Intensive Care Medicine最新文献

{"title":"Altered muscle transcriptome as molecular basis of long-term muscle weakness in survivors from critical illness.","authors":"Ceren Uzun Ayar, Fabian Güiza, Inge Derese, Lies Pauwels, Sarah Vander Perre, Isabel Pintelon, Michaël Casaer, Nathalie Van Aerde, Greet Hermans, Sarah Derde, Lucas Kreiss, Greet Van den Berghe, Ilse Vanhorebeek","doi":"10.1007/s00134-025-07949-3","DOIUrl":"https://doi.org/10.1007/s00134-025-07949-3","url":null,"abstract":"<p><strong>Purpose: </strong>Critically ill patients requiring intensive care unit (ICU) admission suffer from muscle weakness that persists for years, compromising quality-of-life. The pathophysiology of this long-term weakness remains unclear. We hypothesized that former ICU-patients show a long-term abnormal RNA-expression profile, which may contribute to lower long-term strength and for which modifiable risk factors can be identified.</p><p><strong>Methods: </strong>This pre-planned secondary analysis of the EPaNIC-trial compared muscle transcriptomes of 115 former ICU-patients 5 years after critical illness and 30 matched controls with RNA-sequencing, followed by pathway over-representation and differential co-expression analyses of the differentially expressed RNAs. We used multivariable linear regression analyses to identify which of the abnormal RNA-expressions associated with the long-term muscle strength of the patients and to identify potential risk factors for the abnormal RNA-expressions.</p><p><strong>Results: </strong>In former patients, 234 down-regulated and 116 up-regulated RNAs were identified after adjustment for age, sex, and BMI. Pathway over-representation and further molecular and histological analyses indicated impaired mitochondrial energy metabolism, disturbed lipid metabolism, and increased collagen formation/fibrosis in former patients. Abnormal muscle RNA-expression in former patients correlated with lower long-term muscle strength. Several treatments given in-ICU and at 5-year follow-up associated with abnormal RNA-expression, most notably in-ICU early parenteral nutrition (early PN) and glucocorticoid use.</p><p><strong>Conclusion: </strong>Abnormal RNA-expression profiles 5 years after critical illness suggest disrupted mitochondrial function, disturbed lipid metabolism, and fibrosis, associated with lower long-term muscle strength and partly attributable to possibly avoidable risk factors. These findings open perspectives for prevention and possibly treatment of long-term muscle weakness after critical illness.</p><p><strong>Trial registration number and date: </strong>ClinicalTrials.gov-NCT00512122, July 31, 2007.</p>","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":""},"PeriodicalIF":27.1,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144257989","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":"Sodium bicarbonate administration for metabolic acidosis in the intensive care unit: a target trial emulation.","authors":"Sebastiaan Paul Blank, Ruth Miriam Blank, Kevin B Laupland, Alexis Tabah, Denzil Gill, Aashish Kumar, Kyle White, Antony Attokaran, Stephen Luke, Stephen Whebell, Peter Garrett, James McCullough, Philippa McIlroy, Mahesh Ramanan","doi":"10.1007/s00134-025-07979-x","DOIUrl":"https://doi.org/10.1007/s00134-025-07979-x","url":null,"abstract":"<p><strong>Purpose: </strong>Sodium bicarbonate is commonly administered to treat metabolic acidosis in intensive care units (ICUs). There is limited evidence from randomized trials to support this practice, and observational studies show conflicting results. Our aim was to perform a target trial emulation evaluating the effect of bicarbonate therapy on mortality.</p><p><strong>Methods: </strong>Retrospective cohort study using data from 12 Australian ICUs. Inclusion criteria were adults with pH < 7.3 and PCO₂ ≤ 45 mmHg within the first three days. We excluded repeat admissions, toxicology, diabetic ketoacidosis, and pre-existing end-stage renal failure. The treatment intervention was sodium-bicarbonate administration, and the primary outcome was 30-day ICU mortality with ICU discharge as a competing event. We evaluated multiple subgroups, including patients with acute kidney injury, requirement for vasoactive therapy, and pH < 7.2. The primary model utilized a parametric g-computation and rolling entry matching was performed as a sensitivity analysis.</p><p><strong>Results: </strong>We identified 6157 eligible admissions, of which 1764 (29%) received sodium bicarbonate. Bicarbonate therapy was associated with a 1.9% absolute mortality reduction for the primary analysis [risk ratio 0.86, 95% confidence interval (CI) 0.80 to 0.91], and significant benefits were seen across all subgroups evaluated. A similar point estimate of 2.1% was observed in the sensitivity analysis, with a sustained mortality reduction seen at 30 days.</p><p><strong>Conclusion: </strong>In this target trial emulation, bicarbonate administration was associated with a small but statistically significant reduction in mortality for patients with metabolic acidosis. Large sample sizes would be required to demonstrate this effect in a randomized trial.</p>","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":""},"PeriodicalIF":27.1,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144257998","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":"Beyond mortality: a call for long-term outcomes in corticosteroid trials for CAP.","authors":"Ichita Yamamoto","doi":"10.1007/s00134-025-07971-5","DOIUrl":"https://doi.org/10.1007/s00134-025-07971-5","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":""},"PeriodicalIF":27.1,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144257991","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":"Capillary hemoglobin dynamics in CO₂ management after brain injury. Author's reply.","authors":"Shaurya Taran, Mypinder Sekhon, Chiara Robba","doi":"10.1007/s00134-025-07991-1","DOIUrl":"https://doi.org/10.1007/s00134-025-07991-1","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":""},"PeriodicalIF":27.1,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144257992","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":"Telemedicine in critical care.","authors":"Claudia D Spies, Otavio T Ranzani","doi":"10.1007/s00134-025-07955-5","DOIUrl":"https://doi.org/10.1007/s00134-025-07955-5","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":""},"PeriodicalIF":27.1,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144225369","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":"High versus low positive end-expiratory pressure during noninvasive ventilation for hypoxemic respiratory failure: balancing efficacy and lung protection.","authors":"Mohan Giri, Anju Puri, Lan Huang, Shuliang Guo","doi":"10.1007/s00134-025-07950-w","DOIUrl":"https://doi.org/10.1007/s00134-025-07950-w","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":""},"PeriodicalIF":27.1,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144225368","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":"Complex ventilatory dynamics in a patient with flail chest and diaphragmatic dysfunction.","authors":"Atsuko Shono, Ken Tonai, Hisashi Imahase, Shinshu Katayama","doi":"10.1007/s00134-025-07968-0","DOIUrl":"https://doi.org/10.1007/s00134-025-07968-0","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":""},"PeriodicalIF":27.1,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144215736","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 bedside to data and back to bedside: why do we need better data to perform trauma phenotyping and improve trauma care?","authors":"Tobias Gauss, Pierre Bouzat, Julie Josse","doi":"10.1007/s00134-025-07946-6","DOIUrl":"https://doi.org/10.1007/s00134-025-07946-6","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":""},"PeriodicalIF":27.1,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144215737","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":"Shorter antibiotic courses for bloodstream infections can reduce healthcare spending.","authors":"Brett Biebelberg","doi":"10.1007/s00134-025-07952-8","DOIUrl":"https://doi.org/10.1007/s00134-025-07952-8","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":""},"PeriodicalIF":27.1,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144215738","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":"Comparing intravascular and surface cooling methods: a critical look at outcomes for out-of-hospital cardiac arrest patients-author's reply.","authors":"Akil Awad, Martin Jonsson, Josef Dankiewicz, Niklas Nielsen, Per Nordberg","doi":"10.1007/s00134-025-07962-6","DOIUrl":"https://doi.org/10.1007/s00134-025-07962-6","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":""},"PeriodicalIF":27.1,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144208478","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}