Current Opinion in Critical Care最新文献

{"title":"The impact of age, prior health status, and frailty on outcome prediction in critical care.","authors":"Hans Flaatten, Michael Beil, Bertrand Guidet","doi":"10.1097/MCC.0000000000001407","DOIUrl":"10.1097/MCC.0000000000001407","url":null,"abstract":"<p><strong>Purpose of review: </strong>We highlight publications from the year 2025 that examined the contribution of age, frailty, and chronic conditions to outcomes in ICU patients aged 80 years and older. Traditional prediction models are less precise in this population, partly due to the limited inclusion of very old patients in risk prediction tools such as SAPS and APACHE, as well as the absence of geriatric-specific variables in these models.</p><p><strong>Recent findings: </strong>Beyond chronological age, the most important variables associated with survival in this group are general health factors, including frailty and the presence of chronic diseases (multimorbidity). This review discusses studies published over the past year that focus on the impact of these conditions in ICU patients aged over 80 years. There is also a growing focus on nonagenarians, with emerging evidence supporting ICU admission in selected patients within this age group. An important subgroup comprises patients with cognitive impairment. While cognitive outcomes are well described in ICU survivors, less is known about the impact of pre-ICU cognitive decline on outcome.</p><p><strong>Summary: </strong>Findings from these studies confirm increased mortality in this population. However, greater emphasis should be placed on functional outcomes, as well as on the \"second victims\"-family members and caregivers.</p>","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":"469-473"},"PeriodicalIF":3.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148497135","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}

{"title":"Individualizing post-ICU nutrition: from guideline intent to bedside practice.","authors":"Oona Leemans, Zenzi Rosseel, Claude Pichard, Dan Waitzberg, Lee-Anne S Chapple, Krista Haines, Lu Ke, Paul Wischmeyer, Arthur R H van Zanten, Elisabeth De Waele","doi":"10.1097/MCC.0000000000001412","DOIUrl":"10.1097/MCC.0000000000001412","url":null,"abstract":"<p><strong>Purpose of review: </strong>Survivorship of critical illness has increased, shifting attention toward recovery and long-term outcomes. Post-ICU nutrition is emerging as a clinically relevant, yet underperforming contributor to functional recovery and quality of life. Persistent nutritional inadequacy reflects insufficiently defined physiological requirements and limited implementable evidence-based guidance during ICU recovery.</p><p><strong>Recent findings: </strong>Energy and protein delivery sharply decline after ICU discharge, despite persistent metabolic demands. Underfeeding can result from the absence of recovery-specific targets, patient-level barriers (e.g. appetite loss, dysphagia, fatigue), and fragmented care transitions, including premature feeding-tube removal and suboptimal monitoring of oral intake. Structured patient and family engagement can help operationalize individualized nutritional strategies and improve feasibility without substantial resource burden, acting as continuity agents.</p><p><strong>Summary: </strong>Post-ICU nutritional failure reflects combined physiological and implementation challenges. Clinicians should recognize the post-ICU hospitalization period as a potential 'metabolic danger zone', requiring a shift from acute-phase restrictive feeding toward strategies prioritizing functional recovery and lean mass preservation. Improving outcomes requires standardized, yet adaptable, care pathways that bridge ICU-to-ward transitions, operationalize individualization, and integrate patient and family input as clinical instruments. Future research should prioritize multicenter implementation studies centered on 'disability-free survival' to inform adaptive, evidence-based nutritional protocols.</p>","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":"528-535"},"PeriodicalIF":3.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148560972","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}

{"title":"Predicting or describing outcomes: competitive or complementary.","authors":"Rui Moreno","doi":"10.1097/MCC.0000000000001418","DOIUrl":"https://doi.org/10.1097/MCC.0000000000001418","url":null,"abstract":"","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":"32 5","pages":"467-468"},"PeriodicalIF":3.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148896696","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}

{"title":"Predicting, describing, or measuring? How to align model purpose with validity and applicability in critical care outcome research.","authors":"Alexander Tracy, Aasiyah Rashan, Otavio Ranzani","doi":"10.1097/MCC.0000000000001415","DOIUrl":"10.1097/MCC.0000000000001415","url":null,"abstract":"<p><strong>Purpose of review: </strong>Clinical models are commonly applied in critical care for both descriptive and predictive purposes. However, methodological rigour is often lacking in their development and validation. This review examines the principles underlying the multiple domains of model validity. We argue that a clear model purpose and theoretical framework are essential preconditions for validity.</p><p><strong>Recent findings: </strong>Recently developed descriptive and predictive models illustrate different approaches to promoting validity. In developing SOFA-2, eCARTv5, Sepsis-3 and the PHOENIX paediatric sepsis criteria, authors used combinations of expert-driven consensus, data-driven derivation and iterative refinement. These examples demonstrate that validity requires a process of repeated evaluation across distinct populations, settings and time periods.</p><p><strong>Summary: </strong>The best approach to establishing validity combines a clear theoretical framework, structured expert consensus (including Delphi methodology), rigorous statistical evaluation (discrimination, calibration, net benefit) and prospective external validation. The distinction between models designed to predict outcomes and those designed to describe or quantify organ dysfunction is fundamental and should guide development and validation strategy from the outset.</p>","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":"474-483"},"PeriodicalIF":3.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148561000","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}

{"title":"Advanced hemodynamic monitoring of the patient with acute heart failure and cardiogenic shock.","authors":"Antonio Messina, Mathieu Jozwiak, Xavier Monnet","doi":"10.1097/MCC.0000000000001420","DOIUrl":"https://doi.org/10.1097/MCC.0000000000001420","url":null,"abstract":"<p><strong>Purpose of review: </strong>To provide a practical, physiology-driven framework for advanced hemodynamic monitoring in patients with acute heart failure (AHF) and cardiogenic shock, highlighting and supporting clinicians in integrating monitoring tools into an individualized bedside approach.</p><p><strong>Recent findings: </strong>Cardiogenic shock is increasingly recognized as a heterogeneous syndrome involving not only impaired cardiac output, but also systemic inflammation, vasoplegia, tissue hypoperfusion and multiorgan dysfunction. Recent studies have emphasized phenotype-based approaches for both diagnosis and treatment, integrating clinical evaluation, echocardiography, invasive hemodynamics and tissue perfusion markers. Machine learning derived phenotypes have further identified cardiorenal and cardiometabolic profiles associated with distinct prognostic implications. Critical care echocardiography has a central role for rapid diagnosis and serial reassessment, while transpulmonary thermodilution and pulmonary artery catheterization provide complementary information to echocardiography in refractory or complex cases.</p><p><strong>Summary: </strong>Hemodynamic monitoring in AHF and cardiogenic shock should rely on individualized, multimodal and dynamic integration of clinical examination, biomarkers, echocardiography and invasive monitoring. The main goals are to define the underlying phenotype, assess congestion and tissue hypoperfusion, and evaluate treatment response. Echocardiography remains the cornerstone of bedside assessment, whereas invasive monitoring should be reserved for selected high-risk patients with persistent or complex shock.</p>","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":"32 5","pages":"564-572"},"PeriodicalIF":3.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148896738","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}

{"title":"Ventilator-associated pneumonia: newer insights that can drive improved outcomes.","authors":"Andrew F Shorr, Marya D Zilberberg","doi":"10.1097/MCC.0000000000001390","DOIUrl":"10.1097/MCC.0000000000001390","url":null,"abstract":"<p><strong>Purpose of review: </strong>Ventilator-associated pneumonia (VAP) results in substantial morbidity and results in high crude mortality rates. Many recent studies address multiple aspects of VAP ranging from its evolving epidemiology and microbiology to novel means for prevention and treatment.</p><p><strong>Recent findings: </strong>The true incidence of VAP remains difficult to assess given definitional issues, which confound accurate diagnostic conclusions. The lack of a clear gold standard for identifying VAP makes comparisons across different studies difficult, as it remains unclear if like syndromes are actually being described. Nonetheless, VAP remains a clinical and costly challenge. Earlier discussion of achieving 'zero' VAP were clearly misplaced. Furthermore, the microbiology of VAP continues to evolve with the spread of antimicrobial resistance. New attention on the microbiome, though, may prove helpful and enhance our understanding of the pathogenesis of VAP. Simple interventions such a toothbrushing appear to successfully reduce rates of VAP and should be more broadly adopted. Rapid diagnostic tools, which are increasingly utilized to identify the causative pathogen in VAP, appear to have more limitations than previously thought. Several novel antibiotics are now available for treating multidrug-resistant organisms (MDROs) often encountered in VAP. With respect to antibiotic treatment more generally, it appears that shorter durations of therapy are well tolerated and effective, even in cases of VAP caused by MDROs.</p><p><strong>Summary: </strong>Although our knowledge and understanding of VAP continues to advance, many of the general questions of the last decade remain unresolved. We continue to lack a clear and simple means for defining VAP and have yet to identify the optimal approach for prevention. Likewise, despite the availability of newer antimicrobials, we continue to lack rapid diagnostics that can clearly be shown to improve patient-centered endpoints. The availability of newer antibiotics may allow us to more easily and safely treat MDROs, but they have not revolutionized outcomes or been shown to reduce mortality.</p>","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":"443-451"},"PeriodicalIF":3.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147986739","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}

{"title":"How to establish and run a national ICU benchmarking registry.","authors":"Jorge I F Salluh, Amanda Quintairos, Dave A Dongelmans, Tomoko Fujii","doi":"10.1097/MCC.0000000000001411","DOIUrl":"10.1097/MCC.0000000000001411","url":null,"abstract":"<p><strong>Purpose of review: </strong>National ICU benchmarking systems are critical infrastructure for evaluating and improving the quality of critical care across all settings. This review summarizes the recent literature on establishing, operating, and sustaining such systems, drawing on evidence from registries across high-income countries (HICs) and low-and-middle-income countries (LMICs).</p><p><strong>Recent findings: </strong>Recent evidence not only confirms the continued expansion of national ICU registries globally but also reveals persistent heterogeneity in data architecture and severity adjustment approaches. Key advances include the development of common data models enabling international collaboration (LOGIC consortium), the use of federated analysis for score development (SOFA-2), and the validation of simplified severity scores for resource-limited settings. Calibration drift remains universal, requiring periodic reassessment of risk-adjustment models. New methodological work highlights the impact of atypical patients and potential organ donor admissions on standardized mortality ratios. While 46% of registries support observational research, only 22% currently enable interventional studies - representing a major opportunity for the field.</p><p><strong>Summary: </strong>Establishing a national benchmarking system requires deliberate choices about data architecture, severity adjustment, governance, and feedback mechanisms. Challenges vary across the registry lifecycle, from securing initial buy-in and ensuring data quality at scale to maintaining engagement and model accuracy at maturity. The ultimate measure of a benchmarking system is not only the volume and coverage of the data but also the improvements in care it enables.</p>","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":"491-499"},"PeriodicalIF":3.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148387331","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}

{"title":"Septic shock.","authors":"Elizabeth Twichell, Lauren Sattler, Dan Reynolds","doi":"10.1097/MCC.0000000000001409","DOIUrl":"10.1097/MCC.0000000000001409","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review aims to provide a summary of recent updates in resuscitation and vasopressor strategies for septic shock, as well as advancements in precision therapy.</p><p><strong>Recent findings: </strong>Septic shock results from a dysregulated host response to infection and remains a significant cause of global morbidity and mortality. While standard care of septic shock remains protocolized due to improved outcomes with timely antibiotic and fluid administration, recent data have informed a more nuanced, individualized approach to sepsis management. Increasing evidence suggests that septic shock results from dynamic phases of immune dysregulation that may provide targets for precision therapy and data from large clinical trials have informed a complementary approach to fluid and vasopressor administration, rather than a fixed, fluid-centric approach. Results additionally suggest improved outcomes with integration of multimodal perfusion targets, as well as an individualized approach to invasive hemodynamic monitoring and endpoints of resuscitation, such as capillary refill time and mean arterial perfusion pressure targets.</p><p><strong>Summary: </strong>Recent clinical trial data have enhanced physiology-driven septic shock management and demonstrated improved outcomes. Future studies will aim to further understanding of individual sepsis phenotypes and use of precision therapies.</p>","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":"421-428"},"PeriodicalIF":3.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148497152","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}

{"title":"Recent advances and trends in critical care of neuro-infectious disease.","authors":"Jesse Crayle, Baback Arshi","doi":"10.1097/MCC.0000000000001413","DOIUrl":"10.1097/MCC.0000000000001413","url":null,"abstract":"<p><strong>Purpose of review: </strong>This manuscript provides an overview of common and uncommon central nervous system (CNS) infections seen in intensive care settings.</p><p><strong>Recent findings: </strong>Epidemiological studies have demonstrated longitudinal changes in community-acquired bacterial meningitis. Large cohorts have better informed current understanding of both brain abscess and ventriculitis. International trials have led to advancement in the treatment of cryptococcal and tuberculosis meningitis, which is continuing to be studied and optimized for specific patient sub-populations. Recent retrospective data has further defined the spectrum of viral encephalitis and the nuances of diagnostic evaluation.</p><p><strong>Summary: </strong>Neuro-infectious disease in critically ill patients presents challenges of both timely accurate diagnosis and availability of effective treatments. Vaccination-associated shifts in epidemiology coupled with enhanced identification of infectious organisms and recent international clinical trials will continue to evolve existing treatment algorithms. CNS infections in immunocompromised patient populations remain to be an active area of study.</p>","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":"460-466"},"PeriodicalIF":3.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148497122","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}

{"title":"Severe community-acquired pneumonia: a paradigm shift toward precision diagnostics, microbiology, and targeted management.","authors":"Ignacio Martin-Loeches, Marcos I Restrepo, Antoni Torres","doi":"10.1097/MCC.0000000000001410","DOIUrl":"10.1097/MCC.0000000000001410","url":null,"abstract":"<p><strong>Purpose of review: </strong>Severe community-acquired pneumonia (sCAP) remains one of the most lethal infectious syndromes in critical care, with mortality remaining persistently high despite decades of antimicrobial and supportive care advances. This review appraises recent developments in diagnostics, microbiology, and host-response biology, and advocates for a fundamental shift toward precision-driven management.</p><p><strong>Recent findings: </strong>High-resolution molecular diagnostics have exposed the true complexity of sCAP, revealing a substantial viral burden and a polymicrobial ecosystem that challenges traditional pathogen-centric models. Yet, this diagnostic revolution has failed to translate into meaningful antimicrobial stewardship, reflecting a persistent disconnect between detection and decision-making. At the same time, multiomic and transcriptomic studies have redefined sCAP as a biologically heterogeneous syndrome, characterized by divergent host-response states ranging from hyperinflammation to immune dysfunction. These insights are beginning to reshape therapy, supporting phenotype-directed immunomodulation, including selective corticosteroid use and biomarker-guided interventions such as interleukin-1 blockade. In parallel, artificial intelligence and radiomics are emerging as powerful tools capable of integrating complex, multidimensional data, although their clinical utility remains largely unrealized.</p><p><strong>Summary: </strong>sCAP should no longer be approached as a uniform infectious disease but as a spectrum of biologically distinct endotypes. The future lies in integrating pathogen detection with real-time host profiling and advanced analytics to enable truly personalized care. Without this paradigm shift, further gains in outcomes are unlikely.</p>","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":"436-442"},"PeriodicalIF":3.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148497201","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}