Intensive Care Medicine Experimental最新文献

{"title":"Therapeutic hypercapnia after cardiac arrest: still promising or time to move on?","authors":"Wiput Laosuksri, Borwon Wittayachamnankul, Siriporn C Chattipakorn, Nipon Chattipakorn","doi":"10.1186/s40635-026-00974-6","DOIUrl":"10.1186/s40635-026-00974-6","url":null,"abstract":"<p><p>Post-cardiac arrest care remains challenging, with persistently poor neurological and survival outcomes. Accordingly, novel adjunctive interventions are needed. While maintaining normocapnia is the current standard, hypercapnia has been proposed as a potential intervention. However, its role and potential benefits remain unclear. This comprehensive review summarizes current evidence on the use of hypercapnia in post-cardiac arrest care, focusing on neurological, cardiovascular, and survival outcomes, underlying mechanisms, and directions for future clinical investigations. Observational studies have sparked interest in the potential benefits of hypercapnia during the post-cardiac arrest period, including in specific populations. Methodological variations and conflicting findings from earlier studies have prompted the conduct of controlled trials and animal experiments to clarify its effects. Mild hypercapnia appears to be a practical and clinically safe approach, improving cerebral oxygenation without major adverse events. However, no improvement in long-term neurological recovery or survival has been demonstrated. Moreover, the effects on the cardiovascular and other organ systems, as well as mechanisms at the cellular level, remain inconclusive. Although mild hypercapnia may be considered part of a comprehensive post-cardiac arrest care strategy, further studies are needed to define its optimal application, potential synergy with other interventions, the populations most likely to benefit, and its underlying mechanisms.</p>","PeriodicalId":13750,"journal":{"name":"Intensive Care Medicine Experimental","volume":"14 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13589045/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149001839","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: Preclinical evidence for supra-clinical acute kidney injury: current biomarkers are not enough.","authors":"Justine Serre, David Legouis, Sandrine Placier, Charles Verney, Wionna Desvarieux, David Buob, Juliette Hadchouel, Pierre Galichon","doi":"10.1186/s40635-026-00978-2","DOIUrl":"10.1186/s40635-026-00978-2","url":null,"abstract":"","PeriodicalId":13750,"journal":{"name":"Intensive Care Medicine Experimental","volume":"14 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13578171/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148976730","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: mouse models to study von Willebrand factor in inflammation: a scoping review.","authors":"Hassan Masood, Veronica DeYoung, Peter Andrisani, Arthane Kodeeswaran, Taylor Sparring, Jaskirat Arora, Natasha Savic, Jonathan L Babulic, Davide Matino, Patricia C Liaw, Colin A Kretz, Alison Fox-Robichaud","doi":"10.1186/s40635-026-00971-9","DOIUrl":"10.1186/s40635-026-00971-9","url":null,"abstract":"","PeriodicalId":13750,"journal":{"name":"Intensive Care Medicine Experimental","volume":"14 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13558498/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148919606","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":"Novel approach to estimate respiratory quotient from the alveolar gas equation: a proof-of-concept study in pigs.","authors":"Joakim Hedov, Josefin Elzén Junker, Magnus Hallbäck, Per-Arne Lönnqvist, Jacob Karlsson","doi":"10.1186/s40635-026-00969-3","DOIUrl":"10.1186/s40635-026-00969-3","url":null,"abstract":"<p><strong>Background: </strong>The respiratory quotient (RQ) reflects metabolic substrate utilization and is traditionally measured using indirect calorimetry techniques, e.g. Douglas bag, which are technically demanding and not always feasible in clinical practice. The alveolar gas equation (AGE) provides a theoretical relationship between oxygen tension, carbon dioxide tension and RQ and may be rearranged to estimate RQ using standard respiratory measurements. This study aimed to validate a novel method for estimating RQ by reversing the alveolar gas equation.</p><p><strong>Method: </strong>In this prospective experimental study, twelve anesthetized, mechanically ventilated pigs were studied under steady-state conditions. RQ was determined using two methods: (1) reference measurement via Douglas bag collection using Haldane transformation (RQref), and (2) calculation from the rearranged alveolar gas equation using inspired and expired gas measurements (RQcalc). Agreement between methods was assessed using paired t-tests, Bland-Altman analysis with bootstrap confidence intervals, and linear regression.</p><p><strong>Results: </strong>Mean RQref was 0.877 (95% CI 0.845-0.908), while mean RQcalc was 0.994 (95% CI 0.961-1.026), demonstrating a significant difference (p < 0.001). Bland-Altman analysis showed a bias of 0.117 (95% CI 0.103-0.131) with limits of agreement from 0.066 to 0.167 and a mean percentage error of 5%. A strong correlation was observed between methods (r = 0.895, p < 0.001), with RQcalc explaining 80% of the variance in RQref (R² = 0.801).</p><p><strong>Conclusion: </strong>Reversal of the alveolar gas equation enables estimation of RQ with strong correlation to reference measurements but introduces a consistent positive bias. While not directly interchangeable with Douglas bag measurements, this simplified approach may provide a practical, continuous approximation of RQ in settings where conventional metabolic monitoring is not feasible. Additional validation studies are needed to make this method ready for clinical use.</p>","PeriodicalId":13750,"journal":{"name":"Intensive Care Medicine Experimental","volume":"14 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13554020/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148911898","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":"Early mechanical changes of limb muscle in septic shock assessed by dual-plane shear-wave elastography.","authors":"Ivo Neto Silva, Rui Azevedo, Joana Duarte, Stanislas Abrard, José Alberto Duarte, Karim Bendjelid","doi":"10.1186/s40635-026-00968-4","DOIUrl":"10.1186/s40635-026-00968-4","url":null,"abstract":"<p><strong>Background: </strong>Septic shock induces skeletal muscle wasting and neuromuscular dysfunction, contributing to ICU-acquired weakness (ICUAW) and poor recovery after critical illness. Conventional ultrasound primarily captures structural changes but provides limited insight into early muscle mechanical alterations or their relationships with clinical factors. Shear-wave elastography (SWE) enables non-invasive assessment of muscle stiffness, but its performance in critically ill patients remains poorly understood.</p><p><strong>Methods: </strong>In this prospective study, adults with septic shock requiring invasive ventilation underwent daily muscle ultrasound during the first five ICU days. Rectus femoris muscle cross-sectional area, echogenicity and SWE-derived shear modulus (SM_RF) were assessed bilaterally using conventional ultrasound and shear-wave elastography in both longitudinal and transverse orientations at two anatomical sites within the rectus femoris. An exploratory anisotropy estimate was derived from the transverse-to-longitudinal stiffness ratio. ICUAW was evaluated at the time of extubation. Associations between ultrasound markers and clinical variables were explored using correlation and regression analyses.</p><p><strong>Results: </strong>Twenty-seven patients (66.7% male, mean age 61 ± 12 years) were analysed (125 sessions, 4,971 images). Rectus femoris cross-sectional area declined from 3.90 cm² on Day 1 to 2.97 cm² by Day 5 (- 21%, p < 0.01), while echogenicity remained stable. Shear modulus (SM_RF) demonstrated region- and orientation-dependent behaviour. At the lower-third region, longitudinal SM_RF remained relatively stable (7.08 to 7.72 kPa), whereas transverse SM_RF declined significantly (15.20 to 12.30 kPa, p = 0.009), resulting in dynamic changes in the transverse-to-longitudinal stiffness ratio. Muscle atrophy trajectories were similar in patients with and without ICUAW, and no significant between-group differences in SM_RF measures were identified. Higher illness severity (SOFA score, β = 18.18, p = 0.003) and cumulative fluid balance (β = 3.32, p = 0.002) were associated with increases in longitudinal SM_RF. Greater early caloric intake (β = 0.076, p = 0.006) and increases in echogenicity (β = -0.91, p = 0.027) were associated with changes in transverse SM_RF.</p><p><strong>Conclusions: </strong>Rapid muscle loss during early septic shock was accompanied by distinct, site- and direction-specific stiffness changes. Dual-plane SWE identified early mechanical changes, although these measures did not discriminate ICUAW status in this cohort. Associations with clinical variables suggest that SWE may help capture early physiological muscle changes in critical illness.</p>","PeriodicalId":13750,"journal":{"name":"Intensive Care Medicine Experimental","volume":"14 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13538337/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148880316","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":"Arterial cannulation site and ventilation strategy modulate cerebral injury in a rat cardiopulmonary bypass model of Harlequin syndrome.","authors":"Chadi Aludaat, Gabriel Saiydoun, Saade Saade, Jean-Marc Baste, Vincent Magnan, Fabien Doguet, Fabrice Bauer, Jeremy Bellien, Paul Mulder, Emmanuel Besnier","doi":"10.1186/s40635-026-00955-9","DOIUrl":"10.1186/s40635-026-00955-9","url":null,"abstract":"<p><strong>Background: </strong>Differential hypoxemia, or Harlequin syndrome, is a critical concern during veno-arterial extracorporeal membrane oxygenation (VA-ECMO), especially when femoral artery cannulation delivers retrograde flow. This phenomenon may impair cerebral oxygenation and promote brain injury. We investigated whether the arterial cannulation site and ventilation strategy influence acute cerebral injury in a rat cardiopulmonary bypass (CPB) model.</p><p><strong>Methods: </strong>Forty male Wistar rats were randomized into four groups (n = 10 each) according to the arterial cannulation site (carotid [anterograde, A-CPB] or femoral [retrograde, R-CPB]) and ventilation strategy (normal [NV, 100% tidal volume] or low [LV, 50% tidal volume]). All underwent 60 min of CPB at 50-60 mL/kg/min. Systemic hemodynamics, arterial blood gases, and plasma biomarkers of cerebral injury (neuron-specific enolase [NSE] and S100B) were measured. Postmortem brain water content was quantified to assess edema.</p><p><strong>Results: </strong>Mean arterial pressure and heart rate were comparable across groups. Oxygenation (PaO₂) was preserved, whereas PaCO₂ was higher under low ventilation (A-CPB LV vs. A-CPB NV, p = 0.002; R-CPB LV vs. R-CPB NV, p = 0.030). Lactate levels increased significantly in the R-CPB LV group compared with the A-CPB NV group (p = 0.004). At 60 min, NSE and S100B were markedly elevated in the R-CPB LV group compared with the other groups (p < 0.001). Regional brain edema was significantly greater in the cerebellum and left telencephalon of R-CPB LV animals (p < 0.001 and p = 0.002, respectively), whereas other regions showed no significant changes.</p><p><strong>Conclusions: </strong>Femoral retrograde perfusion, particularly under reduced ventilation, exacerbates biochemical and structural markers of cerebral injury in a rat CPB model. These findings reproduce key pathophysiological features of Harlequin syndrome and emphasize the importance of proximal cannulation strategies and optimized ventilation to preserve cerebral oxygen delivery during VA-ECMO support.</p>","PeriodicalId":13750,"journal":{"name":"Intensive Care Medicine Experimental","volume":"14 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13534404/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874057","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":"Association between fluid balance, muscle strength, and muscle quality in critically ill patients: a retrospective observational study.","authors":"Nicolas Arancibia-Ramirez, Yorschua Jalil Contreras, Alexis Silva, L Felipe Damiani, Jorge Molina, Cheryl E Hickmann","doi":"10.1186/s40635-026-00966-6","DOIUrl":"10.1186/s40635-026-00966-6","url":null,"abstract":"<p><strong>Background: </strong>Intensive Care Unit-acquired weakness (ICUAW) is a frequent complication that significantly impairs functional recovery in critically ill patients. Fluid overload during critical illness has been associated with adverse outcomes, but its relationship with peripheral muscle quality and strength remains uncertain. This study aimed to evaluate the association between cumulative fluid balance, ultrasound-assessed muscle quality, and muscle strength in critically ill patients.</p><p><strong>Patients and methods: </strong>We conducted a retrospective analysis of routinely collected data between May and October 2024 in adult ICU patients who were deeply sedated, mechanically ventilated, and had an ICU length of stay ≥24 hours. Muscle and subcutaneous tissue measurements were obtained using ultrasound of the vastus intermedius and rectus femoris within the first 24 hours of ICU admission (day 1) and at clinical awakening. Muscle quality was assessed at both time points using the Heckmatt scale. Global muscle strength was assessed only at clinical awakening using the Medical Research Council Sum Score (MRC-SS), once patients were able to follow commands. Patients without complete ultrasound measurements at both time points were excluded from the final analysis.</p><p><strong>Results: </strong>Eighty patients were included (mean age 51 ± 14 years; APACHE II score 18 ± 5). The main admission diagnoses were predominantly respiratory and septic conditions. Mean cumulative fluid balance at awakening was 2400 ± 800 mL. From ICU admission to awakening, quadriceps thickness decreased, whereas subcutaneous tissue thickness increased and muscle quality deteriorated, as reflected by higher Heckmatt scores. At awakening, cumulative fluid balance showed a strong inverse correlation with global muscle strength (rho = -0.70, p < 0.001) and a moderate positive correlation with subcutaneous tissue thickness. Muscle quality assessed by the Heckmatt scale was moderately inversely correlated with MRC-SS (rho = -0.43, p< 0.001). In multivariable analysis adjusted for age, disease severity, and duration of mechanical ventilation, cumulative fluid balance remained independently associated with lower muscle strength at awakening.</p><p><strong>Conclusions: </strong>Qualitative muscle ultrasound assessment using the Heckmatt scale provides complementary information to muscle thickness measurements. The observed association between cumulative fluid balance and poorer muscle quality suggests that fluid status should be considered when interpreting qualitative muscle ultrasound findings in critically ill patients.</p>","PeriodicalId":13750,"journal":{"name":"Intensive Care Medicine Experimental","volume":"14 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13525138/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148850668","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":"Exploring the temporal statistical relationship between commercial cerebral near-infrared spectroscopy signals and intracranial pressure in traumatic brain injury.","authors":"Noah Silvaggio, Kevin Y Stein, Makenna Coldwell, Vuk Roca, Amanjyot Singh Sainbhi, Isuru Herath, Tobias Bergmann, Rakibul Hasan, Mansoor Hayat, Jaewoong Moon, Frederick A Zeiler","doi":"10.1186/s40635-026-00964-8","DOIUrl":"10.1186/s40635-026-00964-8","url":null,"abstract":"<p><strong>Background: </strong>Monitoring of intracranial pressure (ICP) is important for not only assessing neurological status of patients following traumatic brain injury (TBI), but also for guiding therapeutic interventions for the prevention of secondary neurological injury. Although current ICP monitoring techniques are highly temporally accurate, they come with some significant limitations. These limitations include the invasive nature, expertise required for placement of these devices, high cost associated with maintenance, and poor spatial resolution. Cerebral near-infrared spectroscopy (NIRS) offers a non-invasive alternative technique for cerebral physiological monitoring. This modality eliminates the need for surgical expertise, as well as decreasing the financial cost associated with monitoring cerebral physiology. Preliminary evidence has pointed to a potential link between the NIRS variable, regional oxygen saturation (rSO₂), and invasively obtained ICP. Despite this, there are very few studies that exist that investigate the direct statistical relationship between NIRS variables, such as rSO₂, and invasively obtained ICP. As such, this study set out to characterize and compare the temporal statistical properties of commercial NIRS-based rSO₂, ICP, and mean arterial pressure (MAP) signals.</p><p><strong>Results: </strong>Utilizing retrospective high-frequency physiologic data from a population of 118 TBI patients across different temporal resolutions and data window sizes, we evaluated independent statistical signal structure of rSO₂ and ICP using variance analysis and ARIMA modelling. Following normalization, variance metrics remained significantly different between all physiologic variable comparison groups, across all temporal resolutions and window sizes examined. In contrast, median optimal ARIMA model orders converged, with no significant differences observed between any of the included physiological variables. Next, Pearson correlation, cross-correlation, Granger causality, and VARIMA IRF analysis continued to show increasing temporal similarity between ICP and rSO₂ as temporal resolution decreased and window size increased. In contrast, throughout the majority of the analyses, the relationship between AMP and rSO₂ remained not only consistently weaker, but also more inconsistent across the majority of the analyses.</p><p><strong>Conclusion: </strong>Findings from this study demonstrate convergence in the temporal statistical behaviour of ICP and rSO₂ at lower temporal resolutions, providing a foundation for future predictive non-invasive ICP monitoring approaches. Further investigation into direct statistical relationships and development of reliable non-invasive ICP prediction models using NIRS-derived data remains necessary for clinical utility.</p>","PeriodicalId":13750,"journal":{"name":"Intensive Care Medicine Experimental","volume":"14 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13522304/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148840027","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":"Leveraging ECG foundation models in critical care for sinus rhythm and atrial fibrillation classification.","authors":"Maria Galanty, Michiel Hulleman, Merijn C Reuland, Björn van der Ster, Alexander P J Vlaar, Clara I Sánchez","doi":"10.1186/s40635-026-00949-7","DOIUrl":"10.1186/s40635-026-00949-7","url":null,"abstract":"<p><strong>Background: </strong>Recent advances in deep learning have led to the development of ECG foundation models (ECG-FMs) trained with self-supervised learning, which can extract generalizable representations from large-scale data. In this study, we evaluated the performance of these ECG-FMs in detecting atrial fibrillation and sinus rhythm during continuous monitoring of intensive care unit (ICU) patients, using data from Amsterdam University Medical Center (Amsterdam UMC). Our three-stage study: (i) used within-dataset classification performance on public PhysioNet datasets as an indirect proxy for label consistency, (ii) tested off-the-shelf fine-tuned ECG-FMs on ICU data, and (iii) fine-tuned ECG-FM on curated public datasets, with and without weakly labelled in-house ICU data.</p><p><strong>Results: </strong>Off-the-shelf model showed limited transferability (F1 = 0.68 for sinus rhythm (SR), 0.52 for atrial fibrillation (AF)). Fine-tuning on consistent public datasets achieved robust performance (F1 = 0.91 for SR, 0.82 for AF), while adding weakly labelled ICU data further improved recall at some cost to precision. Performance remained stable across varying ECG lead configurations, supporting adaptability to heterogeneous inputs.</p><p><strong>Conclusions: </strong>These findings indicate that off-the-shelf pre-trained ECG-FMs do not generalise well to continuous monitoring in ICU populations; however, after targeted fine-tuning, they can achieve strong performance even in unseen cohorts, underscoring the importance of high-quality fine-tuning data and rigorous local validation.</p>","PeriodicalId":13750,"journal":{"name":"Intensive Care Medicine Experimental","volume":"14 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13518658/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148828056","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":"Intestinal fatty acid-binding protein (I-FABP) at ICU admission as early biomarker of intestinal injury and predictor of mortality in septic shock.","authors":"Thorben Pape, Pedro David Wendel-Garcia, Nina Rittgerodt, Bahar Nalbant, Jan Hinrichs, Lena S Becker, Anna M Hunkemöller, Jakob Raith, Sören K J Boblitz, Jannik Ruwisch, Pia-Victoria Fangmann, Heiner Wedemeyer, Marius M Hoeper, Christian Bode, Sascha David, Klaus Stahl, Benjamin Seeliger","doi":"10.1186/s40635-026-00963-9","DOIUrl":"10.1186/s40635-026-00963-9","url":null,"abstract":"<p><strong>Background: </strong>Septic shock and acute respiratory distress syndrome (ARDS) are major causes of mortality. Intestinal hypoperfusion is a frequent but often unrecognized complication, and the timing and extent of intestinal injury in these syndromes remain unclear. Intestinal fatty acid-binding protein (I-FABP) has emerged as a potential biomarker of intestinal injury. This study aimed to define a clinically relevant I-FABP cutoff for predicting relevant intestinal injury and to assess its association with disease severity and outcome.</p><p><strong>Methods: </strong>We performed a post-hoc analysis combining cohorts of critically ill patients from the prospective EXCHANGE-pilot, the RCT EXCHANGE-1, and the SPARE-14 registry. The analysis included 102 patients with septic shock and/or ARDS, 22 patients with non-occlusive mesenteric ischemia (NOMI) from the REPERFUSE study, and 20 healthy individuals. Circulating I-FABP concentrations were measured by ELISA in plasma samples obtained at ICU admission. Receiver operating characteristic (ROC) analysis was used to define the optimal I-FABP threshold for predicting intestinal hypoperfusion, using patients with NOMI as positive- and healthy individuals as negative controls. Associations between I-FABP, disease severity, and 28-day mortality were analyzed.</p><p><strong>Results: </strong>ROC analysis identified an initial I-FABP cutoff of 1070 pg/ml (sensitivity 68%, specificity 100%) for the development of intestinal ischemia defined by criteria of manifest NOMI. I-FABP levels at ICU admission were significantly elevated in patients with ARDS and/or septic shock compared with healthy controls (1108 pg/ml (IQR 291-2846) vs. 479 pg/ml (IQR 358-631), p = 0.03), and comparable to those in NOMI patients. Exploratory generalized additive model analyses indicated a non-linear association between I-FABP concentrations and established markers of shock severity. Patients with high I-FABP levels (above 1070 pg/ml) had a higher 28-day mortality (high: 52.9% vs. low: 33.3%, p = 0.02). In a multivariate logistic regression model, I-FABP and SOFA score remained independently associated with 28-day mortality (I-FABP: adjusted OR 1.27 (1.03-1.62), p = 0.023), without independent association of lactate concentration.</p><p><strong>Conclusion: </strong>Elevated plasma I-FABP may identify undetected intestinal injury in critically ill patients with septic shock and/or ARDS and might be associated with higher 28-day mortality. Additionally, I-FABP might reflect a distinct facet of critical illness that is not fully captured by conventional measures of organ dysfunction or shock severity and I-FABP concentrations ≥ 1070 pg/ml may help identify patients at high risk for intestinal ischemia who could benefit from early therapeutic interventions.</p>","PeriodicalId":13750,"journal":{"name":"Intensive Care Medicine Experimental","volume":"14 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13518634/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148828131","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}