Intensive Care Medicine最新文献

How to approach a patient hospitalized for pneumonia who is not responding to treatment? 如何接近治疗无效的肺炎住院患者？

IF 38.9 1区医学

Intensive Care Medicine Pub Date : 2025-05-24 DOI: 10.1007/s00134-025-07903-3

Pedro Povoa, Luís Coelho, Jordi Carratala, Kelly Cawcutt, Sara E. Cosgrove, Ricard Ferrer, Carlos A. Gomez, Michael Klompas, Thiago Lisboa, Ignacio Martin-Loeches, Saad Nseir, Jorge I. F. Salluh, Sias Scherger, Daniel A. Sweeney, Andre C. Kalil

{"title":"How to approach a patient hospitalized for pneumonia who is not responding to treatment?","authors":"Pedro Povoa, Luís Coelho, Jordi Carratala, Kelly Cawcutt, Sara E. Cosgrove, Ricard Ferrer, Carlos A. Gomez, Michael Klompas, Thiago Lisboa, Ignacio Martin-Loeches, Saad Nseir, Jorge I. F. Salluh, Sias Scherger, Daniel A. Sweeney, Andre C. Kalil","doi":"10.1007/s00134-025-07903-3","DOIUrl":"https://doi.org/10.1007/s00134-025-07903-3","url":null,"abstract":"<p>Pneumonia is a frequent cause of intensive care unit (ICU) admission and is the most common infection in ICU patients across all geographic regions. It takes 48-72h for most patients to respond to appropriate antibiotic therapy. Non-response is typically defined as the persistence/worsening of clinical signs—such as fever, respiratory distress, impaired oxygenation and/or radiographic abnormalities—with rates ranging 20–30%. Several factors can contribute to non-response. Host factors, including immunosuppression, chronic lung disease, or ongoing aspiration, may impair resolution. Additionally, incorrect antibiotic dosing, atypical or resistant pathogens (such as multidrug-resistant bacteria, <i>Mycobacterium tuberculosis</i>, or fungal infections) may be responsible, requiring alternative antimicrobial strategies. A septic complication related to pneumonia (e.g., empyema) or not (e.g., acalculous cholecystitis) may need to be excluded. Finally, non-infectious conditions (e.g., pulmonary embolism, malignancy, secondary ARDS or vasculitis) that can mimic or potentiate pneumonia must be considered. Although non-responding pneumonia is frequent, its management lacks strong evidence, and its approach is based mostly on the art of medicine and clinical judgement. Clinicians should continuously reassess the medical history and physical exam, review microbiological data, and consider imaging such as chest CT. Bronchoscopy or repeat sputum sampling may aid in identifying alternative pathogens or non-infectious causes. The management of a non-responding pneumonia depends on the findings of a structured reassessment. Herein, we provide guidance on how to identify and manage non-responding pneumonia. Ultimately, addressing pneumonia that does not respond to antibiotics is crucial for preventing complications, optimizing antimicrobial stewardship, and improving patient outcomes.</p>","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"21 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144130150","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}

引用次数: 0

A critical assessment of corticosteroid trials for hospitalised patients with SARS-CoV-2 disease 对SARS-CoV-2病住院患者皮质类固醇试验的关键评估

IF 38.9 1区医学

Intensive Care Medicine Pub Date : 2025-05-23 DOI: 10.1007/s00134-025-07878-1

Jean Carlet, Didier Payen, Mervyn Singer

引用次数: 0

Practical and theoretical perspectives on early decompressive craniectomy for traumatic brain injury. 外伤性脑损伤早期开颅减压术的实践与理论展望。

IF 38.9 1区医学

Intensive Care Medicine Pub Date : 2025-05-21 DOI: 10.1007/s00134-025-07939-5

Tomoya Okazaki

引用次数: 0

Beyond the dose: rethinking ketamine neurotoxicity in critical illness. 剂量之外：重新思考氯胺酮对危重疾病的神经毒性。

IF 38.9 1区医学

Intensive Care Medicine Pub Date : 2025-05-21 DOI: 10.1007/s00134-025-07951-9

Rongqiang Liao,Xiaoyuan Zheng

引用次数: 0

Understanding and mitigating medication errors associated with patient harm in adult intensive care units: a scoping review 理解和减轻与成人重症监护病房患者伤害相关的用药错误：一项范围综述

IF 38.9 1区医学

Intensive Care Medicine Pub Date : 2025-05-20 DOI: 10.1007/s00134-025-07938-6

Kathryn Puxty, Margo van Mol, María Cruz Martin Delgado, Michael Darmon, Ricardo Ferrer, Alessandro Galazzi, Entela Kondi, Lene Russell, Elena Sancho, Marlies Ostermann, Elie Azoulay, Richard S. Bourne

{"title":"Understanding and mitigating medication errors associated with patient harm in adult intensive care units: a scoping review","authors":"Kathryn Puxty, Margo van Mol, María Cruz Martin Delgado, Michael Darmon, Ricardo Ferrer, Alessandro Galazzi, Entela Kondi, Lene Russell, Elena Sancho, Marlies Ostermann, Elie Azoulay, Richard S. Bourne","doi":"10.1007/s00134-025-07938-6","DOIUrl":"https://doi.org/10.1007/s00134-025-07938-6","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose</h3><p>Medication interventions are fundamental to the care of the critically ill patient in the intensive care unit (ICU), relying on effective and appropriate delivery of the medication use process. Medication errors affect a high proportion of patients in the ICU. This scoping review maps the literature pertaining to medication errors and preventable adverse drug events in the adult ICU.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>We searched seven electronic databases (PubMed, MEDLINE, EMBASE, CINAHL, Web of Science, Cochrane, Google Scholar), identifying 2960 records. After screening against predefined eligibility criteria, 48 records were included for data extraction.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>A high variation in incidence of medication errors and preventable adverse drug events were reported, reflecting the heterogeneity in study designs, surveillance methods and preventability assessments. Associated risks factors include patient (high severity of illness, older age), clinical (renal dysfunction, prolonged ICU stay), staff (staff inexperience, role overload), environmental (interruptions, transfer of care) in addition to high-risk medications. The rate of serious or life-threatening harm was low at 1–5% of all medication errors. Half (<i>n</i> = 11, 55%) of the interventions or mitigation practices were focused on the medication prescription phase.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>Most medication errors in ICU are identified and intercepted by systems and staff. A minority lead to preventable patient harm and increased length of stay. Decision support embedded in e-prescribing systems, medication reconciliation and review processes and clinical pharmacist activities reduce medication errors and patient harm.</p>","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"78 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144096931","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}

引用次数: 0

Prone positioning during VV ECMO: stay on the back or not? VV ECMO时俯卧位：是否保持背部？

IF 38.9 1区医学

Intensive Care Medicine Pub Date : 2025-05-19 DOI: 10.1007/s00134-025-07917-x

Asger Granfeldt,Ghislaine Douflé

引用次数: 0

TRAIN study and transfusion strategies in brain injured patients. 脑损伤患者的TRAIN研究和输血策略。

IF 38.9 1区医学

Intensive Care Medicine Pub Date : 2025-05-19 DOI: 10.1007/s00134-025-07930-0

Fabio Silvio Taccone,Jean-Louis Vincent

引用次数: 0

Nutrition and metabolic control for ICU patients. ICU患者营养与代谢控制。