Intensive Care Medicine最新文献

{"title":"Integrating multidisciplinary expertise in postoperative noninvasive ventilation management. Authors’ reply","authors":"Audrey De Jong, Joris Pensier, Samir Jaber","doi":"10.1007/s00134-024-07633-y","DOIUrl":"https://doi.org/10.1007/s00134-024-07633-y","url":null,"abstract":"No Abstract","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"14 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142489150","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":"Terlipressin use in hepatorenal syndrome-acute kidney injury in cirrhosis","authors":"Florence Wong, Stephen C. Pappas","doi":"10.1007/s00134-024-07681-4","DOIUrl":"https://doi.org/10.1007/s00134-024-07681-4","url":null,"abstract":"No Abstract","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"41 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142487156","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 borders: the impact of international fellowships on professional and personal development","authors":"Stephan von Düring, Damian Ratano, Brian Cuthbertson","doi":"10.1007/s00134-024-07684-1","DOIUrl":"https://doi.org/10.1007/s00134-024-07684-1","url":null,"abstract":"Intensive Care Medicine (ICM) is a specialized field that has evolved significantly from its origins, where critically ill patients were managed by general hospital physicians [1]. Over time, ICM has developed into a distinct discipline requiring intensivists to possess a deep understanding of human pathophysiology, critical illness, and the management of life-threatening conditions, while also leading interprofessional teams [2, 3]. The coronavirus disease 2019 (COVID-19) pandemic highlighted the importance of skilled intensivists, and the increasing demand for intensive care unit (ICU) beds globally indicates a growing need for these specialists [4].","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"45 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142487081","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":"Causal inference can lead us to modifiable mechanisms and informative archetypes in sepsis","authors":"J. Kenneth Baillie, Derek Angus, Katie Burnham, Thierry Calandra, Carolyn Calfee, Alex Gutteridge, Nir Hacohen, Purvesh Khatri, Raymond Langley, Avi Ma’ayan, John Marshall, David Maslove, Hallie C. Prescott, Kathy Rowan, Brendon P. Scicluna, Christopher Seymour, Manu Shankar-Hari, Nathan Shapiro, W. Joost Wiersinga, Mervyn Singer, Adrienne G. Randolph","doi":"10.1007/s00134-024-07665-4","DOIUrl":"https://doi.org/10.1007/s00134-024-07665-4","url":null,"abstract":"<p>Medical progress is reflected in the advance from broad clinical syndromes to mechanistically coherent diagnoses. By this metric, research in sepsis is far behind other areas of medicine—the word itself conflates multiple different disease mechanisms, whilst excluding noninfectious syndromes (e.g., trauma, pancreatitis) with similar pathogenesis. New technologies, both for deep phenotyping and data analysis, offer the capability to define biological states with extreme depth. Progress is limited by a fundamental problem: observed groupings of patients lacking shared causal mechanisms are very poor predictors of response to treatment. Here, we discuss concrete steps to identify groups of patients reflecting archetypes of disease with shared underlying mechanisms of pathogenesis. Recent evidence demonstrates the role of causal inference from host genetics and randomised clinical trials to inform stratification analyses. Genetic studies can directly illuminate drug targets, but in addition they create a reservoir of statistical power that can be divided many times among potential patient subgroups to test for mechanistic coherence, accelerating discovery of modifiable mechanisms for testing in trials. Novel approaches, such as subgroup identification in-flight in clinical trials, will improve efficiency. Within the next decade, we expect ongoing large-scale collaborative projects to discover and test therapeutically relevant sepsis archetypes.</p>","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"6 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142451804","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":"Set reliable hypothesis when using ICEMAN to assess credibility of subgroup analysis. Authors’ reply","authors":"Frederik M. Nielsen, Thomas L. Klitgaard, Morten H. Møller, Olav L. Schjørring, Bodil S. Rasmussen","doi":"10.1007/s00134-024-07678-z","DOIUrl":"https://doi.org/10.1007/s00134-024-07678-z","url":null,"abstract":"No Abstract","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"1 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142451807","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":"Effect of albumin bolus therapy on vasopressor requirement after cardiac surgery? Author’s reply","authors":"Geoffrey J. Wigmore, Adam M. Deane, Jeffrey J. Presneill, Rinaldo Bellomo","doi":"10.1007/s00134-024-07685-0","DOIUrl":"https://doi.org/10.1007/s00134-024-07685-0","url":null,"abstract":"No Abstract","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"104 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142451805","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":"Invasive fungal infections in non-neutropenic patients","authors":"Louis Kreitmann, Stijn Blot, Saad Nseir","doi":"10.1007/s00134-024-07683-2","DOIUrl":"https://doi.org/10.1007/s00134-024-07683-2","url":null,"abstract":"Critically ill patients, particularly those with features of immunosuppression, are susceptible to invasive fungal infections (IFI), which pose significant diagnostic and therapeutic challenges [1]. Candida and Aspergillus, the two most prominent fungal pathogens in this population, will be the focus of this short review.","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"59 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142451806","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 choice of resuscitation fluids—Ionic composition matters. Author’s reply","authors":"Yaseen M. Arabi, Emilie Belley-Cote, Daniel De Backer, Morten H. Møller, Fayez AlShamsi","doi":"10.1007/s00134-024-07666-3","DOIUrl":"https://doi.org/10.1007/s00134-024-07666-3","url":null,"abstract":"We would like to thank Mertzlufft for raising the issue of importance of the physiological composition of crystalloid fluids [1]. In the process of guideline generation, we selected questions with sufficient clinical evidence to support a recommendation [2]. In that regard, we have addressed the question of the balanced crystalloids versus saline, for which multiple randomized clinical trials have been conducted. As highlighted in the guideline document and the article by Mertzlufft et al., there is limited clinical evidence to support other questions about the composition of different balanced crystalloids [3]. This point has been highlighted in the guidelines as an area for further research [2].","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"8 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142440822","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":"EFFECT of daily antiseptic bathing with octenidine on ICU-acquired bacteremia and ICU-acquired multidrug-resistant organisms: a multicenter, cluster-randomized, double-blind, placebo-controlled, cross-over study","authors":"Tiffany Schaumburg, Norbert Köhler, Yasmine Breitenstein, Susanne Kolbe-Busch, Dirk Hasenclever, Iris F. Chaberny","doi":"10.1007/s00134-024-07667-2","DOIUrl":"https://doi.org/10.1007/s00134-024-07667-2","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose</h3><p>Antiseptic bathing has garnered attention in an effort to reduce hospital-acquired infections. Previous studies have shown the efficacy of antiseptic bathing in high-risk environments, such as intensive care units (ICUs), using chlorhexidine. In this study we aimed to evaluate the effectiveness of octenidine as a potential alternative due to its established popularity and widespread use in Europe.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>We compared the rates of ICU-acquired primary bacteremia and ICU-acquired multidrug-resistant organisms (MDROs) in a multicenter, cluster-randomized, double-blind, placebo-controlled, cross-over study using octenidine-impregnated and placebo washcloths. On 44 ICUs in 23 hospitals throughout Germany, we compared individual ICUs with themselves over two 12-month time periods. All data were obtained digitally via hospital information systems as individual ward-movement data and microbiological test results; both endpoints were algorithmically derived.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>104,039 ICU episodes from 93,438 patients with 712,784 microbiological test results were analyzed, thereby detecting 1508 cases of ICU-acquired primary bacteremia and 1871 cases of ICU-acquired MDRO. Bathing with octenidine-impregnated washcloths prevented ICU-acquired primary bacteremia; a risk reduction of 17% was seen homogeneously across all participating ICUs (adjusted hazard ratio (HR) 0.83, 95% confidence interval (CI) [0.75; 0.92], <i>p</i> = 0.0003). This reduction affected predominantly coagulase-negative staphylococci (53%) and enterococci (17%). However, no intervention effect was seen for ICU-acquired MDROs (adjusted HR 0.98, 95% CI [0.83; 1.15]). Heterogeneity among intra-ICU intervention effects on MDRO acquisition was substantial.</p><h3 data-test=\"abstract-sub-heading\">Conclusions</h3><p>Antiseptic bathing with octenidine may be effective in preventing ICU-acquired primary bacteremia, particularly due to Gram-positive bacteria and common skin commensals.</p>","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"6 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142440843","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":"Adjusting risk of acute kidney injury for time on controlled mechanical ventilation in acute respiratory distress syndrome: victim or partner in crime? Authors’ reply","authors":"Edoardo Antonucci, David Chen, Matthieu Legrand","doi":"10.1007/s00134-024-07661-8","DOIUrl":"https://doi.org/10.1007/s00134-024-07661-8","url":null,"abstract":"No Abstract","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"6 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142440819","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}