Annals of Intensive Care最新文献

{"title":"Endotoxin removal by the OXIRIS filter for cardiogenic shock requiring veno-arterial extra-corporeal life support: the ECMORIX randomized controlled trial.","authors":"Maxime Nguyen, Marvin Alvarez, Corentin Evezard, Vivien Berthoud, Damien Leleu, Jean-Paul Pais-De-Barros, Olivier Bouchot, Osama Abou-Arab, Belaid Bouhemad, David Masson, Thomas Gautier, Pierre-Grégoire Guinot","doi":"10.1186/s13613-025-01499-z","DOIUrl":"https://doi.org/10.1186/s13613-025-01499-z","url":null,"abstract":"<p><strong>Background: </strong>Most severe cardiogenic shock requires veno-arterial extracorporeal membrane oxygenation (VA-ECMO). The OXIRIS filter, has shown potential in reducing lipopolysaccharide (LPS) levels. Our objective was to compare the efficacy of the OXIRIS filter versus the ST-150 filter in reducing LPS plasma concentration. We hypothesized that the OXIRIS filter would reduce the endotoxin burden.</p><p><strong>Methods: </strong>We conducted an open-label randomized prospective study in the cardiac intensive care unit of Dijon University Hospital. Forty patients with refractory cardiogenic shock requiring VA-ECMO and renal replacement therapy (RRT) were randomized to receive either OXIRIS filter or ST-150 filter. Blood samples were collected at multiple time points. The primary outcome was LPS mass (measured 24 h after the initiation of treatment). Secondary outcomes included LPS activity, cytokine levels, and clinical outcomes.</p><p><strong>Results: </strong>20 patients were allocated to each group and analyzed. LPS plasma concentrations were not different between the OXIRIS filter and ST-150 filter groups at H24 (599 pmol/ml of esterified 3-OH fatty acids [450;734] vs 520 [456;835], p = 0.983) or when analyzing all time-points by linear mixed modelling (538 [469;723] vs 507 [434;671] at H26, 576 [513;614] vs 624 [503;724] at H48 and 632 [513;660] vs 586 [538;776] at H72, p = 0.882). No significant between groups differences were found in LPS activity, inflammation markers (IL-6, TNF-α, IL-10, MCP-1), SOFA scores, VIS scores, or 28-day mortality (13 (65%) vs 9 (45%) p = 0.21). There was high variability in LPS concentrations, suggesting heterogeneity in endotoxemia.</p><p><strong>Conclusions: </strong>In patients with cardiogenic shock supported by VA-ECMO and requiring renal replacement therapy, we could not evidence any reduction in LPS blood concentration in patients treated with treatment with OXIRIS filter in comparison to ST-150 filter. Further research is required to confirm these findings and optimize endotoxin removal in this population.</p><p><strong>Trials registration: </strong>NCT04886180. Registered 10 May 2021.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"92"},"PeriodicalIF":5.7,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144582869","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":"Intra-hospital transport of adult critically ill patients treated with high flow nasal cannula oxygen: a prospective observational multicenter study.","authors":"Mai-Anh Nay, Alice Bisson, Adrien Auvet, Agathe Delbove, Aziz Berrouba, Toufik Kamel, Maxime Desgrouas, Thierry Boulain","doi":"10.1186/s13613-025-01502-7","DOIUrl":"https://doi.org/10.1186/s13613-025-01502-7","url":null,"abstract":"<p><strong>Background: </strong>Acute respiratory failure is a common reason for admission to the intensive care unit, and patients are frequently treated with high-flow nasal cannula oxygen therapy (HFNC). Intra-hospital transport of critically ill patients, such as between hospital wards and the intensive care unit or for diagnostic exams, is common. Transportable HFNC can be used during these intra-hospital transports. We aimed to evaluate the complications associated with intra-hospital transport of patients treated with HFNC.</p><p><strong>Methods: </strong>We conducted a prospective, descriptive multicenter study between May 2022 and May 2024, involving critically ill adult patients who were treated with HFNC prior to transport and required intra-hospital transport for any reason, accompanied by an intensive care unit team. The primary objective was to evaluate the incidence of severe adverse events including severe hypoxemia (with pulse oxygen saturation of less than 80%), need for intubation, need for non-invasive ventilation or cardiorespiratory arrest during transport. Secondary objectives were to assess the incidence of non-severe adverse events, defined as the need for increased inspired oxygen fraction, switching HFNC for standard oxygen therapy, nasal cannula removal or dysfunction of the HFNC device.</p><p><strong>Results: </strong>We included 165 patients and analyzed 187 transports. Eight (4.3%) severe adverse events occurred in 7 patients including 6 cases of severe transient hypoxemia and 2 cases of non-invasive ventilation. All of them were transient severe hypoxemia that occurred during the first transport. Forty-three (23%) non-severe adverse events occurred, including 29(15.6%) cases of increased inspired oxygen fraction requirement, 7/187 (3.74%) cases of nasal cannula removal, 6/187 (3.2%) cases of HFNC device dysfunction, and 1 (0.5%) case involved replacing HFNC with standard oxygen therapy.</p><p><strong>Conclusion: </strong>HFNC during intra-hospital transport of critically ill patients had a low incidence of severe adverse events. Non-severe adverse events were more frequent, but their potential impact could not be assessed in this study and warrants further investigation.</p><p><strong>Trial registration: </strong>Clinicalstrials.gov, NCT05311007, registered 23 March 2022, https://clinicaltrials.gov/study/NCT05311007?term=hospiflow&rank=1 .</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"93"},"PeriodicalIF":5.7,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144590197","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":"Omics approach to chest electrical impedance tomography reveals physiological cluster of ARDS characterised by increased respiratory drive and effort.","authors":"Tommaso Mauri, Marco Leali, Elena Spinelli, Gaetano Scaramuzzo, Massimo Antonelli, Domenico L Grieco, Savino Spadaro, Giacomo Grasselli","doi":"10.1186/s13613-025-01514-3","DOIUrl":"10.1186/s13613-025-01514-3","url":null,"abstract":"<p><strong>Background: </strong>Non-invasive assessment of respiratory drive and effort in spontaneously breathing ARDS patients is challenging, yet clinically relevant. We explored whether hierarchical clustering applied to electrical impedance tomography (EIT- a radiation-free non-invasive lung imaging technique) identifies ARDS sub-phenotypes with increased drive and effort.</p><p><strong>Results: </strong>Thirty intubated patients with ARDS on assisted mechanical ventilation were monitored by EIT and esophageal pressure during a decremental positive end-expiratory pressure (PEEP) trial. A comprehensive EIT assessment was made (computed variables n = 180) during tidal breathing at different PEEP levels. Agglomerative nesting was applied to scaled data distances. Three clusters of ARDS were identified: inhomogeneous ventilation, unmatched V'/Q, and mismatched V'/Q. The unmatched V'/Q cluster had the highest respiratory drive (p = 0.045) and effort (p = 0.021) at lower PEEP, and experienced longer length of ICU stay (p = 0.019).</p><p><strong>Conclusions: </strong>Higher PEEP levels reduced drive of the unmatched V'/Q cluster, mitigating the physiological differences. Clustering approaches to EIT data identify physiologically and clinically relevant sub-phenotypes of ARDS.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"90"},"PeriodicalIF":5.7,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144582870","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":"Platelet transfusion practice in the intensive care unit: the Nine-I international platelet transfusion survey.","authors":"Lene Russell, Elie Azoulay, Carl Thomas Anthon, Frédéric Pène, Padmastuti Akella, Asma Mabrouki, Kathryn Puxty, Lene Bjerregaard Nielsen, Jo Bønding Andreasen, Thomas Kander, Fredrik Sjövall, Johanna Hästbacka, Christine Lodberg Hvas, Andry Van De Louw, Sanjay Chawla, Philippe R Bauer, Pedro Castro, Pedro Povoa, Luis Coelho, Sara Fernandez, Arzu Topeli, Andreas Barratt-Due, Caterina Barbaglio, Matthias Kochanek, Ignacio Martin-Loeches, Nancy Kentish-Barnes","doi":"10.1186/s13613-025-01494-4","DOIUrl":"https://doi.org/10.1186/s13613-025-01494-4","url":null,"abstract":"<p><strong>Background: </strong>Platelet transfusions are frequent in the Intensive Care Unit (ICU), either as prophylaxis against bleeding complications or as treatment for bleeding. The European Society of Intensive Care Medicine guidelines for ICU patients generally recommend not using prophylactic platelet transfusions unless the platelet count falls below 10 × 10⁹ cells/L in non-bleeding patients and make no recommendation for platelet transfusion threshold in non-massively bleeding patients with thrombocytopenia. Therefore, the decision to transfuse platelets is often left to clinical assessment by the treating physician. This study aims to describe current platelet transfusion preferences among ICU physicians.</p><p><strong>Methods: </strong>An online, anonymous survey consisting of 43 items was produced in two languages (French and English) and distributed by investigators in the Nine-I research network to ICU physicians in Europe and the United States of America. The survey evaluated platelet transfusion practices in ICU patients with and without bleeding, the presence of local guidelines, and factors influencing the decisions to transfuse platelets. Only completed surveys were analysed.</p><p><strong>Results: </strong>We received 997 surveys completed by ICU physicians. Overall, there was large heterogeneity in platelet transfusion practices between and within countries. In non-bleeding, thrombocytopenic medical ICU patients, most would transfuse prophylactic platelets at a platelet count threshold of 10 × 10⁹ cells/L. Thirty percent would change their strategy in patients with bone marrow failure and either be more liberal (60%; 95% Confidence Limits 0.54, 0.66), more restrictive (31%; 0.26,0.36) or seek assistance. Higher thresholds were preferred in surgical patients, prior to procedures and in patients with bleeding. Only 173 (17%; 0.15,0.19) responded that they were confident about the clinical indications every time they prescribed a platelet transfusion. As for existing guidelines, only 123 (12%; 0.10,0.15) responded that they always read them. Colleagues' attitudes and departmental culture were important influencers on transfusion practice.</p><p><strong>Conclusion: </strong>Platelet transfusion practice in the ICU is heterogeneous, both between and within countries; guidelines are often not used, and there is often uncertainty about the clinical indication.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"91"},"PeriodicalIF":5.7,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144582871","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":"Is high flow nasal therapy still warranted for patients with AECOPD and acute hypercapnic respiratory failure?","authors":"Jinlv Qin, Guizuo Wang, Yixing Liao, Wenli Shang, Dong Han","doi":"10.1186/s13613-025-01511-6","DOIUrl":"10.1186/s13613-025-01511-6","url":null,"abstract":"","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"89"},"PeriodicalIF":5.7,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144574703","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":"Adherence to post-cardiac arrest care guidelines and impact on survival and neurological outcome.","authors":"Giulia Merigo, Fabiana Madotto, Aurora Magliocca, Gaetano Florio, Alessandra Rosati, Valentina Castagna, Marco Pagliano, Alberto Zanella, Mauro Panigada, Giacomo Grasselli, Giuseppe Ristagno","doi":"10.1186/s13613-025-01508-1","DOIUrl":"10.1186/s13613-025-01508-1","url":null,"abstract":"<p><strong>Background: </strong>Post-cardiac arrest (CA) care guidelines (GLs) have been introduced in 2010 and periodically updated every 5 years since then (in 2015 and 2021). However, the impact of these GLs on patients' outcome remains underexplored. The aim of this study was to comprehensively evaluate and compare the impact of implementation of three consecutive post-CA GLs over 14 years, on patients' survival and neurological recovery.</p><p><strong>Methods: </strong>This retrospective cohort study included adult patients resuscitated from CA and admitted to the intensive care unit (ICU) between 2011 and 2024. Patients were stratified into three cohorts based on the GL in use (GL2010, GL2015, and GL2024). Adherence to GL recommendations was assessed across seven macro-areas: coronary angiography, haemodynamic, ventilation, temperature control, general ICU management, multimodal neuroprognostication, and seizure control. Predictors of survival and favourable neurological outcome at ICU discharge were evaluated using multivariate logistic regression with LASSO selection. Outcome up to 6 months was also evaluated.</p><p><strong>Results: </strong>A total of 275 patients were included over the 14-year period. Survival to ICU discharge increased from 39.5% in cohort 1 to 53.9% in cohort 3, together with favourable neurological outcome that improved from 30.9 to 42.7%. Adherence to GL recommendations significantly improved across most domains, particularly in haemodynamic management (from 32.0% in cohort 1 to 77.3% in cohort 3), temperature control (from 60.6 to 94.4%), and general ICU management (from 56.3 to 77.6%). Among all interventions, adherence to haemodynamic recommendations was independently associated with improved survival (OR = 2.20, 95% CI: 1.01-4.86).</p><p><strong>Conclusions: </strong>Following the implementation of updated post-CA care GLs, adherence to recommendations improved, particularly in haemodynamic management. Although no statistically significant improvements in survival or neurological outcomes were observed, these findings highlight the potential value of sustained GL-based care.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"88"},"PeriodicalIF":5.7,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12222584/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144537818","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":"Biomarkers for intensive care unit-acquired weakness: a systematic review for prediction, diagnosis and prognosis.","authors":"Jiamei Song, Ting Deng, Qingmei Yu, Xun Luo, Yanmei Miao, Leiyu Xie, Yongming Mei, Peng Xie, Shaolin Chen","doi":"10.1186/s13613-025-01500-9","DOIUrl":"10.1186/s13613-025-01500-9","url":null,"abstract":"<p><strong>Background: </strong>Intensive care unit-acquired weakness (ICU-AW) is a common and debilitating complication in critically ill patients, significantly affecting both short- and long-term outcomes. The existing ICU-AW diagnostic methods are not widely accepted and have a narrow application window. Biomarkers offer potential for diagnosing, predicting, and prognosticating ICU-AW, but a comprehensive synthesis of the available evidence is still lacking.</p><p><strong>Methods: </strong>We conducted a systematic search across PubMed, Cochrane Library, Embase, Web of Science, CNKI, Wanfang Database, China Science and Technology Journal Database (VIP Database), and China Biomedical Literature Database (SinoMed Database) from inception to January 23, 2025. Study quality was assessed using the revised Newcastle-Ottawa scale and the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Data extraction included basic characteristics of the included studies, name of biomarkers, objective, specimen types, sampling time, type of biomarker, ICU-AW diagnostic criteria, and outcomes.</p><p><strong>Results: </strong>Out of 5,769 publications screened, 11 studies of moderate to high quality (scores ≥ 6) involving 1,176 critically ill patients were included. Ten biomarkers were identified and categorized into five mechanisms: muscle injury (myoglobin, N-titin, urinary titin), metabolic pathway (glucose transporter protein type-4), neurological injury (neurofilament light/heavy chain), stress response (growth differentiation factor-15), and inflammatory process (monocyte chemoattractant protein-1, NETs marker cfDNA, and miR-181a). Six biomarkers demonstrated strong predictive and diagnostic accuracy with AUC values exceeding 0.80. Notably, growth differentiation factor-15 exhibited excellent clinical utility across diagnostic, predictive, and prognostic applications (AUC ≥ 0.85). The remaining four biomarkers showed moderate performance, with AUC values ranging from 0.60 to 0.80.</p><p><strong>Conclusion: </strong>While ten biomarkers exhibit potential for ICU-AW assessment, their clinical utility remains inconsistent. This highlights the need for large-scale, prospective validation studies and the incorporation of advanced technologies to refine existing biomarkers and identify novel candidates for ICU-AW prediction, diagnosis and management.</p><p><strong>Date of registration: </strong>Registered 1 August 2024.</p><p><strong>Trial registration: </strong>PROSPERO ID: CRD42024574437.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"86"},"PeriodicalIF":5.7,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12222590/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144537819","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":"High-flow nasal therapy versus non-invasive ventilation for AECOPD: navigating beyond a simple choice- are we asking the right questions??","authors":"Mauro Castro Sayat, Nicolás Colaianni-Alfonso, Adrián Gallardo, Luigi Vetrugno","doi":"10.1186/s13613-025-01510-7","DOIUrl":"10.1186/s13613-025-01510-7","url":null,"abstract":"","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"87"},"PeriodicalIF":5.7,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12222598/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144537820","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":"Impact of awake prone positioning duration on intubation or mortality in COVID-19 patients with acute respiratory failure: secondary analysis of a randomized clinical trial.","authors":"Qin Sun, Rui Zhang, Junyi Zhang, Jianfeng Xie, Yingzi Huang, Yi Yang, Haibo Qiu, Ling Liu, Hui Chen","doi":"10.1186/s13613-025-01501-8","DOIUrl":"10.1186/s13613-025-01501-8","url":null,"abstract":"<p><strong>Background: </strong>Compared with shorter awake prone positioning (APP), prolonged APP (≥ 12 h daily) reduces the intubation rate in patients with COVID-19-related acute hypoxemic respiratory failure (AHRF). However, the optimal APP duration is uncertain. In this secondary analysis, we aimed to explore whether a longer APP duration is associated with improved outcomes and to identify the optimal duration of APP.</p><p><strong>Methods: </strong>Data from a multicenter randomized controlled trial involving nonintubated COVID-19 patients with AHRF were analyzed. Daily APP duration over 7 days after randomization was recorded as the primary exposure in present study. The primary outcome was the time from randomization to APP failure, which was defined as a composite of tracheal intubation or mortality within 28 days. A Cox proportional hazards regression model was employed to elucidate the associations, and the daily duration of APP was treated as time dependent.</p><p><strong>Results: </strong>A total of 409 patients were randomized in the original trial, and 408 were enrolled in this analysis. Among these patients, 105 (25.7%) experienced APP failure. A longer daily APP duration was associated with a lower risk of APP failure, with a hazard ratio (HR) of 0.93 (95% confidence interval (CI): 0.88-0.98), and the association was significant only during the first three days after randomization. There was a nonlinear relationship between the daily APP duration and the risk of APP failure (P = 0.015 for nonlinearity). Compared with patients whose APP duration ranged from 8 to 12 h per day, patients with less than 8 h of APP per day had a greater risk of APP failure (HR 2.44, 95% CI 1.21-4.92), whereas extending APP beyond 12 h per day did not improve the outcomes further (HR 1.03, 95% CI 0.51-2.10, P = 0.932).</p><p><strong>Interpretation: </strong>A longer daily APP duration was associated with a reduced risk of APP failure in COVID-19-related AHRF patients, and the optimal APP duration was 8-12 h per day. Clinical trial ClinicalTrials.gov: NCT05677984, Registered January 3, 2023. https://register.</p><p><strong>Clinicaltrials: </strong>gov/prs/app/action/SelectProtocol?sid=S000CST9&selectaction=Edit&uid=U0000YKY&ts=4&cx=-x0muek.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"84"},"PeriodicalIF":5.7,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12185815/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144473761","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":"Prognosis of Nonagenarian ICU Patients A Bayesian analysis of prospective European studies.","authors":"Daniel Dankl, Raphael Romano Bruno, Michael Beil, Hans Flaatten, Malte Kelm, Sviri Sigal, Wojciech Szczeklik, Muhammed Elhadi, Michael Joannidis, Andreas Koköfer, Barbara Schreiber, Franz Singhartinger, Sandra Oeyen, Brian Marsh, Rui Moreno, Susannah Leaver, Dylan W De Lange, Bertrand Guidet, Ariane Boumendil, Christian Jung, Bernhard Wernly","doi":"10.1186/s13613-025-01496-2","DOIUrl":"10.1186/s13613-025-01496-2","url":null,"abstract":"<p><strong>Background: </strong>As the population ages, the number of very elderly patients (≥ 90 years, nonagenarians) admitted to intensive care units (ICUs) is increasing. This trend raises concerns about the appropriateness of ICU care for this age group, especially due to the uncertainty surrounding their prognosis. Some studies suggest that elderly ICU patients have outcomes similar to slightly younger patients, but skepticism remains due to clinical judgment, cultural attitudes, and resource allocation concerns.</p><p><strong>Methods: </strong>We reassessed the 30-day mortality risk of nonagenarians admitted to ICUs using data from the VIP1, VIP2, and COVIP registries. Bayesian statistical methods, including Markov Chain Monte Carlo (MCMC) simulations, were used to estimate the relative risk (RR) of mortality for nonagenarians compared to octogenarians (80-89 years). Various prior assumptions (non-informative, pessimistic, and skeptical) were incorporated. The analysis adjusted for key variables such as SOFA score, frailty, and treatment limitations.</p><p><strong>Results: </strong>A total of 8,408 patients were included, consisting of 807 nonagenarians and 7,601 octogenarians. The 30-day mortality rate was 45% for nonagenarians and 42% for octogenarians (p = 0.12). Bayesian analysis revealed a high probability (81.1-97.9%) that nonagenarians face a higher 30-day mortality risk. However, the probability of a clinically significantly increase in mortality (RR > 1.1) was moderate (28.9-34.7%), and the probability of a substantial increase (RR > 1.2) was very low (0.03-1.9%).</p><p><strong>Conclusion: </strong>Nonagenarians in the ICU have a slightly higher 30-day mortality risk compared to octogenarians, but the increase is unlikely to exceed clinically meaningful thresholds. Bayesian methods offer more refined mortality risk assessment, suggesting that ICU admission decisions should be based on individualized factors, not just age.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"85"},"PeriodicalIF":5.7,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12185795/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144473762","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}