Intensive Care Medicine最新文献

{"title":"What intensivists need to know about cytomegalovirus infection in immunocompromised ICU patients","authors":"Sara Fernández, Pedro Castro, Elie Azoulay","doi":"10.1007/s00134-024-07737-5","DOIUrl":"https://doi.org/10.1007/s00134-024-07737-5","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose</h3><p>Advances in therapeutic care are leading to an increase in the number of patients living with overt immunosuppression. These patients are at risk of cytomegalovirus (CMV) infection and disease that can lead to or develop during ICU admission. This manuscript aims to describe the clinical presentation, risk factors, and management of CMV infection and disease in this patient population.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>We conducted a literature search in PubMed up to April 2024, focusing on CMV infection and disease in patients with overt immunosuppression (hematopoietic stem cell and solid organ transplantation, solid or hematologic malignancies, HIV infection, immunosuppressive drugs, including corticosteroids, and primary immunodeficiencies) admitted to the intensive care unit (ICU). As there is limited ICU-specific data on CMV in immunosuppressed patients, many of the findings were extrapolated from the general literature.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>CMV infection and disease in immunocompromised critically ill patients is associated with increased mortality and presents significant management challenges. Clinical manifestations are diverse, shaped by the underlying immune deficiency and primary disease. Pneumonia and encephalitis are among the most severe CMV end-organ diseases. CMV infection may also increase the risk of secondary infections and induce life-threatening conditions, such as thrombotic microangiopathy. Importantly, CMV reactivation is not synonymous with CMV disease, and qPCR testing of body fluids cannot reliably differentiate between viral shedding and tissue-invasive infection, which requires histopathological confirmation. Ganciclovir is commonly the first-line anti-viral, though maribavir shows potential for patients unresponsive to other antivirals. Identifying patients who require prophylactic or preemptive antiviral therapy is essential.</p><h3 data-test=\"abstract-sub-heading\">Conclusions</h3><p>CMV infection and disease in critically ill immunocompromised patients pose a unique challenge for intensivists. The broad spectrum of clinical presentations and the difficulty in distinguishing CMV-related symptoms from other causes require a high level of clinical suspicion. Accurate interpretation of nucleic acid load levels and careful evaluation of CMV’s pathogenic role when it is found are critical. Further studies focusing specifically on CMV infection and disease in critically ill immunocompromised patients are needed to optimize management strategies.</p>","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"5 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142934522","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":"Role of nuclear imaging techniques in the management of infections in critically ill patients.","authors":"Camilla Genovese, Besma Mahida, François Rouzet, Jean-François Timsit, Michael Thy","doi":"10.1007/s00134-024-07773-1","DOIUrl":"https://doi.org/10.1007/s00134-024-07773-1","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":""},"PeriodicalIF":27.1,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142948304","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":"Sepsis subtypes and differential treatment response to vitamin C: biological sub-study of the LOVIT trial","authors":"J. Rynne, M. Mosavie, Marie-Hélène Masse, Julie Ménard, Marie-Claude Battista, David M. Maslove, Lorenzo del Sorbo, Charles St-Arnaud, Frederick DAragon, Alison Fox-Robichaud, Emmanuel Charbonney, Neill K. J. Adhikari, François Lamontagne, M. Shankar-Hari","doi":"10.1007/s00134-024-07733-9","DOIUrl":"https://doi.org/10.1007/s00134-024-07733-9","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose</h3><p>We hypothesised that the biological heterogeneity of sepsis may highlight sepsis subtypes with differences in response to intravenous vitamin C treatment in the Lessening Organ Dysfunction with VITamin C (LOVIT) trial. Our aims were to identify sepsis subtypes and to test whether sepsis subtypes have differences in treatment effect to vitamin C and describe putative biological effects of vitamin C treatment.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>We measured biomarkers of inflammation, at baseline and at 7 days post-randomisation, in 457/863 (53.0%) of participants with plasma samples in the LOVIT trial. We used agglomerative hierarchical clustering on log₁₀-transformed baseline data of 26 biomarkers to identify sepsis subtypes. We analysed differences in vitamin C treatment effect with regression models incorporating robust standard errors to report odds ratio and 95% confidence intervals (OR(95% CI)). All analyses were completed blinded to treatment allocation.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Our cohort included 233/429 (54.3%) allocated to vitamin C and 224/434 (51.6%) allocated to placebo. A three-subtype model best explained the variance in our data. Subtype-2 had the highest, and subtype-3 had the lowest levels of inflammatory response. In paired longitudinal samples, vitamin C did not have discernible anti-inflammatory effects, with anti-inflammatory effects related to time since randomisation and concomitant hydrocortisone treatment. The treatment effect estimates (OR (95% CI)) for subtype-1, subtype-2 and subtype-3 were 1.04 (0.63–1.73), 1.33 (0.53–3.36) and 1.95 (0.85–4.49), respectively (test of heterogeneity <i>p</i> = 0.002).</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>We report three sepsis subtypes based on inflammatory response profile. No subtype benefitted from vitamin C treatment in the LOVIT trial, with heterogeneity of treatment effect in the magnitude of harm.</p><h3 data-test=\"abstract-sub-heading\">Trial registration</h3><p>Funded by the Lotte and John Hecht Memorial Foundation; LOVIT ClinicalTrials.gov number, NCT03680274.</p>","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"207 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142934442","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":"Spontaneous pulmonary-twist secondary to Legionnaire’s disease","authors":"S. Cunat, C. Matau, A. Olland, J. Demiselle","doi":"10.1007/s00134-024-07768-y","DOIUrl":"https://doi.org/10.1007/s00134-024-07768-y","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"7 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142934526","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":"Utilization and outcomes of life-supporting interventions in older ICU patients in Japan: a nationwide registry study","authors":"Junji Shiotsuka, Tomoyuki Masuyama, Shigehiko Uchino, Yusuke Sasabuchi, Reina Suzuki, Shohei Ono, Koichi Yoshinaga, Yusuke Iizuka, Masamitsu Sanui","doi":"10.1007/s00134-024-07759-z","DOIUrl":"https://doi.org/10.1007/s00134-024-07759-z","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose</h3><p>The purpose of this study is to describe the implementation of life-supporting interventions and the short-term outcomes of older patients in ICUs in Japan.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>All adult patients admitted to ICUs participating in the Japanese Intensive Care Patient Database (JIPAD) from April 1, 2015, to March 31, 2022, were eligible for inclusion. Information, including life-supporting interventions, was retrieved from the database. Patients were divided into six age groups. The primary outcome of interest was the proportion of receiving a composite of the following interventions: mechanical ventilation, continuous renal replacement therapy, and veno-venous or veno-arterial extracorporeal membrane oxygenation.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Data of a total of 233,093 patients were analyzed. The median age was 71 years, with 18.2% of the patients in their 80s, 5303 patients in their 90s (2.3%), and 67 patients in their 100s. Many life-supporting interventions were provided to older patients. The proportion of patients older than 90 years who received the composite interventions decreased from 40.4% in 18–59 to 27.6% in 90–99. Non-invasive ventilation (NIV) use increased with age, resulting in a consistent proportion of patients receiving either NIV or mechanical ventilation until their 90s. ICU mortality for patients aged 80 years or older was 5.6%, and hospital mortality for this age group was 12.9%. Approximately half of the patients in their 80s and 60% of those older than 90 years did not return home.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>Although life-supporting interventions tended to decrease with age, a considerable number of patients of advanced age still received these interventions.</p>","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"117 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142934520","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":"Dynamic nature of airway resistance in ARDS: methodological concerns in MPR calculations.","authors":"Ziyi He, Chenxi Wang, Huichuan Tian","doi":"10.1007/s00134-024-07771-3","DOIUrl":"https://doi.org/10.1007/s00134-024-07771-3","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":""},"PeriodicalIF":27.1,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142948299","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":"Left ventricular diastolic dysfunction is prevalent but not associated with mortality in patients with septic shock","authors":"Philippe Vignon, Cyril Charron, Annick Legras, Frédérique Musset, Michel Slama, Gwenaël Prat, Stein Silva, David Vandroux, Grégoire Müller, Bruno Levy, Florence Boissier, Bruno Evrard, Marine Goudelin, Stéfan Mankikian, Mai-Anh NAY, Julien Jabot, Béatrice Riu, Pierre Bailly, Julien Maizel, Julie Léger, Antoine Vieillard-Baron","doi":"10.1007/s00134-024-07748-2","DOIUrl":"https://doi.org/10.1007/s00134-024-07748-2","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose</h3><p>Prognostic impact of left ventricular diastolic dysfunction (LVDD) in septic shock patients has not been determined using current diagnostic guidelines. We assessed the relation between LVDD during the first 3 days following intensive care unit (ICU) admission for septic shock and Day-28 mortality.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>This prospective, multicenter, observational study enrolled 402 patients (age: 63 ± 13 year; 59% male; SAPS II: 59 ± 20; SOFA: 9.4 ± 3.6; mechanical ventilation: 74%) with septic shock (Sepsis-3 definition). Patients were echocardiographically assessed within 12 h after admission (Day 1), on Day 2, Day 3, at ICU and at hospital discharge (or Day 28 whichever occurred first), using 2016 American-European guidelines.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>LVDD was present at least once between Day 1 and 3 in 304 patients (76%), and in 56% and 44% of patients at ICU discharge and on Day 28 (or hospital discharge), respectively (43% of patients with follow-up). Seventy-eight of 172 patients (45%) exhibited similar LV diastolic properties throughout the study period while 58 patients (34%) improved their LVDD at follow-up (lower grade: n = 9, regression: n = 49). Day-28 mortality was not statistically different between patients with and without LVDD (80/304 [26%] vs. 25/88 [28%]; OR: 0.900 [0.530–1.527]; p = 0.696). Similar results were obtained when adjusting the multivariate model on SAPSII or SOFA score on admission, together with fluid balance during the first three days of ICU stay (OR: 0.838 [0.471–1.491]: p = 0.547 and OR: 0.887 [0.513–1.534]: p = 0.668, respectively).</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>LVDD was highly prevalent in patients with septic shock but not associated with mortality. It appeared improving in one-third of survivors.</p><h3 data-test=\"abstract-sub-heading\">Trial registration</h3><p>PRODIASYS study registered on ClinicalTrials (September 27, 2016, number NCT02918214).</p>","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"43 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142934521","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":"Benzodiazepine and z-drug prescribing in critical care survivors and the risk of rehospitalisation or death due to falls/trauma and due to any cause: a retrospective matched cohort study using the UK Clinical Practice Research Datalink","authors":"Elizabeth T. Mansi, Christopher T. Rentsch, Richard S. Bourne, Annie Jeffery, Bruce Guthrie, Nazir I. Lone","doi":"10.1007/s00134-024-07762-4","DOIUrl":"https://doi.org/10.1007/s00134-024-07762-4","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose</h3><p>Benzodiazepines and z-drugs are often prescribed to critical care survivors due to high prevalence of mental health problems and insomnia. However, their safety has not been studied in this population.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>Retrospective cohort study of 28,678 adult critical care survivors hospitalised in 2010 and 2018: 4844 prescribed benzodiazepines or z-drugs, matched to 23,834 unexposed survivors using UK Clinical Practice Research Datalink linked datasets. Multivariable stratified Cox regression was used to estimate the adjusted hazards ratio (adjHR) with 95% confidence intervals (CI) of community benzodiazepine/z-drug prescribing and falls/trauma-related events, as well as all-cause 30-day rehospitalisation or death. We performed subgroup analyses on patients without pre-critical care admission prescription of benzodiazepines/z-drugs (‘treatment-naïve’), and sensitivity analyses excluding patients receiving palliative care after discharge.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Prescription of benzodiazepines or z-drugs showed no conclusive evidence of increased risk of falls/trauma-related events in the whole cohort (adjHR 1.27; 95%CI 0.76–2.14) or in treatment-naïve individuals (adjHR 1.79; 95%CI 0.61–5.26), because estimates lacked precision due to low event rates. For all-cause rehospitalisation or death, benzodiazepines/z-drugs were associated with increased risk (whole cohort adjHR 1.24, 95%CI 1.14–1.36; treatment-naïve adjHR 1.66, 95%CI 1.49–1.86). However, after excluding patients treated for palliative care, the association persisted only in treatment-naïve individuals (whole cohort adjHR 1.08, 95%CI 0.98–1.19; treatment-naïve adjHR 1.42, 95%CI1.25–1.62).</p><h3 data-test=\"abstract-sub-heading\">Conclusions</h3><p>Community benzodiazepine and z-drug prescribing was associated with increased risk of all-cause, but not falls/trauma-related, rehospitalisations and deaths in critical care survivors who had not been prescribed these before hospitalisation. Clinicians should balance the possible benefits with the likely harms of prescribing these drugs in this potentially vulnerable patient group.</p>","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"15 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142934519","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":"Best clinical model predicting extubation failure: a diagnostic accuracy post hoc analysis","authors":"Patricia Rodríguez Villamizar, Arnaud W. Thille, Margarita Márquez Doblas, Jean-Pierre Frat, Pilar Leal Sanz, Elena Alonso, Victoria País, Guillermo Morales, Laura Colinas, Alicia Propín, Aida Fernández Olivares, María Martínez Balaguer, Diego Alvaredo Rodrigo, Gonzalo Hernández","doi":"10.1007/s00134-024-07758-0","DOIUrl":"https://doi.org/10.1007/s00134-024-07758-0","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose</h3><p>Predicting extubation failure remains a clinical challenge. This study aimed to determine diagnostic accuracy of models used at the bed side.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>Post hoc analysis of 2341 patients at all risk included in five multicenter randomized trials. Diagnostic accuracy of three clinical prediction models was compared: 3-factors model including age &gt; 65y, chronic heart or pulmonary disease; 4-factors model adding prolonged mechanical ventilation; and 11-factors model including age &gt; 65 years, ≥ 2 comorbidities, prolonged mechanical ventilation, acute heart failure as the primary indication for mechanical ventilation, moderate-to-severe chronic obstructive pulmonary disease, APACHE II score &gt; 12 on extubation day, airway patency problems, inability to deal with respiratory secretions, not simple weaning, obesity, or hypercapnia at the end of the spontaneous breathing trial. Crude and adjusted for spontaneous breathing trial (SBT) models were compared for all-cause reintubation at 7 days using Youden and Kappa indexes.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>The 3-factors model had a very low global prediction capability (Youden index 0.08 and Kappa index 0.04); the 4-factors and 11-factors models had low global prediction capability (Youden index 0.12 and 0.16, and Kappa index 0.06 and 0.07, respectively). Aggressive SBT strategies (pressure support ≥ 7 cm H₂O with or without positive end-expiratory pressure) were associated with extubation failure risk (<i>p</i> &lt; 0.001). All adjusted models had low diagnostic capability (0.08/0.03, 0.07/0.03, and 0.06/0.02 respectively).</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>Based on these results, the 3-factors model reported a very low diagnostic accuracy, and the 4 or 11-factors models showed similar low accuracy. No improvement was observed after adjusting for other aspects of weaning.</p>","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"5 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142935021","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":"How we use ultrasound in the management of weaning from mechanical ventilation","authors":"Pieter R. Tuinman, Zhonghua Shi, Leo Heunks","doi":"10.1007/s00134-024-07753-5","DOIUrl":"https://doi.org/10.1007/s00134-024-07753-5","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"15 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142934523","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}