Annals of Intensive Care最新文献

{"title":"Impact of early versus conventional kidney replacement therapy initiation in tumor lysis syndrome: a target trial emulation.","authors":"Justine Serre, Guillaume Mulier, Charlotte Boud'hors, Marie Lemerle, Moustafa Abdel-Nabey, Corentin Orvain, Anis Chaba, Lucie Biard, Julien Demiselle, Lara Zafrani","doi":"10.1186/s13613-025-01439-x","DOIUrl":"10.1186/s13613-025-01439-x","url":null,"abstract":"<p><strong>Background: </strong>In the context of tumor lysis syndrome (TLS), the optimal timing and criteria for initiating kidney replacement therapy (KRT) remain unclear. This study aims to assess the effect of initiating KRT at various phosphatemia thresholds on Major Adverse Kidney Events at day 30 (MAKE30).</p><p><strong>Methods and results: </strong>We retrospectively emulated a pragmatic clinical trial comparing the effect of KRT initiation at various phosphatemia thresholds versus a conventional approach during TLS on MAKE30. All consecutive patients admitted to the ICU at Saint-Louis University hospital in Paris and Angers University hospital between January 2007 and June 2020, presenting with laboratory TLS were included. The design criteria of a clinical trial were mimicked by using the cloning, censoring and weighting method. The primary outcome was the MAKE30 composite outcome, considering only KRT requirement between day 7 and day 30 for the dialysis criteria. We evaluated multiple phosphatemia thresholds to guide KRT initiation, ranging from 6.20 mg.dL^-1 to 9.30 mg.dL^-1. Among the initial population of 220 patients, 192 were included in the emulated trial (median age 60 years old, with non-Hodgkin Lymphoma and Acute Leukemia being the most frequent hematological malignancies). TLS-related AKI occurred in 140 patients, and 75 patients met the criteria for MAKE30. Regardless of the phosphate threshold considered, KRT initiation based on phosphate level was not associated with a significant difference in the MAKE30 rate. KRT requirement during the first 7 days (Odd Ratio [OR] 4.01 [1.65-4.86], p = 0.003) and non-renal SOFA (OR 1.39 per 1 point increment [1.25-1.57], p < 0.001) were identified as factors associated with MAKE30 (multivariable analysis).</p><p><strong>Conclusion: </strong>Our results do not support the strategy of KRT initiation based on a sole critical phosphatemia level in TLS patients.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"49"},"PeriodicalIF":5.7,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143778746","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":"Does Levosimendan hasten veno-arterial ECMO weaning? A propensity score matching analysis.","authors":"Nicolas Paulo, Antoine Kimmoun, David Hajage, Pierre Hubert, David Levy, Marc Pineton de Chambrun, Juliette Chommeloux, Ouriel Saura, Grégoire Del Marmol, Quentin Moyon, Guillaume Hékimian, Melchior Gautier, Charles Edouard Luyt, Guillaume Lebreton, Bruno Levy, Alain Combes, Matthieu Schmidt","doi":"10.1186/s13613-025-01457-9","DOIUrl":"10.1186/s13613-025-01457-9","url":null,"abstract":"<p><strong>Background: </strong>Preliminary evidence from small, single-center studies suggests levosimendan may improve the likelihood of successful venoarterial extracorporeal membrane oxygenation (VA-ECMO) weaning in patients with cardiogenic shock. However, the literature is limited and presents conflicting results. We aimed to assess the benefits of levosimendan on VA-ECMO for time to successful ECMO weaning, using a pragmatic and rigorous definition of successful VA-ECMO weaning in patients with potential for cardiac function recovery.</p><p><strong>Methods: </strong>A retrospective bicentric study over 6 years was conducted, including patients who received levosimendan during their ECMO course. Patients with post-cardiotomy cardiogenic shock or end-stage chronic heart failure were excluded. Patients receiving levosimendan while on VA-ECMO were matched to those not receiving levosimendan during the same period, based on pre-specified variables and time from ECMO initiation. The primary endpoint was successful VA-ECMO weaning, defined as survival without death, heart transplantation, or LVAD within 30 days after VA-ECMO withdrawal.</p><p><strong>Results: </strong>Over the study period, 320 patients treated with VA-ECMO for refractory cardiogenic shock were included, of whom 68 received levosimendan during their ECMO course. Propensity score matching yielded 47 unique pairs of patients with comparable characteristics. After matching, successful ECMO weaning was achieved in 16 out of 47 patients (34%) in the no-levosimendan group and 21 out of 47 patients (45%) in the levosimendan group (sHR, 1.45 [95% CI, 0.77-2.70]; P = 0.25). Similarly, there were no significant differences between the groups in terms of bridge-to-heart transplant, LVAD, or death. Left ventricular ejection fraction and aortic velocity time integral improved significantly after levosimendan in all patients, regardless of their VA-ECMO weaning status.</p><p><strong>Conclusion: </strong>In patients with non-postoperative cardiogenic shock supported by peripheral VA-ECMO, levosimendan was not associated with increased rates of successful VA-ECMO weaning or improved 30-day and 6-month bridge-free survival. Results from double-blinded randomized controlled trials are urgently needed to clarify the effectiveness and optimal timing of levosimendan in this specific population.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"48"},"PeriodicalIF":5.7,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143778740","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":"Automatic continuous P_0.1 measurements during weaning from mechanical ventilation: a clinical study.","authors":"Delamaire Flora, Maamar Adel, Guillot Pauline, Quelven Quentin, Coirier Valentin, Painvin Benoit, Tadie Jean-Marc, Terzi Nicolas, Gacouin Arnaud","doi":"10.1186/s13613-025-01455-x","DOIUrl":"10.1186/s13613-025-01455-x","url":null,"abstract":"<p><strong>Background: </strong>In critically ill patients, weaning from mechanical ventilation (MV) includes spontaneous breathing trial (SBT) usually followed by a reventilation period in order to recover from the alveolar derecruitement induced by the SBT. The measurement of occlusion pressure during the first 100 ms of an airway occlusion (P_0.1) one of the non-invasive tools available for estimating the respiratory drive, is a determinant of patient respiratory effort. This clinical study explores the use of non-invasive continuous monitoring of occlusion pressure automatically calculated by ventilators in the first 100 ms of airway occlusion (P_0.1 vent) during SBT and reventilation periods. The study aimed to investigate patient or respirator factors influencing P_{0.1 vent} as well as the association of P_{0.1 vent} values with extubation success or failure.</p><p><strong>Patients and methods: </strong>This prospective observational study, conducted from February 2022 to April 2023, included adult patients intubated for more than 24 h and screened for extubation weaning. SBTs were performed for one hour with zero pressure support and zero end-expiratory pressure (PS0 ZEEP). Reventilation followed for an hour with pressure support (8-12 cmH₂O) and PEEP (5 cmH₂O). Data included patient characteristics, ventilator parameters and extubation outcomes.</p><p><strong>Results: </strong>The study involved 224 measurements from 212 patients, with 157 successful extubations, 46 extubation failures at day 7 and 21 SBT failures. P_{0.1 vent} mean values were significantly higher for extubation failures and SBT failures compared to successful extubations (p < 0.001). Delta P_{0.1 vent} ((P_{0.1 vent} reventilation - P_{0.1 vent} SBT)/ P_{0.1 vent} SBT) was significantly different according to whether extubation was a success or a failure: 0.21 (0.02-0.62) cm H₂O vs. P_{0.1 vent} vs. 1.12 (0.54-2.38) cm H₂O; p < 0.0001 respectively. Values significantly differed in both the SBT and the reventilation periods whether or not patients had previous ARDS: 1.08 (0.70; 2.02) cmH₂O vs. 0.80 (0.54; 1.28) cmH₂O respectively (p = 0.003). Noteworthy, P_{0.1 vent} values were influenced by airway humidification systems (0.92 (0.57; 1.54) cmH₂O with humidification vs. 1.27 (0.91; 2.24) cmH₂O without, p = 0.003).</p><p><strong>Conclusion: </strong>The delta of P_0.1vent values between SBT and reventilation are higher for patients who fail extubation, especially for those who had ARDS. While elevated P_{0.1 vent} values were associated with extubation failure, the overlap in values limits its usefulness as a reliable predictor.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"47"},"PeriodicalIF":5.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11961779/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750781","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":"Time-dependent effects of prone position on ventilation-perfusion matching assessed by electrical impedance tomography in patients with COVID-19 ARDS: sub-analysis of a prospective physiological study.","authors":"Yuxian Wang, Yaxiaerjiang Muhetaer, Xin Zheng, Wei Wu, Jiale Tao, Ling Zhu, Jieqiong Song, Zhanqi Zhao, Ming Zhong","doi":"10.1186/s13613-025-01452-0","DOIUrl":"10.1186/s13613-025-01452-0","url":null,"abstract":"<p><strong>Background: </strong>Prone positioning (PP) has been shown to improve oxygenation in patients with acute respiratory distress syndrome (ARDS); with a focus on its early physiological effects. However, the time-dependent effects of PP on ventilation-perfusion (V/Q) matching have not been fully investigated. In this study we aimed to investigate the longitudinal effects of PP on regional V/Q matching and the distribution of ventilation and perfusion in patients with coronavirus disease 2019 (COVID-19)-associated ARDS.</p><p><strong>Methods: </strong>This study analyzed patients with COVID-19 ARDS who were mechanically ventilated and underwent their first PP treatment. V/Q mismatching was assessed using electrical impedance tomography (EIT). At five intervals during the initial PP session PaO₂/FiO₂ measurements and EIT evaluations were performed including: before the initiation of PP while in the supine position (SP), 1 h after PP (PP₁), 3 h after PP (PP₃), 16 h after PP (PP_end), and 3 h after reverting to the supine position (RE-SP₃).</p><p><strong>Results: </strong>In this study eighteen COVID-19 ARDS patients were enrolled. In comparison with SP, PP led to significant improvements in oxygenation, with PaO₂/FiO₂ consistently increasing at each PP time point and peaking at PP_end. Dorsal ventilation significantly increased at PP₁ (P = .047), and steadily rose during PP, with a higher increase at PP_end than PP₁ (P < .001). Dorsal perfusion remained unchanged during the first three hours of PP; however, significantly increased by PP_end. Ventilation and perfusion returned to their baseline levels at RE-SP₃. PP increased normal V/Q (%), and decreased non-perfused (%), low V/Q (%), particularly in the dorsal lung regions, compared with SP. At RE-SP₃, there was a marked increase in the non-ventilated (%), low V/Q (%), and non-perfused (%) compared with PP. The global inhomogeneity (GI)-V/Q ratio was noted to have decreased during PP and correlated with an increase in PaO₂/FiO₂.</p><p><strong>Conclusions: </strong>In COVID-19-induced ARDS patients, prone positioning initially improves oxygenation and V/Q matching by enhancing ventilation distribution and decreasing low V/Q (%). Over time, perfusion changes further improve V/Q matching, but these benefits diminish once the patient returns to the supine position, leading to increased V/Q mismatch. Trial registration Clinical Trials.gov, NCT04725227. Registered 25 January 2021, https://clinicaltrials.gov/study/NCT04725227?cond=NCT04725227&rank=1.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"46"},"PeriodicalIF":5.7,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11958859/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750782","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":"Combination of urinary biomarkers can predict cardiac surgery-associated acute kidney injury: a systematic review and meta-analysis.","authors":"Nikolett Kiss, Márton Papp, Caner Turan, Tamás Kói, Krisztina Madách, Péter Hegyi, László Zubek, Zsolt Molnár","doi":"10.1186/s13613-025-01459-7","DOIUrl":"https://doi.org/10.1186/s13613-025-01459-7","url":null,"abstract":"<p><strong>Introduction: </strong>Acute kidney injury (AKI) develops in 20-50% of patients undergoing cardiac surgery (CS). We aimed to assess the predictive value of urinary biomarkers (UBs) for predicting CS-associated AKI. We also aimed to investigate the accuracy of the combination of UB measurements and their incorporation in predictive models to guide physicians in identifying patients developing CS-associated AKI.</p><p><strong>Methods: </strong>All clinical studies reporting on the diagnostic accuracy of individual or combined UBs were eligible for inclusion. We searched three databases (MEDLINE, EMBASE, and CENTRAL) without any filters or restrictions on the 11th of November, 2022 and reperformed our search on the 3rd of November 2024. Random and mixed effects models were used for meta-analysis. The main effect measure was the area under the Receiver Operating Characteristics curve (AUC). Our primary outcome was the predictive values of each individual UB at different time point measurements to identify patients developing acute kidney injury (KDIGO). As a secondary outcome, we calculated the performance of combinations of UBs and clinical models enhanced by UBs.</p><p><strong>Results: </strong>We screened 13,908 records and included 95 articles (both randomised and non-randomised studies) in the analysis. The predictive value of UBs measured in the intraoperative and early postoperative period was at maximum acceptable, with the highest AUCs of 0.74 [95% CI 0.68, 0.81], 0.73 [0.65, 0.82] and 0.74 [0.72, 0.77] for predicting severe CS-AKI, respectively. To predict all stages of CS-AKI, UBs measured in the intraoperative and early postoperative period yielded AUCs of 0.75 [0.67, 0.82] and 0.73 [0.54, 0.92]. To identify all and severe cases of acute kidney injury, combinations of UB measurements had AUCs of 0.82 [0.75, 0.88] and 0.85 [0.79, 0.91], respectively.</p><p><strong>Conclusion: </strong>The combination of urinary biomarkers measurements leads to good accuracy.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"45"},"PeriodicalIF":5.7,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11953499/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143741867","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":"Correction: Effect of early and later prone positioning on outcomes in invasively ventilated COVID-19 patients with acute respiratory distress syndrome: analysis of the prospective COVID-19 critical care consortium cohort study.","authors":"Andrew J Simpkin, Bairbre A McNicholas, David Hannon, Robert Bartlett, Davide Chiumello, Heidi J Dalton, Kristen Gibbons, Nicole White, Laura Merson, Eddy Fan, Mauro Panigada, Giacomo Grasselli, Anna Motos, Antoni Torres, Ferran Barbé, Pauline Yeung Ng, Jonathon P Fanning, Alistair Nichol, Jacky Y Suen, Gianluigi Li Bassi, John F Fraser, John G Laffey","doi":"10.1186/s13613-025-01466-8","DOIUrl":"10.1186/s13613-025-01466-8","url":null,"abstract":"","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"44"},"PeriodicalIF":5.7,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11950453/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143727517","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":"Ability of diastolic arterial pressure to better characterize the severity of septic shock when adjusted for heart rate and norepinephrine dose.","authors":"Antoine Goury, Zoubir Djerada, Glenn Hernandez, Eduardo Kattan, Romain Griffon, Gustavo Ospina-Tascon, Jan Bakker, Jean-Louis Teboul, Olfa Hamzaoui","doi":"10.1186/s13613-025-01454-y","DOIUrl":"10.1186/s13613-025-01454-y","url":null,"abstract":"<p><strong>Background: </strong>Septic shock is commonly associated with reduction in vasomotor tone, mainly due to vascular hyporesponsiveness to norepinephrine (NE). Although the diastolic arterial pressure (DAP)/heart rate (HR) ratio reflects vasomotor tone, it cannot be a reliable index of vascular responsiveness to NE (VNERi). We hypothesized that adjusting DAP/HR for the NE dose could yield a VNERi value (VNERi = DAP/(NE dose x HR)), knowledge of which can help guiding therapeutic strategies in cases of persistent hypotension despite NE (e.g., increasing NE doses vs. introducing additional vasopressors). For our hypothesis be valid, at least VNERi should demonstrate a stronger association with patient outcome than DAP, DAP/HR or mean arterial pressure (MAP)/NE dose, a global marker of NE responsiveness.</p><p><strong>Methods: </strong>We conducted a post-hoc analysis of the ANDROMEDA-SHOCK database. Hemodynamic variables and initial NE doses were recorded at the randomization time-point, within 4 h of septic shock diagnosis. NE doses were expressed in µg/kg/min (using the bitartrate NE formulation). A multivariate model was employed to compare the associations between these variables and key clinical outcomes, including in-hospital mortality, numbers of vasopressor-free days and of renal replacement therapy (RRT)-free days up to day 28.</p><p><strong>Results: </strong>The ANDROMEDA-SHOCK database included 424 patients with septic shock receiving NE. The median DAP was 52 mmHg [IQR: 45-50] and the median NE dose at inclusion was 0.2 µg/kg/min [IQR: 01-0.4]. In-hospital mortality was 43%. VNERi demonstrated the strongest association with in-hospital mortality compared to DAP, DAP/HR, and MAP/NE dose, emerging as the most significant covariate in the multivariate model. Similar findings were found for the associations with numbers of vasopressor-free days and RRT-free days up to day 28. The model revealed an inverted J-shaped relationship between in-hospital mortality and VNERi, with a nadir point at 6.7, below which mortality increased.</p><p><strong>Conclusions: </strong>In patients receiving NE during early septic shock, VNERi demonstrated the strongest association with outcome compared to DAP, DAP/HR, and MAP/NE dose. Due to its physiological basis and robust association with outcomes, VNERi may serve as a valuable bedside marker of the vascular responsiveness to NE. This index could potentially be integrated into decision-making of early septic shock.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"43"},"PeriodicalIF":5.7,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11937472/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708129","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":"Amikacin use in critically ill patients requiring renal replacement therapy: the AMIDIAL-ICU study.","authors":"Vincent Dupont, Bruno Mourvillier, Coralie Barbe, Vincent Legros, Mathieu Jozwiak, Hamid Merdji, Claire Dupuis, Hadrien Winiszewski, Antoine Marchalot, Guillaume Lacave, Mathilde Neuville, Anne Sagnier, François Barbier, Carine Thivilier, Stéphanie Ruiz, Roland Smonig, Jeremy Rosman, Laurent Argaud, Steven Grangé, Benjamine Sarton, Patrick Chillet, Guillaume Voiriot, Lukshe Kanagaratnam, Zoubir Djerada","doi":"10.1186/s13613-025-01461-z","DOIUrl":"10.1186/s13613-025-01461-z","url":null,"abstract":"<p><strong>Background: </strong>Acute kidney injury (AKI) requiring renal replacement therapy (RRT) is common in intensive care units (ICUs), yet optimal amikacin dosing in this context remains poorly understood.</p><p><strong>Methods: </strong>We conducted a prospective observational study across 18 French hospitals from April 2020 to January 2022. Adult ICU patients (aged > 18 years) receiving their first amikacin dose while on RRT were included. Data on demographics, RRT modalities, amikacin dosing, and therapeutic drug monitoring were collected. Using a pharmacokinetic modeling approach, we evaluated various amikacin regimens and simulated target attainment probabilities across different minimum inhibitory concentrations (MICs).</p><p><strong>Results: </strong>A total of 111 patients were included, with approximately two-thirds receiving continuous RRT. The median amikacin dose was 27 (25-30) mg/kg. Amikacin peak (Cmax) and trough concentrations were monitored in 53 (47.8%) and 76 (68.5%) patients, respectively. Continuous RRT and a history of chronic kidney disease reduced dialytic clearance. For a MIC ≤ 4 mg/L, a 15 mg/kg amikacin dose achieved Cmax/MIC and AUC/MIC targets in ≥ 90% of patients on intermittent dialysis, while 20 mg/kg was required for those on continuous dialysis. For a MIC = 8 mg/L, a 30 mg/kg dose was necessary to achieve Cmax/MIC ≥ 8.</p><p><strong>Conclusions: </strong>Our findings highlight suboptimal adherence to amikacin monitoring guidelines in ICU patients on RRT. Using pharmacokinetic modeling, we identified amikacin dosing recommendations ranging from 15 to 35 mg/kg to optimize efficacy and minimize risks, depending on MIC and dialysis modality.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"42"},"PeriodicalIF":5.7,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11937451/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708130","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":"Selective decontamination regimens in French ICUs: association with reduced infection and resistance emergence.","authors":"Nicolas Massart, Marc Leone, Florian Reizine, Gary Duclos, Anaïs Machut, Charles-Hervé Vacheron, Anne Savey, Emmanuelle Hammad, Arnaud Friggeri, Alain Lepape","doi":"10.1186/s13613-025-01465-9","DOIUrl":"10.1186/s13613-025-01465-9","url":null,"abstract":"<p><strong>Background: </strong>Despite randomized controlled trials with favorable results, few intensive care units (ICUs) implemented selective decontamination (SD) for ICU-acquired infection prevention. We aimed to evaluate, SD implementation and associated-effects in a large network of French ICUs.</p><p><strong>Methods: </strong>This study was conducted using the healthcare-associated infection surveillance cohort \"REA-REZO\" involving 193 participating ICUs. All patients receiving invasive mechanical ventilation for > 24 h were included. In addition to standard of care (SOC), six ICUs applied a SD strategy during the study period. The primary endpoint was the rate of ICU-acquired infection. A propensity-score matched analysis was conducted using non-parsimonious regression model. The secondary endpoint was the rate of colonization by multidrug resistant organisms (MDRO) during the ICU stay.</p><p><strong>Results: </strong>Among 81,661 patients with invasive mechanical ventilation for longer than 24 h, 2727 patients receiving SD were matched with 2 727 receiving SOC. The ICU-acquired infection incidence was lower in the SD group as compared with the SOC group (Incidence Rate Ratio = 0.66 [0.60-0.73]; p < 0.001) although the ICU mortality was similar (31.9% vs 32.5%, respectively p = 0.689). Acquisition of MDRO was lower in the SD group than in the SOC group (40 (1.5%) patients vs. 139 (5.1%) patients p < 0.001).</p><p><strong>Conclusions: </strong>These results showed that a strategy of SD was associated with reduced ICU-acquired infection incidence and decreased emergence of MDRO, while the mortality was not affected.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"41"},"PeriodicalIF":5.7,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11936853/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708184","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":"Anti-RNApol3-Associated myocarditis: an emerging disease linking autoimmunity and infection.","authors":"Paul Quentric, Jean-Luc Charuel, Quentin Moyon, Guillaume Hékimian, Karim Dorgham, François Lifermann, Mathieu Kerneis, Alexis Mathian, Karim Aacha, Isabelle Melki, Juliette Chommeloux, Matthieu Petit, Melchior Gautier, Pierre Bay, Philippe Rouvier, Etienne Charpentier, Omaira da Mata-Jardin, Lucie Lefevre, Christophe Parizot, Ouriel Saura, David Levy, Sofia Ortuno, Matthieu Schmidt, Charles-Edouard Luyt, Guy Gorochov, Zahir Amoura, Alain Combes, Marc Pineton de Chambrun","doi":"10.1186/s13613-025-01443-1","DOIUrl":"10.1186/s13613-025-01443-1","url":null,"abstract":"<p><strong>Background: </strong>Fulminant myocarditis (FM) is a severe condition primarily triggered by viruses. Anti-RNA polymerase III autoantibodies (RNApol3) which are typically found in patients with severe systemic sclerosis, have been reported in patients with influenza-related FM. Our objective is to provide additional insight into RNApol3-associated FM.</p><p><strong>Methods: </strong>We retrospectively included all patients admitted to our institution between January 2013 and June 2023 with acute myocarditis and positive serum RNApol3. We compared their characteristics, etiologies, and outcomes with those of a cohort of RNApol3 negative acute myocarditis.</p><p><strong>Results: </strong>Twenty-nine RNApol3-positive patients, comprising 83% females with a mean age of 39 ± 12 years, were included in this study. Each patient was admitted to the intensive care unit at least once and 11 (38%) relapsed. Triggers included influenza virus in 55% and SARS-CoV-2 virus in 48% of cases. The lowest left ventricular ejection fraction was 10 [5-10] % and the highest troponin value was 82 [22-360] times the ULN. Patients required dobutamine (94%), veno-arterial extracorporeal membrane oxygenation (85%) and pericardiocentesis (38%). At the last follow-up, 76% of patients were still alive, while 7% had undergone cardiac transplantation, and 3% required a left ventricular assist device. Compared to RNApol3-negative cases, RNApol3-positive myocarditis was associated with female gender, fulminant evolution, tamponade, a higher likelihood of being caused by a proven viral infection, and a higher rate of relapse.</p><p><strong>Conclusion: </strong>RNApol3-associated myocarditis is an emerging disease linking autoimmunity and infection and a unique cause of acquired, pathogen-specific, organ-specific immunodeficiency. RNApol3 should be screened in all cases of FM, especially in young women infected by RNA viruses. The risk of FM in RNApol3-positive systemic sclerosis needs further investigation.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"38"},"PeriodicalIF":5.7,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11930900/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143690918","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}