Intensive Care Medicine最新文献

{"title":"From preparedness to resilience: rethinking critical care strategies for future pandemics.","authors":"Manuel Ruiz-Bailén, María Del Carmen Ruiz-Iniesta","doi":"10.1007/s00134-026-08571-7","DOIUrl":"10.1007/s00134-026-08571-7","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":"2228-2231"},"PeriodicalIF":22.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148722189","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":"Digital twins to analyse lung injury indices produced by a new protocol for transitioning to airway pressure release ventilation.","authors":"William Joy, Declan G Bates, Timothy E Scott, Luigi Camporota, Sina Saffaran","doi":"10.1007/s00134-026-08564-6","DOIUrl":"10.1007/s00134-026-08564-6","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":"2252-2254"},"PeriodicalIF":22.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148663676","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":"Understanding the neuroscience of communicating serious news.","authors":"Katerina Rusinova, Robert Rusina, Steven Z Pantilat","doi":"10.1007/s00134-026-08578-0","DOIUrl":"10.1007/s00134-026-08578-0","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":"2232-2235"},"PeriodicalIF":22.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13623768/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148701260","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":"Preoxygenation when noninvasive ventilation is unavailable: authors' reply.","authors":"Yonathan Freund, Ian Ward Abdalla Maia, Aaron E Robinson, Theophile Vieux","doi":"10.1007/s00134-026-08580-6","DOIUrl":"10.1007/s00134-026-08580-6","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":"2257-2258"},"PeriodicalIF":22.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148678356","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":"State-of-the-art review: ß-blockade in critical illness.","authors":"Marlies Ostermann, Daniel De Backer, Emilie Belley-Cote, Maurizio Cecconi, Michelle S Chew, Joanna C Dionne, Steven M Hollenberg, Stephan M Jakob, Salmaan Kanji, Richard Leach, Mark J McPhail, Xavier Monnet, Andrea Morelli, Mervyn Singer, Erika Wilkman, Giuseppe Citerio","doi":"10.1007/s00134-026-08574-4","DOIUrl":"10.1007/s00134-026-08574-4","url":null,"abstract":"<p><p>Critical illness is characterised by activation of the sympathetic nervous system which plays an important adaptive role in maintaining cardiovascular stability and organ perfusion. However, excessive sustained adrenergic stimulation may become maladaptive, contributing to tachyarrhythmias, myocardial injury, immune dysregulation, metabolic derangements, and organ dysfunction. This state-of-the-art review evaluates the role of ß-blocker therapy as a potential strategy to modulate or counteract the adrenergic response in critically ill patients. Current data suggest that their use remains highly context-dependent and controversial. There are established benefits in selected scenarios, including acute myocardial infarction, tachyarrhythmias, hypertensive emergencies, thyroid storm, and prevention of variceal bleeds. In contrast, evidence is limited or conflicting in septic shock, traumatic brain injury, acute heart failure, burns and other critical care syndromes. Concerns include impairment of compensatory cardiovascular responses, reduction of cardiac output, hypotension, and compromised organ perfusion. Furthermore, the safety and efficacy of ß-blockade appear to depend on the type and dose of ß-blocker, patient phenotype, timing of initiation, hemodynamic reserve, and whether therapy represents continuation of chronic treatment, withdrawal and re-initiation, or de novo initiation during acute illness. This review highlights major gaps in knowledge, including the absence of reliable indicators to identify patients most likely to benefit, uncertainty regarding optimal treatment targets and monitoring strategies, and limited randomised evidence in heterogeneous ICU populations. A phenotype-driven, physiology-guided approach that accounts for hemodynamic status, sympathetic spectrum and timing of ß-blocker therapy is likely required to optimise outcomes.</p>","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":"2160-2177"},"PeriodicalIF":22.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148827974","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":"Ultra-early versus early adjunctive vasopressin initiation after norepinephrine escalation in septic shock: a target trial emulation.","authors":"Takaya Nakashima, Taiga Ichinomiya, Mikio Nakajima, Tomohiro Shinozaki, Junichiro Shibata, Tadahiro Goto, Shuntaro Sato, Tetsuya Hara","doi":"10.1007/s00134-026-08575-3","DOIUrl":"10.1007/s00134-026-08575-3","url":null,"abstract":"<p><strong>Purpose: </strong>The optimal timing of adjunctive vasopressin after norepinephrine escalation in septic shock remains uncertain. We emulated a target trial comparing ultra-early vasopressin initiation within 0-3 h with early initiation within > 3-6 h after the norepinephrine infusion rate reached 0.25 μg/kg/min or higher.</p><p><strong>Methods: </strong>We emulated a target trial using electronic health record databases (MIMIC-IV 2008-2022 and eICU-CRD 2014-2015). Adults with septic shock who reached the norepinephrine threshold before vasopressin use were eligible. We used the clone-censor-weight method to estimate cumulative incidence curves under the ultra-early and early initiation strategies and compared them via the weighted Cox model.</p><p><strong>Results: </strong>Among 3810 eligible patients, after cloning, 744 clones adhered to the ultra-early strategy and 293 clones adhered to the early strategy. The weighted 28-day mortality risk was 48.1% under the ultra-early strategy and 53.0% under the early strategy (risk difference, - 5.0 percentage points; 95% confidence interval [CI] - 6.8 to - 3.2), with a restricted mean survival time difference of 1.58 days (95% CI 1.21-1.92) and a hazard ratio (HR) of 0.82 (95% CI 0.78-0.85). Ultra-early initiation was associated with lower renal replacement therapy (HR, 0.68; 95% CI 0.63-0.74), continuous renal replacement therapy (HR, 0.61; 95% CI 0.55-0.68), and medically treated arrhythmia (HR, 0.91; 95% CI 0.83-0.99), but not with lower acute kidney injury.</p><p><strong>Conclusions: </strong>Among adults with septic shock whose norepinephrine infusion reached 0.25 μg/kg/min or higher before vasopressin use, vasopressin initiation within 0-3 h was associated with lower 28-day mortality than initiation within > 3-6 h.</p>","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":"2085-2095"},"PeriodicalIF":22.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148706344","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":"Decades of intensive care medicine trials: what randomised evidence has changed, corrected, and still questions to resolve.","authors":"Ignacio Martin-Loeches, Marc Leone, Craig M Coopersmith, Flavia R Machado, Carol Hodgson, Carolyn S Calfee, Marcus J Schultz","doi":"10.1007/s00134-026-08579-z","DOIUrl":"10.1007/s00134-026-08579-z","url":null,"abstract":"<p><strong>Background: </strong>Randomised controlled trials (RCTs) have reshaped intensive care medicine (ICM), a discipline defined by acute, interacting organ failures, time-sensitive decisions, biological uncertainty, and heterogeneous recovery trajectories. Many interventions supported by strong physiological rationale failed to improve patient-centred outcomes, whereas durable advances often emerged from optimisation of supportive care, avoidance of iatrogenic harm, and reassessment of established practices.</p><p><strong>Methods: </strong>We conducted an interpretive historical review of landmark multicentre RCTs in adult ICM from the early 1990s onwards. PubMed searches, reference lists from major trials and reviews, and international guidelines were used to identify trials with conceptual influence on practice, guidelines, physiological reasoning, therapeutic strategy, research priorities, de-implementation, or outcome framing. Evidence was organised into overlapping paradigms rather than rigid chronological periods.</p><p><strong>Findings: </strong>Across haemodynamic support, mechanical ventilation, renal replacement therapy, antimicrobial treatment, nutrition, glucose control, transfusion, and sedation, landmark RCTs describe more than therapeutic expansion. Early biological and haemodynamic trials exposed the limits of reductionist strategies in syndromic critical illness. Protocol-driven approaches improved timeliness and consistency, but later pragmatic trials showed that rigid targets and invasive algorithms often added little once high-quality usual care was established. More recent trials challenge the assumption that greater intervention intensity improves outcomes, emphasising timing, disease phase, baseline risk, heterogeneity, patient selection, and treatment-related harm. Modern ICM RCTs have clarified not only what works, but what can be reduced, delayed, avoided, or applied selectively. Future progress requires biologically informed, context-sensitive trials focussed on meaningful survival, recovery, and long-term function.</p>","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":"2178-2193"},"PeriodicalIF":22.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148721347","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":"Publisher Correction: 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/s00134-026-08588-y","DOIUrl":"10.1007/s00134-026-08588-y","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":"2263"},"PeriodicalIF":22.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13623775/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148706329","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":"Beyond technology: the case for a family-focused ICU as disruptive innovation.","authors":"Ban Chi Ho Tsui, Howard Ho-Wai Chan, Michael Junhao Qiu, Hassan Haseeb, Jonathan Jenkin Tsui","doi":"10.1007/s00134-026-08525-z","DOIUrl":"10.1007/s00134-026-08525-z","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":"2259-2260"},"PeriodicalIF":22.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148264273","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":"Distinct weaning phenotypes in patients unsuccessful in weaning from invasive mechanical ventilation: a secondary analysis of the WEAN SAFE cohort.","authors":"Reginald Caldecott, Yueyun Zhu, Bairbre A McNicholas, Emanuele Rezoagli, Shaurya Taran, Tài Pham, Leo Heunks, Giacomo Bellani, Laurent Brochard, Andrew J Simpkin, John G Laffey","doi":"10.1007/s00134-026-08592-2","DOIUrl":"10.1007/s00134-026-08592-2","url":null,"abstract":"<p><strong>Objective: </strong>To characterise the trajectories and outcomes of patients who enter the weaning process but fail to wean from invasive mechanical ventilation (MV).</p><p><strong>Methods: </strong>In this secondary analysis of the WorldwidE AssessmeNt of Separation of pAtients From ventilatory assistancE (WEAN SAFE) cohort, we examined weaning duration and intensity, decisions to withdraw or withhold life-sustaining therapy (WLST), and clinical outcomes in patients not weaning from invasive ventilation. The primary outcome was ICU mortality.</p><p><strong>Results: </strong>Of the 5664 patients in the study population, 1270 (22.4%) never underwent a separation attempt (SA), while 4394 (77.6%) had at least one SA; of these, 664 (15.1%) eventually failed weaning from invasive MV at day 90, while 3730 (65.9%) successfully weaned. Failed-Wean patients had the longest duration of invasive ventilation and longest ICU stay of all groups. Compared with Successful-Wean, Failed-Wean patients underwent more separation attempts, but fewer attempted extubations and more reintubations and tracheostomies. ICU mortality was 78% in Failed-Wean compared with 2% in Successful-Wean. Three clinically distinct Failed-Wean phenotypes were identified, distinguished by separation attempt count and WLST timing: Phenotype A (single SA + WLST), Phenotype B (single SA, no WLST), and Phenotype C (> 1 SA). A failed-first SA was strongly associated with WLST decisions. In this cohort, a WLST decision was associated with a higher hazard of ICU mortality and shorter median time to ICU death.</p><p><strong>Conclusions: </strong>Three weaning failure phenotypes were identified with distinct clinical profiles, weaning trajectories, and outcomes. A strong relationship exists between failed first separation attempts, WLST decision, and the risk of death, which deserves further investigation.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov, NCT03255109.</p>","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":"2039-2057"},"PeriodicalIF":22.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148919613","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}