Intensive Care Medicine最新文献

{"title":"Identifying distinct clusters of ICU survivors by integrating demographic, pre-admission quality of life, and clinical data: a large prospective cohort study.","authors":"Lucy L Porter,Lotte Hazeleger,Kirsten Bos,Koen S Simons,Johannes G van der Hoeven,Melda Yeghaian,Margaretha C E van der Woude,Susanne van Santen,Thijs C D Rettig,Marijke de Vries,Mark van den Boogaard,Marieke Zegers","doi":"10.1007/s00134-025-08052-3","DOIUrl":"https://doi.org/10.1007/s00134-025-08052-3","url":null,"abstract":"PURPOSEICU patients differ in pre-ICU health status, comorbidities, and diagnosis, forming a heterogeneous population with diverse long-term outcomes. This study explored whether clustering ICU patients by demographic, pre-admission quality of life, and clinical data, rather than by diagnosis, could identify subgroups that are more informative for patient-centered outcomes post-ICU.METHODSData from the MONITOR-IC prospective cohort study were used. Demographic, pre-admission quality of life, and clinical data from 2361 adult ICU survivors of six hospitals were used to identify clusters, using the k-prototypes algorithm. Data from five additional hospitals (n = 866) were used for external validation. Self-reported physical, mental, and cognitive functioning, and quality of life one year post-ICU were described.RESULTSThe four identified clusters differed significantly in long-term physical, mental, and cognitive functioning, and quality of life. Cluster-A (n = 204), characterized by a healthy pre-ICU status, high disease severity, low Glasgow Coma Scale, and long ICU stay, had a relatively high quality of life at one year, despite experiencing a mean decline from baseline. Cluster-B (n = 877), also a healthy group before admission but less severely ill at ICU admission, reported the best outcomes. Cluster-C (n = 632) included younger, mostly female patients with moderate impairments both pre- and one-year post-ICU. Cluster-D (n = 648), characterized by a low education level and poor baseline health, reported impaired outcomes one year post-ICU, although improved compared to their pre-admission status. External validation confirmed the generalizability of these results.CONCLUSIONThis study identified and externally validated four distinct clusters of ICU patients by integrating both clinical and non-clinical data. These clusters, which differed in long-term physical, mental, and cognitive outcomes, challenge conventional disease-based classification, and support a multidimensional approach to define subgroups of ICU patients.TRIAL REGISTRATIONThe MONITOR-IC study was registered at ClinicalTrials.gov: NCT03246334.","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"50 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144792143","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":"Norepinephrine use at extubation in critically ill patients with obesity: a cohort study with multicenter validation.","authors":"Audrey De Jong,Mathieu Capdevila,Yassir Aarab,Francesca Rabboni,Alina Kozoriz,Guillaume Heupel,Joris Pensier,Ines Lakbar,Clément Monet,Gérald Chanques,Samir Jaber","doi":"10.1007/s00134-025-08066-x","DOIUrl":"https://doi.org/10.1007/s00134-025-08066-x","url":null,"abstract":"PURPOSEThe aim of this study was to assess whether norepinephrine at the time of extubation increases reintubation rates in critically ill patients with obesity.METHODSThe initial step was to analyze data that had been collected prospectively, using a retrospective approach-defined as the main cohort. Then, we validated our findings using data from a multicenter randomized-controlled trial (validation cohort). The primary objective was to compare reintubation within 7 days, between patients with norepinephrine and without norepinephrine at the time of extubation. The secondary objective was to assess norepinephrine doses at extubation, normalized to body weight.RESULTSAmong the 3186 patients included in the main cohort, 837 had obesity. Among them, 213 (25%) were extubated with norepinephrine, with a median norepinephrine dose at extubation of 0.6 mg/h of absolute value which corresponds to 0.097 (0.04-0.17) µg/kg/min of real body weight. No significant difference in reintubation rates was observed between patients extubated with norepinephrine (16%) and those without (17%, p = 0.85). Among the 656 patients with obesity in the validation cohort, we observed similar results, with a reintubation rate of 18% in those extubated with norepinephrine and 15% in those without (p = 0.45). Similar results were observed in the 2349 patients without obesity.INTERPRETATIONIn critically ill patients with obesity, the use of norepinephrine at the time of extubation did not significantly increase the reintubation rates.CLINICAL TRIAL REGISTRATIONNCT04014920 for the validation cohort.","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"31 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144787163","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":"Cardiogenic shock: diagnosis, phenotyping and management.","authors":"Jacob Eifer Møller,Christian Hassager,Alastair Proudfoot,Daniel De Backer,David A Morrow,Hanne Berg Ravn,Konstantin A Krychtiuk,Uwe Zeymer,Holger Thiele","doi":"10.1007/s00134-025-08049-y","DOIUrl":"https://doi.org/10.1007/s00134-025-08049-y","url":null,"abstract":"Cardiogenic shock (CS) is a state of critical end-organ hypoperfusion caused by primary cardiac failure, in which the heart cannot generate sufficient output despite adequate preload and is associated with very high mortality rates. The emergence of precision medicine may enable tailored interventions based on individual patient profiles, including genetic, biomarker, imaging, and clinical data. Advanced hemodynamic monitoring, mechanical circulatory support devices with smaller profiles and higher flow, and targeted pharmacologic therapies have expanded the therapeutic possibilities in CS. However, integrating these novel approaches into clinical practice requires careful alignment with evidence-based medicine. Balancing innovation with robust clinical evidence is crucial. Many technologies enter the clinical sphere before comprehensive trials confirm their benefit, creating potential risks in vulnerable CS patients. Precision medicine must therefore be grounded on rigorous data from randomized-controlled trials, registries, and meta-analyses to ensure safety and efficacy. Collaborative efforts, including large-scale data sharing and international research networks, are essential to bridge the gap between innovation and evidence. The goal is to move beyond a one-size-fits-all model toward a more nuanced, patient-centered approach while maintaining scientific rigor.","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"15 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144787165","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":"Heterogenous treatment effect of neuromuscular blocking agents for moderate-to-severe ARDS: a post hoc Markov model re-analysis of the ACURASYS trial.","authors":"Michael Brunini,Jean-Marie Forel,Xavier Muracciole,Antoine Roch,Dominique Barbolosi,Laurent Papazian","doi":"10.1007/s00134-025-08064-z","DOIUrl":"https://doi.org/10.1007/s00134-025-08064-z","url":null,"abstract":"PURPOSEThe beneficial effects of systematic cisatracurium administration observed in the ACURASYS randomized, multicenter, double-blinded trial may depend on patient-specific factors. This post hoc analysis aimed to explore whether the impact of cisatracurium on mortality varies with baseline characteristics.METHODSA Markov chain analysis was conducted using daily clinical states from inclusion to day 90: death (state 0), under mechanical ventilation (state 1), or weaned and alive at day 90 (state 2). Patient trajectories were modeled accordingly.RESULTSAmong the 321 included patients, subgroup analysis following univariate analysis focused on 130 individuals under 60 years with non-fatal McCabe scores. Within this subgroup, cisatracurium administration and absence of vasopressor use significantly reduced the probability of remaining ventilated. Estimated survival increased therefore from 0.63 (placebo group, N = 62) to 0.93 (cisatracurium group, N = 68). In contrast, among patients with a rapidly or ultimately fatal prognosis according to McCabe score, the probability of survival did not differ substantially between the placebo and cisatracurium groups. Among patients with a PaO2:FiO2 ratio ≤ 100 mmHg at inclusion (N = 65), the estimated survival rate at day 90 was 0.93 in the cisatracurium arm compared with 0.63 in the placebo arm. For patients with a PaO2:FiO2 ratio > 100 mmHg at inclusion (N = 98), the corresponding survival rates were 0.92 and 0.63, respectively. In patients aged ≥ 60 years (N = 158), the daily probability of remaining mechanically ventilated was not influenced by any covariate, including the administration of cisatracurium. These results were confirmed by the performed simulations.CONCLUSIONThe systematic and short-term administration of cisatracurium in patients with moderate-to-severe ARDS appears to confer greater survival benefit in those with a higher baseline life expectancy. Further validation through retrospective and prospective studies is warranted.","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"87 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144787166","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":"Extracorporeal life support for adult patients with ARDS.","authors":"Alain Combes,Alexander Supady,Darryl Abrams,Cara Agerstrand,Jenelle Badulak,Luigi Camporota,Eddy Fan,Niall D Ferguson,John F Fraser,Carol Hodgson,Samir Jaber,Graeme MacLaren,Brijesh V Patel,Giles J Peek,Matthieu Schmidt,Kiran Shekar,Arthur S Slutsky,Daniel Brodie","doi":"10.1007/s00134-025-08070-1","DOIUrl":"https://doi.org/10.1007/s00134-025-08070-1","url":null,"abstract":"Extracorporeal Life Support (ECLS), including venovenous (VV) extracorporeal membrane oxygenation (ECMO) and extracorporeal carbon dioxide removal (ECCO2R) is a temporary support option for patients with severe respiratory failure. Current data and recent guidelines support the use of VV ECMO for select patients with very severe respiratory failure as this technique might improve survival in appropriately selected patients. Patient selection criteria, timing of ECMO initiation and optimal management of mechanical ventilation and anticoagulation, and other adjunctive treatment options are a matter of ongoing research.","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"16 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144787164","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":"Re-evaluating the impact of mechanical ventilation strategies during cardiac surgery with cardiopulmonary bypass: work in progress.","authors":"Matteo Parotto,Samir Jaber,Stefan J Schaller","doi":"10.1007/s00134-025-08057-y","DOIUrl":"https://doi.org/10.1007/s00134-025-08057-y","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"148 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144777812","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":"Noninvasive respiratory supports in ICU.","authors":"Jean-Pierre Frat, Domenico L Grieco, Audrey De Jong, Kevin Gibbs, Guillaume Carteaux, Oriol Roca, Virginie Lemiale, Lise Piquilloud, Nuttapol Rittayamai, Lara Pisani, Gonzalo Hernandez, Arnaud W Thille","doi":"10.1007/s00134-025-08036-3","DOIUrl":"10.1007/s00134-025-08036-3","url":null,"abstract":"<p><strong>Background: </strong>Noninvasive respiratory supports are routinely applied in critically ill patients with acute respiratory failure to avoid intubation and invasive mechanical ventilation, thereby reducing the risk of related complications, and to facilitate successful weaning from mechanical ventilation after extubation. They are also applied during the intubation procedure for preoxygenation with the aim of enhancing oxygenation and ensuring the safety of the procedure.</p><p><strong>Main body: </strong>High-flow nasal oxygen decreases airway dead space, provides a stable concentration of inspired oxygen, generates low level of flow-dependent positive airway pressure, and optimizes comfort. Positive-pressure noninvasive supports include continuous positive-airway pressure and noninvasive ventilation and enable providing higher end-expiratory pressure, thereby further improving oxygenation. Noninvasive ventilation, but not continuous positive-airway pressure, better decreases inspiratory effort, and increases tidal volume and transpulmonary driving pressure.</p><p><strong>Conclusion: </strong>High-flow nasal oxygen has become the first-line therapy in acute hypoxemic respiratory failure, while noninvasive ventilation remains the reference treatment during exacerbations of chronic obstructive pulmonary disease, in patients with respiratory acidosis. In patients requiring intubation, noninvasive ventilation is the optimal technique for preoxygenation to decrease the risk of hypoxemia, while high-flow nasal oxygen is an alternative option for non-hypoxemic patients or those with contraindications to noninvasive ventilation. After extubation in patients at high risk of reintubation, prophylactic noninvasive ventilation, eventually alternating with high-flow nasal oxygen, improves weaning outcome compared to other strategies; high-flow nasal oxygen alone outperforms conventional oxygen in low-risk patients.</p>","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":"1476-1489"},"PeriodicalIF":21.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144698463","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":"OPTPRESS or OPTPRESSIN? Authors' reply.","authors":"Akira Endo, Kazuma Yamakawa, Takashi Tagami, Yutaka Umemura","doi":"10.1007/s00134-025-08011-y","DOIUrl":"10.1007/s00134-025-08011-y","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":"1563-1564"},"PeriodicalIF":21.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144527819","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":"Correction: How to approach a patient hospitalized for pneumonia who is not responding to treatment?","authors":"Pedro Povoa, Luís Coelho, Jordi Carratala, Kelly Cawcutt, Sara E Cosgrove, Ricard Ferrer, Carlos A Gomez, Michael Klompas, Thiago Lisboa, Ignacio Martin-Loeches, Saad Nseir, Jorge I F Salluh, Sias Scherger, Daniel A Sweeney, Andre C Kalil","doi":"10.1007/s00134-025-08027-4","DOIUrl":"10.1007/s00134-025-08027-4","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":"1570-1571"},"PeriodicalIF":21.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12317881/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144626239","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":"High mean arterial pressure (MAP) targets in septic shock: one size does not fit all.","authors":"Ravindranath Tiruvoipati, Amit Kansal, Rakshit Panwar","doi":"10.1007/s00134-025-07983-1","DOIUrl":"10.1007/s00134-025-07983-1","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":"1557-1558"},"PeriodicalIF":21.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144257994","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}