Journal of intensive medicine最新文献

{"title":"The pros and cons of beta-blockers in sepsis: Where do we stand in 2024?","authors":"Daniel De Backer , Dechang Chen","doi":"10.1016/j.jointm.2024.07.002","DOIUrl":"10.1016/j.jointm.2024.07.002","url":null,"abstract":"","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"5 1","pages":"Pages 32-34"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11763536/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143054420","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":"Outcomes and risk factors of transported patients with extracorporeal membrane oxygenation: An ECMO center experience","authors":"Lingjuan Liu ,&nbsp;Dingji Hu ,&nbsp;Tong Hao ,&nbsp;Shanshan Chen ,&nbsp;Lei Chen ,&nbsp;Yike Zhu ,&nbsp;Chenhui Jin ,&nbsp;Jing Wu ,&nbsp;Haoya Fu ,&nbsp;Haibo Qiu ,&nbsp;Yi Yang ,&nbsp;Songqiao Liu","doi":"10.1016/j.jointm.2024.04.003","DOIUrl":"10.1016/j.jointm.2024.04.003","url":null,"abstract":"<div><h3>Background</h3><div>Extracorporeal membrane oxygenation (ECMO) has been proven to be a support method and technology for patients with cardiopulmonary failure. However, the transport of patients under ECMO support is challenging given the high-risk technical maneuvers and patient-care concerns involved. Herein, we examined the safety of ECMO during the transport of critically ill patients and its impact on mortality rates, to provide more secure and effective transport strategies in clinical practice.</div></div><div><h3>Method</h3><div>To assess the safety of ECMO patient transport, this study conducted a retrospective analysis on critically ill adults who required ECMO support and transport at the intensive care unit (ICU) center between 2017 and 2023. The study utilized standard ECMO transport protocols and conducted a comprehensive statistical analysis of the collected clinical data and transport processes. The 28-day survival rate for ECMO patients was determined using Kaplan–Meier analysis, while logistic regression identified prognostic factors.</div></div><div><h3>Result</h3><div>Out of 303 patients supported with ECMO, 111 (36.6%) were transported. 69.4% of the transport group were male, mean age was (42.0±17.0) years, mean body mass index was (24.4±4.6) kg/m², and veno-arterial-ECMO accounted for 52.5%. The median transportation distance was 190 (interquartile range [IQR]: 70–260) km, and the longest distance was 8100 km. The median transit time was 180 (IQR: 100–260) min, and the maximum duration was 1720 min. No severe adverse events including death or mechanical failure occurred during transportation. The 28-day survival rate was 64.7% (<em>n</em>=196) and ICU survival rate was 56.1% (<em>n</em>=170) for the entire cohort; whereas, the 28-day survival rate was 72.1% (<em>n</em>=80) and ICU survival rate was 66.7% (<em>n</em>=74) in the transport group. A non-significant difference in 28-day survival was observed between the two groups after propensity score matching (<em>P</em>=0.56). Additionally, we found that acute physiology and chronic health evaluation II score (odds ratio [OR]=1.06, <em>P</em> &lt;0.01), lactate levels (&gt;5 mmol/L, OR=2.80, <em>P</em>=0.01), and renal replacement therapy initiation (OR=3.03, <em>P</em> &lt;0.01) were associated with increased mortality risk.</div></div><div><h3>Conclusion</h3><div>Transporting patients on ECMO between medical facilities is a safe procedure that does not increase patient mortality rates, provided it is orchestrated and executed by proficient transport teams. The prognostic outcome for these patients is predominantly influenced by their pre-existing medical conditions or by complications that may develop during the course of ECMO therapy. These results form the basis for the creation of specialized ECMO network hubs within healthcare regions.</div></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"5 1","pages":"Pages 35-42"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141396556","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":"Metabolomic profiling and prognostication in COVID-19 acute respiratory distress syndrome","authors":"David Furfaro ,&nbsp;Xiaoyu Che ,&nbsp;Wenhao Gou ,&nbsp;Matthew J. Cummings ,&nbsp;Nischay Mishra ,&nbsp;Daniel Brodie ,&nbsp;Thomas Briese ,&nbsp;Oliver Fiehn ,&nbsp;W. Ian Lipkin ,&nbsp;Max R. O'Donnell","doi":"10.1016/j.jointm.2024.04.001","DOIUrl":"10.1016/j.jointm.2024.04.001","url":null,"abstract":"","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"5 1","pages":"Pages 108-110"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141037971","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":"Awake prone positioning and ventilation distribution as assessed by electric impedance tomography in patients with non-COVID-19 acute hypoxemic respiratory failure: A prospective physiology study","authors":"Jingjing Wang ,&nbsp;Changxing Chen ,&nbsp;Zhanqi Zhao ,&nbsp;Puyu Deng ,&nbsp;Chenchen Zhang ,&nbsp;Yu Zhang ,&nbsp;Hui Lv ,&nbsp;Daonan Chen ,&nbsp;Hui Xie ,&nbsp;Ruilan Wang","doi":"10.1016/j.jointm.2024.07.007","DOIUrl":"10.1016/j.jointm.2024.07.007","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Awake prone positioning (APP) can reportedly reduce the need for intubation and help improve prognosis of patients with acute hypoxemic respiratory failure (AHRF) infected with COVID-19. However, its physiological mechanism remains unclear. In this study, we evaluated the effect of APP on lung ventilation in patients with moderate-to-severe AHRF to better understand the effects on ventilation distribution and to prevent intubation in non-intubated patients.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;The prospective study was performed in the Department of Critical Care Medicine at Shanghai General Hospital, China, from January 2021 to November 2022. The study included patients with AHRF (partial pressure of oxygen [PaO&lt;sub&gt;2&lt;/sub&gt;]/inspired oxygen concentration [FiO&lt;sub&gt;2&lt;/sub&gt;] &lt;200 mmHg or oxygen saturation [SpO&lt;sub&gt;2&lt;/sub&gt;]/FiO&lt;sub&gt;2&lt;/sub&gt; &lt;235) treated with high-flow nasal oxygen. Electrical impedance tomography (EIT) measurements including center of ventilation (COV), global inhomogeneity (GI) index, and regional ventilation delay (RVD) index were performed in the supine position (T&lt;sub&gt;0&lt;/sub&gt;), 30 min after the start of APP (T&lt;sub&gt;1&lt;/sub&gt;), and 30 min returning to supine position after the APP (T&lt;sub&gt;2&lt;/sub&gt;). Clinical parameters like SpO&lt;sub&gt;2&lt;/sub&gt;, respiratory rate (RR), FiO&lt;sub&gt;2&lt;/sub&gt;, heart rate (HR), and ROX (the ratio of SpO&lt;sub&gt;2&lt;/sub&gt; as measured by pulse oximetry/FiO&lt;sub&gt;2&lt;/sub&gt; to RR) were also recorded simultaneously at T&lt;sub&gt;0&lt;/sub&gt;, T&lt;sub&gt;1&lt;/sub&gt;, and T&lt;sub&gt;2&lt;/sub&gt;. To evaluate the effect of the time points on the variables, Mauchly's test was performed for sphericity and repeated measures analysis of variance was applied with Bonferroni's &lt;em&gt;post hoc&lt;/em&gt; multiple comparisons.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Ten patients were enrolled. The PaO&lt;sub&gt;2&lt;/sub&gt;/FiO&lt;sub&gt;2&lt;/sub&gt; ratio was (111.4±33.4) mmHg at the time of recruitment. ROX showed a significant increase after initiation of APP {median (interquartile range [IQR]): T&lt;sub&gt;0&lt;/sub&gt;: 7.5 (6.0–10.1) &lt;em&gt;vs.&lt;/em&gt; T&lt;sub&gt;1&lt;/sub&gt;: 7.6 (6.4–9.3) &lt;em&gt;vs.&lt;/em&gt; T&lt;sub&gt;2&lt;/sub&gt;: 8.3 (7.2–11.0), &lt;em&gt;P&lt;/em&gt;=0.043}. RR (&lt;em&gt;P&lt;/em&gt;=0.409), HR (&lt;em&gt;P&lt;/em&gt;=0.417), and SpO&lt;sub&gt;2&lt;/sub&gt;/FiO&lt;sub&gt;2&lt;/sub&gt; (&lt;em&gt;P&lt;/em&gt;=0.262) did not change significantly during prone positioning (PP). The COV moved from the ventral area to the dorsal area (T&lt;sub&gt;0&lt;/sub&gt;: 48.8%±6.2% &lt;em&gt;vs.&lt;/em&gt; T&lt;sub&gt;1&lt;/sub&gt;: 54.8%±6.8% &lt;em&gt;vs.&lt;/em&gt; T&lt;sub&gt;2&lt;/sub&gt;: 50.3%±6.1%, &lt;em&gt;P&lt;/em&gt;=0.030) after APP. The GI decreased significantly after APP (T&lt;sub&gt;0&lt;/sub&gt;: median=42.7 %, [IQR: 38.3%–47.5%] &lt;em&gt;vs.&lt;/em&gt; T&lt;sub&gt;1&lt;/sub&gt;: median=38.2%, [IQR: 34.6%–50.7%] &lt;em&gt;vs.&lt;/em&gt; T&lt;sub&gt;2&lt;/sub&gt;: median=37.4%, [IQR: 34.2%–41.4%], &lt;em&gt;P&lt;/em&gt;=0.049). RVD (&lt;em&gt;P&lt;/em&gt;=0.794) did not change after APP.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;APP can improve ventilation distribution and homogeneity of lung ventilation as assessed by EIT in non-intubated patients with AHRF.&lt;/div&gt;&lt;div&gt;&lt;strong&gt;Trail Registration&lt;/strong&gt; C","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"5 1","pages":"Pages 43-50"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11763897/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143054385","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":"Current advances in neurocritical care","authors":"Yuqing Chen ,&nbsp;Shuya Wang ,&nbsp;Shanshan Xu ,&nbsp;Ningyuan Xu ,&nbsp;Linlin Zhang ,&nbsp;Jianxin Zhou","doi":"10.1016/j.jointm.2024.04.005","DOIUrl":"10.1016/j.jointm.2024.04.005","url":null,"abstract":"<div><div>This review summarizes the current research advances and guideline updates in neurocritical care. For the therapy of ischemic stroke, the extended treatment time window for thrombectomy and the emergence of novel thrombolytic agents and strategies have brought greater hope for patient recovery. Minimally invasive hematoma evacuation and goal-directed bundled management have shown clinical benefits in treating cerebral hemorrhage. In the treatment of aneurysmal subarachnoid hemorrhage (aSAH), early lumbar drainage can reduce the risk of infarction. Decompressive craniectomy for severe traumatic brain injury has also obtained high-quality evidence support. However, multimodal brain monitoring strategies for patients with traumatic brain injury need further optimization. For patients with cardiac arrest, extracorporeal cardiopulmonary resuscitation can reduce in-hospital mortality and improve long-term neurological prognosis. For neurocritical care patients, abundant high-quality studies have emerged in areas including multimodal neuromonitoring, hemodynamic management, airway management and respiratory therapy, and antiepileptic treatment. In 2023, the guidelines for aSAH have been updated for the first time in the past decade, aiming to provide evidence-based practice recommendations for clinical care. Chinese expert consensuses have also been formulated to guide analgesia and sedation for neurocritical care patients and developed a set of medical quality indicators on neurocritical care, which will enhance standardization and homogenization improvement in neurocritical care quality.</div></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"5 1","pages":"Pages 23-31"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141706520","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":"Title Page","authors":"","doi":"10.1016/S2667-100X(24)00110-5","DOIUrl":"10.1016/S2667-100X(24)00110-5","url":null,"abstract":"","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"5 1","pages":"Pages i-ii"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143128902","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":"Safety and efficacy of selective RIPK1 inhibitor SIR1-365 in hospitalized patients with severe COVID-19: A multicenter, randomized, double-blind, phase 1b trial","authors":"Norberto Chavez-Tapia ,&nbsp;Muneeba Ahsan Sayeed ,&nbsp;Shobha Luxmi ,&nbsp;Douglas J. Kasper ,&nbsp;Fenchao Xue ,&nbsp;Yang Shen ,&nbsp;Weiliang Fan ,&nbsp;Wei Yuan ,&nbsp;Bin Du","doi":"10.1016/j.jointm.2024.07.003","DOIUrl":"10.1016/j.jointm.2024.07.003","url":null,"abstract":"<div><h3>Background</h3><div>Receptor-interacting protein kinase 1 (RIPK1), a serine/threonine protein kinase, is mainly activated by pro-inflammatory cytokines and pathogens, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and its activation could result in apoptosis, necroptosis, or inflammation. This study was conducted to evaluate the safety and efficacy of a potent and selective inhibitor of RIPK1, SIR1-365, in hospitalized patients with severe coronavirus disease 2019 (COVID-19).</div></div><div><h3>Methods</h3><div>This multicenter, randomized, double-blind, phase 1b study screened patients from December 18, 2020 until November 27, 2021. Adults hospitalized with severe COVID-19 (diagnosed ≤2 weeks before screening) were randomized 1:1 to receive oral placebo or SIR1-365 100 mg three times daily for ≤14 consecutive days, with standard-of-care. The primary objective was to evaluate SIR1-365 safety and tolerability. Secondary objectives included an assessment of SIR1-365 efficacy. Descriptive statistics were used to summarize safety. The study was not powered for efficacy testing. Relevant inferential statistical tests were used to aid interpretation of differences in clinical efficacy.</div></div><div><h3>Results</h3><div>Forty-five patients were randomized, 42 were treated. Eighteen patients experienced treatment-emergent adverse events (TEAEs) and 7 patients were ≥ grade 3. Fewer SIR1-365-treated <em>vs</em>. placebo-treated patients experienced TEAEs (30.4% <em>vs.</em> 57.9%) and serious TEAEs (13.0% <em>vs.</em> 26.3%) within 28 days of the first dose. There were no serious treatment-related TEAEs or deaths. Compare to placebo, SIR1-365 significantly increased arterial oxygenation from baseline to day 7 (least-squares mean change [standard error]: 109.4 [26.4] <em>vs.</em> -24.2 [23.6]; <em>P</em>=0.0095), significantly reduced hospitalization duration after treatment (mean±standard deviation: [4.7±3.7] days <em>vs</em>. [8.6±5.6] days; <em>P</em>=0.0145) and respiratory failure incidence (8.3% <em>vs</em>. 38.1%; two-sided <em>P</em>=0.0291) during the study, and numerically shortened the time to clinical improvement in World Health Organization ordinal scale (median: 5.0 days <em>vs.</em> 9.0 days, <em>P</em>=0.0766).</div></div><div><h3>Conclusions</h3><div>SIR1-365 was well tolerated and demonstrated a trend toward quicker recovery than placebo in hospitalized patients with severe COVID-19.</div><div><strong>Trial Registration</strong> ClinicalTrials.gov number: NCT04622332</div></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"5 1","pages":"Pages 70-78"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11763862/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143054418","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":"New drugs for acute kidney injury","authors":"Geoffroy Hariri ,&nbsp;Matthieu Legrand","doi":"10.1016/j.jointm.2024.08.001","DOIUrl":"10.1016/j.jointm.2024.08.001","url":null,"abstract":"<div><div>Acute kidney injury (AKI) presents a significant challenge in the management of critically ill patients, as it is associated with increased mortality, prolonged hospital stays, and increased healthcare costs. In certain conditions, such as during sepsis or after cardiac surgery, AKI is one of the most frequent complications, affecting 30%–50% of patients. Over time, even after the resolution of AKI, it can evolve into chronic kidney disease, a leading global cause of mortality, and cardiovascular complications. Despite significant improvement in the care of critically ill patients over the past two decades, the incidence of AKI remains stable, and novel approaches aiming at reducing its occurrence or improving AKI outcomes are still mostly lacking. However, recent insights into the pathophysiology of AKI within critical care settings have shed light on new pathways for both prevention and treatment, providing various new therapeutic targets aimed to mitigating kidney injury. These advancements highlight the intricate and multifaceted nature of the mechanisms underlying AKI, which could explain the challenge of identifying an effective treatment. Among these targets, modulation of the inflammatory responses and the cellular metabolism, hemodynamic regulation and enhancement of cellular repair mechanisms, have emerged as promising options. These multifaceted approaches offer renewed hope for limiting the incidence and severity of AKI in critically ill patients. Several ongoing clinical trials are evaluating the efficacy of these different strategies and we are facing an exiting time with multiple therapeutic interventions being tested to prevent or treat AKI. In this review, we aim to provide a summary of the new drugs evaluated for preventing or treating AKI in critical care and surgical settings.</div></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"5 1","pages":"Pages 3-11"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11763585/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143054327","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":"Influence of hydrocortisone infusion method on the clinical outcome of patients with septic shock: A systematic review and meta-analysis","authors":"Yuting Li,&nbsp;Youquan Wang,&nbsp;Jianxing Guo,&nbsp;Dong Zhang","doi":"10.1016/j.jointm.2024.05.001","DOIUrl":"10.1016/j.jointm.2024.05.001","url":null,"abstract":"<div><h3>Background</h3><div>The effect of the modality of hydrocortisone administration on clinical outcomes in patients with septic shock remains uncertain. This systematic review and meta-analysis evaluate the impact of intermittent bolus and continuous infusion of hydrocortisone on these outcomes.</div></div><div><h3>Methods</h3><div>We searched the PubMed, Embase databases, and Cochrane Library for randomized controlled trials (RCTs) and cohort studies published from inception to January 1, 2023. We included studies involving adult patients with septic shock. All authors reported our primary outcome of short-term mortality and clearly compared the clinically relevant secondary outcomes (ICU length of stay, hospital length of stay, vasopressor-free days, hyperglycemia, hypernatremia, and ICU-acquired weakness [ICUAW]) of intermittent bolus and continuous infusion of hydrocortisone. Results were expressed as odds ratio (OR) and mean difference (MD) with accompanying 95% confidence interval (CI). The PROSPERO registration number is CRD42023392160.</div></div><div><h3>Results</h3><div>Seven studies, including 554 patients, were included. The primary outcome of this meta-analysis showed no statistically significant difference in the short-term mortality between intermittent bolus and continuous infusion groups (OR=1.21, 95% CI: 0.84 to 1.73; <em>P</em>=0.31; <em>Chi²</em>=9.06; <em>I</em>²=34%). Secondary outcomes showed no statistically significant difference in the ICU length of stay (MD=−0.15, 95% CI: −2.31 to 2.02; <em>P</em>=0.89; <em>Chi²</em>=0.95; <em>I</em>²=0%), hospital length of stay (MD=0.63, 95% CI: −4.24 to 5.50; <em>P</em>=0.80; <em>Chi²</em>=0.61; <em>I</em>²=0%), vasopressor-free days (MD=−1.18, 95% CI: −2.43 to 0.06; <em>P</em>=0.06; <em>Chi²</em>=2.48; <em>I</em>²=60%), hyperglycemia (OR=1.27, 95% CI: 0.80 to 2.02; <em>P</em>=0.31; <em>Chi²</em>=5.23; <em>I</em>²=43%), hypernatremia (OR=0.93, 95% CI: 0.44 to 1.96; <em>P</em>=0.85; <em>Chi²</em>=0.37; <em>I</em>²=0%), or ICUAW (OR=0.83, 95% CI: 0.36 to 1.94; <em>P</em>=0.67; <em>Chi²</em>=0.90; <em>I</em>²=0%) between the two groups.</div></div><div><h3>Conclusions</h3><div>This meta-analysis indicated no significant difference in short-term mortality between intermittent bolus or continuous hydrocortisone infusion in patients with septic shock. Additionally, the hydrocortisone infusion method was not associated with ICU length of stay, hospital length of stay, vasopressor-free days, hyperglycemia, hypernatremia, or ICUAW.</div></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"5 1","pages":"Pages 100-107"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11763613/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143054391","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":"Previous treatment with anthracycline does not affect the course of sepsis in cancer patients: Retrospective cohort study","authors":"Windsor Camille ,&nbsp;Joseph Adrien ,&nbsp;Pons Stephanie ,&nbsp;Mokart Djamel ,&nbsp;Pène Frederic ,&nbsp;Kouatchet Achille ,&nbsp;Demoule Alexandre ,&nbsp;Bruneel Fabrice ,&nbsp;Nyunga Martine ,&nbsp;Borcoman Edith ,&nbsp;Legrand Matthieu ,&nbsp;Darmon Michael ,&nbsp;Zafrani Lara ,&nbsp;Azoulay Elie ,&nbsp;Lemiale Virginie","doi":"10.1016/j.jointm.2024.07.005","DOIUrl":"10.1016/j.jointm.2024.07.005","url":null,"abstract":"<div><h3>Background</h3><div>Cancer patients who are exposed to sepsis and had previous chemotherapy may have increased severity. Among chemotherapeutic agents, anthracyclines have been associated with cardiac toxicity. Like other chemotherapeutic agents, they may cause endothelial toxicity. The aim of this study was to evaluate the effect of anthracycline treatment on the outcome of cancer patients with sepsis.</div></div><div><h3>Methods</h3><div>Data from cancer patients admitted to intensive care units (ICUs) for sepsis or septic shock were extracted from the Groupe de Recherche Respiratoire en Réanimation Onco-Hématologique database (1994–2015). Comparison between patients who received anthracycline and those who did not was performed using a propensity score, including confounding variables (age and underlying diseases). A competing risk adjusted for severity of illness (Sequential Organ Failure Assessment [SOFA] score) was used to analyze the duration of vasopressor requirement.</div></div><div><h3>Results</h3><div>Among 2046 patients, 1070 (52.3%) patients who received anthracycline were compared with 976 (47.7%) who did not. The underlying disease was mostly acute hematological malignancy (49.2%). Sepsis, mostly pneumonia (47.7%), had developed 2 days (interquartile range [IQR]:1–4 days) prior to ICU admission. Most patients (<em>n</em>=1156/1980,58.4%) required vasopressors for 3 days (IQR: 2–6 days). Factors associated with the need for vasopressors were aplasia (hazard ratio [HR]=1.72, 95% confidence interval [CI]: 1.21 to 2.47, <em>P</em>=0.002) and day 1 respiratory SOFA score (HR=7.07, 95% CI: 2.75 to 22.1, <em>P</em> &lt;0.001). Previous anthracycline treatment was not associated with an increased risk of vasopressor use. The duration of vasopressors was not different between patients who received anthracycline and those who did not (<em>P</em>=0.79). Anthracycline was not associated with ICU mortality.</div></div><div><h3>Conclusion</h3><div>Previous anthracycline treatment did not alter the course of sepsis in a cohort of cancer patients admitted to intensive care with sepsis.</div></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"5 1","pages":"Pages 64-69"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11763860/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143054415","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}