Journal of Intensive Care最新文献

{"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}

{"title":"A hybrid multi-criteria decision-making framework for prioritising clinical determinants of medical futility in the intensive care unit.","authors":"Selman Karadayi, Efehan Ulas, Onur Kucuk","doi":"10.1186/s40560-026-00928-w","DOIUrl":"10.1186/s40560-026-00928-w","url":null,"abstract":"<p><p>Determinations of medical futility in the intensive care unit (ICU) are high-stakes, ethically charged, and clinically variable. Contemporary literature increasingly frames such situations as potentially inappropriate treatment (PIT), particularly when physiologically feasible interventions are judged unlikely to provide meaningful benefit. This study aimed to construct a transparent decision-analytical framework for identifying the clinical factors ICU physicians prioritise when assessing futility and PIT, using a hybrid multi-criteria decision-making (MCDM) approach. A decision-analytical modelling study was conducted in Türkiye with a national expert panel of 20 ICU physicians with 1-18 years of post-speciality experience. A two-round Delphi pre-process with five intensivists, using an a priori 80% consensus threshold, identified 15 clinical factors and 8 evaluation criteria. Criterion weights were derived using Shannon Entropy, and six MCDM techniques were applied in parallel. Bootstrap resampling, ±20% sensitivity analysis, and Spearman rank correlation were used to assess stability and agreement. Terminal malignancy (F4) and irreversible neurological injury (F5) ranked first and second across all six methods (mean ranks 1.000 and 2.000, σ = 0.00, 100% bootstrap stability). Inter-method agreement was very strong (Spearman ρ = 0.964-1.000, p < 0.001), while inter-group agreement across experience strata was moderate to strong (ρ = 0.643-0.807, p < 0.01). Documented treatment limitation preference (F15) ranked last across every method and experience group. Early-career clinicians ranked clinical frailty (F2) first, whereas advanced clinicians elevated refractory shock (F6) to fourth. Advanced age (F1) showed the widest experience-related variation, ranking 5th, 14th, and 11th across early-career, mid-career, and advanced groups, respectively. The Top-5 factors remained stable under ± 20% weight perturbation. In this expert-panel MCDM framework, ICU physicians appeared to prioritise biological non-recoverability when assessing futility and PIT, while treating treatment limitation preference as a separate ethical domain. The framework captures clinicians' cognitive prioritisation rather than outcome-validated prognostic accuracy and should be read as a decision-support scaffold, not a bedside prediction tool. Prospective outcome validation and recalibration across different legal and cultural settings are required before clinical implementation.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"14 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13501846/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148813125","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":"Physician-revised AI-generated drafts are associated with higher ratings of written explanations in end-of-life care in the intensive care unit: a scenario-based single-center cross-sectional study.","authors":"Atsushi Kokita, Junpei Haruna, Yuya Goto, Soichi Tanaka, Satoshi Sato, Kenichiro Kikuchi, Masayuki Akatsuka, Ryu Azumaguchi, Ikuto Otsuki, Michiaki Yamakage, Satoshi Kazuma","doi":"10.1186/s40560-026-00930-2","DOIUrl":"10.1186/s40560-026-00930-2","url":null,"abstract":"<p><strong>Background: </strong>In end-of-life care (EOL) in the intensive care unit (ICU), intensivists are expected to provide medically appropriate and empathetic communication to support shared decision-making with patients and their families. Large language models (LLMs) have shown potential to generate medical responses that are perceived as informative and empathetic, and collaborative workflows involving physician review of LLM-generated drafts have been evaluated, particularly for ambulatory patient portal messaging. However, it remains unclear whether this collaborative approach is associated with higher ratings of communication quality in ICU EOL care. In this study, we used clinical scenarios simulating ICU EOL situations to compare the quality of written explanations generated by physicians alone, an LLM-based chatbot alone, and physicians who revised LLM-generated drafts.</p><p><strong>Methods: </strong>In this preliminary, scenario-based study, a total of 45 participants were enrolled, including healthcare professionals and nonhealthcare professionals. Three clinical scenarios simulating ICU EOL care and questions from patients or family members were prepared. For each question, three types of responses were prepared: physician-only, AI-only, and physician-AI collaborative responses. The three prespecified primary outcomes were medical validity and empathy rated by healthcare professionals from diverse specialties and clinical settings, and empathy rated by nonhealthcare professionals, using 5-point Likert scales.</p><p><strong>Results: </strong>In the primary analyses, physician-AI collaborative responses received significantly higher ratings than both physician-only and AI-only responses across all three prespecified primary outcomes. The observed differences between physician-AI collaborative responses and both other response groups were more pronounced for empathy than for medical validity. Physician-only and AI-only responses did not differ significantly for any primary outcome in the primary analyses. Sensitivity and exploratory analyses supported the same overall pattern of higher ratings for physician-AI collaborative responses. By contrast, comparisons between physician-only and AI-only responses varied across analytic approaches.</p><p><strong>Conclusions: </strong>In this scenario-based study of written explanations in ICU EOL care, physician revision of LLM-generated drafts was associated with higher ratings, particularly for empathy. However, the clinical importance of these differences remains uncertain, and the contribution of the LLM-generated draft could not be distinguished from physician revision or the two-stage drafting-and-revision process. Further multicenter, process-matched prospective studies are warranted.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"14 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13501828/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148808655","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":"Time-varying exposure and incomplete target-trial emulation in the dose-response study of early mobilization after cardiac surgery: a methodological commentary.","authors":"Amolakhji, Pehlaj Kumar","doi":"10.1186/s40560-026-00931-1","DOIUrl":"https://doi.org/10.1186/s40560-026-00931-1","url":null,"abstract":"","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"14 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13488585/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148794421","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":"Predictive performance of kinetic eGFR, midregional proadrenomedullin, and H3.1 nucleosomes for acute kidney disease in sepsis: a secondary analysis of a large multicentre randomized controlled trial.","authors":"Caroline Neumann, Frank Bloos, Philipp Franken, Thomas Lehmann, Holger Bogatsch, Johannes Ruhe","doi":"10.1186/s40560-026-00926-y","DOIUrl":"https://doi.org/10.1186/s40560-026-00926-y","url":null,"abstract":"<p><strong>Background: </strong>Sepsis-associated acute kidney injury (SA-AKI) frequently progresses to acute kidney disease (AKD) and is linked to poor outcomes. We evaluated whether combining biomarkers reflecting complementary pathophysiological domains-histone H3.1 nucleosomes (cellular injury), midregional pro-adrenomedullin (MR-proADM; endothelial dysfunction), and kinetic estimated glomerular filtration rate (kinetic eGFR; dynamic renal function)-improves prediction of AKD and renal recovery.</p><p><strong>Methods: </strong>This secondary analysis of the multicentre randomized SISPCT trial included 690 patients with sepsis after exclusion of patients with pre-existing renal replacement therapy or missing AKI data. Biomarkers and kinetic eGFR were assessed at baseline, day 2, and day 7. Multivariable logistic regression models adjusted for age, sex, and non-renal SOFA score were used to assess associations with AKD. Predictive performance was evaluated using receiver operating characteristic (ROC) curves and area under the curve (AUC). Calibration for the combined models for each day was evaluated using bootstrap-corrected calibration plots. Clinical utility was assessed using decision curve analysis with fivefold cross-validation.</p><p><strong>Results: </strong>AKD occurred in 196 patients (28.4%). At baseline, only MR-proADM was independently associated with AKD (adjusted OR 1.17, 95% CI 1.08-1.28; p < 0.001), whereas H3.1 and kinetic eGFR were not. At day 2 and day 7, only changes in kinetic eGFR were independently associated with AKD (both p < 0.001). Discriminative performance increased over time, with AUCs for the combined model of 0.65 at baseline, 0.70 at day 2, and 0.76 at day 7. At later time points, kinetic eGFR consistently showed the highest discriminative performance based on the point estimates of the AUC. An overall good calibration performance was shown. Decision curve analysis demonstrated only modest and inconsistent additional clinical net benefit of the combined model compared with kinetic eGFR alone. AKD was associated with increased 90-day mortality (55% vs. 24%; risk ratio 2.3, 95% CI 1.9-2.9). Biomarkers showed limited and inconsistent performance for prediction of renal recovery.</p><p><strong>Conclusions: </strong>In patients with sepsis, MR-proADM at baseline and dynamic changes in kinetic eGFR during the first week were independently associated with AKD, whereas histone H3.1 nucleosomes provided limited predictive value. Although multimarker models seemed to modestly improve baseline discrimination, this advantage was not sustained over time and added little clinical benefit beyond kinetic eGFR. These findings highlight the value of dynamic renal function assessment for risk stratification of SA-AKI progression to AKD. Trial registration ClinicalTrials.gov Identifier: NCT00832039.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"14 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13488215/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148794361","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":"Prognostic associations of urine output in AKI and dialysis vintage in ESKD at continuous kidney replacement therapy initiation in ICU patients.","authors":"Keisuke Okamoto, Naoki Ozu, Hidetada Fukushima, Masahiko Kawaguchi, Kazuhiko Tsuruya","doi":"10.1186/s40560-026-00929-9","DOIUrl":"10.1186/s40560-026-00929-9","url":null,"abstract":"<p><strong>Background: </strong>Prognostic assessment at continuous kidney replacement therapy (CKRT) initiation remains challenging in ICU practice. CKRT recipients are heterogeneous; most have acute kidney injury (AKI), whereas a clinically important subset has end-stage kidney disease (ESKD). We evaluated whether pre-CKRT urine output in AKI and dialysis vintage in ESKD were associated with short-term prognosis after CKRT initiation.</p><p><strong>Methods: </strong>We conducted a single-center retrospective cohort study of consecutive adults who started CKRT in a combined medical-surgical ICU between 2012 and 2021. Patients were classified at CKRT initiation as ESKD, oliguric AKI, or non-oliguric AKI. ESKD was defined as maintenance hemodialysis or peritoneal dialysis before ICU admission. Among patients with AKI, oliguric and non-oliguric AKI were defined as pre-CKRT urine output <0.5 and ≥0.5 mL/kg/h, respectively. The primary outcome was time to all-cause death within 90 days after CKRT initiation. We used Cox proportional hazards models adjusted for prespecified covariates measured at CKRT initiation. Within ESKD, we modeled dialysis vintage as a continuous variable using Cox models adjusted for APACHE II score and sepsis.</p><p><strong>Results: </strong>Among 560 patients, 66 had ESKD, 305 had oliguric AKI, and 189 had non-oliguric AKI. Documented death within 90 days occurred in 236 patients (42.1%). Using ESKD as the reference, oliguric AKI was not associated with a different hazard of death within 90 days (adjusted hazard ratio [HR], 0.86; 95% confidence interval [CI], 0.58-1.29), whereas non-oliguric AKI was associated with a lower hazard (adjusted HR, 0.63; 95% CI 0.41-0.99). Among patients with ESKD, longer dialysis vintage was associated with a higher hazard of death within 90 days (adjusted HR per 1-year increase, 1.07; 95% CI 1.02-1.11).</p><p><strong>Conclusions: </strong>In ICU patients starting CKRT, pre-CKRT urine output in AKI and dialysis vintage in ESKD were associated with short-term prognosis. Non-oliguric AKI was associated with a lower adjusted hazard of death than ESKD, and longer dialysis vintage was associated with a higher hazard of death within ESKD. These findings require external validation in contemporary multicenter cohorts.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"14 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13543588/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148891243","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":"Impact of an ROX index-guided intubation strategy on mortality in patients receiving high-flow nasal cannula: a target trial emulation.","authors":"Ryohei Yamamoto, Takeshi Tohyama, Ahram Han, Norman Pedersen, Kerollos Nashat Wanis, Joseph Byers, Leo Anthony Celi","doi":"10.1186/s40560-026-00927-x","DOIUrl":"10.1186/s40560-026-00927-x","url":null,"abstract":"<p><strong>Background: </strong>The ROX index (the ratio of peripheral oxygen saturation to the fraction of inspired oxygen, divided by respiratory rate) has been validated to predict high-flow nasal cannula (HFNC) failure, but whether acting on ROX to guide the timing of intubation improves patient outcomes is unknown. We estimated the per-protocol effect of ROX-guided strategies versus usual care on mortality after HFNC initiation.</p><p><strong>Methods: </strong>We emulated target trials using Medical Information Mart for Intensive Care IV (MIMIC-IV) electronic health record data. Adults initiated on HFNC within 7 days of intensive care unit (ICU) admission were eligible. Strategies were usual care or intubation within 2 h after ROX first fell below 3.85, 4.88, or time-varying thresholds (2.85 for hours 1-5, 3.47 for hours 6-11, and 3.85 from hour 12). We used clone-censor-weighting with pooled logistic regression, adjusted for baseline and time-varying covariates, to estimate 30-day mortality.</p><p><strong>Results: </strong>We included 1,651 adults (median age, 66 years; women, 41%). Estimated 30-day mortality under usual care was 26.9% (95% CI 24.7-29.2). ROX < 3.85: 20.5% (95% CI 17.1-24.1; risk difference [RD], -6.5 percentage points [95% CI -9.1 to -3.8]; risk ratio [RR], 0.76 [95% CI 0.66-0.86]). ROX < 4.88: 19.8% (95% CI 16.3-24.0; RD, -7.1 percentage points [95% CI -10.3 to -3.5]; RR, 0.74 [95% CI 0.62-0.87]). Time-varying ROX: 21.3% (95% CI 18.5-24.3; RD, -5.6 percentage points [95% CI -7.9 to -3.4]; RR, 0.79 [95% CI 0.70-0.87]).</p><p><strong>Conclusions: </strong>ROX-guided intubation strategies were associated with lower 30-day mortality than usual care. These findings are hypothesis-generating and support prospective evaluation of the ROX index applied as a decision policy rather than as a prediction score alone; they should not be used to guide intubation decisions at present.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"14 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13543613/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148891008","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: 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":"Maajid Mohi Ud Din Malik, Rajesh Prasad Jayaswal","doi":"10.1186/s40560-026-00903-5","DOIUrl":"https://doi.org/10.1186/s40560-026-00903-5","url":null,"abstract":"","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"14 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13474830/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148761072","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":"Response to: \"Matters arising: 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","doi":"10.1186/s40560-026-00914-2","DOIUrl":"https://doi.org/10.1186/s40560-026-00914-2","url":null,"abstract":"","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"14 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13474515/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148759651","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":"Comparative efficacy of landiolol and bisoprolol transdermal patch in patients with sepsis-related tachycardia: a retrospective cohort study.","authors":"Shuhei Murao, Jumpei Yoshimura, Yutaka Umemura, Jun Oda, Satoshi Fujimi","doi":"10.1186/s40560-026-00924-0","DOIUrl":"10.1186/s40560-026-00924-0","url":null,"abstract":"<p><strong>Background: </strong>Tachycardia is common in sepsis and is associated with poor outcomes. β-blockers have been used for heart rate (HR) control, but comparative evidence between short- and long-acting agents remains limited. The aim of this study was to compare the efficacy and safety of intravenous landiolol and a bisoprolol transdermal patch in patients with sepsis-related tachycardia.</p><p><strong>Methods: </strong>This multicenter retrospective cohort study included adult patients with sepsis-related tachycardia (HR ≥ 100 bpm) treated with landiolol or a bisoprolol transdermal patch at intensive care units (ICUs) participating in a Japanese ICU database, from January 2014 to March 2026. Propensity score matching (PSM) at a 1:1 ratio was performed to adjust for baseline differences between groups. The primary outcome was the proportion of patients who achieved HR control (60-94 bpm) at 24 h. The secondary outcomes included in-hospital mortality, bradycardia incidence, the proportion requiring increased norepinephrine-equivalent doses at 24 h, and trends in HR and mean arterial pressure (MAP) over 24 h.</p><p><strong>Results: </strong>After PSM, data from 950 patients were analyzed (n = 475 in each group). HR control at 24 h did not differ between the two groups (landiolol: 56% vs. bisoprolol: 54%, p = 0.561) in overall sepsis patients. In the subgroup of patients with septic shock, HR control at 24 h was achieved more frequently with landiolol than with bisoprolol (65 vs. 53%; p = 0.046). In-hospital mortality was 5.1% in the landiolol group and 8.0% in the bisoprolol group (p = 0.088). Bradycardia incidence (3.8 vs. 5.9%, p = 0.174) and the proportion of patients requiring increased norepinephrine-equivalent doses at 24 h (16 vs. 13%, p = 0.170) were comparable between the two groups. Landiolol achieved a more rapid HR reduction, whereas bisoprolol induced a moderate decrease in HR.</p><p><strong>Conclusions: </strong>Landiolol and the bisoprolol transdermal patch achieved comparable 24-h HR control in the overall cohort of sepsis patients with tachycardia. A higher rate of HR control with landiolol was observed in patients with septic shock. The effect of these agents on mortality remains unclear, and further studies are warranted.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"14 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13536561/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148880504","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}