"10.1097/MCC.0000000000001423","DOIUrl":"10.1097/MCC.0000000000001423","url":null,"abstract":"Purpose of review: To summarize latest evidence on the use of critical care echocardiography for haemodynamic management of the critically ill patient.Recent findings: Echocardiography is now considered a cornerstone for hemodynamic management and is recommended by recent guidelines. Its ability to quickly assess undifferentiated shock helps clinicians in diagnosis and immediate management. In stabilizing and optimizing treatment of the shocked patient, serial echocardiography guides fluid, vasopressor, and inotrope therapy while allowing detailed assessment of cardiac structure and function. Echocardiography may be used to assess fluid-responsiveness and myocardial function, conversely, echocardiography and ultrasonography can identify patients who are at risk of harm induced by fluid overload, mechanical ventilation and inotropes, allowing further refinement of therapeutic strategies. When continuous cardiac output monitoring or advanced haemodynamic data are required, echocardiography should be complemented with continuous haemodynamic monitoring rather than used alone.Summary: We provide a framework for the optimal use of critical care echocardiography, from a point-of-care tool to a sophisticated hemodynamic monitor.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":"545-563"},"PeriodicalIF":3.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148860448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Invasive mold infections in intensive care in hematological patients. 血液病患者重症监护中的侵袭性霉菌感染。

IF 3.8 3区医学

Current Opinion in Critical Care Pub Date : 2026-10-01 Epub Date: 2026-08-05 DOI: 10.1097/MCC.0000000000001414

Luana Fianchi, Martina Quattrone, Livio Pagano

{"title":"Invasive mold infections in intensive care in hematological patients.","authors":"Luana Fianchi, Martina Quattrone, Livio Pagano","doi":"10.1097/MCC.0000000000001414","DOIUrl":"10.1097/MCC.0000000000001414","url":null,"abstract":"Purpose of review: Invasive mold infections (IMIs) remain a major cause of morbidity and mortality in patients with hematological malignancies, particularly when critical illness develops. Advances in hematological therapies and intensive care medicine have increased the number of high-risk patients admitted to intensive care units (ICUs), where invasive aspergillosis and other mold infections represent important causes of acute respiratory failure and sepsis. This review summarizes current knowledge on IMIs in critically ill hematological patients, focusing on epidemiology, diagnosis, and management.Recent findings: The epidemiology of IMIs is evolving, with increasing recognition of non-Aspergillus molds, including Mucorales , Fusarium , Scedosporium , and Lomentospora species. Diagnosis in the ICU remains challenging because clinical and radiological findings are often nonspecific and conventional diagnostic criteria may be difficult to apply. Recent advances in imaging, fungal biomarkers, and molecular techniques have improved early detection, while new antifungal agents are expanding therapeutic options.Summary: IMIs continue to be associated with high mortality in critically ill patients with hematological malignancies. Early diagnosis, prompt initiation of appropriate antifungal therapy, and multidisciplinary management are essential to improve outcomes. Future efforts should focus on ICU-specific diagnostic strategies, risk stratification, and the integration of emerging antifungal therapies.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":"452-459"},"PeriodicalIF":3.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148697173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Why a new Sequential Organ Failure Assessment score: rationale and development of Sequential Organ Failure Assessment-2. 为什么一个新的序贯器官衰竭评估评分：序贯器官衰竭评估的原理和发展-2。

IF 3.8 3区医学

Current Opinion in Critical Care Pub Date : 2026-10-01 Epub Date: 2026-09-04 DOI: 10.1097/MCC.0000000000001417

Rui Moreno, Andrew Rhodes

{"title":"Why a new Sequential Organ Failure Assessment score: rationale and development of Sequential Organ Failure Assessment-2.","authors":"Rui Moreno, Andrew Rhodes","doi":"10.1097/MCC.0000000000001417","DOIUrl":"https://doi.org/10.1097/MCC.0000000000001417","url":null,"abstract":"Purpose of review: For three decades, the Sequential Organ Failure Assessment (SOFA) score has been central to critical care, offering a simple, reproducible measure of organ dysfunction. Since the original score [Sequential Organ Failure Assessment-1 (SOFA-1)] [1], advances in organ support, drugs, and monitoring, and an ageing, comorbid population have reshaped practice and rendered several tools outdated. This prompted an international initiative to modernize SOFA while preserving its core strengths: simplicity, reproducibility, feasibility across diverse settings, and longitudinal assessment of organ dysfunction.Recent findings: SOFA-2 was developed through a modified Delphi process with 60 international experts and dedicated methodology and validation committees. Expert consensus, systematic reviews, and analyses of multinational databases (high-income, middle-income, and lower-middle-income systems) established its face, content, and predictive validity. The six original organ systems were retained; the gastrointestinal and immune domains were examined but not included because current datasets did not support them. SOFA-2 keeps the architecture of SOFA-1 while updating definitions, reflecting contemporary therapies, and standardizing missing-data handling and the scoring of acute-on-chronic dysfunction.Summary: SOFA-2 is an evolution rather than a reinvention. It must now be tested in the real-world - within definitions such as Sepsis-3, across its derived variables (admission, maximum, delta, discharge), and in varied settings, including low-income and middle-income countries.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":"32 5","pages":"500-505"},"PeriodicalIF":3.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148896706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Providing appropriate response-contingent phase-specific nutrition therapy in critical illness. 在危重疾病中提供适当的反应阶段特异性营养治疗。

IF 3.8 3区医学

Current Opinion in Critical Care Pub Date : 2026-10-01 Epub Date: 2026-08-05 DOI: 10.1097/MCC.0000000000001419

Stephen A McClave, Robert G Martindale, Jayshil J Patel

{"title":"Providing appropriate response-contingent phase-specific nutrition therapy in critical illness.","authors":"Stephen A McClave, Robert G Martindale, Jayshil J Patel","doi":"10.1097/MCC.0000000000001419","DOIUrl":"10.1097/MCC.0000000000001419","url":null,"abstract":"Purpose of review: The pathogenesis of critical illness drives a dynamic cascade of clinical, metabolic, and immunologic abnormalities through the course of disease. Recent randomized trials show that early full-dose feeding for critically ill patients is ineffective and potentially harmful compared to trophic feeding. The aim of this review is to propose a response-contingent phase-specific strategy of nutrition therapy appropriate for this patient population.Recent findings: Barriers to delivering effective nutritional therapy exist, ranging from bioenergetic failure related to mitochondrial dysfunction and gastrointestinal dysmotility with feeding intolerance, to microbial dysbiosis and impaired substrate utilization characterized by inefficient energy production and futile substrate cycling. Emerging concepts are helping to design more appropriate regimens, including estimation of potential benefit from nutritional therapy based on disease severity, risk of net harm, and determination of the stage of enteral nutrition responsiveness, which can be conceptualized as the capacity for achieving phase-specific goals within the constraints of physiologic state, metabolic capacity, safety, and feasibility.Summary: Calibrating goals, dosage, monitoring strategies, and expectations from nutritional therapy is required to overcome barriers imposed by the underlying pathophysiology and to optimize support, as these complex patients transition through the acute phase of critical illness towards recovery and rehabilitation.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":"536-544"},"PeriodicalIF":3.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148697207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Pharmacological treatment of cardiogenic shock. 心源性休克的药物治疗。

IF 3.8 3区医学

Current Opinion in Critical Care Pub Date : 2026-10-01 Epub Date: 2026-06-03 DOI: 10.1097/MCC.0000000000001393

Bruno Levy, Thomas Klein

{"title":"Pharmacological treatment of cardiogenic shock.","authors":"Bruno Levy, Thomas Klein","doi":"10.1097/MCC.0000000000001393","DOIUrl":"10.1097/MCC.0000000000001393","url":null,"abstract":"Purpose of review: Cardiogenic shock remains associated with high mortality despite advances in revascularization and mechanical circulatory support. Pharmacological management, primarily based on vasopressors and inotropes is essential to restore perfusion but remains poorly standardized. This review summarizes recent advances and evolving concepts in the pharmacological treatment of cardiogenic shock, including the transition toward early heart failure therapies.Recent findings: Norepinephrine is consistently recommended as the first-line vasopressor due to its favorable hemodynamic profile and lower arrhythmic risk compared with dopamine. Increasing evidence suggests that epinephrine may be associated with adverse metabolic and clinical effects, including higher rates of refractory shock. Dobutamine remains the most commonly used inotrope, although no clear superiority has been demonstrated over alternative agents such as milrinone or levosimendan. Strategies aimed at reducing catecholamine exposure, including the use of nonadrenergic agents such as vasopressin and early mechanical circulatory support, are gaining interest. In parallel, recent studies suggest that early initiation of guideline-directed heart failure therapies during stabilization may improve long-term outcomes.Summary: Pharmacological management of cardiogenic shock should balance restoration of perfusion and minimization of drug-related toxicity. A continuum approach integrating acute hemodynamic support with early disease-modifying therapy may represent a key strategy to improve outcomes in this high-risk population.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":"521-527"},"PeriodicalIF":3.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148216765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Multinational collaborations in critical care research: feasible and useful? 重症监护研究中的跨国合作：可行和有用？

IF 3.8 3区医学

Current Opinion in Critical Care Pub Date : 2026-10-01 Epub Date: 2026-06-20 DOI: 10.1097/MCC.0000000000001406

Jorge I F Salluh, Luigi Pisani, Giulliana M Moralez, Sheila N Myatra

{"title":"Multinational collaborations in critical care research: feasible and useful?","authors":"Jorge I F Salluh, Luigi Pisani, Giulliana M Moralez, Sheila N Myatra","doi":"10.1097/MCC.0000000000001406","DOIUrl":"10.1097/MCC.0000000000001406","url":null,"abstract":"Purpose of review: Multinational collaborative research has become indispensable for generating evidence capable of informing critical care practice across diverse healthcare systems. This review examines the current landscape of multinational research models including registry-based studies, society-led networks, and south-south collaborations, and evaluates the evidence on their feasibility, scientific value, and emerging methodological innovations.Recent findings: National and multinational ICU registries underpin a growing number of observational studies, adaptive platform trials, and quasi-experimental research. Federated analysis and target trial emulation have emerged as particularly promising approaches for leveraging existing registry data while respecting data governance constraints, with the SOFA-2 development using data from 3.34 million patients across nine countries exemplifying what multinational federated methodology can achieve. Scientific societies and regional networks have driven several landmark studies including REMAP-CAP, WEAN SAFE, LUNG SAFE, CENTER-TBI and the ISCCM ResearchNet, which have demonstrated the feasibility of cost-effective, large-scale international collaborations. South-south collaborations are increasing and are fundamental to advancing equity in evidence generation, mitigating the systematic underrepresentation of low- and middle-income country (LMIC) populations in critical care research.Summary: Multinational collaboration is currently a major source of scientific evidence. The infrastructure, methods, and networks have evolved and are able to support research that is simultaneously rigorous, representative, and relevant across healthcare systems. Sustained investment in interoperable registries, equitable partnerships, and capacity-building will determine whether this momentum translates into improvements in critical care outcomes globally.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":"506-515"},"PeriodicalIF":3.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148276388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Generative artificial intelligence for outcome prediction in critical care: the future is now? 用于重症监护结果预测的生成式人工智能：未来就是现在？

IF 3.8 3区医学

Current Opinion in Critical Care Pub Date : 2026-10-01 Epub Date: 2026-06-25 DOI: 10.1097/MCC.0000000000001408

Jessica D Workum, Christian Jung, Michael Beil

{"title":"Generative artificial intelligence for outcome prediction in critical care: the future is now?","authors":"Jessica D Workum, Christian Jung, Michael Beil","doi":"10.1097/MCC.0000000000001408","DOIUrl":"10.1097/MCC.0000000000001408","url":null,"abstract":"Purpose of review: Artificial intelligence (AI) is expected to transform critical care in fundamental ways. The last generation of AI, i.e. generative AI, provides new capabilities to process and generate sequences of data points, such past clinical events, to forecast outcome trajectories. This technology has evolved rapidly in the past year and shown the potential to improve outcome prediction.Recent findings: The number of publications in this field is still limited indicating major challenges. There are two approaches to use generative AI to predict outcomes - text- and event-based. Whereas large language models (LLM) were deployed to process clinical notes and produce text, generative trajectory models (GTM) analyze sequences of discrete events, such as diagnoses or test results, to predict outcome events. LLM have to extract information from text which may vary substantially in content, granularity and style and, thus, struggle with reliable forecasts. GTM appear to perform significantly better, notably when trained at scale with diverse datasets from various healthcare systems.Summary: Generative AI may shift prognostication in critical care from static risk scoring to models that sequentially simulate \"what happens next,\" but the current evidence remains preliminary and does not yet justify incorporation into bedside clinical decision-making.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":"516-520"},"PeriodicalIF":3.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148327399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0