Journal of intensive medicine最新文献

{"title":"Pathophysiological dynamics in the contact, coagulation, and complement systems during sepsis: Potential targets for nafamostat mesilate","authors":"","doi":"10.1016/j.jointm.2024.02.003","DOIUrl":"10.1016/j.jointm.2024.02.003","url":null,"abstract":"<div><p>Sepsis is a life-threatening syndrome resulting from a dysregulated host response to infection. It is the primary cause of death in the intensive care unit, posing a substantial challenge to human health and medical resource allocation. The pathogenesis and pathophysiology of sepsis are complex. During its onset, pro-inflammatory and anti-inflammatory mechanisms engage in intricate interactions, possibly leading to hyperinflammation, immunosuppression, and long-term immune disease. Of all critical outcomes, hyperinflammation is the main cause of early death among patients with sepsis. Therefore, early suppression of hyperinflammation may improve the prognosis of these patients. Nafamostat mesilate is a serine protease inhibitor, which can inhibit the activation of the complement system, coagulation system, and contact system. In this review, we discuss the pathophysiological changes occurring in these systems during sepsis, and describe the possible targets of the serine protease inhibitor nafamostat mesilate in the treatment of this condition.</p></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"4 4","pages":"Pages 453-467"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667100X24000343/pdfft?md5=a5ef2146e5925d67ab478d7267460b9b&pid=1-s2.0-S2667100X24000343-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140794672","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 causal role of immune cells in susceptibility and severity of COVID-19: A bidirectional Mendelian randomization study","authors":"","doi":"10.1016/j.jointm.2024.02.001","DOIUrl":"10.1016/j.jointm.2024.02.001","url":null,"abstract":"","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"4 4","pages":"Pages 537-538"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667100X24000148/pdfft?md5=c5e592c7e70ab6e88cbe11d7720ce27f&pid=1-s2.0-S2667100X24000148-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140271788","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":"Adaptive platform trials in critical care","authors":"Muralie Vignarajah ,&nbsp;Bram Rochwerg","doi":"10.1016/j.jointm.2024.04.002","DOIUrl":"10.1016/j.jointm.2024.04.002","url":null,"abstract":"","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"4 4","pages":"Pages 478-479"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667100X24000471/pdfft?md5=b264f1271456dd9d38292329b122ab17&pid=1-s2.0-S2667100X24000471-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142149110","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":"Advancing understanding and management of invasive fungal diseases in the intensive care unit: Insights from FUNDICU consensus definitions","authors":"Ignacio Martin-Loeches","doi":"10.1016/j.jointm.2024.06.001","DOIUrl":"10.1016/j.jointm.2024.06.001","url":null,"abstract":"","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"4 4","pages":"Pages 482-483"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667100X24000720/pdfft?md5=0089500e6bd86bd20272d1703930bc85&pid=1-s2.0-S2667100X24000720-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141707272","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":"Relevance of plasma lipoproteins and small metabolites in assessment of nutritional status among patients with severe injuries","authors":"","doi":"10.1016/j.jointm.2024.02.004","DOIUrl":"10.1016/j.jointm.2024.02.004","url":null,"abstract":"<div><h3>Background</h3><p>This study aimed to identify plasma lipoproteins and small metabolites associated with high risk of malnutrition during intensive care unit (ICU) stay in patients with severe injuries.</p></div><div><h3>Methods</h3><p>This observational prospective exploratory study was conducted at two level-1 trauma centers in the Netherlands. Adult patients (aged ≥18 years) who were admitted to the ICU for more than 48 h between July 2018 and April 2022 owing to severe injuries (polytrauma, as defined by Injury Severity Scores of ≥16) caused by blunt trauma were eligible for inclusion. Partial least squares discriminant analysis was used to analyze the relationship of 112 lipoprotein-related components and 23 small metabolites with the risk of malnutrition (modified Nutrition Risk in Critically Ill score). Malnutrition was diagnosed based on Subjective Global Assessment scores. The relationship of lipoprotein properties and small metabolite concentrations with malnutrition (during ICU admission) was evaluated using mixed effects logistic regression.</p></div><div><h3>Results</h3><p>Overall, 51 patients were included. Lower (very) low-density lipoprotein ([V]LDL) (free) cholesterol and phospholipid levels, low particle number, and higher levels of LDL triglycerides were associated with a higher risk of malnutrition (variable importance in projection [VIP] value &gt;1.5). Low levels of most (V)LDL and intermediate-density lipoprotein subfractions and high levels of high-density lipoprotein Apo-A1 were associated with the diagnosis of malnutrition (VIP value &gt;1.5). Increased levels of dimethyl sulfone, trimethylamine N-oxide, creatinine, N, N-dimethylglycine, and pyruvic acid and decreased levels of creatine, methionine, and acetoacetic acid were also indicative of malnutrition (VIP value &gt;1.5). Overall, 14 lipoproteins and 1 small metabolite were significantly associated with a high risk of malnutrition during ICU admission (<em>P</em> &lt;0.05); however, the association did not persist after correcting the false discovery rate (<em>P</em>=0.35 for all).</p></div><div><h3>Conclusion</h3><p>Increased triglyceride in several lipoprotein subfractions and decreased levels of other lipoprotein subfraction lipids and several small metabolites (involved in the homocysteine cycle, ketone body formation, and muscle metabolism) may be indicative of malnutrition risk. Following validation in larger cohorts, these indicators may guide institution of preventive nutritional measures in patients admitted to the ICU with severe injuries.</p></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"4 4","pages":"Pages 496-507"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667100X24000380/pdfft?md5=b352dc663650351f572332b8c2564c95&pid=1-s2.0-S2667100X24000380-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140759253","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":"Effect of music therapy on short-term psychological and physiological outcomes in mechanically ventilated patients: A randomized clinical pilot study","authors":"","doi":"10.1016/j.jointm.2024.01.006","DOIUrl":"10.1016/j.jointm.2024.01.006","url":null,"abstract":"<div><h3>Background</h3><p>Elevated anxiety levels are common in patients on mechanical ventilation (MV) and may challenge recovery. Research suggests music-based interventions may reduce anxiety during MV. However, studies investigating specific music therapy techniques, addressing psychological and physiological well-being in patients on MV, are scarce.</p></div><div><h3>Methods</h3><p>This three-arm randomized clinical pilot study was conducted with MV patients admitted to the intensive care unit (ICU) of Hospital San José in Bogotá, Colombia between March 7, 2022, and July 11, 2022. Patients were divided into three groups: intervention group 1 (IG1), music-assisted relaxation; intervention group 2 (IG2), patient-preferred therapeutic music listening; and control group (CG), standard care. The main outcome measure was the 6-item State-Anxiety Inventory. Secondary outcomes were: pain (measured with a visual analog scale), resilience (measured with the Brief Resilience Scale), agitation/sedation (measured with the Richmond Agitation–Sedation Scale), vital signs (including heart rate, blood pressure, oxygen saturation, and respiratory rate), days of MV, extubation success, and days in the ICU. Additionally, three patients underwent electroencephalography during the interventions.</p></div><div><h3>Results</h3><p>Data from 23 patients were analyzed in this study. The age range of the patients was 24.0–84.0 years, with a median age of 66.0 years (interquartile range: 57.0–74.0). Of the 23 patients, 19 were female (82.6%). No statistically significant differences between the groups were observed for anxiety (<em>P</em>=0.330), pain (<em>P</em>=0.624), resilience (<em>P</em>=0.916), agitation/sedation (<em>P</em>=0.273), length of ICU stay (<em>P</em>=0.785), or vital signs. A statistically significant difference between the groups was found for days of MV (<em>P</em>=0.019). Electroencephalography measurements showed a trend toward delta and theta band power decrease for two patients and a power increase on both beta frequencies (slow and fast) in the frontal areas of the brain for one patient.</p></div><div><h3>Conclusions</h3><p>In this pilot study, music therapy did not significantly affect the anxiety levels in patients on MV. However, the interventions were widely accepted by the staff, patients, and caregivers and were safe, considering the critical medical status of the participants. Further large-scale randomized controlled trials are needed to investigate the potential benefits of music therapeutic interventions in this population.</p><p><strong>Trial Registration</strong> ISRCTN trial registry identifier: ISRCTN16964680</p></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"4 4","pages":"Pages 515-525"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667100X24000161/pdfft?md5=9bf738c306eba37149375a60ce5fb945&pid=1-s2.0-S2667100X24000161-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140400507","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 between hyperglycemia at ICU admission and postoperative acute kidney injury in patients undergoing cardiac surgery: Analysis of the MIMIC-IV database","authors":"Juan Ruan ,&nbsp;Weipeng Huang ,&nbsp;Jun Jiang ,&nbsp;Chang Hu ,&nbsp;Yiming Li ,&nbsp;Zhiyong Peng ,&nbsp;Shuhan Cai","doi":"10.1016/j.jointm.2024.04.004","DOIUrl":"10.1016/j.jointm.2024.04.004","url":null,"abstract":"<div><h3>Background</h3><p>This study aimed to explore the correlation between hyperglycemia at intensive care unit (ICU) admission and the incidence of acute kidney injury (AKI) in patients after cardiac surgery.</p></div><div><h3>Methods</h3><p>We conducted a retrospective cohort study, in which clinical data were extracted from the Medical Information Mart for Intensive Care (MIMIC)-IV database. Adults (≥18 years) in the database who were admitted to the cardiovascular intensive care unit after cardiac surgery were enrolled. The primary outcome was the incidence of AKI within 7 days following ICU admission. Secondary outcomes included ICU mortality, hospital mortality, ICU length of stay, and the 28-day and 90-day mortality. Multivariable Cox regression analysis was used to assess the association between ICU-admission hyperglycemia and AKI incidence within 7 days of ICU admission. Different adjustment strategies were used to adjust for potential confounders. Patients were divided into three groups according to their highest blood glucose levels recorded within 24 h of ICU admission: no hyperglycemia (&lt;140 mg/dL), mild hyperglycemia (140–200 mg/dL), and severe hyperglycemia (≥200 mg/dL).</p></div><div><h3>Results</h3><p>Of the 6905 included patients, 2201 (31.9%) were female, and the median (IQR) age was 68.2 (60.1–75.9) years. In all, 1836 (26.6%) patients had severe hyperglycemia. The incidence of AKI within 7 days of ICU admission, ICU mortality, and hospital mortality was significantly higher in patients with severe admission hyperglycemia than those with mild hyperglycemia or no hyperglycemia (80.3% <em>vs</em>. 73.6% and 61.2%, respectively; 2.8% <em>vs</em>. 0.9% and 1.9%, respectively; and 3.4% <em>vs</em>. 1.2% and 2.5%, respectively; all <em>P</em> &lt;0.001). Severe hyperglycemia was a risk factor for 7-day AKI (Model 1: hazard ratio [HR]=1.4809, 95% confidence interval [CI]: 1.3126 to 1.6707; Model 2: HR=1.1639, 95% CI: 1.0176 to 1.3313; Model 3: HR=1.2014, 95% CI: 1.0490 to 1.3760; all <em>P</em> &lt;0.050). Patients with normal glucose levels (glucose levels &lt;140 mg/dL) had a higher 28-day mortality rate than those with severe hyperglycemia (glucose levels ≥200 mg/dL) (4.0% <em>vs</em>. 3.8%, <em>P</em> &lt;0.001).</p></div><div><h3>Conclusions</h3><p>In post-cardiac surgery patients, severe hyperglycemia within 24 h of ICU admission increases the risk of 7-day AKI, ICU mortality, and hospital mortality. Clinicians should be extra cautious regarding AKI among patients with hyperglycemia at ICU admission after cardiac surgery.</p></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"4 4","pages":"Pages 526-536"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667100X24000665/pdfft?md5=99d8c12a15a59d36251be0bccc5f7401&pid=1-s2.0-S2667100X24000665-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142149510","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":"TRPV1: The key bridge in neuroimmune interactions","authors":"","doi":"10.1016/j.jointm.2024.01.008","DOIUrl":"10.1016/j.jointm.2024.01.008","url":null,"abstract":"<div><p>The nervous and immune systems are crucial in fighting infections and inflammation and in maintaining immune homeostasis. The immune and nervous systems are independent, yet tightly integrated and coordinated organizations. Numerous molecules and receptors play key roles in enabling communication between the two systems. Transient receptor potential vanilloid subfamily member 1 (TRPV1) is a non-selective cation channel, recently shown to be widely expressed in the neuroimmune axis and implicated in neuropathic pain, autoimmune disorders, and immune cell function. TRPV1 is a key bridge in neuroimmune interactions, allowing for smooth and convenient communication between the two systems. Here, we discuss the coordinated cross-talking between the immune and nervous systems and the functional role and the functioning manner of the TRPV1 involved. We suggest that TRPV1 provides new insights into the collaborative relationship between the nervous and immune systems, highlighting exciting opportunities for advanced therapeutic approaches to treating neurogenic inflammation and immune-mediated diseases.</p></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"4 4","pages":"Pages 442-452"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667100X2400032X/pdfft?md5=c89ebda7d6bd06da8655c68eccce2495&pid=1-s2.0-S2667100X2400032X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140778434","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":"Glucocorticoid therapy for acute respiratory distress syndrome: Current concepts","authors":"","doi":"10.1016/j.jointm.2024.02.002","DOIUrl":"10.1016/j.jointm.2024.02.002","url":null,"abstract":"<div><p>Acute respiratory distress syndrome (ARDS), a fatal critical disease, is induced by various insults. ARDS represents a major global public health burden, and the management of ARDS continues to challenge healthcare systems globally, especially during the pandemic of the coronavirus disease 2019 (COVID-19). There remains no confirmed specific pharmacotherapy for ARDS, despite advances in understanding its pathophysiology. Debate continues about the potential role of glucocorticoids (GCs) as a promising ARDS clinical therapy. Questions regarding GC agent, dose, and duration in patients with ARDS need to be answered, because of substantial variations in GC administration regimens across studies. ARDS heterogeneity likely affects the therapeutic actions of exogenous GCs. This review includes progress in determining the GC mechanisms of action and clinical applications in ARDS, especially during the COVID-19 pandemic.</p></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"4 4","pages":"Pages 417-432"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667100X24000331/pdfft?md5=1311ef563468151d4818f26145e2e53e&pid=1-s2.0-S2667100X24000331-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140790963","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":"Severe respiratory syncytial virus disease","authors":"","doi":"10.1016/j.jointm.2024.03.001","DOIUrl":"10.1016/j.jointm.2024.03.001","url":null,"abstract":"<div><p>The burden of respiratory syncytial virus (RSV) disease is widely recognized. Main risk factors for severe disease, such as extreme ages, chronic cardiopulmonary conditions, and immunosuppression, typically coincide with poorer outcomes. While the majority of RSV hospitalizations involve healthy children, a higher proportion of hospitalized adults with underlying conditions need intensive care. Presently, treatment primarily consists of supportive measures. RSV-induced wheezing should be distinguished from respiratory tract thickening, without response to bronchodilators. Obstructive RSV disease frequently overlaps with viral pneumonia. Non-invasive mechanical ventilation and high-flow oxygen therapy represented significant advancements in the management of severe RSV disease in children and may also hold considerable importance in specific phenotypes of RSV disease in adults. Most severe infections manifest with refractory hypoxemia necessitating more advanced ventilatory support and/or extracorporeal membrane oxygenation therapy. Although bacterial co-infection rates are low, they have been associated with worse outcomes. Antibiotic prescription rates are high. Accurately diagnosing bacterial co-infections remains a challenge. Current evidence and antibiotic stewardship policies advise against indiscriminate antibiotic usage, even in severe cases. The role of currently developing antiviral therapies in severe RSV disease will be elucidated in the coming years, contingent upon the success of new vaccines and immune passive strategies involving nirsevimab.</p></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"4 4","pages":"Pages 405-416"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667100X24000379/pdfft?md5=9128c3ed103a89fb48f7f35fd6f1e688&pid=1-s2.0-S2667100X24000379-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140788108","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}