Intensive Care Medicine最新文献

{"title":"Buffering in critical illness: keeping it simple.","authors":"Lorenzo Giosa, Luigi Camporota, Thomas Langer","doi":"10.1007/s00134-025-07832-1","DOIUrl":"10.1007/s00134-025-07832-1","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":"994-995"},"PeriodicalIF":27.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440737","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":"Correction: Pulmonary herpes simplex virus and cytomegalovirus in patients with acute respiratory distress syndrome related to COVID-19.","authors":"Leonoor S Boers, Frank van Someren Gréve, Jarne M van Hattem, Justin de Brabander, Tom Zwaan, Hugo van Willigen, Marion Cornelissen, Menno de Jong, Tom van der Poll, JanWillem Duitman, Janke Schinkel, Lieuwe D J Bos","doi":"10.1007/s00134-025-07854-9","DOIUrl":"10.1007/s00134-025-07854-9","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":"1000-1002"},"PeriodicalIF":27.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12129848/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143978878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low versus high positive end expiratory pressure in noninvasive ventilation for hypoxemic respiratory failure: a multicenter randomized controlled trial","authors":"Jun Duan, Xiaoyi Liu, Weiwei Shu, Shijing Tian, Mingjin Yang, Mengyi Ma, Anchao Song, Qin Liu, Ke Wang, Fuxun Yang, Tao Huang, Lei Jiang, Yueling Hong, Xiaoli Han, Zhi Ao, Linfu Bai, Yiwei Min, Wenhui Hu, Jiao He","doi":"10.1007/s00134-025-07902-4","DOIUrl":"https://doi.org/10.1007/s00134-025-07902-4","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose</h3><p>To assess whether high positive end expiratory pressure (PEEP) reduces the rate of noninvasive ventilation (NIV) failure in hypoxemic patients.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>This multicenter, open-label, randomized controlled trial was conducted across seven ICUs in China. Hypoxemic patients who received NIV via oronasal or nasal mask were randomized 1:1 to either low PEEP (5 cmH₂O) or high PEEP (10–15 cmH₂O) groups, with inspiratory positive airway pressure (IPAP) set at 10–20 cmH₂O and 15–20 cmH₂O, respectively. The primary outcome was NIV failure, defined as intubation, death, or therapy withdrawal (refusal of intubation despite need).</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Between January 11, 2022, and August 31, 2024, 380 patients (190 per group) were enrolled in an intention-to-treat analysis. NIV failure occurred in 43% (82/190) of the low PEEP group and 32% (61/190) of the high PEEP group (absolute difference: 11.1%, 95% CI 1.3–20.5%, p = 0.034). Within 72 h post-randomization, the low PEEP group exhibited lower PaO₂/FiO₂ ratios (mean difference: − 31 mmHg, 95% CI − 38 to − 24) and higher tidal volume (0.8 mL/kg predicted body weight, 95% CI 0.5–1.1) than the high PEEP group. However, the low PEEP group required higher support pressure (mean difference: 2.9 cmH₂O, 95% CI 2.7–3.1). Adverse events did not differ between the groups.</p><h3 data-test=\"abstract-sub-heading\">Conclusions</h3><p>High PEEP during NIV may reduce treatment failure in patients with acute hypoxemic respiratory failure, although this benefit may be partially confounded by higher tidal volume observed in the low PEEP group. However, the interpretation of this effect should be carried out with caution as the study has insufficient statistical power to detect a significant difference.</p><h3 data-test=\"abstract-sub-heading\">Graphical abstract</h3>","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"26 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143889624","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":"Correspondence about the VENTIBRAIN study","authors":"Russell Chabanne, Claire Dahyot-Fizelier, Matthieu Jabaudon","doi":"10.1007/s00134-025-07905-1","DOIUrl":"https://doi.org/10.1007/s00134-025-07905-1","url":null,"abstract":"No Abstract","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"19 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143889626","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":"Persistent severe AKI is bad—where to go now?","authors":"Zoltan Endre, Paola Rebora, Marlies Ostermann","doi":"10.1007/s00134-025-07900-6","DOIUrl":"https://doi.org/10.1007/s00134-025-07900-6","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"8 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143884710","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":"Decision analysis model of rapid versus deferred antibiotic initiation in patients with suspected sepsis in the emergency department","authors":"Terra M. Hill, Lauren T. Kerivan, Katherine A. Vilain, Sam Windham, Nima Sarani, Steven Q. Simpson, Christopher A. Guidry","doi":"10.1007/s00134-025-07899-w","DOIUrl":"https://doi.org/10.1007/s00134-025-07899-w","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose</h3><p>Sepsis remains a major health concern with high associated mortality. Adequate treatment involves the use of antibiotic therapy although the timing of antibiotics is controversial. A decision analysis model of antibiotic initiation was created to determine optimal management of patients with suspected sepsis.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>Two decision trees were created using data from the published literature. A limited model used mortality as the primary outcome using the impact of antibiotic timing on rates of progression to shock and in-hospital mortality. The primary model included mortality and stewardship-related factors such as antibiotic avoidance and antibiotic-associated adverse events. Rapid initiation of antibiotics was defined as universal antibiotic administration within 3 h of presentation whereas deferred initiation included administration up to 6 h. Sensitivity analyses were performed to evaluate the effectiveness of each option.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>When considering only mortality, rapid initiation was the optimal strategy. When considering stewardship-related factors, rapid initiation of antibiotics maximized utility in only 40.6% of model iterations. One-way sensitivity analysis demonstrated rapid initiation of antibiotics was optimal when initiation times were above 1.33 h and the prevalence of infection was above 89.5%. Two-way sensitivity analysis demonstrated that as time to antibiotics increased, rate of true infection above which rapid antibiotics is optimal drops from just under 91% to approximately 88.5%.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>We constructed decision analysis models to characterize optimal conditions for antibiotic initiation in suspected sepsis. Our model suggests that the prevalence of infection needs to be approximately 90% for rapid initiation of antibiotics to be the optimal strategy.</p>","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"7 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143884273","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":"Prone positioning during veno-venous extracorporeal membrane oxygenation: a systematic review and meta-analysis","authors":"Tommaso Pettenuzzo, Eleonora Balzani, Nicolò Sella, Marco Giani, Mara Bassi, Valentina Fincati, Rossella Cescon, Giorgia Pacchiarini, Giovanna Pandolfo, Roberta Ceccato, Lars Grønlykke, Dawid L. Staudacher, Nicolas Nesseler, Senta Jorinde Raasveld, Michele Carron, Elisa Pistollato, Giulia Mormando, Francesco Zarantonello, Alessandro De Cassai, Annalisa Boscolo, Emanuele Rezoagli, Giuseppe Foti, Paolo Navalesi","doi":"10.1007/s00134-025-07877-2","DOIUrl":"https://doi.org/10.1007/s00134-025-07877-2","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose</h3><p>The evidence supporting the benefit on clinical outcomes of prone positioning during veno-venous extracorporeal membrane oxygenation (V-V ECMO) for acute hypoxemic respiratory failure remains inconclusive. We aimed to assess the association of prone positioning, compared to no prone positioning, with 28-day mortality and other clinical outcomes in different patient subgroups.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>A systematic review and meta-analysis of randomized and non-randomized controlled trials (RCTs) using a random-effects model was conducted. An electronic database search up to September 1st, 2024 was performed (PROSPERO CRD42024517602). The RoB 2 and ROBINS-I tools were used for risk of bias assessments.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>We analyzed two RCTs and 20 non-RCTs (3,465 patients). Compared to no prone positioning, the use of prone positioning was associated with lower 28-day (odds ratio [OR] 0.64, 95% confidence interval [CI] 0.42–0.98, p = 0.040, I² = 66%, low certainty of evidence [CoE]) and hospital mortality (OR 0.67, 95% CI 0.54–0.83, p &lt; 0.001, I² = 39%, low CoE), despite fewer 28-day ventilator-free days and longer ECMO duration. Younger age (p = 0.005), a higher sequential organ failure assessment (SOFA) score (p = 0.022), non-Covid-19 etiology (p = 0.003), and lower rates of prone positioning before cannulation (p = 0.049) were associated with a greater benefit from prone positioning.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>In this analysis, among patients supported with V-V ECMO for acute hypoxemic respiratory failure, we observed improved 28-day and hospital mortality in those who received prone positioning, compared to those who did not. However, these findings do not imply causation. Further research is needed to clarify the role of prone positioning in this population.</p>","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"7 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143884709","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":"Reevaluating the safety of shortened antibiotic treatment: a critical evaluation of the EUROBACT-2 study","authors":"Michal Pruc, Maciej Maslyk, Andrzej Krupa, Lukasz Szarpak","doi":"10.1007/s00134-025-07919-9","DOIUrl":"https://doi.org/10.1007/s00134-025-07919-9","url":null,"abstract":"No Abstract","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"18 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143885013","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":"Optimizing non-intubated respiratory support in COVID-19: evaluating the impact of bundle of care strategy on awake prone positioning tolerance. Author’s reply","authors":"Mariano Esperatti, Nora Fuentes, Matias Olmos","doi":"10.1007/s00134-025-07904-2","DOIUrl":"https://doi.org/10.1007/s00134-025-07904-2","url":null,"abstract":"No Abstract","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"46 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143884990","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 surface to core: does better cooling make a difference after cardiac arrest?","authors":"Claudio Sandroni, Louis Delamarre, Jerry P. Nolan","doi":"10.1007/s00134-025-07908-y","DOIUrl":"https://doi.org/10.1007/s00134-025-07908-y","url":null,"abstract":"Hypoxic-ischaemic brain injury (HIBI) is the primary cause of death in patients who are admitted to the intensive care unit (ICU) after out-of-hospital cardiac arrest (OHCA) [1]. Controlled hypothermia has been widely used to mitigate HIBI, following initial trials showing potential benefit from temperature control at 32–36 °C for 12–24 h after arrest [2]. However, in 2021, the TTM-2 randomised clinical trial (RCT)—that assigned 1900 adults with post-OHCA HIBI to controlled hypothermia at 33 °C or controlled normothermia with early treatment of fever (body temperature ≥ 37.8 °C) for 24 h followed by avoidance of fever in both arms for the first 72 h—showed no difference in mortality at 6 months [3]. Arrhythmia resulting in haemodynamic compromise was more common in the hypothermia arm. These results led the European Resuscitation Council (ERC) and the European Society of Intensive Care Medicine (ESICM) to recommend actively preventing fever for HIBI instead of hypothermia for the first 72 h in adult patients with HIBI [4].","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"24 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143880323","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}