Annals of Intensive Care最新文献

{"title":"Decoding portal vein pulsatility: hemodynamic determinants in a post-hoc analysis of a prospective observational trial.","authors":"Cosmin Balan, Bianca Morosanu, Antonia Fodoroiu, Vlad Dobre, Andrei Dumitrache, Robert Thomas Barbulescu, Liana Valeanu, Cornel Robu, Cristian Boros, Alexandru Nica, Adrian Wong, Francesco Corradi, Ioana Marina Grintescu, Serban-Ion Bubenek-Turconi","doi":"10.1186/s13613-025-01498-0","DOIUrl":"https://doi.org/10.1186/s13613-025-01498-0","url":null,"abstract":"<p><strong>Background: </strong>The portal vein pulsatility index (PVPI) reflects systemic congestion and is influenced by both volume status and right ventricular (RV) function. The mean systemic filling pressure analogue (Pmsa), derived from a mathematical model, estimates the interaction between stressed blood volume and systemic vascular compliance, serving as surrogate marker of volume status. This post-hoc analysis of an observational trial investigates the combined role of Pmsa and RV function as determinants of PVPI using echocardiography. Fifty-five mechanically ventilated patients with circulatory failure were included within 6 h of ICU admission following elective open-heart surgery. Fluid-tolerant patients (PVPI < 50%) underwent a passive leg raising (PLR) test; fluid-responsive patients subsequently received 7 mL/kg of Ringer's lactate. PVPI and Pmsa were measured at five timepoints: baseline (T1), after PLR (T2), upon returning to baseline (T3), after fluid administration (T4), and 20 min post-infusion (T5). RV function parameters, including RV to LV end-diastolic area ratio (RVEDA/LVEDA), tricuspid lateral annular systolic velocity (RV S'), RV fractional area change (RVFAC), pulmonary acceleration time (PAT), and right myocardial performance index (RIMP)-were assessed at T1, T4, and T5. Only fluid-responsive patients were evaluated beyond T3.</p><p><strong>Results: </strong>At T1, robust multilinear regression including all patients identified RVEDA/LVEDA (β = 10.38; p < 0.001), RIMP (β = - 6.54; p = 0.002), and RV S' (β = - 0.60; p = 0.002) as significant determinants of squared PVPI. In all patients, repeated measures correlation between Pmsa and PVPI was strong across T1-to-T3 (ρ = 0.785; p < 0.001), increasing from a non-significant correlation at T1 (ρ = 0.215; p = 0.115). Generalized estimating equations conducted only in fluid-responsive patients across T1, T4, and T5 identified Pmsa (β = 4.19; p < 0.001), RV S' (β = - 5.84; p < 0.001), RVEDA/LVEDA (β = 34.85; p = 0.018), and RIMP (β = - 35.28; p = 0.039) as significant determinants of PVPI.</p><p><strong>Conclusion: </strong>RV function and Pmsa are key determinants of PVPI. Their combined assessment may support an individualized congestion management by guiding interventions toward volume status, RV function, or both. Trial registration Primary Trial Registration: NCT06440772. Registered 30 May 2024. Retrospectively registered.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"81"},"PeriodicalIF":5.7,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-mortem lung biopsies in fatal Covid-19 acute respiratory distress syndrome: a prospective cohort study of 169 patients (HISTOCOVID).","authors":"Jean Morin, Christine Sagan, Morgane Pere, Riad Chelha, Pierre Yves Olivier, Georges Simon, Marion Rougon, Frédéric Pène, Alexis Ferre, Toufik Kamel, Alexandre Boyer, Julio Badie, Jan Hayon, Maxens Decavèle, Pierre Garçon, Jean-Christophe Richard, Laurent Argaud, Sami Hraiech, Johann Auchabie, Camille Foucault, François Legay, Paul-Marie Chanareille, Bertrand Souweine, Guillaume Géri, Agathe Delbove, Vincent Bonny, Pascal Beuret, Damien Vimpere, Gaëtan Plantefève, Emmanuel Canet","doi":"10.1186/s13613-025-01493-5","DOIUrl":"10.1186/s13613-025-01493-5","url":null,"abstract":"<p><strong>Background: </strong>Refractory acute respiratory distress syndrome (ARDS) is the leading cause of death in patients with Covid-19. Large studies of lung pathology in patients who died of Covid-19-ARDS may help to understand the mechanisms of death and to guide further research.</p><p><strong>Methods: </strong>This prospective multicentre cohort study included 338 post-mortem, percutaneous, lung biopsies from 169 patients who died of Covid-19-ARDS between 22/04/2020 and 08/03/2021 in 26 intensive care units in France. The biopsies were done at the bedside by the intensivist immediately after death, using a 14G needle and following anatomical landmarks. A pathologist examined all biopsies, describing all elementary lesions and establishing a final histopathological diagnosis.</p><p><strong>Results: </strong>Lung parenchyma was evaluable in 155/169 (92%) patients. Early, proliferative-phase diffuse alveolar damage (DAD) was the most common finding (39%), followed by late proliferative-phase DAD (32%) and exudative-phase DAD (18%); fibrotic-phase DAD was present in three (2%) patients. Organising pneumonia (OP) and acute fibrinous and organising pneumonia (AFOP) were evidenced in 21 (13%) and 16 (9%) patients, respectively. Unclassified interstitial lesions were seen in 33 (21%) patients. Microthrombi were uncommon (6%).</p><p><strong>Conclusions: </strong>DAD was the most common pathological pattern, whereas collagen fibrosis and microthrombi were rare. A quarter of patients had evidence of OP or AFOP. This substantial prevalence of corticosteroid-sensitive patterns suggests that selected patients with refractory Covid-19-ARDS might benefit from higher doses or longer courses of corticosteroids.</p><p><strong>Trial registration: </strong></p><p><strong>Clinicaltrials: </strong>gov NCT04675281. Registered 19 December 2020.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"80"},"PeriodicalIF":5.7,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12158891/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144265059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vascular leakage during circulatory failure: physiopathology, impact and treatments.","authors":"Jérémie Joffre, Peter Radermacher, Hatem Kallel, Iris Marangon, Alexandre Rutault, Yaël Levy, Alexandre Gaudet, Benjamine Sarton, Louis Kreitmann, Lucillia Bezu, Meryl Vedrenne, Thomas Maldiney, Youenn Jouan, Sarah Benghanem, Laure Stiel, Stéphane Germain, Nicolas Bréchot","doi":"10.1186/s13613-025-01474-8","DOIUrl":"10.1186/s13613-025-01474-8","url":null,"abstract":"<p><p>Vascular leakage has emerged as a major factor during circulatory failure. Triggered by the inflammatory process following the recognition of both pathogen-associated molecular patterns (PAMPs) and damage-associated molecular patterns (DAMPs), it worsens circulatory failure through the hypovolemia it induces. It may also crucially participate in secondary microcirculation disorders and organ dysfunctions, due to interstitial edema resulting from extravascular fluid accumulation. Accordingly, fluid balance, i.e., the difference between fluid intake and output, is directly related with outcomes during the different types of shock. Moreover, controlling vascular leakage had beneficial effects in various animal models of circulatory failure. However, despite promising preclinical findings, no routine drug is currently available to control vascular leakage in humans. This review depicts the mechanisms involved in the maintenance of a quiescent endothelium and those implicated in the destabilization of its barrier function in various forms of shocks. It further describes available tools to explore vascular leakage and the most advanced treatments under development.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"79"},"PeriodicalIF":5.7,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12141729/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144233012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lipidomic signatures of ventilator-associated pneumonia in COVID-19 ARDS patients: a new frontier for diagnostic biomarkers.","authors":"Arthur Kassa-Sombo, Charles Verney, Augustin Pasquet, Julien Vaidie, Deborah Brea, Virginie Vasseur, Adeline Cezard, Antoine Lefevre, Camille David, Eric Piver, Lydie Nadal-Desbarats, Patrick Emond, Hélène Blasco, Mustapha Si-Tahar, Antoine Guillon","doi":"10.1186/s13613-025-01492-6","DOIUrl":"10.1186/s13613-025-01492-6","url":null,"abstract":"<p><strong>Background: </strong>Ventilator-associated pneumonia (VAP) is a significant complication in mechanically ventilated patients. Paradoxically, it lacks precise diagnostic criteria, making the identification of a reliable diagnostic indicator an unmet medical need. Lipids are critical regulators of innate lung defense. The aim of the study was to identify lipid alterations specific to VAP in tracheal aspirates of patients with ARDS.</p><p><strong>Methods: </strong>Tracheal aspirates samples from ventilated patients were collected longitudinally from patients with COVID-19-related ARDS. Tracheal aspirates sampled at the day of VAP diagnosis were used to assess VAP specific lipidome and were compared with matched controls (patients without VAP). Lipid detection was performed using ultra-high-performance liquid chromatography with high resolution mass spectrometry. The statistical analysis included: unsupervised multivariate methods, partial least squares discriminant analysis (PLS-DA), orthogonal partial least squares discriminant analysis (OPLS-DA), and the area under the receiver operating characteristic (AUROC) curve to assess classification performance. The Benjamini-Hochberg adjusted p-value was used to control the false discovery rate.</p><p><strong>Results: </strong>We studied 39 patients (26 VAP and 13 control patients). The characteristics of VAP and control patients were similar, including biological markers such as neutrophils, CRP, and PCT. The lipid signature, composed of 272 lipids, differed between VAP and control patients (p = 0.003). Phosphatidylcholines were the most represented with 17 significantly upregulated and 6 downregulated lipids. OPLSDA identified 8 best candidates as VAP biomarkers with sphingomyelin (34:1) and phosphatidylcholine (O-34:1) presenting the best scores (AUROC = 0.85 [0.71-0.95] and 0.83 [0.66-0.94], respectively). Combinations of several lipid biomarkers did not improve the prediction accuracy. During ARDS, lung lipidome mostly resulted in breakdown product of host-pathogen interactions (surfactant and pulmonary cells).</p><p><strong>Conclusion: </strong>We investigated VAP-specific lipids in tracheal aspirate and identified significant alterations in lipidomic profiles, likely driven by active infection dynamic and the breakdown of surfactant and pulmonary cells. Among the potential VAP biomarker candidates in COVID-19 ARDS, sphingomyelin (34:1) and phosphatidylcholine (O-34:1) demonstrated predictive performance for VAP that surpassed all previously tested biomarkers.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"78"},"PeriodicalIF":5.7,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12141186/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144224076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Critically ill patients with necrotizing soft tissue infections in the Caribbean area: unsupervised analysis of a retrospective cohort (2014-2023) with identification of factors associated with mortality.","authors":"Jean-David Pommier, Benoît Tressieres, Pascal Blanchet, Frederic Desmoulins, Pascale Piednoir, Nejla Aissa, Frederic Martino, Marc Valette, Alexandre Demoule, Sebastien Breurec, Laurent Camous","doi":"10.1186/s13613-025-01488-2","DOIUrl":"10.1186/s13613-025-01488-2","url":null,"abstract":"<p><strong>Background: </strong>Scarce epidemiological data are available regarding necrotizing soft tissue infections (NSTIs) in tropical areas. Here we aimed to describe the clinical and biological features, and outcomes, of critically ill patients with NSTIs admitted to an intensive care unit (ICU) in a tropical setting. Furthermore, we analyzed these findings to identify distinct clinical phenotypes and explore their associations with patient outcomes.</p><p><strong>Methods: </strong>This retrospective observational study included all patients with NSTIs admitted to the ICU of the University Hospital of Guadeloupe between January 2014 and December 2023. Subgroups of patients having similar clinical profiles were identified through unsupervised clustering (factor analysis for mixed data, and hierarchical clustering on principal components). Univariate and multivariate analyses identified factors associated with 90-day mortality.</p><p><strong>Results: </strong>During the study period, 91 NSTI patients were admitted to the ICU. The median Simplified Acute Physiology Score (SAPS) II was 45 [IQR 40-66], and the median time between hospital admission and first surgical debridement was 8 h [IQR 6-10 h]. While in the ICU, 65% of patients were mechanically ventilated, 75% experienced shock, and 34% underwent renal replacement therapy. The 90-day mortality rate was 32%. Unsupervised clustering revealed three clusters-mild NSTI (n = 23, 25%), severe NSTI (n = 49, 54%), and fulminant NSTI (n = 19, 21%)-which were associated with different ICU courses and outcomes. Subcutaneous emphysema and sepsis-associated encephalopathy were key components influencing cluster identification. Multivariate analysis revealed that mortality was associated with SAPS II, subcutaneous emphysema, >8 h between hospital admission and first surgery, and immunocompromised status.</p><p><strong>Conclusion: </strong>Unsupervised analysis of critically ill patients with NSTIs in tropical settings revealed three distinct patient clusters that exhibited unique phenotypic characteristics and clinical outcomes. Upon hospital admission, patients with NSTIs should be carefully screened for sepsis-associated encephalopathy, subcutaneous emphysema, and thrombopenia. The present exploratory results must be confirmed in larger multicentric cohorts.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"77"},"PeriodicalIF":5.7,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12130383/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144207467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physiological complexities of intraabdominal hypertension: taming the elephant.","authors":"S Magder","doi":"10.1186/s13613-025-01481-9","DOIUrl":"10.1186/s13613-025-01481-9","url":null,"abstract":"","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"76"},"PeriodicalIF":5.7,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12125405/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144186331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Absolute blood levels and kinetics of neurofilament light (NFL) chains for neurological prognosis in comatose patients after cardiac arrest.","authors":"Timothée Ayasse, Maxime Touron, Marie-Céline Blanc, Estelle Pruvost-Robieux, Jean-Baptiste Lascarrou, Clara Vigneron, Jean-Paul Mira, Frédéric Pène, Alain Cariou, Sarah Benghanem","doi":"10.1186/s13613-025-01491-7","DOIUrl":"10.1186/s13613-025-01491-7","url":null,"abstract":"<p><strong>Introduction: </strong>Despite current guidelines, the prognosis of comatose patients after cardiac arrest (CA) remains indeterminate in approximately 50% of patients. Neurofilament light (NFL) chain, a biomarker of neuronal injury, appears to be a promising tool with better prognostic value compared to neuron-specific enolase (NSE). However, further studies are required. The objective was to evaluate the prognostic value of absolute blood levels and kinetics of NFL measured at 24, 48 and 72 h after CA to predict outcome.</p><p><strong>Methods: </strong>A prospective study conducted at a tertiary CA center conducted between April 2023 and November 2024, including 67 comatose patients after CA with at least one blood NFL measurement. The primary outcome was neurological outcome according to the \"best\" modified Rankin scale (mRS) within 3 months, with a mRS 0-3 defining a good outcome.</p><p><strong>Results: </strong>Participants were 64 years old (IQR [53-75]), and 67% were male. 60% of them had out-of-hospital CA and 42% had an initial shockable rhythm. NFL levels were significantly higher in patients with unfavorable outcome compared to those with favorable outcome at each time point (24 h: 256.0 [96.2-441.9] versus 37.9 [17.4-104.5] pg/mL, p < 0.001; 48 h: 1297.7 [137.6-3605.0] versus 36.4 [19.3-174.0] pg/mL, p < 0.001; 72 h: 1591.9 [350.6-4913.5] versus 49.3 [23.2-146.4] pg/mL, p < 0.001). NFL levels at 24 and 48 h showed moderate prognostic accuracy (AUC 0.80 and 0.88, respectively), while NFL at 72 h demonstrated high accuracy (AUC 0.90). For predicting poor outcome, NFL level at 24 h > 250 pg/mL had a specificity of 0.90 [0.75-0.90] and a sensitivity of 0.51 [0.35-0.67]. At 48 h, NFL > 383 pg/mL had a specificity of 0.94 [0.81-1.00] and a sensitivity of 0.66 [0.50-0.81]. At 72 h, NFL > 510 pg/mL presented a specificity of 1.00 [1.00-1.00] and a sensitivity of 0.74 [0.52-0.91]. To predict a good outcome, NFL levels < 82 pg/mL at 24 h, < 307 pg/mL at 48 h and < 459 pg/mL at 72 h after CA were the best compromise between specificity and sensitivity. NFL kinetic was not associated with neurological outcomes (AUC 0.50), whereas NSE kinetic measured between 24 and 72 h showed high prognostic accuracy (AUC 0.92).</p><p><strong>Conclusion: </strong>In comatose patients after CA, NFL levels at 24, 48 and 72 h could predict both unfavorable and favorable outcomes. Conversely, only the kinetic of NSE levels between 24 and 72 h after CA was associated with neurological outcome.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"75"},"PeriodicalIF":5.7,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12125424/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144186330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Guidelines for the management of emergencies and critical illness in pediatric and adult patients with sickle cell disease.","authors":"Armand Mekontso Dessap, Stephane Dauger, Mehdi Khellaf, Maite Agbakou, Sophie Agut, François Angoulvant, Jean-Benoît Arlet, Cécile Aubron, Florent Baudin, Florence Boissier, Nicolas Bounaud, Pierre Catoire, Jérôme Cecchini, Djamila Chaiba, Anthony Chauvin, Richard Chocron, Benedicte Douay, Delphine Douillet, Narcisse Elenga, Olivier Flechelle, Ségolène Gendreau, Sybille Goddet, Jeremy Guenezan, Anoosha Habibi, Claire Heilbronner, Bérengère Koehl, Pierrick Le Borgne, Philippe Le Conte, Annick Legras, Michael Levy, Bernard Maitre, Mathieu Oberlin, Mehdi Oualha, Nicolas Peschanski, France Pirenne, Corinne Pondarre, Jérôme Rambaud, Keyvan Razazi, Geoffroy Rousseau, Aurélie Schirmann, Isabelle Thuret, Ruddy Valentino, Guillaume Voiriot, Barbara Villoing, Marion Grimaud, Sandrine Jean","doi":"10.1186/s13613-025-01479-3","DOIUrl":"10.1186/s13613-025-01479-3","url":null,"abstract":"<p><p>Forty-two questions were evaluated concerning management of emergencies and critical illnesses in paediatric and adult patients with sickle cell disease. The assessment covered the following areas: patient referral, vaso-occlusive crisis, acute chest syndrome, transfusion therapy, and priapism. The patient referral category included guidelines for admission to intensive care unit and management at specialized reference centers. The vaso-occlusive crisis topic encompassed pain management, hydration, incentive spirometry, and target oxygen saturation levels. For acute chest syndrome, the focus areas included imaging techniques such as lung ultrasound, computed tomography scans, and echocardiography; treatment with systemic corticosteroids; non-invasive ventilation; prophylactic and therapeutic anticoagulation; and procalcitonin and antibiotic therapy. The section on transfusion therapy addressed indications and methods of transfusion, as well as the diagnosis and prediction of delayed hemolytic transfusion reactions. A total of 45 recommendations were proposed, including 14 specific to adults, 13 specific to pediatrics, and 18 applicable to both adults and children, along with three therapeutic algorithms. The Grade of Recommendation Assessment, Development, and Evaluation (GRADE) methodology was adhered to throughout the process. Sixteen recommendations were based on a low level of evidence (GRADE 2+ or 2-), while 26 were based on evidence that could not be classified under the GRADE system and were therefore considered expert opinions. Finally, for three aspects of sickle cell disease management, the experts concluded that no reliable recommendations could be made based on the current state of knowledge. The recommendations and therapeutic algorithms received strong agreement from the experts.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"74"},"PeriodicalIF":5.7,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12123041/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144172412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hospitalization of very old critically ill patients in medical intermediate care units in France: a nationwide population-based study.","authors":"Adrien Migeon, Arthur Kassa-Sombo, Emeline Laurent, Lucile Godillon, Leslie Grammatico-Guillon, Antoine Guillon","doi":"10.1186/s13613-025-01485-5","DOIUrl":"10.1186/s13613-025-01485-5","url":null,"abstract":"<p><strong>Background: </strong>As the trajectory of very old critically-ill patients becomes an increasingly significant global challenge, these patients are often referred to intermediate care units. Intermediate care units provide a level of care that is less intensive than the intensive care unit (ICU) but more advanced than standard hospital wards. We aimed to assess the nationwide utilization of intermediate care units for critically ill patients aged 80 years or older (≥ 80 y.o.) and to examine their characteristics and long-term mortality outcomes.</p><p><strong>Methods: </strong>From the overall adult population (aged 18 years and older) hospitalized in France (French Hospital Discharge Database) from January 1, 2014, to December 31, 2022, patients ≥ 80 y.o. were included. We examined trends in the utilization of medical intermediate care units for critically ill patients ≥ 80 y.o and reported patient characteristics, including the Charlson comorbidity index and Hospital Frailty Risk Score. Readmission rates (hospital or rehabilitation unit) and mortality rates were calculated during a one-year follow-up period after the end of hospital stay.</p><p><strong>Results: </strong>The proportion of patients ≥ 80 y.o. in intermediate care units was 31% whereas it was 17% in ICU. Patients with greater comorbidities and severity were more frequently hospitalized in polyvalent intermediate care units (10% of them receiving acute organ support) compared to specialized intermediate care units. Admission to intermediate care units was associated with a 14% mortality rate during the stay, 28% at one year. Additionally, 58% of intermediate care units patients were rehospitalized within the year following discharge (6% in critical care units).</p><p><strong>Conclusions: </strong>One-third of the patients hospitalized in the intermediate care units in France are aged 80 years or older.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"73"},"PeriodicalIF":5.7,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12116954/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144155783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors influencing the transition phase in acute respiratory distress syndrome: an observational cohort study.","authors":"Anne-Fleur Haudebourg, Louise Chantelot, Safaa Nemlaghi, Luc Haudebourg, Pascale Labedade, Mohamed Ahmed Boujelben, Guillaume Voiriot, Armand Mekontso Dessap, Muriel Fartoukh, Guillaume Carteaux","doi":"10.1186/s13613-025-01484-6","DOIUrl":"10.1186/s13613-025-01484-6","url":null,"abstract":"<p><strong>Background: </strong>Protective ventilation during the acute phase of ARDS and weaning from mechanical ventilation are well-established in current guidelines. However, the intermediate transition phase between these stages remains poorly characterized.</p><p><strong>Objectives: </strong>To describe the transition phase in moderate-to-severe ARDS and evaluate the factors associated with neuromuscular blockade (NMBA) weaning failure and pressure support ventilation (PSV) failure.</p><p><strong>Methods: </strong>This bicentric observational cohort study included patients with moderate-to-severe ARDS requiring NMBA continuous infusion within 72 h post-intubation. The transition phase was defined as the 72 h following the first NMBA weaning attempt. The main endpoints were the rates of NMBA reintroduction and PSV failure. Secondary outcomes included predictive factors for NMBA weaning failure and PSV failure and the impact of tidal volume on patient outcomes.</p><p><strong>Main results: </strong>A total of 196 patients were included. NMBA weaning failure occurred in 74 (38%) patients. COVID-19 (OR 3.98 [1.95-8.41], p < 0.001), pH (OR 0.50 [0.30-0.79], p = 0.004), PaO₂/FiO₂ ratio (OR 0.92 [0.87-0.97], p = 0.007), and high or low driving pressure before first NMBA weaning attempt (< 12 or ≥ 14 cmH₂O) (OR 2.77 [1.16-7.14], p = 0.027) were significantly associated with NMBA reintroduction. PSV was initiated in 147 (75%) patients, with a failure rate of 57%, occurring after a median of 9 h [6-24]. Tidal volume (OR 1.28 [1.06-1.56], p = 0.012) was significantly associated with PSV failure. During PSV, 43% of patients exhibited high tidal volumes (> 8 mL/kg PBW). NMBA weaning failure was associated with fewer ventilator-free days and increased mortality at day 28. PSV failure was associated with fewer ventilator-free days.</p><p><strong>Conclusion: </strong>The transition phase represents a high-risk period in ARDS, with significant failure rates for NMBA weaning and PSV trials that may influence patient outcomes. The transition phase therefore represents a critical area for future research to optimize management during this vulnerable period.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"71"},"PeriodicalIF":5.7,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12104120/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144141280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}