Journal of the Intensive Care Society最新文献

{"title":"Continuous versus intermittent beta-lactam antibiotic infusions in critically ill patients: The UK cohort of the BLING III trial.","authors":"Janis Best-Lane, Farah Al-Beidh, Greg Barton, Dorrilyn Rajbhandari, Xiaoqiu Liu, Jayanthi Mysore, Serena Knowles, Naomi Hammond, Joel Dulhunty, John Myburgh, Jeffrey Lipman, Stephen J Brett","doi":"10.1177/17511437251396871","DOIUrl":"10.1177/17511437251396871","url":null,"abstract":"<p><strong>Background: </strong>There are theoretical reasons why beta-lactam antibiotics may be more effective in treating severe infections if administered by continuous infusion, rather than short intermittent infusions. The Beta-Lactam Infusion Group (BLING) III trial was a multinational randomised clinical trial (RCT) which tested this hypothesis in participants with sepsis who were cared for in an intensive care unit (ICU). The United Kingdom (UK) findings are reported here.</p><p><strong>Methods: </strong>The global trial was an open-label RCT conducted in the UK, Australia, New Zealand, Belgium, France, Sweden and Malaysia. Participants were critically ill adults being treated with meropenem or piperacillin/tazobactam due to a confirmed or presumed infection. Participants were randomised to receive the antibiotic by either continuous infusion or short intermittent infusion at equivalent daily doses as selected by the treating team. The primary outcome was 90-day all-cause mortality; secondary outcomes included clinical cure up to 14 days after randomisation, new infection and acquisition of resistant organisms, ICU and in hospital mortality.</p><p><strong>Results: </strong>Overall, 7202 participants were randomised, with 2900 from the UK. The UK cohort had very similar baseline characteristics and outcomes to the global trial. For continuous versus intermittent infusion, the global trial showed 24.9% versus 26.8% participants had died by 90 days (odds ratio 0.91, 95% CI: 0.81-1.01, <i>p</i> = 0.08); and in the UK 26.7% versus 29.3% participants had died (odds ratio 0.88, 95% CI: 0.75-1.04, <i>p</i> = 0.13). Although not statistically significant, all outcomes showed point estimates in favour of continuous infusion.</p><p><strong>Conclusions: </strong>The findings in the UK cohort are consistent with the conclusions drawn from the global BLING III trial. It seems reasonable to conclude the finding are applicable to the UK.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"30-40"},"PeriodicalIF":1.4,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12662772/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145649342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"No flow, no cough, no clearance? The challenge of airway clearance in ECMO-supported severe acute respiratory failure.","authors":"Tom Lunn, Ema Swingwood, George Ntoumenopoulos","doi":"10.1177/17511437251398343","DOIUrl":"10.1177/17511437251398343","url":null,"abstract":"<p><strong>Background: </strong>Airway clearance is a vital aspect of respiratory care in patients with severe acute respiratory failure receiving veno-venous extracorporeal membrane oxygenation (VV-ECMO). These patients often receive high levels of sedation alongside ultra-lung protective invasive mechanical ventilation, which, while reducing ventilator-induced lung injury, significantly impairs physiological mechanisms essential for secretion clearance, such as expiratory flow bias, mucociliary transport, and effective cough.</p><p><strong>Objectives: </strong>This commentary explores the multifaceted challenges to airway clearance in the VV-ECMO population, evaluating current physiotherapeutic interventions, and identifying critical areas for future research.</p><p><strong>Discussion: </strong>Ultra-lung protective ventilation settings reduce airflow and expiratory shear forces necessary for secretion mobilisation. Concurrent sedation and neuromuscular blockade suppress cough reflexes and promote secretion stasis, while reduced airflow impairs the two-phase gas-liquid flow critical for airway hygiene. Additionally, increased secretion viscosity and altered lung mechanics further limit clearance. Current physiotherapy strategies such as suctioning, hyperinflation, cough augmentation, and manual techniques are often adapted from non-ECMO settings and lack validation in this population. Diagnostic challenges, such as reduced auscultation efficacy, highlight the growing importance of tools like lung ultrasound. Pharmacological adjuncts, including mucolytics and saline lavage, are used despite limited supporting evidence.</p><p><strong>Conclusion: </strong>Airway clearance in patients receiving VV-ECMO is hampered by a convergence of physiological, mechanical, and clinical factors. Existing literature remains scarce and largely extrapolated from conventional invasive mechanical ventilation populations. There is an urgent need for targeted research to define evidence-based interventions tailored to the unique pathophysiology of this complex group.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"113-118"},"PeriodicalIF":1.4,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12640279/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145597310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A final word from the Editor in Chief.","authors":"Daniel Martin","doi":"10.1177/17511437251396862","DOIUrl":"10.1177/17511437251396862","url":null,"abstract":"","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"13-14"},"PeriodicalIF":1.4,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12640271/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145597342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to \"Updated local safety standards for invasive procedures: Guidance or suggestions?\" letter.","authors":"Clare Windsor, Peter Hersey, Waqas Akhtar, Peter Bamford, Jayaprakash Patil","doi":"10.1177/17511437251396731","DOIUrl":"https://doi.org/10.1177/17511437251396731","url":null,"abstract":"","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"17511437251396731"},"PeriodicalIF":1.4,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12634378/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145588805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"NHS blood and transplant donor echocardiography standard to improve organ utilisation in heart transplantation.","authors":"Waqas Akhtar, Marcus Peck, Ashley Miller, Thomas Billyard, Charlotte Goedvolk, Marian Ryan, Hatem Soliman Aboumarie, Fernando Riesgo Gil, Marius Berman, Antonio Rubino","doi":"10.1177/17511437251394267","DOIUrl":"10.1177/17511437251394267","url":null,"abstract":"<p><p>Focused echocardiography plays a vital role in assessing donor hearts and improving donor utilisation in the United Kingdom. A NHS Blood & Transplant working group was established and, through a review of the current evidence and modified Delphi approach, developed guidance for a minimum dataset for image acquisition in donor heart assessment. This is in intended as a pragmatic optional supplementation to current focused echocardiography protocols. We present a donor echocardiography proforma with accompanying educational materials for use in the United Kingdom.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"17511437251394267"},"PeriodicalIF":1.4,"publicationDate":"2025-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12619695/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145542915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adult extracorporeal cardiopulmonary resuscitation in the United Kingdom 2012 to 2022: A multicentre observational study.","authors":"Waqas Akhtar, Eftychia Galiatsou, Sofia Pinto, Neil Brain, Miguel Garcia, Matthew Govier, Simon Finney, Sameer Patel, Henning Pauli, James Raitt, Carla Richardson, Antonio Rubino, Caroline Sampson, Claire Scanlon, Ian Scott, Nicholas Barrett, Alain Vuylsteke, Peter Sherren, Ben Singer, Luigi Camporota, Brijesh Patel, Alex Rosenberg","doi":"10.1177/17511437251392801","DOIUrl":"10.1177/17511437251392801","url":null,"abstract":"<p><strong>Introduction: </strong>Survival rates for cardiac arrest remain low. Extracorporeal cardiopulmonary resuscitation (ECPR) may offer a survival advantage in carefully selected patients. There is limited published data on ECPR in the UK and therefore this study aims to describe the last 11 years provision and outcomes of ECPR in the UK.</p><p><strong>Methods: </strong>This was a multicentre retrospective cohort study in the UK. Centres offering Extracorporeal membrane oxygenation (ECMO) as a potential support in the UK were identified at the first UK ECPR Summit. All centres were asked to submit data on their veno-arterial (VA) ECMO and ECPR patients between 1st January 2012 and 31st December 2022.</p><p><strong>Results: </strong>Over the 11-year period, 2117 patients received VA-ECMO in the UK with 963 survivors at 6 months (45.5%). Of these there were 302 ECPR runs with 92 survivors (30.5%). ECPR contributed to 14.3% of the total VA ECMO runs, with wide between-centre variation ranging from 5.4% to 73.3%. Centres provided a detailed dataset for 129 of the 172 consecutive ECPR cases for a 5-year period to 31st December 2022. The mean (SD) age was 46 ± 5 years, 77% were male and 48.9% presented with a shockable rhythm. The leading cause of cardiac arrest was ischaemic heart disease (45%). Only 14% achieved transient or sustained return of spontaneous circulation prior to initiation of ECMO flow, with mean time CPR to full ECMO flow of 52.5 ± 17.1 min. Percutaneous cannulation was performed in 85.3% of cases, with 51.9% of these procedures taking place in the cardiac catheter laboratory.</p><p><strong>Conclusion: </strong>In an UK cohort of VA ECMO and ECPR patients, the survival rates were comparable to other international registries. The variation in practice highlights the need to explore and address inequity of access to ECMO and ECPR services.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"48-54"},"PeriodicalIF":1.4,"publicationDate":"2025-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12619693/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145542976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anaemia management with red blood cell transfusion to improve post-intensive care disability: Protocol for the ABC post-ICU randomised controlled trial.","authors":"Timothy S Walsh, Lydia Emerson, Jo Singleton, Rachel Locherty, David Hope, Stephanie Cholbi, Annabel Giddings, Alix Macdonald, Nazir Lone, Annemarie B Docherty, Gillian Mead, Simon J Stanworth, Alexander Drakesmith, Noemi B A Roy, Peter Hall, Aileen R Neilson, Roz Pollock, Aryelly Rodriguez, John Norrie, Christopher J Weir, Akshay Shah, David Griffith","doi":"10.1177/17511437251374884","DOIUrl":"10.1177/17511437251374884","url":null,"abstract":"<p><strong>Background: </strong>Anaemia is prevalent after intensive care unit (ICU) discharge as a consequence of factors such as blood sampling, concurrent inflammation affecting erythropoiesis, and the use of restrictive ICU red blood cell (RBC) transfusion practice during inpatient stay. ICU survivors experience poor health-related quality of life (HRQoL). Prevalent symptoms include fatigue and weakness, to which anaemia may contribute. There are no trials exploring the effectiveness of treating anaemia with RBC transfusions post-ICU discharge.</p><p><strong>Methods and analysis: </strong>The ABC post-ICU trial is a multicentre prospective, parallel group, randomised trial, with embedded moderation and mediation analysis. Participants are adult ICU survivors with anaemia (haemoglobin (Hb) ⩽94 g/L) fit for ICU discharge. Patients are randomised to usual care (default Hb transfusion trigger <70 g/L, target 70-90 g/L) or single-unit RBC transfusions to achieve Hb range 100-120 g/L. The intervention is from randomisation to hospital discharge. Primary outcome is the physical component summary score (PCS) of the 36-item short form (SF-36) health survey, which measures HRQoL, assessed 90 days post-randomisation. Secondary outcomes at 90 days include: hospital length of stay, mortality, fatigue score, activities of daily living, and Mental Component Scale score (MCS) SF-36. Outcomes are also measured at 30 and 180 days. Safety outcomes include: new infections, transfusion-related adverse events, and major adverse cardiac events. Analysis includes a moderation analysis based on baseline recalled PCS SF-36, comorbidity burden, mobility, and systemic inflammation (C-reactive protein (CRP) concentration). A mediation analysis based on 30 days blood samples will explore whether anaemia severity (Hb) or persisting inflammation (CRP) mediates intervention effects. A health-economic analysis over 180 days will be conducted. The sample size is 346, providing 90% power to detect a difference in PCS SF-36 of 5 points, assuming >70% completed SF-36 follow-up.</p><p><strong>Clinicaltrialsgov: </strong>NCT04591574.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"98-106"},"PeriodicalIF":1.4,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12611750/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145543008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The experiences of bedside nurses delivering an intensive care sedation study: A process evaluation within the A2B trial.","authors":"Lydia M Emerson, Bronagh Blackwood, Kalliopi Kydonaki, Cathrine McKenzie, Timothy S Walsh, Leanne M Aitken","doi":"10.1177/17511437251381951","DOIUrl":"10.1177/17511437251381951","url":null,"abstract":"<p><strong>Background: </strong>This process evaluation explored delivery of a complex sedation intervention within the Alpha-2 Agonists for Sedation to Produce Better Outcomes from Critical Illness (A2B) trial, which compared dexmedetomidine- and clonidine-based sedation with propofol (usual care). All groups targeted lighter sedation levels. The objective was to understand bedside nurses' experiences delivering the interventions and identify factors influencing protocol adherence and implementation.</p><p><strong>Methods: </strong>A qualitative study using semi-structured interviews was conducted with intensive care unit (ICU) staff (consultants, bedside and research nurses) from A2B trial sites. Thematic analysis explored how participants experienced and delivered trial interventions, with particular focus on bedside nurses' abilities to manage sedation in line with the protocol.</p><p><strong>Results: </strong>Nurses with greater ICU experience described more confidence and adaptability in using alpha-2 agonists, while less experienced staff required support due to limited familiarity with lighter sedation. Hesitancy to up-titrate alpha-2 agonists was common, driven by concerns about bradycardia and hypotension. Reluctance to down-titrate propofol was shaped by fears of agitation and self-extubation. Deep sedation norms, especially amongst nurses trained during the COVID-19 pandemic, further hindered protocol adherence. Research nurses were instrumental in supporting implementation and bridging knowledge gaps.</p><p><strong>Conclusion: </strong>Despite all three trial groups targeting lighter sedation, nurse confidence, safety concerns, and ingrained cultural practices limited adherence to alpha-2 agonist-based protocols. Addressing these barriers through training, support, and cultural change will be essential for future trials and practice shifts involving lighter sedation strategies in ICU.</p><p><strong>Trial registration number: </strong>ClinicalTrials.gov NCT03653832 https://clinicaltrials.gov/study/NCT03653832.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"17511437251381951"},"PeriodicalIF":1.4,"publicationDate":"2025-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12597800/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145497021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding the impact of an online post-ICU peer support group: A survey of patients and families.","authors":"Natalie McEvoy, Sabina Mason, Serena O'Brien, Barbara Egan, Melanie Ryberg","doi":"10.1177/17511437251381958","DOIUrl":"10.1177/17511437251381958","url":null,"abstract":"<p><p>Peer support groups for Intensive Care Unit (ICU) survivors and family members hold promising potential to reduce the psychological burden associated with critical illness and increase social support. We invited all ICU survivors and family members who attended an online peer support group in Ireland ('ICUsteps Dublin' open to those across the Island of Ireland) over a five-year period to complete a brief satisfaction survey. Overall, respondents reported high levels of satisfaction. Four key themes emerged from the open-ended responses: decreased feeling of isolation, gaining insight and perspectives, shared experiences and suggestions for improvement.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"17511437251381958"},"PeriodicalIF":1.4,"publicationDate":"2025-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12583009/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145453457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of appropriate empiric antimicrobial therapy with acute kidney injury in gram-negative sepsis.","authors":"Tetsu Ohnuma, Shreya Khandelwal, Shingo Chihara, Miriam Treggiari, Jamie R Privratsky, Pattrapun Wongsripuemtet, Julia A Messina, Karthik Raghunathan, Vijay Krishnamoorthy","doi":"10.1177/17511437251377990","DOIUrl":"10.1177/17511437251377990","url":null,"abstract":"<p><strong>Background: </strong>Despite advances in sepsis management, the relationship between appropriate empiric antibiotic therapy and acute kidney injury (AKI) in sepsis remains unclear. This study aimed to examine the association of appropriate empiric antimicrobial therapy with AKI in early onset sepsis caused by gram-negative bloodstream infections.</p><p><strong>Methods: </strong>We conducted a retrospective study of gram-negative bloodstream infection episodes in adult patients with early onset sepsis, using the Premier Healthcare Database from 2016 to 2020. The exposure was appropriate empiric antibiotic therapy determined by antibiotic regiments and antimicrobial susceptibilities of pathogens. The primary outcome was development of AKI or death by day 7 after the onset of sepsis. AKI was defined using the Kidney Disease Improving Global Outcome criteria based on serum creatinine levels, as urine output data were not available. The multivariable regression analysis was used to examine the association between appropriate empiric antibiotic therapy and the outcomes.</p><p><strong>Results: </strong>We identified 8565 patients with gram negative sepsis. In the total sample, the proportion of appropriate empiric antibiotic therapy was 93.2%, and the prevalence of AKI was 85.3%. Appropriate empiric antibiotic therapy was associated with decreased risk of AKI or death (adjusted odds ratio 0.70, 95% CI 0.52-0.94). For secondary outcomes, appropriate empiric antibiotic therapy was associated with lower AKI, shorter hospital LOS, lower C. difficile infections. However, it was not associated with in-hospital mortality.</p><p><strong>Conclusion: </strong>Appropriate empiric antibiotic therapy was associated with lower AKI in gram-negative sepsis. Early administration of appropriate antibiotics may prevent development of AKI.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"41-47"},"PeriodicalIF":1.4,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12510998/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145281255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}