Journal of intensive medicine最新文献

{"title":"Causal deep learning to personalize medicine: Which intensive care patients with sepsis will benefit from corticosteroid therapy?","authors":"Ameet Jagesar ,&nbsp;Louk Smalbil ,&nbsp;Etienne Galea ,&nbsp;Tristan Struja ,&nbsp;Tariq Dam ,&nbsp;Paul Hilders ,&nbsp;Martijn Otten ,&nbsp;Laurens Biesheuvel ,&nbsp;Armand Girbes ,&nbsp;Patrick Thoral ,&nbsp;Mark Hoogendoorn ,&nbsp;Paul Elbers","doi":"10.1016/j.jointm.2025.07.002","DOIUrl":"10.1016/j.jointm.2025.07.002","url":null,"abstract":"<div><h3>Background</h3><div>Sepsis, defined as life-threatening organ dysfunction due to dysregulated host response to an infection, often requiring intensive care treatment. There is a strong rationale for the administration of corticosteroids for immunomodulation; however, clinical trials are inconclusive, which may be attributable to heterogeneity in therapeutic effects between individual patients. Leveraging deep learning within a causality framework, we aimed to identify for which intensive care patients with sepsis corticosteroids lead to improved survival.</div></div><div><h3>Methods</h3><div>We trained the treatment agnostic representation network (TARNet) to estimate the reduction in predicted probability of 28-day mortality following initiation of corticosteroid treatment of intensive care patients with sepsis. We used the freely available and public AmsterdamUMCdb ICU database for causal model development, considering 19 predictor variables from the first 24 h of admission, and validated the model with Medical Information Mart for Intensive Care (MIMIC-IV) version 2.2 data. A cut-off of 10% reduction in predicted probability of mortality was used to classify treatment responders.</div></div><div><h3>Results</h3><div>According to the Sepsis-3 criteria, a total of 2920 admissions in AmsterdamUMCdb were eligible. Of these, 1378 were assigned to the intervention group and 1542 to the control group. Internal validation of predictions of the observed outcomes showed an area under the receiver operating characteristic curve (AUROC) of 0.79, while external validation yielded an AUROC of 0.71. Covariate balance of the TARNet model latent representation, as measured by the Wasserstein distance, was 3.6 × 10⁻⁷ for the internal data set and 4.2 × 10⁻⁷ for the external data set. Based on the estimated reduction of predicted mortality, a distinction was made between treatment responders (<em>n</em>=245), non-responders (<em>n</em>=2098), and those predicted to be harmed by corticosteroid treatment (<em>n</em>=577).</div></div><div><h3>Conclusions</h3><div>Corticosteroid treatment responders were those with severe metabolic acidosis and impaired circulation, whereas patients who were less ill based on these parameters were more likely to have increased mortality rates by corticosteroid treatment. There was also a notable discrepancy between the model’s suggestions and the physicians’ treatment that was carried out, implying improvements in the clinical assessment of patients with sepsis are necessary. Given recent years have not yielded new treatments for sepsis, computational clinical decision-support systems are worth exploring.</div></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"6 1","pages":"Pages 61-68"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147286304","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":"When should we start vasopressin in septic shock? Revisiting an old question","authors":"Javier Muñoz ,&nbsp;Jamil Antonio Cedeño","doi":"10.1016/j.jointm.2025.08.007","DOIUrl":"10.1016/j.jointm.2025.08.007","url":null,"abstract":"","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"6 1","pages":"Pages 22-24"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147286435","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":"Global, regional, and national burdens of pancreatitis in adults aged ≥65 years from 1992 to 2021: A trends analysis using data from the 2021 Global Burden of Disease Study","authors":"Hang Qian ,&nbsp;Weifeng Shang ,&nbsp;Sheng Zhang ,&nbsp;Xiaojun Pan,&nbsp;Sisi Huang,&nbsp;Hui Li,&nbsp;Zhenliang Wen,&nbsp;Jiao Liu,&nbsp;Dechang Chen","doi":"10.1016/j.jointm.2025.08.010","DOIUrl":"10.1016/j.jointm.2025.08.010","url":null,"abstract":"<div><h3>Background</h3><div>As the global population ages, pancreatitis in older adults has become a public health issue. Nonetheless, detailed information on its global impact and changing patterns is limited. We sought to explore the epidemiological trends of pancreatitis among older adults (aged ≥65 years) from 1992 to 2021.</div></div><div><h3>Methods</h3><div>Data for pancreatitis incidence and mortality across seven age brackets (65–69, 70–74, 75–79, 80–84, 85–89, 90–94, and ≥95 years) were sourced from the 2021 Global Burden of Diseases, Injuries, and Risk Factors Study. The age-standardized incidence and mortality rates for pancreatitis in older adults were calculated using the direct method of age standardization. Joinpoint regression analysis was used to examine the evolution of age-standardized incidence and mortality rates from 1992 to 2021. Age–period–cohort analysis was conducted to determine the distinct impacts of age, period, and birth cohorts. In addition, Nordpred analysis was applied to forecast global epidemiological trends through 2044.</div></div><div><h3>Results</h3><div>In 2021, the estimated global age-standardized incidence and mortality rates of pancreatitis among older adults were 85.20% (95% confidence interval [CI]: 59.10 to 118.00) per 100,000 population and 7.97% (95% CI: 6.84 to 9.41) per 100,000 population, respectively. The disease burden of incidence and mortality was greatest in Eastern Europe. From 1992 to 2021, both the estimated global age-standardized incidence and mortality rates of pancreatitis among older adults demonstrated significant declining trends. The evolution of trends varied significantly across different regions and 204 countries, with an increased trend of age-standardized incidence rates in the Sociodemographic Index (SDI) regions. The age–period–cohort analysis results showed that the relative risk of incidence and mortality generally exhibited unfavorable trends over time in low-middle and low SDI regions. In addition, the age-standardized incidence and mortality rates were predicted to decrease annually, whereas case numbers of these metrics were predicted to keep increasing until 2044.</div></div><div><h3>Conclusions</h3><div>There are strong heterogeneities in the incidence and mortality trends of older pancreatitis across the world, including both growing case numbers and distributive disparities, which may be instructive for future explorations in the prevention and treatment of this disease.</div></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"6 1","pages":"Pages 42-52"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147286257","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":"N6-methyladenosine methylation in acute lung injury: Mechanisms and research progress","authors":"Yating Hu,&nbsp;Yijie Wang,&nbsp;Xiyue Liu,&nbsp;Xiaoli Xue,&nbsp;Binbin Li,&nbsp;Fangwei Li","doi":"10.1016/j.jointm.2025.07.001","DOIUrl":"10.1016/j.jointm.2025.07.001","url":null,"abstract":"<div><div>N6-methyladenosine (m6A) methylation is the most prevalent and abundant internal post-transcriptional RNA modification in eukaryotic cells, playing an important regulatory role in various biological processes. The biological functions of m6A modification are dynamically and reversibly mediated by methyltransferases (writers), demethylases (erasers), and m6A binding proteins (readers). Acute lung injury (ALI) is a common critical condition characterized by diffuse edema within the pulmonary interstitium and alveoli, and is associated with high morbidity and mortality. Recent studies have identified that aberrant expression of m6A regulators is closely associated with ALI development. This review highlights the progress in research on m6A writers, erasers, and readers in ALI, focusing on their molecular regulatory mechanisms. Elucidating the molecular mechanisms of m6A and its associated proteins in ALI may reveal new therapeutic strategies and targets.</div></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"6 1","pages":"Pages 28-33"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147286493","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 reliability of the plethysmographic perfusion index for detecting fluid responsiveness in critically ill patients","authors":"Younes Aissaoui,&nbsp;Ayoub Bouchama,&nbsp;Chaimae Abouelkemhe,&nbsp;Abdellah Enourhbi,&nbsp;Bassam Bencharfa,&nbsp;Mehdi Didi,&nbsp;Hatim Aguena,&nbsp;Ayoub Belhadj","doi":"10.1016/j.jointm.2025.07.004","DOIUrl":"10.1016/j.jointm.2025.07.004","url":null,"abstract":"<div><h3>Background</h3><div>The assessment of fluid responsiveness (FR) is critical during the initial management of acute circulatory failure (ACF). However, in resource-limited settings or emergency situations, advanced hemodynamic monitoring is often unavailable. The plethysmographic perfusion index (PPI), a non-invasive parameter derived from pulse oximetry, has been proposed as a surrogate marker for changes in cardiac output. The objective of this study was to evaluate the ability of the PPI to detect FR in critically ill patients with ACF during early resuscitation.</div></div><div><h3>Methods</h3><div>This was a prospective observational study conducted over seven months (February to September 2024) in a 10-bed intensive care unit. Adult patients with ACF requiring a 500-mL fluid bolus were enrolled. FR was assessed by transthoracic echocardiography, defined as <em>a</em> ≥ 15% increase in left ventricular outflow tract velocity-time integral (VTI). VTI and PPI values were obtained before and immediately after the completion of fluid administration. The diagnostic performance of changes in PPI (ΔPPI) was assessed using receiver operating characteristic (ROC) curve analysis and a gray zone approach.</div></div><div><h3>Results</h3><div>Fifty patients (29 males and 21 females) were included, with a median age of 65 years (interquartile range [IQR]: 57–77). Sepsis-related ACF accounted for 60% of cases. FR was observed in 33 patients (66%). The area under the ROC curve (AUC) for ΔPPI was 0.778 (95% CI: 0.638 to 0.883, <em>P</em> = 0.004). A ΔPPI threshold of 33% yielded 70% sensitivity and 82% specificity. The gray zone ranged from 0% to 88%, encompassing 30% of the cohort.</div></div><div><h3>Conclusion</h3><div>The PPI demonstrated moderate accuracy in detecting FR during early resuscitation of ACF. As a simple, non-invasive, and widely accessible tool, PPI holds promise for informing fluid management decisions in emergency and critical care settings. Further technological refinements may enhance its diagnostic performance and broaden its clinical applicability.</div><div><strong>Trial registration</strong> Clinical Trials.gov Identifier: NCT06313671.</div></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"6 1","pages":"Pages 34-41"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147286489","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":"Vasoactive drugs and the distribution of crystalloid fluid during acute sepsis","authors":"Robert G. Hahn ,&nbsp;Yuhong Li ,&nbsp;Randal O. Dull","doi":"10.1016/j.jointm.2025.08.008","DOIUrl":"10.1016/j.jointm.2025.08.008","url":null,"abstract":"<div><h3>Background</h3><div>Crystalloid fluid is combined with vasoactive drugs when treating acute sepsis. We used kinetic analysis to compare the effects of vasoactive drugs on the hemodynamics and the volume kinetics of crystalloid fluid in non-septic and septic sheep. Specific attention was given to the effects of drugs and sepsis on fluid distribution to the “third fluid space.”</div></div><div><h3>Methods</h3><div>Forty-nine sheep were studied, of which 25 were made septic by cecal puncture and administration of lipopolysaccharide. A bolus infusion of 20–25 mL/kg of crystalloid fluid was given 1 h later, together with therapeutic doses of phenylephrine, norepinephrine, isoprenaline, dopamine, or esmolol. Central hemodynamics were monitored, and blood samples for the calculation of volume kinetics were taken. The distribution and elimination of the infused volume were calculated using mixed-model kinetics with extensive covariate analyses based on 1134 measurements of the hemoglobin-derived plasma dilution (23 per experiment) and 193 measurements of urine output collected over 180 min.</div></div><div><h3>Results</h3><div>Sepsis induced a hyperkinetic, hypotensive, and vasodilatory state. Cardiac output averaged 12.1 L/min in septic sheep <em>vs</em>. 7.6 L/min in non-septic sheep, and mean arterial pressure was 72 <em>vs</em>. 109 mmHg, respectively. Differences in hemodynamic variables between the non-septic and septic sheep were all statistically significant (<em>P</em> &lt;0.001). However, the modifying influences of vasopressors on hemodynamics and fluid distribution were weakened in the septic state. The rate constant for urine output (<em>k</em>₁₀) was strongly decreased by sepsis, modestly reduced by β₁-adrenergic stimulation, and increased by α₁-adrenergic stimulation. Fluid was able to access the remote slow-exchange interstitial fluid space (“third fluid space”) only during sepsis. In theory, fluid accumulation in this space would decrease by α₁-adrenergic stimulation and increase by β₁-adrenergic stimulation, but differences were small due to the overall weak effects of adrenergic drugs in the septic sheep. We hypothesize that the changeover from brisk urine flow in the non-septic sheep to marked accumulation of fluid in the “third fluid space” was due to inflammation-induced alterations in the interstitial matrix.</div></div><div><h3>Conclusion</h3><div>Vasoactive drugs were less effective in septic compared to non-septic sheep. Most importantly, acute sepsis was characterized by a marked accumulation of fluid in an interstitial fluid space with slow turnover.</div></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"6 1","pages":"Pages 75-82"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147286507","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":"Methodological development of the remote ventilate view platform for real-time monitoring of patient-ventilator asynchrony and respiratory parameters in severe pneumonia patients","authors":"Xiangyu Chen ,&nbsp;Siyi Yuan ,&nbsp;Elias Baedorf Kassis ,&nbsp;Song Zhang ,&nbsp;Yi Chi ,&nbsp;Shengjun Liu ,&nbsp;Fuhong Cai ,&nbsp;Yue Ma ,&nbsp;Yan Li ,&nbsp;Longxiang Su ,&nbsp;Yun Long","doi":"10.1016/j.jointm.2025.07.003","DOIUrl":"10.1016/j.jointm.2025.07.003","url":null,"abstract":"<div><h3>Background</h3><div>Patient-ventilator asynchrony (PVA) is common in critically ill patients undergoing mechanical ventilation and may adversely affect clinical outcomes. Traditional bedside assessment methods are subjective and intermittent. We developed a real-time digital platform to continuously monitor ventilator waveforms and quantify overall asynchrony burden of severe pneumonia patients.</div></div><div><h3>Methods</h3><div>The study retrospectively analyzed mechanically ventilated coronavirus disease 2019 (COVID-19 patients admitted to the Department of Critical Care Medicine of Peking Union Medical College Hospital (PUMCH) from December 2022 to August 2023. Ventilator waveforms were continuously collected and processed using the remote ventilate view platform, which automatically identified eight PVA subtypes and calculated the Overall Asynchrony Index (OAI) across the full ventilation course. Respiratory mechanics were also extracted. Primary outcomes included intensive care unit (ICU) mortality and 28-day ventilator-free days (VFDs), while secondary outcomes included the length of ICU stay and duration of mechanical ventilation. The study used R, Jamovi, and Python for statistical analysis.</div></div><div><h3>Results</h3><div>Twenty-three mechanically ventilated COVID-19 patients admitted to the ICU at Peking Union Medical College Hospital were included in this study. No correlation was found between the index and ventilatory parameters, compliance, and disease severity. Patients with an OAI ≥10 % were more likely to have fewer 28-day VFDs (1.3 days <em>vs</em>. 11.4 days, <em>P</em> = 0.027) and were demonstrated to have a higher ICU mortality (66.7 % <em>vs</em>. 18.2 %, <em>P</em> = 0.036). Among eight types of PVA, flow insufficiency was found to be associated with prognosis (<em>P</em> = 0.012). OAI correlated with the prognosis of COVID-19 patients. Patients with an OAI ≥10 % were more likely to have fewer 28-day VFDs and higher ICU mortality.</div></div><div><h3>Conclusions</h3><div>A higher OAI and increased flow insufficiency were associated with worse outcomes in COVID-19 patients receiving mechanical ventilation. This study demonstrates the feasibility and clinical potential of a real-time, platform-based approach for automated detection and longitudinal monitoring of PVA.</div></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"5 4","pages":"Pages 367-376"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145335065","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":"Seeing Artery and VEin Simultaneously in the long axis (SAVES) for ultrasound-guided infraclavicular axillary/subclavian vein cannulation: A retrospective analysis","authors":"Ruyuan Zhang,&nbsp;Lei Li,&nbsp;Yaoqing Tang,&nbsp;Dechang Chen","doi":"10.1016/j.jointm.2025.05.002","DOIUrl":"10.1016/j.jointm.2025.05.002","url":null,"abstract":"<div><h3>Background</h3><div>The anatomical configuration of the anterior scalene muscle, inserting between the subclavian vein and artery, creates a space between them. By placing an ultrasound probe in the infraclavicular area, an optimal longitudinal view of both the proximal part of the axillary and the distal part of the subclavian vein and artery can be obtained, while the pleura is out of view. This Seeing Artery and VEin Simultaneously in the long axis (SAVES) method for ultrasound-guided infraclavicular axillary/subclavian vein cannulation offers theoretical advantages because it may avoid iatrogenic pneumothorax and reduce the risk of arterial damage. The objective of the present study was, to our knowledge, for the first time, to determine the safety and efficacy of the SAVES method for ultrasound-guided infraclavicular axillary/subclavian vein cannulation in adult critically ill patients.</div></div><div><h3>Methods</h3><div>A retrospective study was performed on consecutive adult critically ill patients who underwent ultrasound-guided infraclavicular axillary/subclavian vein cannulation performed by the same physician in a medical/surgical intensive care unit (12 beds) between 20 August 2021 and 20 December 2024. The overall success rate, the first-pass success rate, the access time and number of attempts, the incidence of difficulty with insertion of the guidewire/dilator/catheter, and the mechanical complication rate were analyzed.</div></div><div><h3>Results</h3><div>A total of 111 adult critically ill patients required 142 ultrasound-guided infraclavicular axillary/subclavian vein punctures using the SAVES method. The overall success rate was 100%, and the first-pass success rate was 75.4%. The access time was 38.5 (interquartile range: 21.5–80.0) s. The proportions of different numbers (1, 2, and 3) of attempted catheterizations were 88.7%, 9.2%, and 2.1%, respectively. The incidence of difficulty with guidewire insertion was 15.5%, while no difficulty with insertion of the dilator or catheter was experienced. No instance of pneumothorax, hemothorax, arterial puncture, brachial plexus injury, or cardiac tamponade was recorded. The incidence of hematoma formation was 2.1%. The occurrence rate of posterior venous wall penetration was 3.5%. The catheter malposition rate was 5.6%.</div></div><div><h3>Conclusions</h3><div>The SAVES technique may be a safe and effective approach for ultrasound-guided infraclavicular axillary/subclavian vein cannulation. A larger controlled prospective study is warranted to confirm these findings.</div></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"5 4","pages":"Pages 350-358"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145335105","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":"History of the Chinese medical association-Chinese society of critical care medicine","authors":"Dechang Chen","doi":"10.1016/j.jointm.2025.08.005","DOIUrl":"10.1016/j.jointm.2025.08.005","url":null,"abstract":"","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"5 4","pages":"Pages 295-297"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145332369","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 pattern of aerosol drug therapy in ARDS patients: A secondary analysis of the Aero-in-ICU study","authors":"Sanjay Singhal ,&nbsp;Sai Saran ,&nbsp;Krupal Joshi ,&nbsp;Mohan Gurjar ,&nbsp;Parnandi Bhaskar Rao ,&nbsp;Jyoti Narayan Sahoo ,&nbsp;Ruchi Dua ,&nbsp;Alok Kumar Sahoo ,&nbsp;Ankur Sharma ,&nbsp;Sonika Agarwal ,&nbsp;Arun Sharma ,&nbsp;Pralay Shankar Ghosh ,&nbsp;Nikhil Kothari ,&nbsp;Kunal Deokar ,&nbsp;Sudipta Mukherjee ,&nbsp;Prakhar Sharma ,&nbsp;BPS Sreedevi ,&nbsp;Prakash Sivaramakrishnan ,&nbsp;Umadri Singh ,&nbsp;Dhivya Sundaram ,&nbsp;Avinash Agrawal","doi":"10.1016/j.jointm.2025.05.003","DOIUrl":"10.1016/j.jointm.2025.05.003","url":null,"abstract":"<div><h3>Background</h3><div>The potential role of aerosol drug therapy (ADT) in patients with acute respiratory distress syndrome (ARDS) remains uncertain. The objective of this study is to determine the prevalence and practice patterns of ADT in patients with ARDS.</div></div><div><h3>Methods</h3><div>This secondary analysis of a prospective observational multi-centric cohort study done in critically ill patients to know the ADT practice pattern was conducted in nine participating intensive care units (ICUs) across India between November 2022 and March 2023. The study recruited newly admitted adult patients (age &gt;18 years) who had an artificial airway and required mechanical ventilation (invasive or non‑invasive). These patients were followed up for the next 14 days or until ICU discharge or death. This secondary analysis collected data about screened patients with ARDS, related to each aerosol therapy including ongoing respiratory support, type of drug, and aerosol‑generating device, including ongoing respiratory support, type of drug, and aerosol‑generating device.</div></div><div><h3>Results</h3><div>Fifty-three (24.3%) of the 218 patients had ARDS, with a mean age of (60.2±14.8) years. At admission, the acute physiology and chronic health evaluation (APACHE II) and sequential organ failure assessment (SOFA) score of the recruited patients were 17.4±7.1 and 7.7±4.0, respectively. Respiratory support was provided with invasive mechanical ventilation (IMV) alone, non-invasive ventilation (NIV) alone, or both in 45.3%, 24.5%, and 30.2% of patients, respectively. The mean duration of the ICU stay was (6.4 ± 4.0) days. Of the 53 patients with ARDS, 51 (96.2%) received 1285 aerosol sessions during follow-up for 330 patient days. Of all patients with ARDS who received aerosol therapy, 71.4% were prescribed while on IMV and 25.7% on NIV. A single drug was used in 60.7% of the aerosol sessions used a single drug, and 39.3% were prescribed combination drugs. Shorter-acting bronchodilators were the predominant drugs, with jet nebulizers (55.4%) being the most commonly used aerosol generators. These were followed by ultrasonic (23.1%) and vibrating-mesh nebulizers (21.5 %). During IMV, only in 50.1% of aerosol sessions (460 out of 918) was an aerosol generator placed at the optimum position (15–30 cm away from the Y-junction).</div></div><div><h3>Conclusions</h3><div>Aerosol therapy is frequently used in ARDS, with bronchodilators being the most common drug. The jet nebulizer is the most familiar aerosol-generating device, but only half of the aerosol sessions are at the optimum position during invasive mechanical ventilation.</div></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"5 4","pages":"Pages 385-391"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145335067","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}