Journal of Intensive Care Medicine最新文献

{"title":"Ten Influential Point-of-Care Ultrasound Papers: 2025 in Review.","authors":"Scott J Millington, Robert T Arntfield, Paul H Mayo, Antoine Vieillard-Baron","doi":"10.1177/08850666261434215","DOIUrl":"10.1177/08850666261434215","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 ten influential papers from the past twelve 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":"436-440"},"PeriodicalIF":2.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13121810/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147499138","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":"Decision-Making About Potentially Non-Beneficial Intensive Care Unit Treatments: Interviews of Family Members from an Academic Public Hospital.","authors":"Jennifer Parrish, Thanh H Neville, Derjung M Tarn, Dong W Chang","doi":"10.1177/08850666251371579","DOIUrl":"10.1177/08850666251371579","url":null,"abstract":"<p><p>ObjectiveDeveloping effective strategies to improve shared decision-making (SDM) about potentially non-beneficial intensive care unit (ICU) treatments for patients with advanced medical illness requires understanding patients' and family members' perspectives. This study explores family members' experiences in discussing potentially non-beneficial treatments with ICU clinicians to identify factors that influenced their decision-making.MethodsSemi-structured interviews of pre-dominantly non-White family members making decisions about potentially non-beneficial ICU treatments were conducted in the medical ICU of an academic public hospital in Los Angeles County. Interviews were audio-recorded, transcribed, and analyzed using thematic analysis.ResultsEighteen surrogate decision-makers were interviewed for this study. Perceived barriers to decision-making included intimidation, dehumanizing family meetings, time-pressure to make decisions, and uncertainty of benefit from ICU treatments. Factors that affected the perceived susceptibility from harm or likelihood of benefit from invasive treatments included health status prior to hospitalization, physicians' discussion of prognoses, and direct observation of clinical status during ICU hospitalization. Greater self-efficacy in making decisions was promoted by stronger family support, gaining experience with the clinical situation, and empathic characteristics of the clinical team.ConclusionsInterviews with family members at a single ICU revealed that strategies to improve decision-making may include emphasizing empathic communication styles that focus on patients' values and preferences for care, reducing time-pressure and uncertainty by seeing the effects of ICU treatments, and creating time for families to adjust and seek social support. Adopting this approach may allow ICU clinicians and family members to become more aligned in their efforts to provide compassionate care for patients while minimizing non-beneficial treatments. These findings need to be validated in larger patient populations.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"427-435"},"PeriodicalIF":2.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957503","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 Impact of the COVID-19 Pandemic on Healthcare Associated Bloodstream Infections in Scottish Intensive Care Units: A Retrospective Cohort Study.","authors":"Jennifer Falconer, Mabel Balfour, Stephanie Walsh, Aynsley Milne, Jodie McCoubrey, Fiona Murdoch, Roselind Hall, Chris Robertson, Laura Imrie, Nazir Lone, Shona Cairns","doi":"10.1177/08850666251368802","DOIUrl":"10.1177/08850666251368802","url":null,"abstract":"<p><p>BackgroundHealthcare associated blood stream infections (BSI) pose a significant risk of morbidity and mortality for patients admitted to intensive care units (ICUs). Recent evidence suggests that the COVID-19 pandemic may have impacted the risk of acquisition.AimThis retrospective cohort study explored risk factors, including patient COVID-19 admission status, associated with incidence rates of BSI in Scottish ICUs during the COVID-19 pandemic compared to a pre-pandemic period.MethodsThree national databases were linked to create a dataset of 38,081 ICU admissions across 41 ICUs during a comparator period of March 2018 to December 2019, and pandemic period of March 2020 to December 2021. Population demographics and clinical risk factors were described according to period of admission and COVID-19 admission status. Cox regression models investigated the influence of risk factors on time to BSI, using a competing risk approach to account for death as a competing event.FindingsIn non-COVID-19 patients, the first two waves of the pandemic significantly increased hazards of BSI (Wave 1 cause-specific hazard ratio (HR) 1.27, 95% Confidence Interval (CI) 1.02-1.59, wave 2a HR 1.39, 95% CI 1.14-1.70), but not mortality. COVID-19 status on admission did not significantly increase hazard of BSI in the pandemic, however there was a significant interaction between COVID-19 and the use of intubation in increasing hazard of BSI (HR 4.64, 95% CI 2.07-10.4) and COVID-19 was significant in increasing the hazard of mortality (HR 2.26, 95% CI 1.77-2.88).ConclusionWhile rates of ICU-acquired BSI were higher during the pandemic period, and in COVID-19 admissions, the reasons for this are multifactorial. Interpretation must consider the competing risk of mortality and how this is influenced by differences in patient population, along with changes that occurred during the pandemic in relation to infection prevention and control procedures, ICU pressures, and COVID-19 treatment and vaccination.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"381-397"},"PeriodicalIF":2.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957370","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":"Diagnostic Accuracy of a Large Language Model (ChatGPT-4) for Patients Admitted to a Community Hospital Medical Intensive Care Unit: A Retrospective Case Study.","authors":"Jassimran Singh, Rhea Bohra, Vaibhavi Mukhtiar, Warren Fernandes, Charmi Bhanushali, Rajaeaswaran Chinnamuthu, Shihla Shireen Kanamgode, June Ellis, Eric Silverman","doi":"10.1177/08850666251368270","DOIUrl":"10.1177/08850666251368270","url":null,"abstract":"<p><p>BackgroundThe future of artificial intelligence in medicine includes the use of machine learning and large language models to improve diagnostic accuracy, as a point-of-care tool, at the time of admission to an acute care hospital. The large language model, ChatGPT-4, has been shown to diagnose complex medical conditions with accuracies comparable to experienced clinicians, however, most published studies involved curated cases or examination-like questions and are not point-of-care. To test the hypothesis that ChatGPT-4 can make an accurate medical diagnosis using real-world medical cases and a convenient cut and paste strategy, we performed a retrospective case study involving critically ill patients admitted to a community hospital medical intensive care unit.MethodsA redacted H&P was essentially cut and pasted into ChatGPT-4 with uniform instructions to make a leading diagnosis and a list of 5 possibilities as a differential diagnosis. All features that could be used to identify patients were removed to ensure privacy and HIPAA compliance. The ChatGPT-4 diagnoses were compared with critical care physician diagnoses using a blinded longitudinal chart review as the ground truth diagnosis.ResultsA total of 120 randomly selected cases were included in the study. The diagnostic accuracy was 88.3% for physicians and 85.0% for ChatGPT-4, with no significant difference by McNemar testing (p-value of 0.249). The agreement between physician diagnosis and ChatGPT-4 diagnosis was moderate, 0.57 (95% CI: 0.35-0.79), based on Cohen's kappa statistic.ConclusionThese results suggest that ChatGTP-4 achieved diagnostic accuracy comparable to board certified physicians in the context of critically ill patients admitted to a community medical intensive care unit. Furthermore, the agreement was only moderate, suggesting that there may be complementary ways of combining the diagnostic acumen of physicians and ChatGPT-4 to improve overall accuracy. A prospective study would be necessary to determine if ChatGPT-4 could improve patient outcomes as a point-of-care tool at the time of admission.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"413-420"},"PeriodicalIF":2.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144873593","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 the Use of Long-Acting Insulin and Hypoglycemia in Critically Ill Patients with Diabetes.","authors":"Amina Ammar, Nataliya Sorochak, Renee Paxton, Melissa Lipari, Christopher Giuliano","doi":"10.1177/08850666251371709","DOIUrl":"10.1177/08850666251371709","url":null,"abstract":"<p><p><b>Introduction</b>: Hypoglycemia in critically ill patients increases morbidity and mortality. Subcutaneous long-acting insulin (LAI) in patients without diabetes is associated with hypoglycemia in the SICU. However, limited evidence exists in patients with diabetes. <b>Methods:</b> This was a single-center, retrospective cohort study evaluating patients with T2DM who were admitted to the SICU for 24 h and received LAI in combination with sliding scale insulin (LAI + SSI) or sliding scale insulin (SSI) alone. The primary outcome was the incidence of hypoglycemia (BG < 70 mg/dL) in patients who received LAI + SSI or SSI. Secondary outcomes evaluated the number of glucose values across defined categories: hypoglycemia (54-70 mg/dL), severe hypoglycemia (<54 mg/dL), euglycemia (70-180 mg/dL), hyperglycemia (>180 mg/dL) and glycemic variability. <b>Results:</b> A total of 228 patients were included in the final analysis. The incidence of hypoglycemia occurred in 17.5% of patients in the LAI + SSI cohort and 18.4% in the SSI cohort (p = .86). After controlling for confounders, no differences were observed with LAI + SSI versus SSI for hypoglycemia (OR 1.09, 95% CI 0.46-2.6, p = .85). Secondary outcomes demonstrated no difference in total hypoglycemia (37 vs 31, p = .80), severe hypoglycemia (15 vs 34, p = .17) and euglycemia (1622 vs 1780, p = .22) in the LAI + SSI cohort compared to SSI alone. Hyperglycemia occurred more frequently with LAI + SSI. However, after adjusting for confounders there was no difference in hyperglycemia (OR 1.8, 95% CI 0.7-4.6, p = .22). No difference was observed in glycemic variability between LAI + SSI and SSI (26.5 vs 24.5, p = .21). <b>Conclusion and Relevance:</b> The addition of LAI to SSI in SICU patients with T2DM was not associated with an increased risk of hypoglycemia.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"421-426"},"PeriodicalIF":2.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957547","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":"From Static Midline Venous Pressure Comparison to Dynamic Fluid Responsiveness Prediction: A Suggested Future Direction.","authors":"Kongwen Huang, Xiaowen Qiu","doi":"10.1177/08850666261442828","DOIUrl":"10.1177/08850666261442828","url":null,"abstract":"","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"443"},"PeriodicalIF":2.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147673959","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":"Systemic and Pulmonary Microcirculation, Double Microcirculation: From Basic Concepts to Treatment Key Points.","authors":"Guangjian Wang, Qingyu Deng, Jie Wang, Qian Zhang, Hui Lian, Xiaoting Wang","doi":"10.1177/08850666251321786","DOIUrl":"10.1177/08850666251321786","url":null,"abstract":"<p><p>It seems logical to divide the macrocirculation into systemic and pulmonary circulation, but it is rare in clinical practice to further subdivide microcirculation into systemic and pulmonary microcirculation. Both systemic and pulmonary microcirculations play important roles in the development and progression of critical illness. Therefore, targeting the overall microcirculation status for clinical treatment may overlook the heterogeneity of different critically ill patients. It seems unavoidable to further subdivide the microcirculation, so this review explains the differences in structure, function, blood flow regulation, and other important aspects between systemic and pulmonary microcirculation, systematically presenting the concept of \"double microcirculation.\" At the same time, to refine the critical care treatment and even improve the prognosis of critically ill patients, we further propose and explain the treatment key points based on \"double microcirculation protection.\"</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"365-380"},"PeriodicalIF":2.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144022625","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 Role of Venoarterial ECMO in the Management of Sepsis-Induced Cardiomyopathy and Refractory Shock: An Analytic Review.","authors":"AnhTuan Mai, Yusuf Yasarlar, Mohammed Awad, Yusuke Terasaki, Kenton Zehr, Ayman O Soubani, Zahia Esber","doi":"10.1177/08850666251321788","DOIUrl":"10.1177/08850666251321788","url":null,"abstract":"<p><p>Sepsis-induced cardiomyopathy is a severe complication seen in patients with refractory septic shock, characterized by cardiac dysfunction due to an overwhelming inflammatory response secondary to infection. Despite its reversible nature, sepsis-induced cardiomyopathy (SIC) can significantly increase mortality in septic shock patients despite treating the underlying infection. Prompt recognition and aggressive intervention can potentially support the recovery of cellular injuries caused by inflammation and improve outcomes. Recently, venoarterial-extracorporeal membrane oxygenation (VA-ECMO) has gained attention as a potential mechanical support for managing these patients with SIC and cardiogenic shock. However, the lack of consensus in defining SIC and the variation in inclusion criteria for VA-ECMO implementation in acute sepsis-induced cardiogenic shock made it challenging to interpret the results of related studies. A more specific definition of SIC and careful selection of patients who may benefit from ECMO support could improve outcomes in this population. This analytic review discusses the mechanisms leading to cardiomyocyte injury and SIC, and summarizes recent studies including the efficacy of VA-ECMO in managing refractory septic shock due to SIC.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"355-364"},"PeriodicalIF":2.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143971683","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":"Artificial Liver Support.","authors":"Hyung Kook Kim, David T Huang, Ali Al-Khafaji","doi":"10.1177/08850666261445379","DOIUrl":"https://doi.org/10.1177/08850666261445379","url":null,"abstract":"<p><p>Acute liver failure (ALF) and acute-on-chronic liver failure (ACLF) both have high mortality rates without liver transplantation. Artificial liver support systems may benefit patients with liver failure, serving as a bridge to transplantation or as a destination therapy allowing recovery. There are currently two types of artificial liver support systems: non-biological and biological. Non-biological artificial liver (NBAL) support systems primarily focus on detoxification by removing toxins through selective membranes and adsorbent materials. Well-known NBAL systems are plasma exchange, Molecular Adsorbent Recirculating System (MARS), Single-Pass Albumin Dialysis (SPAD), and the Fractionated Plasma Separation and Adsorption System (Prometheus). NBAL therapies consistently reduce bilirubin and improve encephalopathy; however, pivotal randomized controlled trials such as RELIEF (MARS) and HELIOS (Prometheus) did not confirm a survival advantage, although plasma exchange improved transplant-free survival in acute liver failure. Biological artificial liver (BAL) support systems use human or animal-derived hepatocytes to temporarily replace liver function, including the Extracorporeal Liver Assist Device (ELAD), HepatAssist, and stem-cell-based systems. Early BAL studies showed biochemical and neurological improvements, but large trials such as VTL-308 failed to demonstrate a significant survival benefit over standard medical therapy. Overall, while NBAL and BAL therapies can improve encephalopathy, renal function, and cholestasis, current evidence does not show a clear mortality benefit, and artificial liver support systems remain supportive rather than curative.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666261445379"},"PeriodicalIF":2.1,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774051","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":"Safety, Efficacy, and Clinical Outcomes of APRV in ARDS: A Systematic Review and Meta-Analysis.","authors":"Rushi Patel, Jacob Thompson, Viraj Panchal, Namra Patel, Viral Patel, Juan Iribarren","doi":"10.1177/08850666261445419","DOIUrl":"https://doi.org/10.1177/08850666261445419","url":null,"abstract":"<p><p>IntroductionAirway pressure release ventilation (APRV) has been proposed as an alternative mode of mechanical ventilation for patients with acute respiratory distress syndrome (ARDS), aiming to enhance oxygenation while minimizing ventilator-induced lung injury. However, its comparative efficacy and safety relative to conventional ventilation strategies remain unclear. As such, this systematic review and meta-analysis was conducted to evaluate clinical and physiological outcomes associated with APRV in ARDS patients.MethodsFollowing PRISMA guidelines, a comprehensive literature search was conducted across online databases through June 2025. Eligible studies included investigations comparing APRV with conventional ventilation modes in adult ARDS patients. Pooled mean differences and odds ratios with 95% confidence intervals were calculated using random-effects models.ResultsNine studies encompassing 1921 patients met inclusion criteria. APRV was found to significantly improve oxygenation early in treatment, reflected by higher PaO₂/FiO₂ ratios on Days 1 and 3, and was associated with shorter ICU length of stay and more ventilator-free days compared with conventional ventilation. Plateau pressures were also notably reduced at Days 3 and 7, suggesting a lung-protective effect. However, no significant differences were observed in ICU or hospital mortality, total ventilator duration, or overall hospital length of stay.ConclusionThese findings imply that APRV is able to enhance early oxygenation and improve ICU-related outcomes in ARDS without increasing mortality risk. While its physiologic advantages and potential lung-protective characteristics support its use as a viable alternative ventilation strategy, further large-scale trials are needed to confirm these findings and define optimal implementation protocols.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666261445419"},"PeriodicalIF":2.1,"publicationDate":"2026-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147773089","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}