Intensive Care Medicine最新文献

{"title":"Is acute respiratory distress syndrome a preventable disease?","authors":"Hemang Yadav, John J Marini, Ognjen Gajic","doi":"10.1007/s00134-026-08493-4","DOIUrl":"10.1007/s00134-026-08493-4","url":null,"abstract":"<p><strong>Purpose: </strong>Sixty years after its initial description, the epidemiology and pathophysiology of acute respiratory distress syndrome (ARDS) have evolved substantially. This narrative review examines whether ARDS is a preventable disease, evaluating the evidence for successful prevention of iatrogenic phenotypes and the challenges that remain for noniatrogenic causes.</p><p><strong>Methods: </strong>We reviewed the published literature on ARDS prevention, including evidence from clinical trials, population-based epidemiologic studies, implementation research, and biological subphenotyping studies, synthesized through the framework of the multiple hit hypothesis.</p><p><strong>Results: </strong>For iatrogenic phenotypes, ARDS prevention has substantially succeeded. Transfusion-related acute lung injury has declined dramatically following male-predominant plasma policies. Lung-protective ventilation initiated in emergency departments and operating rooms has reduced both ARDS incidence and mortality. Bundled care approaches combining restrictive fluid and transfusion strategies, aspiration precautions, and early antimicrobials have further reduced iatrogenic lung injury. What remains under the ARDS label is an increasingly heterogeneous collection of conditions driven by upstream host-pathogen interactions and biological phenotype. Pharmacologic prevention trials in unselected populations have been consistently disappointing, likely because biologically distinct subphenotypes respond differently to treatment. Additionally, the population-attributable fraction of death from ARDS is modest, suggesting that even successful prevention may not translate into proportional mortality reduction.</p><p><strong>Conclusion: </strong>Extending prevention beyond iatrogenic causes will require precision approaches: phenotype-targeted pharmacotherapy, individualized mechanical ventilation, and systematic implementation of evidence-based practices across the care continuum.</p>","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":"1827-1832"},"PeriodicalIF":22.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148198855","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 emerging role of diaphragm neurostimulation in ARDS.","authors":"Martin Dres, Leo Heunks, Ewan C Goligher","doi":"10.1007/s00134-026-08443-0","DOIUrl":"10.1007/s00134-026-08443-0","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":"1996-1998"},"PeriodicalIF":22.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147868282","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":"Balancing lung and brain: physiological strategies for ARDS management in acute brain injury.","authors":"Chiara Robba, Nekane Romero-García, Shaurya Taran, Rafael Badenes, Luigi Camporota, Patricia R M Rocco, Mariangela Pellegrini, Lise Piquilloud, Antoine Roquilly, Matthieu Schmidt, Fabio Silvio Taccone, Sarah Wahlster, Nicolò Antonino Patroniti","doi":"10.1007/s00134-026-08595-z","DOIUrl":"10.1007/s00134-026-08595-z","url":null,"abstract":"<p><p>Acute respiratory distress syndrome (ARDS) is a common and clinically significant complication in patients with acute brain injury (ABI), affecting up to one-third of critically ill individuals and contributing to increased mortality, prolonged mechanical ventilation, and worse neurological outcomes. The coexistence of ARDS and ABI creates a fundamental therapeutic dilemma: strategies that protect the lung may adversely affect cerebral physiology, whilst neuroprotective targets may compromise respiratory management. This narrative review examined the pathophysiological interactions between the injured lung and brain, highlighting the competing effects of key ventilatory variables. Lung-protective ventilation, including low tidal volume and higher positive end-expiratory pressure (PEEP), reduces ventilator-induced lung injury but may increase arterial carbon dioxide (PaCO₂), resulting in intracranial hypertension and impaired cerebral perfusion. Conversely, strict control of PaCO₂ and optimisation of cerebral perfusion may necessitate deviations from conventional ARDS strategies. Oxygenation targets further illustrate this tension, as both hypoxaemia and hyperoxaemia can exacerbate secondary brain injury. We synthesised current evidence on respiratory support, including non-invasive strategies, invasive mechanical ventilation, rescue therapies such as prone positioning and extracorporeal support, and pharmacological interventions, with emphasis on their differential effects on pulmonary and cerebral physiology. Attention was also given to the role of multimodal neuromonitoring, including intracranial pressure and brain tissue oxygenation, as tools to individualise ventilatory management and reconcile competing organ priorities. Overall, available data support a shift from protocolised approaches towards physiology-driven, patient-specific strategies that integrate lung mechanics, gas exchange and cerebral haemodynamics in patients with concomitant ARDS and ABI. Future studies should incorporate combined lung and brain endpoints to define strategies that simultaneously minimise ventilator-induced lung injury and secondary brain injury.</p>","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":"1958-1973"},"PeriodicalIF":22.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13562141/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148840063","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":"Corticosteroids in ARDS: old controversies, new insights, and future directions.","authors":"Tara Daoud, Jesus Villar, Djillali Annane","doi":"10.1007/s00134-026-08567-3","DOIUrl":"10.1007/s00134-026-08567-3","url":null,"abstract":"<p><p>Corticosteroids modulate key inflammatory and fibroproliferative pathways involved in ARDS through genomic and non-genomic glucocorticoid receptor signaling. Advances in ARDS pathophysiology have highlighted the importance of timing, inflammatory burden, and host response in determining treatment efficacy. Clinical evidence supports corticosteroid use in moderate-to-severe ARDS, particularly in COVID-19 ARDS and severe community-acquired pneumonia, with reductions in mortality and duration of mechanical ventilation. However, treatment effects remain heterogeneous across etiologies and biological subphenotypes. Recent identification of hyperinflammatory and hypoinflammatory ARDS phenotypes suggests that corticosteroid responsiveness is not uniform. Hyperinflammatory phenotypes and septic ARDS appear more likely to benefit, whereas evidence remains limited or conflicting in influenza-associated and non-septic ARDS. Long-term effects and adverse outcomes, including metabolic complications and ICU-acquired weakness, remain insufficiently characterized. Future research is increasingly focused on precision medicine approaches integrating biomarkers, adaptive platform trials, and phenotype-guided strategies. Emerging developments include lung-targeted corticosteroid delivery systems and selective glucocorticoid receptor modulators designed to improve efficacy while reducing systemic toxicity. Corticosteroids should therefore be considered a context-dependent therapy whose benefit is influenced by etiology, disease stage, inflammatory phenotype, and timing of administration.</p>","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":"1928-1942"},"PeriodicalIF":22.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148721502","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 the ventilator: deploying adjuvant therapies across the course of ARDS.","authors":"Laveena Munshi, Gordon Rubenfeld, Hannah Wunsch","doi":"10.1007/s00134-026-08594-0","DOIUrl":"10.1007/s00134-026-08594-0","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":"2026-2030"},"PeriodicalIF":22.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148880234","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":"Acute respiratory distress mimickers: a practical approach for intensivists.","authors":"Pierre Bay, Aude Gibelin, Nicolas de Prost","doi":"10.1007/s00134-026-08496-1","DOIUrl":"10.1007/s00134-026-08496-1","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":"1992-1995"},"PeriodicalIF":22.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148149797","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":"Heart-lung interactions in ARDS: practical bedside implications.","authors":"Maurizio Cecconi, Francesca Collino, Michael R Pinsky","doi":"10.1007/s00134-026-08583-3","DOIUrl":"10.1007/s00134-026-08583-3","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":"2031-2034"},"PeriodicalIF":22.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148701220","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":"Should the esophageal balloon catheter be deployed to personalize ventilation of ARDS?","authors":"John J Marini, Niall D Ferguson, Daniel Talmor","doi":"10.1007/s00134-026-08572-6","DOIUrl":"10.1007/s00134-026-08572-6","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":"2010-2013"},"PeriodicalIF":22.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148812868","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":"Surviving Sepsis Campaign beyond survival: aligning sepsis care with patient goals.","authors":"Jozef Kesecioglu, Victoria Metaxa, Elie Azoulay","doi":"10.1007/s00134-026-08590-4","DOIUrl":"https://doi.org/10.1007/s00134-026-08590-4","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":""},"PeriodicalIF":22.0,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148864853","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-associated liver injury: from liver-test risk signals to immunobiology-guided precision medicine.","authors":"Antonios Katsounas, Emmanuel Tsochatzis, Jordi Rello","doi":"10.1007/s00134-026-08593-1","DOIUrl":"10.1007/s00134-026-08593-1","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":""},"PeriodicalIF":22.0,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148864830","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}