Annals of Intensive Care最新文献

{"title":"Transitions and determinants of ICU-acquired frailty after critical illness: A multicenter cohort study using a multistate Markov model.","authors":"Tingting Wu, Yueqing Wei, Lan Shi, Rongjin Lin, Hong Li","doi":"10.1016/j.aicoj.2026.100070","DOIUrl":"https://doi.org/10.1016/j.aicoj.2026.100070","url":null,"abstract":"<p><strong>Background: </strong>Preexisting frailty at ICU admission has been well investigated and linked to adverse outcomes, the continuum and determinants of new onset of frailty remain poorly characterized. This study aimed to estimate transition probabilities and intensities across non-frailty, frailty, and death after critical illness, and explore a set of potential variables associated with these transitions.</p><p><strong>Methods: </strong>We conducted a multicenter prospective cohort study of ICU survivors, followed from ICU discharge to 6 months. Frailty was assessed with the Clinical Frailty Scale (CFS), with scores ≥5 defined as frail and <4 as non-frail. Multistate Markov models were used to estimate transition probabilities and intensities among three states: frailty, non-frailty, and death. Univariate and multivariable Markov models were used to identify predictors of state transitions.</p><p><strong>Results: </strong>At follow-up, 66.1% of frail patients reversed to non-frail, 25.7% remained frail, and 8.2% died. Among those non-frails at baseline, 72.9% remained stable, 21.2% developed frailty, and 5.9% died. Recovery from frailty occurred more than three times as often as progression from non-frailty to frailty (transition intensity ratio, 3.12; 95% CI, 2.22-4.38). The transition from frailty to death was over twice as frequent as from non-frailty to death (ratio, 2.52; 95% CI, 0.39-16.37). Sepsis-related complications significantly increased the risk of frailty onset and mortality, whereas higher body mass index, muscle mass, handgrip strength, and phase angle consistently promoted recovery and survival. Older age, female sex, comorbidities, malnutrition, and prolonged ICU or hospital stay impaired recovery.</p><p><strong>Conclusions: </strong>Frailty after critical illness is a dynamic and potentially reversible condition, with transitions shaped by sepsis-related complications, nutritional and muscular status, and patient vulnerability factors. Early post-ICU frailty assessment and targeted interventions addressing infection, nutrition, and physical function may facilitate recovery and improve survival in ICU survivors.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100070"},"PeriodicalIF":5.5,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13142025/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147831794","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":"CytoSorb haemoadsorption in critically ill children: a multicentre observational study on feasibility, safety, and outcomes, the CYTOPED study.","authors":"Gabriella Bottari, Stefania Bianzina, Anna Tessari, Monica Fae, Sara Giovannini, Stefano Scollo, Elena Caporossi, Fabio Paglialonga, Pietro Lonardi, Raffaella Sagredini, Alessandro Simonini, Fabio Caramelli, Germana Longo, Corrado Cecchetti, Andrea Moscatelli, Isabella Guzzo","doi":"10.1016/j.aicoj.2026.100073","DOIUrl":"https://doi.org/10.1016/j.aicoj.2026.100073","url":null,"abstract":"<p><strong>Introduction: </strong>CytoSorb® is a cartridge for the adsorption of inflammatory mediators, bilirubin, myoglobin and other xenobiotics, directly from the blood stream. Clinical experience is widely documented in adults, whereas, in the paediatric settings, it is currently limited to single case reports or monocentric studies. In order to be able to collect evidence in larger paediatric populations, an Italian multicentre network (CYTOPED study group) was founded.</p><p><strong>Methods: </strong>Italian multicentric observational registry on the use of CytoSorb® in critically ill paediatric patients. Prospective enrolment by Italian Children's Hospitals has been ongoing since February 2021 with a retrospective analysis conducted from February 2018 to February 2021.</p><p><strong>Results: </strong>62 patients have been enrolled. Median Paediatric Logistic Organ Dysfunction 2 (PELOD-2) score on Paediatric Intensive Care Unit (PICU) admission was 7 (IQR 4;10). The primary clinical indications for haemoadsorption (HA) were sepsis or septic shock (<i>n</i> = 36), followed by liver failure, rhabdomyolysis, cardiac surgery. CytoSorb® has been applied in 87% of cases integrated in a continuous renal replacement therapy (CRRT) circuit. The median time of HA was 48 h (IQR 26;72) and the median number of cartridges used was 2 (IQR 1;3). Anticoagulation in the extracorporeal circuit has been managed with heparin (76%) and regional citrate anticoagulation (24%). Adverse events were recorded in 12 patients.</p><p><strong>Conclusion: </strong>Our data provide some insights into safety and feasibility of CytoSorb® therapy in children. The advancement of the study and the prospective arm of CYTOPED registry will allow further investigation into this therapy, including dosage, timing and use of antibiotics in conjunction with extracorporeal blood purification techniques.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100073"},"PeriodicalIF":5.5,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13141983/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832833","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":"Invasive hemodynamic monitoring-guided resuscitation improves survival in shock: A systematic review and meta-analysis.","authors":"Liliána Nagy, Petra Réka Tóth, Caner Turan, Dávid Laczkó, Lili Légár, Basak Danisan, Zoltán Sipos, Péter Hegyi, Zsolt Molnár, László Zubek","doi":"10.1016/j.aicoj.2026.100071","DOIUrl":"https://doi.org/10.1016/j.aicoj.2026.100071","url":null,"abstract":"<p><strong>Background: </strong>Mortality in shock may reach 60%; hence, immediate, adequate resuscitation has a crucial role in improving outcomes. Detailed hemodynamic monitoring is desirable, but evidence on its outcome benefits is limited. Therefore, this study aimed to compare advanced hemodynamic monitoring (AHDM)-guided clinical decision-making and treatment with conventional ones in terms of outcomes in shock.</p><p><strong>Methods: </strong>A systematic search was performed in three databases (PubMed, EMBASE, and Cochrane Library) until 9 November 2024. Randomised controlled trials, non-randomised and observational studies involving adult shock patients were eligible for inclusion. Main outcomes were in-hospital and 30-day mortality, and secondary outcomes included length of stay, need for and duration of organ support, and amount of fluid administered. Meta-analyses were performed using a random-effects model, with heterogeneity and risk of bias assessed. The review protocol was registered in PROSPERO (ID: CRD42024607758).</p><p><strong>Results: </strong>A total of 34 studies, including seven RCTs and 636,441 shock patients, were analysed to compare AHDM with conventional monitoring. The use of any type of AHDM was associated with a significantly lower in-hospital mortality for any type of shock (OR: 0.66; 95% CI: [0.48; 0.91], <i>p</i> = 0.014), especially in cardiogenic shock patients, managed with pulmonary artery catheter-guided therapy (OR: 0.68, 95% CI: [0.60; 0.78], <i>p</i> < 0.001). This contrasts with the significantly higher odds of requiring organ support treatment, including inotropes (OR: 2.32, CI: [1.29; 4.19], <i>p</i> = 0.012), vasopressors (OR: 1.46, CI: [1.05; 2.04], <i>p</i> = 0.030), mechanical circulatory support (OR: 2.85, CI: [1.62; 5.02], <i>p</i> = 0.002), renal replacement therapy or mechanical ventilation, although the duration of mechanical ventilation was shorter. Heterogeneity was predictably high due to the variety of shock types and monitoring methods. Risk of bias was predominantly low in RCTs and serious in observational studies.</p><p><strong>Conclusion: </strong>AHDM use is associated with a significant reduction in mortality in shock patients, with the greatest benefit observed in cardiogenic shock. The observed outcomes suggest that AHDM may facilitate qualitative changes in decision-making, consistent with precision-guided resuscitation.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100071"},"PeriodicalIF":5.5,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13141741/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832778","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":"Venovenous extracorporeal membrane oxygenation initiation and reduction in vasopressor requirements.","authors":"Rosa Labanca, Stefano Fresilli, Giovanni Landoni","doi":"10.1016/j.aicoj.2026.100069","DOIUrl":"https://doi.org/10.1016/j.aicoj.2026.100069","url":null,"abstract":"","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100069"},"PeriodicalIF":5.5,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13136997/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147831772","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":"Comparison between invasive radial and femoral arterial pressures and carotid tonometry in ICU patients: A physiological study.","authors":"Mathieu Jozwiak, Salma Al Kahf, Emilien Umbdenstock, Jean-Louis Teboul, Denis Chemla","doi":"10.1016/j.aicoj.2026.100068","DOIUrl":"https://doi.org/10.1016/j.aicoj.2026.100068","url":null,"abstract":"<p><strong>Background: </strong>Peripheral arterial pressure is used to guide hemodynamic management in intensive care unit (ICU) patients and for estimating various parameters of left ventricular afterload and function. Nevertheless, there is a physiological amplification of pressure from central to peripheral arteries, that remains to be documented in ICU patients. Our aim was to compare central to peripheral pressure amplification at the radial and femoral artery levels in ICU patients.</p><p><strong>Methods: </strong>In this prospective, observational and single-center study, we included consecutive spontaneously breathing patients already equipped with an arterial catheter. Carotid systolic arterial pressure obtained by carotid tonometry was considered a surrogate of aortic systolic pressure. We calculated pulse pressure amplification (PP_AMP, difference between femoral or radial PP and carotid PP), systolic pressure amplification (SP_AMP, difference between femoral or radial SP and carotid SP), PP ratio and SP ratio. The primary endpoint was the difference in PP_AMP and SP_AMP between the femoral and radial arteries. Secondary endpoints were the difference between peripheral and central estimates of cardiac power output (CPO), total arterial stiffness and effective arterial elastance (Ea).</p><p><strong>Results: </strong>98 patients were included: 68(69%) were men, with a mean age of 62 ± 16 years, and 42(43%) had a history of arterial hypertension. The arterial catheter was located in the radial artery in 59(60%) patients and the femoral artery in 39(40%) patients. Femoral and radial SAP and PP were higher than carotid SAP and PP (p < 0.001). The PP_AMP and the SP_AMP (12 ± 11 <i>vs.</i> 8 ± 10 mmHg p = 0.04 for both), the PP ratio (p = 0.03) and the SP ratio (p = 0.04) were higher at the radial than at the femoral artery level. Femoral and radial estimates of CPO overestimated centrally-derived CPO, with more marked overestimation at the radial than femoral artery level (9 ± 9 vs. 5 ± 7%, p = 0.04). The amount of overestimation was correlated to PP_AMP and SP_AMP (r = 0.85for both), PP ratio (r = 0.77) and SP ratio (r = 0.85) (all p < 0.001). Similar results were found for total arterial stiffness and Ea.</p><p><strong>Conclusions: </strong>The pressure amplification was lower at the femoral than radial artery level and should not be neglected in ICU patients when interpreting arterial pressures and estimating hemodynamic variables.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100068"},"PeriodicalIF":5.5,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13137008/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832821","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":"Regional citrate anticoagulation for renal replacement therapy during venovenous ECMO: A randomized crossover pilot study.","authors":"Marco Giani, Marta Frazzei, Roberto Rona, Thomas Langer, Matteo Pozzi, Giuseppe Foti, Emanuele Rezoagli","doi":"10.1016/j.aicoj.2026.100072","DOIUrl":"https://doi.org/10.1016/j.aicoj.2026.100072","url":null,"abstract":"<p><strong>Background: </strong>Regional citrate anticoagulation (RCA) is suggested as the preferred anticoagulation strategy during continuous renal replacement therapy (CRRT), as it prolongs circuit lifespan while minimizing bleeding complications. However, evidence on its use in CRRT circuits during extracorporeal membrane oxygenation (ECMO) is limited. In patients receiving ECMO, systemic anticoagulation with unfractionated heparin (UFH) is routinely administered to maintain circuit patency and is often relied upon to anticoagulate the CRRT circuit, limiting the use of regional citrate anticoagulation. The aim of this study is to evaluate whether adding regional citrate anticoagulation (RCA) to systemic unfractionated heparin (UFH) reduces CRRT circuits clotting in patients undergoing venovenous extracorporeal membrane oxygenation (VV ECMO).</p><p><strong>Results: </strong>Patients were randomized to receive alternating CRRT circuits anticoagulated with either systemic UFH alone or regional citrate anticoagulation added to systemic UFH (RCA + UFH), according to a predefined crossover sequence. Each circuit was maintained for up to 72 h or until clotting occurred. Coagulation parameters, CRRT pressures, and thromboelastography (TEG) data were collected.A total of 66 CRRT circuits from 18 patients were analyzed (33 RCA + UFH; 33 UFH). No clotting events occurred in the RCA + UFH circuits, whereas 6 events were observed with UFH alone (0% vs 19%; <i>p</i> < 0.001). Cox proportional hazards analysis showed significantly longer circuit survival with RCA + UFH compared to UFH alone (p = 0.029). Platelet counts increased during RCA + UFH but declined during UFH alone (median change +6 vs -7 ×10³/μL; <i>p</i> < 0.001), with a significantly more favorable overall trend under RCA + UFH (effect estimate +13 × 10³/μL, 95% CI 8-19). D-dimer levels increased significantly during UFH alone, whereas a lower increase was observed with RCA + UFH (effect estimate -782 μg/L, 95% CI -1525 to -39).Thromboelastography performed at the circuit level showed significantly prolonged R-times with RCA + UFH compared with UFH alone (median R-time 90 <i>vs.</i> 30 min; <i>p</i> < 0.001). No clinically relevant RCA-related metabolic complications were observed, including no episodes of severe hypernatremia, metabolic alkalosis, or citrate accumulation.</p><p><strong>Conclusions: </strong>In patients undergoing VV ECMO, adding regional citrate anticoagulation to systemic unfractionated heparin reduced CRRT circuit clotting, prevented platelet consumption. This technique was feasible, safe, and may improve CRRT efficiency in this high-risk population.</p><p><strong>Clinical trial: </strong>ClinicalTrials.gov Identifier NCT05148026.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100072"},"PeriodicalIF":5.5,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13137002/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832769","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":"Corrigendum to \"Clinical outcomes of persistent sepsis-associated acute kidney injury in septic shock: a post-hoc analysis of a multicenter prospective cohort study\" [Ann Intensive Care (2026) 100041].","authors":"Michihito Kyo, Yu Kawazoe, Takeshi Morimoto, Hitoshi Yamamura, Kyohei Miyamoto, Noriko Miyagawa, Yoshinori Ohta, Kazuya Kikutani, Shinichiro Ohshimo, Nobuyuki Hirohashi, Nobuaki Shime","doi":"10.1016/j.aicoj.2026.100065","DOIUrl":"https://doi.org/10.1016/j.aicoj.2026.100065","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1016/j.aicoj.2026.100041.].</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100065"},"PeriodicalIF":5.5,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13112387/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147759836","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":"Are King's College and Clichy-Villejuif criteria used for liver transplantation still appropriate? A retrospective study over a 25-year period.","authors":"Clément Monet, Laurène Fusi, Yassir Aarab, Lauriane Degravi, Ines Lakbar, Mathieu Capdevila, Joris Pensier, Lucy Meunier, Jose Ursic-Bedoya, Bader Al Taweel, Fouad Belafia, Gérald Chanques, Audrey De Jong, Georges Philippe Pageaux, Samir Jaber","doi":"10.1016/j.aicoj.2026.100067","DOIUrl":"https://doi.org/10.1016/j.aicoj.2026.100067","url":null,"abstract":"<p><strong>Background: </strong>Acute liver injury (ALI) is a life-threatening condition that may require liver transplantation (LT). For over three decades, the King's College Hospital (KCH) and Clichy-Villejuif (CV) criteria have guided LT decisions, but their relevance in the modern intensive care unit (ICU) era remains uncertain. This study aimed to assess the \"real-life\" incidence of LT among ICU patients with ALI fulfilling these criteria. We retrospectively analysed prospectively collected data from 2000 to 2025 in a tertiary ICU with an active LT program. All consecutive adult patients with ALI fulfilling KCH and/or CV criteria without contraindications were included. The primary endpoint was the incidence of LT. Secondary endpoints included ICU and one-year survival, organ support requirements, temporal trends and transplant-free survival according to criteria fulfilment.</p><p><strong>Results: </strong>Among 396 patients with ALI, 118 fulfilled KCH and/or CV criteria without contraindications for LT. The incidence of LT was 34% (40 out of 118). ICU and one-year survival did not significantly differ between transplanted and not transplanted patients (88% vs. 92% and 85% vs. 81%, respectively). Transplanted patients had more severe liver dysfunction, reflected by higher MELD scores driven by higher values of bilirubin and INR. They were more likely to have auto-immune hepatitis (23% vs. 1%, p < 0.01), and less likely to have acetaminophen-induced (25% vs. 46%, p = 0.03) or ischaemic ALI (2% vs. 26%, p < 0.01). Encephalopathy progression was more frequent in transplanted patients. The delay between ICU admission and LT significantly increased over the study period. Among not transplanted patients, one-year transplant-free survival exceeded 80% overall and remained high across all KCH/CV fulfilment patterns.</p><p><strong>Conclusion: </strong>In our cohort, only one-third of ALI patients fulfilling emergency LT criteria underwent transplantation. These findings suggest that historical KCH and CV criteria have limited ability to identify patients with poor prognosis without LT in the context of modern intensive care.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100067"},"PeriodicalIF":5.5,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13123610/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147760206","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":"Brain neurovascular unit biomarkers: a hypothesis-driven paradigm to advance understanding of post-cardiac arrest cerebral injury.","authors":"Mathieu Bellal, Suzanne Goursaud, Marina Rubio, Olivier Martinaud, Denis Vivien, Damien Du Cheyron, Cédric Daubin","doi":"10.1016/j.aicoj.2026.100064","DOIUrl":"https://doi.org/10.1016/j.aicoj.2026.100064","url":null,"abstract":"<p><strong>Purpose of review: </strong>To examine the pathophysiology of cerebral complications following cardiac arrest, to summarise the current state of neurological prognostication, and to explore, as a hypothesis-driven paradigm, how the biological signature of brain neurovascular unit injury, captured through a panel of emerging and innovative biomarkers, may serve as a predictive and/or diagnostic tool for cognitive impairment and overall neurological prognosis in the medium, and long term post-cardiac arrest.</p><p><strong>Recent findings: </strong>The 2025 Post-Resuscitation Care Guidelines advocate a multimodal approach to early neurological prognostication within 72 h. However, no standardised strategy exists for assessing medium and long-term neurological complications in cardiac arrest survivors. Emerging research, predominantly preclinical and conducted in the field of chronic neurovascular diseases outside the cardiac arrest context, has linked brain neurovascular unit dysfunction to cognitive impairment through the expression of novel circulating biomarkers. These findings offer a potential translational research avenue applicable to cardiac arrest and represent a promising pathway to improve the understanding, diagnosis, and prognostication of delayed neurological sequelae following cardiac arrest.</p><p><strong>Conclusion: </strong>Within a multimodal prognostic approach, emerging brain neurovascular unit biomarkers may provide valuable insights into the diagnosis and overall neurological prognosis in the medium and long term after cardiac arrest, thereby supporting preventive and personalised care strategies for cardiac arrest survivors.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100064"},"PeriodicalIF":5.5,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13122231/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147760201","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":"Lactate in cardiogenic shock: pathophysiology, prognostic value, and clinical interpretation.","authors":"Bruno Levy, Glenn Hernandez, Hamid Merdji","doi":"10.1016/j.aicoj.2026.100061","DOIUrl":"https://doi.org/10.1016/j.aicoj.2026.100061","url":null,"abstract":"<p><p>In cardiogenic shock (CS), blood lactate concentration is routinely used to assess shock severity and guide clinical decisions. However, lactate interpretation is often oversimplified, leading to confusion between disease severity, shock reversibility, and treatment failure. A clinically grounded understanding of lactate behavior throughout the course of CS is therefore required. In CS, lactate elevation primarily reflects the magnitude and duration of systemic hypoperfusion caused by reduced cardiac output, often compounded by regional ischemia, particularly in the splanchnic territory. In addition to anaerobic mechanisms, lactate production is influenced by adrenergic stimulation, post-cardiac arrest syndrome, ischemia-reperfusion injury, systemic inflammation, and mitochondrial dysfunction. Impaired hepatic and renal clearance further contributes to sustained hyperlactatemia, explaining why lactate may remain elevated despite apparent restoration of macrocirculatory variables. Clinically, admission lactate is a robust marker of initial shock severity and is consistently associated with early mortality. However, once resuscitation has started, isolated lactate values provide limited information. Serial measurements and lactate trajectories over time more accurately reflect metabolic recovery and response to therapy. Early lactate clearance identifies patients with reversible shock physiology, whereas persistent or rising lactate levels indicate refractory shock, ongoing microcirculatory dysfunction, or impaired clearance. In CS patients requiring mechanical circulatory support, particularly veno-arterial extracorporeal membrane oxygenation (VA-ECMO), lactate plays a central role in clinical assessment. Pre-implantation lactate reflects disease severity but should not be interpreted as a stand-alone criterion for futility. Following VA-ECMO initiation, early lactate clearance is one of the strongest predictors of survival, while persistent hyperlactatemia despite adequate device flow is associated with multiorgan failure and poor outcome. In CS, lactate should be interpreted as an integrative and dynamic biomarker reflecting the balance between hypoperfusion, metabolic stress, and clearance rather than tissue hypoxia alone. Trajectory-based lactate assessment, closely aligned with clinical context and circulatory support strategies, provides critical information for risk stratification, therapeutic guidance, and evaluation of shock reversibility.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100061"},"PeriodicalIF":5.5,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13122817/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147760119","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}