Journal of intensive medicine最新文献

{"title":"Redefining ARDS phenotypes: Challenges in the precision medicine era","authors":"Raffaele Merola , Denise Battaglini","doi":"10.1016/j.jointm.2025.08.002","DOIUrl":"10.1016/j.jointm.2025.08.002","url":null,"abstract":"","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"5 4","pages":"Pages 333-335"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145335107","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":"Corticosteroids in sepsis","authors":"Jihene Mahmoud ,&nbsp;Marie Alice Bovy ,&nbsp;Nicholas Heming ,&nbsp;Djillali Annane","doi":"10.1016/j.jointm.2025.08.006","DOIUrl":"10.1016/j.jointm.2025.08.006","url":null,"abstract":"<div><div>Sepsis is a major health and socioeconomic burden worldwide. Although international guidelines have helped reduce crude mortality rates from sepsis by optimizing infection control and support of vital organ function, there are still no specific therapies for sepsis, other than corticosteroids. The aims of this narrative review were to provide readers with the most recent data on corticosteroids, as well as up-to-date evidence regarding their effects in patients with sepsis. Corticosteroids regulate the function of most cell types involved in host response to infections, through both genomic and non-genomic effects, reprogramming immune cells (via regulation of mitochondrial metabolism) toward anti-inflammatory types, restoring endothelial cell function and endothelium integrity, facilitating epithelium repair, and restoring vascular smooth muscle function, as well as organ perfusion. In patients with sepsis, these effects are achieved using supraphysiological doses of corticosteroids, equating to approximately 200 mg/day of hydrocortisone equivalent for 5–15 days, depending on the clinical context. The molecular and cellular effects of corticosteroids translate into prevention and reversal of the need for vasopressor, respiratory, and renal supportive therapies, as well as acceleration of organ function resolution, shorter intensive care unit (ICU) and hospital stays, and improved short- and mid-term survival. Remaining gaps in knowledge and evidence to inform practice include insufficient data about the effects of corticosteroids in children, a lack of reliable biomarkers to distinguish those patients who can benefit from treatment, and inadequate information about the effects of corticosteroids on the long-term sequelae of sepsis.</div></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"5 4","pages":"Pages 304-312"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145335102","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":"Dynamic alterations of lymphocyte subsets following sepsis in octogenarian and elder patients","authors":"Jiahui Zhang ,&nbsp;Wei Cheng ,&nbsp;Dongkai Li ,&nbsp;Ran Guo ,&nbsp;Guoyu Zhao ,&nbsp;Na Cui","doi":"10.1016/j.jointm.2025.04.002","DOIUrl":"10.1016/j.jointm.2025.04.002","url":null,"abstract":"<div><h3>Background</h3><div>Sepsis is defined as a life-threatening organ dysfunction caused by dysregulated host responses to infections. This study aimed to investigate the early and dynamic changes in peripheral lymphocyte subsets following sepsis in octogenarian and elder patients and whether these changes were related to 28-day mortality.</div></div><div><h3>Methods</h3><div>A prospective cohort study of 3601 consecutive patients admitted to the intensive care unit (ICU) was performed between March 2017 and January 2023. Peripheral blood samples were collected on admission, Day 3, and Day 7 for patients with sepsis and on enrollment for patients without sepsis. Lymphocyte subsets were detected by flow cytometry. The 28-day mortality was determined using Kaplan–Meier analysis, while Cox regression identified prognostic factors.</div></div><div><h3>Results</h3><div>All enrolled patients were divided into three groups: adult (18–64 years), elder (65–79 years), and octogenarian (≥80 years). Sepsis induced a numerical reduction in lymphocytes (median=0.653 [IQR: 0.500–1.038] <em>vs</em>. median=0.840 [IQR: 0.579–1.142] × 10⁹/L, <em>P</em>=0.043) and CD3⁺ T-cell counts (median=0.461 [IQR: 0.312–0.759] <em>vs</em>. median=0.590 [IQR: 0.417–0.789] × 10⁹/L, <em>P</em>=0.021) in octogenarian patients. Kaplan–Meier survival curves showed that in the elder (<em>P</em> [log-rank test] &lt; 0.001) and octogenarian (<em>P</em> [log-rank test]=0.02) groups, patients with CD3⁺ T-cell nonrecovery on Day 3 and Day 7 had the highest mortality, followed by those with late recovery, and the lowest mortality was observed in the early recovery group. Multivariate Cox regression analysis demonstrated that age (hazard ratio [HR]=1.217, 95% confidence interval [CI]: 1.050 to 1.410, <em>P</em>=0.009) and CD3⁺T-cell counts (HR=0.999, 95% CI: 0.999 to 1.000, <em>P</em> &lt; 0.001) were independent risk factors associated with 28-day mortality in patients with sepsis.</div></div><div><h3>Conclusions</h3><div>Sepsis induced a numerical reduction in lymphocytes and CD3⁺ T-cell counts in octogenarian patients (≥80 years). The persistent decrease of CD3⁺ T-cell counts on Day 3 and Day 7 following sepsis was associated with higher mortality in elder and octogenarian patients.</div><div><strong>Trial registration</strong> Chinese Clinical Trial Registry identifier: ChiCTR-ROC-17010750.</div></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"5 4","pages":"Pages 359-366"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145335150","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":"High-flow nasal oxygen is the reference treatment in acute hypoxemic respiratory failure: Con","authors":"Gabriel Kemoun ,&nbsp;Alexandre Demoule","doi":"10.1016/j.jointm.2024.12.005","DOIUrl":"10.1016/j.jointm.2024.12.005","url":null,"abstract":"<div><div>Over the past decade and boosted by the coronavirus disease 2019 (COVID-19) pandemic, high-flow nasal oxygen (HFNO) has been increasingly used in the intensive care unit (ICU) to treat acute hypoxemic respiratory failure (AHRF). In this review, we show that despite this wide and rapid increase in the use of HFNO to treat AHRF, HFNO does not fulfill all the criteria of a “reference treatment”. First, there are some inconsistencies between the studies that provided a positive signal toward the possible benefit of HFNO in AHRF. The two high-quality studies were negative in terms of primary outcome although they provided promising signals in favor of HFNO in terms of secondary outcomes or unplanned secondary analysis. The significance of the only positive study suffers from notable limitations and other trials, conducted in COVID-19 and in immunocompromised patients, are definitely negative and do not even provide promising signals in favor of HFNO. Of note, authors of some of the large randomized controlled trials (RCTs) on HFNO have received grants or personal fees from manufacturers of HFNO devices. Second, meta-analyses do not show positive results regarding the efficacy of HFNO on mortality and recent guidelines do not support its use to improve this outcome, although they recommend HFNO use to reduce intubation rate. Third, HFNO is associated with risks that should be accounted for. There are concerns that HFNO may delay intubation, which is in turn associated with higher mortality and prolonged length of stay. In addition, with HFNO, high inspiratory effort may generate high lung strain and overstretch, a phenomenon termed patient self-inflicted lung injury (P-SILI). Fourth, there are concerns regarding access to HFNO in resource-limited settings. Fifth, there are also concerns regarding the deleterious environmental impact of HFNO due to the high volume of consumables and high oxygen flow, which remain to be precisely quantified and balanced with the potential reduction in intubation rate. Considering all these limitations, HFNO is not yet the reference treatment for AHRF.</div></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"5 3","pages":"Pages 230-236"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144522356","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":"High-flow nasal oxygen is the reference treatment in acute hypoxemic respiratory failure: Pro","authors":"Jean-Pierre Frat ,&nbsp;Sylvain Le Pape","doi":"10.1016/j.jointm.2024.12.003","DOIUrl":"10.1016/j.jointm.2024.12.003","url":null,"abstract":"<div><div>In patients with hypoxemic acute respiratory failure (ARF), the first-line treatment is oxygen therapy, which may include the administration of high-flow nasal oxygen (HFNO), noninvasive ventilation (NIV), or continuous positive airway pressure (CPAP). In addition to improving oxygenation, HFNO and NIV reduce the work of breathing as compared to standard oxygen, while CPAP does not. However, tolerance to NIV and CPAP is clinically challenging, resulting in treatment interruption in 10 %–20 % of cases. Compared to standard oxygen, HFNO has been shown to reduce the risk of intubation, while the benefits of NIV or CPAP, even when delivered via a helmet, require further evaluation. Although evidence for the efficacy of HFNO in reducing mortality remains inconclusive, HFNO has emerged as the reference treatment and is recommended for patients with hypoxemic ARF given its benefit in reducing the risk of intubation.</div></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"5 3","pages":"Pages 222-229"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144522355","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":"Free flow Helmet continuous positive airway pressure: The devil is in the “valve's” details!","authors":"Sergio Lassola ,&nbsp;Eleonora Balzani ,&nbsp;Silvia De Rosa ,&nbsp;Marta Turella ,&nbsp;Giacomo Bellani","doi":"10.1016/j.jointm.2025.03.003","DOIUrl":"10.1016/j.jointm.2025.03.003","url":null,"abstract":"","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"5 3","pages":"Pages 219-221"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144522612","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":"Timing of initiating renal replacement therapy in acute kidney injury","authors":"Saber Davide Barbar ,&nbsp;Marine Jacquier ,&nbsp;Thomas Maldiney","doi":"10.1016/j.jointm.2024.12.004","DOIUrl":"10.1016/j.jointm.2024.12.004","url":null,"abstract":"","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"5 3","pages":"Pages 246-248"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144522358","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":"Noninvasive respiratory supports for acute hypoxemic respiratory failure","authors":"Arnaud W. Thille ,&nbsp;Rémi Coudroy","doi":"10.1016/j.jointm.2025.04.001","DOIUrl":"10.1016/j.jointm.2025.04.001","url":null,"abstract":"","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"5 3","pages":"Pages 214-215"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144522610","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":"Nationwide survey on ICU visiting policies in Mainland of China: Current practices and perspectives","authors":"Yanxia Huang ,&nbsp;Mei Meng ,&nbsp;Xiaojun Pan ,&nbsp;Sheng Zhang,&nbsp;Lidi Zhang,&nbsp;Jiao Liu,&nbsp;Dechang Chen","doi":"10.1016/j.jointm.2024.12.009","DOIUrl":"10.1016/j.jointm.2024.12.009","url":null,"abstract":"<div><h3>Background</h3><div>Family presence is essential in reducing delirium and promoting early recovery of patients in the intensive care unit (ICU). This study was conducted through a questionnaire survey to examine the current visitation policies of ICUs in China and explore flexible visitation options.</div></div><div><h3>Methods</h3><div>Two versions of independently developed questionnaire, informed by relevant literature, was distributed in two versions: a medical staff questionnaire and a family questionnaire. The survey was administered online and conducted anonymously, with participants completing it after scanning a two-dimensional bar code. Data were collected from January 2020 to June 2020. We accessed the difference between the two groups were compared and the association between factors associated with family satisfaction were assessed.</div></div><div><h3>Results</h3><div>A total of 1200 hospitals across 30 provinces participated, yielding 16,359 valid responses (13,483 from medical staff and 2876 from family members). Currently, 90.5 % of the ICUs allow once-daily visitation, whereas only 1.2 % permit unrestricted visitation. Family care was allowed in 15.0 % of the ICUs at the end of the patient's life, and 30.3 % allowed flexible visitation for rehabilitation exercises. Among medical staff, 73.9 % of doctors and 58.7 % of nurses supported flexible visitation when rehabilitation exercises are needed. In addition, 73.3 % of family members were willing to help with rehabilitation exercises, and 77.3 % were satisfied with the existing visitation policies.</div></div><div><h3>Conclusions</h3><div>Most ICUs in mainland of China enforce restrictive visitation policies, most medical staff and family members accept. Moreover, flexible visitation policies for rehabilitation purposes may be increasingly acceptable in the future.</div></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"5 3","pages":"Pages 269-275"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144522362","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 association of blood eosinophil levels with sepsis and mortality risk: An observational and Mendelian Randomization Study","authors":"Jiajia Ren ,&nbsp;Xiaoming Gao ,&nbsp;Jueheng Liu ,&nbsp;Mingzhu Liu ,&nbsp;Aihui Dai ,&nbsp;Chuchu Zhang ,&nbsp;Guorong Deng ,&nbsp;Xi Xu ,&nbsp;Ruohan Li ,&nbsp;Jiamei Li ,&nbsp;Gang Wang","doi":"10.1016/j.jointm.2025.03.001","DOIUrl":"10.1016/j.jointm.2025.03.001","url":null,"abstract":"","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"5 3","pages":"Pages 292-294"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144522365","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}