Journal of intensive medicine最新文献

{"title":"Videoart in the intensive care unit: A prospective observational study","authors":"Tomer Arad ,&nbsp;Sabina Kalinchuk ,&nbsp;Dina Grinas ,&nbsp;Moran Hellerman-Itzhaki ,&nbsp;Guy Fishman ,&nbsp;Itai Bendavid ,&nbsp;Liran Statlender ,&nbsp;Ilya Kagan ,&nbsp;Pierre Singer","doi":"10.1016/j.jointm.2025.02.001","DOIUrl":"10.1016/j.jointm.2025.02.001","url":null,"abstract":"<div><h3>Background</h3><div>This study sought to evaluate the role of videoart in decreasing the risk of stress symptoms in patients hospitalized in the intensive care unit (ICU).</div></div><div><h3>Methods</h3><div>This is a prospective observational cohort study conducted in a general ICU in which 8 of 18 rooms are equipped with a videoart system. Competent patients who spent at least 48 h in the ICU were asked to complete an Impact of Events Scale (IES) questionnaire during hospitalization and at least 1 year after discharge. Patients were recruited from April 2017 until June 2020, and follow-up phone calls were made from June to August 2021. The primary outcome was an IES score indicative of significant stress symptoms during hospitalization. Secondary outcomes were IES scores indicative of significant stress symptoms after discharge and clinical parameters during hospital stay. The cut-off value for high-risk stress symptoms was 26. However, because there is uncertainty in the literature regarding the desired cut-off value, two other values were also analyzed. Outcomes that were found statistically significant were further examined using a logistic regression model for the control of confounders.</div></div><div><h3>Results</h3><div>Eighty-one patients completed the questionnaire during hospital stay and 24 patients after discharge. At home, patients who were exposed to videoart had a marginally lower mean IES score (median=6 [interquartile range: 0–18] <em>vs.</em> median=32 [interquartile range:10–45], <em>P</em> = 0.054) and a significantly lower rate of high-risk stress symptoms using the primary cut-off value (11.8 % <em>vs.</em> 57.1 %, <em>P</em>=0.038; odds ratio=10.00 95 % CI: 1.22 to 81.80, <em>P</em>=0.03). However, statistical significance was lost after adjustment for confounders (odds ratio=12.00, 95 % CI: 0.67 to 222.00, <em>P</em>=0.09) . There was no difference in the mean IES score, significant stress symptoms rate, or in any of the other endpoints examined during the hospital stay.</div></div><div><h3>Conclusions</h3><div>There is a trend toward the beneficial effect of videoart for the alleviation of stress symptoms among ICU patients. However, further study is needed to examine the role of this technology.</div></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"5 4","pages":"Pages 400-406"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145335104","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":"ICU readmission and mortality risk prediction: Generalizability of a multi-hospital model","authors":"Tariq A. Dam ,&nbsp;Daan de Bruin ,&nbsp;Giovanni Cinà ,&nbsp;Patrick J. Thoral ,&nbsp;Paul W.G. Elbers ,&nbsp;Corstiaan A. den Uil ,&nbsp;Reinier F. Crane","doi":"10.1016/j.jointm.2025.03.007","DOIUrl":"10.1016/j.jointm.2025.03.007","url":null,"abstract":"<div><h3>Background</h3><div>Inadvertent intensive care unit (ICU) readmission is associated with longer length of stay and increased mortality. Conversely, delayed ICU discharge may represent inefficient use of resources. To better inform discharge timing, several hospitals have implemented machine learning models to predict readmission risk following discharge. However, these models are typically created locally and may not generalize well to other hospitals or patient populations. A single multi-hospital-based model might provide more accurate predictions and insight into features that are applicable across diverse clinical settings.</div></div><div><h3>Methods</h3><div>This study involved a retrospective multi-center cohort from one academic hospital (Amsterdam University Medical Center [AUMC]) and two large teaching hospitals (Maasstad Ziekenhuis [MSZ] and OLVG). Data from the latter two hospitals were combined to create a pooled model, which was tested on the academic hospital dataset. Data relating to all adult ICU patients were included, starting from the implementation of the electronic health record system until the commencement of model development for each hospital. An XGBoost model was trained to predict a composite outcome of readmission or mortality within 7 days and an autoencoder was used as an out-of-distribution (OOD) detector to capture dataset heterogeneity.</div></div><div><h3>Results</h3><div>In total, 44,837 patients were available for analysis across the three hospitals. The average readmission rates were 7.1 %, 6.9 %, and 5.9 % for MSZ, OLVG, and AUMC, respectively. Performance evaluation of the local models on AUMC data demonstrated weighted area under the receiver operating characteristic curves of 69.7 %±0.8 %, 70.5 %±0.5 %, and 76.5 %±1.9 %, respectively, whereas the pooled model achieved a weighted area under the receiver operating characteristic curves of 71.1 %±0.7 %. The difference between internal and external performance was reduced when cardiac surgery patients were excluded. The key features across models were albumin levels and the use of oxygen therapy.</div></div><div><h3>Discussion</h3><div>A single, multi-hospital-based model performed comparably on external datasets, especially when cardiac surgery patients were excluded. However, when applied externally, model predictions risk being uncalibrated for specific patient subgroups and require careful calibration before implementation. While external models were more stable than local ones over OOD scores, their performance was comparable after excluding cardiac surgery patients. Although pooling data marginally improved performance on external datasets, the incorporation of data from diverse hospitals is likely to provide greater benefits.</div></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"5 4","pages":"Pages 377-384"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145335068","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":"Joint application of multiplex drop-off digital PCR, droplet digital PCR, and metagenomic next-generation sequencing for the diagnosis of suspected infectious diseases: A retrospective cohort study","authors":"Shanshan Jin ,&nbsp;Shiyu Meng ,&nbsp;Qiuping Huang ,&nbsp;Hui Xie ,&nbsp;Jingjing Zheng ,&nbsp;Ruilan Wang","doi":"10.1016/j.jointm.2025.03.006","DOIUrl":"10.1016/j.jointm.2025.03.006","url":null,"abstract":"<div><h3>Background</h3><div>Critically ill patients in ICUs are highly vulnerable to infectious diseases. Early and accurate identification of pathogens is vital for initiating appropriate antimicrobial therapy. To evaluate the diagnostic effectiveness in patients with suspected infectious diseases; three different molecular technologies and conventional microbiological tests were used.</div></div><div><h3>Methods</h3><div>A total of 97 individuals suspected of having infectious diseases were retrospectively enrolled from July 2023 to January 2024 at Shanghai General Hospital. Samples were collected for metagenomic next-generation sequencing (mNGS), droplet digital polymerase chain reaction (ddPCR), multiplex drop-off digital polymerase chain reaction (MDO-dPCR), and conventional microbiological tests (CMTs) for suspected pathogen detection. The diagnostic efficacies of the three molecular technologies and CMTs were compared, and the effects of their joint application on clinical outcomes were evaluated. Intergroup comparisons were performed using the Kruskal–Wallis test, with a <em>P</em>-value &lt;0.05 considered statistically significant.</div></div><div><h3>Results</h3><div>Joint detection exhibited a high negative predictive value. The sensitivity of MDO-dPCR, ddPCR, and mNGS was 52.6%, 48.5%, and 96.6%, respectively; and the corresponding specificity was 72.5%, 73.3%, and 50.0%. A positive correlation was observed between pathogen copies detected using MDO-dPCR and procalcitonin (Pearson’s <em>ρ</em>=0.21, <em>P</em>=0.039), acute physiology and chronic health evaluation II (Pearson’s <em>ρ</em>=0.24, <em>P</em> =0.018), and sequential organ failure assessment (Pearson’s <em>ρ</em>=0.25, <em>P</em>=0.012). Therapeutic regimens were adjusted in 51.5% of the patients (50/97) based on the results of the combination tests.</div></div><div><h3>Conclusions</h3><div>In the present study, we highlighted the significance of molecular technologies for the early diagnosis of patients with suspected infections. These technologies can serve as a complement to CMTs and should be implemented promptly to guide clinicians in providing timely and effective anti-infective treatments. Future studies should aim to confirm these findings in large-scale clinical trials to refine diagnostic protocols, while also incorporating cost-utility analyses.</div></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"5 4","pages":"Pages 407-418"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145335103","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":"Severe invasive Streptococcus pyogenes infections: A 15-year observational study with molecular characterization of isolates among intensive care adults","authors":"Loreto Vidaur ,&nbsp;Izaskun Azkarate ,&nbsp;Estibaliz Salas ,&nbsp;Iñigo Ansa ,&nbsp;Diego Vicente ,&nbsp;Jordi Rello ,&nbsp;Milagrosa Montes","doi":"10.1016/j.jointm.2025.06.001","DOIUrl":"10.1016/j.jointm.2025.06.001","url":null,"abstract":"<div><h3>Background</h3><div>Improving outcomes among patients with invasive group A <em>Streptococcus pyogenes</em> (iGAS) infections is an unmet clinical need. The main objective of this study was to analyze epidemiological and outcome differences in adults admitted to the intensive care unit (ICU) with iGAS infection over a 15-year period and to evaluate the impact of M1uk isolates and clindamycin optimization on patient outcomes.</div></div><div><h3>Methods</h3><div>This was a single-center observational study conducted at the ICU of Donostia University Hospital, located in Donostia, Spain. The recruitment of all consecutive adult patients admitted to the ICU by iGAS was carried out from January 2010 to May 2024 and divided into three periods: pre-pandemic (January 2010–2019), pandemic (2020–2021), and post-pandemic (May 2022–2024). The main outcome variables were ICU length of stay, hospital length of stay, and ICU mortality. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) software (version 25; SPSS Inc., Chicago, IL, USA). A significance level of <em>P</em> &lt;0.05 was considered for all analyses.</div></div><div><h3>Results</h3><div>Sixty-eight adults were enrolled, with a crude mortality in pre- and post-pandemic periods being 25.5% and 10.0% (<em>P</em>=0.200), respectively. Twenty (29.4%) were respiratory and 29 (41.2%) were soft tissue infections. The incidence had valleys (&lt;1/100,000) in 2020 and 2021 and peaks (&gt;4/100,000 inhabitants) in 2014, 2019, and 2023. Pre-pandemic patients were significantly younger (median: 58.0 <em>vs.</em> 67.5 years, <em>P</em> &lt;0.050), had lower Charlson scores (median: 0 <em>vs.</em> 2, <em>P</em>=0.009), and required more renal replacement therapy (48.9% <em>vs.</em> 15.0%, <em>P</em>=0.013). <em>Emm1</em> type was the most frequent isolated strain, with the M1uk lineage being represented in 6 out of 7 <em>Emm1</em> isolates in post-pandemic period. M1uk-infected patients were older (median: 67.0 <em>vs.</em> 50.0 years, <em>P</em>=0.073) but mortality was similar. Most patients (86.6%) received β-lactams plus clindamycin. Interestingly, time to clindamycin administration was earlier (median: 1 h <em>vs.</em> 24 h; <em>P</em> &lt;0.050) in the post-pandemic period with a 5-fold increase in ICU mortality (5.6% to 26.5%, OR=6.14, 95% CI: 0.74 to 50.85; <em>P</em>=0.090) among those adults who did not receive clindamycin in the emergency department.</div></div><div><h3>Conclusions</h3><div>The incidence of iGAS infections requiring ICU admission showed no significant increase post-Coronavirus Disease-19 pandemic. The highly toxigenic M1uk strain became predominant, but it was not associated with worse mortality among adult ICU patients.</div></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"5 4","pages":"Pages 336-343"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145335149","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 international, prospective CytOSorbⓇ treatMent Of critically ill patientS (COSMOS) registry: Interim results from the first 150 patients","authors":"Ricard Ferrer ,&nbsp;Matthias Thielmann ,&nbsp;Andreas Kribben ,&nbsp;Moritz Unglaube ,&nbsp;Bartosz Tyczynski ,&nbsp;Julian Kreutz ,&nbsp;Andreas Baumann ,&nbsp;Ulf Guenther ,&nbsp;Dietrich Henzler ,&nbsp;Thomas Kirschning ,&nbsp;Aschraf El-Essawi ,&nbsp;Thomas Günther ,&nbsp;Martin Bellgardt ,&nbsp;Gabriella Bottari ,&nbsp;Filippo Aucella ,&nbsp;Jorge Hidalgo ,&nbsp;Jean-Louis Teboul ,&nbsp;Dana Tomescu ,&nbsp;Teresa Klaus ,&nbsp;Weihong Fan ,&nbsp;Fabio Silvio Taccone","doi":"10.1016/j.jointm.2025.05.001","DOIUrl":"10.1016/j.jointm.2025.05.001","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;The CytOSorb&lt;sup&gt;Ⓡ&lt;/sup&gt; treatMent Of critically ill patientS (COSMOS) registry is an observational, prospective, multicenter, international real-world data collection platform executed in countries where the CytoSorb&lt;sup&gt;Ⓡ&lt;/sup&gt; (CS) 300 mL device is approved and routinely used in everyday clinical practice. This study aims to investigate utilization patterns of the hemoadsorption device and associated outcomes in critical care.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Since July 2022, patients who were treated with CS as part of their intensive care treatment were enrolled from 16 sites in Germany, Italy, and Spain in the registry. After informed consent, real-world clinical data are systematically collected at multiple intervals, including 24 h before CS start, during CS treatment, and 24 h post-CS treatment, as well as at discharge from intensive care unit (ICU) and hospital discharge, and final follow-up on day 90. Vital status was assessed as ICU survival, 30-day survival, overall hospital survival, and 90-day survival. We compared details on the type of extracorporeal circuit used, device flow rate, anticoagulation regimen, vasopressor requirements, fluid balance, ratio of partial pressure of oxygen in arterial blood to the fraction of inspiratory oxygen concentration (P/F ratio), myoglobin in the rhabdomyolysis cohort and bilirubin in the liver failure cohort before and after CS treatment. Safety of the device was assessed by investigator-reported device-related adverse effects. Data were presented as either mean ± standard deviation or as median with interquartile range (IQR).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;A total of 150 patients were enrolled, 23 patients did not have any data entry by the time of the data readout for this interim analysis conducted and therefore had to be excluded from the analysis (33 % female, mean age [59±17] years). CS indications included septic shock (57.6 %), cardiogenic shock (12.9 %), and rhabdomyolysis (10.6 %). CS was mainly integrated with renal replacement therapy (82.8 %). Median Acute Physiology and Chronic Health Evaluation II score was 23 (IQR: 17–29), Sequential Organ Failure Assessment score 12 (IQR: 9–15), and ICU stay 20 (IQR: 11–33) days. Median interleukin-6 decreased significantly from 862.4 (IQR: 142–97,457) pg/mL in the 24 h before CS treatment to 202.8 (IQR: 42–3247) pg/mL in the 24 h post-CS treatment (&lt;em&gt;P&lt;/em&gt; &lt;0.0001). Post-CS, lactate and creatinine levels significantly decreased, fluid balance improved from 1386 (IQR: 220–3168) mL to 275 (IQR: -768–1846) mL (&lt;em&gt;P&lt;/em&gt; &lt;0.0001) and median P/F ratio increased from 132 (IQR: 68–208) mmHg to 189 (IQR: 115–260) mmHg (&lt;em&gt;P&lt;/em&gt; &lt;0.0001). Norepinephrine requirements reduced from 0.30 (IQR: 0.18–0.46) µg/(kg·min) to 0.19 (IQR: 0.10–0.33) µg/(kg·min) (&lt;em&gt;P&lt;/em&gt;=0.0003). In rhabdomyolysis patients, myoglobin decreased from 18,976 (IQR: 1934–34,275) to 835 (IQR: 623–5925) µg/L (&lt;em&gt;P&lt;/em&gt;=0.0273). Obser","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"5 4","pages":"Pages 392-399"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145335066","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":"Enhancing outcomes in pediatric populations with continuous renal replacement therapy: Current multidisciplinary strategies and innovations","authors":"Flora R. Gallegos ,&nbsp;Parth Shirode ,&nbsp;Max Gilliland ,&nbsp;Jieji Hu ,&nbsp;Amanda Osagie-Ogbeide ,&nbsp;Sidharth Kumar Sethi ,&nbsp;Rupesh Raina","doi":"10.1016/j.jointm.2025.03.005","DOIUrl":"10.1016/j.jointm.2025.03.005","url":null,"abstract":"<div><div>Continuous renal replacement therapy (CRRT) is critical in managing several conditions in critically ill pediatric patients. The clinical and economic impact of CRRT is profound and diverse, similar to the patients and conditions it is used to treat. Although much medical literature surrounds CRRT in adults, there remains a gap in research for pediatric populations. This article provides a brief review of current kidney replacement therapies, focusing on CRRT indications, prescribing practices, and modality comparisons. We aim to evaluate the current practical considerations and effectiveness of these therapies and highlight recent advances and future directions, especially in relation to the pediatric patient population. We analyzed recent literature and clinical guidelines on CRRT for critically ill pediatric patients. Key considerations include prescription strategies and comparison of different CRRT modalities, and essential considerations include anticoagulation, settings, and complications. We also explore recent advances in CRRT technologies and their role in clinical management. CRRT offers significant benefits for patients with severe kidney impairments by providing continuous support and improving outcomes. Discussing current recommendations and uses of CRRT and recent advancements will improve its safety and efficacy. Advances in technology and clinical practice are enhancing the use of CRRT, though further research is needed to optimize treatment and address ongoing challenges.</div></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"5 4","pages":"Pages 323-332"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145334922","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":"Post-traumatic vasospasm: Epidemiology, specificities, risk factors, and therapeutics","authors":"Clara Perrault ,&nbsp;Audrey Melcus ,&nbsp;Etienne Lefevre ,&nbsp;Eimad Shotar ,&nbsp;David Ditchi ,&nbsp;Lamine Abdennour ,&nbsp;Vincent Degos ,&nbsp;Alice Jacquens","doi":"10.1016/j.jointm.2025.05.004","DOIUrl":"10.1016/j.jointm.2025.05.004","url":null,"abstract":"<div><div>Post-traumatic vasospasm (PTV) of intracranial arteries is a serious complication of traumatic brain injury (TBI) that can lead to significant neurological deficits and ischemic brain lesions. Despite its clinical relevance, the pathogenesis of PTV is not fully understood, and effective management strategies remain a challenge. This review aims to synthesize the current knowledge on pathophysiology, risk factors, detection, prevention, and treatment of PTV. Early detection of PTV is made difficult by the complexity of TBI and its management. The gold standard for vasospasm detection remains digital subtraction angiography (DSA). However, noninvasive techniques such as transcranial Doppler (TCD) and S100 protein monitoring may assist in detecting PTV. Compared with vasospasm associated with aneurysmal subarachnoid hemorrhage (aSAH), PTV appears to occur earlier and to resolve more quickly. Several risk factors have been identified, including the severity of TBI, younger age, SAH, or the presence of other hematomas. Treatment options include nimodipine and endovascular therapies, such as angioplasty and milrinone, though these require careful management due to their invasive nature and potential hypotensive effect. PTV represents a critical complication of TBI, requiring early detection and timely intervention to prevent secondary brain injuries. Although current strategies, such as nimodipine and intra-arterial therapies, have shown promise, further research is needed to refine these approaches and improve outcomes. Enhanced understanding of PTV’s pathophysiology, along with the development of more effective diagnostic and therapeutic tools, is essential for advancing patient care in TBI.</div></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"5 4","pages":"Pages 313-322"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145335101","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":"Comparison of hydrocortisone 100 mg bolus plus 200 mg/day infusion vs. infusion alone in refractory septic shock","authors":"Ukrit Jiradechpitak,&nbsp;Theerapon Tangsuwanaruk,&nbsp;Patipan Sitthiprawiat,&nbsp;Borwon Wittayachamnankul","doi":"10.1016/j.jointm.2025.02.002","DOIUrl":"10.1016/j.jointm.2025.02.002","url":null,"abstract":"<div><h3>Background</h3><div>Current guidelines recommend the addition of hydrocortisone 200 mg/day for the treatment of septic shock unresponsive to fluids and vasopressors. However, the benefits of adding a 100 mg bolus to this regimen remain unclear. The study assessed the efficacy of the administration of hydrocortisone 200 mg/day with or without a 100 mg bolus in refractory septic shock.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included adult patients with refractory septic shock treated at a tertiary care center between 2019 and 2023. Patients were divided into bolus group (receiving a 100 mg hydrocortisone bolus followed by a 200 mg/day continuous infusion) and non-bolus group (receiving a continuous infusion of 200 mg/day without the addition of a bolus) based on physician decision. The primary outcomes were the duration of vasopressor and shock reversal. Secondary outcomes included 28-day mortality and length of hospital stay. Comparisons between groups were performed using chi-squared tests, <em>t</em>-tests, and Kaplan–Meier survival analysis.</div></div><div><h3>Results</h3><div>A total of 184 patients were included, 149 patients in the bolus group and 35 patients in the non-bolus group. The median vasopressor duration was 1 (interquartile range [IQR]: 1–2) days in both groups (<em>P</em>=0.967). Shock reversal occurred in 79.9 % of the bolus group and 82.9 % of the non-bolus group (OR=0.82, 95% CI: 0.30 to 2.23, <em>P</em>=0.688). Secondary outcomes in the bolus group and non-bolus group, including 28-day mortality (30.2 % <em>vs.</em> 22.9 %, OR=1.46, 95% CI: 0.62 to 3.43, <em>P</em>=0.745) and hospital length of stay (9 [IQR: 6-17] days <em>vs</em>. 11 [IQR: 5-15] days, <em>P</em>=0.875), did not show any significant differences. Kaplan–Meier survival analysis showed no difference in 28-day survival between groups (HR=1.29, 95% CI: 0.73 to 2.30, <em>P</em>=0.373).</div></div><div><h3>Conclusion</h3><div>The addition of a 100 mg bolus to a 200 mg/day hydrocortisone regimen may not impact clinical outcomes in refractory septic shock.</div></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"5 4","pages":"Pages 344-349"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145335106","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":"Initial fluid resuscitation in septic shock: Reassessing the 30 mL/kg paradigm","authors":"Jean-Louis Teboul ,&nbsp;Jiao Liu ,&nbsp;Olfa Hamzaoui","doi":"10.1016/j.jointm.2025.08.001","DOIUrl":"10.1016/j.jointm.2025.08.001","url":null,"abstract":"","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"5 4","pages":"Pages 298-300"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145332370","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":"Sex-related differences in antimicrobial dosing for sepsis: Bridging the equity gap","authors":"Helena Barrasa ,&nbsp;Goiatz Balziskueta ,&nbsp;Jordi Rello","doi":"10.1016/j.jointm.2025.08.004","DOIUrl":"10.1016/j.jointm.2025.08.004","url":null,"abstract":"","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"5 4","pages":"Pages 301-303"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145332371","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}