Intensive Care Medicine最新文献

{"title":"Is mechanical power truly the culprit in VILI? Rethinking causality in light of airway closure","authors":"Jan van Egmond, Colin Speight, Jan Paul Mulier","doi":"10.1007/s00134-025-08079-6","DOIUrl":"https://doi.org/10.1007/s00134-025-08079-6","url":null,"abstract":"No Abstract","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"12 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144923949","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":"Commentary on the DEMEL trial evaluating melatonin for delirium prevention in mechanically ventilated ICU patients","authors":"Niloufar Dadashpour, Majid Golestanieraghi","doi":"10.1007/s00134-025-08065-y","DOIUrl":"https://doi.org/10.1007/s00134-025-08065-y","url":null,"abstract":"No Abstract","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"60 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144923950","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":"How we use ultrasound to support clinical decisions on fluid administration in critical ill patients","authors":"Oliver Hunsicker, Filippo Sanfilippo, Pieter R. Tuinman","doi":"10.1007/s00134-025-08088-5","DOIUrl":"https://doi.org/10.1007/s00134-025-08088-5","url":null,"abstract":"Intravenous fluid administration is a common critical care intervention and fluids should be treated as drugs with specific indications [1]. Traditionally, fluid therapy focussed mainly on increasing cardiac output. However, fluid administration can have harmful consequences, such as pulmonary or visceral interstitial oedema, which worsens organ dysfunction. In this context, critical care ultrasound (CCUS) helps to assess potential risks and benefits of fluid administration. We describe our use of CCUS to support clinical decisions regarding fluid administration, focussing primarily on the optimization and stabilisation phase of the critically ill patient.","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"17 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144923951","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 skin failure complicating chikungunya infection","authors":"Camille Windsor, Ngankou Kela Nganwa, Saskia Ingen-Housz-Oro, Nicolas de Prost","doi":"10.1007/s00134-025-08081-y","DOIUrl":"https://doi.org/10.1007/s00134-025-08081-y","url":null,"abstract":"No Abstract","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"23 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144923948","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":"Temporal stability of phenotypes of acute respiratory distress syndrome: clinical implications for early corticosteroid therapy and mortality","authors":"Joris Pensier, Maxime Fosset, Béla-Simon Paschold, Dario von Wedel, Simone Redaelli, Ben L. P. Braeuer, Victor Novack, Felix Balzer, Boris Jung, Marcelo B. P. Amato, Samir Jaber, Daniel Talmor, Elias Baedorf-Kassis, Maximilian S. Schaefer","doi":"10.1007/s00134-025-08089-4","DOIUrl":"https://doi.org/10.1007/s00134-025-08089-4","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose</h3><p>Inflammatory phenotypes of acute respiratory distress syndrome (ARDS) can predict patient outcomes and potentially response to treatment. The aim was to assess whether inflammatory phenotypes can be characterized over time using clinical surrogate data and used to guide therapy with corticosteroids.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>Individual patient data and biomarkers from six multicenter randomized controlled trials (development, <i>n</i> = 1207; validation, <i>n</i> = 2751) were analyzed to establish an open-source AI Clinical Classifier (https://bostonmontpelliercare.shinyapps.io/AIClarity) for inflammatory phenotypes of ARDS using routine clinical data. Then, patients from a retrospective cohort (investigation, <i>n</i> = 5578) underwent classification from baseline to day 30. A discrete-time Bayesian Markov model assessed temporal stability at 3-day intervals. A target trial emulation and longitudinal logistic regression assessed corticosteroid effect on 30-day mortality depending on phenotype.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>The AI Clinical Classifier identified 2169 (39%) hyperinflammatory and 3409 (61%) hypoinflammatory patients. 1053 (49%) and 826 (24%) patients died within 30 days, respectively (<i>p</i> &lt; 0.001). Over 30 days, 49%(1072/2169) of hyperinflammatory patients at baseline transitioned to hypoinflammatory, and 7%(229/3409) of hypoinflammatory patients at baseline transitioned to hyperinflammatory (<i>p</i> &lt; 0.001). Phenotypes predicted response to corticosteroids, with lower mortality in hyperinflammatory patients (IPW-weighted hazard ratio [HR]: 0.81 [0.67–0.98], <i>p</i> = 0.033), and higher mortality in hypoinflammatory patients (IPW-weighted HR: 1.26 [1.06–1.50], <i>p</i> = 0.009). At day 3, a positive response to corticosteroids only persisted among patients who remained hyperinflammatory (adjusted odds ratio = 0.51, 95% CI 0.32–0.80, <i>p</i> = 0.004).</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>Characterization of inflammatory ARDS phenotypes using clinical surrogate data allows physicians to monitor patients throughout the course of the disease and guide clinical treatment. Corticosteroids may be beneficial in hyperinflammatory ARDS and harmful in hypoinflammatory ARDS.</p>","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"35 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144923952","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":"Clinical spectrum of purpura in invasive meningococcal disease","authors":"Damien Contou, Nicolas de Prost","doi":"10.1007/s00134-025-08068-9","DOIUrl":"https://doi.org/10.1007/s00134-025-08068-9","url":null,"abstract":"No Abstract","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"60 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144923981","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":"Prolonged P14 latency predicts mortality in deep sedation: implications for neuroprotective sedation strategies","authors":"Longsheng Zhang, Zitian Luo, Renzhe Lin","doi":"10.1007/s00134-025-08084-9","DOIUrl":"https://doi.org/10.1007/s00134-025-08084-9","url":null,"abstract":"No Abstract","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"26 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144923984","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":"ICP‑AId: International expert survey assessing the potential clinical impact of intracranial pressure predictions at the bedside","authors":"Brenda Pörteners, Giorgia Carra, Marcel Aries, Fabian Guïza, Geert Meyfroidt","doi":"10.1007/s00134-025-08092-9","DOIUrl":"https://doi.org/10.1007/s00134-025-08092-9","url":null,"abstract":"No Abstract","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"21 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144923954","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":"Revisiting the timing of intervention in necrotising pancreatitis","authors":"M. Gatt, G. Piton, D. Poole","doi":"10.1007/s00134-025-08078-7","DOIUrl":"https://doi.org/10.1007/s00134-025-08078-7","url":null,"abstract":"Acute pancreatitis is a leading cause of emergency hospitalisation, with its incidence and aetiology varying geographically [1]. While most patients pursue a mild course, approximately 20% develop acute necrotising pancreatitis (ANP), with some progressing to secondary infected necrotising pancreatitis (INP), often associated with organ failure, and consequent high morbidity and mortality [2, 3]. Persistent organ failure (POF) for 48 h or more, which defines severe acute pancreatitis as per the revised Atlanta classification [3], remains a major clinical challenge, frequently requiring intensive care support with a commensurate strain on healthcare resources. Much effort has been expended into trying to modify disease progression in patients with INP with the ultimate aspiration of improving outcome.","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"30 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144923980","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":"Personalized driving pressure-guided positive end-expiratory pressure in patients at risk of postoperative respiratory failure (IMPROVE-2): a multicenter, pragmatic, randomized clinical trial","authors":"Emmanuel Futier, Audrey De Jong, Cédric Cirenei, Thomas Godet, Matthieu Jabaudon, Jean-Michel Constantin, Nicolas Grillot, Pierre Bouzat, Lois Henry, Dimitri Margetis, Gilles Lebuffe, Marc Garnier, Céline Lambert, Bruno Pereira, Samir Jaber","doi":"10.1007/s00134-025-08082-x","DOIUrl":"https://doi.org/10.1007/s00134-025-08082-x","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose</h3><p>Airway driving pressure has garnered considerable attention for lung-protective ventilation. We evaluated the clinical effectiveness of airway driving pressure as a target to individualize positive-end-expiratory pressure (PEEP) setting in mechanically ventilated patients at risk for postoperative respiratory failure.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>We conducted a multicenter, pragmatic, assessor-masked, randomized trial among adult patients undergoing emergency abdominal surgery in 22 hospitals in France. Patients were assigned 1:1 to receive individually adjusted highest PEEP targeting a driving pressure &lt; 13 cmH₂O after an initial recruitment maneuver (intervention group) or to a fixed PEEP level of 5 cmH₂O (control group). The primary outcome was a composite of postoperative respiratory failure (failure to wean from the ventilator or the composite of reintubation or curative non-invasive ventilation) or all-cause mortality at 30 days. Secondary outcomes included components of the composite primary outcome.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>The primary outcome occurred in 87 out of 338 (25.7%) intervention patients and in 69 out of 341 (20.2%) control patients (difference, 5.5%; 95% confidence interval [CI] − 0.8 to 11.8; relative risk, 1.27; 95%CI 0.96–1.68; <i>p</i> = 0.08). The difference was primarily due to an increased incidence of reintubation or need for curative non-invasive ventilation among intervention patients (difference, 7.1%; 95% CI 2.5–11.9; relative risk, 1.97; 95% CI 1.24–3.11; <i>p</i> = 0.004). Other secondary outcomes did not differ.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>Among patients at risk for postoperative respiratory failure after emergency abdominal surgery, a strategy of individually adjusted highest PEEP in targeting driving pressure lower than 13 cmH₂O did not reduce postoperative respiratory failure or death.</p><h3 data-test=\"abstract-sub-heading\">Trial registration</h3><p>ClinicalTrials.gov Identifier: NCT03987789.</p>","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"26 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144923953","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}