Intensive Care Medicine最新文献

{"title":"Open-source clinical classifiers for ARDS: democratizing precision or diluting biology?","authors":"Rombout B E van Amstel,John P Reilly,Lieuwe D J Bos","doi":"10.1007/s00134-025-08169-5","DOIUrl":"https://doi.org/10.1007/s00134-025-08169-5","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"52 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145339080","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":"European Resuscitation Council and European Society of Intensive Care Medicine guidelines 2025: post-resuscitation care.","authors":"Jerry P Nolan, Claudio Sandroni, Alain Cariou, Tobias Cronberg, Sonia D'Arrigo, Kirstie Haywood, Astrid Hoedemaekers, Gisela Lilja, Nikolaos Nikolaou, Theresa Mariero Olasveengen, Chiara Robba, Markus B Skrifvars, Paul Swindell, Jasmeet Soar","doi":"10.1007/s00134-025-08117-3","DOIUrl":"https://doi.org/10.1007/s00134-025-08117-3","url":null,"abstract":"<p><p>The European Resuscitation Council (ERC) and the European Society of Intensive Care Medicine (ESICM) have collaborated to produce these post-resuscitation care guidelines for adults, which are based on the International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations (CoSTR) pubished by the International Liaison Committee on Resuscitation (ILCOR). The topics covered include the post-cardiac arrest syndrome, diagnosis of cause of cardiac arrest, control of oxygenation and ventilation, coronary reperfusion, haemodynamic monitoring and management, control of seizures, temperature control, general intensive care management, prognostication, long-term outcome, rehabilitation, and organ donation. The post-resuscitation care of children is described in the ERC guidelines 2025 Paediatric Life Support.</p>","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":""},"PeriodicalIF":21.2,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145345088","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":"Life-threatening immune-related adverse events in the intensive care unit: a narrative review.","authors":"Samuel Pichon,Ghadi Zebian,Côme Bureau,Clémentine Levy,Charlotte Lacombe,Eve Desmedt,Pauline Wils,Emilie Merlen,Arnaud Lionet,Louis Terriou,Aurore Collet,Emmanuel Ledoult,Helene Zephir,Massih Ningarhari,Vincent Sobanski,Arnaud Scherpereel,Alexandra Forestier,David Launay,Mercedes Jourdain","doi":"10.1007/s00134-025-08155-x","DOIUrl":"https://doi.org/10.1007/s00134-025-08155-x","url":null,"abstract":"BACKGROUNDImmune checkpoint inhibitors (ICIs) have revolutionized cancer treatment by significantly improving survival across various malignancies. However, they are associated with immune-related adverse events (irAEs), resulting from excessive immune activation. Some irAEs can be life-threatening and require intensive care unit (ICU) management. These toxicities involve cardiovascular, pulmonary, hepatic, gastrointestinal, neurologic, endocrine, and hematologic systems and often occur early in the ICI course. As ICI become increasingly integrated into earlier phases of cancer care, intensivists must be prepared to manage irAEs.DESIGNNarrative review objectives: To summarize the evolving evidence on the epidemiology, diagnosis, and management of severe irAEs requiring intensive care by looking for the most relevant articles up to August 2025. The review emphasizes (1) the rationale and timing for immunosuppression beyond corticosteroids, (2) the integration of hemodynamic and organ support strategies, and (3) the importance of multidisciplinary coordination between oncology and critical care teams.RESULTSEarly recognition, structured diagnostic evaluation, and multidisciplinary management are key to optimizing outcomes. Although overall mortality remains high-particularly in myocarditis and multisystem involvement-timely diagnosis and individualized immunosuppressive therapy can improve survival. Rechallenge with ICIs may be cautiously considered in selected patients after full clinical recovery and comprehensive risk assessment. This review aims to support intensivists facing this emerging clinical scenario by synthesizing current evidence and practical strategies for balancing immune modulation with oncologic efficacy in the ICU setting.","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"52 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145338838","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":"Septic shock secondary to a rat-bite fever.","authors":"Antoine Hamon,Jules Grégory,Hadrien Kimseng,Myriam Lamamri","doi":"10.1007/s00134-025-08148-w","DOIUrl":"https://doi.org/10.1007/s00134-025-08148-w","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"22 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145331815","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 numbers: do nomograms capture the complexity of RRT dosing? Author's reply.","authors":"Manuel Colmenero,Jason A Roberts,Jeffrey Lipman,Marta Ulldemolins","doi":"10.1007/s00134-025-08160-0","DOIUrl":"https://doi.org/10.1007/s00134-025-08160-0","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"114 6 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145331814","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":"Prevalence and incidence of ICU delirium and pain: a systematic review and meta-analysis.","authors":"Amanda Y Leong,Stefan Edginton,Laurie A Lee,Natalia Jaworska,Lisa Burry,Kirsten M Fiest,Christopher J Doig,Daniel J Niven","doi":"10.1007/s00134-025-08167-7","DOIUrl":"https://doi.org/10.1007/s00134-025-08167-7","url":null,"abstract":"PURPOSEWe performed a secondary analysis of a prior systematic review and meta-analysis to examine the prevalence and incidence of ICU delirium and pain.METHODSThe original search examined MEDLINE, EMBASE, CINAHL, and the Cochrane Central Register of Controlled trials from inception to May 15, 2023 (PROSPERO ID: CRD42022367715). Articles eligible for the current study derived from those previously reviewed at full text review. Included in the current study were randomised or observational studies among critically ill adults, that reported delirium or pain incidence or prevalence. Proportion data was transformed using the Freeman-Tukey double arcsine method prior to pooling using a random effects meta-analysis model. Joanna Briggs' Institute prevalence checklist was used for risk of bias.RESULTSFrom 517 full-text articles, 213 original studies, 226 publications (183,285 patients) were included. The pooled delirium prevalence (173 studies) was 35.7% (95%CI 32.4-39.0%). The most common delirium subtype was hypoactive (16.5%, 95%CI 12.1-21.4%). The pooled delirium incidence (41 studies) was 28.8% (95%CI 23.2-34.8%). The pooled pain prevalence (11 studies) was 43.5% (95%CI 28.6-58.9%). Delirium prevalence but not incidence decreased since 2013 (before: 39.9%, 95%CI 34.7-45.3% vs. after: 32.3%, 95%CI 28.2-36.5%, p = 0.02). Pain prevalence decreased significantly since publication of pain, agitation and delirium guidelines in 2013 (before: 64.6%, 95%CI 41.6-84.6% vs. after: 35.8%, 95%CI 20.5-52.6%, p = 0.046).CONCLUSIONSDelirium and pain prevalence among adults admitted to ICUs have decreased since publication of pain, agitation and delirium guidelines. However, both remain common, occurring in up to one-half of patients.","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"41 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145331813","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":"When 'Early' isn't early: time to rethink the timing of mobilization in the ICU.","authors":"Katarzyna Kotfis,Łukasz Szarpak,Michał Pruc,Aleksandra Szylińska,Wojciech Dąbrowski","doi":"10.1007/s00134-025-08170-y","DOIUrl":"https://doi.org/10.1007/s00134-025-08170-y","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"72 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145331810","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":"Breaking the dogma: from contraindication to personalized prone positioning in brain-injured patients.","authors":"Domenico Junior Brunetti,Daniele Guerino Biasucci","doi":"10.1007/s00134-025-08157-9","DOIUrl":"https://doi.org/10.1007/s00134-025-08157-9","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"6 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145331864","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":"Invasive candidiasis in intensive care medicine: shaping the future of diagnosis and therapy.","authors":"Ignacio Martin-Loeches,Oliver A Cornely,David W Denning,Jesús Guinea,Matteo Bassetti,Johan Maertens,Martin Hoenigl,Souha S Kanj,Monica Slavin,Luis Ostrosky-Zeichner,Patricia Muñoz","doi":"10.1007/s00134-025-08151-1","DOIUrl":"https://doi.org/10.1007/s00134-025-08151-1","url":null,"abstract":"BACKGROUNDInvasive candidiasis (IC) remains one of the most challenging infections in critical care, contributing significantly to morbidity, prolonged organ support, and mortality among intensive care unit (ICU) patients. The clinical landscape of IC is evolving, with increasing recognition of Candida non-albicans species and other yeasts formerly classified as Candida spp., alongside emerging multidrug resistance and growing complexity in host immune profiles.OBJECTIVESThis contemporary, multidisciplinary narrative review-authored by intensivists, infectious diseases specialists, clinical microbiologists, and pharmacologists-aims to provide ICU clinicians with practical, up-to-date insights into the diagnosis and management of IC. To maintain clinical focus, the review excludes non-IC fungal infections and non-ICU patient populations.METHODSRelevant literature and expert consensus were critically reviewed to summarize current diagnostic and therapeutic approaches for IC in critically ill patients. Emphasis was placed on pragmatic clinical application, diagnostic limitations, antifungal stewardship, and personalized therapeutic decision-making.RESULTSDespite the availability of novel antifungal agents with improved pharmacokinetic properties, treatment success in IC depends equally on timely and accurate diagnosis and individualized, context-aware therapy. Blood cultures continue to demonstrate limited sensitivity (~40%). Non-culture assays, including β-D-glucan and molecular diagnostics, provide faster detection and high negative predictive value but suffer from low positive predictive value and inconsistent adoption in clinical practice. The absence of validated host-derived biomarkers further limits risk stratification, antifungal discontinuation decisions, and personalized care.CONCLUSIONSEmerging antifungal agents, stewardship strategies, and multidisciplinary care models are essential to improve clinical outcomes and reduce antifungal resistance. This review underscores the need for integrated, team-based diagnostic and therapeutic approaches to close persistent gaps in IC management, ultimately promoting more effective, timely, and individualized care for critically ill patients with Candida spp.INFECTIONS","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"11 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145331811","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":"Flow reduction trial: a time-bound daily protocol to wean high-flow nasal cannula.","authors":"Zhe Li,Zhanqi Zhao,Simone Gattarello,Yuan Gao, ","doi":"10.1007/s00134-025-08171-x","DOIUrl":"https://doi.org/10.1007/s00134-025-08171-x","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"98 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145331812","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}