Intensive Care Medicine最新文献

{"title":"Deploying AI in the ICU: learning from successes and failures.","authors":"Matthieu Komorowski,Maurizio Cecconi","doi":"10.1007/s00134-025-08131-5","DOIUrl":"https://doi.org/10.1007/s00134-025-08131-5","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"29 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182628","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":"From drilling skulls to training machines: rethinking medical wisdom in the age of AI.","authors":"Antonio Messina","doi":"10.1007/s00134-025-08116-4","DOIUrl":"https://doi.org/10.1007/s00134-025-08116-4","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"69 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182630","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":"Being comfortable being uncomfortable: lessons from the dojo to the ICU.","authors":"Luke Flower","doi":"10.1007/s00134-025-08127-1","DOIUrl":"https://doi.org/10.1007/s00134-025-08127-1","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"194 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182631","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":"Rethinking high PEEP strategies after IMPROVE-2?","authors":"Marcus J Schultz,Lukas Gasteiger,Galina A Dorland,Ary Serpa Neto,Guido Mazzinari","doi":"10.1007/s00134-025-08144-0","DOIUrl":"https://doi.org/10.1007/s00134-025-08144-0","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"23 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182689","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":"Improving representation in critical care research","authors":"Sangeeta Mehta, Lucy Modra","doi":"10.1007/s00134-025-08133-3","DOIUrl":"https://doi.org/10.1007/s00134-025-08133-3","url":null,"abstract":"No Abstract","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"83 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145133604","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":"Acute respiratory distress syndrome in patients with cancer: the YELENNA prospective multinational observational cohort study","authors":"Peter Schellongowski, Michael Darmon, Philipp Eller, Laveena Munshi, Tobias Liebregts, Victoria Metaxa, Luca Montini, Tobias Lahmer, Fabio S. Taccone, Andry van de Louw, Martin Balik, Peter Pickkers, Pleun Hemelaar, Hemang Yadav, Andreas Barratt-Due, Thomas Karvunidis, Jordi Riera, Gennaro Martucci, Ignacio Martin-Loeches, Pedro Castro, Nina Buchtele, Virginie Lemiale, Stefan Hatzl, Guillaume Dumas, Thomas Staudinger, Elie Azoulay","doi":"10.1007/s00134-025-08113-7","DOIUrl":"https://doi.org/10.1007/s00134-025-08113-7","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose</h3><p>Acute respiratory failure is the leading reason for intensive care unit (ICU) admission among critically ill patients with cancer. We aimed to describe the clinical characteristics, risk factors, and outcomes of patients with cancer and acute respiratory distress syndrome (ARDS) and to evaluate associations of venovenous extracorporeal membrane oxygenation (ECMO) with outcomes in the subgroup with severe ARDS.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>We conducted a multinational, prospective, observational cohort study of patients with cancer and ARDS in 13 countries in Europe and North America. The primary endpoint was 90-day mortality.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Among 715 included patients, 73.4% had hematologic malignancies and 26.6% solid tumors; 31.2% had undergone hematopoietic stem-cell transplantation (168 allogeneic). ICU, hospital, and 90-day mortality rates were 55.3%, 70.9%, and 73.2%, respectively. By multivariate analysis, independent predictors of higher 90-day mortality were older age, peripheral vascular disease, severe ARDS at inclusion, acute kidney injury, and ICU admission as a time-limited trial (vs. full code). Conversely, lymphoma was associated with lower 90-day mortality. Among the 322 patients (45.7%) with severe ARDS at inclusion, 90-day mortality was 82.2%; with no difference between patients who received ECMO (<i>n</i> = 58, 18%) and those who did not (82.6% vs. 80.7%, <i>P</i> = 0.89). This finding remained unchanged in a double-adjusted overlap- and propensity-weighted Cox mixed-effects model (adjusted hazard ratio, 1.12; 95% confidence interval 0.65–1.94; <i>P</i> = 0.69).</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>Patients with cancer and ARDS, particularly severe forms, experience high 90-day mortality, irrespective of ECMO use. These findings suggest a need for nuanced ICU goals-of-care discussions and raise concerns about the generalizability of ECMO guidelines to this population.</p>","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"95 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145133603","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?","authors":"Parth Aphale, Shashank Dokania, Himanshu Shekhar","doi":"10.1007/s00134-025-08130-6","DOIUrl":"https://doi.org/10.1007/s00134-025-08130-6","url":null,"abstract":"No Abstract","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"16 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145116186","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":"Parmacogenetics in ICU patients: a short introduction","authors":"Nicole G. M. Hunfeld, Ari Ercole, Jesse J. Swen","doi":"10.1007/s00134-025-08125-3","DOIUrl":"https://doi.org/10.1007/s00134-025-08125-3","url":null,"abstract":"Pharmacogenetics (PGx) studies the effect of genetic variation on drug response to tailor drug treatment to the individual patient’s needs. The clinical application of pharmacogenetic testing was mostly limited to investigate cases of an unexplained toxic drug response. For example, we reported a case of azathioprine overexposure in a newborn who was identified as a homozygous TPMT*3C genotype, which results in accumulation of 6-TGN, the active metabolite of azathioprine [1].While the application of retrospective testing remains useful in specific cases, the ultimate aim of pharmacogenetic testing is to apply our understanding of how genetic variation affects drug response and toxicity pre-emptively, informing precision therapeutic choices. Together, the Clinical Pharmacogenetic Implementation Consortium (CPIC) and Dutch Pharmacogenetics Working Group (DPWG) have published evidence-based guidelines for more than 100 gene–drug pairs [2]. Interestingly, the frequency of actionable variants commonly occur on a population level and 90–95% of individuals across multiple populations carry at least one actionable variant [3]. Moreover, the drugs covered in the guidelines are commonly prescribed, including antidepressants, anticoagulants, pain medication and chemotherapy, with an estimated ~ 25% of the individuals carrying an actionable variant relevant to the drugs they are using [4].The clinical utility of a pre-emptive pharmacogenetic panel strategy was recently tested in the PREPARE-study [5]. PREPARE was a prospective study that enrolled 6944 patients who started treatment with one of the 39 drugs that had an actionable recommendation in the DPWG. The results showed that pre-emptive application of the 12-gene PGx panel test combined with DPWG recommendations resulted in 30% lower risk for clinically relevant (grade 2–5 CTCAE) adverse drug reactions in the first 12 weeks after treatment initiation. Together with other available evidence these data provide a robust evidence base for a broader clinical application of pre-emptive pharmacogenetic testing [6].PGx testing is most likely to be clinically relevant for drugs with a narrow therapeutic index, a consistent PK-PD relationship and where it is difficult to predict response (or adverse effects) and little time is available for trial-and-error. Therefore, in addition to clinical fields where PGx is already well accepted (e.g. oncology and psychiatry) the intensive care unit (ICU), with complex patients receiving multiple drugs concomitantly, will also benefit from PGx testing.","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"8 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145116158","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":"Monocyte HLA-DR expression in septic shock patients: insights from a 20-year real-world cohort of 1023 cases","authors":"Guillaume Monneret, Thomas Lafon, Morgane Gossez, Bruno Evrard, Maxime Bodinier, Thomas Rimmelé, Laurent Argaud, Martin Cour, Arnaud Friggeri, Alain Lepape, Bernard Allaouchiche, Anne-Claire Lukaszewicz, Fabienne Venet","doi":"10.1007/s00134-025-08110-w","DOIUrl":"https://doi.org/10.1007/s00134-025-08110-w","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose</h3><p>Septic patients simultaneously experience hyperinflammation and immunosuppression, the latter driving ICU-acquired infections, prolonged stays in ICU, and increased mortality. As immunostimulant therapies enter clinical trials, effective stratification is critical to identify patients with the most profound immune dysfunction. Monocyte HLA-DR expression (mHLA-DR) has emerged as the most reliable and actionable biomarker of sepsis-induced immunosuppression.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>We conducted a real-world, 20-year cohort study of 1023 septic shock patients, measuring mHLA-DR by standardized flow cytometry during the first week of ICU admission. Primary outcomes included day-28 and day-90 mortality, and ICU-acquired infections.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Low mHLA-DR (&lt; 8000 AB/C, a threshold already used in phase II trials) was significantly associated with increased mortality and ICU-acquired infections. This association held across static and dynamic measures, multivariate analyses, Kaplan–Meier survival curves, and trajectory clustering (<i>K</i>-means).</p><h3 data-test=\"abstract-sub-heading\">Conclusions</h3><p>This large real-world study confirms that mHLA-DR is a robust enrichment biomarker for identifying the most immunosuppressed septic shock patients at higher risk of adverse outcomes. Importantly, time-course analysis suggests that early immune downregulation may represent a physiological adaptation, while delayed and persistent immunosuppression is associated with worse outcomes. Early single time-point measurements may fail to identify patients who are unlikely to develop delayed immunosuppression. Tracking mHLA-DR trajectories after the initial ICU days is essential for detecting persistent immune dysfunction and selecting patients in case of immunostimulant approaches.</p>","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"79 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145116157","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":"Hypervirulent Klebsiella pneumoniae: watch the eyes.","authors":"Yan Wang,He Zhou,Meiling Ding,Penghui Wei","doi":"10.1007/s00134-025-08109-3","DOIUrl":"https://doi.org/10.1007/s00134-025-08109-3","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"16 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145103457","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}