Journal of Intensive Care最新文献

{"title":"Hemoglobin trends and transfusion practices after cardiac arrest: a cohort study.","authors":"Luke Andrea, Gregory Marecki, Joshua M Kimbrell, Dennis Lin, Felice Chandra, ChihHao Yuan, Ari Moskowitz","doi":"10.1186/s40560-026-00952-w","DOIUrl":"10.1186/s40560-026-00952-w","url":null,"abstract":"<p><strong>Background: </strong>Hemoglobin targets are absent from post-cardiac arrest guidelines. New trials suggest that patients with brain and myocardial injury, injuries common post-arrest, may benefit from higher hemoglobin targets. Trends in post-arrest hemoglobin and real-world practices remain poorly characterized.</p><p><strong>Methods: </strong>We performed a retrospective cohort study of consecutive adult cardiac arrests at three academic hospitals. We screened in-hospital and out-of-hospital arrests with resuscitation efforts ongoing at hospital arrival for inclusion. Patients who survived the initial resuscitation and had a hemoglobin value measured were included. All post-arrest hemoglobin values and red blood cell transfusions were collected through 30 days; descriptive statistics and graphical visualization were used to present hemoglobin trends and transfusion practices. Exploratory analyses evaluated the association between hemoglobin and in-hospital mortality.</p><p><strong>Results: </strong>Of 2,634 cardiac arrests, 958 met inclusion criteria, with 152 (15.9%) out-of-hospital arrests and 806 (84.1%) in-hospital. The mean initial post-arrest hemoglobin was 9.75 g/dL (SD 2.60), with hemoglobin levels declining progressively over the first 20 days post-arrest. Red cell transfusions were delivered for 369 (38.5%) patients in the 30 days post-arrest, with 1,238 total transfusions. The mean pre-transfusion hemoglobin value was 6.96 g/dL (SD 1.06). Pre-transfusion hemoglobin levels were < 7 g/dL for 762 (61.6%) of transfusions, and ≥ 7 g/dL for 476 (38.4%) of transfusions. Over 30 days, the highest proportion of patients transfused was in the first 48 h. Patients with initial post-arrest hemoglobin ≥ 9 g/dL had lower in-hospital mortality (adjusted OR 0.62, 95% CI 0.46-0.84, p<0.01). In time-varying analysis, post-arrest hemoglobin through 30 days demonstrated an L-shaped association with mortality, with 95% of the total reduction in mortality hazard captured below 9.20 g/dL.</p><p><strong>Conclusions: </strong>Anemia is common after cardiac arrest, worsening in initial survivors. There is substantial variation in pre-transfusion hemoglobin levels, reflecting clinical equipoise. Clinical trials are needed to disentangle anemia as a driver versus a marker of outcomes, and test whether the risk is modifiable.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"14 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13670545/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194774","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":"Proteomic identification of resistin as a NET-associated neutrophil activity marker in sepsis.","authors":"Ema Hashiguchi, Akane Shinkai, Michiko Katsuno, Mineji Hayakawa, Takaaki Totoki, Masayoshi Tasaki, Takashi Ito","doi":"10.1186/s40560-026-00954-8","DOIUrl":"https://doi.org/10.1186/s40560-026-00954-8","url":null,"abstract":"<p><strong>Background: </strong>Neutrophil extracellular traps (NETs) contribute to organ dysfunction in sepsis, yet clinically accessible biomarkers reflecting NET-associated pathology remain limited. We sought to identify circulating proteins associated with NET formation and evaluate their clinical relevance in sepsis.</p><p><strong>Methods: </strong>Unbiased proteomic profiling of stimulated human neutrophil supernatants and serum from murine sepsis was performed to identify proteins released during NET formation and elevated in vivo. Candidate biomarkers were selected through integration of these datasets and filtering based on cell type-specific expression profiles, followed by validation in patients with sepsis and healthy controls.</p><p><strong>Results: </strong>Integrative analysis identified five candidate circulating markers associated with NET formation in sepsis: cathelicidin antimicrobial peptide, lactotransferrin, neutrophil gelatinase-associated lipocalin (NGAL), resistin, and histone H4. Among these, resistin, a recently recognized neutrophil-associated protein, and NGAL demonstrated the strongest associations with sepsis-associated complications. Both markers were elevated in patients with sepsis and correlated with circulating cell-free DNA levels. In receiver operating characteristic curve analyses, resistin discriminated multiple organ failure (AUC, 0.83) and disseminated intravascular coagulation (AUC, 0.81), whereas NGAL demonstrated similarly robust performance (AUC, 0.84 and 0.79, respectively). Both markers outperformed conventional clinical parameters for discriminating sepsis-associated complications.</p><p><strong>Conclusions: </strong>These findings identify resistin as a circulating marker associated with NET formation that captures key features of sepsis-associated immunothrombosis and organ failure and may improve assessment of disease severity and risk stratification.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"14 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13660192/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182284","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":"Temporal changes in clinical practices for patients considered clinically brain dead: a single-center cohort study.","authors":"Yoshiyuki Ueda, Tetsuya Yumoto, Kohei Tokioka, Ippei Matsuo, Tomohiro Hiraoka, Takashi Hongo, Takafumi Obara, Yoshinori Kosaki, Tsuyoshi Nojima, Toshiyuki Aokage, Kohei Tsukahara, Hiromichi Naito, Atsunori Nakao","doi":"10.1186/s40560-026-00944-w","DOIUrl":"https://doi.org/10.1186/s40560-026-00944-w","url":null,"abstract":"<p><strong>Background: </strong>Patients considered clinically brain dead undergo neurological assessment and critical care management, along with discussions with their families regarding goals of care and, when appropriate, organ donation. However, how these clinical and organ donation-related practices have evolved over time remains poorly characterized in Japan. We aimed to evaluate temporal changes in neurological assessment, critical care management, and organ donation-related processes among patients considered clinically brain dead.</p><p><strong>Methods: </strong>We conducted a retrospective single-center cohort study including consecutive patients considered clinically brain dead in the Emergency ICU of Okayama University Hospital between January 2017 and December 2025. Patients were identified through routine auditory brainstem response testing during evaluation for a brain-death-compatible state. Temporal changes in the determination of a brain-death-compatible state, organ donation discussion, and critical care management were evaluated by calendar year, with three study phases (2017-2019, 2020-2022, and 2023-2025) used for descriptive presentation. Annual trends were assessed using logistic regression and nonparametric trend analyses.</p><p><strong>Results: </strong>Among 128 eligible patients, organ donation was discussed with the families of 110 (85.9%), and 41 (37.3%) subsequently underwent organ donation after brain death. Calendar-year analyses showed increasing corticosteroid use (odds ratio [OR] per year, 1.64; 95% confidence interval [CI] 1.34-2.01; p < 0.001) and earlier initiation of corticosteroids and vasopressin, whereas no significant trends were observed in vasopressin use or in the timing of determination of a brain-death-compatible state or the initial organ donation discussion. The likelihood of organ donation discussion increased significantly over time (OR per year, 1.44; 95% CI 1.17-1.79; p = 0.001) and remained significant in a sensitivity analysis restricted to patients in whom discussion was considered feasible (OR per year, 2.11; 95% CI 1.42-3.15; p < 0.001).</p><p><strong>Conclusions: </strong>The opportunity for organ donation discussion increased over time among patients considered clinically brain dead, while the proportion of families consenting to donation remained relatively stable. This increase occurred alongside the progressive development of structured multidisciplinary processes, although their contribution to the observed temporal trend cannot be determined from this descriptive study.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"14 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13660217/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182243","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":"Early versus deferred intravenous calcium in patients with sepsis and ionized hypocalcemia: a target-trial emulation.","authors":"Yuhang Zhang, Guoying Liao, Chenghao Liu, Guanyu Chen, Jianli Song, Yinsheng Liao, Lulu Zhang","doi":"10.1186/s40560-026-00953-9","DOIUrl":"https://doi.org/10.1186/s40560-026-00953-9","url":null,"abstract":"<p><strong>Background: </strong>Intravenous calcium is frequently administered during sepsis, yet whether early treatment improves 24-h hemodynamic recovery remains uncertain. We compared 24-h hemodynamic recovery between calcium initiation within 2 h of a non-emergency low-ionized calcium (iCa) result and no calcium initiation during the first 6 h after the result.</p><p><strong>Methods: </strong>We conducted a retrospective target-trial emulation of 2016-2025 high-resolution electronic health records from Zigong Fourth People's Hospital. Adults with sepsis, final or corrected iCa of 0.90-1.10 mmol/L, and no emergency indication were eligible at result availability. Strategies were executed calcium within 2 h versus no calcium through 6 h; care after 6 h was unrestricted. Clone-censor weighting and overlap tilting addressed grace periods, measured time-varying confounding, and clinical equipoise. The primary outcome was being alive and vasopressor-free at 24 h. Estimates and two-sided 95% percentile intervals came from 2,000 patient-level bootstrap samples with model refitting.</p><p><strong>Results: </strong>Of 5,993 patients, 1,538 initiated calcium within 2 h, 147 initiated at 2-6 h, and 4,308 received none through 6 h; none of the latter initiated calcium during 6-24 h. The standardized probability of 24-h hemodynamic recovery was 69.9% with early calcium and 61.1% with deferral, corresponding to a risk difference of + 8.69 percentage points (95% percentile interval, + 4.66 to + 12.84) and a risk ratio of 1.142 (1.074-1.214). The estimated association varied with baseline norepinephrine-equivalent dose (Holm-adjusted P = 2.00 × 10⁻⁶), whereas the iCa interaction did not remain statistically supported after adjustment (P = 0.097). Early calcium was associated with a 1.29-percentage-point higher observed risk of hypercalcemia (95% percentile interval, + 0.64 to + 2.05). Intervals for severe arrhythmia, new renal replacement therapy, and hospital mortality included the null.</p><p><strong>Conclusions: </strong>Early intravenous calcium was associated with a higher probability of 24-h hemodynamic recovery than the deferred strategy, whose observed pathway involved no calcium through 24 h. Estimated effects were larger at higher vasopressor doses. Early calcium was associated with a modestly higher observed risk of hypercalcemia. These findings support randomized evaluation in vasopressor-treated patients. Baseline iCa modification remains exploratory.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"14 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13660333/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182261","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":"Development and validation of VentPilot: an AI-based recommendation system for mechanical ventilation.","authors":"Hong Yeul Lee, Gaon An, Yeonwoo Jeong, Edward J Schenck, Ho Geol Ryu, Brian W Pickering, Vitaly Herasevich, Daniel A Diedrich, Seungyong Moon, Hyun-Lim Yang, Hyung-Chul Lee, Wun Hur, Jaewon Choi, Seokjun Lee, Jeongjae Lee, Won-Seok Hur, Sebin Kim, Yoonshik Kim, Rajesh Ranganath, Kyunghyun Cho, Sang-Min Lee, Hyun Oh Song","doi":"10.1186/s40560-026-00947-7","DOIUrl":"10.1186/s40560-026-00947-7","url":null,"abstract":"<p><strong>Background: </strong>Mechanical ventilation requires repeated adjustment to changing patient physiology, but consistent individualized management remains challenging. We developed VentPilot, an artificial intelligence-based system for recommending ventilator settings, and evaluated it in multicenter retrospective validation cohorts.</p><p><strong>Methods: </strong>VentPilot was developed using offline reinforcement learning on high-resolution physiologic and ventilator trajectories from Seoul National University Hospital (SNUH), with a reward combining ventilator-free days and intensivist-derived preference feedback. We evaluated VentPilot in an internal validation cohort from SNUH and an external validation cohort from Mayo Clinic. Fitted Q-evaluation assessed the estimated return of VentPilot relative to observed clinician behavior under the prespecified reward function. In a complementary inverse probability-weighted analysis, clinical outcomes were compared between patients with higher versus lower concordance between observed ventilator settings and VentPilot recommendations.</p><p><strong>Results: </strong>Among 4296 mechanically ventilated adults, 3002 were included in the derivation cohort, 283 in the internal validation cohort, and 1011 in the external validation cohort. Under the prespecified reward function, fitted Q-evaluation estimated higher returns for VentPilot than for observed clinician behavior in both validation cohorts, with differences in overall reward of 1.6 (95% CI 0.8-2.5) and 1.3 (95% CI 0.6-2.0), respectively. In inverse probability-weighted analyses, higher concordance with VentPilot recommendations was associated with more ventilator-free days within 28 days, with mean differences of 5.0 days (95% CI 2.4-7.6) and 3.1 days (95% CI 1.7-4.6), respectively. Higher concordance was also associated with lower 28-day mortality and shorter ICU length of stay.</p><p><strong>Conclusions: </strong>In multicenter retrospective validation cohorts, fitted Q-evaluation estimated higher returns for VentPilot than for observed clinician behavior under the prespecified reward function, while greater concordance between observed care and VentPilot recommendations was associated with more favorable clinical outcomes. Further clinical evaluation is warranted to establish VentPilot's safety, usability, and clinical impact.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"14 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13629005/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110908","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":"Subphenotype-specific serum proteomic signatures in patients with ARDS.","authors":"Michihito Kyo, Masashi Kawami, Yasuo Uchida, Kazuya Kikutani, Daisuke Kasugai, Shinichiro Ohshimo, Nobuyuki Hirohashi, Nobuaki Shime","doi":"10.1186/s40560-026-00951-x","DOIUrl":"https://doi.org/10.1186/s40560-026-00951-x","url":null,"abstract":"<p><strong>Background: </strong>Acute respiratory distress syndrome (ARDS) is associated with a substantial burden of morbidity and mortality. Previous studies have identified reproducible hyperinflammatory and hypoinflammatory ARDS subphenotypes with distinct clinical outcomes and treatment responses. Although recent transcriptomic studies have provided insights into biological differences between these subphenotypes, the role of the circulating proteome remains incompletely understood.</p><p><strong>Methods: </strong>In this prospective study, patients with ARDS were classified into hyperinflammatory or hypoinflammatory subphenotypes using a previously validated 3-variable classifier based on bicarbonate, interleukin-6, and soluble tumor necrosis factor receptor 1. Serum proteomic profiling was performed to identify differentially abundant proteins between subphenotypes. Biological pathways were examined using gene set enrichment analysis. To provide cellular expression context for the subphenotype-associated serum proteins, serum proteomic data were mapped onto publicly available single-cell RNA-seq datasets from peripheral blood mononuclear cells, neutrophils, and tracheal aspirates.</p><p><strong>Results: </strong>Among 31 patients with ARDS, 13 (42%) were classified as having the hyperinflammatory subphenotype and 18 (58%) as having the hypoinflammatory subphenotype. Both 28-day and in-hospital mortality were higher in the hyperinflammatory subphenotype than in the hypoinflammatory subphenotype (46% vs. 11%, P=0.04; 62% vs. 11%, P=0.01, respectively). In total, 54 serum proteins were differentially abundant between subphenotypes. These proteins represented biologically relevant categories, including endothelial injury, immunoregulation, coagulation/fibrinolysis, complement regulation, tissue remodeling, and metabolism-related proteins. Gene set enrichment analysis identified pathways differentially enriched between subphenotypes, including cell adhesion, cell-cell signaling, and cytokine responses (all FDR < 0.10). In external single-cell RNA-seq reference datasets, genes encoding the subphenotype-associated proteins were expressed predominantly in CD14 and CD16 monocytes in PBMCs, showed distinct expression patterns across immature and CD163+IL1R2^hi^ circulating neutrophil states, and were expressed mainly in macrophage and monocyte populations, with additional epithelial expression, in tracheal aspirates.</p><p><strong>Conclusions: </strong>Serum proteomic profiling identified distinct protein patterns associated with established ARDS inflammatory subphenotypes, providing insights into the biological heterogeneity of ARDS.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"14 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13628812/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110839","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":"Rapid progression of diffuse alveolar damage in ARDS: temporal alignment, composite phenotype, and physiological interpretation.","authors":"Weixu Mao, Xuanjun Liu, Wei Liu","doi":"10.1186/s40560-026-00948-6","DOIUrl":"https://doi.org/10.1186/s40560-026-00948-6","url":null,"abstract":"<p><p>A recent study associated early proliferative or fibrotic diffuse alveolar damage with mortality in acute respiratory distress syndrome. We highlight four interpretive concerns: phenotype status was assigned at biopsy after follow-up began, creating potential immortal-time bias; a single biopsy cannot measure pathological velocity; sparse and imbalanced phase-by-timing cells limit component-specific inference; and concurrent physiological measurements complicate causal interpretation. Until delayed-entry survival and phase-specific sensitivity analyses are reported, the phenotype is better viewed as early advanced-phase histology than evidence of accelerated pathology.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"14 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13625332/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110847","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":"Age-related modification of the association between arterial blood pH and intensive care unit mortality: a nationwide retrospective observational study using the Japanese Intensive Care Patient Database (JIPAD).","authors":"Shunsaku Goto, Hiromu Okano, Hiroshi Okamoto","doi":"10.1186/s40560-026-00946-8","DOIUrl":"10.1186/s40560-026-00946-8","url":null,"abstract":"<p><strong>Background: </strong>The lowest arterial blood pH within the first 24 h of intensive care unit (ICU) admission is a widely used prognostic indicator in critically ill patients and is incorporated into multiple established prognostic models. Although older adults represent a growing proportion of ICU admissions and have reduced physiological reserves, it remains unclear whether age modifies the prognostic association between arterial blood pH and ICU mortality. We aimed to evaluate this association and to examine whether it differed by patient age.</p><p><strong>Methods: </strong>We conducted a nationwide retrospective cohort study using data from the Japanese Intensive Care Patient Database (2018-2023), including adult patients (≥ 18 years) admitted to participating ICUs. Primary exposure was defined as the lowest arterial blood pH recorded within the first 24 h of ICU admission, and the primary outcome was ICU mortality. Associations were evaluated using multivariate Cox proportional hazard models with restricted cubic splines adjusted for clinically relevant covariates and stratified by institution. Effect modification by age (18-64 vs ≥ 65 years) was assessed using an interaction term, and an additional model with continuous spline-transformed age was used to examine dose-response relationships.</p><p><strong>Results: </strong>Among 324,806 ICU admissions, 215,880 (66.5%) were aged ≥ 65 years; ICU mortality was 4.4%. Lower arterial pH was nonlinearly associated with higher ICU mortality, with a stronger association in patients aged ≥ 65 years than in those aged 18-64 years (p for interaction < 0.001). At pH 7.0 versus 7.35-7.45, the aHR for ICU mortality was 3.40 (95% CI, 3.07-3.76) in patients aged 18-64 years and 4.73 (95% CI, 4.33-5.16) in those aged ≥ 65 years. Continuous-age modeling supported this age-related modification across the age spectrum.</p><p><strong>Conclusions: </strong>A lower arterial blood pH was associated with higher ICU mortality, and this association was modified by age. The prognostic impact of acidemia was more pronounced in older patients, suggesting that the interpretation of the lowest arterial blood pH may benefit from consideration of patient age. Further studies are needed to evaluate whether age-specific approaches to acid-base assessment improve prognostic accuracy in patients with critical illness.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"14 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13621626/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149081116","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":"Discrete cerebral oximetry measurements and the potential contribution of hemolysis to circulating neuron-specific enolase after pediatric cardiac surgery.","authors":"Ziqing Hu, Zihao Bai, Xuming Mo","doi":"10.1186/s40560-026-00949-5","DOIUrl":"10.1186/s40560-026-00949-5","url":null,"abstract":"<p><p>Wang and colleagues reported an association between the minimum of three intraoperative regional cerebral oxygen saturation measurements and peak plasma neuron-specific enolase in infants aged ≤ 6 months undergoing cardiac surgery. Two issues warrant consideration. Hemolysis related to cardiopulmonary bypass may affect circulating neuron-specific enolase independently of neuronal injury, but whether hemolysis influenced the reported association cannot be determined. Describing the minimum of three discrete measurements as a nadir may imply continuous ascertainment. These measurements cannot characterize transient desaturation, duration below threshold, or cumulative hypoxic burden. Individual hemolysis measures and continuous cerebral oximetry could clarify the reported association.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"14 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13621596/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149081073","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":"Association between age and outcomes of evidence-based feeding protocol versus usual care in critically ill patients: secondary analysis of a multicenter cluster-randomised controlled trial.","authors":"Qiuhui Wang, Jin Ke, Yizhe Chen, Hongyang Xu, Dingye Wu, Lu Ke, Fengming Liang, Yang Chen","doi":"10.1186/s40560-026-00942-y","DOIUrl":"10.1186/s40560-026-00942-y","url":null,"abstract":"<p><strong>Background: </strong>Nutrition therapy is essential in critically ill patients, yet large randomised trials have shown inconsistent results regarding the effect of an evidence-based feeding protocol. The NEED trial showed a feeding protocol could effectively promote delivery of enteral nutrition (EN) but did not reduce mortality. Age-related physiological differences may modify responses to nutritional therapy. This post hoc analysis of the NEED trial evaluated whether age modifies the association between implementation of an evidence-based feeding protocol and clinical outcomes among critically ill patients.</p><p><strong>Methods: </strong>This secondary analysis used data from the multicentre cluster-randomised NEED trial conducted across intensive care units (ICUs) in China. Adult patients newly admitted to participating ICUs were assigned to active implementation of a feeding protocol or usual care. Age was analyzed as both a continuous variable and predefined categories (≤65, 66-75, and ≥76 years). The primary effect-modification analysis evaluated the treatment-age interaction for 28-day all-cause mortality. Secondary outcome analyses, including organ failure (OF), persistent multiple OF, ICU length of stay, ICU-free days, infection within 7 days, and feeding intolerance, were exploratory. Mixed-effects Cox and logistic regression models were used to assess treatment effects and age-treatment interactions.</p><p><strong>Results: </strong>Among 2672 patients included in the analysis (median age 62 years [IQR 49-74]; 1798 [67.3%] male), the effect of evidence-based feeding protocol on 28-day mortality varied with age. Treatment benefit attenuated progressively with increasing age, with each 10-year increase associated with a higher adjusted hazard ratio (HR) for mortality (1.28; 95% CI 1.13-1.46; continuous interaction P < 0.001). In age-stratified analyses, the intervention reduced mortality in patients aged ≤65 years (adjusted HR 0.64; 95% CI 0.44-0.92) but not in those aged 66-75 years (adjusted HR 1.01; 95% CI 0.64-1.60) or ≥76 years (adjusted HR 1.29; 95% CI 0.89-1.88; categorical interaction P = 0.010). An exploratory analysis showed a similar age-dependent pattern for persistent multiple OF (interaction P = 0.017). Results were consistent in per-protocol and sensitivity analyses.</p><p><strong>Conclusions: </strong>In this secondary analysis, associations between an evidence-based feeding protocol and clinical outcomes differed across age groups. These exploratory and hypothesis-generating findings suggest potential age-related heterogeneity in treatment response, which requires confirmation in future prospective studies. Research registration unique identifying number (UIN) of the original NEED trial: ISRCTN Registry, Registry number: ISRCTN 12233792, registered on November 24, 2017.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"14 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13591688/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149012371","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}