Journal of Intensive Care Medicine最新文献

{"title":"Characteristics of <i>Serratia marcescens</i> Bacteremia in Comparison to Other Gram-Negative Bacteremia in Infants in the Pediatric Cardiac Intensive Care Unit A Case-Control Study (2012-2022).","authors":"Eran Shostak, Eliana Fanous, Ofer Schiller, Yael Feinstein, Magda Zomer, Tzippy Shochat, Gilat Livni","doi":"10.1177/08850666261424210","DOIUrl":"10.1177/08850666261424210","url":null,"abstract":"<p><p>Purpose<i>Serratia marcescens</i> is a well-recognized hospital-acquired pathogen frequently implicated in outbreaks in neonatal and pediatric intensive care units. We compared clinical characteristics of infants with <i>Serratia</i> bloodstream infections (BSI) to those with non-<i>Serratia</i> gram-negative BSI.MethodsA retrospective case-control study comparing infants (0-2 y/o) hospitalized at our referral pediatric cardiac intensive care unit (PCICU), who acquired gram-negative blood cultures, during 2012-2022. Patients were categorized into two groups: <i>S. marcescens</i> BSI versus non-<i>Serratia</i> gram-negative BSI. Demographic and clinical data were extracted from our medical databases.ResultsOf 112 patients meeting inclusion criteria, 40 (36%) had <i>Serratia</i> BSI and 72 (64%) non-<i>Serratia</i> gram-negative BSI. Blood stream infection with <i>Serratia</i> occurred later postoperatively (median 15 vs 7 days, <i>p</i> < .01), were associated with less pre-infection inotropic support (median VIS 0 vs 5, <i>p</i> < .01) and higher rates of multisite involvement (35% vs 18%, <i>p</i> = .04). Duration of indwelling vascular catheters at time of infection was longer in the <i>Serratia</i> group (median 10 vs 7 days, <i>p</i> = .03). No associated mortality was attributed to <i>Serratia</i> BSI, as compared to a 5.6% mortality rate in the non-<i>Serratia</i> group.Conclusions<i>Serratia</i> BSI in the PCICU tends to develop later during hospitalization, involves more multiple infection sites, and is associated with longer vascular catheters dwell durations at the time of infection. <i>Serratia</i> infections appeared sporadically throughout the year without seasonal clustering. This supports the importance of stringent infection control practices and warrants prospective studies on prevention strategies.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"992-998"},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147616118","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":"Ethical Considerations and End-of-Life Care in Donor and Transplant Critical Care.","authors":"Krishna A Chokshi, Antoinette R Esce, Ankita Mehta, Robert M Arnold","doi":"10.1177/08850666261465291","DOIUrl":"10.1177/08850666261465291","url":null,"abstract":"<p><p>Advances in organ transplantation and mechanical circulatory support technologies have deepened the ethical complexity of care for critically ill patients across the donation-transplant continuum, especially at the end-of-life. This narrative review is structured around four clinical scenarios faced by bedside intensivists: patients awaiting transplantation, patients for whom transplant is no longer an option, patients who may become organ donors, and transplant patients at the end-of-life. Across these contexts, clinicians must navigate prognostic uncertainty, steward scarce resources, and address potentially nonbeneficial treatment, while respecting patient values. Through case-based analysis, we offer practical ethical guidance and emphasize the critical role of skilled communication, ethics consultation, and palliative care in supporting bedside decision-making.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"1030-1038"},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148360822","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":"Developmental Care in the Early Years in Pediatric Intensive Care Patients as a Strategy to Mitigate Pediatric Post-Intensive-Care Syndrome: A Narrative Review.","authors":"Ari R Joffe, Charlene M T Robertson","doi":"10.1177/08850666251340646","DOIUrl":"10.1177/08850666251340646","url":null,"abstract":"<p><p>Survivors after pediatric critical care often have adverse sequelae in domains of cognition, executive function, attention, memory, visual-spatial skills, language, motor function, behavior, and emotional functioning, the post-intensive-care syndrome pediatric (PICS-p). The time from birth to approximately age 2 years is a period of rapid structural and functional brain development. The fundamental structural and functional architecture of the brain is in place by the second year of life. This narrative review focuses on how we, in the pediatric intensive care unit (PICU), can work towards maximizing each patient's full potential despite adverse experiences during hospitalization. In part I, concepts relevant to understanding the effects of hospitalization in PICU on brain development are clarified, including concepts of toxic stress and trauma, sensitive periods and cascades, experience-expectant neural plasticity in the early years, and resilience and buffering of adversity focused on relational care. In part II, evidence is presented that these concepts are important because they describe the effects of early childhood adversity that are pervasive on physical health, cognitive, and emotional outcomes throughout the lifespan. Evidence is presented to show that intervention to improve these outcomes can be effective. In part III, the concepts and evidence are synthesized by focusing on the opportunity before us, what we must and can do better while patients are in the PICU, in order to improve their long-term lifelong outcomes. We present evidence to argue that we in pediatric critical care must take a public-health approach to address the key environmental conditions necessary for optimal early childhood development and hence facilitate children's ability to thrive. Future research must aim to determine what works best and what does not work in the PICU. Early childhood investments to improve lifelong outcomes have great potential to help patients and reduce the growing burden of healthcare costs.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"947-961"},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13538926/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144024526","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":"Long-Acting Insulin and Hypoglycemia in Critically Ill Patients with Diabetes: A Sensitivity Analysis.","authors":"Amina Ammar, Nataliya Sorochak, Renee Paxton, Melissa Lipari, Christopher Giuliano","doi":"10.1177/08850666261462876","DOIUrl":"10.1177/08850666261462876","url":null,"abstract":"","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"1045-1046"},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148391105","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":"Sustained Mayer-Like Very-Low-Frequency Blood Pressure Oscillations in a 16-Year-Old After Drowning Associated Lung Injury.","authors":"Eli Shapiro, Eric Scheier","doi":"10.1177/08850666261469480","DOIUrl":"10.1177/08850666261469480","url":null,"abstract":"<p><p>ObjectiveTo describe sustained, large-amplitude, Mayer-like very-low-frequency (VLF) oscillations in invasive arterial blood pressure following drowning-associated lung injury in an adolescent.DesignSingle-patient case report.SettingPediatric intensive care unit at a tertiary medical center.PatientsA previously healthy 16-year-old male.InterventionsMechanical ventilation for severe hypoxemia and pulmonary hemorrhage; vasopressor support with epinephrine; aggressive fluid resuscitation; bronchoscopy after cessation of bleeding.Measurements and Main ResultsInvasive arterial blood pressure monitoring demonstrated rhythmic oscillations with a periodicity of ∼28 s (≈0.036 Hz; ≈2.1 cycles/min) and amplitudes of 30-40 mm Hg. The pattern was not phase-locked to cardiac or ventilatory cycles, persisted for ∼12 h, and resolved before extubation. Noninvasive cuff readings corroborated the pattern, and discontinuation of epinephrine, replacement of the arterial line, tubing, transducer, and monitor did not change the oscillations.ConclusionsSustained, large-amplitude Mayer-like oscillations were observed after a severe hypoxic event in the setting of drowning-associated lung injury. The pattern likely reflects intense autonomic activation, plausibly amplified by catecholamine exposure and blood loss. Recognition may prevent misclassification as artifact or arrhythmia and may indicate heightened autonomic drive at the bedside.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"1039-1042"},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148436896","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":"Cognitive Health and Quality of Life After Surviving Sepsis: A Narrative Review.","authors":"Khalia Ackermann, Nanda Aryal, Johanna Westbrook, Ling Li","doi":"10.1177/08850666251340631","DOIUrl":"10.1177/08850666251340631","url":null,"abstract":"<p><p>Purpose of the researchSepsis is a leading cause of disease and affects approximately a third of ICU patients worldwide. Despite the rising number of sepsis survivors, the burden of cognitive and quality of life related post-sepsis morbidities remains understudied. This narrative review aimed to summarize and discuss current research investigating the quality of life and the burden of cognitive, mental, and functional health morbidities in sepsis survivors at different stages of life.Major findingsSepsis survivors of all ages were affected by cognitive dysfunction, with very preterm neonatal sepsis survivors reporting higher odds of neurodevelopmental disabilities, childhood sepsis survivors reporting delayed development, and adult sepsis survivors reporting cognitive decline, including a higher risk of dementia. Mental health concerns were reported in both survivors and family members, with limited mixed evidence for post-traumatic stress disorder, depression, suicide, and anxiety. Survivor functional status is frequently impacted in diverse ways, with both physical and mental changes often inhibiting daily life. Lastly, the impact of sepsis on survivor quality of life is mixed. While sepsis survivors frequently report poorer quality of life compared to the general population, studies have reported no difference in quality of life when comparing sepsis survivors with other critical illness survivors.ConclusionsSepsis impacts the quality of life and cognitive, mental, and functional health in numerous diverse ways across the lifespan. Future research should focus on sepsis survivorship in children, and the mental health burden of sepsis across all age groups.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"936-946"},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13538917/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078508","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":"Higher Serum Cortisol is Associated with Delayed Shock Resolution in Septic Shock Patients.","authors":"Sophon Dumrongsukit, Suranut Charoensri, Kamonwan Mulalin, Anupol Panitchote","doi":"10.1177/08850666261423897","DOIUrl":"10.1177/08850666261423897","url":null,"abstract":"<p><p>IntroductionElevated serum cortisol levels at the onset of septic shock have been linked to increased mortality. However, their relationship with hemodynamic recovery, particularly shock reversal, has not been well studied.MethodsWe conducted a prospective cohort study at Srinagarind Hospital, Thailand, between June 2019 and December 2021, enrolling adult patients diagnosed with septic shock in the emergency department. Serum cortisol levels and illness severity (SOFA and APACHE III scores) were assessed at diagnosis. Shock reversal was defined as vasopressor discontinuation with sustained mean arterial pressure ≥ 65 mm Hg for 24 h.ResultsOf 81 enrolled patients, 58 (71.6%) achieved shock reversal within 72 h. Higher serum cortisol levels were independently associated with a lower probability of shock reversal at 72 h (HR per 1 µg/dL increase: 0.95, 95% CI: 0.92-0.97) and with reduced likelihood of early shock control at 6 h (HR: 0.96, 95% CI: 0.93-0.99). Compared with cortisol < 18 µg/dL, levels of 18-30 µg/dL and > 30 µg/dL were associated with substantially lower probabilities of 72-h shock reversal (HR: 0.31, 95% CI: 0.15-0.64; HR: 0.17, 95% CI: 0.08-0.37, respectively). Each 10 µg/dL increase in cortisol corresponded to a 0.64-point increase in SOFA score at 72 h (95% CI: 0.28-1.0). No significant association was observed with 28-day mortality.ConclusionElevated serum cortisol at the onset of septic shock independently predicted delayed shock reversal and a lower likelihood of early shock control, but was not associated with 28-day mortality.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"986-991"},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146220063","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":"Hyperlactatemia and Lactic Acidosis in Critically Ill Patients with Hematological Malignancies: A Single Center Retrospective Study.","authors":"Andry Van de Louw, Garrett Thompson","doi":"10.1177/08850666261421885","DOIUrl":"10.1177/08850666261421885","url":null,"abstract":"<p><p>BackgroundHematological malignancies expose patients to lactic acidosis, either type A (mostly due to sepsis) or B (malignancy related). As information is scarce about lactic acidosis in this population, we aimed to describe its characteristics and impact on outcome.MethodsRetrospective chart review of all patients with hematological malignancies admitted to the ICU and with lactates measured between 2008 and 2018. Hyperlactatemia and lactic acidosis were defined by blood lactate levels ≥ 2 and 4 mmol/L respectively.ResultsHyperlactatemia and lactic acidosis were present in 60% and 30% of the 666 patients included respectively and lactic acidosis was independently associated with hospital mortality (OR 2.00, 95% CI 1.02-3.87, p = 0.04). A cluster analysis in the whole population revealed 3 clusters of patients with prognostic implication: a first cluster was characterized by diverse hematological malignancies, low incidence of hyperlactatemia, low requirements for vital organ support and low mortality (14%). A second cluster included patients mostly with type A lactic acidosis due to septic shock or cardiac arrest, with severe multiorgan failure and extremely high mortality (87%), whereas the third cluster included patients frequently with lymphoma and no obvious cause for lactic acidosis and was characterized by less severe multiorgan failure and intermediate mortality (40%). Patients with type B lactic acidosis were more frequently male, with lymphoma, they had less severe hyperlactatemia, acidosis, acute kidney injury, they required less vital organ support and had lower mortality rate than type A acidosis (32.4% vs 77.2%, p < 0.001).ConclusionsLactic acidosis was frequent in ICU patients with hematological malignancies and associated with mortality. As a surrogate for type B acidosis, patients with no obvious cause for lactic acidosis and no vasopressor requirements had lower mortality than type A lactic acidosis.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"962-969"},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146207224","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":"Age-Related Differences in Benzodiazepine Dosing for Mechanically Ventilated Pediatric ICU Patients: A Retrospective Cohort Study.","authors":"Amanda R Kolmar, Daniela Bravo, Ricardo A Fonseca, Michael A Kramer, Jinli Wang, Kristin P Guilliams, Brian M Fuller","doi":"10.1177/08850666261432099","DOIUrl":"10.1177/08850666261432099","url":null,"abstract":"<p><p>ObjectivesOur primary objective was to determine differences in benzodiazepine doses given for tolerance of mechanical ventilation based on age cohorts in a pediatric intensive care unit (ICU) population. We hypothesized younger subjects would see increased doses of benzodiazepines.MethodsThis was a single center, retrospective cohort study of mechanically ventilated pediatric ICU patients receiving benzodiazepines. The primary outcome was a difference in midazolam and lorazepam dose intensity (mg/kg/day) between age cohorts. Primary outcomes were analyzed using an unadjusted linear mixed-effects model with random subject effect. If the model was significant, we performed multivariable regression analysis. When the overall adjusted model was significant, Tukey-adjusted pairwise comparisons were performed, and geometric mean ratio and 95% CI were estimated.ResultsThe initial query returned 790 encounters across 747 unique subjects who received benzodiazepines. Dose intensity was calculated for midazolam and lorazepam. After adjusting for degree of illness, PIM3, and indication for mechanical ventilation, infants received, on average, 2.55 higher midazolam dose intensity ((1.30, 5.00), <i>P</i> < .01) than older childhood subjects and preschool-aged subjects received 2.95 higher midazolam dose intensity ((1.50, 5.81), <i>P</i> < .01) than older childhood subjects. Infants received 1.53 times higher lorazepam dose intensity than elementary-aged subjects ((1.03, 2.30), <i>P</i> = .03) and 1.98 times higher lorazepam dose intensity than older childhood subjects ((1.39, 2.82), <i>P</i> < .01).ConclusionsOur study demonstrates among children receiving benzodiazepines to tolerate endotracheal intubation, children less than five years of age receive significantly higher benzodiazepine dose intensity than many of their older pediatric counterparts. Given the negative impact of sedative agents on developing brains and the increased risk of delirium with benzodiazepines, further investigation into variation in sedative dosing, including pharmacogenomics and differences in patient-centered clinical outcomes, is warranted.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"1022-1029"},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147499148","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 Peak Systolic Velocity Variation of Superior Mesenteric Artery May Predict Gastrointestinal Dysfunction in Septic Patients: A Clinical Observational Research.","authors":"Jiao-Long Yuan, Zi-Yu Ye, Xiang Yin, Jia-Kui Sun, Xin-Pei Sun, Xiang Wang","doi":"10.1177/08850666261424869","DOIUrl":"10.1177/08850666261424869","url":null,"abstract":"<p><p>BackgroundTo investigate the clinical significance of peak systolic velocity (PSV) variation of superior mesenteric artery (SMA) in predicting gastrointestinal dysfunction in septic patients.MethodsA clinical observational study was accomplished in our department. The SMA PSV values on days 1-3 after admission and the PSV variation were measured. The gastrointestinal dysfunction score (GIDS), the numbers of patients with feeding intolerance (FI) symptoms during enteral feeding, and the FI days were recorded. The clinical characteristics, inflammatory biomarkers levels, and disease severity and outcome variables were also collected.ResultsA total of 111 septic patients were enrolled during the study period. The median SMA PSV was 84.4 cm/s on admission. The PSV variation was negatively correlated with GIDS on day 3 (R² = 0.376), GIDS on day 7 (R² = 0.371), and FI days (R² = 0.266) at a moderate strength, whereas was positively correlated with the ICU-free days (R² = 0.116) at a weak strength. Moreover, the PSV variation had a notable value to predict the development of GIDS >2, feeding intolerance, and 28-day mortality. We divided patients into three groups on basis of PSV variation values: -30% < variation ≤ -10% (Group A), -10% < variation ≤ 10% (Group B), and 10% < variation ≤ 30% (Group C). Patients in Group A had increased severity scores, serum levels of procalcitonin, interleukin (IL)-6, IL-10, C-reactive protein, and white blood cell counts compared to those in Group B and C (<i>P</i> < .01). The Group A had increased GIDS, FI incidence, FI days, and 28-day mortality compared to the other two groups (<i>P</i> < .001). The days free of mechanical ventilation and continuous renal replacement therapy in Group A were also lower than those in Group B and C (<i>P</i> < .001).ConclusionThe SMA PSV variation may be correlated with gastrointestinal function in sepsis.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"999-1007"},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147284026","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}