Journal of Intensive Care最新文献

{"title":"Aspiration pneumonia in the world's most aged society: age-stratified ICU management and outcomes from a nationwide Japanese registry.","authors":"Satoru Sekiya, Shunsaku Goto, Hiromu Okano, Hiroshi Okamoto","doi":"10.1186/s40560-026-00923-1","DOIUrl":"10.1186/s40560-026-00923-1","url":null,"abstract":"<p><strong>Objectives: </strong>To describe the age-stratified clinical characteristics, ICU management, and in-hospital outcomes of adults admitted to Japanese ICUs with aspiration pneumonia.</p><p><strong>Design: </strong>Multicenter, retrospective, observational cohort study.</p><p><strong>Setting: </strong>Multiple ICUs participated in the Japanese Intensive Care Patient Database (JIPAD), a nationwide registry of the Japanese Society of Intensive Care Medicine, from 2015 to 2023.</p><p><strong>Patients: </strong>Adults ≥ 18 years admitted to ICUs with a primary diagnosis of aspiration pneumonia.</p><p><strong>Measurements and main results: </strong>Among 3,906 eligible ICU admissions (median age, 76 years [IQR, 68-83]; 75.5% male), illness severity at admission increased with age (median APACHE III score, 74 [56-91] in patients aged 18-64 years vs. 96 [81-120] in those aged ≥ 85 years). Invasive mechanical ventilation (MV) was used in 68.8% of patients and was less frequent in older age groups (18-64 years: 73.2%; 65-74 years: 74.2%; 75-84 years: 69.9%; ≥ 85 years: 55.4%). Overall in-hospital mortality was 28.3% and increased across age groups (18-64 years: 13.7%; 65-74 years: 25.0%; 75-84 years: 32.1%; ≥ 85 years: 39.3%). Median hospital and ICU lengths of stay were 32 days (IQR, 16-58) and 120.4 h (IQR, 54.4-234.8), respectively. In-hospital pathways differed markedly across age groups: among patients aged ≥ 85 years, in-hospital mortality reached 39.3%, and home discharge was achieved in only 19.9%, compared with 13.7% and 45.2% among patients aged 18-64 years, respectively. In the exploratory adjusted analyses, the probability of in-hospital mortality increased with age, whereas that of MV use decreased, particularly in patients aged > 75 years.</p><p><strong>Conclusions: </strong>Older patients with aspiration pneumonia had higher illness severity yet received less MV, and had higher in-hospital mortality and lower home discharge rates. These nationwide data describe the current state of ICU-managed aspiration pneumonia in a super-aged society and may provide a reference point for future comparative studies.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"14 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13536822/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148880464","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":"Role and prognostic value of N6-methyladenosine RNA modification regulators in glycolytic reprogramming during sepsis.","authors":"Xia Liu, Yanyu Zhang, Lei Feng, Aruna Xiang, Zhuqing Kang, Qi Zhang, Lei Kang","doi":"10.1186/s40560-026-00920-4","DOIUrl":"10.1186/s40560-026-00920-4","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to investigate the expression profiling characteristics of N6-methyladenosine (m6A) RNA modification regulators in sepsis, their associations with glycolytic metabolic reprogramming, and their preliminary prognostic value.</p><p><strong>Methods: </strong>We integrated multiple sepsis transcriptomic cohorts (GSE65682, GSE95233, GSE54514) from the GEO database to systematically analyze the differential expression of 15 m6A regulators. Gene Set Variation Analysis (GSVA) scores, weighted gene co-expression network analysis (WGCNA) networks, and Spearman correlation analyses were utilized to assess the associations between m6A regulators and glycolytic activity. The regulation of glycolytic genes by m6A modifications was confirmed using ALKBH5 knockout models (GSE198316, GSE224650) and MeRIP-seq data (GSE225143). A prognostic model was developed by integrating CIBERSORT immune cell infiltration analysis, single-cell RNA sequencing data (GSE147363), and LASSO-Cox regression.</p><p><strong>Results: </strong>Most m6A regulators are significantly downregulated in patients with sepsis, while IGF2BP2 and IGF2BP3 are upregulated. ALKBH5 clusters with IGF2BP2 within the same WGCNA module and exhibits a positive correlation with glycolytic activity (rho=0.592, P=1.0 × 10⁻²⁹). The differentially expressed genes (DEGs) resulting from ALKBH5 knockout significantly overlap with sepsis-associated DEGs (n=124; OR=2.48, P=5.10 × 10⁻¹¹), which are enriched in the HIF-1 signaling pathway and glycolytic processes. Independent validation confirmed a directional consistency of 89.6%. MeRIP-seq data indicated m6A-mediated associations with glycolytic genes, including ENO1, GAPDH, HK2, and LDHA. Single-cell analysis demonstrated a positive correlation between ALKBH5 and most glycolytic genes in CD14+ monocytes. A prognostic model based on four m6A genes (HNRNPC, YTHDF1, YTHDF2, VIRMA) achieved a C-index of 0.750 in the training set and 0.709-0.718 in external validation sets.</p><p><strong>Conclusion: </strong>These integrated analyses suggest that ALKBH5-associated m6A modification is correlated with sepsis-associated glycolytic reprogramming and support a biologically plausible, hypothesis-generating ALKBH5-associated glycolytic program that requires prospective and experimental validation. The m6A-based four-gene model showed preliminary prognostic potential for 28-day mortality, but its external reproducibility was incomplete and requires validation in larger, prospectively collected and clinically harmonized cohorts.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"14 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13528130/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148865321","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 prolonged pre-intubation high-flow nasal cannula duration with survival and successful V-V ECMO liberation in severe ARDS: a retrospective multicenter study.","authors":"Ryuichi Nakayama, Naofumi Bunya, Mitsuaki Nishikimi, Shinichiro Ohshimo, Kenshiro Wada, Arisa Aoyagi, Shuji Uemura, Nobuaki Shime, Eichi Narimatsu","doi":"10.1186/s40560-026-00915-1","DOIUrl":"10.1186/s40560-026-00915-1","url":null,"abstract":"<p><strong>Background: </strong>In patients with severe acute respiratory distress syndrome (ARDS), prolonged invasive mechanical ventilation (IMV) prior to veno-venous extracorporeal membrane oxygenation (V-V ECMO) is a known risk factor for poor outcomes. However, the clinical impact of high-flow nasal cannula (HFNC) duration before intubation remains poorly defined. We examined the association between pre-intubation HFNC duration and clinical outcomes, including survival and ECMO liberation.</p><p><strong>Methods: </strong>This retrospective multicenter study using the J-CARVE registry analyzed 209 adults with severe ARDS who received HFNC before V-V ECMO (2012-2022). The continuous risk of prolonged HFNC for 60-day in-hospital mortality was evaluated using multivariable logistic regression. Subsequently, patients were stratified into Short (< 3 days) and Long (≥ 3 days) HFNC groups using an exploratory ROC-derived cutoff. Clinical outcomes (60-day in-hospital mortality and successful ECMO liberation) were further analyzed using multivariable Cox and Fine-Gray models.</p><p><strong>Results: </strong>Multivariable logistic regression identified prolonged HFNC duration (analyzed continuously) as an independent risk factor for 60-day in-hospital mortality (adjusted odds ratio 1.22 per 1-day increase; 95% CI 1.07-1.39; P = 0.0035). Sixty-nine patients (33.0%) were in the Long HFNC group. After adjustment, prolonged HFNC (≥ 3 days) was independently associated with a twofold increase in 60-day in-hospital mortality (adjusted Hazard Ratio 2.27; 95% CI 1.24-4.15; P = 0.008). Furthermore, successful ECMO liberation was significantly lower in the Long HFNC group (adjusted Subdistribution Hazard Ratio 0.68; 95% CI 0.50-0.94; P = 0.018).</p><p><strong>Conclusions: </strong>Extended pre-intubation HFNC duration was associated with increased mortality and impaired lung recovery in severe ARDS. Rather than a direct cause of injury, prolonged HFNC likely serves as a complex prognostic marker reflecting disease trajectory and delayed escalation. Clinicians should recognize prolonged HFNC as a continuous trajectory of accumulating risk, rather than relying solely on IMV duration to guide ECMO initiation.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"14 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13505073/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148813072","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":"Sequence and timing of organ donation discussions in brain-dead donors: a subanalysis of the J-RESPECT study.","authors":"Tetsuya Yumoto, Hiromichi Naito, Mineji Hayakawa, Shoji Yokobori, Kei Nishiyama, Takahiro Atsumi, Osamu Tasaki, Junya Tsurukiri, Mariko Hayamizu, Shimon Murahashi, Munehiro Hayashi, Takeshi Nishimura, Yukari Goto, Hiromichi Narumiya, Atsushi Mizutani, Mamoru Miyajima, Junya Shimazaki, Takeshi Miura, Nozomu Shima, Kazuki Deuchi, Hitomi Nakayasu, Hitoshi Kano, Takashi Yorifuji, Atsunori Nakao","doi":"10.1186/s40560-026-00905-3","DOIUrl":"10.1186/s40560-026-00905-3","url":null,"abstract":"<p><strong>Background: </strong>The optimal timing of organ donation discussions in patients with catastrophic brain injury remains unclear. In Japan, national guidance recommends providing information after recognition of a state compatible with brain death; however, real-world practice has not been well characterized. This study aimed to evaluate the sequence of organ donation option presentation relative to clinical determination of a brain death-compatible state and to assess option presentation timing.</p><p><strong>Methods: </strong>We conducted a multicenter retrospective cohort study using data from the J-RESPECT study, including adult brain-dead donors from 16 institutions in Japan between 2010 and 2023. Donors were classified as brain death-first (option presented after clinical determination of a brain death-compatible state) or option-first (option presented before such determination). Mixed-effects logistic and linear regression models with random intercepts for institution were used to examine factors associated with presentation sequence and timing.</p><p><strong>Results: </strong>Among 190 donors, 76 (40%) were classified as brain death-first and 114 (60%) as option-first. In mixed-effects logistic regression, age was the only independent factor associated with presentation sequence (adjusted OR 1.03 per year, 95% CI 1.00-1.07), while substantial between-institution variability was observed (intraclass correlation coefficient = 0.32). Institutional timing policy was not significantly associated with presentation sequence. The median interval from admission to option presentation was 5 days in the brain death-first group and 2 days in the option-first group (p < 0.001).</p><p><strong>Conclusions: </strong>Substantial inter-institutional variability exists in the sequence and timing of organ donation discussions in Japan. Further studies are needed to determine optimal approaches to organ donation communication and timing in clinical practice.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"14 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13505128/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148818393","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":"Validation of the updated sequential organ failure assessment (SOFA)-2 score in emergency department septic shock.","authors":"Sejoong Ahn, Sang-Min Kim, Jong-Hak Park, Guntak Lee, Hyunglan Chang, Won Young Kim, Tae Gun Shin, Kyuseok Kim","doi":"10.1186/s40560-026-00921-3","DOIUrl":"10.1186/s40560-026-00921-3","url":null,"abstract":"<p><strong>Objectives: </strong>The original Sequential Organ Failure Assessment (SOFA-1) score is widely used to quantify organ dysfunction in critically ill patients, including those with septic shock. A recently updated, data-driven SOFA score (SOFA-2) revises component thresholds and incorporates contemporary organ support modalities. While SOFA-2 has been validated in intensive care unit populations, its performance in the emergency department (ED), particularly among patients with septic shock, is uncertain. We therefore sought to validate SOFA-2 in ED patients with septic shock.</p><p><strong>Methods: </strong>In this observational study, we analyzed two prospective septic shock registries. Adult ED patients with septic shock were included. SOFA-1 and SOFA-2 scores were calculated using the worst physiologic and laboratory values recorded within the first 24 h in the ED. We compared score distributions and examined mortality across score ranges. Discrimination for in-hospital, 28-day, and 90-day mortality was evaluated using the area under the receiver operating characteristic curve (AUROC). Calibration for in-hospital mortality was assessed using the calibration curve and Brier scores. Reclassification performance was evaluated using continuous net reclassification improvement (NRI) and integrated discrimination improvement (IDI).</p><p><strong>Results: </strong>The study included 2669 patients in Cohort A and 1443 patients in Cohort B. SOFA-1 and SOFA-2 score distributions differed significantly. Mortality generally increased with higher SOFA-1 and SOFA-2 scores across all outcomes. SOFA-2 demonstrated significantly higher AUROCs than SOFA-1 for in-hospital, 28-day, and 90-day mortality in both cohorts (Cohort A: 0.734 vs. 0.702, 0.719 vs. 0.694, and 0.680 vs. 0.658; Cohort B: 0.719 vs. 0.671, 0.737 vs. 0.689, and 0.711 vs. 0.666; all p < 0.001). SOFA-2 showed generally closer agreement between predicted and observed in-hospital mortality and lower Brier scores. Continuous NRI (0.276-0.635) and IDI (0.024-0.062) also favored SOFA-2 across all mortality outcomes (all p < 0.001). In adjusted analyses, each 1-point increase in SOFA-2 was independently associated with higher mortality. Sensitivity analyses and pooled analyses showed consistent findings.</p><p><strong>Conclusion: </strong>Among ED patients with septic shock, SOFA-2 showed modestly improved discrimination, closer agreement between predicted and observed in-hospital mortality with lower overall prediction error, and more favorable continuous reclassification metrics compared with SOFA-1. These findings support the external validation of SOFA-2 in this population and warrant further evaluation in diverse ED settings.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"14 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13536635/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148880544","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 prediction of intensive care unit-acquired weakness using quadriceps ultrasound and routine clinical variables: development and temporal validation of a prospective multicentre machine-learning model.","authors":"Tongjuan Zou, Xuehua Chen, Jun Li, Xianying Lei, Hengyu Cai, Li Zhang, Li Zhang, Xueying Zeng, Qionglan Dong, Shurong Zhang, Yan Kang, Bo Wang, Zhongwei Zhang, Xiaodong Jin, Wanhong Yin","doi":"10.1186/s40560-026-00919-x","DOIUrl":"10.1186/s40560-026-00919-x","url":null,"abstract":"<p><strong>Background: </strong>Intensive care unit-acquired weakness (ICUAW) is frequent in critically ill adults and is associated with adverse outcomes, but early recognition is difficult because standard diagnosis relies on volitional strength testing.</p><p><strong>Methods: </strong>In this prospective multicentre cohort study across 16 tertiary ICUs in southwest China, adults expected to remain in the ICU for ≥ 3 days underwent quadriceps ultrasound and routine clinical assessment within 24 h of admission. ICUAW was defined by the first evaluable Medical Research Council (MRC) score during ICU stay. We developed and compared nine algorithms in a development cohort (n = 858) and performed temporal external validation in a later cohort (n = 345).</p><p><strong>Results: </strong>ICUAW occurred in 579/858 (67.5%) patients in the development cohort and 181/345 (52.5%) in the validation cohort. In external validation, a random forest model integrating unpressurised ultrasound and clinical features achieved an area under the receiver operating characteristic curve (AUC) of 0.810 (95% CI 0.765-0.855), with sensitivity 0.983 (0.952-0.997) and specificity 0.726 (0.651-0.792). The corresponding pressurised-ultrasound model showed lower discrimination (AUC 0.730 [0.676-0.783]) and specificity (0.506 [0.427-0.585]). Shapley additive explanations (SHAP) highlighted quadriceps muscle thickness, Sequential Organ Failure Assessment (SOFA) score, albumin, and inflammatory markers as key contributors. In additional incremental-value analyses using the General RF model as the reference, the unpressurised RF model improved risk reclassification and discrimination (cf-NRI 0.490, 95% CI 0.277-0.698; IDI 0.072, 95% CI 0.045-0.099), whereas the pressurised RF model showed a smaller cf-NRI improvement (0.231, 95% CI 0.011-0.463) with less consistent IDI improvement (0.019, 95% CI - 0.002 to 0.040).</p><p><strong>Conclusions: </strong>This early ultrasound-clinical model may identify patients at high risk of ICUAW before strength testing becomes feasible and support earlier targeting of preventive and rehabilitation strategies. Trial registration Registered in the Chinese Clinical Trial Registry (ChiCTR2300075581) on September 8, 2023.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"14 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13445787/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148684877","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":"Factors influencing the acceptability of remote multicomponent rehabilitation versus standard care following critical illness: a theory-informed qualitative study embedded within the iRehab trial.","authors":"Cara G Ghiglieri, Bronwen A Connolly, Darren Murphy, Daniel F McAuley, Brenda M O'Neill, Judy M Bradley","doi":"10.1186/s40560-026-00908-0","DOIUrl":"10.1186/s40560-026-00908-0","url":null,"abstract":"<p><strong>Background: </strong>Adults who survive critical illness requiring mechanical ventilation frequently experience prolonged physical, psychological, and social difficulties following discharge, yet access to structured recovery support remains variable. This study explored how ICU survivors and staff perceived the acceptability of a remote multicomponent rehabilitation programme versus standard care following discharge from critical care.</p><p><strong>Methods: </strong>A theory-informed qualitative interview study was conducted, guided by the Theoretical Framework of Acceptability. ICU survivors who received either remote multicomponent rehabilitation or standard care, alongside staff involved in delivery, were purposively sampled from a pragmatic UK trial (iRehab) across 24 hospital sites. Semi-structured interviews were audio-recorded, transcribed verbatim, and analysed using framework analysis. Thirty-five ICU survivors and six staff members participated in interviews conducted between January 2023 and June 2025.</p><p><strong>Results: </strong>Eight inter-related themes captured the factors shaping acceptability during recovery after ICU discharge. Participants who received remote multicomponent rehabilitation generally found it acceptable, as it provided structure, continuity, and support for confidence-building and self-management. In contrast, standard care was often experienced as lacking coordination and follow-up, leaving individuals to navigate recovery with limited support. However, acceptability was not experienced in the same way by all participants. Digital delivery and optional components, such as peer support, were valued by many but not by everyone, depending on readiness, context, and capability.</p><p><strong>Conclusions: </strong>Remote multicomponent rehabilitation was valued for its structure, continuity, and support, while standard care was often experienced as lacking these features. Acceptability of support was shaped by how well it aligned with survivors' needs and contexts. These findings support the integration of structured, flexible rehabilitation pathways into post-ICU care. Trial registration ISRCTN11266403; registered 26 July 2022.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"14 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13504833/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148818672","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":"Surgical site infection incidence and surgical antibiotic prophylaxis in the ICU patient: a multicenter observational study.","authors":"Bruno Pastene, Nyl Chemli, Emmanuel Dudoignon, François Depret, Minh-Pierre Lê, Nicolas Mongardon, Anne-Claire Lukaszewicz, Romain Ronflé, Marie Le Baron, Laurent Zieleskiewicz, Ignacio Martin-Loeches, Gary Duclos, Marc Leone","doi":"10.1186/s40560-026-00916-0","DOIUrl":"10.1186/s40560-026-00916-0","url":null,"abstract":"<p><strong>Background: </strong>Surgical site infection (SSI) is a major cause of postoperative morbidity. Surgical antibiotic prophylaxis (SAP), defined as the pre-incision administration of an antimicrobial agent targeting likely organisms in clean or clean-contaminated procedures without active infection at the operative site, is a cornerstone of prevention in surgery. However, critically ill patients represent a distinct population with profound susceptibility to infection. Data on SSI incidence and SAP practices in patients undergoing surgery during an intensive care unit (ICU) stay remain scarce.</p><p><strong>Methods: </strong>Retrospective multicenter cohort study in five French ICUs (March 2022-March 2023). Adult patients (≥18 years) with an ICU stay ≥ 48 h who underwent surgery during their ICU stay were included. Primary outcome was SSI incidence after surgery. Generalized estimating equations (GEE) with a prespecified adjustment set were used to estimate the adjusted association between antimicrobial spectrum and SSI, accounting for clustering within centers.</p><p><strong>Results: </strong>338 patients were included (median age 56 years, IQR 35 - 67; 72% male). Overall SSI incidence was 21%. Procedures with suspected infection present at time of surgery (PATOS) (n = 52, 15%) had an SSI incidence of 37%, against 18% in PATOS-negative patients. In the primary adjusted GEE analysis, broad-spectrum vs. narrow-spectrum antimicrobials (OR 3.06; 95%CI 1.63-5.76; P < 0.001) and no antimicrobial vs. narrow-spectrum antimicrobials (OR 2.49; 95%CI 1.01-6.15; P = 0.048) were independently associated with SSI. Stratified analysis showed that antimicrobial spectrum also had significant effect on SSI risk on PATOS-positive and trauma patients. SSI was associated with prolonged ICU/hospital length of stay, increased organ support use, and worse outcomes at day 28 and day 90.</p><p><strong>Conclusions: </strong>SSI affects more than one in five critically ill patients. After adjustment for prespecified confounders, the association with broad-spectrum therapy likely reflected confounding by indication, whereas the absence of any antimicrobial coverage was independently associated with increased SSI risk. Conventional SAP guidelines derived from non-ICU populations may not apply to critically ill patients. ICU-specific prophylactic strategies, improved coordination between ICU and operating room teams, and prospective studies are needed to enhance SSI prevention in this high-risk population.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"14 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13523194/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148840262","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":"EIT-assessed ventilation-perfusion responses to prone positioning and inhaled nitric oxide in mechanically ventilated COVID-19-related ARDS: a prospective sequential study.","authors":"Yuxian Wang, Yuyang Dai, Xin Zheng, Ling Zhu, Yaxiaerjiang Muhetaer, Zhanqi Zhao, Kai Liu, Ming Zhong","doi":"10.1186/s40560-026-00918-y","DOIUrl":"10.1186/s40560-026-00918-y","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Prone positioning (PP) and inhaled nitric oxide (iNO) are widely utilized rescue therapies for severe hypoxemia during invasive mechanical ventilation. However, their combined effects on regional ventilation-perfusion (V/Q) matching remain incompletely characterized. This study utilized single-plane saline-contrast electrical impedance tomography (EIT) to achieve real-time bedside visualization and evaluate the relative spatial mechanisms of these interventions in patients with COVID-19-related ARDS.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a prospective sequential physiological study in mechanically ventilated patients with moderate-to-severe COVID-19-related acute respiratory distress syndrome (ARDS). Relative regional ventilation, perfusion, and V/Q matching distributions were monitored across four predefined, fixed sequential conditions: supine position ventilation (SPV), SPV with iNO (20 ppm for 1 h; SPV + iNO), prone position ventilation after stabilization (PPV), and PPV with an additional 1 h of iNO (PPV + iNO). Primary analyses focused on prespecified within-patient contrasts, supplemented by exploratory difference-in-differences (DiD) analyses to evaluate position-dependent vascular responses.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Twenty-eight patients completed all study phases. Hemodynamics and conventional respiratory mechanics remained remarkably stable across all four conditions. Systemic oxygenation improved progressively; both SPV + iNO and PPV significantly increased PaO&lt;sub&gt;2&lt;/sub&gt; and PaO&lt;sub&gt;2&lt;/sub&gt;/FiO&lt;sub&gt;2&lt;/sub&gt; compared to SPV alone, while the addition of iNO during PPV (PPV + iNO) yielded further oxygenation improvements and reduced FiO&lt;sub&gt;2&lt;/sub&gt; requirements. Within the EIT-assessed thoracic slice, SPV + iNO produced the most widespread V/Q improvements, significantly reducing the global non-perfused fraction (-7.28%), wasted ventilation (-8.14%), wasted perfusion (-5.89%), and the global inhomogeneity of perfusion (GIper). Transitioning to PPV similarly reduced the global non-perfused fraction (-8.76%) and GIper, while ventral-to-dorsal ventilation distribution remained stable. Notably, while PPV + iNO improved systemic oxygenation, it did not produce additional significant reductions in global EIT V/Q metrics, and locally increased the dorsal low V/Q compartment (+ 4.01%). DiD analyses revealed that while body position did not significantly modify the acute systemic oxygenation response to iNO, it significantly altered EIT-derived V/Q responses, indicating an attenuated capacity for iNO to improve regional V/Q matching in the imaged slice when administered in the prone position.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Both prone positioning and iNO improved oxygenation in moderate-to-severe COVID-19-related ARDS. Within the EIT-assessed thoracic slice, these improvements were accompanied by better regional V/Q matching, which was mainly perfusion-related rather than ventilation-related and ","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"14 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13527915/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148865200","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":"Physical restraint in the intensive care units: a narrative review of current practices and outcomes.","authors":"Xiaobo Yang","doi":"10.1186/s40560-026-00913-3","DOIUrl":"10.1186/s40560-026-00913-3","url":null,"abstract":"<p><strong>Background: </strong>Physical restraint remains common in the intensive care unit (ICU), but it is increasingly questioned following recent high‑quality evidence, particularly the R2D2‑ICU trial, which challenges the assumption that reducing restraint inherently improves short‑term neurological outcomes.</p><p><strong>Main body: </strong>Epidemiological data reveal significant variability in the prevalence of restraint use, which is influenced by a complex interplay of patient characteristics, caregiver factors, and systemic elements. The evidence on its effectiveness for mainly preventing the pulling out of tubes is questionable. However, its association with a range of negative physical, neurological, and psychological outcomes. It also imposes a heavy burden of moral distress on caregivers, who are tasked with balancing patient safety against the imperative to minimize harm. Successful minimization of restraint use requires multicomponent approaches.</p><p><strong>Conclusion: </strong>Moving toward restraint minimization requires a paradigm shift from viewing physical restraint as a standard safety tool to recognizing it as a potentially harmful intervention of last resort. Future evaluations should adopt the triadic outcomes framework outlined here, assessing neurological and psychological outcomes, family satisfaction, and caregiver moral burden to guide ethically sound, sustainable ICU practice.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13523299/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148549513","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}