Intensive Care Medicine最新文献

{"title":"Delirium prevention requires more than melatonin: insights from the DEMEL trial.","authors":"Flávia Gabe Beltrami, Laura Drehmer, Regis Goulart Rosa, Cassiano Teixeira, Felippe Leopoldo Dexheimer Neto","doi":"10.1007/s00134-025-08076-9","DOIUrl":"10.1007/s00134-025-08076-9","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":""},"PeriodicalIF":21.2,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144873056","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 Clinical Practice Guideline on fluid therapy in adult critically ill patients: Part 3-fluid removal at de-escalation phase.","authors":"Marlies Ostermann, Fayez Alshamsi, Antonio Artigas Raventos, Maurizio Cecconi, Carole Ichai, Christina Jones, Manu L N G Malbrain, Xavier Monnet, Marek Nalos, Zhiyong Peng, Carmen A Pfortmueller, John Prowle, Otavio Ranzani, Manu Shankar-Hari, Adrian Wong, Morten Hylander Møller, Daniel De Backer","doi":"10.1007/s00134-025-08058-x","DOIUrl":"10.1007/s00134-025-08058-x","url":null,"abstract":"<p><strong>Purpose: </strong>This is the third of three parts of the clinical practice guideline from the European Society of Intensive Care Medicine (ESICM) on fluid management in adult critically ill patients. This part addresses fluid removal in the de-escalation phase of shock management.</p><p><strong>Methods: </strong>This guideline was formulated by an international panel of clinical experts, methodologists, and patient representatives. A literature search was conducted to identify relevant randomized controlled trials (RCTs) in adults published up to February 2025. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology was applied to evaluate the certainty of evidence and to move from evidence to decision.</p><p><strong>Results: </strong>Based on data from 13 RCTs, the panel issued three conditional recommendations. The panel suggested de-escalation of fluid therapy over no de-escalation in critically ill adults after the acute phase of fluid resuscitation (low certainty evidence). They suggested protocolized fluid removal by diuretics over usual care in critically ill patients after the acute phase of fluid resuscitation (moderate certainty evidence). A conditional recommendation was issued against the routine use of ultrafiltration or extracorporeal fluid removal in critically ill adults after the acute phase of fluid resuscitation, without other indication for RRT (low certainty evidence). There was limited evidence to comment on fluid removal in specific patient cohorts.</p><p><strong>Conclusions: </strong>This ESICM guideline provides three recommendations to inform clinicians on fluid removal during the de-escalation phase in critically ill patients with shock who no longer need fluid resuscitation.</p>","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":""},"PeriodicalIF":21.2,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144873058","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 we use critical care ultrasonography in the management of cardiogenic shock: a strategic game of chess in intensive care.","authors":"Filippo Sanfilippo,Siddharth Dugar,Michelle S Chew","doi":"10.1007/s00134-025-08048-z","DOIUrl":"https://doi.org/10.1007/s00134-025-08048-z","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"37 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144851206","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":"Meropenem and piperacillin/tazobactam optimised dosing regimens for critically ill patients receiving renal replacement therapy.","authors":"Jason A Roberts,Marta Ulldemolins,Xin Liu,João P Baptista,Irma Bilgrami,Clement Boidin,Alexander Brinkmann,Pedro Castro,Gordon Choi,Louise Cole,Jan J De Waele,Renae Deans,Sine Donnellan,Glenn M Eastwood,Otto R Frey,Sylvain Goutelle,Rebecca Gresham,Janattul Ain Jamal,Gavin M Joynt,Salmaan Kanji,Stefan Kluge,Christina König,Vasilios P Koulouras,Melissa Lassig-Smith,Pierre-Francois Laterre,Anna Lee,Jean-Yves Lefrant,Katie Lei,Patricia Leung,Mireia Llaurado-Serra,Ignacio Martin-Loeches,Mohd Basri Mat Nor,Yugan Mudaliar,Marlies Ostermann,Sanjoy K Paul,Sandra L Peake,Jordi Rello,Darren M Roberts,Michael S Roberts,Brent Richards,Alejandro Rodríguez,Anka C Roehr,Claire Roger,Leonardo Seoane,Mahipal Sinnollareddy,Eduardo Sousa,Dolors Soy,Anna Spring,Therese Starr,Dianne Stephens,Fabio Silvio Taccone,Jane Thomas,John Turnidge,Miia Valkonen,Julie M Varghese,Steven C Wallis,Robert J Walker,Tricia Williams,Luke C Wilson,Xavier Wittebole,Daniel F B Wright,Xanthi T Zikou,Rinaldo Bellomo,Jeffrey Lipman, ","doi":"10.1007/s00134-025-08067-w","DOIUrl":"https://doi.org/10.1007/s00134-025-08067-w","url":null,"abstract":"PURPOSEOptimal dosing of meropenem and piperacillin/tazobactam in critically ill patients receiving renal replacement therapy (RRT) is uncertain due to variable pharmacokinetics. We aimed to develop generalisable optimised dosing recommendations for these antibiotics.METHODSProspective, multinational pharmacokinetic study including patients requiring various forms of RRT. Independent population PK models were developed, externally validated and applied to perform Monte Carlo dosing simulations using Monolix and Simulx. We calculated the probability that these dosing regimens achieved standard and high therapeutic unbound antibiotic concentrations over 100% of the dosing interval for the treatment of Enterobacterales and Pseudomonas aeruginosa.RESULTSWe enrolled 300 patients from 22 intensive care units across 12 countries receiving continuous veno-venous haemodialysis (13.0%), haemofiltration (23.3%), haemodiafiltration (48.4%) or sustained low-efficiency dialysis (15.3%). Models were developed using data from 234 patients (8322 samples) and validated with 66 additional patients (560 samples). Predictive performance was high, with mean prediction errors of - 5.2% for meropenem and - 16.9% for piperacillin. Dosing simulations showed that meropenem and piperacillin/tazobactam dosing requirements were dependent on urine output and RRT intensity and duration (p < 0.05). In all scenarios, extended/continuous infusions led to a better achievement of effective concentrations with lower daily doses compared to short infusion. Dosing nomograms were developed to inform dosing for different RRT settings, urine outputs, and target concentrations.CONCLUSIONRRT intensity and duration and urine output determine meropenem and piperacillin/tazobactam dosing requirements in critically ill patients receiving RRT. Extended/continuous infusions facilitate the attainment of effective concentrations.","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"7 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144825884","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":"Hemodynamic and neurological presentations of invasive meningococcal disease in adults: a nationwide study across 100+ French ICUs : The RETRO-MENINGO study.","authors":"Damien Contou,Benoit Painvin,Delphine Daubin,Arthur Orieux,Hugo Pirollet,Martin Cour,Benjamine Sarton,Marie Gauvrit,Mathilde Taillantou-Candau,Paola Lepoutre,Guillaume Louis,Fabrice Bruneel,Christelle Teiten,Maud Vincendeau,Marion Giry,François Legay,Rémi Coudroy,Olivier Puig,Pierre Bay,Guillaume Schnell,Geoffrey Ledoux,Romain Sonneville,Danielle Reuter,Xavier Valette,Piotr Szychowiak,Nicolas Dufour,Tomas Urbina,Gaëtan Plantefève,Nicolas de Prost, ","doi":"10.1007/s00134-025-08043-4","DOIUrl":"https://doi.org/10.1007/s00134-025-08043-4","url":null,"abstract":"PURPOSEInvasive meningococcal disease (IMD) is a rare but potentially fatal infection caused by Neisseria meningitidis. In adults requiring admission to intensive care unit (ICU), IMD typically presents with two distinct clinical presentations: neurological (meningitis) and hemodynamic (sepsis). These presentations are often conflated, despite the differences in pathophysiology and outcome.METHODSRETRO-MENINGO is a nationwide, multicentre, retrospective cohort study conducted in 102 French ICUs between January 1, 2016, and December 31, 2024. Adults (≥ 18 years) admitted to the ICU with a microbiologically confirmed IMD were categorised as having either a neurological or a hemodynamic presentation according to the main reason for ICU admission. The primary outcome was day-60 mortality in each presentation.RESULTSOf 654 patients (median age 33 years [IQR 21-56]; 63.5% without comorbidities), 407 (62%) had a neurological and 247 (38%) a hemodynamic presentation at ICU admission. Hemodynamic presentation was associated with older age (39.0 vs. 30.0 years; p = 0.001), immunosuppression (17.0% vs. 7.1%; p < 0.001), purpuric rash (55.9% vs. 43.7%; p = 0.003), earlier ICU admission (1 vs. 2 days; p = 0.001) and more frequent bacteremia (83.8% vs. 35.6%; p < 0.001). Serogroup B was predominant in neurological presentation, whereas serogroup W135 was more common in hemodynamic presentation. Compared to neurological presentation, hemodynamic presentation required more organ support (vasopressors, invasive mechanical ventilation, transfusions, renal replacement therapy) and had a significantly higher day-60 mortality (25.5% vs. 4.7%; p < 0.001). Hemodynamic presentation (aOR 4.33, 95% CI 2.26-8.62; p < 0.001), absence of comorbidities (aOR 2.21, 95% CI 1.19-4.23; p = 0.014), age > 35 years (aOR 3.65, 95% CI 1.73-6.07; p < 0.001), arterial lactate level > 5 mmol/L (aOR 2.60, 95% CI 1.43-4.77; p = 0.002) and symptom onset < 24 h (aOR 1.90, 95% CI 1.00-3.55; p = 0.040) were independently associated with day-60 mortality, while early administration of a parenteral third-generation cephalosporin prior to ICU admission was strongly protective (aOR 0.31, 95% CI 0.18-0.55; p < 0.001).CONCLUSIONNeurological and hemodynamic presentation of IMD are clinically and prognostically distinct. Recognition of these phenotypes is critical for appropriate management and prediction of outcome.","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"31 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144819643","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":"2D- and 3D-EIT are different, but which one is correct?","authors":"Ling Sang,Rui Zhang,Meng Dai,Junhong Jiang,Lin Yang","doi":"10.1007/s00134-025-08069-8","DOIUrl":"https://doi.org/10.1007/s00134-025-08069-8","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"291 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144819644","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":"What measures have been used to explore the outcomes of family members of critically ill patients: a scoping review.","authors":"Claire Brown,Peter Hartley,Faye Forsyth,Leanne M Boehm,Graham Martin,Isla Kuhn,Natalie Pattison,Bronwen Connolly,Nazir Lone,Valerie Danesh,Joanne McPeake","doi":"10.1007/s00134-025-08072-z","DOIUrl":"https://doi.org/10.1007/s00134-025-08072-z","url":null,"abstract":"BACKGROUNDFamily members of critically ill patients are known to experience short and longer term challenges, including emotional and social problems. To undertake robust future interventional research to support this cohort, we undertook a comprehensive evaluation of the measures used in family outcome research to date.DESIGNScoping review. We searched Medline, PsycINFO, Scopus, CINAHL, and Web of Science (core collection) for articles published between 2000 and 2024 which examined the outcomes of family members of critically ill patients. Data on outcome measures, study design, and population characteristics were extracted from eligible studies.RESULTSWe reviewed 9873 abstracts and identified 388 eligible unique family member cohorts. Across these studies, there were 59 (15.2%) randomised control trials, 287 (74.0%) observational cohorts, 8 (2.1%) quality improvement programmes, and 34 (8.8%) non-randomised controlled interventional studies. Most research was undertaken in USA, Canada, and Europe (n = 264, 67.5%). A total of 218 different outcomes measures were used across the studies included. In this review, 345 (89%) studies measured emotional or psychological outcomes, 85 (22%) measured family experience outcomes, 65 (17%) measured general functional status, quality of life or well-being outcomes, 35 (9%) measured environmental or social outcomes, and 10 (3%) measured cognitive outcomes.CONCLUSIONSWe identified 388 studies which reported the outcomes of family members of critically ill patients. Over 200 different outcomes measures were utilised, exploring conceptual domains such as quality of life as well as psychological and social outcomes. The majority of studies were observational in nature with variable follow-up timelines. This review has highlighted that a core outcome measure set is essential to enable reliable, robust, and comparable interventional research in this area.","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"13 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144819645","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?","authors":"Lei Zuo,Jinwen Ni","doi":"10.1007/s00134-025-08075-w","DOIUrl":"https://doi.org/10.1007/s00134-025-08075-w","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"90 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144819642","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":"ICU venous thromboembolism prophylaxis: revisiting external validity, vulnerable subgroups, and diagnostic standards, with future directions.","authors":"Jianmin Qu","doi":"10.1007/s00134-025-08077-8","DOIUrl":"https://doi.org/10.1007/s00134-025-08077-8","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"16 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144819641","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":"0.3 mg Melatonin: still too much?","authors":"Sulong Zheng","doi":"10.1007/s00134-025-08073-y","DOIUrl":"https://doi.org/10.1007/s00134-025-08073-y","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"36 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144792129","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}