Intensive Care Medicine最新文献

{"title":"Beyond classical boundaries: rethinking ICU access in acute leukemia","authors":"Guillaume Berton,Norbert Vey","doi":"10.1007/s00134-026-08623-y","DOIUrl":"https://doi.org/10.1007/s00134-026-08623-y","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"1 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149020709","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":"A multicenter randomized, double-blinded placebo-controlled phase 2 trial to evaluate safety and efficacy of ilofotase alfa in patients at risk for kidney injury following open heart surgery.","authors":"Louis Mourisse, Marlies Ostermann, Steven Thiessen, Alexander Dumoulin, Alexander P J Vlaar, Eric Hoste, Selim Mosbahi, Antoine Schneider, Alexander Zarbock, Johannes Boehm, Peter Rosenberger, Matthias Thielmann, Eric Dubois, Jonah Powell-Tuck, Kamran Baig, Wencke Renette, Ingrid Meex, Margreet Klop-Rhiel, Krijna Opschoor, Wim Vandenberghe, Matthias Siepe, Christian Strauss, Felix Wirth, Matthias Winkel, Liesbeth Hof, Maarten Kraan, Juliane Bernholz, Peter Pickkers","doi":"10.1007/s00134-026-08596-y","DOIUrl":"https://doi.org/10.1007/s00134-026-08596-y","url":null,"abstract":"<p><strong>Introduction: </strong>Acute impairment of kidney function after cardiac surgery is common and associated with an increased morbidity and mortality. Ilofotase alfa has demonstrated potential to attenuate renal injury through its immunomodulatory effects. We evaluated the safety and efficacy of ilofotase alfa in preventing renal functional impairment in cardiac surgery patients.</p><p><strong>Methods: </strong>This phase 2, multi-center, randomized, double-blinded, placebo-controlled trial employing a two-arm, parallel-group design randomized adult patients at a high risk of renal functional impairment after on-pump cardiac surgery. Patients with a pre-existent estimated glomerular filtration rate of 25-65 ml/min/1.73m² scheduled to undergo complex cardiac surgery were eligible. Patients received two intravenous doses (128 mg) of ilofotase alfa or placebo perioperatively. The primary endpoint was the ratio between the highest serum creatinine levels within five days postoperative relative to the pre-operative level (sCrRatio). The secondary endpoint was major adverse kidney events up to day 60 (MAKE60).</p><p><strong>Results: </strong>In total, 244 patients were randomized of whom 204 received two doses and were included in the trial analysis: 109 patients were treated with ilofotase alfa and 95 received placebo. The mean±SD sCrRatio in the ilofotase alfa group was 1.21±0.42, compared to 1.27±0.50 for placebo (p=0.31). MAKE60 incidence was 15.9% in the ilofotase alfa group and 15.4% in the placebo group (p=0.87). No safety concerns were raised.</p><p><strong>Conclusion: </strong>Administration of ilofotase alfa did not attenuate short- and longer-term renal function loss in patients at a high risk of renal functional impairment after on-pump cardiac surgery. No safety concerns of ilofotase alfa emerged.</p><p><strong>Trial registration: </strong>EUCT Number: 2023-505859-45 US IND Number: 117 605 ClinicalTrials.gov ID: NCT06168799.</p>","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":""},"PeriodicalIF":22.0,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149016726","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":"Rehabilitation and the post-intensive care syndrome across the recovery continuum: a narrative review.","authors":"Stefan J Schaller, Teresa Cardoso, Sabrina Eggmann, Martina Hermann, Cheryl E Hickmann, Rahel Naef, Margo van Mol, Simone Piva, Emilio Rodriguez-Ruiz, Mahan Sadjadi, Akos Tiboldi, Greet Van den Berghe, Marion Wiegele, David McWilliams, Björn Weiss","doi":"10.1007/s00134-026-08600-5","DOIUrl":"10.1007/s00134-026-08600-5","url":null,"abstract":"<p><strong>Purpose: </strong>Improved survival from critical illness has produced a growing population of intensive care unit (ICU) survivors with new or worsened physical, cognitive, and mental-health impairment, defined as post-intensive care syndrome (PICS), and frequent distress among families/caregivers (PICS-family, PICS-F). This narrative review synthesises the evidence in adults treated in high-resource settings.</p><p><strong>Methods: </strong>Rather than a formal guideline process, we used a structured descriptive approach: for each recommendation, we identified the predominant study design, assessed the consistency of findings, summarised uncertainties, and assigned an evidence-strength label (high, moderate, low, or insufficient).</p><p><strong>Results: </strong>We summarise the definition of PICS and its overlap with related constructs (post-sepsis morbidity, chronic critical illness, post-COVID conditions, and frailty); the mechanisms linking acute injury to persistent disability, including skeletal-muscle pathobiology, neuroinflammation, mitochondrial and neuroendocrine dysfunction, and epigenetic change; and the instruments assessing the three PICS core domains (recommending a two-step assessment approach), as well as quality of life, across the care continuum. We describe preventive and rehabilitative interventions from the ICU (e.g., the ABCDEF bundle that includes light/no sedation, delirium prevention, early mobilisation and family participation) through the ward to the post-hospital phase, the heterogeneous organisation of post-ICU recovery services, PICS-F, the educational and cultural change needed, and the health-system and policy context. PICS-F affects 20-60% of relatives; nurse-led family interventions seem promising.</p><p><strong>Conclusion: </strong>The evidence base remains limited and heterogeneous, preventing firm recommendations. Research priorities include harmonised outcome measurement, phenotyping of recovery trajectories, the optimal dose and timing of rehabilitation, and rigorous comparison of follow-up models.</p>","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":""},"PeriodicalIF":22.0,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148919618","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":"Temporal trends in critical care burden and outcomes of Andes virus-associated hantavirus cardiopulmonary syndrome: a national Chilean cohort.","authors":"Gabriela Meza-Fuentes, Iris Delgado, Pablo A Vial, Alex Godoy-Faúndez, Diego Rivera, Yanara Bernal, Jerónimo Graf, René López","doi":"10.1007/s00134-026-08599-9","DOIUrl":"https://doi.org/10.1007/s00134-026-08599-9","url":null,"abstract":"<p><strong>Purpose: </strong>Andes virus causes hantavirus cardiopulmonary syndrome (HCPS), a severe disease found in central and southern parts of Chile and Argentina. Recently a case-outbreak of HCPS was reported on a cruise ship, therefore contemporary data on organ support and outcomes is required. The objective of this study was to assess organ support use and patient outcomes in patients admitted with HCPS.</p><p><strong>Methods: </strong>We used the Diagnosis-Related Groups (DGR) database to analyse patients admitted in 31 Chilean hospitals between January 1, 2019, and December 31, 2024. They were stratified by the maximal respiratory support received: no respiratory support, non-invasive ventilation (NIV), invasive mechanical ventilation (MV) or extracorporeal membrane oxygenation (ECMO). Hospital length of stay (LOS) and in-hospital mortality were the main outcomes assessed. In-hospital mortality was further analysed by pre-COVID-19 pandemic, pandemic, and post-pandemic periods.</p><p><strong>Results: </strong>A total of 215 patients with HCPS were identified, of whom 69.3% were males and 87% were adults. Of 148 patients who required respiratory support, 14.2% received NIV, 36.5% received MV and 49.3% required ECMO. Hospital LOS was 8 [3-15] days and in-hospital mortality was 20.5%. Case fatality rates were 29.6% for patients receiving MV and 32.9% for those receiving ECMO. The pandemic period was independently associated with higher in-hospital mortality (aOR 2.73 [1.06-7.63]; p = 0.045).</p><p><strong>Conclusion: </strong>HCPS caused by Andes virus remains associated with high in-hospital mortality and substantial amounts of respiratory support, particularly MV and ECMO. Moreover, the COVID-19 pandemic was associated with a significant increase in HCPS mortality.</p>","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":""},"PeriodicalIF":22.0,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148880207","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":"Perioperative ARDS: beyond definitions toward etiology-driven care.","authors":"Stefano Romagnoli, Lorenzo Ball, Samir Jaber","doi":"10.1007/s00134-026-08465-8","DOIUrl":"10.1007/s00134-026-08465-8","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":"2023-2025"},"PeriodicalIF":22.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837534","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":"Imaging in ARDS: physiology-guided decisions in the AI era.","authors":"Lorenzo Ball, Luigi Camporota, Jean-Michel Constantin","doi":"10.1007/s00134-026-08503-5","DOIUrl":"10.1007/s00134-026-08503-5","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":"2003-2005"},"PeriodicalIF":22.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148149810","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":"ARDS management in trauma patients.","authors":"Sergio Lassola, Francesco Cipulli, Eleonora Balzani, Sandra Magnoni, Marco Mastandrea, Riccardo Giovannetti, Simon Rauch, Xavier Monnet, Giacomo Bellani","doi":"10.1007/s00134-026-08581-5","DOIUrl":"10.1007/s00134-026-08581-5","url":null,"abstract":"<p><p>Acute respiratory distress syndrome (ARDS) is a frequent and severe complication in trauma patients, arising from a complex interplay between direct tissue injury, systemic inflammation, and resuscitation-related factors. Although trauma accounts for a minority of ARDS cases overall, its incidence remains high in patients with severe thoracic injury. The pathophysiology is best described by a \"multi-hit\" model, in which the initial traumatic insult is followed by a dysregulated inflammatory response and additional secondary insults, including transfusion, infection, or fat embolism, ultimately leading to alveolar-capillary barrier disruption and respiratory failure. Early identification of patients at risk is crucial and relies on clinical severity scores and multimodal imaging. Thoracic imaging, including chest X-ray, lung ultrasound, and computed tomography, plays a central role in diagnosis, monitoring, and risk stratification. Management is largely supportive and based on lung-protective ventilation strategies, with careful integration of non-invasive respiratory support in selected patients. Pain control, hemodynamic optimization, and timely surgical interventions are key components of care, as they directly influence respiratory mechanics and may prevent progression to ARDS. Special clinical scenarios, including traumatic brain injury and hypothermia, require individualized approaches due to complex brain-lung and systemic interactions. Overall, a multidisciplinary, physiology-driven strategy is essential to optimize outcomes in trauma-related ARDS.</p>","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":"1943-1957"},"PeriodicalIF":22.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13562153/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148828009","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":"An unusual ARDS mimicker.","authors":"Stéphane Bourlet, Salomé Smadja, Shanta Valainathan, Damien Contou","doi":"10.1007/s00134-026-08507-1","DOIUrl":"10.1007/s00134-026-08507-1","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":"2035-2037"},"PeriodicalIF":22.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148204809","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":"Prone positioning in ARDS.","authors":"Stephan Ehrmann, Jie Li, Ling Liu, Claude Guérin","doi":"10.1007/s00134-026-08543-x","DOIUrl":"10.1007/s00134-026-08543-x","url":null,"abstract":"<p><p>Over the past five decades, prone positioning has evolved from single case reports to an evidence-based intervention. Initially used as a rescue therapy, it is now recognized as an integral component of lung-protective mechanical ventilation strategies, applied early in intubated patients with acute respiratory distress syndrome (ARDS) with a PaO₂/F_IO₂ ratio < 150 mmHg. The COVID-19 pandemic further expanded its use to non-intubated patients, the so-called awake prone position (APP), with promising results. APP requires confirmation in non-COVID patients and in a more routine ICU practice. Improved oxygenation is a consistent and well-recognized effect of prone positioning in both intubated and non-intubated patients with ARDS. Beyond its effects on gas exchange, prone positioning mitigates ventilator-induced lung injury by reducing lung stress and strain and may also confer favorable hemodynamic effects. This article reviews the physiologic rationale for prone positioning, evidence from randomized controlled trials, current guideline recommendations, practical aspects of implementation, and ongoing questions in both intubated and non-intubated patients.</p>","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":"1881-1894"},"PeriodicalIF":22.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13562319/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148520154","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":"Acute respiratory distress syndrome in patients with obesity.","authors":"Audrey De Jong, Lorenzo Berra, Gonzalo Hernández","doi":"10.1007/s00134-026-08488-1","DOIUrl":"10.1007/s00134-026-08488-1","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":"1989-1991"},"PeriodicalIF":22.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148029923","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}