Journal of Intensive Care最新文献

{"title":"Effect of early intubation on patient-centered outcomes in urosepsis: a retrospective multicenter cohort study.","authors":"Masafumi Suga, Ryan Ling, Sho Katsuragawa, Yahya Shehabi, David Pilcher, Ashwin Subramaniam","doi":"10.1186/s40560-025-00829-4","DOIUrl":"https://doi.org/10.1186/s40560-025-00829-4","url":null,"abstract":"<p><strong>Background: </strong>Urosepsis has a reported mortality rate of up to 13.5%, and approximately 38% of affected patients require intubation. This study evaluated the association between the timing of intubation and in-hospital mortality among patients with urosepsis.</p><p><strong>Methods: </strong>We conducted a multicenter retrospective cohort study using the Australian and New Zealand Intensive Care Registry Adult Patient Database. Adult ICU patients (≥ 16 years) with a primary diagnosis of urosepsis admitted between 1 January 2018 and 1 April 2023 were included. Patients were classified into early (≤ 24 h from ICU admission) or delayed (> 24 h) intubation groups. The primary outcome was in-hospital mortality. Secondary outcomes included ICU and hospital lengths of stay (LOS), mortality at 6, and 12 months. Outcomes were analyzed using multivariable logistic or linear regression models.</p><p><strong>Results: </strong>Of 1,235 patients across 151 sites, 983 patients (79.6%) received early intubation. In-hospital mortality was similar between early and delayed intubation groups (19.2% vs. 17.5%, p = 0.52). Early intubation was not associated with in-hospital mortality (adjusted odds ratio [OR] = 0.76; 95% confidence intervals [95% CI] 0.51-1.13). Patients with early intubation had shorter ICU LOS (adjusted point estimate = -2.94 days; 95% CI -3.90 to -1.98) but not hospital LOS. There was no association between early intubation and mortality at 6 months (adjusted OR = 0.76; 95% CI 0.53-1.10) and 12 months (adjusted OR = 0.75; 95% CI 0.53-1.06).</p><p><strong>Conclusions: </strong>Early intubation within the first 24 h after ICU admission was not associated with reduced in-hospital or long-term mortality among patients with urosepsis.</p><p><strong>Trial registration: </strong>Alfred Hospital Ethics Committee (Reference 762/24) and the Australian and New Zealand Intensive Care Society (ANZICS) Centre for Outcome and Resource Evaluation Management Committee.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"13 1","pages":"58"},"PeriodicalIF":4.7,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145355083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between early administration of mucoactive agents and in-hospital mortality in patients with pneumonia requiring mechanical ventilation: a nationwide cohort study.","authors":"Akira Sasaki, Mikio Nakajima, Tomohiro Shinozaki, Yusuke Sasabuchi, Hiroyuki Ohbe, Richard H Kaszynski, Yuya Kimura, Kojiro Morita, Tadahiro Goto, Yuki Aiyama, Izumi Nakayama, Hiroki Matsui, Kiyohide Fushimi, Hidenobu Ochiai, Hideo Yasunaga","doi":"10.1186/s40560-025-00826-7","DOIUrl":"10.1186/s40560-025-00826-7","url":null,"abstract":"<p><strong>Background: </strong>In patients with pneumonia requiring mechanical ventilation, increased airway secretions are associated with prolonged mechanical ventilation, but the effect of mucoactive agents remains unclear. The present study aimed to investigate the association between early administration of mucoactive agents and in-hospital mortality in patients with pneumonia requiring mechanical ventilation.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using the Japanese Diagnosis Procedure Combination database, a nationwide inpatient database. Adult patients were eligible if they had a primary diagnosis of pneumonia and required invasive mechanical ventilation within 2 days of admission, with ventilation continued for ≥ 2 days between April 2012 and March 2023. Patients were divided into those who received at least one mucoactive agent within 2 days after the initiation of mechanical ventilation (mucoactive agent group) and those who did not (control group). Mucoactive agents included ambroxol (oral), bromhexine (oral, intravenous and nebulized), fudosteine (oral), carbocisteine (oral) and N-acetylcysteine (nebulized). We performed a propensity score overlap weighting analysis to compare in-hospital mortality. The number of ventilator-free days at 28 days was assessed as a secondary outcome. We also performed sensitivity analyses using inverse probability of treatment weighting, generalized estimating equations, and doubly robust methods.</p><p><strong>Results: </strong>Eligible patients (n = 10,942) were categorized into the mucoactive agent group (n = 2246) or control group (n = 8696). The most commonly prescribed mucoactive agent was carbocisteine (oral). After overlap weighting, in-hospital mortality was significantly lower in the mucoactive agent group than in the control group (25.2% vs. 27.5%; risk difference, - 2.3%; 95% confidence interval, - 4.4% to - 0.3%; p = 0.028). Ventilator-free days at 28 days did not significantly differ between the mucoactive agent group and the control group. Sensitivity analyses yielded similar results.</p><p><strong>Conclusions: </strong>In patients with ventilated pneumonia, early administration of mucoactive agents was associated with lower in-hospital mortality.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"13 1","pages":"57"},"PeriodicalIF":4.7,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12532859/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145308249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Granulomonocytapheresis for chronic inflammatory diseases and sepsis.","authors":"Toshiaki Iba, Hideshi Okada, Takahiro Miki, Michio Mineshima, Ricard Ferrer","doi":"10.1186/s40560-025-00825-8","DOIUrl":"10.1186/s40560-025-00825-8","url":null,"abstract":"<p><p>Granulomonocytapheresis (GMA) has long been used to treat refractory chronic inflammatory diseases. Recently, an exploratory clinical study showed that GMA was effective for sepsis, and its use has been approved in Japan. The purpose of this review is to spread the knowledge about GMA in chronic and acute inflammation. GMA is a selective extracorporeal therapy designed to remove activated granulocytes and monocytes, key drivers of inflammation in various immune-mediated diseases. Initially developed for ulcerative colitis, GMA has since demonstrated immunomodulatory effects in conditions such as Crohn's disease, rheumatoid arthritis, and dermatologic disorders, by depleting activated myeloid cells and altering cytokine profiles, reducing tumor necrosis factor (TNF)-α, interleukin (IL)-6, and increasing IL-10. GMA aims to restore immune homeostasis without the systemic immunosuppression associated with pharmacologic agents. Recently, its application has expanded to critical care settings. In sepsis and cytokine storm syndromes, where overwhelming innate immune activation leads to organ dysfunction, GMA may offer therapeutic benefit. Preclinical models and pilot studies in septic patients suggest that GMA can reduce inflammatory mediators, improve hemodynamics, and support organ recovery. Reflecting this potential, GMA was approved for insurance reimbursement in Japan in August 2025 as adjunctive therapy for sepsis with systemic inflammation. Although GMA is a promising therapy for specific patients, there is limited supporting data, and its effect should be proven in future trials.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"13 1","pages":"56"},"PeriodicalIF":4.7,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12495845/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145225439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dose-response relationship between transfusion and the incidence of infection in critically ill patients: a systematic review and dose-response meta-analysis.","authors":"Shodai Yoshihiro, Yuki Kataoka, Takashi Hongo, Takahiro Tsuge, Hiroaki Matsuo","doi":"10.1186/s40560-025-00822-x","DOIUrl":"10.1186/s40560-025-00822-x","url":null,"abstract":"<p><strong>Purpose: </strong>To estimate the association between red blood cell (RBC) transfusion volume and hospital-acquired infections (HAI) in critically ill patients, with a particular focus on identifying the potential threshold volumes at which infection risk changes.</p><p><strong>Methods: </strong>The MEDLINE, CENTRAL, Embase, and Transfusion Evidence Library databases were searched for studies published from database inception to November 2024. Citation searches and reference checks of the relevant guidelines were combined. Studies that evaluated transfusion and anemia pharmacotherapy in critically ill patients were included. Outcome of interest was the incidence of HAI. We conducted a dose-response meta-analysis (DRMA) using a one-stage random-effects model.</p><p><strong>Results: </strong>We identified 39,453 records after searching the databases. After combining the results of citation searches and reference checks of the guidelines, 45 studies were eligible. For the DRMA, we eliminated 14 studies without results and 15 with a critical risk of bias. We included 9587 patients from 16 studies. Our DRMA showed a non-linear risk curve, with odds ratio for HAI decreasing and reaching a trough at three units of RBC transfusion. Three units of RBC may not increase the risk of HAI in critically ill patients. However, the clinical implications of higher RBC transfusion volumes remain unclear.</p><p><strong>Conclusions: </strong>Our findings suggest a non-linear relationship between RBC transfusion volume and HAI risk in critically ill patients, highlighting the need for further research to inform individualized transfusion strategies. Clinical Trial Registration http://osf.io/a9cwd.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"13 1","pages":"53"},"PeriodicalIF":4.7,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12486664/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145199664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Strategies for discontinuing vasopressin and norepinephrine during the recovery phase of shock: a single-center retrospective study.","authors":"Shiho Suganuma, Shigehiko Uchino, Seiya Nishiyama, Yusuke Sasabuchi, Shinshu Katayama","doi":"10.1186/s40560-025-00823-w","DOIUrl":"10.1186/s40560-025-00823-w","url":null,"abstract":"<p><strong>Background: </strong>The optimal strategy for discontinuing arginine vasopressin and norepinephrine in patients recovering from shock remains uncertain. Although prior studies have suggested a higher risk of hypotension when arginine vasopressin is discontinued first, these findings may have been influenced by baseline imbalances and tapering practices. We conducted a retrospective study to evaluate whether the order of discontinuation between arginine vasopressin and norepinephrine was associated with the incidence of hypotension during the recovery phase of shock, with vasopressor end doses converted to norepinephrine equivalents for analysis.</p><p><strong>Methods: </strong>This was a single-center retrospective cohort study of intensive care unit patients with shock who received both arginine vasopressin and norepinephrine from August 2017 to March 2024. Patients were categorized based on whether arginine vasopressin or norepinephrine was discontinued first. The primary outcome was the incidence of hypotension within 24 h of vasopressor cessation, defined as mean arterial pressure < 60 mmHg requiring a ≥ 25% increase in the remaining vasopressor, reinstitution of the stopped agent, or a bolus of ≥ 500 mL crystalloid or 25 g albumin. Overlap weighting using propensity scores was applied to adjust for baseline imbalances both in the overall cohort and in the septic shock subgroup. Propensity scores were estimated using logistic model, including baseline characteristics, hemodynamic parameters, and vasopressor end doses in norepinephrine equivalents.</p><p><strong>Results: </strong>A total of 524 patients were analyzed, with 293 discontinuing AVP first and 231 discontinuing NE first. In the unadjusted cohorts, hypotension occurred in 19% of the AVP-first group and 26% of the NE-first group. After overlap weighting, all baseline covariates were balanced between the groups, and the incidence of hypotension was not significantly different (19% vs 21%, P = 0.59). In the septic shock subgroup (n = 267), the weighted analysis showed no significant difference in the incidence of hypotension between groups.</p><p><strong>Conclusions: </strong>In patients recovering from shock who received both arginine vasopressin and norepinephrine, discontinuing arginine vasopressin first was not associated with a higher risk of hypotension.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"13 1","pages":"52"},"PeriodicalIF":4.7,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12487481/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145199695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expert consensus statement on the evaluation, treatment, and transfer of cardiogenic shock using a Delphi method approach: a report of the Japan Critical Care Cardiology Committee (J4 CS).","authors":"Takahiro Nakashima, Toru Kondo, Jun Nakata, Keita Saku, Shoji Kawakami, Masanari Kuwabara, Takeshi Yamamoto, Migaku Kikuchi, Ichiro Takeuchi, Kuniya Asai, Naoki Sato","doi":"10.1186/s40560-025-00791-1","DOIUrl":"10.1186/s40560-025-00791-1","url":null,"abstract":"","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"13 1","pages":"50"},"PeriodicalIF":4.7,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12482070/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145199727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Classifying diarrhea in critically ill patients through various criteria: a cohort study.","authors":"Ryohei Yamamoto, Hajime Yamazaki, Takatoshi Koroki, Yuna Ueta, Ryo Ueno, Yosuke Yamamoto","doi":"10.1186/s40560-025-00824-9","DOIUrl":"10.1186/s40560-025-00824-9","url":null,"abstract":"<p><strong>Background: </strong>The absence of consensus criteria for diarrhea in critically ill patients poses challenges, including an uncertain prevalence and inconsistent findings regarding the impact of diarrhea on mortality. This study aimed to examine the prevalence of diarrhea, the agreement among different diagnostic criteria, and their association with mortality.</p><p><strong>Methods: </strong>A single-center cohort study was conducted among consecutive adult patients admitted to the intensive care unit (ICU) for at least three days between January 2017 and December 2018. The six diarrhea criteria evaluated were based on frequency, quantity, and consistency. These included the European Society of Intensive Care Medicine (ESICM) criteria (≥ 3 times and > 200 g/day loose or liquid stool), the World Health Organization (WHO) criteria (≥ 3 times loose or liquid stool), the Bristol Stool Chart Scale (BSCS) score of 6 or 7, and other quantity- or frequency-based definitions. Outcomes included: (1) prevalence of diarrhea according to each definition, (2) agreement between criteria, and (3) association between diarrhea and in-hospital mortality. Associations were assessed using multivariable Cox proportional hazards models, yielding hazard ratios (HRs) and 95% confidence intervals (CIs).</p><p><strong>Results: </strong>Among 700 participants, 61% were men; the median age was 71 years. The prevalence of diarrhea ranged from 9 to 39%, depending on the criteria used. The WHO and ESICM criteria showed similar prevalences (18.7% and 15.1%, respectively) and high agreement (Kappa 0.87). However, both had weak agreement with the BSCS criteria (prevalence 39.3%; Kappa 0.52 and 0.43, respectively). In univariable analyses, the presence of diarrhea was associated with in-hospital mortality, regardless of the criteria used. In multivariable analyses, only the > 400 g/day loose or liquid stool, > 200 g/day loose or liquid stool, and BSCS criteria maintained this association; the adjusted HRs (95% CI) were 1.93 (1.29‒2.90), 1.78 (1.19‒2.64), and 1.73 (1.15‒2.60), respectively.</p><p><strong>Conclusions: </strong>Diarrhea prevalence varied from 9-39% across definitions. WHO and ESICM, both frequency‑based, differed from BSCS and weight‑based criteria. Given the difficulty of accurate frequency counting in ICU patients, consistency‑ or weight‑based definitions may offer a more practical alternative for both clinical practice and research.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"13 1","pages":"55"},"PeriodicalIF":4.7,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12487300/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145199685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in internal jugular vein respiratory variation during tidal volume challenge predict volume responsiveness in lumbar surgery under protective ventilation: a prospective cohort study.","authors":"Mimi Wu, Jie Xu, Xiaojie Liu, Yuanyuan Dong, Yu'e Sun, Xiaoping Gu, Jinhua Bo","doi":"10.1186/s40560-025-00821-y","DOIUrl":"10.1186/s40560-025-00821-y","url":null,"abstract":"<p><strong>Background: </strong>Internal jugular vein respiratory variation (IJVV) has been proposed as a dynamic predictor of fluid responsiveness. However, its utility is limited in patients with low tidal volume (Vt) ventilation in the prone position. We conducted this study to determine whether a transient increase in Vt from 6 to 8 ml kg^-1 of the predicted body weight (PBW), which is the \"tidal volume challenge (TVC)\", improves the feasibility of the IJVV in patients undergoing posterior lumbar surgery ventilated with a low Vt.</p><p><strong>Methods: </strong>This was a prospective study conducted in the operating room. Patients were studied at baseline (a Vt of 6 ml kg^-1 PBW), during a 1 min increase in the Vt to 8 ml kg^-1 of the PBW, during a 1 min shift to the Trendelenburg maneuver, and after fluid administration. Baseline values of the IJVV, pulse pressure variation (PPV), and stroke volume variation (SVV) [IJVV₆, PPV₆, and SVV₆, respectively], and the changes in the IJVV during a TVC (ΔIJVV_6-8) were measured. The change in cardiac index during a Trendelenburg maneuver (ΔCI_trend) was also recorded. Volume responsiveness was defined by a ΔCI_trend ≥ 8%. The primary outcome was determination of the ΔIJVV_6-8 in predicting volume responsiveness during low Vt ventilation in the prone position. The secondary outcomes included an estimation of the IJVV₆, PPV₆, and SVV₆ diagnostic performances in predicting volume responsiveness in this surgical setting.</p><p><strong>Results: </strong>Sixty-one patients were included in the study, 31 (50.82%) of whom were deemed volume responsive. The ΔIJVV_6-8 predicted volume responsiveness with area under the receiver operating characteristic curve (AUC) of 0.96 (95% CI 0.88-0.99; P < 0.001), with a sensitivity of 96.77% and a specificity of 86.67%. In addition, the AUC for ΔIJVV_6-8 was significantly higher than that for IJVV₆, PPV₆, and SVV₆, as confirmed by DeLong's test (P = 0.04, P < 0.001, and P = 0.01, respectively).</p><p><strong>Conclusions: </strong>In patients undergoing posterior lumbar surgery with low Vt ventilation, changes in IJVV during a TVC effectively predict volume responsiveness and are more reliable than IJVV, PPV, and SVV in this surgical context.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"13 1","pages":"54"},"PeriodicalIF":4.7,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12486619/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145199752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nationwide survey of adherence to the Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2024 in the initial management of sepsis.","authors":"Takehiko Oami, Daisuke Kasugai, Kazuma Yamakawa, Tadashi Matsuoka, Kenichi Kano, Yoshitaka Aoki, Tomoaki Yatabe, Nobuaki Shime, Taka-Aki Nakada","doi":"10.1186/s40560-025-00819-6","DOIUrl":"10.1186/s40560-025-00819-6","url":null,"abstract":"<p><strong>Background: </strong>The Japanese Clinical Practice Guidelines for the Management of Sepsis and Septic Shock 2024 (J-SSCG2024) were developed to improve the standardization and quality of sepsis care across various clinical settings. However, real-world adherence to these recommendations among healthcare professionals in Japan remains unclear. The objective of this study was to assess patterns of adherence to the J-SSCG2024 and identify factors associated with variation in clinical practice.</p><p><strong>Methods: </strong>We conducted a nationwide web-based cross-sectional survey targeting healthcare professionals, administering a questionnaire that included 23 items reflecting the key J-SSCG2024 recommendations for the initial management of sepsis, along with demographic and professional background information. Cluster analysis was performed to identify the distinct adherence patterns. Subgroup analyses were conducted to explore the association between respondent characteristics and guideline compliance. Additionally, sensitivity analyses were performed to evaluate the robustness of the findings across distinct cluster numbers.</p><p><strong>Results: </strong>A total of 734 healthcare professionals participated in the survey, most of whom were physicians (92.4%) with over 20 years of clinical experience (54.0%). High adherence was observed for recommendations, such as blood purification and the use of first-line vasopressors. However, substantial variation was detected in practices related to adjuvant therapies and initial resuscitation, particularly regarding the timing of vasopressor initiation and the use of beta-blockers. Cluster analysis revealed four distinct adherence profiles. Higher adherence was associated with expertise in emergency and critical care medicine, affiliation with intensive care units or emergency departments, and a higher number of patients with sepsis managed monthly. These findings were consistent across the sensitivity analyses.</p><p><strong>Conclusions: </strong>This nationwide survey identified characteristic clusters based on adherence to the J-SSCG2024 among Japanese clinicians. Targeted implementation strategies are essential to enhance guideline adoption, particularly among clinicians outside specialized critical care settings.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"13 1","pages":"51"},"PeriodicalIF":4.7,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12482439/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145199748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term recovery of sensorimotor functions and prediction of participation in survivors of critical illness: a prospective cohort study.","authors":"Johanna Weghorn, Melanie Finsterhölzl, Franziska Wippenbeck, Klaus Jahn, Marion Egger, Jeannine Bergmann","doi":"10.1186/s40560-025-00808-9","DOIUrl":"10.1186/s40560-025-00808-9","url":null,"abstract":"<p><strong>Background: </strong>Survivors of critical illness frequently face physical, cognitive and psychological impairments after intensive care. Sensorimotor impairments potentially have a negative impact on participation. However, comprehensive understanding of sensorimotor recovery and participation in survivors of critical illness is limited. Therefore, the aims of this study were to quantify long-term sensorimotor recovery in survivors of critical illness, to examine participation in daily life 1.5 years after illness onset, and to assess the predictive capacity of sensorimotor assessments for future participation.</p><p><strong>Methods: </strong>Survivors of critical illness who were mechanically ventilated ≥ 5 days on the ICU and who were admitted with weakness to neurorehabilitation were included in this single-center prospective cohort study. Time effects on sensation, muscle strength, balance, walking and dexterity were described at admission to and at discharge from rehabilitation, and 1.5 years after critical illness onset. Participation was assessed with the Reintegration to Normal Living Index. A multiple linear regression with sensorimotor outcomes at rehabilitation admission was conducted to find predictive associations with participation. The model was compared to an extended regression model containing demographic variables and factors known to be associated with participation or quality of life.</p><p><strong>Results: </strong>All sensorimotor outcomes among participants (n = 250, median age 63 (54-73) years) improved over time. However, in most patients some deficits remained after rehabilitation and on long-term follow-up. Good participation (≥ 75%) was achieved by 60.2% of survivors 1.5 years after critical illness onset. Concerning participation, the Mini Balance Evaluation Systems Test (Mini-BESTest) together with the Box-and-Block-Test, the Five-Times-Sit-to-Stand-Test, and the Medical Research Council score at rehabilitation admission formed a predictive model (R² = 0.157, p < 0.001). The extended regression analysis resulted in a model (R² = 0.357, p < 0.001) with the variables depression, duration of mechanical ventilation, cognitive function, Mini-BESTest, comorbidities, sex and cerebral lesion.</p><p><strong>Conclusions: </strong>We observed significant improvements in sensorimotor function, albeit with lingering deficits in sensation, strength, balance, dexterity and participation. Sensorimotor functions at rehabilitation start have limited explanatory power in predicting participation 1.5 years after disease onset. Trial registration German Clinical Trial Register, DRKS00021753. Date of registration: September 03, 2020.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"13 1","pages":"49"},"PeriodicalIF":4.7,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12418612/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145029862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}