Journal of the Intensive Care Society最新文献

{"title":"Recurrent ICU admissions following deliberate self-poisoning: Clinical, ethical, and emotional pressures on critical care services.","authors":"Harry Calder, Ayush Sinha","doi":"10.1177/17511437251410035","DOIUrl":"10.1177/17511437251410035","url":null,"abstract":"","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"17511437251410035"},"PeriodicalIF":1.9,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12779531/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145953300","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 prospective cohort feasibility study of real-time beta-lactam antimicrobial therapeutic drug monitoring in critically ill patients with lower respiratory infection: The TDM-TIME study.","authors":"Jan Hansel, Jake Lain, Emmanuel O Erhieyovwe, Aybaniz Ismayilli, James Orr, Brian G Keevil, Kayode Ogungbenro, Paul M Dark, Timothy W Felton","doi":"10.1177/17511437251404324","DOIUrl":"10.1177/17511437251404324","url":null,"abstract":"<p><strong>Background: </strong>Critically ill patients with lower respiratory tract infections often fail to achieve therapeutic beta-lactam antibiotic concentrations, despite standard dosing. Therapeutic drug monitoring (TDM) may improve attaining drug exposure, but delayed turnaround times limit its clinical impact. The objective of this study was to evaluate the feasibility of delivering real-time beta-lactam TDM results within two dosing intervals.</p><p><strong>Methods: </strong>We conducted a single-centre prospective cohort feasibility study in two ICUs in Manchester, UK. Critically ill adult patients receiving piperacillin/tazobactam or meropenem for suspected or confirmed lower respiratory infection were enrolled. Blood samples were collected for analysis and drug quantification, with the primary outcome being the proportion of TDM results returned within two dosing intervals. Secondary outcomes included detailed time-to-result, clinical and microbiological outcomes. TDM results were not released to clinical teams.</p><p><strong>Results: </strong>We recruited 30 participants, of whom 20 (67%) had TDM results available within two dosing intervals. The median time from blood sampling to TDM result was 10.9 h, with a median time from antimicrobial initiation to result of 25.4 h. At 28 days, 70% of participants were alive, with a median (IQR) ICU and hospital length of stay of 7 (5-25) and 17 (10-27) days, respectively. Resistant pathogen strains were isolated in 4/21 (19%) participants.</p><p><strong>Discussion: </strong>Recruitment of critically ill participants into a time-sensitive trial of TDM is feasible. Timely feedback of beta-lactam TDM results to clinicians is achievable, however, barriers to streamlined around-the-clock implementation remain. Future clinical trials of beta-lactam TDM should factor turnaround times into study design.</p><p><strong>Registration: </strong>NCT05971979.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"22-29"},"PeriodicalIF":1.4,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12738274/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145850686","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":"Sand aspiration managed with extracorporeal membrane oxygenation and a mechanical insufflation-exsufflation device: A case report.","authors":"Raphael Holmes, Mike Brown, Charlotte Atkinson, Lajos Szentgyorgyi","doi":"10.1177/17511437251401434","DOIUrl":"10.1177/17511437251401434","url":null,"abstract":"<p><p>We present a case of a class 3 drowning event with severe sand aspiration, successfully managed with mechanical ventilation, bronchoalveolar lavage, ECMO, and the use of a mechanical insufflation-exsufflation device (MI-E). Sand aspiration is a potentially lethal consequence of near-drowning events. It may cause respiratory failure by several mechanisms, including laryngospasm, upper or lower airway obstruction and an intrinsic acute respiratory distress syndrome (ARDS) related to the sand itself. Its standard management involves lung-protective mechanical ventilation strategies, bronchoalveolar lavage, and, more recently, extracorporeal membrane oxygenation (ECMO) in adult and paediatric cases. MI-E devices are commonly used by physiotherapists in the intensive care setting to facilitate secretion clearance in extubated patients, reducing the occurrence of ventilator-associated pneumonia. However, their use in intubated patients in the UK is not as common due to a lack of evidence and experience. The evidence supporting their use in intubated patients is of low quality, and we have not found any examples of their use for clearing aspirated particulate matter or in conjunction with ECMO in the literature. We believe this is the first time MI-E has been used this way. We argue that it could be a valuable addition to the management of sand and other particulate aspirations, even in severe cases requiring ECMO, and it warrants further exploration. Using a MI-E device may significantly decrease the duration of ECMO treatment, reducing its associated complications and expenses.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"107-112"},"PeriodicalIF":1.4,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12716973/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145805790","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":"ERRATUM to \"Volume 26 Issue 1_suppl, February 2025\".","authors":"","doi":"10.1177/17511437251374125","DOIUrl":"https://doi.org/10.1177/17511437251374125","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1177/17511437241311087.].</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":"26 1 Suppl","pages":"29"},"PeriodicalIF":1.4,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12701271/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145757739","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":"Does in-bed cycling delivered within 48 hours of mechanical ventilation, reduce the occurrence of delirium in critically ill patients: A mixed-methods feasibility randomised controlled trial protocol.","authors":"Jacqueline Bennion, Mark Hudson, Mary Hickson, Victoria Allgar, Bridie Kent, David McWilliams, Daniel Martin","doi":"10.1177/17511437251400612","DOIUrl":"10.1177/17511437251400612","url":null,"abstract":"<p><strong>Background: </strong>Delirium is a severe neuropsychiatric clinical state presenting as an acute onset of cognitive deficits. Patients receiving invasive mechanical ventilation (IMV), have the highest incidence (50%-80%) of delirium amongst patients admitted to intensive care units. Preliminary data indicates that early mobilisation is associated with reduced delirium in critically ill patients. However, definitive evidence is lacking. Current practice varies due to many barriers to patients, who require IMV, receiving early mobilisation interventions. In-bed cycling may address some of these barriers. This research aims to evaluate the feasibility and acceptability of early in-bed cycling to reduce delirium in critically ill patients.</p><p><strong>Methods: </strong>This multi-site feasibility randomised controlled trial will evaluate early (⩽48 h following IMV), in-bed cycling as a method of early mobilisation, to reduce delirium. Eighty-four participants will be randomised across three sites in a 1:1 ratio, to receive either early in-bed cycling in addition to usual care or usual care alone. The primary outcome is feasibility (recruitment, retention, intervention fidelity). Secondary outcomes include different methods of measuring delirium, physical function, length of stay, ventilator free days, sedation free days, Richmond Agitation Sedation Scale, adverse events and mortality. Descriptive statistical analyses will be conducted. Hypothesis testing will be used for exploratory analysis of the mechanistic sub-study outcomes. An embedded qualitative interview study will evaluate the acceptability of this research.</p><p><strong>Conclusion: </strong>This trial has been prospectively registered (ISRCTN74277350) and received full ethical approval (REC reference: 24/SC/0096). The trial opened to recruitment in July 2024. Recruitment will take place across 18-months.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"90-97"},"PeriodicalIF":1.4,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12685707/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145726586","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":"Diagnosing death, best interests, consent and the law.","authors":"Liam Scott","doi":"10.1177/17511437251404337","DOIUrl":"https://doi.org/10.1177/17511437251404337","url":null,"abstract":"","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"17511437251404337"},"PeriodicalIF":1.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12668982/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145670211","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":"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}