Intensive Care Medicine Experimental最新文献

{"title":"The effects of urine alkalinization on kidney function in critically ill patients with COVID-19: a proof-of-concept randomized clinical trial.","authors":"Nuttha Lumlertgul, John A Kellum, Jonah Powell-Tuck, Moncy Mathew, Sunita Sardiwal, Marlies Ostermann","doi":"10.1186/s40635-025-00739-7","DOIUrl":"10.1186/s40635-025-00739-7","url":null,"abstract":"<p><strong>Background: </strong>Acute kidney injury (AKI) is a common complication of COVID-19. While the exact mechanisms remain unclear, direct viral infection of renal tubular epithelial cells is hypothesized. Given the pH-dependent entry of coronaviruses into host cells, urine alkalinization was proposed as a potential preventive strategy.</p><p><strong>Methods: </strong>This was a proof-of-concept prospective, randomized clinical trial in critically ill patients with COVID-19. Patients were randomized to urine alkalinization versus usual care. The intervention group received intravenous 8.4% sodium bicarbonate to achieve a urine pH ≥ 7.5 up to 10 days after randomization. The primary outcome was the proportion of patients achieving target urine pH. Secondary outcomes included changes in urine tissue inhibitor of metalloproteinases-2 (TIMP-2) and insulin-like growth factor-binding protein 7 (IGFBP7), AKI development, renal replacement therapy, and adverse effects.</p><p><strong>Results: </strong>The trial was terminated early due to slow recruitment and the end of the COVID-19 pandemic. Sixteen patients were enrolled (median age 48 years old, 75% male). More patients in the intervention group achieved target urine pH than in the control group (75% vs 37.5%, P = 0.315). There was a separation of urine pH between both groups throughout 10 days (P = 0.097 for interaction). However, the intervention did not significantly impact urine [TIMP-2]x[IGFBP7] concentrations (P = 0.813 for interaction) or clinical outcomes, including AKI occurrence (risk ratio 0.6 (95% confidence interval 0.21, 1.70), P = 0.619). More patients in the intervention group experienced hypernatremia and metabolic alkalosis. Notably, patients with elevated urine [TIMP-2]x[IGFBP7] concentrations and AKI had higher ICU and 60-day mortality.</p><p><strong>Conclusions: </strong>While urine alkalinization is feasible and can increase urine pH, we could not demonstrate differences in AKI rates or changes in urine [TIMP-2]x[IGFBP7] concentrations in critically ill COVID-19 patients.</p>","PeriodicalId":13750,"journal":{"name":"Intensive Care Medicine Experimental","volume":"13 1","pages":"33"},"PeriodicalIF":2.8,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11889288/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expiratory ventilation assistance versus pressure-controlled ventilation with ambient oxygen in a hemorrhagic trauma model: a prehospital rescue option?","authors":"Tomas Karlsson, Jenny Gustavsson, Katrin Wellfelt, Mattias Günther","doi":"10.1186/s40635-025-00742-y","DOIUrl":"10.1186/s40635-025-00742-y","url":null,"abstract":"<p><strong>Background: </strong>Prehospital airway management is critical for maintaining oxygenation after severe trauma hemorrhage. In cases of semi-obstructed airways, intubation with an endotracheal tube may fail, whereas a 14 French intubating catheter may provide an alternative for ventilation. Expiratory ventilation assistance (EVA) through such a catheter could serve as a prehospital rescue option, particularly when oxygen supply is limited. This study evaluates whether EVA with ambient air is sufficient to maintain oxygenation and compares its effectiveness with pressure-controlled ventilation (PCV).</p><p><strong>Methods: </strong>Twenty-three anesthetized swines (mean weight 58.3 kg, SD 4.6) were subjected to 32% blood volume hemorrhage and allocated to either EVA (n = 11) or PCV (n = 12). Historical data were used in the control group. Three phases were studied: 15 min without intervention (emulating initial prehospital care), 30 min of whole blood resuscitation, and 15 min post-resuscitation. Parameters including oxygen delivery (DO₂), oxygen consumption (VO₂), arterial saturation (SaO₂), intratracheal pressures, and lactate levels were measured.</p><p><strong>Results: </strong>EVA and PCV demonstrated similar effectiveness in maintaining indexed DO₂ (p = 0.114), VO₂ (p = 0.325), oxygen extraction rate (p = 0.841), and SaO₂ (p = 0.097). Intratracheal pressures were significantly lower with EVA (p < 0.0001). EVA maintained clinically sufficient oxygenation (PaO₂ > 8.6 kPa) but PaCO₂ levels increased compared with control. Lactate levels were significantly lower in the EVA group during resuscitation (3.1 mmol/L vs. 4.8 mmol/L, p = 0.032).</p><p><strong>Conclusion: </strong>Both EVA and PCV effectively maintained oxygen delivery and sufficient oxygenation after trauma hemorrhage and whole blood resuscitation. Lower intratracheal pressures and reduced lactate accumulation with EVA suggest it may be a viable prehospital rescue method, especially in scenarios with limited oxygen supply. Further investigation is warranted to optimize its application.</p>","PeriodicalId":13750,"journal":{"name":"Intensive Care Medicine Experimental","volume":"13 1","pages":"31"},"PeriodicalIF":2.8,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11889277/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: Impact of hemoadsorption with CytoSorb^® on meropenem and piperacillin exposure in critically ill patients in a post-CKRT setup: a single-center, retrospective data analysis.","authors":"Golschan Asgarpur, Franz Weber, Peggy Kiessling, Nilufar Akbari, Fabian Stroben, Bernadette Kleikamp, Charlotte Kloft, Sascha Treskatsch, Stefan Angermair","doi":"10.1186/s40635-025-00723-1","DOIUrl":"10.1186/s40635-025-00723-1","url":null,"abstract":"","PeriodicalId":13750,"journal":{"name":"Intensive Care Medicine Experimental","volume":"13 1","pages":"30"},"PeriodicalIF":2.8,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11876509/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143541976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Machine learning-based identification of efficient and restrictive physiological subphenotypes in acute respiratory distress syndrome.","authors":"Gabriela Meza-Fuentes, Iris Delgado, Mario Barbé, Ignacio Sánchez-Barraza, Mauricio A Retamal, René López","doi":"10.1186/s40635-025-00737-9","DOIUrl":"10.1186/s40635-025-00737-9","url":null,"abstract":"<p><strong>Introduction: </strong>Acute respiratory distress syndrome (ARDS) is a severe condition with high morbidity and mortality, characterized by significant clinical heterogeneity. This heterogeneity complicates treatment selection and patient inclusion in clinical trials. Therefore, the objective of this study is to identify physiological subphenotypes of ARDS using machine learning, and to determine ventilatory variables that can effectively discriminate between these subphenotypes in a bedside setting with high performance, highlighting potential utility for future clinical stratification approaches.</p><p><strong>Methodology: </strong>A retrospective cohort study was conducted using data from our ICU, covering admissions from 2017 to 2021. The study included 224 patients over 18 years of age diagnosed with ARDS according to the Berlin criteria and undergoing invasive mechanical ventilation (IMV). Data on physiological and ventilatory variables were collected during the first 24 h IMV. We applied machine learning techniques to categorize subphenotypes in ARDS patients. Initially, we employed the unsupervised Gaussian Mixture Classification Model approach to group patients into subphenotypes. Subsequently, we applied supervised models such as XGBoost to perform root cause analysis, evaluate the classification of patients into these subgroups, and measure their performance.</p><p><strong>Results: </strong>Our models identified two ARDS subphenotypes with significant clinical differences and significant outcomes. Subphenotype Efficient (n = 172) was characterized by lower mortality, lower clinical severity and presented a less restrictive pattern with better gas exchange compared to Subphenotype Restrictive (n = 52), which showed the opposite. The models demonstrated high performance with an area under the ROC curve of 0.94, sensitivity of 94.2% and specificity of 87.5%, in addition to an F1 score of 0.85. The most influential variables in the discrimination of subphenotypes were distension pressure, respiratory frequency and exhaled carbon dioxide volume.</p><p><strong>Conclusion: </strong>This study presents an approach to improve subphenotype categorization in ARDS. The generation of clustering and prediction models by machine learning involving clinical, ventilatory mechanics, and gas exchange variables allowed for more accurate stratification of patients. These findings have the potential to optimize individualized treatment selection and improve clinical outcomes in patients with ARDS.</p>","PeriodicalId":13750,"journal":{"name":"Intensive Care Medicine Experimental","volume":"13 1","pages":"29"},"PeriodicalIF":2.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11872963/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143537112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Elucidating the causal relationship of mechanical power and lung injury: a dynamic approach to ventilator management.","authors":"ChaoPing Wu, Arif Canakoglu, Jacob Vine, Anya Mathur, Ronit Nath, Markos Kashiouris, Piyush Mathur, Ari Ercole, Paul Elbers, Abhijit Duggal, Ken Koon Wong, Anirban Bhattacharyya","doi":"10.1186/s40635-025-00736-w","DOIUrl":"10.1186/s40635-025-00736-w","url":null,"abstract":"<p><strong>Background: </strong>Mechanical power (MP) serves as a crucial predictive indicator for ventilator-induced lung injury and plays a pivotal role in tailoring the management of mechanical ventilation. However, its application across different diseases and stages remains nuanced.</p><p><strong>Methods: </strong>Using AmsterdamUMCdb, we conducted a retrospective study to analyze the causal relationship between MP and outcomes of invasive mechanical ventilation, specifically SpO₂/FiO₂ ratio (P/F) and ventilator-free days at day 28 (VFD28). We employed causal inferential analysis with backdoor linear regression and double machine learning, guided by directed acyclic graphs, to estimate the average treatment effect (ATE) in the whole population and conditional average treatment effect (CATE) in the individual cohort. Additionally, to enhance interpretability and identify MP thresholds, we conducted a simulation analysis.</p><p><strong>Results: </strong>In the study, we included 11,110 unique admissions into analysis, of which 58.3% (6391) were surgical admissions. We revealed a negative and significant causal effect of median MP on VFD28, with estimated ATEs of -0.135 (95% confidence interval [CI]: -0.15 to -0.121). The similar effect was not observed in Maximal MP and minimal MP. The effect of MP was more pronounced in the medical subgroup, with a CATE of -0.173 (95% CI: -0.197 to -0.143) determined through backdoor linear regression. Patients with cardio, respiratory, and infection diagnoses, who required long-term intubation, sustained higher impact on CATEs across various admission diagnoses. Our simulations showed that there is no single MP threshold that can be applied to all patients, as the optimal threshold varies depending on the patient's condition.</p><p><strong>Conclusion: </strong>Our study underscores the importance of tailoring MP adjustments on an individualized basis in ventilator management. This approach opens up new avenues for personalized treatment strategies and provides fresh insights into the real-time impact of MP in diverse clinical scenarios. It highlights the significance of median MP while acknowledging the absence of universally applicable thresholds.</p>","PeriodicalId":13750,"journal":{"name":"Intensive Care Medicine Experimental","volume":"13 1","pages":"28"},"PeriodicalIF":2.8,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11871266/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143523428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corticosteroid and antimicrobial therapy in macrolide-resistant pneumococcal pneumonia porcine model.","authors":"Ana Motos, Minlan Yang, Denise Battaglini, Hua Yang, Andrea Meli, Joaquim Bobi, Roberto Cabrera, Giacomo Tanzella, Carmen Rosa Vargas, Marta Arrieta, Blanca Llonch, Nona Rovira-Ribalta, Enric Barbeta, Pierluigi di Giannatale, Stefano Nogas, Laia Fernández-Barat, Montserrat Rigol, Kasra Kiarostami, Ignacio Martín-Loeches, Jordi Vila, Daniel Martinez, Gianluigi Li Bassi, Antoni Torres","doi":"10.1186/s40635-025-00731-1","DOIUrl":"10.1186/s40635-025-00731-1","url":null,"abstract":"<p><strong>Background: </strong>Streptococcus pneumoniae, a primary cause of community-acquired pneumonia (CAP), is typically treated with β-lactams and macrolides or quinolones. Corticosteroids are now recommended as adjunctive therapy in severe CAP to improve outcomes. In this prospective randomized animal study, we evaluated the bactericidal efficacy of various antibiotic regimens combined with corticosteroids using a porcine pneumococcal pneumonia model.</p><p><strong>Results: </strong>In 30 White-Landrace female pigs, pneumonia was induced by intrabronchial inoculation of macrolide-resistant S. pneumoniae 19A isolate. Animals were randomized to receive saline, ceftriaxone (CRO) with levofloxacin (LVX), CRO with azithromycin (AZM), or combinations of these with methylprednisolone (MP). The primary outcome, S. pneumoniae concentrations in lung tissue after 48 h of treatment, showed that the CRO + LVX, CRO + AZM, CRO + LVX + MP, and CRO + AZM + MP groups were equally effective in reducing bacterial load. However, complete bacterial eradication from lung tissue was achieved only in the CRO + AZM + MP group. Secondary outcomes, including bacterial burden in tracheal aspirates and bronchoalveolar lavage (BAL) samples, showed similar bactericidal activity across all treatment groups. The CRO + AZM + MP group demonstrated the most controlled inflammatory response, achieving baseline levels of inflammation, while other groups exhibited elevated inflammatory markers.</p><p><strong>Conclusions: </strong>Despite using a macrolide-resistant S. pneumoniae isolate, the combination of CRO, AZM, and MP achieves similar or even superior results compared to other antibiotic combinations. This regimen provides both bactericidal and immunomodulatory benefits, suggesting its effectiveness in treating macrolide-resistant S. pneumoniae pneumonia.</p>","PeriodicalId":13750,"journal":{"name":"Intensive Care Medicine Experimental","volume":"13 1","pages":"27"},"PeriodicalIF":2.8,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11868001/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143523420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Wearable devices for patient monitoring in the intensive care unit.","authors":"Alessandra Angelucci, Massimiliano Greco, Maurizio Cecconi, Andrea Aliverti","doi":"10.1186/s40635-025-00738-8","DOIUrl":"10.1186/s40635-025-00738-8","url":null,"abstract":"<p><p>Wearable devices (WDs), originally launched for fitness, are now increasingly recognized as valuable technologies in several clinical applications, including the intensive care unit (ICU). These devices allow for continuous, non-invasive monitoring of physiological parameters such as heart rate, respiratory rate, blood pressure, glucose levels, and posture and movement. WDs offer significant advantages in making monitoring less invasive and could help bridge gaps between ICUs and standard hospital wards, ensuring more effective transitioning to lower-level monitoring after discharge from the ICU. WDs are also promising tools in applications like delirium detection, vital signs monitoring in limited resource settings, and prevention of hospital-acquired pressure injuries. Despite the potential of WDs, challenges such as measurement accuracy, explainability of data processing algorithms, and actual integration into the clinical decision-making process persist. Further research is necessary to validate the effectiveness of WDs and to integrate them into clinical practice in critical care environments.Take home messages Wearable devices are revolutionizing patient monitoring in ICUs and step down units by providing continuous, non-invasive, and cost-effective solutions. Validation of their accuracy and integration in the clinical decision-making process remain crucial for widespread clinical adoption.</p>","PeriodicalId":13750,"journal":{"name":"Intensive Care Medicine Experimental","volume":"13 1","pages":"26"},"PeriodicalIF":2.8,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11868008/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143523432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Renal mitochondria response to sepsis: a sequential biopsy evaluation of experimental porcine model.","authors":"Jiri Müller, Jiri Chvojka, Lenka Ledvinova, Jan Benes, Zdenek Tuma, Martina Grundmanova, Jan Jedlicka, Jitka Kuncova, Martin Matejovic","doi":"10.1186/s40635-025-00732-0","DOIUrl":"10.1186/s40635-025-00732-0","url":null,"abstract":"<p><strong>Background: </strong>The pathophysiology of sepsis-induced acute kidney injury remains elusive. Although mitochondrial dysfunction is often perceived as the main culprit, data from preclinical models yielded conflicting results so far. The aim of this study was to assess the immune-metabolic background of sepsis-associated renal dysfunction using sequential biopsy approach with mitochondria function evaluation in a large clinically relevant porcine models mimicking two different paces and severity of sepsis and couple this approach with traditional parameters of renal physiology.</p><p><strong>Methods: </strong>In this randomized, open-label study, 15 anaesthetized, mechanically ventilated and instrumented (renal artery flow probe and renal vein catheter) pigs were randomized in two disease severity groups-low severity (LS) sepsis (0.5 g/kg of autologous faeces intraperitoneally) and high severity (HS) sepsis (1 g/kg of autologous faeces intraperitoneally). Sequential cortical biopsies of the left kidney were performed and a pyramid-shaped kidney specimen with cortex, medulla and renal papilla was resected and processed at the end of the experiment. Oxygraphic data and western blot analysis of proteins involved in mitochondrial biogenesis and degradation were obtained.</p><p><strong>Results: </strong>In contrast to increased mitochondrial activity observed in LS sepsis, a significant decrease in the oxidative phosphorylation capacity together with an increase in the respiratory system uncoupling was observed during the first 24 h after sepsis induction in the HS group. Those changes preceded alterations of renal haemodynamics. Furthermore, serum creatinine rose significantly during the first 24 h, indicating that renal dysfunction is not primarily driven by haemodynamic changes. Compared to cortex, renal medulla had significantly lower oxidative phosphorylation capacity and electron-transport system activity. PGC-1-alfa, a marker of mitochondrial biogenesis, was significantly decreased in HS group.</p><p><strong>Conclusions: </strong>In this experimental model, unique sequential tissue data show that the nature and dynamics of renal mitochondrial responses to sepsis are profoundly determined by the severity of infectious challenge and resulting magnitude of inflammatory insult. High disease severity is associated with early and stepwise progression of mitochondria dysfunction and acute kidney injury, both occurring independently from later renal macro-haemodynamic alterations. Our data may help explain the conflicting results of preclinical studies and suggest that sepsis encompasses a very broad spectrum of sepsis-induced acute kidney injury endotypes.</p>","PeriodicalId":13750,"journal":{"name":"Intensive Care Medicine Experimental","volume":"13 1","pages":"25"},"PeriodicalIF":2.8,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11846788/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unlocking opportunities to transform patient care: an expert insight on limitations and opportunities in patient monitoring.","authors":"Maurizio Cecconi, Ana L Hutanu, John Beard, Patricio Gonzalez-Pizarro, Marlies Ostermann, Anna Batchelor, Jos M Latour, Jörn Grensemann, Michele Giovanni Mondino, Jesus Caballero, Manfred Blobner, Finn M Radtke","doi":"10.1186/s40635-025-00733-z","DOIUrl":"10.1186/s40635-025-00733-z","url":null,"abstract":"<p><strong>Background: </strong>Current patient monitoring technologies are crucial for delivering personalised and timely care and are critical in achieving the best health outcomes while maintaining high care standards. However, these technologies also present several challenges affecting patients and healthcare professionals.</p><p><strong>Information overload: </strong>Healthcare providers often deal with excess data, making it challenging to identify the most critical patient information quickly. This may lead to delays in necessary interventions and potentially poorer patient outcomes.</p><p><strong>Alarm fatigue: </strong>Many patient monitoring systems trigger frequent false alarms. This high incidence can cause healthcare providers to become desensitised, potentially leading to slower response times or overlooked important alerts.</p><p><strong>Integration challenges: </strong>Current systems often need more seamless integration with other healthcare technologies, making it difficult for healthcare providers to have a cohesive view of the patient's health. This lack of integration can impair care coordination and increase workloads. This paper presents the findings from a group of experts who described the state of the art of patient monitoring and discussed potential solutions and new pathways for developing these technologies.</p>","PeriodicalId":13750,"journal":{"name":"Intensive Care Medicine Experimental","volume":"13 1","pages":"24"},"PeriodicalIF":2.8,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11845334/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143472197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Teicoplanin pharmacokinetics in critically ill patients on extracorporeal organ support: a retrospective analysis.","authors":"Giovanni Camen, Pedro David Wendel-Garcia, Rolf Erlebach, Mattia Müller, Caroline John, Alix Buhlmann, Rea Andermatt, Reto A Schuepbach, Sascha David, Daniel A Hofmaenner","doi":"10.1186/s40635-025-00729-9","DOIUrl":"10.1186/s40635-025-00729-9","url":null,"abstract":"<p><strong>Background: </strong>Extracorporeal membrane oxygenation (ECMO) can alter the pharmacokinetics of diverse antimicrobials, posing challenges in achieving therapeutic drug levels. Some literature suggests that teicoplanin may require higher dosing in ECMO patients, however the respective evidence is scarce. The aim of this study was to assess teicoplanin trough levels in critically patients on ECMO support and to compare patients with and without additional continuous renal replacement therapy (CRRT). We conducted a retrospective study at the Intensive Care Unit (ICU) of the University Hospital Zurich, Switzerland. Teicoplanin trough levels and doses were analyzed in critically ill patients during ECMO support by means of a non-parametric local estimated polynomial regression. Outcomes included the proportion of patients with insufficient or toxic teicoplanin trough levels, dosage adjustments, and differences in teicoplanin trough levels between patients with and without additional CRRT during ECMO support.</p><p><strong>Results: </strong>After screening 172 patients receiving teicoplanin therapy during their ICU stay from 1.1.2020 to 19.07.2023, a total of 23 adult patients were included. The proportion of patients with insufficient teicoplanin levels was notably higher during ECMO support compared to patients with toxic levels (78.3% vs. 13% of patients, respectively). Teicoplanin dosages mostly were increased during the first few days of ECMO treatment. Concomitant CRRT led to a further increase in the proportion of patients with insufficient levels.</p><p><strong>Conclusions: </strong>Teicoplanin trough levels using standard dosing tend to be low in patients on ECMO support, especially in the early days of therapy. Higher doses than the standard regimen are often necessary to achieve therapeutic levels, particularly in patients receiving additional CRRT.</p>","PeriodicalId":13750,"journal":{"name":"Intensive Care Medicine Experimental","volume":"13 1","pages":"22"},"PeriodicalIF":2.8,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11845331/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}