Intensive Care Medicine最新文献

{"title":"Prolonged P14 latency predicts mortality in deep sedation: implications for neuroprotective sedation strategies","authors":"Longsheng Zhang, Zitian Luo, Renzhe Lin","doi":"10.1007/s00134-025-08084-9","DOIUrl":"https://doi.org/10.1007/s00134-025-08084-9","url":null,"abstract":"No Abstract","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"26 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144923984","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":"Revisiting the timing of intervention in necrotising pancreatitis","authors":"M. Gatt, G. Piton, D. Poole","doi":"10.1007/s00134-025-08078-7","DOIUrl":"https://doi.org/10.1007/s00134-025-08078-7","url":null,"abstract":"Acute pancreatitis is a leading cause of emergency hospitalisation, with its incidence and aetiology varying geographically [1]. While most patients pursue a mild course, approximately 20% develop acute necrotising pancreatitis (ANP), with some progressing to secondary infected necrotising pancreatitis (INP), often associated with organ failure, and consequent high morbidity and mortality [2, 3]. Persistent organ failure (POF) for 48 h or more, which defines severe acute pancreatitis as per the revised Atlanta classification [3], remains a major clinical challenge, frequently requiring intensive care support with a commensurate strain on healthcare resources. Much effort has been expended into trying to modify disease progression in patients with INP with the ultimate aspiration of improving outcome.","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"30 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144923980","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":"Personalized driving pressure-guided positive end-expiratory pressure in patients at risk of postoperative respiratory failure (IMPROVE-2): a multicenter, pragmatic, randomized clinical trial","authors":"Emmanuel Futier, Audrey De Jong, Cédric Cirenei, Thomas Godet, Matthieu Jabaudon, Jean-Michel Constantin, Nicolas Grillot, Pierre Bouzat, Lois Henry, Dimitri Margetis, Gilles Lebuffe, Marc Garnier, Céline Lambert, Bruno Pereira, Samir Jaber","doi":"10.1007/s00134-025-08082-x","DOIUrl":"https://doi.org/10.1007/s00134-025-08082-x","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose</h3><p>Airway driving pressure has garnered considerable attention for lung-protective ventilation. We evaluated the clinical effectiveness of airway driving pressure as a target to individualize positive-end-expiratory pressure (PEEP) setting in mechanically ventilated patients at risk for postoperative respiratory failure.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>We conducted a multicenter, pragmatic, assessor-masked, randomized trial among adult patients undergoing emergency abdominal surgery in 22 hospitals in France. Patients were assigned 1:1 to receive individually adjusted highest PEEP targeting a driving pressure &lt; 13 cmH₂O after an initial recruitment maneuver (intervention group) or to a fixed PEEP level of 5 cmH₂O (control group). The primary outcome was a composite of postoperative respiratory failure (failure to wean from the ventilator or the composite of reintubation or curative non-invasive ventilation) or all-cause mortality at 30 days. Secondary outcomes included components of the composite primary outcome.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>The primary outcome occurred in 87 out of 338 (25.7%) intervention patients and in 69 out of 341 (20.2%) control patients (difference, 5.5%; 95% confidence interval [CI] − 0.8 to 11.8; relative risk, 1.27; 95%CI 0.96–1.68; <i>p</i> = 0.08). The difference was primarily due to an increased incidence of reintubation or need for curative non-invasive ventilation among intervention patients (difference, 7.1%; 95% CI 2.5–11.9; relative risk, 1.97; 95% CI 1.24–3.11; <i>p</i> = 0.004). Other secondary outcomes did not differ.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>Among patients at risk for postoperative respiratory failure after emergency abdominal surgery, a strategy of individually adjusted highest PEEP in targeting driving pressure lower than 13 cmH₂O did not reduce postoperative respiratory failure or death.</p><h3 data-test=\"abstract-sub-heading\">Trial registration</h3><p>ClinicalTrials.gov Identifier: NCT03987789.</p>","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"26 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144923953","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}