Journal of critical care最新文献

{"title":"Letter to the editor: “External validation of eight different models to predict sepsis mortality in intensive care units”","authors":"Yanghui Hu , Jinyan Guo , Weifeng Yao","doi":"10.1016/j.jcrc.2025.155267","DOIUrl":"10.1016/j.jcrc.2025.155267","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"91 ","pages":"Article 155267"},"PeriodicalIF":2.9,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145117704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Septic shock: Past, present, and perspectives","authors":"Erika P. Plata-Menchaca ,&nbsp;Orlando Rubén Pérez-Nieto ,&nbsp;Eduardo Kattan ,&nbsp;Toshiaki Iba ,&nbsp;Ricard Ferrer","doi":"10.1016/j.jcrc.2025.155269","DOIUrl":"10.1016/j.jcrc.2025.155269","url":null,"abstract":"<div><div>Septic shock remains one of the most severe complications of infection, defined by circulatory, cellular, and metabolic dysfunction and associated with persistently high mortality. The concept has evolved markedly, from early descriptions of “blood poisoning” to the recognition of sepsis as a systemic syndrome in the late 20th century. Consensus definitions and large clinical trials, including early goal-directed therapy, led to structured treatment bundles and the launch of the Surviving Sepsis Campaign, which have contributed to gradual improvements in survival.</div><div>Current management emphasizes rapid recognition, timely antimicrobials, source control, fluid resuscitation, and vasopressor support, with norepinephrine as the first-line agent. Nevertheless, significant heterogeneity among patients complicates decision-making, and debate continues around fluid thresholds, timing of vasopressor initiation, and the use of adjunctive therapies such as corticosteroids or immunomodulators.</div><div>Looking ahead, precision medicine and emerging technologies promise to refine sepsis care. Machine learning and multi-omic approaches are improving risk prediction, enabling identification of sepsis subphenotypes, and guiding individualized treatment strategies. Bedside tools assessing microcirculatory function and rapid biomarker assays may further enhance prognostication and resuscitation. Effective implementation science and rigorous validation of these tools will be critical for translating innovation into improved outcomes.</div><div>Septic shock management has advanced substantially, yet further progress requires not only personalization and innovation but also concerted efforts to reduce global disparities in access to timely diagnosis, evidence-based treatment, and long-term survivorship care.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"91 ","pages":"Article 155269"},"PeriodicalIF":2.9,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early energy delivery and 28-day mortality in critically ill patients with sepsis: Post hoc analysis of a multicenter cluster-randomised controlled trial","authors":"Qiuhui Wang ,&nbsp;Jin Ke ,&nbsp;Yizhe Chen ,&nbsp;Hongyang Xu ,&nbsp;Dingye Wu ,&nbsp;Lu Ke ,&nbsp;Fengming Liang ,&nbsp;Yang Chen ,&nbsp;for the Chinese Critical Care Nutrition Trials Group (CCCNTG)","doi":"10.1016/j.jcrc.2025.155265","DOIUrl":"10.1016/j.jcrc.2025.155265","url":null,"abstract":"<div><h3>Background</h3><div>Sepsis remains a leading cause of mortality in intensive care units (ICU), but optimal energy delivery strategies remain unclear. This post hoc analysis examines the association between early energy delivery and 28-day all-cause mortality in ICU patients with sepsis.</div></div><div><h3>Methods</h3><div>This post hoc analysis of the multicentre NEED trial (ISRCTN12233792) included ICU patients with sepsis and ≥ 7-day stays. Early energy delivery (first 7 days) was calculated as a percentage of the target 25 kcal/kg ideal body weight. Patients were stratified by mNUTRIC score (&lt;5 vs ≥5). Associations with 28-day mortality were assessed using Cox models and Kaplan-Meier analysis, with subgroup and spline analyses exploring effect modification and nonlinearity.</div></div><div><h3>Results</h3><div>This analysis included 1162 sepsis patients (median age 66.0 years, 66.3 % male), with 183 (15.7 %) patients deceased within 28-day after ICU admission. The optimal energy delivery thresholds were identified as 100 % of the target for low-risk and 60 % for high-risk patients. Cox proportional hazards models further confirmed that in the high-risk group, achieving≥60 % of the target was associated with a lower 28-day mortality risk (hazard ratio = 0.588, 95 % conficence interval: 0.388–0.891), whereas no benefit was observed in low-risk patients. Additionally, no significant interactions were found in subgroup analyses. Restricted cubic spline analysis suggested a downward trend in mortality risk with increasing energy delivery in high-risk patients (P-nonlinear = 0.063).</div></div><div><h3>Conclusions</h3><div>Early energy delivery ≥60 % of target is linked to lower 28-day mortality in high-risk sepsis patients, with no clear benefit in low-risk groups. These results support risk-based nutritional strategies in sepsis care.</div><div><strong>Trials registration:</strong> ISRCTN 12233792, registered on November 24, 2017.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"91 ","pages":"Article 155265"},"PeriodicalIF":2.9,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From promise to practice: A roadmap for artificial intelligence in critical care","authors":"Geoffray Agard ,&nbsp;Sami Hraiech ,&nbsp;Tobias Gauss","doi":"10.1016/j.jcrc.2025.155263","DOIUrl":"10.1016/j.jcrc.2025.155263","url":null,"abstract":"<div><div>Artificial intelligence (AI) has regained strong momentum in medicine, driven by unprecedented computing power and the availability of massive clinical datasets. Intensive care units (ICUs) are at the forefront of this movement, given their unique combination of high data density, decision-making under uncertainty, and the vulnerability of critically ill patients. Yet despite the abundance of proof-of-concept studies, the clinical translation of AI tools remains strikingly limited, with fewer than 2 % of published algorithms prospectively evaluated in real-world ICU settings.</div><div>In this editorial, we discuss the roadmap proposed by Workum et al., which outlines a progressive, risk-aligned framework for the integration of AI in critical care. Beyond model performance, the authors emphasize fundamental values such as fairness, explainability, and accountability, while highlighting the practical challenges of data interoperability, infrastructure, governance, and liability. Their work reminds us that AI adoption is not primarily hindered by algorithms themselves but by the surrounding ecosystem of data quality, regulatory clarity, and clinician trust.</div><div>We argue that the true promise of AI in the ICU lies not in rapid technological breakthroughs but in careful, evidence-based, and human-centered implementation. Whether these systems will ultimately improve patient-centered outcomes remains uncertain. The roadmap by Workum et al. should therefore be read as a call for cautious progress: to begin with low-risk applications, to invest in infrastructure and interdisciplinary collaboration, and to rigorously evaluate clinical benefit before moving toward high-stakes medical decision support.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"91 ","pages":"Article 155263"},"PeriodicalIF":2.9,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145086019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Target attainment with continuously administered cefotaxime in critically ill patients – a retrospective cohort study","authors":"C. Stephani ,&nbsp;L. Weber ,&nbsp;J. Wieditz ,&nbsp;F. Streit ,&nbsp;M.S. Winkler ,&nbsp;C. Lanckohr ,&nbsp;M. Schulze ,&nbsp;S. Scheithauer ,&nbsp;O. Moerer","doi":"10.1016/j.jcrc.2025.155264","DOIUrl":"10.1016/j.jcrc.2025.155264","url":null,"abstract":"<div><h3>Introduction</h3><div>Cefotaxime is a beta-lactam-antibiotic commonly used in the treatment of severe pneumonia, sepsis, and meningitis. However, there is little scientific literature regarding continuously administered cefotaxime in critically ill patients. We aimed at evaluating cefotaxime dosing performance and at characterizing factors with relevance for cefotaxime plasma levels.</div></div><div><h3>Methods</h3><div>We retrospectively screened electronic medical records of critically ill patients who had received cefotaxime continuously – starting with an initial 2 g loading dose followed by continuous infusion of 6 g per day - along with regular cefotaxime-plasma-level measurements and dose adjustments according to a predefined target concentration window. Additionally, we extracted a broad range of related clinical and laboratory parameters and conducted correlation and regression analyses.</div></div><div><h3>Results</h3><div>Cefotaxime plasma levels of &gt;8 mg/l (&gt;4xMIC breakpoint for Enterobacterales) initially were reached in all (96/96) patients and remained above 8 mg/l (236/237) in nearly all follow-up measurements based on 338 single cefotaxime measurements of 105 patients. Additionally, 90 % (85/96) of first plasma level measurements surpassed the eightfold MIC breakpoint for Enterobacterales (16 mg/l). In accordance with a highly significant negative correlation (−0.69 [−0.79 - -0.56]) between the estimated glomerular filtration rate (eGFR) and cefotaxime plasma levels, multiple linear regression attributed nearly 50 % of plasma level variance to the eGFR.</div></div><div><h3>Conclusions</h3><div>Our real-world analysis demonstrates that continuous administration of a standard dose of 6 g cefotaxime per day invariably ensures bactericidal plasma concentrations regarding Enterobacterales even with augmented renal function. We propose specific adjustments of daily doses for normal and reduced renal function.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"91 ","pages":"Article 155264"},"PeriodicalIF":2.9,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145080925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of dexmedetomidine on clinical and management outcomes in patients with septic shock: A systematic review and meta-analysis of randomized trials","authors":"Alhareth Alsagban ,&nbsp;Omar Saab ,&nbsp;Hasan Al-Obaidi ,&nbsp;Marwah Algodi ,&nbsp;Michael Koenig ,&nbsp;Bela Patel","doi":"10.1016/j.jcrc.2025.155251","DOIUrl":"10.1016/j.jcrc.2025.155251","url":null,"abstract":"<div><h3>Background</h3><div>Septic shock constitutes a significant health concern, resulting in substantial morbidity and mortality. Dexmedetomidine (DEX) was reported to significantly mitigate vasopressor resistance in septic shock, enhancing clinical outcomes. We aim to investigate DEX effect on mortality, clinical, and management outcomes in septic shock patients.</div></div><div><h3>Methods</h3><div>Systematic review and meta-analysis synthesizing evidence from randomized controlled trials (RCTs) obtained from PubMed, CENTRAL, Scopus, and Web of Science until January 2025 without language restrictions. Using Stata MP v. 17, fixed-effects model used to report dichotomous outcomes and continuous outcomes using relative risk (RR) and mean difference (MD), respectively, with a 95 % confidence interval (CI). PROSPERO ID: CRD42025641437.</div></div><div><h3>Results</h3><div>Eight RCTs and 662 patients were included. There was no significant difference between DEX and usual care for the primary outcome of in-hospital mortality (RR: 0.78, 95 % CI [0.56, 1.11], <em>p</em> = 0.17). Similarly, no significant differences were found for secondary outcomes of ICU mortality (RR: 0.73, 95 % CI [0.48, 1.13], <em>p</em> = 0.16), and long-term mortality (RR: 0.90, 95 % CI [0.73, 1.11], <em>p</em> = 0.33). No significant difference between both groups regarding the ICU length of stay (LOS) (MD: 0.07, 95 % CI [−0.97, 1.12], <em>p</em> = 0.89), mechanical ventilation duration (MD: 0.29, 95 % CI [−0.26, 0.84], <em>p</em> = 0.30), and vasopressor infusion duration (MD: -0.32, 95 % CI [−0.79, 0.15], <em>p</em> = 0.18). However, DEX significantly increased hospital LOS (MD: 1.12, 95 % CI [0.19, 2.04], <em>p</em> = 0.02).</div></div><div><h3>Conclusion</h3><div>With low certainty of evidence, DEX did not significantly impact mortality, ICU LOS, mechanical ventilation duration, vasopressor infusion duration, acute kidney injury, bradycardia, hypotension, and delirium. Still, DEX significantly increased hospital LOS.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"91 ","pages":"Article 155251"},"PeriodicalIF":2.9,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145086032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The association between albumin-corrected anion gap and in-hospital mortality in critically ill COPD patients: A multicenter retrospective study from eICU collaborative research database","authors":"Zhiwei Long ,&nbsp;Guisheng Xian ,&nbsp;Zixuan Xiang ,&nbsp;Xiaofeng Zhu ,&nbsp;Yue Zhou ,&nbsp;Zhengtu Li ,&nbsp;Shaoqiang Li ,&nbsp;Yangqing Zhan ,&nbsp;Feng Ye ,&nbsp;Yan Wang","doi":"10.1016/j.jcrc.2025.155260","DOIUrl":"10.1016/j.jcrc.2025.155260","url":null,"abstract":"<div><h3>Background</h3><div>Patients with chronic obstructive pulmonary disease (COPD) in the intensive care unit (ICU) often have poor prognoses. Early assessment of disease severity is crucial for timely interventions to improve outcomes. The albumin-corrected anion gap (ACAG) reflects the degree of metabolic acidosis and reduces the interference of hypoalbuminemia in the results, making it a suitable marker for COPD patients in the ICU. This study aims to explore the association between ACAG and in-hospital mortality in ICU patients with COPD.</div></div><div><h3>Methods</h3><div>We extracted data from 4304 ICU-admitted COPD patients from the eICU Database and categorized them into four groups based on ACAG quartiles. Logistic regression models were used to analyze the relationship between ACAG and in-hospital mortality in critically ill COPD patients. Restricted cubic spline (RCS) was employed to further explore the potential non-linear association between ACAG and in-hospital mortality. Receiver operating characteristic (ROC) and decision curve analysis (DCA) were used to compare the predictive performance of ACAG and the anion gap. Subgroup analyses were performed to investigate potential interactions.</div></div><div><h3>Results</h3><div>Higher ACAG levels were a strong predictor of in-hospital mortality in critically ill COPD patients. A non-linear relationship was observed between elevated ACAG levels and increased risk of in-hospital mortality, with a sharp increase in mortality risk when ACAG exceeded 15. Compared with the anion gap, ACAG demonstrated superior predictive ability. Subgroup analysis revealed that ACAG had a stronger predictive value in patients younger than 65 years.</div></div><div><h3>Conclusions</h3><div>ACAG is an effective predictor of in-hospital mortality in ICU patients with COPD, offering better predictive power than the anion gap. ACAG can assist in early disease monitoring and risk stratification in critically ill COPD patients.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"91 ","pages":"Article 155260"},"PeriodicalIF":2.9,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145080277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of opioid requirements in mechanically ventilated patients taking buprenorphine/naloxone prior to admission","authors":"Molly O'Connell ,&nbsp;Ashley Kamp ,&nbsp;Sean Mertz ,&nbsp;Michelle Kuhrt ,&nbsp;Lexie Zidanyue Yang ,&nbsp;Alaattin Erkanli ,&nbsp;Christopher E. Cox ,&nbsp;Bridgette Kram","doi":"10.1016/j.jcrc.2025.155261","DOIUrl":"10.1016/j.jcrc.2025.155261","url":null,"abstract":"<div><h3>Background</h3><div>With limited data quantifying opioid requirements based on substance use history, including buprenorphine/naloxone use, optimal pain management for mechanically ventilated patients remains unknown.</div></div><div><h3>Objective</h3><div>To compare opioid requirements in mechanically ventilated adults admitted to the intensive care unit (ICU) taking buprenorphine/naloxone prior to admission compared to those who do not.</div></div><div><h3>Methods</h3><div>This multicenter, retrospective study included adults admitted to a medical ICU and mechanically ventilated for at least 12 h. The primary endpoint was mean hourly opioid rate (fentanyl equivalents [FE], μg FE/h) from intubation until extubation or up to 72 h. Secondary endpoints included sedative requirements and time with pain and depth of sedation scores within goal. To adjust for confounders, a negative binomial model was performed.</div></div><div><h3>Results</h3><div>Of 176 patients, 47 took buprenorphine/naloxone, 69 were opioid-naïve, and 60 were opioid-tolerant. There was no difference in mean hourly opioid rate between buprenorphine/naloxone (40.8 ± 37.1 μg FE/h) and opioid-naïve (31.7 ± 32.5 μg FE/h; <em>p</em> = 0.17) and opioid-tolerant patients (51 ± 46 μg FE/h; <em>p</em> = 0.22). Multivariable regression demonstrated similar hourly rates in buprenorphine/naloxone and opioid-naïve patients, but opioid-tolerant patients had 50 % higher rates (estimated rate ratio 1.5, 95 % CI [1.01, 2.23]). Time spent with pain scores at goal was similar. Time spent with sedation scores at goal was similar between buprenorphine/naloxone and opioid-naïve patients, but was lower than opioid-tolerant patients.</div></div><div><h3>Conclusion</h3><div>Patients taking buprenorphine/naloxone prior to admission who are mechanically ventilated for at least 12 h may have opioid requirements similar to opioid-naïve patients and lower than opioid-tolerant patients.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"91 ","pages":"Article 155261"},"PeriodicalIF":2.9,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145080866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Continuous infusion of Beta-Lactams in the critically ill: Considerations for global implementation","authors":"Kerina J. Denny ,&nbsp;Janis Best-Lane ,&nbsp;Stephen J. Brett ,&nbsp;Joel Dulhunty ,&nbsp;Andries G.S. Gous ,&nbsp;Flavia R. Machado ,&nbsp;Rekha Pai Mangalore ,&nbsp;Reena Mehta ,&nbsp;Dorrilyn Rajbhandari ,&nbsp;Juan Scribante ,&nbsp;Jeffery Lipman","doi":"10.1016/j.jcrc.2025.155254","DOIUrl":"10.1016/j.jcrc.2025.155254","url":null,"abstract":"<div><div>β-lactam antibiotics are the most commonly used antibiotics for the empiric and targeted treatment of infection in the critically ill. Timely administration of an effective dose of β-lactams is critical to reduce infection-associated morbidity and mortality.</div><div>Continuous infusion (CI) of β-lactam antibiotics is now an evidence-based strategy to optimise treatment in critically ill patients with infection. However, the widespread implementation of CI of β-lactams requires consideration of various practical and pharmaceutical related factors.</div><div>The following addresses barriers to the implementation of CI of β-lactam antibiotics, including specific considerations for low resource settings, and aims to provide practical solutions for the translation of evidence into practice.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"91 ","pages":"Article 155254"},"PeriodicalIF":2.9,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145080868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current challenges in understanding, diagnosing and managing sepsis-induced cardiac dysfunction","authors":"Catalina Paraschiv ,&nbsp;Mihaela Roxana Popescu Moraru ,&nbsp;Livia Florentina Paduraru ,&nbsp;Claudia Andreea Palcau ,&nbsp;Andreea Catarina Popescu ,&nbsp;Serban Mihai Balanescu","doi":"10.1016/j.jcrc.2025.155250","DOIUrl":"10.1016/j.jcrc.2025.155250","url":null,"abstract":"<div><div>Sepsis is a severe, life-threatening condition, which may be responsible for multiple complications, including cardiovascular events. Despite being a common complication, sepsis-induced cardiac dysfunction (SICD) is still not entirely understood. This review underlines the diagnosis challenges, discusses the prognosis and proposes a diagnosis path for patients with suspected SICD. Existing severity scoring systems are not able or designed to predict the risk of cardiac dysfunction in septic patients. Current biomarkers are not sufficient for the diagnosis of SICD, only for the exclusion of acute myocardial infarction. Troponin levels may be negative or slightly elevated in sepsis-induced cardiac dysfunction and natriuretic peptides are significantly more elevated in septic patients who develop cardiac dysfunction. Electrocardiogram changes are not always present. However, ischemic ST-T changes might be observed. Furthermore, sepsis is a risk factor for developing new-onset atrial fibrillation. Repeat echocardiography remains the crucial diagnosis method used to describe this reversible cardiac disorder. Acute cardiac dysfunction in septic patients requires a differential diagnosis between acute coronary syndrome, myocarditis, Takotsubo Syndrome and SICD. A combination of clinical, biochemical or imaging data is not yet validated for diagnosing SICD.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"91 ","pages":"Article 155250"},"PeriodicalIF":2.9,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145044321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}