Journal of Intensive Care Medicine最新文献

{"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}

{"title":"Association Between Post-Operative Serum Lactate, Fluid Administration, and Outcome in Living Donor Liver Transplant Recipients: A Ten-Year Experience.","authors":"Nauman Farooq, David J Wallace, Dana R Jorgensen, David T Huang, Abhinav Humar, Ali Al-Khafaji","doi":"10.1177/08850666251406213","DOIUrl":"10.1177/08850666251406213","url":null,"abstract":"<p><p>BackgroundFor some liver transplant recipients, elevated lactate after transplantation is associated with early allograft dysfunction (EAD). Determining which patients with elevated lactate will develop EAD is a challenge because lactate can accumulate due to increased production, decreased hepatic clearance, or both. Intravenous fluid administration may be beneficial for patients with elevated lactate who have insufficient intravenous circulating vascular volume, or it may result in vascular volume overload and allograft injury from congestion for patients who have adequate perfusion and no signs of shock. We hypothesized that in absence of other signs of shock, intravenous fluid administration would not be associated with improved graft function for patients with elevated post-transplant lactate.MethodsWe performed a single-center cohort study of living donor liver transplant recipients between March 2009-June 2018 (n = 197). We categorized the study population based on the highest lactate in the first 6 h of the post-transplant ICU stay (Group 1: < 3 mmol/L; Group 2: 3-6 mmol/L and Group 3: > 6 mmol/L). Our primary exposure was post-transplant ICU intravenous fluid administration and primary outcome was EAD.ResultsSixty- four (32.5%) patients developed EAD: 24 (26.7%) in Group 1, 21 (29.6%) in Group 2 and 19 (52.8%) in Group 3. Within group 2, there was no difference between EAD and non-EAD patients in baseline characteristics, vasopressor use at two hours, or urine output. In a linear mixed model in Group 2 patients, there was a significant difference in the mean fluid intake during the first 36 h of ICU stay for those who developed EAD compared to those who did not (EAD: 826 ± 56 ml vs non-EAD: 680 ± 39 ml respectively, p = 0.03).ConclusionOur results show that elevated lactate after liver transplant is frequently caused by decreased lactate clearance. Following liver transplantation, intensivists should interpret elevated lactate levels in clinical context before administering intravenous fluids.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"752-757"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13250268/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148149699","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":"Can one use serum Lactate Concentration to Correct for the Anion gap?","authors":"Ramin Sam, Nancy Zhou, Emilio Fernandez, Jonathan Amatruda, Antonios H Tzamaloukas","doi":"10.1177/08850666251411921","DOIUrl":"10.1177/08850666251411921","url":null,"abstract":"<p><p>Patients in the intensive care unit often develop anion gap metabolic acidosis most commonly from lactic acidosis. Clinicians routinely measure serum lactate levels, but it is not clear if one is able to use the measured serum lactate level to determine if there is a second cause for anion gap metabolic acidosis in these critically ill patients. In this report, 503 episodes of lactic acidosis with serum lactate levels greater than 5 mmol/L at a single institution over two years were analyzed. The average serum anion gap minus serum lactate level in these patients was 6.9 ± 0.21 mEq/L, the average corrected anion gap was -1.3 ± 0.23 mEq/L and the average strong ion gap was 5.1 ± 0.3 mEq/L. The majority of the episodes with anion gap-serum lactate concentration >8.0 mEq/L were explained by elevated serum albumin concentration, elevated serum phosphorus concentration, presence of ketones in the urine or high β-hydroxybutyrate concentrations. The above data suggest that one can use the measured serum lactate concentration and subtract from the serum anion gap to determine if there is a second reason for anion gap metabolic acidosis.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"786-793"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13250269/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145911900","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":"Critically Ill Patients with Severe Cirrhosis Receiving Dexmedetomidine at a Higher Risk of Cardiovascular Instability: Application of an Objective Novel Cirrhosis Scoring System.","authors":"Emma Kabalka, Zachary Smith, Geneva Tatem, Benjamin August","doi":"10.1177/08850666251408751","DOIUrl":"10.1177/08850666251408751","url":null,"abstract":"<p><p>BackgroundDexmedetomidine is a first-line sedative in intensive care unit (ICU) patients. Dexmedetomidine has a high hepatic extraction ratio, where clearance is primarily determined by hepatic blood flow. In cirrhosis, hepatic blood flow is reduced, and reduced dexmedetomidine clearance may confer increased susceptibility to cardiovascular adverse effects. Drug-induced hypotension can complicate diagnosis and treatment for the ICU-based clinician. This study's objective was to evaluate clinically significant cardiovascular adverse drug reactions (CS CV-ADRs) according to liver disease severity, stratified by the Albumin-Bilirubin (ALBI) grade, in patients with cirrhosis.MethodsThis retrospective, observational, case-control study using inverse probability of treatment weighting with the propensity score assessed adults at an academic medical center in Detroit, Michigan, from July 2018 through June 2023. Critically ill patients with cirrhosis receiving intravenous dexmedetomidine in an ICU were included. Patients experiencing a CS CV-ADR within 24 h of dexmedetomidine initiation were cases and those without a CS CV-ADR were controls. The primary outcome was incidence of CS CV-ADRs stratified by liver disease severity. A CS CV-ADR included a hemodynamic event and clinically relevant intervention each within 60 minutes. A multivariable regression was used to identify predictors of CS CV-ADRs.ResultsA total of 95 cases and 95 controls were included. The median (IQR) time to CS CV-ADR was 2.4 h (1.3-9.8). Liver disease severity was stratified using the ALBI Grade, ranging from ALBI Grade 1 (least severe) to Grade 3 (most severe) disease. ALBI Grade 3 was significantly associated with increased odds of CS CV-ADRs (Adjusted OR 2.25; 95% CI [1.47-3.46]).ConclusionsIncreasing liver disease severity according to ALBI Grade was associated with greater odds of CS CV-ADRs in critically ill patients with cirrhosis receiving dexmedetomidine. ALBI Grade may be an objective tool for predicting adverse effects of dexmedetomidine or development of dose adjustments for liver dysfunction.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"758-764"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145809568","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 Pulmonary Artery Catheter Utilization with Outcomes in Patients with Cardiogenic Shock: A Retrospective Propensity-Matched Study.","authors":"Shahin Isha, Akshat Banga, Ananya Biswas, Bekure Siraw, Tamal Basak, Mubashir Ayaz Ahmed, Juveriya Yasmeen, Titilope Olanipekun, Anirban Bhattacharyya, Devang K Sanghavi, Pablo Moreno Franco, Shyam Chalise, Piyanuch P Pataramekin, Daniel P Djondo, Amrik Ray, William M Sanders","doi":"10.1177/08850666251405856","DOIUrl":"10.1177/08850666251405856","url":null,"abstract":"<p><p>PurposeDespite the need for advanced hemodynamic monitoring, the role of the pulmonary artery catheter (PAC) in cardiogenic shock (CS) remains controversial due to conflicting evidence from previous studies.Material and MethodsThis single-center retrospective study utilized the MIMIC-IV database to assess the impact of PAC use on 30-day in-hospital mortality and clinical outcomes in CS patients admitted between 2008 and 2019. Propensity score matching (PS) and inverse propensity treatment weighting (IPTW) were employed to adjust for baseline differences. The primary outcome was 30-day in-hospital mortality; secondary outcomes included hospital and ICU length of stay and complications. Cox proportional hazard ratio analyses were performed to evaluate the association between PAC use and mortality outcomes.ResultsThe final cohort consisted of 1940 adult CS patients, with 134 receiving PAC and 1806 not. PAC use significantly reduced 30-day in-hospital mortality (PS-matched HR 0.57, 95% CI: 0.39-0.83; IPTW HR 0.58, 95% CI: 0.35-0.96) but was associated with longer hospital stays (16.47 vs 12.37 days) and ICU stays (9.26 vs 7.52 days).ConclusionPAC use in CS patients was associated with improved short-term survival but also with longer hospitalization and potential complications, underscoring the need for careful patient selection and further research.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"742-751"},"PeriodicalIF":2.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145742954","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":"Outcomes of Sedative Hypnotic Agents Used for Endotracheal Intubation in Critically Ill Adults: A Systematic Review with Exploratory Meta-Analysis.","authors":"Nathan J Smischney, George Williams, Craig S Jabaley, Ashish K Khanna, Bethany Bouldin, Andrew R Petrilli, Hao Deng, Elissa A Kinzelman-Vesely, Ronald G Pearl","doi":"10.1177/08850666251337702","DOIUrl":"10.1177/08850666251337702","url":null,"abstract":"<p><p>ObjectiveSpecific sedative hypnotic agents, administered to facilitate endotracheal intubation (ETI) in critically ill adults, may lead to adverse outcomes such as peri-intubation cardiovascular collapse. However, little is known from systematic investigations of the impact these individual agents have on cardiovascular function or other clinical outcomes.Data sourcesMEDLINE, Embase, CENTRAL, ClinicalTrials.gov, Scopus and Web of science databases.Study selectionWe conducted a systematic search for randomized and non-randomized studies that evaluated adult (≥18 years) critically ill patients who were sedated to facilitate ETI with ketamine, propofol, ketamine/propofol, etomidate, or a benzodiazepine and who had data on peri-intubation hemodynamics and at least one other outcome involving acute kidney injury, delirium, opioid use, intubation difficulty, sequential organ failure assessment, length of stay, or mortality. Eighty-five studies were identified for eligibility assessment with 23 included in the analysis.Data extractionTwo reviewers independently screened articles, extracted data from selected articles, and assessed risk of bias using ROBINS-I for observational studies and revised Cochrane Risk of Bias tool for randomized controlled trials.Data synthesisAcute cardiovascular dysfunction (peri-intubation hemodynamic instability and/or cardiac arrest) was similar between etomidate and ketamine with more events seen when propofol versus non-propofol sedation was administered. However, exploratory meta-analysis demonstrated no difference between etomidate and ketamine (OR 1.05 [95%CI 0.60-1.84]) or between etomidate and propofol (OR 0.91 [95%CI 0.33-2.46]). Compared to ketamine, etomidate demonstrated lower survival to hospital discharge in the included studies in exploratory meta-analysis OR 0.76 (95%CI 0.62-0.92). Limited data existed for other outcomes with no discernible differences between sedative agents.ConclusionsAcute cardiovascular dysfunction was more common when propofol, as compared to non-propofol sedation, was administered, although not statistically significant in exploratory meta-analysis. In addition, etomidate conferred lower survival to hospital discharge versus non-etomidate sedation, which was confirmed in exploratory meta-analysis of etomidate versus ketamine.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"706-723"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078510","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}