Journal of Intensive Care最新文献

{"title":"Response to \"Predicting high-flow nasal cannula failure: beyond static indices toward dynamic physiologic assessment\".","authors":"Yaxiaerjiang Muhetaer, Shi-Min Zhang, Amanguli Moming, Kai Liu, Ming Zhong","doi":"10.1186/s40560-026-00880-9","DOIUrl":"https://doi.org/10.1186/s40560-026-00880-9","url":null,"abstract":"","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"14 1","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838990","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":"Predicting high-flow nasal cannula failure: beyond static indices toward dynamic physiologic assessment.","authors":"Jay Prakash, Kalavathy Swarna, Bodhisatwa Choudhuri","doi":"10.1186/s40560-026-00876-5","DOIUrl":"https://doi.org/10.1186/s40560-026-00876-5","url":null,"abstract":"","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"14 1","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838985","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":"Drug sequestration and metabolite formation: key pharmacokinetic challenges for levosimendan use during ECMO support in cardiogenic shock.","authors":"Nicolas Tebib, Lucas Liaudet, Zied Ltaief","doi":"10.1186/s40560-026-00884-5","DOIUrl":"https://doi.org/10.1186/s40560-026-00884-5","url":null,"abstract":"<p><strong>Background: </strong>In patients with refractory cardiogenic shock, veno-arterial extracorporeal membrane oxygenation (ECMO) provides temporary circulatory support, but optimal strategies to promote myocardial recovery and facilitate ECMO weaning remain uncertain. Levosimendan is a calcium-sensitizing inotrope and vasodilator that improves cardiac performance and may support cardiac function and shorten the duration of ECMO support.</p><p><strong>Discussion: </strong>The recent multicenter randomized placebo-controlled LEVOECMO trial demonstrated no benefit of early levosimendan infusion on ECMO weaning or clinical outcomes, providing robust evidence against routine and early use. Several pharmacokinetic factors may have attenuated levosimendan efficacy in this setting. Levosimendan is prone to sequestration within the ECMO circuit, particularly early after cannulation. Moreover, its short half life and its reliance on hepatic and intestinal metabolism for the generation of the long-acting active metabolite may limit its effectiveness during the early phase of cardiogenic shock, when high incidence of hepatic dysfunction and mesenteric hypoperfusion may contribute to reduced active metabolite production. In addition, renal replacement therapy is frequently required in ECMO patients and may further reduce plasma concentrations of active metabolites. Taken together, and in the absence of therapeutic drug monitoring, these factors may result in highly variable and unpredictable exposure to active metabolites among patients. These considerations raise the hypothesis that alternative strategies such as delayed initiation with therapeutic drug monitoring might improve exposure to levosimendan and its active metabolites.</p><p><strong>Conclusion: </strong>While recent evidence discourages routine early levosimendan use during ECMO for cardiogenic shock, a personalized, pharmacology-driven approach needs further investigation before a definitive conclusion.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"14 1","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13107766/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147773674","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":"Effect modification by chronic kidney disease on renal outcomes in septic shock patients undergoing high-MAP targeting: a secondary analysis of the OPTPRESS trial.","authors":"Hiraaki Okuzawa, Akira Endo, Tomohiro Akutsu, Keisuke Suzuki, Hiromasa Hoshi, Kazuma Yamakawa, Takashi Tagami, Yutaka Umemura","doi":"10.1186/s40560-026-00882-7","DOIUrl":"https://doi.org/10.1186/s40560-026-00882-7","url":null,"abstract":"<p><strong>Background: </strong>The optimal mean arterial pressure (MAP) target for renal protection in septic shock remains unclear. Although higher MAP targets have been suggested to improve renal outcomes in selected patient subgroups, it is unknown whether baseline chronic kidney disease (CKD) modifies the renal response to MAP targeting strategies.</p><p><strong>Methods: </strong>We conducted a post hoc secondary analysis of the OPTPRESS trial, a multicenter randomized controlled trial enrolling patients aged ≥ 65 years with septic shock, comparing high-MAP (80-85 mmHg) versus standard-MAP (65-70 mmHg) targets. The primary outcome was renal replacement therapy-free days (RRT-FD) at 28 days, and the secondary outcome was major adverse kidney events (MAKE) at hospital discharge. Multivariable regression models were used to assess the interaction between MAP targeting strategy and documented history of CKD status. Stratified analysis was subsequently performed within CKD and non-CKD subgroups. Sensitivity analysis using inverse probability of treatment weighting (IPTW) and multiple imputation was conducted.</p><p><strong>Results: </strong>Among 431 patients included in the complete case analysis, 70 had CKD and 361 did not. A statistically significant interaction between MAP targeting strategy and CKD status was observed for RRT-FD (p for interaction = 0.040). In adjusted analyses stratified by CKD status, high-MAP targeting was associated with fewer RRT-FD in patients without CKD (adjusted β, - 3.5 days; 95% CI - 5.94 to - 1.11), whereas no significant association was observed in patients with CKD (adjusted β, + 2.0 days; 95% CI - 4.34 to + 8.35). For MAKE, the direction of effect was consistent with that observed for RRT-FD although statistical significance was not reached in patients without CKD. Sensitivity analysis yielded directionally consistent findings.</p><p><strong>Conclusions: </strong>Documented history of CKD may modify the renal response to high-MAP targeting in elderly patients with septic shock. High-MAP targets were associated with fewer RRT-FD in patients without CKD. Given the exploratory and post hoc nature of this analysis, these findings should be interpreted cautiously and warrant confirmation in prospective studies evaluating individualized MAP targets according to baseline renal function in septic shock.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147716931","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":"Remimazolam in pediatric sedation and anesthesia: current perspectives and clinical considerations.","authors":"Satoshi Kimura, Moritoki Egi","doi":"10.1186/s40560-026-00881-8","DOIUrl":"https://doi.org/10.1186/s40560-026-00881-8","url":null,"abstract":"<p><p>Remimazolam is a novel, short-acting benzodiazepine that acts as a high-affinity selective ligand for the GABA-A receptor. Since its approval, growing evidence has demonstrated its safety and efficacy for sedation and anesthesia in adult patients. Recently, increasing interest has emerged regarding the utility of remimazolam in pediatric patients due to its favorable characteristics, including its limited suppressive effect on respiration and circulation in comparison to other sedatives. However, its clinical use in pediatric patients requires special consideration despite the overall safety profile of remimazolam. Because of differences in body composition and dynamic physiological changes during growth and development, the pharmacokinetic and pharmacodynamic properties of remimazolam in children may differ from those in adults. Therefore, a clear understanding of its pharmacological properties, potential indications, limitations, and reverse options is essential for clinical use. Previous studies have suggested that higher doses relative to body size may be required in pediatric patients than in adult patients for adequate sedation and anesthesia. While body weight-based dosing regimens are straightforward, age-related differences in pharmacokinetics and pharmacodynamics may increase the risk of under- or overdosing. The use of concentration prediction models may assist in dose and infusion rate adjustments. Advances in electroencephalogram monitoring during sedation and anesthesia may also provide valuable guidance, although age-dependent EEG differences and the distinct effects of remimazolam in comparison to other sedatives require further investigation. Despite its short-acting nature and low risk of accumulation, the combination of relatively high dose requirements and potentially reduced clearance in children raises a theoretical concern regarding rebound effects in this population. Therefore, careful dose titration, appropriate monitoring, and judicious reversal are necessary to ensure safe administration in pediatric practice.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147690355","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":"Computed tomography in ARDS, from morphological insights to AI-powered multi-modal analysis: a narrative review.","authors":"Zirui Xu, Yongran Wu, Azhen Wang, You Shang, Le Yang, Xiaojing Zou","doi":"10.1186/s40560-026-00883-6","DOIUrl":"https://doi.org/10.1186/s40560-026-00883-6","url":null,"abstract":"<p><strong>Background: </strong>Acute respiratory distress syndrome (ARDS) is a critical clinical condition characterized by acute respiratory failure and high mortality. It poses considerable challenges in both diagnosis and management. Imaging constitutes a central element of the conceptual framework for ARDS, with computed tomography (CT) being an essential technical tool for studying the morphological and pathological mechanisms of lung tissue in ARDS.</p><p><strong>Main text: </strong>CT imaging has provided profound insights into the respiratory mechanics in ARDS and has informed the optimization of ventilation strategies. It is widely used to characterize the typical pathophysiological manifestations of ARDS in the lungs and can quantify the distribution of ventilation, perfusion, and pulmonary edema. Moreover, CT-based morphological classification of ARDS constitutes a significant component of ARDS subphenotypes research. However, given the heterogeneity in both its diagnosis and response to treatment, a single assessment model is insufficient to meet the management needs of patients with ARDS. The widespread application of artificial intelligence (AI) has greatly facilitated the quantitative analysis of CT imaging, enabling the integration of multidimensional data, such as CT imaging, pulmonary functional data, and laboratory tests.</p><p><strong>Conclusion: </strong>This narrative review adopts a CT-centric viewpoint, delineating the progressive shift in the diagnosis, phenotyping, and management of ARDS from qualitative to quantitative analysis and from unimodal to multimodal evaluation, propelled by ongoing advances in AI. Looking forward, CT-based multimodal fusion analysis holds promise for identifying more precise therapeutic biomarkers and advancing the development of individualized treatment strategies for ARDS.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147662469","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":"PICS-SES postintensive care syndrome and socioeconomic status.","authors":"Jean-Pierre Quenot, Marine Jacquier, Isabelle Fournel, Alicia Taha, Fiona Ecarnot, Nicolas Meunier-Beillard, Pascal Andreu, Jean-Baptiste Roudaut, Marie Labruyère, Jean-Philippe Rigaud","doi":"10.1186/s40560-026-00878-3","DOIUrl":"10.1186/s40560-026-00878-3","url":null,"abstract":"<p><p>Postintensive care syndrome (PICS) encompasses physical, psychological, and cognitive sequelae following an intensive care unit (ICU) stay, with repercussions also extending to patients' families (PICS-F). Beyond health-related outcomes, ICU survivors frequently face social and economic challenges, including reduced income, unemployment, social isolation, and increased dependence on welfare. Socioeconomic status (SES), defined by access to material, human, and social resources, is a major determinant of health inequities and influences both the risk and severity of PICS. Evidence suggests that low SES is associated with poorer quality of life, increased need for long-term care, and higher mortality after ICU discharge. Recent studies show that educational level and employment status significantly impact long-term recovery, underlining the interaction between social vulnerability and PICS. The ongoing SOPICS trial will further explore these associations using the EPICES score to identify high-risk patients. Integrating SES into PICS management is essential, with social workers playing a central role in coordinating discharge planning, welfare access, and support services. Future research should assess the impact of tailored social interventions on PICS outcomes, aiming to mitigate inequities and improve reintegration after critical illness.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"14 1","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13040774/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147592503","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":"The hemodynamics of tracheal intubation in critically ill patients: a narrative review.","authors":"Yuki Kotani, Takatoshi Koroki, Yoshiro Hayashi, Vincenzo Russotto","doi":"10.1186/s40560-026-00877-4","DOIUrl":"10.1186/s40560-026-00877-4","url":null,"abstract":"<p><strong>Background: </strong>Tracheal intubation is a ubiquitous but high-risk procedure in critically ill patients, often required in the setting of severe hypoxemia, shock, or metabolic acidosis. Despite being a life-saving procedure, it is associated with a high incidence of peri-intubation adverse events. In a large international study (INTUBE), more than 40% of intubations in critically ill patients were complicated by cardiovascular instability, approximately 10% by severe hypoxemia, and over 3% by cardiac arrest, highlighting the magnitude of risk in this population. Among these complications, cardiovascular instability-particularly hypotension-emerges as the most frequent and most consequential, being independently associated with increased intensive care unit (ICU) and 28-day mortality. However, robust randomized evidence to guide optimal peri-intubation hemodynamic management remains scarce, leaving clinicians to rely largely on physiologic reasoning.</p><p><strong>Main body: </strong>Hemodynamic physiology during intubation is highly dynamic and influenced by cumulative and interacting threats. Critically ill patients often present with an endogenous catecholamine surge that temporarily preserves perfusion but reflects a fragile reserve. The administration of induction agents rapidly abolishes this sympathetic drive, leading to abrupt decreases in systemic vascular resistance and cardiac output. Apnea introduces hypoxemia, hypercapnia, and acidosis, all of which further impair myocardial contractility and catecholaminergic response, with increased arrhythmogenic risk. The subsequent initiation of positive-pressure ventilation raises intrathoracic pressure, reduces venous return, and increases right ventricular afterload, especially in the context of acute respiratory distress syndrome with hypoxic pulmonary vasoconstriction or pulmonary microthrombosis. Finally, post-intubation sedation, ventilator settings, and vasopressor therapy continue to shape the hemodynamic trajectory.</p><p><strong>Conclusions: </strong>This narrative review synthesizes current evidence and physiological insights into a structured timeline extending from induction to post-intubation care.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13151387/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147530023","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":"Critical evaluation of \"Exploratory characterization of dynamic soluble programmed death-ligand 1 trajectories and their association with mortality in critical COVID-19\".","authors":"Zubaida Bibi, Kausar Ali","doi":"10.1186/s40560-026-00867-6","DOIUrl":"10.1186/s40560-026-00867-6","url":null,"abstract":"<p><p>Recent work describing longitudinal soluble programmed death-ligand 1 (sPD-L1) trajectories in critically ill patients with COVID-19 provides valuable insight into immune checkpoint dynamics and mortality risk. However, interpretation of these findings warrants caution. Longitudinal analyses are vulnerable to survivorship and informative censoring bias, potentially overstating declining biomarker trends among survivors. In addition, the absence of time-varying adjustment for evolving disease severity and organ support limits causal inference regarding sPD-L1 as an independent prognostic marker. Finally, renal dysfunction may confound circulating sPD-L1 concentrations through impaired clearance. Addressing these methodological issues is essential for validating sPD-L1 as a robust prognostic biomarker in critical illness.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"14 1","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13019976/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147520884","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":"SOFA-2 versus SOFA-1 for mortality prediction in critically ill patients.","authors":"Songjie Bai, Meiling Huang, Hui Chen, Xinyi Yang, Lin Chen, Fen Liu, Xuehuan Wen","doi":"10.1186/s40560-026-00875-6","DOIUrl":"10.1186/s40560-026-00875-6","url":null,"abstract":"<p><p>We validated the SOFA-2 score against the SOFA-1 score using 65,366 critically ill patients from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. SOFA-2 demonstrated superior discrimination for ICU mortality (AUROC: 0.829 [95% CI 0.823-0.835] vs. 0.796 [0.789-0.803]) and in-hospital mortality (0.789 [0.783-0.794] vs. 0.763 [0.757-0.769]) compared with SOFA-1. Of 65,366 patients, 40,990 (62.7%) were reclassified to higher scores under SOFA-2. Within each SOFA-1 stratum, those assigned higher SOFA-2 scores consistently demonstrated higher ICU mortality, confirming clinically meaningful reclassification. These findings provide additional external validation supporting the advantages of SOFA-2 for risk stratification in critically ill patients.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"14 1","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13011272/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147512727","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}