Journal of intensive medicine最新文献

{"title":"Artificial intelligence in ARDS: From automated support to personalized ventilation","authors":"Javier Muñoz , Nerio José Fernández-Araujo , Rocío Ruíz-Cacho , Javier Muñoz-Visedo","doi":"10.1016/j.jointm.2025.10.003","DOIUrl":"10.1016/j.jointm.2025.10.003","url":null,"abstract":"","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"6 2","pages":"Pages 128-131"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147667321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oral acetaminophen and postoperative delirium in noncardiac surgical older patients requiring intensive care unit admission: A pragmatic randomized controlled trial","authors":"Lina Zhang ,&nbsp;Milin Peng ,&nbsp;Haisong Zhang ,&nbsp;Chengfang Xiang ,&nbsp;Yuhang Ai ,&nbsp;Yanyan Kong ,&nbsp;Meijingrong Xiang ,&nbsp;Zhaoxin Qian ,&nbsp;Lingzhong Meng","doi":"10.1016/j.jointm.2025.10.005","DOIUrl":"10.1016/j.jointm.2025.10.005","url":null,"abstract":"<div><h3>Background</h3><div>Analgesic strategies sparing opioids may reduce the incidence of postoperative delirium (POD), a grave complication affecting primarily older surgical patients. The effect of oral acetaminophen on POD in noncardiac surgical older patients requiring intensive care unit (ICU) admission is unknown.</div></div><div><h3>Methods</h3><div>This single-center, pragmatic, open-label, parallel randomized controlled trial conducted in the ICU of Xiangya Hospital, from February 2019 to April 2021 evaluated the effect of oral acetaminophen <em>vs.</em> intravenous sufentanil on POD in noncardiac surgical patients aged ≥65 years. Patients in the acetaminophen group received oral acetaminophen, 500 mg, every 8 h, for the first 48 h after ICU admission, while patients in the sufentanil group received intravenous sufentanil 3.0 µg/h, throughout the first 48 h after ICU admission. The primary outcome was POD on postoperative days 1–5 by the confusion assessment method. The secondary outcomes included pain score, ICU and hospital stay, 28-day mortality, gastrointestinal complications, quality of life, and cognitive function by telephone interview for cognitive status modified questionnaire.</div></div><div><h3>Results</h3><div>A total of 164 patients, median aged 74.8 (IQR: 62–91) years, participated in this study. POD occurred in 9 out of 82 patients (11.0%) in the acetaminophen group and 14 out of 82 patients (17.1%) in the sufentanil group. Oral acetaminophen did not lead to a reduced POD risk (risk ratio = 0.6; 95% CI: 0.3 to 1.4; <em>P</em> = 0.262). There was no between-group difference in the distribution of the accumulated POD incidence throughout postoperative days 1–5 (log-rank <em>P</em> = 0.270). There were no between-group differences among the secondary outcome measures.</div></div><div><h3>Conclusions</h3><div>Oral acetaminophen administered during the initial 48 h after ICU admission did not lead to a reduced incidence of POD compared with intravenous sufentanil treatments in older noncardiac surgical patients.</div><div><strong>Trial Registration</strong> ClinicalTrials.gov Identifier: NCT03763084.</div></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"6 2","pages":"Pages 141-149"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147667323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Practice guideline on the prevention and treatment of central line-associated bloodstream infection: Part 1––Diagnosis and prevention","authors":"Yan Kang ,&nbsp;Xiangdong Guan ,&nbsp;Dechang Chen","doi":"10.1016/j.jointm.2025.10.008","DOIUrl":"10.1016/j.jointm.2025.10.008","url":null,"abstract":"<div><div>Central line-associated bloodstream infection (CLABSI) is a severe complication of indwelling intravascular catheters and a leading cause of healthcare-associated infections in intensive care units (ICUs). CLABSI significantly increases mortality, prolongs hospital stays, and elevates healthcare costs. Recent large-scale clinical studies of CLABSI diagnosis, treatment, and prevention, alongside evolving antibiotic resistance patterns and new antimicrobial developments, have necessitated updates to clinical management strategies. Consequently, the Chinese Society of Critical Care Medicine (CSCCM) has updated the 2007 guideline on intravascular catheter-related infections. This guideline was developed using Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology for evidence assessment. A multidisciplinary working group formulated clinical questions, conducted systematic literature reviews, performed meta-analyses, and synthesized evidence to draft recommendations. The recommendations underwent iterative revisions through expert panel reviews, remote and in-person meetings, and two rounds of voting by the Society’s Standing Committee before finalization. The guideline comprises 52 recommendations, focusing on adult patients in ICU with central venous catheters. This document, Part 1, addresses diagnosis and prevention, formulated using GRADE methodology. The aims of the guideline are to standardize best practices, reduce CLABSI incidence, and improve the outcomes of patients in ICUs.</div><div><strong>Practice Guideline Registration:</strong> Practice Guideline Registration for Transparency (PREPARE-2024CN873).</div></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"6 2","pages":"Pages 83-92"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147667318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The current situation of intensive care units in Chinese mainland: A nationwide survey","authors":"Sheng Zhang ,&nbsp;Jiao Liu ,&nbsp;Hang Qian ,&nbsp;Weifeng Shang ,&nbsp;Xijing Zhang ,&nbsp;Bo Hu ,&nbsp;Yi Yang ,&nbsp;Yuan Xu ,&nbsp;Ling Liu ,&nbsp;Xiaoting Wang ,&nbsp;Xiuling Shang ,&nbsp;Jianfeng Wu ,&nbsp;Xuelian Liao ,&nbsp;Fen Liu ,&nbsp;Jinglun Liu ,&nbsp;Changsong Wang ,&nbsp;Qianghong Xu ,&nbsp;Yonghao Xu ,&nbsp;Kaijiang Yu ,&nbsp;Xiangdong Guan ,&nbsp;Dechang Chen","doi":"10.1016/j.jointm.2025.08.011","DOIUrl":"10.1016/j.jointm.2025.08.011","url":null,"abstract":"<div><h3>Background</h3><div>Previous studies have highlighted the importance of intensive care units (ICUs) in providing specialized care for critically ill patients. However, little is known about the current distribution of ICU resources, medical personnel, and available technologies across hospitals of different levels in Chinese mainland. In response, this study evaluated the distribution of ICU resources, personnel, major diseases, medical techniques, and the relationship between ICU bed availability and economic development to provide an overview of the current state of ICU services in Chinese mainland.</div></div><div><h3>Methods</h3><div>A comprehensive questionnaire was distributed to intensivists at all levels of hospitals in Chinese mainland via the Questionnaire Starmini-program, a commonly used web-based survey platform in China. The questionnaire covered a wide range of items, including the demographic characteristics of intensivists, ICU type and capacity, composition of medical teams, disease classification, and available medical techniques.</div></div><div><h3>Results</h3><div>Data were analyzed from 3637 intensivists working in 2005 hospitals throughout Chinese mainland, representing approximately half of all hospitals with ICU settings nationwide. The median number of hospital beds was 1000 (interquartile range [IQR], 547–1800), and the median number of ICU beds was 17 (IQR: 11–25). Overall, 600 (IQR: 300–1091) patients were admitted to the ICU annually at each hospital. The mean number of ICU beds per 100,000 people was 5.31 in 2022. The majority of the surveyed medical groups (ranging from 97.7% to 98.8%) led by chief physicians have experience in treating the eight most common conditions managed in the ICU, including severe pneumonia, cardiogenic shock, hypovolemic shock, sepsis, septic shock, cardiopulmonary resuscitation, acute respiratory distress syndrome, and acute renal injury. Regarding essential medical techniques in the ICU, 98.2%, 86.5%, 71.2%, and 24.1% of surveyed hospitals have implemented invasive mechanical ventilation, continuous blood purification, bedside ultrasound, and extracorporeal membrane oxygenation, respectively.</div></div><div><h3>Conclusions</h3><div>This survey indicates that, although ICUs in Chinese mainland have advanced significantly to some extent, there are still challenges to address, such as regional disparities and hospital grade differences.</div></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"6 2","pages":"Pages 132-140"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147667322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perfusion index and fluid responsiveness: Are we asking the right question?","authors":"Osama Abou-Arab ,&nbsp;Christopher Lai ,&nbsp;Jihad Mallat","doi":"10.1016/j.jointm.2025.10.001","DOIUrl":"10.1016/j.jointm.2025.10.001","url":null,"abstract":"","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"6 1","pages":"Pages 19-21"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147286430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between ICU rehabilitation parameters and recovery of activities of daily living in mechanically ventilated patients: A multicenter prospective observational study","authors":"Shinichi Watanabe ,&nbsp;Kota Yamauchi ,&nbsp;Yuji Naito ,&nbsp;Tomohiro Yoshikawa ,&nbsp;Daisetsu Yasumura ,&nbsp;Yoshie Hirota ,&nbsp;Yasunari Morita","doi":"10.1016/j.jointm.2025.08.003","DOIUrl":"10.1016/j.jointm.2025.08.003","url":null,"abstract":"<div><h3>Background</h3><div>Recovery of activities of daily living (ADL) is a key outcome for critically ill patients following intensive care unit (ICU) admission. However, the relationship between early rehabilitation parameters and ADL recovery remains unclear.</div></div><div><h3>Methods</h3><div>This <em>post hoc</em> secondary analysis of the IPAM study (UMIN000047578), a multicenter prospective cohort, included adult ICU patients who required mechanical ventilation. Patients with pre-existing walking dependence, neurological or mental disorders, or terminal conditions were excluded. Five rehabilitation parameters were assessed during ICU stay: dose (mean Mobilization Quantification Score [MQS]), intensity (highest ICU mobility scale [IMS]), duration, frequency, and start time. The primary outcome was the Barthel index (BI), measured at five time points: prehospitalization, ICU discharge, day 7, day 14, and hospital discharge or day 28, whichever came first. Patients were categorized into three groups based on ADL recovery: early recovery (BI ≥85 within 14 days post-ICU), recovery (BI ≥ 85 by discharge), and delayed recovery (BI &lt;85 by discharge). Multinomial logistic regression was used to assess associations.</div></div><div><h3>Results</h3><div>Among 121 eligible patients, 28.9% achieved early recovery, 28.9% recovery, and 42.2% delayed recovery. Patients in the early recovery group had significantly higher mean MQS (median=6.7, interquartile range [IQR]: 4.1–12.6 <em>vs.</em> median=2.3, IQR: 0.8–3.3 in the delayed group; <em>P</em> &lt;0.001) and Medical Research Council (MRC) scores (median=54.0, IQR: 48.0–58.0 <em>vs.</em> median=39.5, IQR: 24.0–50.5; <em>P</em> &lt;0.001), and shorter ICU (median=7.2 days,IQR: 5.5–9.8<em>vs.</em> median=9.3 days, IQR: 6.0–17.2 ) and hospital stays (median=20.9 days, IQR: 17.0–28.5 <em>vs.</em> median=50.9 days,IQR: 35.9–80.0; <em>P</em> &lt;0.001) compared to delayed recovery. Delayed recovery was independently and significantly associated with lower mean MQS (odds ratio [OR] = 0.51, 95% CI: 0.37 to 0.68, <em>P</em> &lt;0.001) and lower highest IMS (OR=0.86, 95% CI: 0.75 to 0.96, <em>P</em>=0.001), whereas no significant associations with any rehabilitation parameters were found in the early recovery group.</div></div><div><h3>Conclusions</h3><div>Higher rehabilitation dose and intensity during ICU stay were associated with a reduced risk of delayed ADL recovery. Optimizing these parameters may improve functional outcomes in critically ill patients. These findings should be interpreted with caution, as the analysis was <em>post hoc</em> and exploratory in nature.</div></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"6 1","pages":"Pages 53-60"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147286214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing vascular tone and vascular responsiveness to norepinephrine: How simple tools can help?","authors":"Olfa Hamzaoui ,&nbsp;Antoine Goury ,&nbsp;Jean-Louis Teboul","doi":"10.1016/j.jointm.2025.09.001","DOIUrl":"10.1016/j.jointm.2025.09.001","url":null,"abstract":"","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"6 1","pages":"Pages 16-18"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147286246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond one-size-fits-all: Addressing patient heterogeneity through precision-based oxygen therapy research in critical care","authors":"Wenqi Huang ,&nbsp;Li Lu","doi":"10.1016/j.jointm.2025.10.004","DOIUrl":"10.1016/j.jointm.2025.10.004","url":null,"abstract":"","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"6 1","pages":"Pages 25-27"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147286290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of 6-hour urine creatinine clearance as the kidney component in the SOFA score: An observational cohort study","authors":"Liran Statlender ,&nbsp;Tzippy Shochat ,&nbsp;Mzia Moshiashvili ,&nbsp;Eyal Robinson ,&nbsp;Moran Hellerman Itzhaki ,&nbsp;Itai Bendavid ,&nbsp;Guy Fishman ,&nbsp;Pierre Singer ,&nbsp;Ilya Kagan","doi":"10.1016/j.jointm.2025.08.009","DOIUrl":"10.1016/j.jointm.2025.08.009","url":null,"abstract":"<div><h3>Background</h3><div>The Sequential Organ Failure Assessment (SOFA) score, originally designed to reflect disease severity, is now recognized as a prognostic tool for critically ill patients. Recently, calls have emerged to update the score to better align it with contemporary clinical practice.</div></div><div><h3>Methods</h3><div>This single-center, prospective, observational study was conducted in a general intensive care unit (ICU) of a university-affiliated tertiary hospital from September 10, 2023, to January 7, 2025. Urinary creatinine clearance (CrCl) was calculated daily using 6-h urine collection (CrCl_6h) obtained during the first five nights after admission. Based on CrCl and Kidney Disease: ImprovingGlobal Outcomes (KDIGO) chronic kidney disease criteria, patients were categorized into five groups (0−4), with subsequent calculation of a modified SOFA score according to this grouping. The predictive ability of serum creatinine (Scr), urine output, CrCl_6h, the original SOFA score, and the modified SOFA score for ICU and 90-day mortality was compared by evaluating their area under the receiver operating characteristic (AUROC) values.</div></div><div><h3>Results</h3><div>A total of 200 patients were included in the study. The ICU mortality for these patients was 12.0% while the 90-day mortality reached 29.5%. Compared with Scr, CrCl_6h displayed significantly higher AUROC values for mortality prediction on almost all days examined. For example, on day 3, the AUROC values were 0.821 <em>vs.</em> 0.730 (<em>P</em>=0.003) for ICU mortality, and 0.760 <em>vs.</em> 0.662 (<em>P</em>=0.002) for 90-day mortality. Similarly, the modified SOFA score showed significantly greater predictive performance on most days assessed. On day 3, the AUROC values were 0.791 <em>vs.</em> 0.706 (<em>P</em>=0.046) for ICU mortality, and 0.741 <em>vs.</em> 0.655 (<em>P</em>=0.007) for 90-day mortality.</div></div><div><h3>Conclusion</h3><div>The categorization of urinary CrCl based on a 6-h urine collection can improve the ability of the SOFA score for predicting mortality.</div><div><strong>Trial Registration:</strong> <span><span>Clinicaltrials.gov</span><svg><path></path></svg></span> Identifier: NCT06779331</div></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"6 1","pages":"Pages 69-74"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147286286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Guidelines for the construction and management of critical care medicine in China (2025 Edition)","authors":"","doi":"10.1016/j.jointm.2025.09.004","DOIUrl":"10.1016/j.jointm.2025.09.004","url":null,"abstract":"<div><div>Critical care medicine is a clinical medical discipline that studies the pathogenesis, progression, diagnosis, and management of life-threatening diseases caused by various etiological factors. The Intensive Care Unit (ICU), as the core clinical setting of critical care medicine, is responsible for the full-cycle management of critically ill patients, covering a series of comprehensive measures from early warning to rehabilitation. In 2024, the National Health Commission and seven other ministries jointly issued the “Opinions on Strengthening the Capacity Building of Critical Care Medical Services”, promoting the discipline into a new stage of high‑quality development. Based on this, the Chinese Society of Critical Care Medicine (CSCCM) organized domestic experts to discuss and formulate the “Guidelines for the Construction and Management of Critical Care Medicine in China (2025 Edition).” The guidelines focus on core elements of discipline organization and development, covering nine areas: ICU ward construction, ICU admission criteria, staffing and technical requirements for professionals, equipment configuration, quality management, professional training and continuing education, scientific research, response to public health emergencies, and improved service models. The working group initially formed recommended entries through initiation, literature search and screening, and synthesis of medical evidence. The preliminary recommendations were then revised through expert panel reviews, remote and face-to-face meetings, revisions, and finally finalized by voting at the Standing Committee of CSCCM, resulting in the establishment of foundational and developmental discipline construction guidelines. The guidelines apply to ICUs in secondary and above healthcare institutions, providing a scientific framework for discipline planning, construction, and management to enhance the quality of critical care services.</div><div>Practice guideline registration: Practice Guideline Registration for Transparency (PREPARE-2025CN972).</div></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"6 1","pages":"Pages 1-15"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147286499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}