Journal of Intensive Care Medicine最新文献

{"title":"Oxygen Delivery in the Adult Intensive Care Unit with a Focus on Hyperoxic Acute Lung Injury Pathogenesis and Clinical Manifestations.","authors":"Zachary M Harris, Edward P Manning","doi":"10.1177/08850666261481468","DOIUrl":"https://doi.org/10.1177/08850666261481468","url":null,"abstract":"<p><p>High oxygen damages human lung, called hyperoxic acute lung injury (HALI). HALI pathogenesis involves formation of reactive oxygen species (ROS) which overwhelm antioxidant mechanisms and lead to alveolar epithelial and endothelial cell death and interstitial inflammation. Resultant alveolar flooding causes ventilation-perfusion (V/Q) mismatch, hypoxic respiratory failure, and death. 12-16 h of severe hyperoxic exposure potentiates symptoms that include substernal chest discomfort, cough, and sore throat. Alterations in pulmonary function that ensue are decreased vital capacity (VC), decreased arterial oxygen tension (PaO₂), increased intrapulmonary shunt, and increased dead space-to-tidal volume ratio (V_D/V_T). A multitude of observational studies demonstrate harm of hyperoxic exposure in critically ill patients. While one randomized clinical trial (RCT) found targeting a lower oxygenation target in critically ill patients was beneficial compared with a higher target, another RCT demonstrated harm of such a strategy in patients with acute respiratory distress syndrome (ARDS). Multiple subsequent RCTs examining effects of lower- and higher-oxygenation strategies in critically ill patients identify no clear benefit of either strategy in the general ICU population. However, heterogeneous effects of lower- and higher-oxygenation approaches in ICU patient subgroups warrant further investigation. It is paramount that ICU physicians recognize that lethal and sublethal amounts of hyperoxia result in lung damage and that patients who require hyperoxia to avoid deleterious hypoxia can be at risk for HALI. For each patient in the ICU, it is likely that ideal oxygen targets depend on the specific medical conditions affecting the patient and is a promising area of future study.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666261481468"},"PeriodicalIF":2.3,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148840396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and Validation of an Interpretable Machine Learning Model for Predicting In-Hospital Mortality in Diabetic Patients with Sepsis-Associated Acute Kidney Injury.","authors":"Yanni Wang, Hongjie Shen, Shengze Wu, Suibi Yang, Feng Guo, Min Yang, Zhongheng Zhang","doi":"10.1177/08850666261479295","DOIUrl":"https://doi.org/10.1177/08850666261479295","url":null,"abstract":"<p><p>BackgroundSepsis-associated acute kidney injury (SA-AKI) is a common and severe complication in critically ill patients, with poor prognosis. Diabetes may further increase adverse outcomes through infection susceptibility, immune dysfunction, and renal vulnerability. However, mortality prediction models for patients with diabetes complicated by SA-AKI remain limited. This study aimed to develop and validate a machine learning-based model for early in-hospital mortality prediction in this population.MethodsA total of 6929 patients with SA-AKI and diabetes were identified from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database and randomly divided into training and validation sets at a ratio of 7:3. Ninety-four variables, including demographics, diagnoses, clinical parameters, and medication records within the first 24 h after ICU admission, were extracted. Twelve machine learning algorithms were developed and compared, and the optimal model was selected. Recursive feature elimination was used to identify key predictors, while SHapley Additive exPlanations were applied for model interpretation. The final model was deployed as a web-based tool and externally tested using the eICU Collaborative Research Database.ResultsThirty-two key predictors were ultimately selected, including urine output rate, platelet count, lactate, weight, blood glucose, SOFA score, pH, blood urea nitrogen, vital signs, coagulation indices, vasopressor use, and other clinically relevant variables. The categorical boosting algorithm model presented better predictive performance [receiver operating characteristic (AUC): 0.828] than other models [accuracy (ACC): 70.9%, sensitivity: 78.7%, specificity: 69%, F1 score: 0.509, positive predictive value (PPV): 33.7%, and negative predictive value (NPV): 93.1%]. External testing using data from the eICU database was also well validated (AUC: 0.793).ConclusionsA CatBoost-based machine learning model incorporating 32 clinically accessible variables showed good predictive performance for in-hospital mortality in patients with diabetes and SA-AKI, supporting early risk stratification and clinical decision-making.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666261479295"},"PeriodicalIF":2.3,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148840446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Statin Use With Short- and Long-Term Mortality in Critically Ill Patients With Aortic Stenosis: A Retrospective Cohort Study.","authors":"Yue Yu, Sanshuai Chang, Ke Shang, Yuemiao Jiao, Yang Li, Liuyang Tian, Guangyuan Song, Chengqian Yin","doi":"10.1177/08850666261469110","DOIUrl":"https://doi.org/10.1177/08850666261469110","url":null,"abstract":"<p><p>BackgroundStatins have not been shown to modify valvular disease progression in relatively stable aortic stenosis populations, but their prognostic relevance during critical illness remains unclear.MethodsWe conducted a retrospective cohort study using the MIMIC-IV database. Adult patients with aortic stenosis were included at their first ICU stay if the ICU length of stay was at least 24 h. In-hospital statin prescription exposure was identified from prescription records. The primary outcome was 30-day all-cause mortality after ICU admission, with secondary outcomes at 7, 60, 120, and 365 days. Associations were assessed using hierarchical Cox regression models and propensity score matching (1:1 nearest-neighbor matching; caliper 0.03). Multiple imputation was applied for variables with less than 30% missingness. A 24-h landmark sensitivity analysis was additionally performed for the 30-day primary endpoint.ResultsA total of 1484 patients were included, of whom 1030 had statin prescription exposure and 454 did not; propensity score matching yielded 706 patients. In the fully adjusted primary model, statin exposure was associated with lower 30-day mortality (hazard ratio [HR] 0.458, 95% CI 0.312-0.674; P < 0.0001). In the matched cohort, statin use remained associated with lower 30-day mortality (HR 0.424, 95% CI 0.269-0.666; P < 0.001).ResultsThe results were materially unchanged in the 24-h landmark sensitivity analysis (HR 0.434, 95% CI 0.288-0.653; P < 0.0001). E-values ranged from 2.80 to 5.91.ConclusionsIn this retrospective ICU cohort of patients with aortic stenosis, in-hospital statin prescription exposure was associated with lower all-cause mortality across evaluated follow-up time points. Prospective studies that better account for treatment selection and time-varying exposure are warranted.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666261469110"},"PeriodicalIF":2.3,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148840464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diarrhea in Critically ill Patients: Evaluation and Management in the Intensive Care Unit.","authors":"Marwan N Hassan","doi":"10.1177/08850666261462918","DOIUrl":"https://doi.org/10.1177/08850666261462918","url":null,"abstract":"<p><p>ObjectiveDiarrhea is a common and clinically significant problem in critically ill patients, often reflecting underlying gastrointestinal dysfunction, systemic illness, or iatrogenic factors. The study aims to provide a practical framework for intensivists to identify, evaluate, and manage diarrhea in the critically ill patients, emphasizing its clinical significance, diagnostic approach, and management strategies.MethodsThis review synthesizes current evidence on the epidemiology, pathophysiology, and risk factors of ICU diarrhea. Life-threatening and non-life-threatening causes are discussed, including Clostridioides difficile infection, acute mesenteric ischemia, critical illness-associated diarrhea, drug-induced diarrhea, and enteral nutrition-related diarrhea. Diagnostic strategies, including bedside assessment, stool testing, and imaging, are outlined, alongside therapeutic approaches prioritizing fluid and electrolyte balance, modification of iatrogenic triggers, and optimization of enteral nutrition.ResultsICU diarrhea is associated with increased morbidity, fluid and electrolyte disturbances, malnutrition, skin breakdown, secondary infections, prolonged ICU stay, and higher healthcare costs. Early recognition, systematic evaluation, and a structured management plan can reduce complications and maintain enteral nutrition.ConclusionDiarrhea in critically ill patients is a marker of gut dysfunction and systemic instability. A multidisciplinary, evidence-based approach is essential to improve outcomes, prevent complications, and optimize nutritional support.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666261462918"},"PeriodicalIF":2.3,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148840456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Higher Risk of Acute Kidney Injury in Sepsis Patients with High PEEP Trajectories: A Study Using the Latent Class Trajectory Model Based on the MIMIC-IV Database.","authors":"Ke Zhan, Ling Qi, Dongmei Zhang, Changliang Zhu, Liling Zhang, Santao Ou, Ling Xue, Yuhan Tang, Weihua Wu","doi":"10.1177/08850666261479704","DOIUrl":"https://doi.org/10.1177/08850666261479704","url":null,"abstract":"<p><p>ObjectiveUsing the MIMIC database, this study aimed to clarify the link between high positive end-expiratory pressure (PEEP) and acute kidney injury (AKI) in septic patients, identify the characteristics of those with high PEEP, and provide evidence for protecting the kidneys of septic patients on mechanical ventilation.MethodsData of septic patients on mechanical ventilation were extracted from the MIMIC-IV database. Daily mean PEEP values for the first 10 days were calculated. The latent class trajectory model (LCTM) was leveraged to identify PEEP trajectory changes, and the optimal number of trajectories was estimated with the Bayesian information criterion. Binary regression explored the link between different PEEP trajectories and AKI.Results2142 septic patients on mechanical ventilation were included. LCTM analysis classified 1275 (59.52%) into the low PEEP, 649 (30.30%) into the medium PEEP, and 218 (10.18%) into the high PEEP groups. After confounders were adjusted, compared to the low PEEP group, the odds ratios (ORs) and 95% confidence intervals (CIs) for AKI were 1.43 (95% CI: 1.15, 1.76, <i>P</i> <i>=</i> <i>0.001</i>) in the medium and 1.63 (95% CI: 1.18, 2.25, <i>P</i> <i>=</i> <i>0.003</i>) in the high PEEP groups.ConclusionIn septic patients on mechanical ventilation, those with high PEEP have a higher AKI risk. PEEP could be a risk assessment indicator for AKI in critically ill septic patients.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666261479704"},"PeriodicalIF":2.3,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148829431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of Presepsin in Cirrhosis: A Potential Marker of Infections and Decompensation Events in Cirrhotic Patients.","authors":"Andrea Piccioni, Valeria Maccauro, Marcello Candelli, Mariella Fuorlo, Cristina Kadhim, Marcello Covino, Alberto Valentini, Dana Shiffer, Yaroslava Longhitano, Gloria Nuzzolo, Antonio Gasbarrini, Francesco Franceschi, Giulia Pignataro","doi":"10.1177/08850666261464987","DOIUrl":"https://doi.org/10.1177/08850666261464987","url":null,"abstract":"<p><p>Liver cirrhosis is still one of the leading causes of death in the Western world. Although viral agents have been eradicated or controlled by antiviral drugs, metabolic dysfunction and toxic compounds are emerging as pivotal factors in liver dysfunction. Moreover, acute events such as infections can lead to cirrhosis decompensation and acute-on-chronic liver failure, thus increasing hospitalization and both short- and long-term mortality rates. Therefore, early diagnosis and prompt treatment of both infections and decompensation events represent the primary goal for preventing acute deterioration and reducing the overall mortality rate in this fragile population. However, in clinical practice, this remains challenging. Currently, highly effective non-invasive diagnostic and prognostic markers of infection and decompensation have not been definitively identified, even though several molecules have been proposed (eg, presepsin, monocyte distribution width, C-reactive protein, procalcitonin). In this literature review, we focus specifically on the role of presepsin as a potential marker of infections and decompensation events in cirrhotic patients, as its role in the early diagnosis of sepsis has already been established in non-cirrhotic populations. Nevertheless, clinical trials and strong literary evidence regarding presepsin in the cirrhotic population are still scarce, but we hope that in the future, this molecule may serve to guide clinicians in therapeutic choices within a hospital setting.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666261464987"},"PeriodicalIF":2.3,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148794284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enteral Nutrition Delivery Methods and Clinical Outcomes in Critically Ill Patients: A Retrospective Cohort Study.","authors":"Yekta Jalaeian, Huma Saleem, Seda Akben, Abdolvahab Khademi, Nicole Behrooz, Anoeil Odisho, Laura Wrightwood, Sanjana Varghese, Hayley Abell, Eduard Shaykhinurov, Hadi Javan, Ryan Wu, Phillip Ma, Michael Roth, David Yamane, Daniel King, Mary Baginsky","doi":"10.1177/08850666261475590","DOIUrl":"10.1177/08850666261475590","url":null,"abstract":"<p><p>BackgroundAdequate enteral nutrition is essential in critical illness, yet optimal delivery strategies remain debated. Rate-based and volume-based are commonly used, with prior studies suggesting improved caloric delivery with volume-based. However, real-world clinical outcomes, particularly with mixed protocols and in COVID-19 patients, are unclear. We hypothesized that volume-based would improve caloric delivery versus rate-based or mixed, and that critically ill COVID-19 patients would achieve a lower goal intake.MethodsThis single-center retrospective cohort study included ICU patients (2020-2023) receiving ≥48 h of enteral nutrition via rate-based, volume-based, or mixed strategies. The primary outcome was the percentage of prescribed intake achieved. Secondary outcomes included hospital and ICU length of stay, ventilator days, hospital-acquired pressure injuries and infections. Baseline illness severity was assessed using standard comorbidity and organ failure scores.ResultsAmong 324 patients, 24% achieved ≥80% of caloric goal, with no difference across feeding strategies (<i>P</i> = .30). Mixed feeding was associated with longer hospital and ICU stays, more ventilator days, and longer enteral nutrition duration (all <i>P</i> < .01). Mixed feeding was associated with higher pressure injury compared with rate-based (30% vs 16%, <i>P</i> = .03), with no association with hospital-acquired infections. Among patients achieving ≥80% prescribed intake, associations with ICU length of stay and ventilator days were no longer significant.COVID-19 status did not modify these associations, with longer stays in COVID-positive patients receiving mixed protocol.ConclusionsVolume-based did not improve total energy delivery. Mixed feeding was associated with worse clinical outcomes, likely reflecting greater illness complexity rather than causation. Consistency of nutrition delivery may be more important than protocol type. Prospective multicenter studies are needed.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666261475590"},"PeriodicalIF":2.3,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148724444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rapid Resolution of Hypoxemia is Common and Associated with Lower Mortality Among Intubated Patients with Acute Hypoxemic Respiratory Failure.","authors":"Samuel R Chiacchia, Jennifer G Wilson, Cynthia Perez, Jonasel Roque, Alexandria Jensen, Joe Levitt, Andrew R Moore, Angela J Rogers","doi":"10.1177/08850666261475636","DOIUrl":"10.1177/08850666261475636","url":null,"abstract":"<p><p>ObjectiveTo evaluate the prevalence, clinical trajectory, and biologic phenotype of patients with rapidly improving acute hypoxemic respiratory failure (riAHRF), a subgroup of mechanically ventilated patients hypothesized to share features with the low-mortality, hypo-inflammatory phenotype previously described in rapidly improving ARDS.DesignSingle-center retrospective cohort study with nested biomarker analysis.SettingAcademic quaternary care medical intensive care unit (ICU) in California.PatientsTwo cohorts of mechanically ventilated ICU patients with AHRF were included: (1) 631 patients identified through the electronic health record (EHR) between March 1, 2022 and February 1, 2024, and (2) 164 patients in the Stanford ICU Biobank who had banked plasma samples collected within 24 h of intubation. Patients with cardiogenic or traumatic etiologies were excluded in both cohorts. AHRF was defined by PaO²/FiO² < 300 or SpO²/FiO² < 315 on the day of intubation. Resolution of hypoxemia was defined by achievement of minimal ventilator settings (FiO² ≤ 0.4 and PEEP ≤ 5 cmH²O for ≥ 6 h). riAHRF was defined as reaching minimal ventilator settings within 24 h of intubation.InterventionsNone.Measurements and Main ResultsIn the EHR cohort, 61% of patients experienced riAHRF. These patients had significantly lower 90-day mortality (22% vs 49%, <i>P</i> < .001) and more ventilator-free days (median 25 vs 23, <i>P</i> < .001) compared to non-riAHRF patients. Differences in clinical variables related to respiratory status, including S:F, respiratory rate, and blood gas data were subtle but statistically significant. In the BioBank cohort, riAHRF patients had lower levels of IL-8, IL-6, and sTNFR.ConclusionsRapidly improving AHRF (riAHRF) is common in patients intubated for AHRF and is associated with lower mortality and a hypo-inflammatory biomarker profile.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666261475636"},"PeriodicalIF":2.3,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148726604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Two-Decade Analysis of Post-Procedural Respiratory Disorder Mortality Among Older Adults in the United States.","authors":"Swetha Balaji, Muzamil Khan, Wajdan Ahmad, Anika Goel, Ayesha Ahmed Cheema","doi":"10.1177/08850666261465300","DOIUrl":"https://doi.org/10.1177/08850666261465300","url":null,"abstract":"<p><strong>Background: </strong>Post-procedural respiratory disorders (PPRDs), including tracheostomy complications and post-surgical pulmonary insufficiency, are serious peri-operative complications among older adults. Despite their clinical importance, national mortality trends related to PPRDs have not been comprehensively characterized.</p><p><strong>Methods: </strong>We analyzed data from the CDC WONDER Multiple Cause of Death database from 1999 to 2020, focusing on decedents aged ≥65 years with ICD-10 codes J95.0-J95.9. Age-adjusted mortality rates (AAMRs) per 100 000 were calculated using the 2000 U.S. standard population. Joinpoint regression was used to assess temporal trends and estimate average annual percent change (AAPC) with 95% confidence intervals (CIs).</p><p><strong>Results: </strong>From 1999 to 2020, there were 34 722 deaths due to PPRDs among older adults. The overall AAMR declined from 6.47 to 1.78 per 100,000, with an AAPC of -5.81% (95% CI: -6.71 to -5.14). AAMRs declined across all subgroups. By sex, AAPCs were -6.71% for males and -6.11% for females. By race/ethnicity, the steepest declines occurred among Asian or Pacific Islanders (-6.99%), followed by Black individuals (-6.59%), White individuals (-6.26%), and Hispanic individuals (-5.65%). By age, the greatest decline was observed in those ≥85 years (-6.73%), followed by those aged 65-74 (-6.51%) and 75-84 (-5.80%). Geographic differences were noted: metropolitan areas showed a steeper decline (-6.37%) compared to non-metropolitan areas (-5.81%).</p><p><strong>Conclusion: </strong>PPRD-related mortality in older U.S. adults declined substantially over the past two decades. The observed decline may reflect advances in perioperative respiratory care, anesthesia practices, and critical care delivery over time. However, persistent disparities by race, age, and geography suggest targeted interventions to reduce preventable postoperative mortality and improve equity in surgical outcomes.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666261465300"},"PeriodicalIF":2.3,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148678889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Meropenem Exposure During Extracorporeal Membrane Oxygenation: What Should Intensivists Know? A Scoping Review.","authors":"Jonathan Camilo Ramirez, Sergio Fabian Rodriguez, Alirio Bastidas, Daniela Vargas, Juan-Francisco Guevara, Claudia Poveda-Henao, Mario Mercado, Rosa Helena Bustos Cruz","doi":"10.1177/08850666261469109","DOIUrl":"https://doi.org/10.1177/08850666261469109","url":null,"abstract":"<p><p>BackgroundExtracorporeal membrane oxygenation (ECMO) is increasingly used in adults with severe respiratory and/or cardiac failure. Because ECMO may alter drug pharmacokinetics (PK), optimizing antimicrobial dosing in this population remains challenging. Meropenem is widely administered in intensive care units (ICUs), yet its disposition during ECMO is not fully understood. This scoping review aimed to characterize population PK methodologies and synthesize current evidence on meropenem pharmacokinetics and pharmacodynamics (PK/PD) in critically ill adults receiving ECMO.MethodsA scoping review was conducted according to PRISMA-ScR guidelines. Studies reporting population PK and/or PD data for meropenem in adult ICU patients undergoing ECMO were included. Systematic searches were performed in Embase, PubMed, LILACS, ProQuest, Web of Science, and Scopus for publications between January 1, 2012, and December 31, 2022. Two independent reviewers screened and selected eligible studies.ResultsEleven studies, including observational cohorts, case series, and simulation-based analyses, met inclusion criteria. Across studies, glomerular filtration rate (GFR) and renal replacement therapy (RRT) were the principal determinants of meropenem clearance, whereas ECMO had a comparatively limited direct effect. Although ECMO may transiently increase volume of distribution and promote early drug sequestration within the circuit, these effects were generally outweighed by renal function parameters. Standard dosing regimens frequently failed to achieve pharmacodynamic targets (fT > MIC ≥40-100%), particularly in patients with augmented renal clearance (ARC). Prolonged or continuous infusions combined with therapeutic drug monitoring (TDM) were consistently associated with improved target attainment.ConclusionsIn ECMO-supported critically ill adults, meropenem exposure is driven predominantly by residual renal function, RRT, and ARC rather than ECMO itself. Individualized dosing strategies incorporating PK modeling and TDM are essential to optimize therapy. Prospective, standardized studies are needed to refine dosing recommendations in this complex population.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666261469109"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148653805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}