Journal of Intensive Care Medicine最新文献

{"title":"Do ICU Admissions Following Rapid Response Events Differ by Patient Demographics?","authors":"Shahla Siddiqui, Ryan Gould, Jennifer Stevens","doi":"10.1177/08850666251415523","DOIUrl":"10.1177/08850666251415523","url":null,"abstract":"<p><p>BackgroundRapid response systems (RRS) have been developed to identify and manage clinical deterioration on hospital floors. However, disparities in downstream care decisions, particularly ICU triage, remain poorly understood. This study investigated the role of demographic variables in ICU admission decisions following rapid response activation.MethodsWe conducted a retrospective analysis of 37,400 RRS activations at a tertiary academic medical center (2013-2023). Data included demographics, primary service at time of trigger trigger reasons, and code status. The RRS comprises an ICU nurse, respiratory therapist, and on-call ICU physician; however, the attending physician of record determines final disposition. Multivariable logistic regression estimated odds of ICU transfer, adjusted for age, sex, marital status, race, ethnicity, primary service, code status, and trigger reason; 95% CIs are reported.ResultsOf 13,799 patients, 1126 (8.2%) were transferred to the ICU after a trigger. Female sex was associated with 13.5% lower odds of ICU admission (OR 0.865; p < 0.05), and married status was associated with 18.6% higher odds of admission (OR 1.186; p < 0.05). Race and age were not significantly associated with ICU transfer. Interaction terms between race and activation reason were nonsignificant.ConclusionDespite similar clinical criteria for activation, female patients were less likely to be transferred to the ICU than male patients following a rapid response activation. This suggests a potential difference in acute care decision-making. Further research using a combination of prospective and mixed methods approaches would be beneficial to examine how healthcare providers make decisions and to explore strategies to reduce potential unintentional influences.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"874-882"},"PeriodicalIF":2.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147616076","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":"Prognosis of Patients with Lung Cancer Admitted to the Intensive Care Unit: A Systematic Review and Meta-Analysis.","authors":"Ahmed Elkhapery, Hazem Taifour, Chengu Niu, Ayman O Soubani","doi":"10.1177/08850666251339451","DOIUrl":"10.1177/08850666251339451","url":null,"abstract":"<p><p>IntroductionDespite recent advances in the care of critically ill patients with cancer, studies show that lung cancer is associated with higher Intensive Care Unit (ICU) mortality than other types of cancer. This systematic review and meta-analysis aim to investigate the ICU outcomes and predictors of mortality in critically ill patients with lung cancer.MethodsPubMed, OVID MEDLINE, Cochrane and Embase were searched to identify relevant studies. The primary outcome was ICU mortality. The secondary outcomes were hospital mortality and predictors of mortality. Abstracts, case reports and case series were excluded.ResultsThirty-three studies met inclusion criteria, including 28 cohort studies (n = 4123) and five population-based studies (n = 82,475). The pooled ICU mortality was 46.4% (95% CI 41.0-51.8; n = 16,772). The pooled hospital mortality was 51.9% (95% CI 46.9-56.9; n = 72,215). The pooled long-term mortality (6-12 months) was 73.5%, (95% CI 68.2- 78.2; n = 84,008). Predictors of mortality included the presence of metastatic disease (RR 1.30, 95% CI 1.06-1.59), poor performance status (RR 1.33, 95% CI 1.12-1.57), requirement for mechanical ventilation (RR 2.25, 95% CI 1.58-3.21), requirement for vasopressors (RR 1.95, 95% CI 1.54-2.46), higher APACHE or SAPS score (standardized mean difference 0.63, 95% CI 0.45-0.80), and higher SOFA score (mean difference 1.95, 95% CI 1.21-2.70).ConclusionCritically ill patients with lung cancer have reasonable short term but poor long-term outcome. Focused and early goals of care discussions are crucial part of ICU care in this patient population.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"814-829"},"PeriodicalIF":2.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078511","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":"Acute Severe Asthma in the Intensive Care Unit: From Bronchodilators to Extracorporeal Membrane Oxygenation.","authors":"Parisa Abedi, Geoffrey Chupp, Gabriella Wilson, Sandra Zaeh, Astha Chichra","doi":"10.1177/08850666261466238","DOIUrl":"https://doi.org/10.1177/08850666261466238","url":null,"abstract":"<p><p>Acute severe asthma exacerbations are life-threatening critical care emergencies characterized by profound airflow obstruction, respiratory acidosis, and risk for cardiopulmonary arrest. For the purposes of this review, the term 'acute severe asthma' is used to encompass what has variably been described as near-fatal asthma, status asthmaticus, and life-threatening asthma in the literature. Early recognition of impending respiratory failure, timely intubation and a stepwise approach to supportive interventions are critically important to minimize the risk of mortality and optimize outcomes. Initial treatment focuses on prompt initiation of medical therapies to stabilize ventilation and prevent progression to respiratory failure. If intubated, ventilatory strategies aimed at reducing dynamic hyperinflation and auto-PEEP with permissive hypercapnia need to be considered. When conventional management fails or when barotrauma risk, acid base derangements or hypoxemia become life-threatening, venovenous extracorporeal membrane oxygenation (VV-ECMO) can be utilized as a bridge to recovery. Given its invasiveness, careful patient selection for VV-ECMO is essential. This review provides an overview of: 1) the pathophysiology of acute severe asthma exacerbations, 2) expert guidelines and 3) consensus on best practices for the optimal use of standard and adjunctive pharmacologic treatments and mechanical ventilation strategies, and 4) patient selection criteria for and the emerging role of VV-ECMO for the treatment of acute severe asthma.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666261466238"},"PeriodicalIF":2.3,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148840448","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":"Modern Approaches to the Treatment of Respiratory Distress Syndrome in Children: The Role of Surfactant and Antenatal Prophylaxis.","authors":"Aisuluu Omurzakova, Venera Azhikulova, Mairamkan Sharipova, Nargiza Kurbanova, Gulnura Zhunusbaeva","doi":"10.1177/08850666261454656","DOIUrl":"https://doi.org/10.1177/08850666261454656","url":null,"abstract":"<p><p>Background and ObjectiveThe aim of the study was to evaluate the multilevel impact of antenatal prophylaxis and modern non-invasive respiratory strategies on the course and outcomes of respiratory distress syndrome in new-borns.MethodsA total of 4080 hospitalisations of preterm and full-term infants with confirmed respiratory failure, born between 1 January 2017 and 30 September 2024, who received care at the Osh Regional Clinical Maternity Hospital (Kyrgyzstan), were included in the retrospective cohort registry. Gestational age, body weight, completeness of the antenatal glucocorticoid course, method of respiratory support, surfactant administration technique, incidence of bronchopulmonary dysplasia, and mortality were analysed.ResultsOver the observation period, the number of completed courses of betamethasone or dexamethasone increased from 120 to 442, and the proportion of early support with continuous positive airway pressure rose from 24% to 56%. In 2024, minimally invasive surfactant administration via thin catheter was applied in 70% of cases, which was accompanied by a reduction in the mean duration of mechanical ventilation from 68 ± 18 to 36 ± 12 h (p < 0.01) and a decrease in the incidence of bronchopulmonary dysplasia among infants weighing <1000 g from 42% to 26% (p = 0.03). Mortality within the first seven days of life declined from 21.7% to 11.4%, and the proportion of deaths within the first 24 h - from 30% to 12%. Among children who received a full antenatal course, the need for invasive ventilation amounted to only 6.8%, compared with 23.4% without prophylaxis (p < 0.001).ConclusionThe obtained data demonstrated the synergy of timely hormonal preparation and minimally invasive respiratory technologies, which made it possible to halve early neonatal mortality even in a resource-limited setting and laid the foundation for the introduction of a national protocol for managing respiratory distress syndrome in new-borns.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666261454656"},"PeriodicalIF":2.3,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148840429","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":"Correlation Study Between Inflammatory Markers and Pathogenic Characteristics in Patients with Severe Pneumonia in Intensive Care Units.","authors":"Xiufang Lu, Yali Kang, Lin Liu, Jingping Liu, Qiuyue Zhang, Jinjing Tian, Chuntang Tong","doi":"10.1177/08850666261480632","DOIUrl":"https://doi.org/10.1177/08850666261480632","url":null,"abstract":"<p><p>ObjectiveTo determine pathogen-specific inflammatory biomarker profiles, develop predictive models for Gram-negative infections and evaluate the added value of serial biomarker monitoring in critically ill patients with severe pneumonia in intensive care units (ICUs).MethodsThis retrospective cohort study included 126 adults admitted to a tertiary ICU between 1 June 2021 and 31 May 2024. Procalcitonin (PCT), C-reactive protein (CRP) and interleukin-6 (IL-6) were measured at admission and on ICU days 3, 5 and 7. Biomarker-pathogen associations were assessed using Spearman correlation, receiver operating characteristic (ROC) analysis, multivariate regression and stratified analysis of polymicrobial infection and ICU secondary superinfection.ResultsPredominant pathogens were Acinetobacter baumannii (15.9%), Candida spp. (14.3%), Klebsiella pneumoniae (9.5%), Escherichia coli (7.1%), Pseudomonas aeruginosa (6.3%) and Staphylococcus aureus (3.2%). PCT and IL-6 correlated with Gram-negative infection, especially K. pneumoniae (PCT: r = 0.56, p < 0.001; IL-6: r = 0.51, p < 0.001). PCT ≥ 2.8 ng/mL predicted Gram-negative pneumonia with an AUC of 0.83 (95%CI: 0.78-0.88), 79% sensitivity and 74% specificity. Combining PCT>2.8 ng/mL with IL-6 > 95 pg/mL increased specificity to 87% in monomicrobial Gram-negative infection and 83% in polymicrobial cases. Sustained dual elevation over 72 h predicted 28-day ICU mortality (HR = 2.14, 95%CI: 1.32-3.47) and dynamic trends predicted secondary superinfection better than admission biomarkers (AUC: 0.81 vs 0.65). PCT and IL-6 did not distinguish multidrug-resistant from antimicrobial-susceptible K. pneumoniae.ConclusionPCT and IL-6 help identify Gram-negative pneumonia and serial monitoring adds prognostic value, but biomarker thresholds should be interpreted with clinical findings and microbiological susceptibility results.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666261480632"},"PeriodicalIF":2.3,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148840375","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":"Oxygen Delivery in the Adult Intensive Care Unit with a Focus on Hyperoxic Acute Lung Injury Pathogenesis and Clinical Manifestations.","authors":"Zachary M Harris, Edward P Manning","doi":"10.1177/08850666261481468","DOIUrl":"https://doi.org/10.1177/08850666261481468","url":null,"abstract":"<p><p>High oxygen damages human lung, called hyperoxic acute lung injury (HALI). HALI pathogenesis involves formation of reactive oxygen species (ROS) which overwhelm antioxidant mechanisms and lead to alveolar epithelial and endothelial cell death and interstitial inflammation. Resultant alveolar flooding causes ventilation-perfusion (V/Q) mismatch, hypoxic respiratory failure, and death. 12-16 h of severe hyperoxic exposure potentiates symptoms that include substernal chest discomfort, cough, and sore throat. Alterations in pulmonary function that ensue are decreased vital capacity (VC), decreased arterial oxygen tension (PaO₂), increased intrapulmonary shunt, and increased dead space-to-tidal volume ratio (V_D/V_T). A multitude of observational studies demonstrate harm of hyperoxic exposure in critically ill patients. While one randomized clinical trial (RCT) found targeting a lower oxygenation target in critically ill patients was beneficial compared with a higher target, another RCT demonstrated harm of such a strategy in patients with acute respiratory distress syndrome (ARDS). Multiple subsequent RCTs examining effects of lower- and higher-oxygenation strategies in critically ill patients identify no clear benefit of either strategy in the general ICU population. However, heterogeneous effects of lower- and higher-oxygenation approaches in ICU patient subgroups warrant further investigation. It is paramount that ICU physicians recognize that lethal and sublethal amounts of hyperoxia result in lung damage and that patients who require hyperoxia to avoid deleterious hypoxia can be at risk for HALI. For each patient in the ICU, it is likely that ideal oxygen targets depend on the specific medical conditions affecting the patient and is a promising area of future study.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666261481468"},"PeriodicalIF":2.3,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148840396","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":"Development and Validation of an Interpretable Machine Learning Model for Predicting In-Hospital Mortality in Diabetic Patients with Sepsis-Associated Acute Kidney Injury.","authors":"Yanni Wang, Hongjie Shen, Shengze Wu, Suibi Yang, Feng Guo, Min Yang, Zhongheng Zhang","doi":"10.1177/08850666261479295","DOIUrl":"https://doi.org/10.1177/08850666261479295","url":null,"abstract":"<p><p>BackgroundSepsis-associated acute kidney injury (SA-AKI) is a common and severe complication in critically ill patients, with poor prognosis. Diabetes may further increase adverse outcomes through infection susceptibility, immune dysfunction, and renal vulnerability. However, mortality prediction models for patients with diabetes complicated by SA-AKI remain limited. This study aimed to develop and validate a machine learning-based model for early in-hospital mortality prediction in this population.MethodsA total of 6929 patients with SA-AKI and diabetes were identified from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database and randomly divided into training and validation sets at a ratio of 7:3. Ninety-four variables, including demographics, diagnoses, clinical parameters, and medication records within the first 24 h after ICU admission, were extracted. Twelve machine learning algorithms were developed and compared, and the optimal model was selected. Recursive feature elimination was used to identify key predictors, while SHapley Additive exPlanations were applied for model interpretation. The final model was deployed as a web-based tool and externally tested using the eICU Collaborative Research Database.ResultsThirty-two key predictors were ultimately selected, including urine output rate, platelet count, lactate, weight, blood glucose, SOFA score, pH, blood urea nitrogen, vital signs, coagulation indices, vasopressor use, and other clinically relevant variables. The categorical boosting algorithm model presented better predictive performance [receiver operating characteristic (AUC): 0.828] than other models [accuracy (ACC): 70.9%, sensitivity: 78.7%, specificity: 69%, F1 score: 0.509, positive predictive value (PPV): 33.7%, and negative predictive value (NPV): 93.1%]. External testing using data from the eICU database was also well validated (AUC: 0.793).ConclusionsA CatBoost-based machine learning model incorporating 32 clinically accessible variables showed good predictive performance for in-hospital mortality in patients with diabetes and SA-AKI, supporting early risk stratification and clinical decision-making.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666261479295"},"PeriodicalIF":2.3,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148840446","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 Statin Use With Short- and Long-Term Mortality in Critically Ill Patients With Aortic Stenosis: A Retrospective Cohort Study.","authors":"Yue Yu, Sanshuai Chang, Ke Shang, Yuemiao Jiao, Yang Li, Liuyang Tian, Guangyuan Song, Chengqian Yin","doi":"10.1177/08850666261469110","DOIUrl":"https://doi.org/10.1177/08850666261469110","url":null,"abstract":"<p><p>BackgroundStatins have not been shown to modify valvular disease progression in relatively stable aortic stenosis populations, but their prognostic relevance during critical illness remains unclear.MethodsWe conducted a retrospective cohort study using the MIMIC-IV database. Adult patients with aortic stenosis were included at their first ICU stay if the ICU length of stay was at least 24 h. In-hospital statin prescription exposure was identified from prescription records. The primary outcome was 30-day all-cause mortality after ICU admission, with secondary outcomes at 7, 60, 120, and 365 days. Associations were assessed using hierarchical Cox regression models and propensity score matching (1:1 nearest-neighbor matching; caliper 0.03). Multiple imputation was applied for variables with less than 30% missingness. A 24-h landmark sensitivity analysis was additionally performed for the 30-day primary endpoint.ResultsA total of 1484 patients were included, of whom 1030 had statin prescription exposure and 454 did not; propensity score matching yielded 706 patients. In the fully adjusted primary model, statin exposure was associated with lower 30-day mortality (hazard ratio [HR] 0.458, 95% CI 0.312-0.674; P < 0.0001). In the matched cohort, statin use remained associated with lower 30-day mortality (HR 0.424, 95% CI 0.269-0.666; P < 0.001).ResultsThe results were materially unchanged in the 24-h landmark sensitivity analysis (HR 0.434, 95% CI 0.288-0.653; P < 0.0001). E-values ranged from 2.80 to 5.91.ConclusionsIn this retrospective ICU cohort of patients with aortic stenosis, in-hospital statin prescription exposure was associated with lower all-cause mortality across evaluated follow-up time points. Prospective studies that better account for treatment selection and time-varying exposure are warranted.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666261469110"},"PeriodicalIF":2.3,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148840464","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":"Diarrhea in Critically ill Patients: Evaluation and Management in the Intensive Care Unit.","authors":"Marwan N Hassan","doi":"10.1177/08850666261462918","DOIUrl":"https://doi.org/10.1177/08850666261462918","url":null,"abstract":"<p><p>ObjectiveDiarrhea is a common and clinically significant problem in critically ill patients, often reflecting underlying gastrointestinal dysfunction, systemic illness, or iatrogenic factors. The study aims to provide a practical framework for intensivists to identify, evaluate, and manage diarrhea in the critically ill patients, emphasizing its clinical significance, diagnostic approach, and management strategies.MethodsThis review synthesizes current evidence on the epidemiology, pathophysiology, and risk factors of ICU diarrhea. Life-threatening and non-life-threatening causes are discussed, including Clostridioides difficile infection, acute mesenteric ischemia, critical illness-associated diarrhea, drug-induced diarrhea, and enteral nutrition-related diarrhea. Diagnostic strategies, including bedside assessment, stool testing, and imaging, are outlined, alongside therapeutic approaches prioritizing fluid and electrolyte balance, modification of iatrogenic triggers, and optimization of enteral nutrition.ResultsICU diarrhea is associated with increased morbidity, fluid and electrolyte disturbances, malnutrition, skin breakdown, secondary infections, prolonged ICU stay, and higher healthcare costs. Early recognition, systematic evaluation, and a structured management plan can reduce complications and maintain enteral nutrition.ConclusionDiarrhea in critically ill patients is a marker of gut dysfunction and systemic instability. A multidisciplinary, evidence-based approach is essential to improve outcomes, prevent complications, and optimize nutritional support.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666261462918"},"PeriodicalIF":2.3,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148840456","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":"Higher Risk of Acute Kidney Injury in Sepsis Patients with High PEEP Trajectories: A Study Using the Latent Class Trajectory Model Based on the MIMIC-IV Database.","authors":"Ke Zhan, Ling Qi, Dongmei Zhang, Changliang Zhu, Liling Zhang, Santao Ou, Ling Xue, Yuhan Tang, Weihua Wu","doi":"10.1177/08850666261479704","DOIUrl":"https://doi.org/10.1177/08850666261479704","url":null,"abstract":"<p><p>ObjectiveUsing the MIMIC database, this study aimed to clarify the link between high positive end-expiratory pressure (PEEP) and acute kidney injury (AKI) in septic patients, identify the characteristics of those with high PEEP, and provide evidence for protecting the kidneys of septic patients on mechanical ventilation.MethodsData of septic patients on mechanical ventilation were extracted from the MIMIC-IV database. Daily mean PEEP values for the first 10 days were calculated. The latent class trajectory model (LCTM) was leveraged to identify PEEP trajectory changes, and the optimal number of trajectories was estimated with the Bayesian information criterion. Binary regression explored the link between different PEEP trajectories and AKI.Results2142 septic patients on mechanical ventilation were included. LCTM analysis classified 1275 (59.52%) into the low PEEP, 649 (30.30%) into the medium PEEP, and 218 (10.18%) into the high PEEP groups. After confounders were adjusted, compared to the low PEEP group, the odds ratios (ORs) and 95% confidence intervals (CIs) for AKI were 1.43 (95% CI: 1.15, 1.76, <i>P</i> <i>=</i> <i>0.001</i>) in the medium and 1.63 (95% CI: 1.18, 2.25, <i>P</i> <i>=</i> <i>0.003</i>) in the high PEEP groups.ConclusionIn septic patients on mechanical ventilation, those with high PEEP have a higher AKI risk. PEEP could be a risk assessment indicator for AKI in critically ill septic patients.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666261479704"},"PeriodicalIF":2.3,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148829431","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}