Intensive Care Medicine最新文献_第10页

European Society of Intensive Care Medicine (ESICM) 2025 clinical practice guideline on fluid therapy in adult critically ill patients: part 2—the volume of resuscitation fluids 欧洲重症医学会（ESICM） 2025年成人危重病人液体治疗临床实践指南：第2部分-复苏液体的量

IF 38.9 1区医学

Intensive Care Medicine Pub Date : 2025-03-31 DOI: 10.1007/s00134-025-07840-1

Armand Mekontso Dessap, Fayez AlShamsi, Alessandro Belletti, Daniel De Backer, Anthony Delaney, Morten Hylander Møller, Segolène Gendreau, Glenn Hernandez, Flavia R. Machado, Mervyn Mer, Manuel Ignacio Monge Garcia, Sheila Nainan Myatra, Zhiyong Peng, Anders Perner, Michael R. Pinsky, Sameer Sharif, Jean-Louis Teboul, Antoine Vieillard-Baron, Waleed Alhazzani

{"title":"European Society of Intensive Care Medicine (ESICM) 2025 clinical practice guideline on fluid therapy in adult critically ill patients: part 2—the volume of resuscitation fluids","authors":"Armand Mekontso Dessap, Fayez AlShamsi, Alessandro Belletti, Daniel De Backer, Anthony Delaney, Morten Hylander Møller, Segolène Gendreau, Glenn Hernandez, Flavia R. Machado, Mervyn Mer, Manuel Ignacio Monge Garcia, Sheila Nainan Myatra, Zhiyong Peng, Anders Perner, Michael R. Pinsky, Sameer Sharif, Jean-Louis Teboul, Antoine Vieillard-Baron, Waleed Alhazzani","doi":"10.1007/s00134-025-07840-1","DOIUrl":"https://doi.org/10.1007/s00134-025-07840-1","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Objective</h3><p>This European Society of Intensive Care Medicine (ESICM) guideline provides evidence-based recommendations on the volume of early resuscitation fluid for adult critically ill patients.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>An international panel of experts developed the guideline, focusing on fluid resuscitation volume in adult critically ill patients with circulatory failure. Using the PICO format, questions were formulated, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was applied to assess evidence and formulate recommendations.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>In adults with sepsis or septic shock, the guideline suggests administering up to 30 ml/kg of intravenous crystalloids in the initial phase, with adjustments based on clinical context and frequent reassessments (very low certainty of evidence). We suggest using an individualized approach in the optimization phase (very low certainty of evidence). No recommendation could be made for or against restrictive or liberal fluid strategies in the optimization phase (moderate certainty of no effect). For hemorrhagic shock, a restrictive fluid strategy is suggested after blunt trauma (moderate certainty) and penetrating trauma (low certainty), with fluid administration for non-traumatic hemorrhagic shock guided by hemodynamic and biochemical parameters (ungraded best practice). For circulatory failure due to left-sided cardiogenic shock, fluid resuscitation as the primary treatment is not recommended. Fluids should be administered cautiously for cardiac tamponade until definitive treatment and guided by surrogate markers of right heart congestion in acute pulmonary embolism (ungraded best practice). No recommendation could be made for circulatory failure associated with acute respiratory distress syndrome.</p><h3 data-test=\"abstract-sub-heading\">Conclusions</h3><p>The panel made four conditional recommendations and four ungraded best practice statements. No recommendations were made for two questions. Knowledge gaps were identified, and suggestions for future research were provided.</p>","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"49 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143737145","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

Metabolic septic shock sub-phenotypes, stability over time and association with clinical outcome 代谢性脓毒性休克亚型、随时间变化的稳定性以及与临床结果的关系

IF 38.9 1区医学

Intensive Care Medicine Pub Date : 2025-03-31 DOI: 10.1007/s00134-025-07859-4

David B. Antcliffe, Elsa Harte, Humma Hussain, Beatriz Jiménez, Charlotte Browning, Anthony C. Gordon

{"title":"Metabolic septic shock sub-phenotypes, stability over time and association with clinical outcome","authors":"David B. Antcliffe, Elsa Harte, Humma Hussain, Beatriz Jiménez, Charlotte Browning, Anthony C. Gordon","doi":"10.1007/s00134-025-07859-4","DOIUrl":"https://doi.org/10.1007/s00134-025-07859-4","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose</h3><p>Machine learning has shown promise to detect useful subgroups of patients with sepsis from gene expression and protein data. This approach has rarely been deployed in metabolomic datasets. Metabolomic data are of interest as they capture effects from the genome, proteome, and environmental. We aimed to discover metabolic sub-phenotypes of septic shock, examine their temporal stability and association with clinical outcome.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>Analysis was performed in two double-blind randomized trials in septic shock (LeoPARDS (1402 samples from 470 patients) and VANISH (493 samples from 173 patients)). Patients were included soon after the onset of shock and had serum collected at up to four time points. Metabolic clusters were identified from 474 metabolites using k-means clustering in LeoPARDS and predicted in VANISH with an elastic net classifier.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Three sub-phenotypes were found. The main determinants of cluster membership were lipid species, especially lysophospholipids. Low lysophospholipid sub-phenotypes were associated with higher circulating cytokine levels. Persistence of low lysophospholipid sub-phenotypes was associated with higher mortality compared to the high lysophospholipid sub-phenotype (LeoPARDS: cluster 2 odds ratio 3.66 (95% CI 1.88–7.20), <i>p</i> = 0.0001, cluster 3 2.49 (1.29–4.81), <i>p</i> = 0.006; VANISH: cluster 2 4.13 (1.17–15.61), <i>p</i> = 0.03), cluster 3 3.22 (1.09–9.92), <i>p</i> = 0.04, vs cluster 1). We found no heterogeneity of treatment effect for any of the trial interventions by baseline metabolic sub-phenotype.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>Three metabolic subgroups exist in septic shock which evolve over time. Persistence of low lysophospholipid sub-phenotypes is associated with mortality. Monitoring these subgroups could help identify patients at risk of poor outcome and direct novel therapies such as lysophospholipid supplementation.</p><h3 data-test=\"abstract-sub-heading\">Registration</h3><p>Clinicaltirals.gov Identifiers, VANISH: ISRCTN 20769191, LeoPARDS: ISRCTN12776039.</p>","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"73 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143737146","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

Balancing spontaneous ventilation and lung protection in ARDS: insights from the PC-SV trial. 在ARDS中平衡自发通气和肺保护：来自PC-SV试验的见解。

IF 27.1 1区医学

Intensive Care Medicine Pub Date : 2025-03-27 DOI: 10.1007/s00134-025-07866-5

Yuxian Wang, Kai Liu, Ling Zhu, Jieqiong Song, Ming Zhong

引用次数: 0

Supporting the bereaved child in the adult ICU: let’s take the first step! 支持成人重症监护病房的丧儿：让我们迈出第一步！

IF 38.9 1区医学

Intensive Care Medicine Pub Date : 2025-03-27 DOI: 10.1007/s00134-025-07876-3

Bruna Brandao Barreto, Mariana Luz, Julia Tavares-Pereira, Dimitri Gusmao-Flores

引用次数: 0

Innovations in ICM: transparency, integrity and accessibility ICM的创新：透明度、完整性和可及性