Intensive Care Medicine最新文献

{"title":"Temporal trends and prognostic factors in critically ill adult patients with acute leukemia: an individual participant data meta-analysis.","authors":"Dara Chean, Thibault Dupont, Joseph L Nates, Nirmala K Manjappachar, Marijana Medic, Gulbin Aygencel, Corentin Orvain, Achille Kouatchet, Ajay Sheshadri, Tasmea K Haque, Lene Russell, Thomas Pabst, Melda Turkoglu, Marlies Ostermann, Marcio Soares, Tugba Cetintepe, Rena Buckstein, Nahema Issa, Djamel Mokart, Pedro Caruso, Patricia Cornejo-Juarez, David Schnell, Tobias Lahmer, Sofiane Fodil, Etienne Lengliné, David Luque-Paz, Virginie Lemiale, Daniele Poole, Michael Darmon, Elie Azoulay","doi":"10.1007/s00134-026-08449-8","DOIUrl":"https://doi.org/10.1007/s00134-026-08449-8","url":null,"abstract":"<p><strong>Purpose: </strong>Critically ill patients with acute leukemia often require an intensive care unit (ICU) admission. As major therapeutic advances have been made during the last decades, the aim of this study was to assess temporal trends in ICU mortality, and identify prognostic factors to inform clinician decision-making.</p><p><strong>Methods: </strong>We conducted an individual participant data meta-analysis of studies including adults with acute leukemia admitted to the ICU. Patients with a history of allogeneic hematopoietic stem cell transplantation were excluded. Mixed-effects logistic regression models, accounting for center of ICU admission as a random variable, evaluated factors associated with ICU mortality, with particular focus on year of ICU admission, age (> 65 years) and invasive mechanical ventilation.</p><p><strong>Results: </strong>A total of 2003 patients from 55 ICUs across 19 countries were included (median age 58 years [IQR 44-67]; 72% acute myeloid leukemia [AML]; 64% admitted during induction chemotherapy). Invasive mechanical ventilation, vasopressors, and renal replacement therapy were required in 55%, 57%, and 21% of patients, respectively. Crude ICU mortality was 45% overall and 66% among ventilated patients. Age > 65 years (odds ratio (OR) 1.98 [95% CI 1.49-2.64]), diagnosis of AML (OR 1.70 [1.23-2.34]), admission during diagnosis or induction chemotherapy (OR 1.50 [1.08-2.07]), relapsed or refractory disease (OR 2.08 [1.36-3.21]), the need for mechanical ventilation (OR 6.46 [4.84-8.63]), and the need for other life-sustaining therapies (OR 2.21 [1.62-3.02]) were associated with increased ICU mortality. Year of ICU admission was associated with improved survival only among ventilated patients (OR per additional year 0.93 [0.93-0.93]).</p><p><strong>Conclusions: </strong>In this large international individual participant meta-analysis, survival of critically ill patients with acute leukemia improved over time, particularly among those requiring mechanical ventilation. Age and the need for mechanical ventilation and other life-sustaining therapies remain strong, independent predictors of ICU mortality. Future work should integrate frailty and functional assessments to refine prognostic stratification and guide treatment intensity in this complex population.</p><p><strong>Trial registration: </strong>The protocol was registered in PROSPERO (CRD420251046286).</p>","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":""},"PeriodicalIF":21.2,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147814648","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":"Driving pressure and postoperative ARDS: an intraoperative silent alarm?","authors":"Djamel Mokart, Laurent Chow-Chine, Antoine Sannini, Magali Bisbal, Marion Faucher","doi":"10.1007/s00134-026-08457-8","DOIUrl":"https://doi.org/10.1007/s00134-026-08457-8","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":""},"PeriodicalIF":21.2,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147814593","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":"Mechanical ventilation for ICU patients with obesity: current best practices and future directions.","authors":"Ângelo Roncalli, Aurio Fajardo Campoverdi, Alice Gallo de Moraes","doi":"10.1007/s00134-026-08451-0","DOIUrl":"https://doi.org/10.1007/s00134-026-08451-0","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":""},"PeriodicalIF":21.2,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147770505","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":"Stepwise clinical and diagnostic strategy for coma of unknown origin.","authors":"Stein Silva, Miriam Treggiari, Giuseppe Citerio, Robert David Stevens, Marzia De Lucia, Virginia Newcombe, Aurore Thibaut, Nicolas Weiss, Romain Sonneville","doi":"10.1007/s00134-026-08418-1","DOIUrl":"https://doi.org/10.1007/s00134-026-08418-1","url":null,"abstract":"<p><p>Coma represents a critical failure of brain systems regulating arousal and awareness, posing significant diagnostic challenges when its origin is unknown. Accurate and timely diagnosis is essential to identify reversible causes and guide treatment. Here, we propose a comprehensive stepwise diagnostic algorithm integrating clinical examination, electroencephalography, neuroimaging, and laboratory investigations, emphasizing iterative reassessment to inform early decision-making. This approach, grounded in the pathophysiology of coma and current consciousness frameworks, facilitates localization of brain dysfunction and prioritizes detection of treatable etiologies. Emerging neurotechnologies, including advanced MRI and multimodal AI, hold promise for enhancing diagnosis and personalized management. Our framework aims to improve clinical outcomes by promoting systematic, physiology-based evaluation of coma of unknown origin in acute-care settings.</p>","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":""},"PeriodicalIF":21.2,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147770467","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":"Standard of care for rehabilitation in critical illness.","authors":"Carol L Hodgson, Elizabeth Ayre, Tessa Broadley, Lisa Burry, Kelly Casey, Craig Dale, Sabrina Eggmann, Amy Freeman-Sanderson, Michelle E Kho, Michelle Paton, Emma J Ridley, Louise Rose, Stefan J Schaller, Margaret S Herridge","doi":"10.1007/s00134-026-08427-0","DOIUrl":"https://doi.org/10.1007/s00134-026-08427-0","url":null,"abstract":"<p><strong>Background: </strong>Rehabilitation is recognised as a cornerstone of intensive care, essential for optimising functional recovery and reducing long-term disability. Contemporary ICU populations, characterised by advanced age, multimorbidity, and prolonged stays, are at heightened risk of muscle wasting, immobility, frailty, cognitive decline, and functional dependence. Mitigation of these sequelae requires careful interprofessional collaboration for person-centred rehabilitation across the care continuum.</p><p><strong>Content: </strong>This review synthesises evidence from randomised controlled trials, meta-analyses, and clinical practice guidelines on rehabilitation during and after intensive care. Best practice within the ICU begins with early awakening and mobilisation with evidence demonstrating that physical rehabilitation is safe, with low adverse-event rates. Furthermore, multiprofessional strategies that span across ICU, ward, and community are required to address complex problems including physical, cognitive, and psychological sequelae of critical illness.</p><p><strong>Future directions: </strong>Research priorities include detailed reporting of intervention dose (timing, intensity, duration) for both usual care and rehabilitation provided within clinical trials, and development of intervention implementation strategies that enhance uptake and fidelity in routine practice.</p><p><strong>Conclusion: </strong>Rehabilitation is integral to contemporary ICU care, spanning the trajectory of recovery into the community. Within the ICU, it requires interprofessional, experienced healthcare personnel to assess clinical status for safe rehabilitation and to identify an individual's anticipated recovery trajectory. Standardised intervention reporting and implementation-focussed research are essential to advance evidence and improve outcomes for critically ill patients.</p>","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":""},"PeriodicalIF":21.2,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147770508","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":"Which issues should be addressed in future trials regarding the use of corticosteroids in community acquired pneumonia? A survey of REMAP-CAP investigators.","authors":"Nicholas Heming,Kristina E Rudd,Srinivas Murthy,Derek C Angus,Bijan Teja, ","doi":"10.1007/s00134-026-08445-y","DOIUrl":"https://doi.org/10.1007/s00134-026-08445-y","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"21 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147754683","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":"Restrictive nutrition in shock: reassuring renal signals-but no proof of safety.","authors":"Silvia De Rosa,Matthieu Legrand,Michael Joannidis","doi":"10.1007/s00134-026-08437-y","DOIUrl":"https://doi.org/10.1007/s00134-026-08437-y","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"1 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147751234","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":"Risk heterogeneity within hypoinflammatory acute respiratory failure: continuous probabilities identify high-risk patients masked by binary classification.","authors":"Nanditha Venkatesan,Faraaz Ali Shah,William Bain,Zhiyi Yang,Charles S Dela Cruz,Rebecca M Baron,Benjamin Zuchelkowski,Alicia N Rizzo,Sonia Joshi,Antonio Arciniegas,Katherin Zambrano,Hamam Aneis,Florian B Mayr,Alison Morris,Victor B Talisa,Bryan J McVerry,Seyed Mehdi Nouraie,Georgios D Kitsios","doi":"10.1007/s00134-026-08406-5","DOIUrl":"https://doi.org/10.1007/s00134-026-08406-5","url":null,"abstract":"PURPOSEBinary inflammatory subphenotype classification (hyperinflammatory vs. hypoinflammatory) may guide trial enrollment in acute hypoxemic respiratory failure (AHRF), but assumes within-category homogeneity. We determined whether continuous probabilities reveal clinically meaningful heterogeneity.METHODSWe analyzed 575 critically ill adults with AHRF (Pittsburgh Acute Lung Injury Registry) and validated findings in 1134 patients from the EDEN trial, the COVID-19 cohorts, and the RoCI registry. Continuous subphenotype probabilities were calculated using a parsimonious biomarker model (IL-6, sTNFR-1, bicarbonate; probability threshold 0.5). The primary outcome was 90-day mortality.RESULTSAmong 575 patients, 77 patients (13%) were hyperinflammatory and 498 (87%) hypoinflammatory. Hyperinflammatory patients demonstrated prognostic homogeneity (mortality overall 55%, p = 0.72, across tertiles). Hypoinflammatory patients exhibited marked heterogeneity: 90-day mortality increased from 19 to 31% to 40% across probability tertiles (P < 0.001). Restricted cubic spline modeling demonstrated a strong non-linear relationship between continuous probabilities and mortality, with the steepest risk increases occurring below the 0.5 threshold. Clinical severity scores and biomarkers of immune activation increased progressively across hypoinflammatory tertiles (all P < 0.001). Among 330 patients with longitudinal sampling, rising probability trajectories within hypoinflammatory groups predicted 50-100% mortality vs. 16-40% for stable or declining trajectories (all P < 0.001); hyperinflammatory patients had poor outcomes regardless of trajectory. External validation confirmed heterogeneity and preserved non-linear probability-mortality patterns across cohorts. Similar patterns were observed with the procalcitonin-based model.CONCLUSIONSBinary classification obscures substantial prognostic heterogeneity within hypoinflammatory AHRF patients. Continuous probability-based stratification may identify additional trial-eligible high-risk patients and improve enrollment strategies for subphenotype-guided trials.","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"54 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147751233","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":"The ultrasound of silence: author's reply.","authors":"Massimo Antonelli,Hallie C Prescott","doi":"10.1007/s00134-026-08444-z","DOIUrl":"https://doi.org/10.1007/s00134-026-08444-z","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"62 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147751236","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":"Non-invasive intracranial pressure estimation in the intensive care unit: narrative review of methods and clinical applications.","authors":"Edoardo Picetti,Daniele Guerino Biasucci,Elisa Gouvea Bogossian,Sérgio Brasil,Danilo Cardim,Marek Czosnyka,Daniel A Godoy,Gregory W J Hawryluk,Mohammad I Hirzallah,Frank A Rasulo,Carla Bittencourt Rynkowski,Andres M Rubiano,Fabio Silvio Taccone,Chiara Robba","doi":"10.1007/s00134-026-08420-7","DOIUrl":"https://doi.org/10.1007/s00134-026-08420-7","url":null,"abstract":"Despite invasive methods are the gold standard for intracranial pressure (ICP) measurement, several non-invasive techniques (nICP) have been proposed as surrogate, although their use remains insufficiently recognized in clinical practice. These include transcranial Doppler blood flow velocity assessment (arterial or venous), optic nerve sheath diameter (ONSD), automated pupillometry, measurement of skull expansion and compliance, brain imaging, double-depth ophthalmic artery blood flow velocity, and ultrasound time-of-flight. The main limitations of all indirect methods are calibration and zeroing, which constrain the absolute accuracy of non-invasive ICP monitoring. For transcranial Doppler-based methods, the 95% limits of agreement are approximately ± 7-15 mmHg, while for ONSD-based techniques they range from ± 7-10 mmHg. Improved predictive accuracy may be achieved by combining different modalities and applying advanced signal analysis techniques. Importantly, in patients with acute brain injury, nICP can complement invasive monitoring by guiding patient selection for urgent monitoring, facilitating brain assessment in moderate traumatic brain injury, and assisting management in patients with coagulopathy. In the general intensive care population, nICP may provide valuable information after cardiac arrest, liver failure, and sepsis. In the emergency department, early detection of intracranial hypertension helps prevent missing the \"golden hour\" of brain care. Finally, nICP is particularly relevant in low-resource settings, where intensive care facilities are limited.","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"295 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147751222","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}