Journal of Intensive Care最新文献

{"title":"Pathogen-oriented mNGS is not equivalent to microbiome profiling: interpreting BALF mNGS diversity in ARDS.","authors":"Li Li, Song Lei, Chansokhon Ngan","doi":"10.1186/s40560-026-00943-x","DOIUrl":"10.1186/s40560-026-00943-x","url":null,"abstract":"<p><p>Gao et al. provide valuable data-linking bronchoalveolar lavage fluid metagenomic next-generation sequencing with inflammatory subphenotypes of acute respiratory distress syndrome. We highlight three issues relevant to interpretation: an apparent inconsistency concerning exclusion of samples with no micro-organisms detected, use of a pathogen-oriented workflow for community-level ecological inference, and the distinction between detection yield and diagnostic performance without an independent reference standard. Clarification of sample eligibility, sensitivity analysis including technically valid samples reported as negative by sequencing, and confirmation that sequencing and bioinformatic procedures are validated for quantitative microbiome analysis would strengthen interpretation.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"14 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13589869/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149012392","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":"Implementation of a standardized Impella-specific management pathway in cardiogenic shock.","authors":"Kenji Kanenawa, Akihiro Isotani, Kento Matsui, Keisuke Miyamoto, Katsunori Miyahara, Norihito Oyanagi, Kengo Korai, Toshinari Kaku, Shinichi Tsumaru, Takehiko Matsuo, Norimasa Matsuda, Shinichi Kakumoto, Takenori Domei, Makoto Hyodo, Shinichi Shirai, Kenji Ando, Koh Ono","doi":"10.1186/s40560-026-00937-9","DOIUrl":"10.1186/s40560-026-00937-9","url":null,"abstract":"<p><strong>Background: </strong>Device-related complications remain frequent during Impella support. Although coordinated multidisciplinary care and standardized protocols are recommended for cardiogenic shock, Impella-specific management pathways have not been established. We evaluated implementation of a standardized Impella-specific management pathway (SIM) and the accompanying changes in care processes and in-hospital outcomes.</p><p><strong>Methods: </strong>This single-center, before-and-after observational study included 190 consecutive patients with cardiogenic shock treated with Impella, 88 before implementation and 102 after SIM introduction. SIM combined multidisciplinary education and implementation support, peri-implant strategy, access-site and limb-perfusion management, hemolysis surveillance, and hemodynamic optimization. The primary endpoint was all-cause in-hospital mortality, and the key secondary endpoint was Impella-related Bleeding Academic Research Consortium type 3 or 5 bleeding. Both were analyzed using overlap-weighted cause-specific Cox models.</p><p><strong>Results: </strong>After SIM introduction, pre-PCI Impella use among patients with acute myocardial infarction increased from 36.2 to 76.2%, and 16-Fr sheath use increased from 0 to 80.2%. The rate of detected hemolysis increased progressively, whereas the time spent outside the target ranges for mean arterial pressure and central venous pressure decreased. After overlap weighting, all covariates included in the propensity-score model were balanced (absolute standardized mean difference <0.10). In-hospital death occurred in 58.0% before implementation and 33.3% after SIM introduction (hazard ratio, 0.51; 95% confidence interval, 0.32-0.84; P = 0.009). No significant interaction was observed according to SCAI shock stage, arrest or ECPELLA status at Impella insertion. Impella-related type 3 or 5 bleeding occurred in 30.7 and 12.7%, respectively (hazard ratio, 0.33; 95% confidence interval, 0.16-0.67; P = 0.002). BARC type 5 bleeding, acute limb ischemia, and stroke did not differ significantly.</p><p><strong>Conclusions: </strong>SIM was progressively implemented across the catheterization laboratory and ICU, accompanied by measurable changes in care processes and lower rates of major bleeding and in-hospital death. Prospective multicenter studies should assess whether these findings are reproducible.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"14 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13560191/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148929997","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":"Matters arising: cellular composition, regulatory directionality, and prognostic reproducibility in m6A-associated glycolytic reprogramming during sepsis.","authors":"Qiyue Xu, Peihong Li, Hongyi Hu, Xian Gu","doi":"10.1186/s40560-026-00938-8","DOIUrl":"10.1186/s40560-026-00938-8","url":null,"abstract":"","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"14 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13551972/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148911759","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":"Analysis of the pulmonary microbiome in ARDS patients using bronchoalveolar lavage fluid metagenomic next-generation sequencing: a retrospective observational study.","authors":"Xingchen Gao, Ruiqi Qin, Jing He","doi":"10.1186/s40560-026-00940-0","DOIUrl":"10.1186/s40560-026-00940-0","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Acute respiratory distress syndrome (ARDS) exhibits significant clinical heterogeneity, with inflammatory subphenotypes (hypoinflammatory and hyperinflammatory) representing a key axis for precision medicine. The role of the pulmonary microbiome in these subphenotypes remains poorly understood.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This retrospective study enrolled 159 ARDS patients. Using a validated machine-learning classifier, patients were stratified into hypoinflammatory (n=92) and hyperinflammatory (n=67) groups. Bronchoalveolar lavage fluid (BALF) was analyzed by metagenomic next-generation sequencing (mNGS) and conventional microbiological testing (CMT). Clinical characteristics, pathogen profiles, and pulmonary microbiome composition were compared between groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Patients in the hyperinflammatory phenotype had more severe disease, with significantly higher in-hospital mortality (65.7% vs. 30.4%, P &lt; 0.001) and 28-day mortality (53.7% vs. 22.8%, P &lt; 0.001). mNGS demonstrated superior diagnostic performance, identifying pathogens in 18.2% of cases that were negative by conventional microbiological testing (CMT), whereas CMT alone detected pathogens in only 2.5% of mNGS-negative cases. mNGS showed significant advantages in viral detection (74.5% vs. 28.2%, P &lt; 0.001) and in the identification of mixed infections (74.5% vs. 41.1%, P &lt; 0.001). Acinetobacter baumannii was the most prevalent species in both phenotypes; however, the hyperinflammatory phenotype was enriched for Klebsiella pneumoniae, Legionella pneumophila, and influenza A (H1N1), whereas Stenotrophomonas maltophilia and herpesviruses were more prevalent in the hypoinflammatory phenotype. Species richness was significantly reduced in the hyperinflammatory phenotype (Chao1, P &lt; 0.001; ACE, P = 0.001). In adjusted analyses, this association remained virtually unchanged after adjustment for ARDS etiological category and pulmonary vs. extrapulmonary ARDS, and remained significant in the fully adjusted model additionally accounting for age, sex, and immunosuppression (Chao1: P = 0.002; ACE: P = 0.003). Evenness indices (Shannon/Simpson) and overall community structure (β-diversity; PERMANOVA, P = 0.156) did not differ between phenotypes, suggesting a selective depletion of rare, low-abundance taxa rather than a global restructuring of the pulmonary microbiota. Linear discriminant analysis effect size (LEfSe) identified differentially abundant taxa of exploratory significance: the hyperinflammatory phenotype was enriched for Bifidobacterium dentium and Gemella sanguinis, whereas the hypoinflammatory phenotype was enriched for commensals such as Streptococcus mitis. Network analysis revealed well-defined positive and negative correlations between pathogens and commensal taxa.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The hyperinflammatory phenotype of ARDS is characterized by greater clinical severity and a distinct pulmonary microbiom","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"14 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13551742/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148911541","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":"Utilization and outcomes of organs from ECMO-supported brain-dead donors: two-center experience.","authors":"Jihyuk Chung, Ryoung-Eun Ko, Sora Cha, Siwon Oh, Suk Kyung Lim, Jeong Hoon Yang, Kiick Sung, Min Ho Ju, Yang Hyun Cho","doi":"10.1186/s40560-026-00933-z","DOIUrl":"10.1186/s40560-026-00933-z","url":null,"abstract":"<p><strong>Background: </strong>Organ shortages remain a critical global challenge, and extracorporeal membrane oxygenation (ECMO) has emerged as a potential strategy to preserve organ perfusion and expand the donation after brain death (DBD) donor pool. In regions where donation after circulatory death (DCD) is not legally permitted, maximizing DBD donor utilization carries particular clinical and policy importance. However, evidence regarding organ-specific recovery rates and post-transplant graft outcomes in ECMO-supported DBD donors remains limited and heterogeneous.</p><p><strong>Methods: </strong>We conducted a two-center retrospective cohort study of all consecutive brain-dead organ donors managed at two tertiary referral centers between January 2012 and June 2025. Donors were stratified by ECMO exposure prior to organ procurement. Primary outcomes were organ-specific recovery rates and the number of organs recovered per donor. Kaplan-Meier analysis with log-rank testing was used to evaluate post-transplant recipient survival stratified by donor ECMO exposure and organ type.</p><p><strong>Results: </strong>Of 210 donors (ECMO n=25, non-ECMO n=185), baseline demographics and cause of brain death were broadly comparable, although ECMO donors more frequently had antecedent cardiac arrest (76.0% vs 53.5%, P=0.001), reflecting a population that would likely not have survived to brain death determination without extracorporeal support. Thoracic organ recovery was markedly lower in the ECMO group (heart 4.2% vs 47.6%; lung 4.2% vs 47.0%; both P<0.001), attributable primarily to underlying cardiopulmonary pathology. Abdominal organ recovery was preserved, with comparable rates for liver (75.0% vs 84.3%, P=0.586) and kidneys (right 87.5% vs 89.7%, P=0.845; left 87.5% vs 91.4%, P=0.649). Recipient survival was comparable across organ types; for liver grafts, ECMO-derived organs maintained higher survival probability at late follow-up (log-rank P=0.02), a hypothesis-generating finding that should be interpreted with caution given the small number of events.</p><p><strong>Conclusions: </strong>ECMO-supported donors can preserve abdominal organ viability and achieve post-transplant recipient survival comparable to conventional DBD donors, although these findings are exploratory given the small sample size and retrospective design. Whether structured ECMO use represents a meaningful strategy for donor pool expansion, particularly in settings where DCD is unavailable, warrants confirmation in larger prospective studies.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"14 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13543426/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148891427","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":"Effectiveness of a standardized weaning protocol in tracheostomized patients with prolonged mechanical ventilation: a prospective single-arm interventional trial.","authors":"Chenxi Zhang, Ranran Zhang, Jingyi Ge, Qing Li, Bo Yang, Bin Zhang, Jianjun Wang, Ting Zhou, Hongying Jiang","doi":"10.1186/s40560-026-00935-x","DOIUrl":"10.1186/s40560-026-00935-x","url":null,"abstract":"<p><strong>Background: </strong>Patients requiring prolonged mechanical ventilation (PMV) after tracheostomy represent a severely deconditioned population with high mortality and substantial healthcare burden. Weaning outcomes vary widely across centers, and evidence supporting standardized protocol in dedicated rehabilitation settings remains limited.</p><p><strong>Methods: </strong>We conducted a prospective, single-arm interventional trial at a specialized weaning unit (SWU) of a tertiary rehabilitation hospital. From January 2025 to October 2025, consecutive tracheostomized PMV patients were enrolled and managed with a standardized stepwise weaning protocol integrating spontaneous breathing trials, high-flow oxygen therapy, and noninvasive ventilator. The primary outcome was the 60-day weaning success rate, which was tested against a pre-specified historical benchmark (p₀ = 65%) using exact binomial, score-based, and Katz log-method analyses. Secondary outcomes included 6-month mortality, analyzed through modified Poisson regression with propensity score matching and overlap weighting. An individualized calculated weaning score was developed using LASSO-Poisson regression with log(p₀) as an offset to elucidate the heterogeneity in treatment response.</p><p><strong>Results: </strong>Weaning success was achieved in 189 of 250 patients (75.6%; 95% CI 69.9-80.5%), significantly exceeding the historical benchmark (RR, 1.16; 95% CI 1.08-1.25; p < 0.001). Mean weaning duration was 19.9 ± 10.0 days; 30-day reconnection occurred in 2.1% of successfully weaned patients. Six-month mortality was 14.4% and was lower among successfully weaned patients (9.0% vs 31.1%) with confounding and limited event numbers precluding a definitive causal inference. Tertile stratification by the calculated weaning score revealed a monotonic gradient in weaning success (T1, 44.0%; T2, 84.3%; T3, 98.8%; trend p < 0.001). The tool was deployed online at https://jianghongying.shinyapps.io/Weaning-for-PMV/ .</p><p><strong>Conclusions: </strong>A standardized weaning protocol delivered in a dedicated rehabilitation unit was associated with a 60-day weaning success rate that exceeded a pre-specified historical benchmark in PMV patients. The individualized calculated weaning score identifies clinical phenotypes for individualized decision-making; the accompanying web-based calculator is provided as an exploratory research tool and warrants external validation before any routine clinical application.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov, NCT06642714.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"14 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13536708/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148880475","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":"Recorded body height and sex differences in lung-protective ventilation among adults with ARDS: an 11-year single-centre cohort study.","authors":"Marius Huehn, Lea Willemsen, Matthias Manfred Deininger, Judith Huth, Jana C Mossanen, Jens Spiesshoefer, Gernot Marx, Tim-Philipp Simon, Thomas Breuer","doi":"10.1186/s40560-026-00936-w","DOIUrl":"10.1186/s40560-026-00936-w","url":null,"abstract":"<p><strong>Background: </strong>Lung-protective ventilation (LPV) reduces mortality in ARDS, but adherence remains incomplete and women and shorter patients disproportionately receive tidal volumes above predicted-body-weight (PBW)-based targets. The relative associations of recorded sex and body height with this disparity remain uncertain.</p><p><strong>Methods: </strong>Retrospective single-centre cohort study (January 2013 to December 2023, RWTH Aachen University Hospital surgical ICU). Adults (≥ 18 years) with Berlin-definition ARDS receiving mechanical ventilation for ≥ 72 h were included. Patient-level adherence to lung-protective targets was described, and repeated-measure PBW-normalised tidal volume and mechanical power were analysed with linear mixed-effects models containing a patient-level random intercept and fixed effects for recorded sex, centred recorded height, age, BMI, SAPS II, SOFA, ARDS aetiology, linear relative ICU day and the lowest same-day PaO₂/FiO₂ ratio.</p><p><strong>Results: </strong>Among 798 adults (263 women [33.0%]), unadjusted analyses showed that women received higher tidal volumes per kg PBW than men (median, 7.6 vs. 6.8 mL/kg PBW; p < 0.001), with lower VT adherence (55.3% vs. 76.1%; p < 0.001), higher plateau and driving pressures, and higher PBW-normalised mechanical power. In 527 patients contributing 58,802 observations, the simultaneous adjusted VT model yielded a female-sex coefficient of 0.051 mL/kg PBW (95% CI, -0.273 to 0.376; p = 0.756), whereas recorded height was inversely associated with VT/kg PBW (β per cm, -0.0342; 95% CI, -0.0498 to -0.0185; p < 0.001); the sex-by-height interaction was not supported (p = 0.971). In the corresponding mechanical-power model (410 patients; 44,725 observations), the female-sex coefficient was -0.0158 J·min⁻¹·kg PBW⁻¹ (95% CI, -0.0512 to 0.0196; p = 0.384).</p><p><strong>Conclusions: </strong>Unadjusted analyses showed lower lung-protective ventilation adherence in women. In the simultaneous adjusted model, recorded height, but not recorded sex, was independently associated with VT/kg PBW. Because PBW incorporates both sex and height and recorded height was not validated against a reference measurement, the study does not establish mediation or measurement error as the underlying mechanism. Standardised direct height measurement and PBW-based decision support warrant prospective evaluation.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"14 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13528038/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148865230","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 of serum uric acid, gout with incident sepsis: a large population-based prospective cohort study from UK Biobank.","authors":"Yingdong Han, Yudian Zhang, Chunyue Chen, Menghui Yao, Juan Wu, Tiange Xie, Yun Zhang, Xuejun Zeng","doi":"10.1186/s40560-026-00925-z","DOIUrl":"10.1186/s40560-026-00925-z","url":null,"abstract":"<p><strong>Background: </strong>Sepsis remains a major cause of morbidity and mortality, yet current strategies for identifying susceptible individuals provide limited discriminatory performance. Although serum uric acid (SUA) and gout have been implicated in inflammatory and immune dysregulation, the associations of clinical urate phenotypes with incident sepsis risk and prognosis remain incompletely understood.</p><p><strong>Methods: </strong>A prospective cohort analysis was conducted using UK Biobank data including 466,611 participants, in which clinical urate phenotypes (normal uric acid, asymptomatic HUA, and gout) were evaluated as primary exposures, with SUA quartiles and separate HUA and gout status analyses used as alternative exposure definitions, using multivariable Cox proportional hazards models, restricted cubic spline analyses, subgroup analyses, and sensitivity analyses including Fine-Gray competing-risk models.</p><p><strong>Results: </strong>During a median follow-up of 14.53 years, 16,210 incident sepsis cases were identified. Compared with the normal uric acid group, asymptomatic HUA and gout were associated with higher sepsis risk after full adjustment, with HRs of 1.31 (95% CI 1.26-1.36; P < 0.001) and 1.35 (95% CI 1.25-1.46; P < 0.001), respectively. Sepsis risk increased progressively across SUA quartiles, with HRs of 1.06 (95% CI 1.01-1.12), 1.12 (95% CI 1.07-1.19), and 1.27 (95% CI 1.20-1.34) for Q2, Q3, and Q4 relative to Q1, respectively. Restricted cubic spline analysis shown a nonlinear association between SUA and sepsis risk (P < 0.001; P for nonlinearity < 0.001), with risk increasing above approximately 384.8 μmol/L. For 28-day all-cause mortality among sepsis patients, asymptomatic HUA remained associated with a higher risk in the fully adjusted model (HR 1.17, 95% CI 1.07-1.29, P < 0.01), whereas the association for baseline gout was not significant after adjustment.</p><p><strong>Conclusion: </strong>Higher SUA levels, HUA, and gout were associated with a higher incidence of sepsis in this observational cohort. Among patients who developed sepsis, asymptomatic HUA was associated with modestly higher short-term mortality, whereas this risk was not observed in the gout group.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"14 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13523487/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148850893","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-dependent cerebral oxygenation and brain injury in pediatric cardiac surgery: vulnerability of infants aged ≤6 months.","authors":"Zeng-Chun Wang, Ling-Shan Yu, Qi-Liang Zhang, Ye Chen, Dan-Wei Zhang","doi":"10.1186/s40560-026-00934-y","DOIUrl":"10.1186/s40560-026-00934-y","url":null,"abstract":"<p><strong>Background: </strong>Despite the growing use of regional cerebral oxygen saturation (rScO₂) monitoring in pediatric cardiac surgery, whether age affects perioperative rScO₂ trajectories or modifies the association between rScO₂ and organ injury remains unclear. In this study, age-specific rScO₂ patterns were delineated, and whether age modified the association between rScO₂ nadir and postoperative neurological and myocardial injury biomarkers was evaluated.</p><p><strong>Methods: </strong>This prospective cohort study included 104 children who underwent congenital heart surgery and whose ages were ≤6 months (n=47), 6-12 months (n=28), and >12 months (n=29). Perioperative rScO₂ was continuously monitored at five time points: pre-cardiopulmonary bypass (CPB), CPB, aortic cross-clamp (ACC), post-return of spontaneous circulation (ROSC), and postoperative day 2 (POD2). Linear mixed-effects models with age-group-by-time interactions were used to test differences in rScO₂ trajectory between age groups. Multivariable linear regression was used to assess the association between the rScO₂ nadir and peak biomarkers levels (NSE, GFAP, S100β, cTnI, CK-MB, NT-proBNP), with age interactions included, followed by age-stratified analyses.</p><p><strong>Results: </strong>Perioperative rScO₂ followed a U-shaped pattern across all age groups, with the ≤6-month group consistently exhibiting the lowest levels. Compared with infants >12 months, those ≤6 months exhibited greater decreases in rScO₂ during both CPB (β_{>12-month*CPB} = 4.17, 95% CI [0.47, 7.87], P = 0.027) and ACC (β_{>12-month*ACC} = 4.75, 95% CI [1.05, 8.45], P = 0.012). Significant age interactions for the rScO₂ nadir-NSE association were observed for the 6-12 months group (β = 0.41, 95% CI [0.05, 0.77], P=0.027) and the >12-month group (β = 0.43, 95% CI [0.01, 0.84], P=0.044) relative to the ≤6-month reference. In age-stratified analyses, the rScO₂ nadir was significantly inversely associated with peak NSE only in the ≤6-month group (β = -0.27, 95% CI [-0.48, -0.07], P=0.001). No significant associations were found between the rScO₂ nadir and other neurological biomarkers (GFAP, S100β) or any myocardial biomarkers (CK-MB, cTnI, NT-proBNP) across age groups.</p><p><strong>Conclusions: </strong>Age affects both rScO₂ trajectories and their association with peak NSE. Infants ≤6 months exhibited the lowest rScO₂ values and a significant inverse association between the rScO₂ nadir and peak NSE, supporting the need for more intensive monitoring in this subgroup.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"14 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13505047/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148818635","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":"Timing of hemoadsorption in sepsis: redefining early through mediator-guided therapy.","authors":"Prit Kusirisin, John A Kellum, Nattachai Srisawat","doi":"10.1186/s40560-026-00932-0","DOIUrl":"10.1186/s40560-026-00932-0","url":null,"abstract":"<p><strong>Background: </strong>Hemoadsorption is gaining acceptance as an adjunctive extracorporeal blood purification strategy in sepsis and septic shock; however, its clinical value remains contingent on two closely linked variables: when therapy is initiated and in whom it should be used. This review synthesizes the pathophysiological rationale, conceptual models of mediator removal, available devices, and clinical evidence for hemoadsorption in sepsis, with particular attention to patient selection.</p><p><strong>Main body: </strong>Sepsis is driven by a self-amplifying mediator cascade in which exogenous pathogenic substances and host response mediators increase rapidly, progressively committing potentially salvageable organs to injury and failure. Mechanistic theories of blood purification provide a rationale for early hemoadsorption, when mediator concentrations are high and dysregulated. Clinical evidence, however, remains limited: polymyxin B hemoadsorption guided by the endotoxin activity assay has demonstrated a survival benefit in a randomized trial, whereas supportive findings for cytokine adsorption derive largely from small trials, observational cohorts, and subgroup or post hoc analyses. These findings remain hypothesis-generating and require prospective validation in biomarker-enriched, phenotype-guided randomized trials.</p><p><strong>Conclusion: </strong>Current evidence supports moving beyond a fixed hours-from-onset definition of \"early\" treatment toward a biological definition, in which hemoadsorption is initiated in patients with a dysregulated hyperinflammatory host response, after key inflammatory mediators have crossed a toxic threshold and before irreversible organ injury becomes established.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"14 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13504785/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148818328","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}