Intensive Care Medicine最新文献

{"title":"Driving pressure as a target for lung protective strategies: from ARDS critically-ill patients to the operating room—Lessons from the IMPROVE-2 Trial","authors":"Louis Delamarre, John J. Marini, Claude Guerin","doi":"10.1007/s00134-025-08120-8","DOIUrl":"https://doi.org/10.1007/s00134-025-08120-8","url":null,"abstract":"Protecting the lung from injurious strain imposed by mechanical ventilation remains a cornerstone in perioperative and critical care medicine. Yet, how best to achieve this goal and whether this strategy translates into improved outcomes in patients without established acute respiratory distress syndrome (ARDS) continues to spark debate. The recently published IMPROVE-2 trial by Futier et al. [1] adds an important piece to this discussion, examining whether targeting driving pressure (DP) to individualize positive end expiratory pressure (PEEP) in the operating room can prevent postoperative pulmonary complications in patients at risk of postoperative respiratory failure.","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"95 1 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145077411","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":"Heterogeneity in the response to a high vs low mean arterial pressure target in patients with septic shock a post hoc analysis of a randomized controlled trial.","authors":"Romain Pirracchio,Nicholas Fong,Matthieu Legrand","doi":"10.1007/s00134-025-08104-8","DOIUrl":"https://doi.org/10.1007/s00134-025-08104-8","url":null,"abstract":"BACKGROUNDThe best blood pressure target in sepsis is a matter of debate. SEPSIS-PAM, a large multicenter pragmatic randomized controlled trial, compared two mean arterial pressure targets (65-70 mmHg vs 80-85 mmHg) in septic shock and did not find any difference in mortality. The goal of this study was to assess whether (i) heterogeneity of treatment effect (HTE) exists in the response to different targets and (ii) the initial clinical trajectory can inform the optimal blood pressure target.METHODSThe primary outcome was mortality at day 28. Secondary outcomes included mortality at day 90, acute kidney injury (AKI), and severe AKI based on the KDIGO classification, need for renal replacement therapy, renal replacement therapy, and vasopressor-free days. The presence of HTE was tested for and, if present, quantified. The interaction between post-randomization evolution of the MAP, norepinephrine requirements, lactate, mottling score, and urine output was estimated using a multimediation analysis.RESULTS776 patients were enrolled and analyzed in this study. There was no evidence of significant treatment effect heterogeneity based on baseline characteristics (sweep p-value = 0.664; 95% CI: 0.633-0.673). The direct effect of a higher MAP target on mortality, holding 24 h mediators at their control-level values, was not significant (RD = 0.017; 95% CI - 0.052 to 0.086; p = 0.62). However, if reaching a higher MAP required high norepinephrine doses and/or did not result in mottled skin resolution at 24 h, the effect transmitted through those mediators was associated with higher mortality (risk difference = 0.027; 95% CI 0.012-0.047 and 0.012; 95% CI 0.001-0.026).CONCLUSIONOur results suggest the absence of heterogeneity of the response to different blood pressure targets in patients with septic shock. Targeting a higher MAP target may be associated with harm when high norepinephrine doses are required or when mottled skin is present.TRIAL REGISTRATIONSEPSISPAM ClinicalTrials.gov number, NCT01149278.","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"5 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071684","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":"Echocardiography guided management of atrial fibrillation.","authors":"M Balik,P Vignon,M S Chew,G Tavazzi,P Mayo,G Doufle,J Aron,J Hastings,B Cholley,K Jiroutkova,M Slama,A Herpain,A McLean","doi":"10.1007/s00134-025-08112-8","DOIUrl":"https://doi.org/10.1007/s00134-025-08112-8","url":null,"abstract":"BACKGROUNDThe growing burden of atrial fibrillation (AF) experienced by the general population translates into an increased incidence in the intensive care setting, further aggravated by illness severity. New onset AF has been established as an independent mortality predictor. Cardiology management guidelines are based on major trials that included ambulatory patients with varying degrees of ventricular systolic and diastolic dysfunction, and with variable dependences of left ventricular filling on atrial systole. Emphasis is placed on rate control combined with anticoagulation therapy, along with careful consideration of limiting any myocardial depression by antiarrhythmic medication in patients who often already have some form of structural heart disease.DESIGNNarrative review Objectives: Critical care echocardiography (CCE) is well established as a widely available diagnostic and monitoring tool in haemodynamically unstable patients. It assists in identifying risk factors associated with arrhythmias, reveals parameters associated with arrhythmia chronicity, and guides therapy to facilitate a return to sinus rhythm. CCE helps guide the crucial management decision to seek either rhythm or rate control and, with rhythm control, monitors return of mechanical sinus rhythm with left atrial recovery post cardioversion. Echocardiography can also help when conflicting management goals are present, such as guideline-driven therapeutic anticoagulation in the intensive care patient that is at significant risk of bleeding.RESULTSThis review seeks to assist intensive care practitioners managing patients with AF, with a focus on the many benefits CCE offers, blending specific intensive care medicine data to current cardiology guidelines on arrhythmia management in these severely ill patients.","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"35 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071681","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":"Publisher Correction: A reappraisal of association between ventilator-associated events and mortality among critically ill patients using marginal structural model: multicenter observational study","authors":"Susumu Nakahashi, Kei Suzuki, Takaya Nakashima, Yoshiro Hayashi, Yuko Tanabe, Aiko Tanaka, Shinsuke Hashiuchi, Chizuru Yamashita, Yusuke Ito, Takeshi Wada, Ayahiro Yamashita, Masanori Shima, Tetsuya Hoshino, Kiyoshi Moriyama, Satoshi Kazuma, Hyun Ah Lee, Yoshikazu Yamaguchi, Yukari Nakamura, Yu Kawanobe, Toshiki Sofue, Yuki Nishimura, Tomohiro Shinozaki, Tadahiro Goto, Satoru Hashimoto, Yuji Fujino, Nobuaki Shime","doi":"10.1007/s00134-025-08115-5","DOIUrl":"https://doi.org/10.1007/s00134-025-08115-5","url":null,"abstract":"<b>Publisher Correction</b><b>: </b><b>Intensive Care Medicine </b>https://doi.org/10.1007/s00134-025-08074-x","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"21 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145072280","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":"Serum sickness: a mimic of septic shock.","authors":"Takafumi Todaka","doi":"10.1007/s00134-025-08118-2","DOIUrl":"https://doi.org/10.1007/s00134-025-08118-2","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"64 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071688","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":"Ethical tensions and professional attitudes toward circulatory death organ donation in the ICU: a systematic review.","authors":"Alessandra Agnese Grossi,Martina Baiardo Redaelli,Francesco Procaccio,Mario Picozzi,Giuseppe Citerio,Luca Cabrini","doi":"10.1007/s00134-025-08100-y","DOIUrl":"https://doi.org/10.1007/s00134-025-08100-y","url":null,"abstract":"PURPOSEDonation after circulatory death (DCD) represents a valuable opportunity to expand the organ donor pool. However, its implementation in intensive care units (ICUs) remains ethically and emotionally complex. ICU healthcare professionals (HCPs) play a pivotal role in this process, yet their attitudes, knowledge, and perceived challenges are not fully understood. This systematic review aimed to explore ICU HCPs' attitudes (as defined by Rosenberg and Hovland) toward controlled DCD (cDCD).METHODSWe conducted a systematic review of studies published until March 2025 in four databases. Eligible studies included original research reporting ICU-specific data on HCPs' attitudes toward DCD. Study quality was assessed using the Mixed Methods Appraisal Tool. A structured narrative synthesis was performed.RESULTSTwenty-five studies involving 3,878 HCPs were included. Overall, support for DCD was evident though it remained lower than for donation after brain death. Ethical concerns focused on potential conflicts of interest between the withdrawal of life-sustaining treatment and the pursuit of organ donation, the timing of withdrawal, the urgency of organ retrieval, and the challenge of balancing compassionate end-of-life care with procedural imperatives. Common barriers included the lack of standardized protocols, insufficient training, and uncertainty surrounding death determination.CONCLUSIONSWhile ICU HCPs generally support DCD, significant ethical tensions and systemic barriers persist. Institutional efforts should focus on implementing clear protocols, promoting interprofessional education, and providing emotional support to ensure ethical integrity and staff well-being. Future research should explore differences in attitudes between uDCD and cDCD and work toward the development of validated tools to assess professional attitudes.","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"124 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071679","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":"Update on acute brain injury","authors":"Chiara Robba, Sarah Wahlster, Virginia Newcombe","doi":"10.1007/s00134-025-08121-7","DOIUrl":"https://doi.org/10.1007/s00134-025-08121-7","url":null,"abstract":"Despite recent advances in understanding and managing acute brain injury (ABI), it remains a major contributor to mortality and disability worldwide. As there are currently no interventions available to reverse the primary injury, ABI management in the intensive care unit (ICU) is mainly focused on minimising secondary brain damage [1]. Given the heterogeneous pathophysiologies involved in ABI, a shift towards individualised care based on disease endotype and phenotype is warranted to improve outcomes. In this manuscript, we summarise key aspects of the latest evidence on ABI management in the ICU.","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"78 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145072219","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":"Maintaining very low tidal volume ventilation with PEEP during CPB in cardiac surgery patients: are HLA-DR, IL-6, and MDSCs relatively accurately mirror the relationship between atelectasis and immune dysfunction? Author’s reply","authors":"Mathieu Lesouhaitier, Nicolas Terzi, Arnaud Gacouin, Jean-Marc Tadié","doi":"10.1007/s00134-025-08119-1","DOIUrl":"https://doi.org/10.1007/s00134-025-08119-1","url":null,"abstract":"No Abstract","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"34 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145059334","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":"Head up, face down-a practical framework for proning brain-injured patients with ARDS.","authors":"Sarah Wahlster,James A Town,Chiara Robba","doi":"10.1007/s00134-025-08097-4","DOIUrl":"https://doi.org/10.1007/s00134-025-08097-4","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"66 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145032162","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":"Primary cardiac lymphoma initially suspected as device-associated thrombus: a multimodal imaging diagnosis.","authors":"Yi Zhang,Zubaire Yasheng,Zhenxing Sun,Ziming Zhang","doi":"10.1007/s00134-025-08103-9","DOIUrl":"https://doi.org/10.1007/s00134-025-08103-9","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"18 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145032126","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}