Current Opinion in Critical Care最新文献

{"title":"Practical implications of \"personalized nutrition therapy\".","authors":"Kyle R Stephens, Rebecca A Busch","doi":"10.1097/MCC.0000000000001287","DOIUrl":"10.1097/MCC.0000000000001287","url":null,"abstract":"<p><strong>Purpose of review: </strong>When considering \"personalized nutrition therapy,\" particularly in the intensive care unit (ICU), the default response is indirect calorimetry (IC). However, predictive equations (PEs) remain more commonly used due to cost and logistical constraints. A recent paradigm shift in how nutrition support is viewed during the early phases of critical illness has also called into question if exact energy targets are what constitutes \"personalized nutrition therapy.\" This review examines recent evidence comparing IC and PE based nutrition support in the ICU, highlighting practical issues around timing, patient selection, and nutrition adequacy and aims to redefine the focus of personalized nutrition therapy moving forward.</p><p><strong>Recent findings: </strong>Systematic reviews and meta-analyses from 2020 to 2025 yield mixed results. Some suggest that IC-guided nutrition may reduce short-term mortality; others report higher mechanical ventilation days. Studies also show IC-based protocols typically deliver more calories than PE-based methods, potentially risking overfeeding if not carefully managed. Special populations - large burn cases, patients with obesity, and older adults - can show wide discrepancies between measured vs. predicted energy expenditures.</p><p><strong>Summary: </strong>While IC can capture individual metabolic demands more accurately than PEs, especially in complex patients, logistical barriers and uncertainty about the ideal calorie target complicate its adoption. Evidence to support early use of IC in the ICU remains inconclusive. Further research into emerging patient identifiers based on phenotypic, metabolomic, or mechanistic profiles may redefine personalized critical care nutrition.</p>","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":"393-400"},"PeriodicalIF":3.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144309635","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":"Biologic rationale and evidence for high-dose hydroxocobalamin in septic shock.","authors":"Jayshil J Patel, Jason Carr, Rodney Willoughby","doi":"10.1097/MCC.0000000000001289","DOIUrl":"10.1097/MCC.0000000000001289","url":null,"abstract":"<p><strong>Purposes of review: </strong>The inflammatory response in sepsis raises circulatory levels of gaseous transmitters (gasotransmitters) nitric oxide (NO) and hydrogen sulfide (H 2 S), both of which generate and sustain septic shock. Current best practices, including early intravenous fluid, early antibiotics, and vasopressor support, do not target gasotransmitters. A single 5-g dose of intravenous hydroxocobalamin (high-dose HOC) is a safe intervention that targets circulating gasotransmitters. In this review, we provide an overview of the role of gasotransmitters in septic shock, outline the rationale for high-dose HOC in septic shock, and summarize clinical evidence for high-dose HOC in septic shock.</p><p><strong>Recent findings: </strong>NO and H 2 S are elevated early in septic shock, activate inflammatory pathways, and higher levels correlate with greater severity of illness. Preclinical evidence demonstrates high-dose HOC improves outcomes in models of septic shock by scavenging circulating NO and H 2 S. Multiple case series and a Phase IIa trial show that high-dose HOC is a safe intervention that reduces vasopressor dose in adults with septic shock. Without high-level evidence, clinicians across the United States are using high-dose HOC for adults with septic shock.</p><p><strong>Summary: </strong>High-dose HOC is a promising, nontoxic intervention that targets the pathophysiologic pathway of septic shock. Despite compelling observational and Phase IIa trial data, a pivotal phase III trial testing high-dose HOC in adults with septic shock is required before widespread use can be recommended.</p>","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":"387-392"},"PeriodicalIF":3.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144301267","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":"Microaxial flow-pump support in patients with cardiogenic shock: a review of the literature.","authors":"Tobias T Krause, Nikos Werner, Juergen Leick","doi":"10.1097/MCC.0000000000001279","DOIUrl":"10.1097/MCC.0000000000001279","url":null,"abstract":"<p><strong>Purpose of review: </strong>The purpose of this review is to summarize the current evidence in the treatment of patients with cardiogenic shock focusing on the use of microaxial flow pump (mAFP) support.</p><p><strong>Recent findings: </strong>In recent years, the use of mAFP for the treatment of patients with cardiogenic shock has increased. This review summarizes the most important studies on this topic from recent years with a focus on patients with ST-elevation myocardial infarction-related cardiogenic shock (STEMI-CS).</p><p><strong>Summary: </strong>Based on the results of a recently published randomized trial (DanGer Shock study), it is essential for clinical practice to carry out a differentiated patient selection to achieve a survival benefit. Specifically, according to the current findings, patients with STEMI-CS, intact right ventricular function, and a low probability of hypoxic brain damage appear to benefit most from treatment with mAFP. A subgroup analysis also suggests a benefit to patients younger than 77 years old.</p>","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":"464-472"},"PeriodicalIF":3.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144301269","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":"Cardiac and systemic inflammation in cardiogenic shock.","authors":"Guillaume Théry, Nadia Aissaoui, Olfa Hamzaoui","doi":"10.1097/MCC.0000000000001286","DOIUrl":"10.1097/MCC.0000000000001286","url":null,"abstract":"<p><strong>Purpose of review: </strong>The understanding of cardiogenic shock (CS) has significantly evolved over the past decades. Initially regarded as a purely mechanistic syndrome, CS is now recognized as a multifaceted condition that incorporates a complex interplay of hemodynamic compromise and a cascading inflammatory response. This review aims to describing cardiac and systemic inflammation involvement in cardiogenic shock.</p><p><strong>Recent findings: </strong>Defining subphenotypes among CS patients is mandatory as it is no longer considered as a homogeneous entity. Accordingly, including inflammatory biomarkers in a risk-stratification approach and identifying populations who will predictably respond to tailored therapies is a major concern.</p><p><strong>Summary: </strong>In this review, we propose a narrative review on cardiac and systemic inflammation occurring in CS, current research on inflammatory biomarkers and their implications in risk-stratification, and upcoming trials on therapies targeting inflammation.</p>","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":"437-443"},"PeriodicalIF":3.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144309631","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":"Impaired muscle metabolism in the ICU: interrogating the underlying pathophysiology.","authors":"Lee-Anne S Chapple, Gordon S Lynch, Olav Rooyackers","doi":"10.1097/MCC.0000000000001285","DOIUrl":"10.1097/MCC.0000000000001285","url":null,"abstract":"<p><strong>Purpose of review: </strong>Accelerated muscle wasting in critically ill patients contributes to poor recovery outcomes. Critical care guidelines recommend delivering higher protein doses; yet, increasing evidence suggests harm from higher protein doses.</p><p><strong>Recent findings: </strong>Definitive randomised controlled trials in critically ill adults have reported signals of harm from higher protein administration compared to lower protein doses or standard of care, with significant results pertaining to reduced health-related quality of life and worse outcomes in sub-groups of acute kidney injury and higher illness severity. Physiological data demonstrate anabolic resistance to dietary protein and elevated rates of protein degradation. Recent human studies propose novel mechanisms to explain these results, including inflammation, apoptosis, and deranged concentrations of vitamin D and intramuscular zinc. Preclinical models may elucidate mechanisms core to muscle wasting: 'micro muscles' cell culture systems can assess muscle loss in response to nutrient administration; and both rodent and large animal models allow for mechanistic interrogation of muscle metabolism in response to feeding.</p><p><strong>Summary: </strong>Higher protein doses alone are unlikely to attenuate muscle wasting. Understanding mechanisms for anabolic resistance and increased protein degradation, employing preclinical models, will support the development of targeted strategies to prevent muscle loss during critical illness.</p>","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":"363-369"},"PeriodicalIF":3.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144309634","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":"Gastrointestinal function and nutritional interventions in septic shock.","authors":"Kaspar F Bachmann, Antonella Cotoia, Annika Reintam Blaser","doi":"10.1097/MCC.0000000000001302","DOIUrl":"https://doi.org/10.1097/MCC.0000000000001302","url":null,"abstract":"<p><strong>Purpose of the review: </strong>Gastrointestinal (GI) dysfunction significantly impacts patient outcomes in septic shock, complicating clinical management due to its central role in systemic inflammation, barrier integrity, and nutrient assimilation. This review summarizes the evolving understanding of GI dysfunction during septic shock and provides an updated framework for clinical management.</p><p><strong>Recent findings: </strong>New insights from recent studies focus on individualized nutritional strategies over standardized calorie-driven targets, highlighting risks associated with aggressive enteral nutrition, such as exacerbation of gut ischemia and bowel distension, and microbial dysbiosis. Maintaining splanchnic perfusion, monitoring GI dysfunction with standardized tools, and advancing nutritional support progressively based on patient-specific gastrointestinal tolerance are current strategies. Novel adjunctive therapies targeting gut permeability and microbiome restoration have been proposed, yet robust clinical data remain limited.</p><p><strong>Summary: </strong>Clinical management should prioritize hemodynamic stabilization and organ support rather than immediately targeting any nutritional goals. Monitoring GI function systematically and tailoring nutritional interventions may prevent complications and support recovery. Future research should validate monitoring tools, refine individual patient assessment, and evaluate novel therapeutic interventions to improve patient-centered outcomes in septic shock.</p>","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144599683","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":"Acute respiratory distress syndrome: new pathophysiological insights.","authors":"Asyl Harbiye, Hélène B van den Heuvel, Lieuwe D J Bos, Leonoor S Boers","doi":"10.1097/MCC.0000000000001303","DOIUrl":"https://doi.org/10.1097/MCC.0000000000001303","url":null,"abstract":"<p><strong>Purpose of review: </strong>Acute respiratory distress syndrome (ARDS) remains a major cause of critical illness with high morbidity and mortality. Despite advances in supportive care, targeted therapies have failed, in part due to an incomplete understanding of alveolar immune dysregulation. This review provides a timely synthesis of emerging mechanisms in alveolar immune dysregulation that underlie the development and persistence of ARDS.</p><p><strong>Recent findings: </strong>Recent studies highlight the role of neutrophil heterogeneity, alveolar macrophage-derived extracellular vesicle signaling, and epithelial barrier dysfunction in driving hyperinflammation and susceptibility to secondary infections. Mechanical ventilation strategies, particularly those influencing driving pressure, further shape the alveolar immune environment. Cross-talk between immune cells and mechanical forces appears central to the pathogenesis of sustained lung injury.</p><p><strong>Summary: </strong>Understanding the dynamic interplay between alveolar immune responses and secondary insults is critical for the development of precision medicine approaches in ARDS. Future research should prioritize the identification of compartment-specific biomarkers and therapeutic targets aimed at restoring immune balance and preventing nonresolving lung injury.</p>","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144574996","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":"ICU scoring systems: current perspectives and future directions.","authors":"Jorge I F Salluh, Giulliana M Moralez, Alexander Tracy, Rodrigo Octavio Deliberato","doi":"10.1097/MCC.0000000000001305","DOIUrl":"https://doi.org/10.1097/MCC.0000000000001305","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review aims to summarize the recent publications and future perspectives on the use of ICU scoring systems mainly for the assessment of ICU performance, resource use and benchmarking. Additionally, we provide current limitations and future directions on the use of scoring systems.</p><p><strong>Recent findings: </strong>Generalizability and precision remain major challenges to the use of ICU-score systems. Recent innovations in this field have been driven by the expansion of national and international critical care registries, alongside advancements in data science.Models developed using data from specific regions lack broader applicability. Simplified scoring systems have been proposed to address the urgent need for a global ICU predictive model. Scoring systems can facilitate research, outcome prediction, and healthcare quality comparisons across different settings. A global ICU score system would need minimal data collection requirements, but its use would be inherently limited by the trade-off between generalizability and precision. In parallel, the search for more precise models has led to recent advances. Artificial intelligence-based models have improved predictive abilities compared to traditional scores. Omics data integration and diverse variables and dimensions may interact to predict outcomes. Dynamic models can update such predictions. However, implementation challenges persist, including the need for validation across diverse settings and addressing issues such as transparency, reproducibility, and potential biases.</p><p><strong>Summary: </strong>Traditionally, ICU scoring systems enable the assessment of patients' severity of illness and consequently the risk-adjusted evaluation of ICU performance and resource use. The expansion of national ICU registries has advanced their use internationally for quality assessment, quality improvement and benchmarking. Novel approaches and methodologies, including the use of machine learning and data science, are making progress in improving the scores performance and expanding their use beyond risk-adjusted mortality.</p>","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144574997","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":"Role of artificial intelligence in ICU therapeutic decision-making for severe infections.","authors":"Daniele Roberto Giacobbe, Antonio Vena, Matteo Bassetti","doi":"10.1097/MCC.0000000000001304","DOIUrl":"https://doi.org/10.1097/MCC.0000000000001304","url":null,"abstract":"<p><strong>Purpose of review: </strong>To discuss current and future role of artificial intelligence in predicting severe infections and supporting decisions on antibiotic treatment in critically ill patients in intensive care units (ICU), focusing in particular on some relevant conceptual changes compared to classical clinical reasoning.</p><p><strong>Recent findings: </strong>Several studies have evaluated the ability of machine learning techniques for severe infection prediction, while other studies have explored the potential of large language models (LLM)-based tools to assist clinicians in deciding which antimicrobial agent(s) to prescribe to patients with severe infections.</p><p><strong>Summary: </strong>The support of artificial intelligence for infection prediction and antimicrobial prescribing has shown the potential to improve the treatment of severe infections in ICU. However, the limited number of studies focused on ICU should be highlighted, along with the need to thoroughly address the issue of patients' privacy and to improve the ethical and legal frameworks for decision accountability, as well as the transparency and quality of training data. A standardized approach to the accuracy-interpretability trade-off would also be essential to outline a correct and shared approach both for the future conduct of studies and for the interpretation of their evidence for clinical practice.</p>","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144574998","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: how long is long enough?","authors":"Despoina Koulenti, Maria-Panagiota Almyroudi, Antonios Katsounas","doi":"10.1097/MCC.0000000000001298","DOIUrl":"https://doi.org/10.1097/MCC.0000000000001298","url":null,"abstract":"<p><strong>Purpose of review: </strong>To provide an updated overview of optimal antibiotic duration in ventilator-associated pneumonia (VAP), integrating guideline recommendations, clinical evidence, and expert opinion.</p><p><strong>Recent findings: </strong>A randomized controlled trial, retrospective studies and meta-analyses support shorter (≤7-8-day) regimens for immunocompetent patients with VAP, reducing toxicity and, potentially, resistance development without compromising outcomes. However, while short-course regimens are increasingly supported, recent trials of newer agents often report durations >7 days, reflecting real-world challenges in resistant pathogens and trial design.</p><p><strong>Summary: </strong>VAP remains the leading healthcare-associated infection in intensive care units (ICUs), related to worse outcomes and contributing substantially to antimicrobial use. Historically, prolonged antibiotic courses (≥10-14) were standard, particularly for cases involving multidrug-resistant (MDR) or extensively drug-resistant (XDR) organisms. This review synthesizes current evidence supporting shorter course therapy for VAP (≤7-8 days), emphasizing the importance of clinical response and individualization. While guideline convergence on 7-8 days has grown, exceptions apply for specific pathogens (e.g., nonfermenters, MDR or XDR organisms), bacteremia, slow response, or structural lung disease. Biomarkers like procalcitonin may assist in select cases but lack VAP-specific validation. Regular reassessment is essential to balance efficacy with stewardship. Evidence gaps remain for immunocompromised patients and ultra-short regimens.</p>","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144574999","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}