Intensive Care Medicine最新文献

{"title":"Effect of the 1-h bundle on mortality in patients with suspected sepsis in the emergency department: faster is better for the sicker ones!","authors":"Romain Jouffroy, Benoît Vivien, Papa Gueye","doi":"10.1007/s00134-024-07594-2","DOIUrl":"10.1007/s00134-024-07594-2","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":"1938-1939"},"PeriodicalIF":27.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142125652","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":"European Society of Intensive Care Medicine guidelines on end of life and palliative care in the intensive care unit.","authors":"Jozef Kesecioglu, Katerina Rusinova, Daniela Alampi, Yaseen M Arabi, Julie Benbenishty, Dominique Benoit, Carole Boulanger, Maurizio Cecconi, Christopher Cox, Marjel van Dam, Diederik van Dijk, James Downar, Nikolas Efstathiou, Ruth Endacott, Alessandro Galazzi, Fiona van Gelder, Rik T Gerritsen, Armand Girbes, Laura Hawyrluck, Margaret Herridge, Jan Hudec, Nancy Kentish-Barnes, Monika Kerckhoffs, Jos M Latour, Jan Malaska, Annachiara Marra, Stephanie Meddick-Dyson, Spyridon Mentzelopoulos, Mervyn Mer, Victoria Metaxa, Andrej Michalsen, Rajesh Mishra, Giovanni Mistraletti, Margo van Mol, Rui Moreno, Judith Nelson, Andrea Ortiz Suñer, Natalie Pattison, Tereza Prokopova, Kathleen Puntillo, Kathryn Puxty, Samah Al Qahtani, Lukas Radbruch, Emilio Rodriguez-Ruiz, Ron Sabar, Stefan J Schaller, Shahla Siddiqui, Charles L Sprung, Michele Umbrello, Marco Vergano, Massimo Zambon, Marieke Zegers, Michael Darmon, Elie Azoulay","doi":"10.1007/s00134-024-07579-1","DOIUrl":"10.1007/s00134-024-07579-1","url":null,"abstract":"<p><p>The European Society of Intensive Care Medicine (ESICM) has developed evidence-based recommendations and expert opinions about end-of-life (EoL) and palliative care for critically ill adults to optimize patient-centered care, improving outcomes of relatives, and supporting intensive care unit (ICU) staff in delivering compassionate and effective EoL and palliative care. An international multi-disciplinary panel of clinical experts, a methodologist, and representatives of patients and families examined key domains, including variability across countries, decision-making, palliative-care integration, communication, family-centered care, and conflict management. Eight evidence-based recommendations (6 of low level of evidence and 2 of high level of evidence) and 19 expert opinions were presented. EoL legislation and the importance of respecting the autonomy and preferences of patients were given close attention. Differences in EoL care depending on country income and healthcare provision were considered. Structured EoL decision-making strategies are recommended to improve outcomes of patients and relatives, as well as staff satisfaction and mental health. Early integration of palliative care and the use of standardized tools for symptom assessment are suggested for patients at high risk of dying. Communication training for ICU staff and printed communication aids for families are advocated to improve outcomes and satisfaction. Methods for enhancing family-centeredness of care include structured family conferences and culturally sensitive interventions. Conflict-management protocols and strategies to prevent burnout among healthcare professionals are also considered. The work done to develop these guidelines highlights many areas requiring further research.</p>","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":"1740-1766"},"PeriodicalIF":27.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11541285/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142365150","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":"Navigating the ventilator in acute brain injury: a forceful call for clarity and caution.","authors":"Rogerio da Hora Passos, Igor Dovorake Lourenço, Cilene Saghabi de Medeiros Silva, Thiago Domingos Correa, Arnaldo Alves da Silva","doi":"10.1007/s00134-024-07550-0","DOIUrl":"10.1007/s00134-024-07550-0","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":"1959-1960"},"PeriodicalIF":27.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141734032","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":"Further gut microbiota and critical illness issues.","authors":"Michal Pruc, Krzysztof Kurek, Damian Swieczkowski, Lukasz Szarpak","doi":"10.1007/s00134-024-07580-8","DOIUrl":"10.1007/s00134-024-07580-8","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":"1957-1958"},"PeriodicalIF":27.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141975630","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 relationship of malnutrition, frailty, and sarcopenia in critical care.","authors":"Jacek Smereka, Michal Pruc, Maciej Cyran, Lukasz Szarpak","doi":"10.1007/s00134-024-07595-1","DOIUrl":"10.1007/s00134-024-07595-1","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":"1949-1950"},"PeriodicalIF":27.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141999870","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":"Clinical phenotyping uncovers heterogeneous associations between corticosteroid treatment and survival in critically ill COVID-19 patients.","authors":"Niklas Bruse, Anna Motos, Rombout van Amstel, Eckart de Bie, Emma J Kooistra, Aron Jansen, Dirk van Lier, Jason Kennedy, Daniel Schwarzkopf, Daniel Thomas-Rüddel, Jesus F Bermejo-Martin, Ferran Barbe, Nicolette F de Keizer, Michael Bauer, Johannes G van der Hoeven, Antoni Torres, Christopher Seymour, Lonneke van Vught, Peter Pickkers, Matthijs Kox","doi":"10.1007/s00134-024-07593-3","DOIUrl":"10.1007/s00134-024-07593-3","url":null,"abstract":"<p><strong>Purpose: </strong>Disease heterogeneity in coronavirus disease 2019 (COVID-19) may render the current one-size-fits-all treatment approach suboptimal. We aimed to identify and immunologically characterize clinical phenotypes among critically ill COVID-19 patients, and to assess heterogeneity of corticosteroid treatment effect.</p><p><strong>Methods: </strong>We applied consensus k-means clustering on 21 clinical parameters obtained within 24 h after admission to the intensive care unit (ICU) from 13,279 COVID-19 patients admitted to 82 Dutch ICUs from February 2020 to February 2022. Derived phenotypes were reproduced in 6225 COVID-19 ICU patients from Spain (February 2020 to December 2021). Longitudinal immunological characterization was performed in three COVID-19 ICU cohorts from the Netherlands and Germany, and associations between corticosteroid treatment and survival were assessed across phenotypes.</p><p><strong>Results: </strong>We derived three phenotypes: COVIDICU1 (43% of patients) consisted of younger patients with the lowest Acute Physiology And Chronic Health Evaluation (APACHE) scores, highest body mass index (BMI), lowest PaO₂/FiO₂ ratio, and a 90-day in-hospital mortality rate of 18%. COVIDICU2 patients (37%) had the lowest BMI, were older and had higher APACHE scores and mortality rate (24%) than COVIDICU1. Patients with COVIDICU3 (20%) were the eldest with the most comorbidities, the highest APACHE scores, acute kidney injury and metabolic dysregulations, and the highest mortality rate (47%). These patients also displayed the most pronounced inflammatory response. Corticosteroid therapy started at day 5 [2-9] after ICU admission and administered for 5 [3-7] days was associated with an increased risk for 90-day mortality in patients with the COVIDICU1 and COVIDICU2 phenotypes (hazard ratio [HR] 1.59 [1.09-2.31], p = 0.015 and HR 1.79 [1.42-2.26], p < 0.001, respectively), but not in patients with the COVIDICU3 phenotype (HR 1.08 [0.76-1.54], p = 0.654).</p><p><strong>Conclusion: </strong>Our multinational study identified three distinct clinical COVID-19 phenotypes, each exhibiting marked differences in demographic, clinical, and immunological features, and in the response to late and short-term corticosteroid treatment.</p>","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":"1884-1896"},"PeriodicalIF":27.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11541258/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142055502","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":"Skin decontamination to prevent infections in the intensive care unit.","authors":"Marc Bonten, Bruno Martins Tomazini, Stephan Harbarth","doi":"10.1007/s00134-024-07701-3","DOIUrl":"10.1007/s00134-024-07701-3","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":""},"PeriodicalIF":27.1,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142557757","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":"Protocolized fluid balance neutralization during continuous renal replacement therapy.","authors":"Raghavan Murugan, John Prowle, William Beaubien-Souligny","doi":"10.1007/s00134-024-07698-9","DOIUrl":"10.1007/s00134-024-07698-9","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":""},"PeriodicalIF":27.1,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142557756","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":"Preventing ventilator-associated pneumonia non-pharmacologically","authors":"Manuel Krone, Christian Seeber, Peter Nydahl","doi":"10.1007/s00134-024-07696-x","DOIUrl":"https://doi.org/10.1007/s00134-024-07696-x","url":null,"abstract":"In critically ill, intubated patients on intensive care unit (ICU), ventilator-associated pneumonia (VAP) is a significant complication contributing to substantial mortality, morbidity, and prolonged stays, which in turn requires considerable financial and natural resources [1, 2]. Preventing VAP is therefore essential for improving patients’ safety and enhancing the outcomes’ cost-effectiveness and sustainability of healthcare [1].","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"10 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142536891","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 I perform diaphragmatic ultrasound in the intensive care unit","authors":"Greet Hermans, Alexandre Demoule, Leo Heunks","doi":"10.1007/s00134-024-07688-x","DOIUrl":"https://doi.org/10.1007/s00134-024-07688-x","url":null,"abstract":"The diaphragm is a thin, dome-shaped muscle, comprising a costal and crural part, and a non-contracting central tendon. Muscle fiber activation shortens and thickens the diaphragm in the zone of apposition, moving the dome caudally. Diaphragm function, defined as the ability to contract and generate pressure, has substantial reserve capacity. However, clinically significant diaphragm weakness, a marked reduction in its force-generating ability, is an uncommon reason of respiratory failure causing admission to the intensive care unit (ICU). It more commonly develops in critically ill patients, even early during their ICU stay. The pathophysiology hereof remains incompletely understood, with disuse and inflammation recognized as key risk factors [1]. Critical illness-associated diaphragm weakness may complicate weaning and worsen outcomes [2]. Therefore, in specific clinical settings, evaluation of diaphragm function in the ICU is important. Ultrasound allows to noninvasively visualize the diaphragm function and activity at the bedside. In this article, we present our clinical experience with diaphragm ultrasound in daily care.","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"105 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142520072","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}