Journal of Intensive Care最新文献

{"title":"Authors' response to commentary on \"Echocardiographic phenotypes in sepsis: identifying subgroups using latent profile analysis\".","authors":"Tatyana Shvilkina, Gabriel Erion-Barner, Timothy P Downs, Ryan Burke, Nadim Kattouf, Jordan B Strom, Robert E Gerszten, Tamar Sofer, Daniel B Kramer, Michael W Donnino, Michael J Lanspa, Nathan I Shapiro","doi":"10.1186/s40560-026-00896-1","DOIUrl":"10.1186/s40560-026-00896-1","url":null,"abstract":"","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"14 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13335305/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148396854","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":"Comment on: Echocardiographic phenotypes in sepsis: identifying subgroups using latent profile analysis.","authors":"Ngan Hoang Kim Trieu, Thanh Luan Nguyen","doi":"10.1186/s40560-026-00888-1","DOIUrl":"10.1186/s40560-026-00888-1","url":null,"abstract":"<p><p>In this comment, we aim to provide a perspective on the study by Shvilkina et al. entitled \"Echocardiographic phenotypes in sepsis: identifying subgroups using latent profile analysis\". After summarizing the principal findings, we discuss several issues related to the interpretation of cluster-based phenotypes. These considerations highlight important methodological limitations that may influence the validity and clinical applicability of the proposed phenotypes.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"14 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13335310/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148396864","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":"Longitudinal immune-inflammatory profiles and mortality in older adults with sepsis: a multicentre prospective cohort study.","authors":"Xianwen Wang, Miaomiao Fu, Chunhui Li, Jialin Jin, Na Cui, Xuelian Liao, Zhanwen Wang, Zhihong Zuo, Qihang Huang, Lina Zhang, Zhaoxin Qian","doi":"10.1186/s40560-026-00902-6","DOIUrl":"10.1186/s40560-026-00902-6","url":null,"abstract":"<p><strong>Background: </strong>Older adults are at high risk of sepsis, but the immune-inflammatory features distinguishing sepsis from nonsevere infection and their prognostic relevance remain incompletely defined. We aimed to characterize immune-inflammatory profiles across the older adult infection spectrum and evaluate their longitudinal association with in-hospital mortality.</p><p><strong>Methods: </strong>In this multicentre prospective observational cohort, 1,851 participants aged ≥ 60 years were enrolled, including healthy controls, patients with nonsevere infection, and patients with sepsis. Immune-cell subsets, cytokines, complement components, and routine laboratory indices were assessed. Adjusted cross-sectional comparisons were performed using multivariable linear regression. Among patients with sepsis, model-estimated longitudinal profiles from intensive care unit (ICU) day 1 to day 7 were analysed using linear mixed-effects models among available scheduled measurements, and day-1 biomarkers associated with in-hospital mortality were evaluated using Cox regression.</p><p><strong>Results: </strong>The cohort included 524 healthy controls, 511 patients with nonsevere infection, and 816 patients with sepsis. Across the infection spectrum, sepsis was characterized by progressively lower circulating lymphocyte, T-cell, cluster of differentiation 8 (CD8⁺) T-cell, and natural killer (NK)-cell counts, together with higher interleukin (IL)-6, IL-8, and IL-10 levels. These differences remained after adjustment for age, sex, and major comorbidities. Among patients with available follow-up measurements, non-survivors had consistently higher Sequential Organ Failure Assessment (SOFA) scores, IL-6, and IL-10 and lower lymphocyte, T-cell, CD8⁺ T-cell, NK-cell, and complement component 3 (C3) levels. No time-by-outcome interaction remained significant after false-discovery-rate correction. In multivariable Cox models, higher day-1 SOFA score and IL-10 were associated with increased in-hospital mortality, whereas higher NK-cell count was associated with lower mortality.</p><p><strong>Conclusions: </strong>In older adults, sepsis was associated with an adjusted circulating immune-inflammatory pattern characterized by lower cellular immune markers and higher cytokine levels. This separation was evident on ICU day 1 and remained observable among patients with available follow-up measurements. Given the observational design, these associations should not be interpreted as causal.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13501803/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148387581","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":"Adenosine 5'-monophosphate prevents sepsis-associated muscle wasting by activating AMPK and suppressing IL-1β inflammatory cytokines.","authors":"Ikumi Yoshihara, Narumi Yoshihara, Kei Hanafusa, Koichiro Sueyoshi, Yuko Ono, Nao Umei, Shin Watanabe, Ken Okamoto, Hiroshi Tanaka, Yutaka Kondo","doi":"10.1186/s40560-026-00901-7","DOIUrl":"10.1186/s40560-026-00901-7","url":null,"abstract":"<p><strong>Background: </strong>Sepsis-associated muscle wasting (SAMW) causes long-term functional decline, even after recovery. Emerging evidence indicates that adenosine 5'-monophosphate (AMP) confers organ-protective effects in response to physiological stress or injury, potentially through the activation of AMP-activated protein kinase (AMPK) signalling pathways. In this study, we investigated the effects of AMP on SAMW to evaluate its efficacy as a therapeutic agent to alleviate SAMW.</p><p><strong>Methods: </strong>In vivo, a mouse model of cecum ligation and puncture sepsis was established using male C57BL/6 mice, which received intraperitoneal AMP (0.5 mg/g) or saline as a control. In vitro, C2C12 myoblasts and RAW264.7 macrophages were cultured under standard conditions and treated with AMP. Forelimb grip strength, blood and muscle sampling, western blotting, AMP assays, RNA sequencing, ELISA, flow cytometry, real-time PCR, immunohistochemistry, histology, and computed tomography imaging were performed to assess molecular, cellular, and physiological responses. In addition, plasma samples from patients with sepsis were analysed to explore translational relevance.</p><p><strong>Results: </strong>AMP suppressed sepsis-induced inflammatory cytokine production and improved muscle strength by attenuating mammalian target of rapamycin complex 1 activation and modulating AMPK signaling, thereby contributing to the preservation of muscle mass and a reduction in systemic inflammation. In vitro, AMP suppressed LPS- induced IL-1β production in RAW264.7 macrophages and attenuated LPS- or IL-1β-induced myotube atrophy in C2C12 cells and shifted the cells towards a fast-twitch phenotype. Evaluation of clinical samples revealed elevated inflammatory cytokines in patients with sepsis exhibiting muscle wasting.</p><p><strong>Conclusions: </strong>This study demonstrates that AMP effectively mitigates SAMW by activating AMPK and suppressing IL-1β-mediated molecular pathways. These findings highlight the potential of AMP as a novel therapeutic agent for preserving skeletal muscle functionality and morphology in sepsis.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13501565/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148387669","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":"Update on sepsis treatment.","authors":"Luis Chiscano-Camon, Juan Carlos Ruiz-Rodríguez, Adolf Ruiz-Sanmartin, Pablo Nicolas-Morales, Manuel Hernandez-Gonzalez, Ricard Ferrer","doi":"10.1186/s40560-026-00898-z","DOIUrl":"10.1186/s40560-026-00898-z","url":null,"abstract":"<p><p>Sepsis and septic shock remain a global health challenge with high mortality and long-term morbidity. Contemporary evidence highlights immune dysregulation, endothelial dysfunction, and glycocalyx degradation as key pathophysiological drivers. Clinical management has evolved from uniform approaches to precision-guided strategies that integrate subphenotyping, biomarkers and novel therapies. This review synthesizes data from guidelines, translational research, and clinical trials to provide a comprehensive perspective on current management and future directions in sepsis care.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13495181/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148368614","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":"Clinical implications of ferroptosis in critical illness: a narrative review.","authors":"Tom Stroobants, Cyril Willemart, Magali Walravens, Geraldine Veeckmans, Symen Ligthart, Eric Hoste, Dominique D Benoit, Tom Vanden Berghe, Philippe G Jorens","doi":"10.1186/s40560-026-00899-y","DOIUrl":"10.1186/s40560-026-00899-y","url":null,"abstract":"<p><p>Despite major advances in care for patients admitted to the intensive care unit (ICU), mortality remains high and functional outcomes for ICU survivors are often poor. The persistent burden underscores the need for innovative, mechanism-based approaches. Precision medicine has emerged as a promising paradigm in critical illness, and regulated cell death (RCD) may offer a novel entry point for targeted interventions. Among the various RCD pathways, ferroptosis, an iron-dependent form of RCD driven by excessive lipid peroxidation within cellular membranes, has gained increasing attention. Its mechanistic distinctiveness from other RCDs and potential reversibility make it particularly relevant in acute, dynamic disease states. In this narrative review, we explore the role of ferroptosis in critical care, focusing on high-impact conditions such as sepsis, COVID-19, ischaemia-reperfusion injury, and neurological emergencies. We outline the molecular mechanisms of ferroptosis and discuss how it may contribute to organ dysfunction across systems. While most insights to date stem from preclinical models, emerging clinical data suggest translational potential. We highlight key studies, discuss current limitations in detection and therapeutic targeting, and consider how the evaluation of ferroptosis could help shape the future of precision medicine in the ICU.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13495188/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148352127","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":"Tracheal intubation in the critically ill: beyond the airway, toward hemodynamic precision.","authors":"Jay Prakash, Tonny Veenith, Shio Priye, Bodhisatwa Choudhuri","doi":"10.1186/s40560-026-00894-3","DOIUrl":"10.1186/s40560-026-00894-3","url":null,"abstract":"","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"14 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13292578/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148317347","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":"Standardized low-flow ventilation with PEEP maintenance during bronchoscopy in mechanically ventilated ICU patients: a pilot trial.","authors":"Jordan Uguet, Charles-Hervé Vacheron, Margot Bonnet, Annaelle Caillet, Emmanuelle Bertreau, Donatien De Marignan, Romain Fort, Chloé Gerbaud, Andrei Iordache, Guillaume Izaute, Lucille Jay, Mélanie Levrard, Jerome Lenoir, Fabrice Thiollière, Olivia Vassal, Florent Wallet, Bernard Allaouchiche, Auguste Dargent","doi":"10.1186/s40560-026-00895-2","DOIUrl":"10.1186/s40560-026-00895-2","url":null,"abstract":"<p><strong>Background: </strong>Fiberoptic bronchoscopy in mechanically ventilated ICU patients can markedly increase airway resistance and peak inspiratory pressure (PIP), limit effective tidal volume delivery, and provoke transient hypoxemia, hypercapnia, dynamic hyperinflation, and hemodynamic instability. However, per-procedural ventilator management remains heterogeneous.</p><p><strong>Methods: </strong>This single-center trial with before-and-after design assessed the feasibility and safety of implementing a standardized low-flow ventilation protocol, and characterized its physiological effects (particularly peak inspiratory pressure), during bronchoscopy in adults intubated and ventilated in volume-assist-control mode.</p><p><strong>Results: </strong>During the observational phase (n = 36), ventilator settings reflected usual practice (increased pressure alarm and reduced PEEP; no routine flow reduction). Following a 1-month training period, the intervention phase (n = 35) implemented an inspiratory flow rate of 20 L/min, unchanged PEEP, and a reduced respiratory rate to achieve an I:E ratio of 1:2. Physiologic and ventilator data were automatically recorded at 1-min intervals. The primary endpoint was peak inspiratory pressure (PIP), a physiological endpoint reflecting the mechanical effect of the intervention. Secondary endpoints included minute ventilation (MV), end-tidal CO2 (EtCO2), oxygenation metrics, ventilator alarms, and hypotension, feasibility and procedural safety. PIP decreased substantially (45 [35, 65] cmH2O vs. 82 [59, 93] cmH₂O; p < 0.001), resulting in a reduction in the time spent with pressure alarms (3.4% vs. 24%; p < 0.0001). However, MV (5.2 [4.6, 5.9] L/min vs. 6.4 [4.1, 7.3] L/min; p = 0.2), and EtCO2 (36 [30, 40] mmHg vs. 31 [27, 39] mmHg; p = 0.4) did not differ significantly. PEEP was maintained in the intervention group (8 [6, 10] cmH2O vs. 2 [0, 5] cmH₂O; p = 0.001). The protocol was demonstrated short-term procedural safety signals, as average SpO₂ (98.9 [93.7, 100.0]% vs. 99.9 [96.8, 100.0], p = 0.082), and hypotension incidence (8.6% vs. 14%; p = 0.7) did not differ significantly.</p><p><strong>Conclusions: </strong>This protocol implementation study demonstrates that standardized low-flow ventilation with PEEP maintenance is feasible and safe during bronchoscopy in mechanically ventilated patients, with a significant reduction in peak inspiratory pressure as a robust mechanical signal. Alveolar ventilation and hemodynamic tolerance were preserved. These findings support the conduct of further research to evaluate clinical outcomes.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13495311/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148295216","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":"Diagnostic performance of package insert-based screening for potential drug-drug interactions in ICU patients receiving injectable medications: a retrospective diagnostic accuracy study using Lexi-Interact as the comparator in Japan.","authors":"Takahiro Kato, Noriko Yasukawa, Eriko Uno, Kenta Kanamori, Eizo Watanabe, Yukihiro Hamada","doi":"10.1186/s40560-026-00890-7","DOIUrl":"10.1186/s40560-026-00890-7","url":null,"abstract":"<p><strong>Background: </strong>No established gold standard exists for identifying potential drug-drug interactions (pDDIs). In Japan, package inserts are commonly used for pDDI screening in clinical practice, whereas internationally curated databases such as Lexi-Interact serve widely as clinical decision support tools. However, the performance of package insert-based pDDI identification in intensive care unit (ICU) settings has not been fully evaluated. Therefore, in this study, we aimed to evaluate the concordance of package insert-based screening for detecting pDDIs in ICU patients receiving injectable medications, using Lexi-Interact as the comparator.</p><p><strong>Methods: </strong>This single-center retrospective cohort study included adult ICU admissions involving patients aged ≥ 18 years at two ICUs of a tertiary hospital. Clinically significant pDDIs among injectable drugs were assessed at three predefined timepoints (day 2, day 5, and the day before ICU discharge). Package insert-based pDDI identification was compared with Lexi-Interact as the comparator. The primary outcome was the negative predictive value (NPV) of package insert-based screening for clinically significant pDDIs. Diagnostic performance was evaluated using sensitivity, specificity, positive predictive value (PPV), and weighted kappa in relation to Lexi-Interact as a pragmatic comparator. Robustness was assessed via ICU admission-level cluster bootstrap analysis with 10,000 resamples.</p><p><strong>Results: </strong>Among 345 eligible ICU admissions, package insert-based screening yielded an NPV of 0.98, a sensitivity of 0.80, a specificity of 0.91, and a PPV of 0.51 compared with Lexi-Interact. Agreement between the two sources was moderate (weighted kappa = 0.57). Bootstrap analysis confirmed stable estimates of diagnostic performance. Interactions identified exclusively by Lexi-Interact were predominantly category C, with only one category D interaction and no category X interactions.</p><p><strong>Conclusions: </strong>In ICU settings, package insert-based identification of pDDIs involving injectable drugs showed high NPV, sensitivity, and specificity relative to Lexi-Interact. These findings suggest that package insert-based screening may serve as a practical initial screening approach with substantial concordance with Lexi-Interact classifications in ICU pharmacotherapy. Nevertheless, discrepancies in interaction severity classification highlight the potential benefit of complementary use of internationally established databases to enhance clinical interpretation and medication safety in critical care.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13491932/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148264628","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":"Feasibility of a nurse-led patch-type electroencephalography monitoring protocol with arterial spin labeling in patients with severe traumatic brain injury: a prospective observational study.","authors":"Masahiro Asami, Hikaru Nakata, Ryoichiro Kondo, Yukiko Nakajima, Shintaro Furuya, Junko Yoshida, Koichi Yasaka, Tomoo Inoue, Nobuo Noshita, Toshie Takahashi, Hiroki Sasaki, Shigemasa Taguchi, Kazuya Kiyota","doi":"10.1186/s40560-026-00893-4","DOIUrl":"10.1186/s40560-026-00893-4","url":null,"abstract":"<p><p>Nonconvulsive seizures are clinically important in severe traumatic brain injury but are difficult to detect when continuous electroencephalography (EEG) is not feasible in the intensive care unit. We conducted a prospective observational study to evaluate a nurse-led patch-type EEG protocol, with arterial spin labeling (ASL) magnetic resonance imaging as an exploratory comparator. Patch-type EEG monitoring was feasible in 21 of 24 enrolled patients (87.5%), and both EEG and ASL assessments were evaluable in 16 patients. Electrographic seizures were detected in four patients (25%), with all of them showing corresponding focal hyperperfusion on imaging. These findings suggest that simplified patch-type EEG monitoring is feasible in this setting; however, further studies are warranted to determine the clinical relevance of nurse-led patch-type EEG monitoring.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13491853/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148239455","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}