Intensive Care Medicine最新文献

{"title":"Maintenance and resuscitation fluids for brain injury: keep them salty and not too sweet but mind the kidney.","authors":"Niels van Regenmortel,Mathieu van der Jagt","doi":"10.1007/s00134-025-08050-5","DOIUrl":"https://doi.org/10.1007/s00134-025-08050-5","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"68 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144720296","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":"Norepinephrine pharmacolexicology: a chronological review of dose reporting and the implications of salt formulations.","authors":"Jacopo D'Andria Ursoleo,Alice Bottussi,Ashish K Khanna,Marc Leone,Patrick M Wieruszewski,Fabrizio Monaco","doi":"10.1007/s00134-025-08053-2","DOIUrl":"https://doi.org/10.1007/s00134-025-08053-2","url":null,"abstract":"Uncertainties in norepinephrine dose reporting due to variable labeling practices secondary to salt formulation considerations have resulted in significant clinical and research challenges, potentially leading to impaired comparability across studies. The objective of this review was to summarize the chronology of the available literature on the issue of norepinephrine salt formulations and dose reporting. A systematic search of PubMed/MEDLINE, EMBASE, and Google Scholar databases was conducted to identify pertinent studies addressing the variability in norepinephrine salt formulations and labeling practices, the evolution of pharmacological understanding, and recent developments in proposed guidelines. The included investigations were then synthesized in a narrative fashion and subsequently organized chronologically to trace the progression of findings over time, thus highlighting the implications of dosing variability, and provide insight into strategies that may be used to attain global harmonization in norepinephrine dose reporting. National efforts-such as the United States Salt Policy and the French implementation model-offer a structured pathway toward harmonization. Consistency in norepinephrine dose reporting globally is of upmost importance such that trials may be designed appropriately, evidence syntheses may be interpreted appropriately, and research findings may be appropriately used to inform clinical practice.","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"27 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144720025","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":"Identification of transcriptomic sepsis endotypes in sub-Saharan Africa: derivation, validation, and global alignment in two Ugandan cohorts.","authors":"Matthew J Cummings,Julius J Lutwama,Alin S Tomoiaga,Meng Zhao,Nicholas Owor,Xuan Lu,Peter James Eliku,Jesse E Ross,Christopher Nsereko,Irene Nayiga,Stephen Kyebambe,John Bosco Nsubuga,Joseph Shinyale,Ignatius Asasira,Tonny Kiyingi,Thomas Ochar,Moses Kiwubeyi,Rittah Nankwanga,Steven J Reynolds,Martina Cathy Nakibuuka,John Kayiwa,Mercy Haumba,Joweria Nakaseegu,Xiaoyu Che,Kai Nie,Seunghee Kim-Schulze,Sankar Ghosh,W Ian Lipkin,Max R O'Donnell,Barnabas Bakamutumaho","doi":"10.1007/s00134-025-08047-0","DOIUrl":"https://doi.org/10.1007/s00134-025-08047-0","url":null,"abstract":"PURPOSESub-Saharan Africa carries the highest global burden of critical illness, yet transcriptomic sepsis endotypes have not been defined in the region. Their clinical relevance and alignment with endotypes identified in high-income countries (HICs) remain unknown.METHODSWe analyzed data from two prospective observational cohorts of critically ill adults with sepsis in Uganda (discovery cohort [Tororo, rural], N = 243; validation cohort [Entebbe, urban], N = 112). Unsupervised clustering of whole-blood RNAseq data was used to identify endotypes in the discovery cohort. A random forest classifier was used to predict endotype assignment in the validation cohort. Differential gene expression, pathway enrichment, and digital cytometry were used to define endotype pathobiology and determine overlap with HIC-derived endotypes.RESULTSTwo endotypes-Uganda Sepsis Endotypes 1 (USE-1) and 2 (USE-2)-were identified in the discovery cohort. USE-2, marked by neutrophil-driven innate immune activation and lymphocyte suppression, was associated with greater physiological severity and higher mortality (41.3% vs. 22.0%; absolute difference 19.3%, 95% CI 7.6-30.9%), irrespective of HIV, tuberculosis, or malaria infection. A 13-gene classifier (misclassification rate 1.43%) replicated two endotypes in the validation cohort with similar biological and clinical profiles. USE-2 showed strong transcriptional overlap with SRS1 and inflammopathic endotypes but only modest concordance in patient-level assignments. Overlap with Mars1 was variable.CONCLUSIONSWe identified two transcriptomic sepsis endotypes in Uganda that reflect inter-individual differences in targetable pathobiology and confer prognostic enrichment across high-burden infections. Divergence from HIC-derived endotypes highlights the need for sepsis classifications that are both globally relevant and locally responsive.","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"144 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144720294","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":"Challenges in assessing HRQoL after ICU sepsis.","authors":"Jinhuo Wang,Yue Wang,Jianrong Guo","doi":"10.1007/s00134-025-08051-4","DOIUrl":"https://doi.org/10.1007/s00134-025-08051-4","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"26 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144720014","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":"State of the art: Renal recovery after AKI - from basic science to clinical practice.","authors":"Marlies Ostermann,Lui G Forni,Michael Joannidis,Sandra L Kane-Gill,Matthieu Legrand,Nuttha Lumlertgul,Bairbre McNicholas,Melanie Meersch,Celine Monard,Peter Pickkers,John Prowle,Thomas Rimmelé,Antoine Schneider,Alexander Zarbock,John A Kellum","doi":"10.1007/s00134-025-08035-4","DOIUrl":"https://doi.org/10.1007/s00134-025-08035-4","url":null,"abstract":"PURPOSEAcute kidney injury (AKI) is common in critically ill patients and associated with a high risk of mortality, chronic kidney disease (CKD) and cardiovascular morbidity. The risks are higher in patients with incomplete or no renal recovery. The purpose of this review is to summarize the current understanding of the mechanisms of renal recovery, list some key risk factors for nonrecovery and highlight knowledge gaps.METHODSNarrative review of key data in the literature.RESULTSRecovery from AKI is an active process. When damage to the kidney is mild, full regeneration is possible; with extensive damage, fibrosis sets in. Current strategies to achieve renal recovery focus on identification of the mechanism of injury and minimizing further insults. Nephrotoxic exposures and various forms of dialytrauma impair recovery. The likelihood that repair will be maladaptive increases with age and extent/duration of injury. Return of glomerular filtration rate to pre-injury levels does not exclude nephron loss and development of CKD. Post-discharge follow-up of AKI survivors is important, but there are ongoing uncertainties and clinical practice is variable. Research is ongoing to determine the role of pharmacological interventions.CONCLUSIONSThe prognosis of AKI is critically tied to renal recovery, and there is great urgency to identify effective therapies.","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"710 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144720298","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":"Syndromic diagnostics in pneumonia: the quest for impact continues.","authors":"Andrew Conway Morris,Vandack Nobre,Luis Coelho,Jose Garnacho-Montero","doi":"10.1007/s00134-025-08056-z","DOIUrl":"https://doi.org/10.1007/s00134-025-08056-z","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"24 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144720015","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":"Choosing wisely: who really benefits from critical care EEG monitoring?","authors":"Cecil D Hahn,Andrea O Rossetti","doi":"10.1007/s00134-025-08040-7","DOIUrl":"https://doi.org/10.1007/s00134-025-08040-7","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"2 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144720016","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":"Noninvasive respiratory supports in ICU.","authors":"Jean-Pierre Frat, Domenico L Grieco, Audrey De Jong, Kevin Gibbs, Guillaume Carteaux, Oriol Roca, Virginie Lemiale, Lise Piquilloud, Nuttapol Rittayamai, Lara Pisani, Gonzalo Hernandez, Arnaud W Thille","doi":"10.1007/s00134-025-08036-3","DOIUrl":"https://doi.org/10.1007/s00134-025-08036-3","url":null,"abstract":"<p><strong>Background: </strong>Noninvasive respiratory supports are routinely applied in critically ill patients with acute respiratory failure to avoid intubation and invasive mechanical ventilation, thereby reducing the risk of related complications, and to facilitate successful weaning from mechanical ventilation after extubation. They are also applied during the intubation procedure for preoxygenation with the aim of enhancing oxygenation and ensuring the safety of the procedure.</p><p><strong>Main body: </strong>High-flow nasal oxygen decreases airway dead space, provides a stable concentration of inspired oxygen, generates low level of flow-dependent positive airway pressure, and optimizes comfort. Positive-pressure noninvasive supports include continuous positive-airway pressure and noninvasive ventilation and enable providing higher end-expiratory pressure, thereby further improving oxygenation. Noninvasive ventilation, but not continuous positive-airway pressure, better decreases inspiratory effort, and increases tidal volume and transpulmonary driving pressure.</p><p><strong>Conclusion: </strong>High-flow nasal oxygen has become the first-line therapy in acute hypoxemic respiratory failure, while noninvasive ventilation remains the reference treatment during exacerbations of chronic obstructive pulmonary disease, in patients with respiratory acidosis. In patients requiring intubation, noninvasive ventilation is the optimal technique for preoxygenation to decrease the risk of hypoxemia, while high-flow nasal oxygen is an alternative option for non-hypoxemic patients or those with contraindications to noninvasive ventilation. After extubation in patients at high risk of reintubation, prophylactic noninvasive ventilation, eventually alternating with high-flow nasal oxygen, improves weaning outcome compared to other strategies; high-flow nasal oxygen alone outperforms conventional oxygen in low-risk patients.</p>","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":""},"PeriodicalIF":27.1,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144698463","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":"Neurotoxicity of sedative drugs: a matter of concern in adults?","authors":"Giovanni Landoni,Yuki Kotani,Vladimir Lomivorotov","doi":"10.1007/s00134-025-08030-9","DOIUrl":"https://doi.org/10.1007/s00134-025-08030-9","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"18 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144693523","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":"Melatonin for ICU Delirium Prevention: Optimal Pharmacokinetics but No Clinical Benefit in the DEMEL Trial.","authors":"Bin Liu,Peng Huang,Yanchao Liang,Bo Xie","doi":"10.1007/s00134-025-08037-2","DOIUrl":"https://doi.org/10.1007/s00134-025-08037-2","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"115 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144693525","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}