Journal of Intensive Care Medicine最新文献

{"title":"Impact of Sepsis Onset Timing on All-Cause Mortality in Acute Pancreatitis: A Multicenter Retrospective Cohort Study.","authors":"Xiaodong Huang, Siyao Liu, Zhihong Xu, Xiong Liu, Jun Hu, Mandong Pan, Chengbin Yang, Jiyan Lin, Xianwei Huang","doi":"10.1177/08850666251319289","DOIUrl":"10.1177/08850666251319289","url":null,"abstract":"<p><p>BackgroundSepsis complicates acute pancreatitis (AP), increasing mortality risk. Few studies have examined how sepsis and its onset timing affect mortality in AP. This study evaluates the association between sepsis occurrence and all-cause mortality in AP, focusing specifically on the impact of sepsis onset timing.MethodsThis multicenter retrospective cohort study included 494 ICU-admitted AP patients from the MIMIC-IV database and 91 from our center. Patients were grouped by sepsis occurrence and onset timing. Clinical outcomes were in-hospital and 90-day all-cause mortality. Machine learning identified key variables associated with mortality. Multivariable regression analyzed the impact of sepsis and its onset timing on mortality. To reduce baseline differences, propensity score matching (PSM) based on time to sepsis was conducted. After PSM, Kaplan-Meier survival analyses incorporated data from our center for validation. Restricted cubic spline analysis examined any nonlinear relationship between sepsis onset timing and mortality.ResultsPatients with sepsis had significantly higher in-hospital and 90-day mortality rates than those without sepsis (<i>p</i> < 0.05). Sepsis was identified as a significant risk factor for in-hospital mortality and remained significantly associated after adjusting for key variables (<i>p</i> < 0.05). However, sepsis onset timing did not significantly impact in-hospital or 90-day mortality. These findings were validated after PSM and with our center's data. No nonlinear relationship between sepsis onset timing and mortality was found.ConclusionSepsis significantly increases all-cause mortality in AP patients, but the timing of its onset has limited impact. Continuous monitoring and intervention for sepsis during hospitalization are recommended to improve prognosis.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"759-768"},"PeriodicalIF":3.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143449318","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":"Takotsubo Cardiomyopathy After Subarachnoid Hemorrhage: Who Is At Risk?","authors":"Alejandro Pando, Roger Cheng, Caryn J Ha, Gaurav Gupta, Arevik Abramyan, Sourav Mukherjee, Jeffrey Pradeep Raj, James K Liu, Hai Sun, Kiwon Lee","doi":"10.1177/08850666251313759","DOIUrl":"10.1177/08850666251313759","url":null,"abstract":"<p><p>IntroductionTakotsubo Cardiomyopathy (TCM) is a rare but well recognized complication of subarachnoid hemorrhage associated with increased morbidity and poor clinical outcomes. There is a scarcity of literature describing the prevalence and risk factors associated with this complication. The aim of this study was to identify patients who are at risk of developing TCM in non-traumatic subarachnoid hemorrhage.MethodsThe 2016 to 2021 National Inpatient Sample (NIS) was used to identify adult inpatients with a primary diagnosis of non-traumatic subarachnoid hemorrhage. Univariate and multivariable analyses adjusting for patient demographics, comorbidity status, and hemorrhage etiology were used to characterize statistical associations with disease-related complications. Patients with TCM were further divided into those with \"good\" or \"poor\" functional outcomes and compared.ResultsA total of 42 141 patients were identified as having a subarachnoid hemorrhage from 2016 to 2021. Of these patients 486 patients (1.2%) were found to have TCM. TCM was associated with increased length of stay (19.15 ± 17.8 days vs 11.72 ± 14.4, <i>P</i> < .001), increased total costs ($451 502.59 ± 443 777.9 vs $242 327.92 ± 338 862.3, <i>P</i> < .001), increased number of days from admission to first procedure (1.74 ± 4.5 vs 1.94 ± 5.0, <i>P</i> < .001), and increased mortality (31.7% vs 22.8%, <i>P</i> < .001). After controlling for confounding factors, independent risk factors for TCM in patients with non-traumatic subarachnoid hemorrhage included: Female (Odds Ratio [OR]: 3.11, 95% Confidence Interval [CI]: 2.50-3.89, <i>P</i> < .001), Congestive Heart Failure (OR:4.60, CI:3.70-5.71, <i>P</i> < .001), and Fluid and Electrolyte Disorders (OR: 2.52, CI: 2.05-3.11, <i>P</i> < .001). Patients with good functional outcomes were found to have younger age (54.85 years ± 14.0 vs 58.14 ± 14.7, <i>P</i> < .001), decreased length of stay (17.11 ± 16.9 vs 19.83 ± 18.1, <i>P</i> < .001), decreased total charge ($370 245.94 ± 517 702.8 vs $477 366.55 ± 417 122.4, <i>P</i> < .001), and decreased mortality (<i>P</i> < .001) compared to those with poor functional outcomes.ConclusionTCM after subarachnoid hemorrhage is associated with increased mortality, length of stay, total cost, number of procedures in patients, and number of days to first procedure. Neurosurgeons and Neurocritical care medical professionals should be aware of the comorbidities and factors associated with increased TCM after subarachnoid hemorrhage in order to improve patient outcomes.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"749-758"},"PeriodicalIF":3.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006852","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":"Seasonal Patterns of Sepsis Incidence and Mortality in the United States: A Nationwide Analysis.","authors":"Ryota Sato, Daisuke Hasegawa, Siddharth Dugar","doi":"10.1177/08850666251353423","DOIUrl":"https://doi.org/10.1177/08850666251353423","url":null,"abstract":"<p><p>PurposeThe aim of this study was to describe seasonal variation in the incidence and outcomes of sepsis in the United States.MethodsThis is a retrospective study using National Inpatient Sample database from 2017-2019. Adult sepsis patients were identified based on the CMS SEP-1 measure codes. Monthly sepsis incidence, in-hospital mortality, and organ failure patterns were analyzed. Multivariable logistic regression was used to assess in-hospital mortality by month. We also analyzed the monthly variation in each type of organ failure to uncover patterns that could account for the observed differences in sepsis incidence and outcomes.Main ResultsThere were 57,019,369 hospitalizations due to sepsis during the study period. The incidence of sepsis hospitalizations was highest in January. January also had the highest in-hospital mortality rate (10.66%), while July had the lowest (8.66%). A multivariable logistic regression analysis showed that January had a significantly higher mortality rate compared to July (odds ratio of 1.22, p < 0.001). The relationship between month and in-hospital mortality for sepsis followed a U-shaped pattern (from January to December), both in raw and adjusted analysis. Respiratory failure similarly followed the U-shaped pattern, with January having the highest incidence, and July and August the lowest. Other organ failures showed consistent patterns throughout the year. The relationship between sepsis due to pneumonia was also U-shaped, especially in the Southern region.ConclusionsThis study revealed a U-shaped relationship between both incidence and in-hospital mortality of sepsis, and month throughout the year, with a peak during winter months. Respiratory failure significantly increased in winter, while other organ failures remained constant throughout the year. These data suggest that respiratory infection and respiratory failure appear to mediate the seasonal variation observed in sepsis incidence and mortality, respectively.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666251353423"},"PeriodicalIF":3.0,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144528371","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":"Impact of Veno-Venous Extracorporeal Membrane Oxygenation on Right Ventricular Impairment in Severe ARDS: A Prospective Observational Longitudinal Study.","authors":"Alice Marguerite Conrad, Daniel Duerschmied, Christoph Boesing, Manfred Thiel, Grietje Beck, Thomas Luecke, Patricia R M Rocco, Joerg Krebs, Gregor Loosen","doi":"10.1177/08850666251352445","DOIUrl":"https://doi.org/10.1177/08850666251352445","url":null,"abstract":"<p><p>PurposeRight ventricular impairment (RVI) can be alleviated by the initiation of veno-venous extracorporeal membrane oxygenation (V-V ECMO), which enhances gas exchange and allows for less invasive mechanical ventilation. However, the progression of RVI during V-V ECMO remains unclear. This study assesses echocardiographic changes in RVI over a five-day period in twenty acute respiratory distress syndrome (ARDS) patients with V-V ECMO support.Material and MethodsOver a five-day period of V-V ECMO support, we examined echocardiographic markers of RVI, including right and left ventricular end-diastolic area ratio (RVEDA/LVEDA), tricuspid annular plane systolic excursion (TAPSE), tricuspid valve lateral anulus peak systolic velocity (<i>S</i>'), right ventricular fractional area change (FAC), and right ventricular myocardial performance index. Secondary objectives included changes in mechanical power transmitted to the respiratory system, hemodynamics and gas-exchange.ResultsRVEDA/LVEDA ratio remained elevated (0.8 [0.7-0.8] vs 0.7 [0.7-0.9]; <i>p</i> = .986), TAPSE decreased (2.0[1.6-2.5] cm vs 1.7 [1.4-2.2] cm; <i>p</i> = .024) while no changes were observed in <i>S</i>' (16 [13-21] cm/s vs 15 [12-18] cm/s; <i>p</i> = .136) and FAC (38 [27-47] % vs 36 [29-43] %; <i>p</i> = .627). The right ventricular myocardial performance index improved (0.74 [0.45-1.00] vs 0.51 [0.42-0.80]; <i>p</i> = .004). Lung mechanical power was significantly reduced due to a decrease in lung elastic and resistive components.ConclusionsDespite preserved longitudinal function and improved global performance, RVI persisted in severe ARDS patients on V-V ECMO, as indicated by the RVEDA/LVEDA ratio. These findings suggest that mechanisms beyond hypoxemia, hypercapnia and the invasiveness of mechanical ventilation contribute to RVI in these patients.Trial registrationThis trial was registered with the German Clinical Trials Register (DRKS00028584) on March 28, 2022. https://drks.de/search/en/trial/DRKS00028584.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666251352445"},"PeriodicalIF":3.0,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144528370","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":"Weight Categories Have no Impact on Mortality in Patients Treated with Extracorporeal Membrane Oxygenation (ECMO).","authors":"Meredith Marefat, Mehrtash Hashemzadeh, Mohammad Reza Movahed","doi":"10.1177/08850666251351574","DOIUrl":"https://doi.org/10.1177/08850666251351574","url":null,"abstract":"<p><p>BackgroundExtracorporeal Membrane Oxygenation (ECMO) is a critical support system for patients with acute and severe cardiac and respiratory failure. This study investigates the impact of different patient body weight categories on the mortality rates of patients undergoing ECMO support.MethodsUsing the Nationwide Sample (NIS) database and ICD-10 codes for 2016 to 2020 in adults over age 18, we evaluated total mortality based on weight categories compared to normal weights using univariate and multivariate analyses.ResultsA total population of 47 990 patients underwent ECMO insertion with a mean age of 52.6 years. Total mortality was 45.7%. Patients with cachexia, overweight, and obesity had similar mortality to normal-weight patients. (Cachexia: 43.75%, normal weight: 46.30%, <i>p</i> = .60, OR = 0.90, 95% CI: 0.61-1.33, overweight 42.31%, <i>p</i> = .69, OR = 0.85, 95% CI: 0.38-1.89, and obesity 45.73%, <i>p</i> = .73, OR = 0.98, 95% CI: 0.85-1.12). However, morbid obesity had the lowest mortality in the univariate analysis (41.89%, <i>p</i> = .01, OR = 0.84, 95% CI: 0.73-0.96) but was not significant in the multivariate analysis (<i>p</i> = .66, OR: 0.97, CI: 0.83-1.12). Separating peripheral veno-arterial versus veno-venous ECMO showed similar results with similar mortalities based on weight categories.ConclusionsOur data suggest that the 'obesity paradox' does not exist in ECMO-treated patients, with no effect of weight on total mortality . Further research is necessary to understand the underlying factors contributing to these outcomes.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666251351574"},"PeriodicalIF":3.0,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144511995","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":"Adrenal Insufficiency After Glucocorticoid Use in the Pediatric Intensive Care Unit.","authors":"Ashley N Radig, Vanessa A Curtis, Erik Westlund, Christina L Cifra","doi":"10.1177/08850666251352447","DOIUrl":"https://doi.org/10.1177/08850666251352447","url":null,"abstract":"<p><p>IntroductionGlucocorticoids are commonly used in pediatric critical illness and may lead to subsequent adrenal insufficiency, causing morbidity among pediatric intensive care unit (PICU) survivors. We aimed to determine the prevalence of and risk factors for adrenal insufficiency among children who received glucocorticoids during PICU admission.MethodsWe conducted a retrospective cohort study using structured medical record review to determine the prevalence of adrenal insufficiency and clinical characteristics of PICU patients 0-18 years old who received enteral and/or parenteral glucocorticoids. Patients were consecutively admitted to an academic tertiary referral PICU over 2 years.ResultsAmong 530 patients who received glucocorticoids, 12 (2.3%) were diagnosed with adrenal insufficiency at a median of 55 (IQR 8-156) days after initial glucocorticoid exposure. Unadjusted analyses showed that patients with adrenal insufficiency were younger (median 0.5 vs 2 years, <i>p</i> = .020), had a longer PICU stay (79 vs 4 days, <i>p</i> < .001) and hospital stay (96 vs 6 days, <i>p</i> < .001), and had a lower survival rate at 1 year after PICU discharge (75% vs 94%, <i>p</i> = .033). There were no significant differences in sex, race/ethnicity, illness severity, or diagnostic categories. Patients with adrenal insufficiency were more likely to have received glucocorticoids for hyperinflammation (21% vs 8%) and less likely for reactive airway disease (10% vs 26%) (<i>p</i> = .036), had a higher median total hydrocortisone equivalent dose (2508 vs 480 mg, <i>p</i> = .007), and were more likely to have had a steroid taper (48% vs 24%, <i>p</i> = .003). Multivariable logistic regression showed no significant associations between clinical characteristics and the diagnosis of adrenal insufficiency.ConclusionsAmong PICU patients who received glucocorticoids, 2.3% were subsequently diagnosed with adrenal insufficiency. We identified potential risk factors for adrenal insufficiency after glucocorticoid use in the PICU, which warrant future study to better delineate and mitigate adrenal insufficiency's contribution to morbidity and mortality among critically ill children.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666251352447"},"PeriodicalIF":3.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144497356","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":"Application of New Pediatric Sepsis Definition to a Multicenter Observational Cohort of Previously Enrolled Severe Sepsis Patients Defined by SIRS Plus Organ Dysfunction.","authors":"Kate F Kernan, Mohammed Shaik, Christopher M Horvat, Dana Y Fuhrman, Zachary Aldewereld, Robert A Berg, David Wessel, Murray M Pollack, Kathleen Meert, Mark W Hall, Christopher J L Newth, Tom Shanley, Rick E Harrison, Joseph A Carcillo, Rajesh K Aneja","doi":"10.1177/08850666251349790","DOIUrl":"10.1177/08850666251349790","url":null,"abstract":"<p><p>IntroductionIn 2024, a Society of Critical Care Medicine task force updated the pediatric sepsis definition from the presence of suspected or confirmed infection, and a systemic inflammatory response (SIRS) with organ dysfunction, to a novel definition. Our objective is to identify how many patients previously identified as having severe sepsis would continue to meet the new definition.Materials and methodsWe performed a secondary analysis of the Phenotyping Sepsis-Induced Multiple Organ Failure cohort of 401 children with suspected or confirmed infection, two of four SIRS criteria and organ dysfunction enrolled between 2015-2017. We calculated a modified Phoenix Sepsis Criteria Score (mPSC) for participants and compared those with mPSC of greater than or equal to 2 or less than 2 according to the 2024 definition.ResultsOf 401 children, 132 (33%) did not meet mPSC definitions. While children meeting mPSC had more organ dysfunction, the total mortality did not differ. One in 4 children requiring extracorporeal membrane oxygenation and 1 in 4 mortalities did not meet the mPSC definition. In logistic regression models, in the complete cohort, hematologic (OR 4.4, 95% CI: 1.8-10.2, <i>P</i>-value = .001), central nervous system (OR 2.3, 95% CI: 1.0-5.1, <i>P</i>-value = .046) and renal failure (OR: 3.2, 95% CI:1.2-7.9, <i>P</i>-value = .017) predicted mortality; in the mPSC subgroup pulmonary (OR: 3.6, 95% CI:1.3-13.3, <i>P</i>-value = .030) and hematologic failure (OR 5.6, 95% CI: 2.2-14.5, <i>P</i>-value = .0003) were significant predictors. In the mPSC excluded subgroup, only renal failure predicted mortality (OR 9.6, 95% CI 1.1-73.0, <i>P</i>-value = .028).ConclusionsFurther study of the impact of the 2024 data-driven organ dysfunction definition on pediatric sepsis research, patient safety, and clinical benchmarking efforts is warranted.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666251349790"},"PeriodicalIF":3.0,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12216587/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144302298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prediction of Acute Kidney Injury in Critically ill Patients with Community-Acquired Pneumonia Using Machine Learning.","authors":"Wenwen Ji, Guangdong Wang, Tingting Liu, Mengcong Li, Na Wang, Tinghua Hu, Zhihong Shi","doi":"10.1177/08850666251349792","DOIUrl":"https://doi.org/10.1177/08850666251349792","url":null,"abstract":"<p><p>BackgroundThe incidence of acute kidney injury (AKI) is increased in patients with community-acquired pneumonia (CAP), contributing to poor outcomes in ICUs. Early identification of patients at high risk for AKI is essential for timely intervention. This study aimed to develop a machine learning model for predicting AKI in CAP patients.MethodsPatients with CAP were identified from the MIMIC-IV database using ICD codes. AKI was defined according to the KDIGO criteria. Baseline characteristics, vital signs, laboratory data, comorbidities, and clinical scores were extracted. LASSO regression was applied for feature selection, and eight machine learning models, including logistic regression, k-nearest neighbors, decision tree, random forest, support vector machine, neural network, XGBoost, and LightGBM, were developed. Model performance was evaluated using AUC, sensitivity, specificity, accuracy, recall, F1 score, calibration curves, and decision curve analysis (DCA). SHapley Additive exPlanations (SHAP) were used to interpret the final model. A web-based risk calculator was created for clinical application.ResultsA total of 3213 CAP patients were included, with 2723 (84.8%) developing AKI. XGBoost demonstrated the best performance with an AUC of 0.937 (95% CI: 0.922-0.952), sensitivity of 0.875, specificity of 0.855, accuracy of 0.865 (95% CI: 0.841-0.887), recall of 0.875, and F1 score of 0.866. DCA showed the highest net benefit for XGBoost across various risk thresholds. After recursive feature elimination, a simplified model with seven key variables, including urine output, weight, ventilation, first-day minimum PTT, first-day maximum sodium, first-day minimum heart rate, and first-day maximum temperature, maintained high predictive performance (AUC = 0.925, 95% CI: 0.908-0.941).ConclusionsThe XGBoost model accurately predicted AKI risk in CAP patients, demonstrating robust performance and clinical utility. The web-based calculator offers an accessible tool for individualized risk assessment, supporting early detection and management of AKI in ICUs.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666251349792"},"PeriodicalIF":3.0,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144302299","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":"The Diagnosis and Management of Hepatorenal Syndrome: A Comprehensive Update for the Intensivist.","authors":"J Pedro Teixeira, Constantine J Karvellas, Juan Carlos Q Velez","doi":"10.1177/08850666251345408","DOIUrl":"https://doi.org/10.1177/08850666251345408","url":null,"abstract":"<p><p>Intensivists are being increasingly tasked with caring for critically ill patients with cirrhosis (ie, acute-on-chronic liver failure), many of whom develop acute kidney injury (AKI). Among the most morbid and complex causes of AKI in patients with cirrhosis is hepatorenal syndrome (HRS-AKI). Though HRS-AKI accounts for a fraction of AKI cases in the setting of cirrhosis, recent data suggest that effective pharmacologic treatment of HRS-AKI requires rapid diagnosis to allow for prompt intervention. Consequently, a firm understanding of the diagnosis and treatment of HRS-AKI is vital for all intensivists. In this review, we summarize recent developments in the diagnosis and treatment of HRS-AKI. Chief among these is the recent realization that HRS-AKI is not a diagnosis of exclusion, but instead may coexist with other forms of AKI, such as acute tubular injury, or may develop in the context of pre-existing chronic kidney disease. Moreover, with multiple recent trials suggesting that administration of fixed doses of intravenous albumin to unselected patients with cirrhosis and AKI may cause harm via volume overload and pulmonary edema, no longer is a 48-h trial of intravenous albumin recommended for all patients with AKI and cirrhosis. Instead, the newest guidelines recommend thoughtful assessment of volume status in all patients with AKI and cirrhosis and determination of an HRS-AKI diagnosis within 24 h to allow for prompt initiation of effective therapy. Short of liver transplantation, treatment of HRS-AKI is with vasoconstrictive agents. Though commonly used, midodrine/octreotide should largely be abandoned due to lack of efficacy. While recent trials have confirmed the effectiveness of terlipressin, its use is associated with a risk of potentially fatal respiratory failure and therefore requires careful patient selection and monitoring. As such, treatment of HRS-AKI with norepinephrine in the intensive care unit will remain the primary treatment option for many patients.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666251345408"},"PeriodicalIF":3.0,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144234357","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":"Ten Influential Point-of-Care Ultrasound Papers: 2023 in Review.","authors":"Scott J Millington, Mangala Narasimhan, Paul H Mayo, Antoine Vieillard-Baron","doi":"10.1177/08850666241233556","DOIUrl":"10.1177/08850666241233556","url":null,"abstract":"<p><p>In an effort to help keep busy clinicians up to date with the latest ultrasound research, our group of experts has selected 10 influential papers from the past 12 months and provided a short summary of each. We hope to provide emergency physicians, intensivists, and other acute care providers with a succinct update concerning some key areas of ultrasound interest.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"583-587"},"PeriodicalIF":3.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12095873/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139905837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}