Annals of Intensive Care最新文献

{"title":"Phenotypic characterization of patients with ANCA-associated vasculitis and diffuse alveolar hemorrhage: a data-driven analysis of a multicentre, retrospective, nationwide cohort.","authors":"Segolene Gendreau, Anne-Claire Sanna, Cyrielle Desnos, Romain Lombardi, Jolan Malherbe, Dimitri Titeca-Beauport, Florian Reizine, Raphael Porcher, Benjamin Terrier, Nicolas de Prost","doi":"10.1016/j.aicoj.2026.100180","DOIUrl":"https://doi.org/10.1016/j.aicoj.2026.100180","url":null,"abstract":"<p><strong>Background: </strong>Severe diffuse alveolar hemorrhage (DAH) is a potentially fatal complication of ANCA-associated vasculitides (AAV). This study aimed to identify distinct clinical phenotypes among patients to the ICU, and to examine their association with mortality.</p><p><strong>Methods: </strong>We conducted an ancillary analysis of the national multicenter retrospective PLEXHIA cohort, including 197 patients with severe AAV-related DAH, defined by respiratory symptoms with new infiltrates consistent with alveolar hemorrhage, along with oxygen saturation ≤85%, high-flow oxygen or mechanical ventilation requirement. Kohonen self-organizing maps were applied to predefined clinical variables at ICU admission, excluding treatment and outcomes. Clusters were interpreted and compared regarding organ involvement, severity, management, and mortality at 30 and 90 days.</p><p><strong>Results: </strong>Between 2012 and 2024, 197 patients (66 years old, 52% female) were included, revealing marked clinical heterogeneity. Three phenotypes emerged: The MPO pulmonary-renal (MPO-PR) cluster included patients with anti-MPO ANCA, renal involvement and high oxygen requirements. The mild-respiratory (Mild-R) cluster included predominantly female patients with less severe respiratory compromise and mild renal involvement. The PR3 multi-organ (PR3-MO) cluster involved younger patients with anti-PR3 ANCA, severe acute respiratory failure and multiorgan failure. Renal replacement therapy was most frequent in the MPO-PR group (73%), while invasive mechanical ventilation was most common in the MPO-PR and PR3-MO groups (71% and 68%). Thirty-day mortality differed significantly: 23% (MPO-PR), 4% (mild-R cluster), and 14% (PR3-MO cluster).</p><p><strong>Conclusion: </strong>This large ICU cohort highlights three clinically relevant phenotypes of AAV-related DAH, which could inform the development of phenotype-driven immunosuppressive strategies.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100180"},"PeriodicalIF":6.9,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13677274/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223231","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":"Longitudinal measurements of inflammatory mediators in patients at risk of sepsis in the Emergency Department.","authors":"Berta Cistero, Veronica Monforte, Marta Camprubi-Rimblas, Aina Areny-Balagueró, Elena Campana-Duel, Aida Fernandez, Antonio Casabella-Pernas, Elisa Nuez-Zaragoza, Iu Martin, Adriana Tomas, Irune Minarro, Marta Vila, Mireia Cuevas, Mar Sanchez, Xavier Belda, Monica Lopez Rodriguez, Tiago Teles, Maria F Savone, Carlos Stable, Patricia Salom Merce, Carla Guijarro Viudez, Juan Tajan, Gemma Goma Fernandez, Maria L Martinez, Lina Kramer, Rombout van Amstel, Emilio Diaz Santos, Lluis Blanch, Emilio M Gene Tous, Lieuwe D J Bos, Antonio Artigas Raventos, Adrian Ceccato","doi":"10.1016/j.aicoj.2026.100178","DOIUrl":"10.1016/j.aicoj.2026.100178","url":null,"abstract":"<p><p>Sepsis is a complex condition with time‑dependent evolution, and longitudinal biomarker dynamics may improve its characterisation. We hypothesised that biomarker kinetics are associated with sepsis, the intensity of organ dysfunction, and patient survival. This single‑centre, prospective, observational study included adult patients presenting to the Emergency Department with suspected infection and a National Early Warning Score 2 (NEWS2) ≥3. Blood samples were collected at baseline, 4 and 24 h and pro-inflammatory and anti-inflammatory cytokines, chemokines, as well as other inflammatory mediators or acute-phase reactants, were analysed. Linear and nonlinear mixed-effects models assessed associations between biomarker trajectories over time, sepsis diagnosis, and organ dysfunction severity. Joint models evaluated the predictive value of biomarker kinetics during the first 24 h for in‑hospital mortality. Of 214 screened patients, 173 were analysed and 137(79%) developed sepsis. Linear and nonlinear mixed models showed significant time‑dependent decreases in IL10 (β -0.016, 95%CI -0.028 to -0.004), IL1RN (β -0.014, 95%CI -0.024 to -0.004), and IL6 (β -1.021, 95%CI -1.609 to -0.433 for the first spline 0-4 h). Sepsis diagnosis was associated with higher IL1RN (β 0.378, 95%CI 0.153-0.603) and TNFRSF1A (β 0.40, 95%CI 0.21-0.58); a significant interaction between sepsis and time was observed only for IL6 (β -0.33, CI95% -0.653 to-0.007) for the second spline 4-24 h. Increasing SOFA scores correlated with elevated IL10 (β 0.048), IL1RN (β 0.044), CCL2 (β 0.046), TNFRSF1A (β 0.050), and procalcitonin (PCT; β 2.15), all p < 0.01. The SOFA score-time interaction was significant only for IL6 (β 0.122, 95%CI 0.006 to 0.238 during the first spline 0-4 h followed by β -0.080, 95%CI -0.133 to -0.027 for the second spline 4-24 h). Joint survival models adjusted identified associations between longitudinal IL8 (HR 0.655, 95%CrI 0.582-0.728), TNFRSF1A (HR 0.505, 95%CrI 0.419-0.682), and PCT (HR 1.004, 95%CrI 1.001-1.008) concentrations and survival outcome. However, IL8 and TNFRSF1A showed an unexpected inverse association with survival, and the overall discriminatory performance was modest. In conclusion, Sepsis status and organ dysfunction severity were associated with distinct inflammatory biomarker levels and kinetics. IL6 showed a unique time‑dependent relationship, whereas the dynamics of TNFRSF1A, IL8 and PCT showed exploratory associations with survival. Further studies are warranted to confirm our results.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100178"},"PeriodicalIF":6.9,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13675847/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149214969","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":"Dynamics of ventriculo-arterial coupling and peripheral tissue perfusion during early resuscitation of septic shock.","authors":"Juan Daniel Caicedo Ruiz, Gustavo García Gallardo, Jose Luis Aldana, Eduardo Kattan, Ricardo Castro, Glenn Hernandez, Michael Pinsky, Jihad Mallat, Gustavo Adolfo Ospina-Tascón","doi":"10.1016/j.aicoj.2026.100179","DOIUrl":"https://doi.org/10.1016/j.aicoj.2026.100179","url":null,"abstract":"<p><strong>Background: </strong>Left ventriculo-arterial coupling (LVAC), the ratio of arterial elastance to left ventricular end-systolic elastance, is a dimensionless index that depicts the interaction between arterial load and cardiac contractility, reflecting energy transmission from the heart to the proximal arterial tree. Nevertheless, how dynamic variations of LVAC may impact tissue perfusion remains unclear. We evaluated the dynamic relationship between LVAC and capillary refill time (CRT), a peripheral perfusion surrogate, during early resuscitation of septic shock.</p><p><strong>Methods: </strong>Adult patients were prospectively included within 4-h of meeting Sepsis-3.0 septic shock criteria. LVAC was estimated at inclusion and 6-hours later by combining transthoracic echocardiography with arterial pressure monitoring, while CRT was simultaneously assessed. Patients were classified as uncoupled when LVAC > 1.36. Variations in CRT between baseline and 6-h were compared across four groups defined by LVAC evolution: (1) coupled-to-coupled; (2) coupled-to-uncoupled; (3) uncoupled-to-coupled; (4) uncoupled-to-uncoupled. Additionally, paired measurements before/after fluid loading and/or dobutamine initiation were analyzed. CRT differences among groups were compared using Kruskal-Wallis testing, followed by Dunn's post-hoc test for pairwise comparisons. Paired-Wilcoxon tests assessed CRT variations before/after interventions according to pre-intervention LVAC status.</p><p><strong>Results: </strong>Eighty-four patients were included. CRT variation between baseline and 6-h differed significantly among groups (Kruskal-Wallis, p = 0.013), with CRT improvement in uncoupled-to-coupled (-33.8 [-53.1 to -1.2]%, p = 0.013) and worsening in coupled-to-uncoupled patients (17.5 [7.1-31.3]%, p = 0.013). Persistently coupled and uncoupled groups exhibited heterogeneous CRT responses at 6-h. Thirty-one fluid loads and thirty-two inotrope interventions were also analyzed. CRT decreased after dobutamine in initially uncoupled patients (-26.2%, p = 0.007) but not after fluid loading (-9.5%, p = 0.656) despite both interventions significantly increasing stroke volume in uncoupled LVAC condition (+14.0%, p = 0.021 and +14.2%, p < 0.001, for fluids and dobutamine, respectively). CRT did not change after either intervention in patients already coupled.</p><p><strong>Conclusion: </strong>Although LVAC improvement was associated with recovery of peripheral perfusion in some patients, and its deterioration with CRT prolongation in others, this relationship proved to be weak. Indeed, inconsistent CRT behavior among persistently coupled or uncoupled patients, and the heterogeneous response to resuscitative interventions suggest peripheral perfusion often evolves independently of energy transmitted from the heart to proximal arterial tree.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100179"},"PeriodicalIF":6.9,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13677266/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223172","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":"Direct tracheostomy in Guillain-Barré syndrome: indication and timing both matter.","authors":"Hao Lin, Peng Liu","doi":"10.1016/j.aicoj.2026.100175","DOIUrl":"https://doi.org/10.1016/j.aicoj.2026.100175","url":null,"abstract":"","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100175"},"PeriodicalIF":6.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13677268/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223143","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":"Direct tracheostomy in Guillain-Barré syndrome: indication and timing both matter. Authors' reply.","authors":"Arnaud W Thille, Louis Chamblet, Sylvain Le Pape, Rémi Coudroy","doi":"10.1016/j.aicoj.2026.100177","DOIUrl":"10.1016/j.aicoj.2026.100177","url":null,"abstract":"","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100177"},"PeriodicalIF":6.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13675846/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149214996","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":"Clarifying causal questions in tracheostomy strategies for Guillain-Barré syndrome.","authors":"Chenchen Jiang","doi":"10.1016/j.aicoj.2026.100176","DOIUrl":"https://doi.org/10.1016/j.aicoj.2026.100176","url":null,"abstract":"","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100176"},"PeriodicalIF":6.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13677262/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223098","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":"Agreement between chest radiograph and computed tomography for the diagnosis of acute respiratory distress syndrome: A retrospective observational study.","authors":"Jérémy Caldonazzo, Guillaume Herpe, Maïa Joos, François Arrivé, Chloé Villaret, Sylvain Le Pape, Vincent Menguy, Anne Veinstein, Jean-Pierre Frat, Arnaud W Thille, Rémi Coudroy","doi":"10.1016/j.aicoj.2026.100172","DOIUrl":"10.1016/j.aicoj.2026.100172","url":null,"abstract":"<p><strong>Background: </strong>The presence of bilateral lung infiltrates on chest imaging is a mandatory clinical criterion for the diagnosis of acute respiratory distress syndrome (ARDS). Although lung infiltrates are usually identified on chest radiograph in clinical practice, chest computed tomography (CT) outperforms chest radiograph for the diagnosis of lung infiltrates. We hypothesized that the performance of chest radiograph for the diagnosis of ARDS, as compared to chest CT as reference, is limited.</p><p><strong>Methods: </strong>We conducted a retrospective, single-center, observational study over a 7-year period, including patients who met all but the imaging criterion for ARDS (defined by the Berlin criteria) and who underwent a chest CT and a chest radiograph the same day. Chest CT was interpreted by two radiologists and considered as the gold standard diagnosis of ARDS whereas chest radiographs were interpreted by two intensivists. The primary outcome was the agreement between chest radiograph and chest CT for the diagnosis of ARDS in the overall population. Secondary outcomes included the performance of chest radiograph for the diagnosis of ARDS in the overall population and in predefined subgroups, especially based on patient characteristics, imaging features, timing between chest radiograph and CT, and inter-rater agreement. Agreement was assessed using Cohen's kappa, and diagnostic performance using sensitivity, specificity, predictive values, and accuracy for the primary outcome and subgroup analyses.</p><p><strong>Results: </strong>Out of the 277 patients included during the study period, prevalence of ARDS on chest CT among hypoxemic intubated patients fulfilling all but the imaging criteria for ARDS was 81%. Overall, the agreement was fair to moderate and consistent across subgroups. Sensitivity of chest radiograph for the diagnosis of ARDS ranged from 74% to 80%, higher in patients with four quadrants involved on chest radiograph (100%), and lower in patients with focal ARDS on chest CT (54-67%).</p><p><strong>Conclusion: </strong>Chest radiograph has limited performance for the diagnosis of ARDS, and at least 20% of patients with ARDS on chest CT were not diagnosed using chest radiograph. Systematic chest CT in hypoxemic intubated patients may reduce the under-recognition of ARDS and contribute to effective implementation of protective ventilation strategies.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100172"},"PeriodicalIF":6.9,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13675848/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149214989","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":"Permissive versus conventional weaning from venovenous ECMO in patients with ARDS: a retrospective cohort study.","authors":"Quentin Moyon, Yoel Benitha, Chahem Harba, Maria Teresa Passarelli, Charles Juvin, Guillaume Lebreton, Juliette Chommeloux, Guillaume Hékimian, Alexandre Coppens, Ouriel Saura, David Levy, Charles-Edouard Luyt, Alain Combes, Matthieu Schmidt","doi":"10.1016/j.aicoj.2026.100174","DOIUrl":"https://doi.org/10.1016/j.aicoj.2026.100174","url":null,"abstract":"<p><strong>Background: </strong>Criteria for weaning from venovenous extracorporeal membrane oxygenation (V-V ECMO) in acute respiratory distress syndrome (ARDS) remain poorly standardized. Some patients are decannulated despite persistent abnormalities in respiratory mechanics once oxygenation and carbon dioxide clearance are considered adequate. We aimed to compare outcomes associated with permissive versus conventional V-V ECMO weaning.</p><p><strong>Methods: </strong>We conducted a retrospective single-center cohort study including adult patients with refractory ARDS treated with V-V ECMO between January 2015 and December 2022 who were successfully decannulated while receiving invasive mechanical ventilation. Permissive weaning was defined as ECMO decannulation despite persistence of at least one of the following criteria during the sweep gas-off trial: plateau pressure ≥30 cmH₂O, driving pressure ≥20 cmH₂O, positive end-expiratory pressure ≥15 cmH₂O, or tidal volume ≤5 mL/kg predicted body weight. The primary outcome was 90-day mortality after ECMO decannulation. Secondary outcomes included liberation from mechanical ventilation within 90 days, analyzed using competing-risk models with death as a competing event. Associations with mortality were assessed using landmark Cox proportional hazards models anchored at decannulation.</p><p><strong>Results: </strong>Among 469 patients treated with V-V ECMO, 280 successfully decannulated patients were included; 117 (42%) underwent permissive weaning and 163 (58%) conventional weaning. Baseline characteristics were broadly similar, although body mass index was higher and SARS-CoV-2 ARDS more frequent in the permissive group. Patients undergoing permissive weaning had longer ECMO support (19 [9-37] vs. 12 [6-27] days; p < 0.01). At the sweep gas-off trial, respiratory mechanics remained more impaired in the permissive group, whereas oxygenation parameters were comparable. In landmark analysis, permissive weaning was associated with higher 90-day mortality in both univariable (hazard ratio [HR] 3.53, 95% confidence interval [CI] 1.62-7.66; p < 0.01) and multivariable analyses (adjusted HR 4.45, 95% CI 1.98-9.97; p < 0.01). However, permissive weaning was not associated with delayed liberation from mechanical ventilation by day 90 (adjusted subdistribution HR 0.90, 95% CI 0.70-1.17; p = 0.4).</p><p><strong>Conclusions: </strong>Among patients with severe ARDS successfully decannulated from V-V ECMO, permissive weaning was associated with increased 90-day mortality but not with delayed liberation from mechanical ventilation.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100174"},"PeriodicalIF":6.9,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13677267/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223225","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":"The effect of time-varying left ventricular ejection fraction on clinical outcome in critically ill COVID-19 patients.","authors":"M S Chew, S Jansson, M Jozwiak, Z Hassanzadeh, H Didriksson, C Jonsson, H Andersson, M Åström Aneq, M Slama, A Vieillard Baron, P Vignon, H Zhang, S Huang","doi":"10.1016/j.aicoj.2026.100171","DOIUrl":"10.1016/j.aicoj.2026.100171","url":null,"abstract":"<p><strong>Background: </strong>Although right ventricular (RV) dysfunction and acute cor pulmonale are associated with adverse outcomes in critically ill patients with COVID-19, the prognostic significance of left ventricular (LV) systolic dysfunction remains insufficiently characterized. In particular, dynamic changes in cardiac function during intensive care has seldom been studied. We therefore investigated the association between time-varying LV systolic function, assessed by LV ejection fraction (LVEF) and intensive care unit (ICU) mortality in patients with COVID-19, taking into account right ventricular function and forward flow.</p><p><strong>Methods: </strong>This retrospective observational cohort study combined three ICU data repositories comprising 808 patients with 1614 echocardiographic examinations. Time-varying LV systolic function (LVEF ≤ 50%, 51-70%, >70%) was the primary exposure, and ICU mortality was the outcome. Multivariable Cox models with time-varying covariates, including, acute cor pulmonale, left ventricular outflow tract velocity time integral and key clinical characteristics were used to assess associations between LV systolic function phenotypes and outcome.</p><p><strong>Results: </strong>At baseline, 27% of patients had abnormal LV systolic function (LVEF ≤ 50%) and 17% had hyperdynamic LV function (LVEF > 70%). The proportion of patients with normal LV systolic function increased over time. Abnormal LV systolic function was most prevalent at the first echocardiographic examination (27%) and least prevalent at the fifth examination (17%), whereas hyperdynamic LV function became more frequent during ICU stay, peaking at the 4th echocardiographic examination. Abnormal (aHR; 1.174, 95% CI: 0.901-1.531) or hyperdynamic (aHR: 1.041, 95% CI: 0.785-1.379) LV systolic dysfunction was not independently associated with ICU mortality.</p><p><strong>Conclusion: </strong>In critically ill patients with COVID-19, LV systolic dysfunction, including both abnormal and hyperdynamic LV phenotypes, were common and dynamic during ICU stay. LV systolic dysfunction was not independently associated with ICU mortality when modelled longitudinally and adjusted for RV dysfunction, forward flow and other clinical covariates. These findings suggest that the prognostic value LVEF phenotypes in severe COVID-19 may be limited. Further studies incorporating more sensitive measures of LV function and biomarkers of myocardial injury may be required to delineate subtle changes not captured by LVEF.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100171"},"PeriodicalIF":6.9,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13677176/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149219704","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":"The hidden severity of new psychoactive substances: clinical evidence from emergency and intensive care admissions in Taiwan.","authors":"Po-Hsiang Liao, Chih-Chuan Lin, Chia-Ming Chang, Sung-Wei Liu, Te-I Weng, Hsien-Yi Chen, Cheng-Chung Fang, Jiun-Hao Yu, Yu-Jang Su, Yen-Chia Chen","doi":"10.1016/j.aicoj.2026.100163","DOIUrl":"https://doi.org/10.1016/j.aicoj.2026.100163","url":null,"abstract":"<p><strong>Background: </strong>New psychoactive substances (NPS) have emerged as a growing threat in Taiwan, yet their clinical severity compared with traditional illicit drugs (TID) remains uncertain. This study aimed to compare the clinical characteristics and critical outcomes between patients with NPS and TID poisoning confirmed by liquid chromatography-tandem mass spectrometry (LC-MS/MS).</p><p><strong>Methods and results: </strong>We conducted a multicenter retrospective cohort study across 10 hospitals within six medical systems in Taiwan. Between March 2019 and January 2020, 1,378 patients with suspected drug intoxication underwent urine LC-MS/MS analysis at certified toxicology laboratories. A total of 362 patients (26.3%) tested positive, including 147 (40.6%) with NPSs, 130 (35.9%) with TIDs, and 85 (23.5%) with mixed substances.Demographic, clinical, and laboratory data were collected through a chart review. Synthetic cathinones and ketamine analogs were the most frequently detected NPSs, whereas methamphetamine/amphetamine and morphine were predominant among TID cases. Critical outcomes were defined as intensive care unit admission or death in the emergency department. The overall rate of critical outcomes was 18.3% (252/1,378). The odds of critical illness did not significantly differ between NPS and TID users (adjusted odds ratio, 0.94; 95% confidence interval [CI], 0.51-1.74). Kaplan-Meier survival analysis revealed no significant difference in short-term survival among the NPS, TID, and mixed-drug groups (log-rank p = 0.665).</p><p><strong>Conclusions: </strong>No statistically significant difference in clinical severity or mortality risk was observed between NPS and TID poisoning. These findings highlight that NPS exposure has a similar potential for critical illness and should be managed with the same clinical vigilance as conventional drug poisoning.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100163"},"PeriodicalIF":6.9,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13677263/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223182","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}