Intensive Care Medicine最新文献

{"title":"Temporal trends in critical care burden and outcomes of Andes virus-associated hantavirus cardiopulmonary syndrome: a national Chilean cohort.","authors":"Gabriela Meza-Fuentes, Iris Delgado, Pablo A Vial, Alex Godoy-Faúndez, Diego Rivera, Yanara Bernal, Jerónimo Graf, René López","doi":"10.1007/s00134-026-08599-9","DOIUrl":"https://doi.org/10.1007/s00134-026-08599-9","url":null,"abstract":"<p><strong>Purpose: </strong>Andes virus causes hantavirus cardiopulmonary syndrome (HCPS), a severe disease found in central and southern parts of Chile and Argentina. Recently a case-outbreak of HCPS was reported on a cruise ship, therefore contemporary data on organ support and outcomes is required. The objective of this study was to assess organ support use and patient outcomes in patients admitted with HCPS.</p><p><strong>Methods: </strong>We used the Diagnosis-Related Groups (DGR) database to analyse patients admitted in 31 Chilean hospitals between January 1, 2019, and December 31, 2024. They were stratified by the maximal respiratory support received: no respiratory support, non-invasive ventilation (NIV), invasive mechanical ventilation (MV) or extracorporeal membrane oxygenation (ECMO). Hospital length of stay (LOS) and in-hospital mortality were the main outcomes assessed. In-hospital mortality was further analysed by pre-COVID-19 pandemic, pandemic, and post-pandemic periods.</p><p><strong>Results: </strong>A total of 215 patients with HCPS were identified, of whom 69.3% were males and 87% were adults. Of 148 patients who required respiratory support, 14.2% received NIV, 36.5% received MV and 49.3% required ECMO. Hospital LOS was 8 [3-15] days and in-hospital mortality was 20.5%. Case fatality rates were 29.6% for patients receiving MV and 32.9% for those receiving ECMO. The pandemic period was independently associated with higher in-hospital mortality (aOR 2.73 [1.06-7.63]; p = 0.045).</p><p><strong>Conclusion: </strong>HCPS caused by Andes virus remains associated with high in-hospital mortality and substantial amounts of respiratory support, particularly MV and ECMO. Moreover, the COVID-19 pandemic was associated with a significant increase in HCPS mortality.</p>","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":""},"PeriodicalIF":22.0,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148880207","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 the ventilator: deploying adjuvant therapies across the course of ARDS.","authors":"Laveena Munshi, Gordon Rubenfeld, Hannah Wunsch","doi":"10.1007/s00134-026-08594-0","DOIUrl":"https://doi.org/10.1007/s00134-026-08594-0","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":""},"PeriodicalIF":22.0,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148880234","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":"Surviving Sepsis Campaign beyond survival: aligning sepsis care with patient goals.","authors":"Jozef Kesecioglu, Victoria Metaxa, Elie Azoulay","doi":"10.1007/s00134-026-08590-4","DOIUrl":"https://doi.org/10.1007/s00134-026-08590-4","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":""},"PeriodicalIF":22.0,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148864853","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":"Sepsis-associated liver injury: from liver-test risk signals to immunobiology-guided precision medicine.","authors":"Antonios Katsounas, Emmanuel Tsochatzis, Jordi Rello","doi":"10.1007/s00134-026-08593-1","DOIUrl":"https://doi.org/10.1007/s00134-026-08593-1","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":""},"PeriodicalIF":22.0,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148864830","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":"Hypernatremia in the critically Ill: beyond free water replacement.","authors":"Themistoklis Paraskevas, Marlies Ostermann, Michael Joannidis","doi":"10.1007/s00134-026-08566-4","DOIUrl":"https://doi.org/10.1007/s00134-026-08566-4","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":""},"PeriodicalIF":22.0,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148864828","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":"Balancing lung and brain: physiological strategies for ARDS management in acute brain injury.","authors":"Chiara Robba, Nekane Romero-García, Shaurya Taran, Rafael Badenes, Luigi Camporota, Patricia R M Rocco, Mariangela Pellegrini, Lise Piquilloud, Antoine Roquilly, Matthieu Schmidt, Fabio Silvio Taccone, Sarah Wahlster, Nicolò Antonino Patroniti","doi":"10.1007/s00134-026-08595-z","DOIUrl":"https://doi.org/10.1007/s00134-026-08595-z","url":null,"abstract":"<p><p>Acute respiratory distress syndrome (ARDS) is a common and clinically significant complication in patients with acute brain injury (ABI), affecting up to one-third of critically ill individuals and contributing to increased mortality, prolonged mechanical ventilation, and worse neurological outcomes. The coexistence of ARDS and ABI creates a fundamental therapeutic dilemma: strategies that protect the lung may adversely affect cerebral physiology, whilst neuroprotective targets may compromise respiratory management. This narrative review examined the pathophysiological interactions between the injured lung and brain, highlighting the competing effects of key ventilatory variables. Lung-protective ventilation, including low tidal volume and higher positive end-expiratory pressure (PEEP), reduces ventilator-induced lung injury but may increase arterial carbon dioxide (PaCO₂), resulting in intracranial hypertension and impaired cerebral perfusion. Conversely, strict control of PaCO₂ and optimisation of cerebral perfusion may necessitate deviations from conventional ARDS strategies. Oxygenation targets further illustrate this tension, as both hypoxaemia and hyperoxaemia can exacerbate secondary brain injury. We synthesised current evidence on respiratory support, including non-invasive strategies, invasive mechanical ventilation, rescue therapies such as prone positioning and extracorporeal support, and pharmacological interventions, with emphasis on their differential effects on pulmonary and cerebral physiology. Attention was also given to the role of multimodal neuromonitoring, including intracranial pressure and brain tissue oxygenation, as tools to individualise ventilatory management and reconcile competing organ priorities. Overall, available data support a shift from protocolised approaches towards physiology-driven, patient-specific strategies that integrate lung mechanics, gas exchange and cerebral haemodynamics in patients with concomitant ARDS and ABI. Future studies should incorporate combined lung and brain endpoints to define strategies that simultaneously minimise ventilator-induced lung injury and secondary brain injury.</p>","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":""},"PeriodicalIF":22.0,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148840063","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":"ARDS management in trauma patients.","authors":"Sergio Lassola, Francesco Cipulli, Eleonora Balzani, Sandra Magnoni, Marco Mastandrea, Riccardo Giovannetti, Simon Rauch, Xavier Monnet, Giacomo Bellani","doi":"10.1007/s00134-026-08581-5","DOIUrl":"https://doi.org/10.1007/s00134-026-08581-5","url":null,"abstract":"<p><p>Acute respiratory distress syndrome (ARDS) is a frequent and severe complication in trauma patients, arising from a complex interplay between direct tissue injury, systemic inflammation, and resuscitation-related factors. Although trauma accounts for a minority of ARDS cases overall, its incidence remains high in patients with severe thoracic injury. The pathophysiology is best described by a \"multi-hit\" model, in which the initial traumatic insult is followed by a dysregulated inflammatory response and additional secondary insults, including transfusion, infection, or fat embolism, ultimately leading to alveolar-capillary barrier disruption and respiratory failure. Early identification of patients at risk is crucial and relies on clinical severity scores and multimodal imaging. Thoracic imaging, including chest X-ray, lung ultrasound, and computed tomography, plays a central role in diagnosis, monitoring, and risk stratification. Management is largely supportive and based on lung-protective ventilation strategies, with careful integration of non-invasive respiratory support in selected patients. Pain control, hemodynamic optimization, and timely surgical interventions are key components of care, as they directly influence respiratory mechanics and may prevent progression to ARDS. Special clinical scenarios, including traumatic brain injury and hypothermia, require individualized approaches due to complex brain-lung and systemic interactions. Overall, a multidisciplinary, physiology-driven strategy is essential to optimize outcomes in trauma-related ARDS.</p>","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":""},"PeriodicalIF":22.0,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148828009","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 review: ß-blockade in critical illness.","authors":"Marlies Ostermann, Daniel De Backer, Emilie Belley-Cote, Maurizio Cecconi, Michelle S Chew, Joanna C Dionne, Steven M Hollenberg, Stephan M Jakob, Salmaan Kanji, Richard Leach, Mark J McPhail, Xavier Monnet, Andrea Morelli, Mervyn Singer, Erika Wilkman, Giuseppe Citerio","doi":"10.1007/s00134-026-08574-4","DOIUrl":"https://doi.org/10.1007/s00134-026-08574-4","url":null,"abstract":"<p><p>Critical illness is characterised by activation of the sympathetic nervous system which plays an important adaptive role in maintaining cardiovascular stability and organ perfusion. However, excessive sustained adrenergic stimulation may become maladaptive, contributing to tachyarrhythmias, myocardial injury, immune dysregulation, metabolic derangements, and organ dysfunction. This state-of-the-art review evaluates the role of ß-blocker therapy as a potential strategy to modulate or counteract the adrenergic response in critically ill patients. Current data suggest that their use remains highly context-dependent and controversial. There are established benefits in selected scenarios, including acute myocardial infarction, tachyarrhythmias, hypertensive emergencies, thyroid storm, and prevention of variceal bleeds. In contrast, evidence is limited or conflicting in septic shock, traumatic brain injury, acute heart failure, burns and other critical care syndromes. Concerns include impairment of compensatory cardiovascular responses, reduction of cardiac output, hypotension, and compromised organ perfusion. Furthermore, the safety and efficacy of ß-blockade appear to depend on the type and dose of ß-blocker, patient phenotype, timing of initiation, hemodynamic reserve, and whether therapy represents continuation of chronic treatment, withdrawal and re-initiation, or de novo initiation during acute illness. This review highlights major gaps in knowledge, including the absence of reliable indicators to identify patients most likely to benefit, uncertainty regarding optimal treatment targets and monitoring strategies, and limited randomised evidence in heterogeneous ICU populations. A phenotype-driven, physiology-guided approach that accounts for hemodynamic status, sympathetic spectrum and timing of ß-blocker therapy is likely required to optimise outcomes.</p>","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":""},"PeriodicalIF":22.0,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148827974","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":"Early mobilization for mechanical ventilation for sepsis or acute respiratory failure (EVER): a multicenter randomized controlled trial with 12-month outcomes.","authors":"Chi Ryang Chung, Suk-Kyung Hong, Danbee Kang, Ryoung-Eun Ko, Juhee Cho, Won Kim, Jong Geol Do, Myung-Jun Shin, Yong Beom Shin, So Young Ahn, Yu Hui Won, Song I Lee, Hak-Jae Lee, Heung-Bum Lee, Myunghun Jang, Jiyeon Kang, Gee Young Suh","doi":"10.1007/s00134-026-08598-w","DOIUrl":"https://doi.org/10.1007/s00134-026-08598-w","url":null,"abstract":"<p><strong>Purpose: </strong>Early mobilization is recommended for adults on mechanical ventilation, but the timing, the dose, and the real-world effectiveness, particularly in Asian ICUs, remain unclear. We assessed whether a structured six-step early mobilization programme enhances functional status at ICU discharge and longer-term recovery.</p><p><strong>Methods: </strong>A multicenter, randomized, open-label study was conducted across five tertiary hospitals in South Korea (September 2020 to July 2024). Adult patients with sepsis or respiratory failure anticipated to require invasive ventilation for ≥ 48 h were randomly assigned (1:1) to the intervention or usual care. The primary outcome was the FSS-ICU at ICU discharge. Secondary outcomes included in-hospital mortality, muscle strength, physical performance, and patient-reported outcomes evaluated at 1, 3, 6, and 12 months. Analyses followed the intention-to-treat principle.</p><p><strong>Results: </strong>We enrolled 169 participants (93 intervention; 76 usual care). At ICU discharge, the FSS-ICU did not differ between groups (mean 23.6 [SD 11.8] vs. 22.2 [SD 10.8]; P = 0.44). The intervention group began mobilization earlier (median 30.0 vs. 45.9 h), underwent more sessions (median 11 vs. 4), and accumulated more mobilization time (median 330 vs. 120 min). Patients achieving mobilization Step ≥ 4 (sit to stand or higher) had higher FSS-ICU at ICU discharge compared with matched usual care (mean 30.6 vs. 23.3; P < 0.01). Long-term outcomes (EQ-5D, SF-36 PCS/MCS, IES-R-K, MoCA-BLIND, and PICS) improved similarly in both groups over 12 months without significant differences.</p><p><strong>Conclusions: </strong>In this multicenter randomized controlled trial of mechanically ventilated patients with sepsis or acute respiratory failure, a protocolized early mobilization program did not improve functional status at ICU discharge or at 12 months compared with usual care.</p><p><strong>Trial registration: </strong>NCT04582760, registered 12 October 2020.</p>","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":""},"PeriodicalIF":22.0,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148828033","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":"Should the esophageal balloon catheter be deployed to personalize ventilation of ARDS?","authors":"John J Marini, Niall D Ferguson, Daniel Talmor","doi":"10.1007/s00134-026-08572-6","DOIUrl":"https://doi.org/10.1007/s00134-026-08572-6","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":""},"PeriodicalIF":22.0,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148812868","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}