Journal of Intensive Care Medicine最新文献

{"title":"Maternal Sepsis for the Intensivist: Recognition, ICU Triage, and Pregnancy-Adapted Management.","authors":"Felicia Chen","doi":"10.1177/08850666261480633","DOIUrl":"https://doi.org/10.1177/08850666261480633","url":null,"abstract":"<p><p>Sepsis in pregnancy and the puerperium is a leading, and often preventable, cause of maternal critical illness. This narrative review summarizes pregnancy-adapted physiology, epidemiology, clinical recognition, intensive care unit triage, and management, with particular emphasis on decision-making around ICU admission and the practical delivery of organ support for intensivists who do not routinely manage obstetric patients.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666261480633"},"PeriodicalIF":2.3,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148887736","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":"Inferior Vena Cava Filters: Relevant Issues for Hospitalists and Intensivists.","authors":"Joshua Valbuena, Eric vanSonnenberg, T Gregory Walker","doi":"10.1177/08850666261469135","DOIUrl":"https://doi.org/10.1177/08850666261469135","url":null,"abstract":"<p><p>Inferior Vena Cava (IVC) filters are medical devices that are inserted into the IVC as a form of mechanical prophylaxis against pulmonary emboli (PE). Placement of IVC filters is controversial, as IVC filters can lead to complications, especially when left implanted for longer than the recommended time. In this review, IVC filter complications are divided into several categories: acute, long-term, and those associated with filter removal. Life-threatening complications of IVC filter use also are examined. Key factors for IVC filter selection are discussed, with a focus on the patients who present with indications for mechanical PE prophylaxis in an acute care setting. Additionally, filters with increased rates of complications, as well as the indications for filter removal, are discussed with an emphasis on applications in critical care medicine.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666261469135"},"PeriodicalIF":2.3,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148887771","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":"Incidence and Risk Factors for Invasive Mechanical Ventilation Dependency in Japan: A Nationwide Retrospective Cohort Study.","authors":"Hiroyuki Ohbe, Monique Daniels, Daisuke Kudo, Hiroki Matsui, Stef Groenewoud, Werner Brouwer, Hideo Yasunaga","doi":"10.1177/08850666261469500","DOIUrl":"https://doi.org/10.1177/08850666261469500","url":null,"abstract":"<p><p>ObjectivesTo describe the incidence and risk factors for becoming dependent on invasive mechanical ventilation (IMV) in Japan.DesignRetrospective cohort study using a nationwide inpatient database from April 1, 2014, to March 31, 2020.SettingMore than 1500 acute care hospitals participating in the Diagnosis Procedure Combination Study Group Database, covering approximately 50% of all hospitalizations in acute care hospitals in Japan.PatientsAdults (≥18 years), in whom IMV was initiated during hospitalization. IMV-dependency was defined as discharge while still receiving IMV after ≥7 days and having undergone tracheostomy during hospitalization.InterventionsNone.Measurements And Main ResultsOf the 388,752 patients in whom IMV was initiated, 7805 (2.0%) became IMV dependent. In-hospital mortality occurred in 138,111 (35.5%) patients, and 242,836 (62.5%) were discharged without IMV dependency. The incidence of IMV dependency increased over time, from 1.6% in 2014 to 2.4% in 2019. Patients who became IMV dependent had a mean age of 71.3 years, and 49% were ≥75 years. Emergency admissions accounted for 91.7% of cases, and 68.1% presented with impaired consciousness at admission. In multinomial regression analysis (reference: discharged alive without IMV dependency), older age (≥75 years; RRR 1.48, 95% CI 1.41-1.56), impaired consciousness at admission (RRR 1.75, 95% CI 1.63-1.88), emergency admission (RRR 2.18, 95% CI 1.97-2.42), and surgery prior to IMV (RRR 1.92, 95% CI 1.82-2.03) were independently associated with IMV dependency.ConclusionsThe incidence of IMV dependency increased over time. Identified risk factors may inform clinical decision-making and advance care planning.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666261469500"},"PeriodicalIF":2.3,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148887687","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":"Machine Learning-Based Subtype Classification of Sepsis-Associated Acute Kidney Injury and Differential Responses to Renal Replacement Therapy.","authors":"Hongkun Zhang, Shengzhi Wang, Tao Zhang, Baisen Wang, Ziqi Jiang, Zhenqi Guo","doi":"10.1177/08850666261483582","DOIUrl":"https://doi.org/10.1177/08850666261483582","url":null,"abstract":"<p><p>BackgroundSepsis-associated acute kidney injury (SA-AKI) is highly heterogeneous with controversial optimal renal replacement therapy (RRT) strategies. Machine learning enables subphenotype identification, and exploring RRT response differences across SA-AKI subtypes is critical for precision care.MethodsThis retrospective cohort study analyzed adult SA-AKI patients from the Medical Information Mart for Intensive Care IV database. K-means clustering classified SA-AKI subtypes; nine machine learning models were built to predict 28-day mortality, with model performance validated and interpreted via Shapley Additive Explanations. Multivariable logistic regression with interaction terms assessed RRT's heterogeneous treatment effects (HTE) across subtypes. Sensitivity analysis was used to assess the reliability of the research results.Results21359 patients were stratified into 3 AKI subtypes (C1: moderate severity; C2, severe hyperglycemia; C3, mild conditions and high inflammatory responses). C2 had the highest 28-day mortality (30.8%) and RRT utilization (19.2%). Random Forest had a greater performance in training set [area under the curve (AUC) = 0.961], while Light Gradient Boosting Machine (Lightgbm) was better in test set (AUC = 0.814), with Sequential Organ Failure Assessment (SOFA) score as the top predictor. RRT had a negative correlation with 28-day mortality [odds ratio (OR)= 0.810, <i>P</i> = 0.006], with a significant difference only in C1. HTE test for RRT showed no statistical significance (<i>P</i> = 0.141). Sensitivity analysis results supported the reliability of the research findings.ConclusionSA-AKI has three distinct subtypes with divergent clinical characteristics. Lightgbm effectively predicts SA-AKI prognosis, and RRT may benefit C1 subtype patients. Although there is not enough evidence to prove the HTE of RRT among subgroups, this study provides a phenotypic framework for advancing precision kidney support in SA-AKI.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666261483582"},"PeriodicalIF":2.3,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148887722","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":"Inside Prognostication Meetings in the Neuro-Intensive Care Unit: How Clinicians Convey Evidence to Families - A Mixed-Methods Study.","authors":"Mahimasri Kotamreddy, Brooke Honzel, Miriam Quinlan, Raphael Carandang, Susanne Muehlschlegel","doi":"10.1177/08850666261483617","DOIUrl":"https://doi.org/10.1177/08850666261483617","url":null,"abstract":"<p><p>ObjectivesEffective communication with surrogate decision-makers is critical in neuro-intensive care settings, where complex prognostication shapes high-stakes decision-making. To better understand how clinicians convey prognostic evidence in clinician-family meetings for patients with severe acute brain injuries (SABI), we characterized and quantified types of evidence-sharing used by clinicians in these meetings and explored their independent predictors and associations with quality of communication (QOC) and patient-centeredness.MethodsIn this mixed-methods study, we first qualitatively analyzed 70 transcripts of audio-recorded routine clinician-family meetings for patients with SABI. Since it provides a clear and systematic taxonomy for classifying information, we applied an established legal framework to categorize clinician statements into four evidence types: \"<i>Real\"</i>(current clinical status of the patient); \"<i>Documentary\"</i>(research/literature regarding the patient's condition); \"<i>Demonstrative\"</i>(diagnostic tests/imaging to explain the clinical status); and \"<i>Testimonial\"</i>(disclosure of clinician's own personal experiences). Next, we employed univariate and multivariable mixed-models to explore predictors of evidence-sharing types, as well as associations with validated measures of surrogate-perceived QOC and patient-centeredness of care.ResultsWe identified a total of 780 statements of evidence-sharing, of which the majority were \"Real\"(mean proportion 56 ± 23% across all transcripts), followed by \"Demonstrative\"(29 ± 22%), \"Documentary\"(12 ± 15%), and \"Testimonial\"(3 ± 6%), with substantial inter-meeting variability, as indicated by wide standard deviations. In univariate analyses, longer meetings and non-Latino/Hispanic patient ethnicity predicted more evidence-sharing statements; however, after multivariable adjustment accounting for clinician- and patient-level clustering, only meeting length remained significant. Exploratory analyses found no associations between the standardized proportion of any evidence type and surrogate-perceived QOC or patient-centeredness.ConclusionsClinicians' disclosure of prognostic information to families of patients with SABI varied widely in quantity and type of evidence shared. Evidence type was not associated with surrogate-perceived QOC or patient-centeredness, suggesting that factors beyond evidentiary content may shape families' communication experiences. Applying a structured framework to categorize evidence-sharing provides a novel way to systematically study prognostic communication in neurocritical care.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666261483617"},"PeriodicalIF":2.3,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148887709","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":"Pan Immune Inflammation Value in Identifying Sepsis High-Inflammatory and Immunosuppressive Phenotype.","authors":"Xiao Zhu, Qing Lu, Xin Liu, Xianxiang Zeng","doi":"10.1177/08850666261473228","DOIUrl":"https://doi.org/10.1177/08850666261473228","url":null,"abstract":"<p><p>BackgroundThe Pan-Immune Inflammation Value (PIV) is a potential indicator of immune phenotypes in sepsis.ObjectiveTo explore the association between PIV and clinically defined high-inflammatory and immunosuppressive phenotypes in sepsis and to evaluate its potential predictive value.MethodsClinical data from 156 patients with sepsis were retrospectively analyzed. Patients were divided into high inflammatory (n = 82) and immunosuppressive (n = 74) groups based on their immune status. The clinical data and laboratory indicators were compared between the two groups. Pearson's correlation analysis was used to determine the correlations between PIV and clinical indicators. Multiple logistic regression analysis was performed to identify the independent influencing factors. Receiver Operating Characteristic (ROC) analysis was used to evaluate the discriminatory ability of relevant indicators between the two sepsis phenotypes. Bootstrap method was used for validation, with 1000 repeated samples used to construct a calibration curve.ResultsThe APACHE II score was higher, and the levels of PCT, CRP, and PIV were elevated in the high-inflammatory group, whereas IgG levels were lower (P < 0.05). Pearson correlation analysis showed that APACHE II, PCT, and CRP were positively correlated with PIV, whereas IgG was negatively correlated with PIV (r = 0.760, 0.775, 0.770, and -0.765, respectively; P < 0.05). Multivariate logistic regression analysis identified APACHE II, PCT, CRP, IgG, and PIV as independent predictors of sepsis phenotypes (P < 0.05). ROC analysis showed that the combined detection of these indicators had higher AUC values than the individual indicators (Z = 4.447, 4.065, 4.414, 3.859, and 4.403, respectively; P < 0.05). The calibration curve demonstrated good agreement between the predicted and observed probabilities.ConclusionCombined detection of APACHE II, PCT, CRP, IgG, and PIV were associated with high-inflammatory and immunosuppressive phenotypes in sepsis and demonstrated moderate predictive value for phenotypic stratification. Further studies with dynamic monitoring and larger sample sizes are required to verify the clinical value of these indicators.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666261473228"},"PeriodicalIF":2.3,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148887739","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":"HbA1c Stratification Identifies High-Risk ICU Patients: Mortality and Complications in a Retrospective Critical Care Cohort.","authors":"Paul Karim, Isaac Huang, Jiahui Chen, Marco Sanvitti, Robert Canelli, Federico Bilotta","doi":"10.1177/08850666261483519","DOIUrl":"https://doi.org/10.1177/08850666261483519","url":null,"abstract":"<p><p>IntroductionGlycemic variability is common in critical illness and can obscure the prognostic significance of premorbid glycemic status. Hemoglobin A1c (HbA1c) reflects chronic glycemia and may improve risk stratification beyond acute glucose measurements. We examined whether HbA1c-defined glycemic phenotypes were associated with in-hospital complications and mortality among critically ill adults.MethodsWe conducted a retrospective cohort study using MIMIC-IV (v3.1), a de-identified database of ICU admissions at Beth Israel Deaconess Medical Center (2008-2019). Adults (≥18 years) with a documented HbA1c during the index hospitalization and first ICU admission were included (<i>N</i> = 13,552). Patients were classified into eight mutually exclusive groups based on diabetes diagnosis status and HbA1c: healthy (≤5.7% without diabetes), undiagnosed prediabetes (5.8%-6.4%), undiagnosed diabetes (≥6.5%), and five diagnosed-diabetes strata (<6.0%, 6.0%-6.9%, 7.0%-7.9%, 8.0%-8.9%, ≥9.0%). Multivariable logistic regression adjusted for age and sex compared each group with healthy controls for composite complications and in-hospital mortality.ResultsHbA1c was available in 20.7% of first ICU admissions; 40.7% of included patients had diagnosed diabetes and 2.6% had undiagnosed diabetes. Compared with healthy controls, odds of any complication were higher in undiagnosed prediabetes (OR 1.28, 95% CI 1.11-1.48; <i>p</i> < .001) and several diagnosed-diabetes strata (OR range 1.31-1.90; all <i>p</i> ≤ .006). Renal complications showed the most consistent elevation across dysglycemic groups, including very poor glycemic control (OR 2.22, 95% CI 1.95-2.53; <i>p</i> < .001). Sepsis-related complications were increased across all diabetes-range groups; undiagnosed diabetes had OR 2.08 (95% CI 1.53-2.83; <i>p</i> < .001). In-hospital mortality was highest in undiagnosed diabetes (OR 2.33, 95% CI 1.73-3.14; <i>p</i> < .001).ConclusionAmong ICU patients in whom HbA1c was measured, HbA1c-defined dysglycemia, particularly undiagnosed diabetes, was associated with substantially higher ICU morbidity and mortality. Because HbA1c testing was selective and provided limited incremental prognostic value beyond established severity scores, these findings should be considered hypothesis-generating and require prospective validation before supporting routine HbA1c screening.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666261483519"},"PeriodicalIF":2.3,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148887780","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":"Non-Invasive Prediction of Fluid Responsiveness in Septic Shock: A Prospective Study of Transcutaneous Partial Pressure of Oxygen and Aortic Valve Velocity.","authors":"Sanjith Saseedharan, Supriya Pabalkar","doi":"10.1177/08850666261477711","DOIUrl":"https://doi.org/10.1177/08850666261477711","url":null,"abstract":"<p><p>Background and AimsEvaluating fluid responsiveness is essential in managing septic shock because both inadequate resuscitation and over-resuscitation can result in detrimental consequences. Non-invasive techniques are increasingly preferred to guide fluid therapy. This study aimed to evaluate the effectiveness of TCPO2 and AVVTI in predicting AVVTI-defined fluid responsiveness in patients with septic shock.Patients and MethodsFrom September 2023 to March 2024, this prospective study was conducted in the intensive care unit of S L Raheja Hospital, Mumbai, India. A total of 69 adult septic shock patients with clinical indicators of tissue hypoperfusion and without contraindications to passive leg raising (PLR) were enrolled. TCPO2 was evaluated using a transcutaneous oxygen monitor, whereas AVVTI was determined by 2D echocardiography. For statistical analysis, Wilcoxon tests, Spearman's correlation, linear regression, and ROC curve analysis were used.ResultsFollowing PLR, TCPO2 and AVVTI exhibited significant increases from 73.9 ± 17.5 to 77.9 ± 18.5 units and from 13.5 ± 4.6 to 14.6 ± 4.8 units, respectively (both p = 0.001). A positive correlation was found between percentage change in TCPO2 and AVVTI (r = 0.53, p < 0.001). ROC analysis revealed that TCPO2 had an AUC of 0.81, with a sensitivity of 87.1% and specificity of 63.2% at a TCPO2 change cutoff of 4.9% for predicting AVVTI-defined fluid responsiveness. Age had a negative correlation with variation in TCPO2. Gender did not significantly influence baseline TCPO2 level.ConclusionsTCPO2 and AVVTI are non-invasive tools that may assist in evaluating fluid responsiveness in septic shock. Variations in response of these measures according to patient age underscore the necessity for age-specific fluid management tools.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666261477711"},"PeriodicalIF":2.3,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148887725","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":"Hypoxic Hepatitis in Critically Ill Patients: Incidence, Clinical Characteristics, and Outcomes - A Systematic Review and Meta-Analysis.","authors":"Carlos David Trevilla Martínez, Yeison Cruz Castillo, Mariela Denise Fermin Madera, Supritha Chintamaneni, Brenda Tatiana Camacho Ramirez, Laura A Gray, Gabriela Flores Monar, Bansi Sutariya, Camila Sanchez Cruz, Ernesto Calderón-Martinez, Sushovan Guha, Rashmi Advani","doi":"10.1177/08850666261475587","DOIUrl":"https://doi.org/10.1177/08850666261475587","url":null,"abstract":"<p><p>BackgroundHypoxic hepatitis (HH), also termed ischemic hepatitis and historically described as shock liver, is an acute liver injury syndrome in critically ill patients characterized by a rapid and marked rise in aminotransferases in the setting of circulatory, cardiac, or respiratory failure, after exclusion of other causes of acute hepatic injury. Despite its clinical relevance, the true incidence and prognostic significance of HH remain unclear. This systematic review and meta-analysis aimed to determine the pooled incidence, mortality, and outcomes of HH in critically ill patients.MethodsThis study followed PRISMA guidelines and was registered in PROSPERO (CRD420251088120). A systematic search of PubMed, Scopus, Web of Science, EMBASE, Cochrane, LILACS, CNKI, and Google Scholar was conducted on July 4, 2025. Randomized, cohort, and case-control studies involving critically ill adults were included. Primary outcomes were HH incidence and mortality; secondary outcomes included length of stay, organ support, and comparisons with non-HH patients. Random-effects meta-analyses were performed, with heterogeneity assessed using I² statistics.ResultsOf 3236 records, 25 studies (150,928 patients) met inclusion criteria. The pooled prevalence of HH in ICU patients was 8.3%, and all-cause mortality was 64.0%. Compared with non-HH patients, HH was associated with higher all-cause mortality (RR 2.94). Mechanical ventilation (RR 2.44) and renal replacement therapy (RR 3.80) showed elevated but statistically non-significant associations. Cardiogenic shock, cardiac arrest, and sepsis were the leading reported precipitants.ConclusionHH affects a substantial proportion of ICU patients and is consistently associated with adverse outcomes and greater organ support use. However, the available evidence supports HH primarily as an associated prognostic marker rather than a proven causal determinant of mortality. Findings should be interpreted cautiously because of high heterogeneity, potential residual confounding, and possible publication bias. Standardized diagnostic criteria and prospective studies evaluating incremental prognostic value beyond established ICU severity scores are needed.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666261475587"},"PeriodicalIF":2.3,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148887733","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":"Comparison of Midline Venous Catheters Versus Peripherally Inserted Central Catheters for Intravenous Therapy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.","authors":"Kumail Mustafa Ali, Hafsa Ahmed, Syeda Fatima Mustafa Zaidi, Talha Khalid, Ahmed Hasan, Urooba Mughal, Ibrahim Zulfiqar Ali, Farida Khan Kakar, Muhammad Hamza, Samina Fnu, Rohin Kumar, Suraksha Rani, Tayyaba Uzair, Ahmed Mustafa Rashid","doi":"10.1177/08850666261475585","DOIUrl":"https://doi.org/10.1177/08850666261475585","url":null,"abstract":"<p><p>BackgroundMidline venous catheters (MVCs) have been encouraged as alternatives to peripherally inserted central catheters (PICCs) for intermediate to long-term intravenous therapy. However, randomized controlled trials (RCTs) have reported contradictory findings regarding their comparative safety and resilience. We aim to compare MVCs and PICCs in patients receiving intravenous therapy.MethodsPubMed/MEDLINE, Embase, Scopus, and the Cochrane Central databases were searched from inception through March 2025. RCTs comparing MVCs with PICCs in both pediatric and adult population were included. Primary outcomes included total complications, premature catheter removal, and median dwell times. Secondary outcomes included leakage, infiltration, occlusion, catheter-related bloodstream infection, dislodgement, pain, thrombosis, phlebitis, internal malposition, and local infection. Data were pooled using random-effects meta-analysis and reported as risk ratios (RRs) or weighted mean differences (WMDs) with 95% confidence intervals (CIs).ResultsSeven RCTs including 910 patients (MVC: 454, PICC: 456) met the inclusion criteria. Compared with PICCs, the available RCT evidence suggests that MVCs were associated with a higher risk of overall complications (RR: 2.57; 95% CI: 1.54, 4.31; <i>p</i> = 0.0003), premature catheter removal (RR: 3.91; 95% CI: 1.85, 8.27; <i>p</i> = 0.0004), and shorter median dwell time (WMD: -2.06; 95% CI: -3.18, -0.94; <i>p</i> = 0.0003). MVCs also showed higher point estimates for infiltration (RR: 3.77; 95% CI: 1.08, 13.14; <i>p</i> = 0.04), leakage (RR: 2.91; 95% CI: 1.00, 8.50; <i>p</i> = 0.05), and occlusion (RR: 3.61; 95% CI: 2.13, 6.11; <i>p</i> < 0.00001). No significant differences were reported between the two groups for catheter-related bloodstream infection, thrombosis, phlebitis, dislodgment, internal malposition, or local infection, although the event rates were low and the confidence intervals were wide, limiting certainty. Subgroup analyses were broadly consistent across adult and pediatric populations, although some pediatric-only estimates remained imprecise.ConclusionsThe available RCT evidence suggests that MVCs are associated with a higher rate of mechanical complications and reduced catheter longevity compared with PICCs. However, low event rates and imprecise estimates limit interpretation of the non-significant findings, especially for the infection-related and thrombosis outcomes, so these results do not establish equivalence between groups and should be interpreted cautiously. Our data suggest that MVCs may be selectively used based on therapy duration, infusate characteristics, and patient-specific factors rather than as routine substitutes for PICCs. Larger randomized trials with longer follow-up are required to validate the findings.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666261475585"},"PeriodicalIF":2.3,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148880835","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}