Annals of Intensive Care最新文献

{"title":"Transition phase in acute respiratory distress syndrome: paving the way for our next major challenge.","authors":"Anne-Fleur Haudebourg, Guillaume Carteaux","doi":"10.1186/s13613-025-01566-5","DOIUrl":"10.1186/s13613-025-01566-5","url":null,"abstract":"","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"148"},"PeriodicalIF":5.5,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12480186/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145190700","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":"Circulating biomarkers of vasoplegia: a systematic review.","authors":"Naomi Boyer, Prateek Upadhyay, Megan H Hicks, Alexander Zarbock, Ashish K Khanna, Lui G Forni, Benedict C Creagh-Brown","doi":"10.1186/s13613-025-01564-7","DOIUrl":"10.1186/s13613-025-01564-7","url":null,"abstract":"<p><strong>Background: </strong>Vasoplegia is characterised by persistent hypotension and reduced systemic vascular resistance despite preserved cardiac output, commonly arising in sepsis, following major surgery, and within systemic inflammatory responses. Despite its clinical significance and association with poor outcomes, there is no universally accepted definition or standardised biomarker, impeding early diagnosis, stratification, and targeted therapy. While individual studies have examined biomarkers within specific clinical contexts such as septic shock or cardiac surgery, no comprehensive synthesis across all aetiologies of vasoplegia has previously been undertaken.</p><p><strong>Objectives: </strong>To systematically evaluate and synthesise the current evidence regarding circulating biomarkers associated with the incidence, severity, prediction, and progression of vasoplegia across diverse critical care and perioperative populations. As well as review definitions used across literature.</p><p><strong>Methods: </strong>This systematic review was conducted in accordance with PRISMA 2020 guidelines and registered on PROSPERO (CRD42024438786). Studies were included if they investigated adult patients in critical care or perioperative settings with vasoplegia defined by reduced vascular resistance and hypotension requiring vasopressors.</p><p><strong>Results: </strong>A total of 43 studies met inclusion criteria. The included studies examined 39 unique biomarkers, with renin and adrenomedullin being the most frequently studied. Heterogeneity in definitions of vasoplegia, outcome measures, and comparator populations precluded meta-analysis. However, several biomarkers demonstrated potential clinical utility: elevated renin levels correlated with vasopressor requirements and haemodynamic instability, while adrenomedullin levels were predictive of vasoplegia development and duration.</p><p><strong>Conclusions: </strong>The lack of standardisation in biomarker assay methods and vasoplegia definitions remains a significant barrier to comparative analysis. Whilst this review highlights renin and adrenomedullin as promising candidate biomarkers for vasoplegia, the heterogeneity in study design, biomarker measurement, and diagnostic criteria underscores the urgent need for a consensus definition of vasoplegia, standardised sampling protocols, and unified outcome measures. Future research should focus on biomarker-guided risk stratification and personalised therapies, with an emphasis on validating predictive and mechanistic roles across diverse vasoplegic phenotypes.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"150"},"PeriodicalIF":5.5,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12480150/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145190731","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":"Rethinking the \"transition phase\" in ARDS: can we afford to overlook the physiology behind NMBA weaning and PSV failure??","authors":"Nan Xiong, Yinde Huang","doi":"10.1186/s13613-025-01565-6","DOIUrl":"10.1186/s13613-025-01565-6","url":null,"abstract":"","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"147"},"PeriodicalIF":5.5,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12480303/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145190713","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":"Mechanical power normalisation methods to predict ICU mortality: a retrospective cohort study.","authors":"Reza Khorasanee, Barnaby Sanderson, Emilia Tomarchio, Patrick D Collins, Riccardo Del Signore, Sridevi Shetty, Mara Chioccola, Francesca Pugliese, Francesca Collino, Louise Rose, Lorenzo Giosa, Luigi Camporota","doi":"10.1186/s13613-025-01562-9","DOIUrl":"10.1186/s13613-025-01562-9","url":null,"abstract":"<p><strong>Background: </strong>The optimal mechanical ventilation strategy to minimise ventilator-induced lung injury (VILI) remains uncertain. Mechanical power (MP) is a key VILI determinant, but whether and how MP should be normalised to individual patient characteristics is unclear. In this study, we aimed to evaluate whether the discriminatory accuracy of MP for ICU mortality in mechanically ventilated patients improves when normalised to physiologically relevant variables that reflect individual susceptibility to VILI. We also explored whether the relationship between MP, MP_ratio, and mortality is linear or exhibits a threshold effect.</p><p><strong>Methods: </strong>In this retrospective observational study, we extracted granular electronic healthcare record data for mechanically ventilated adults in a single centre over a seven-year period. Primary exposures were MP with five normalisations: for dead space (expressed as corrected minute ventilation, ventilatory ratio, or end-tidal to arterial CO₂ ratio); aerated lung size (compliance), and normal idealised MP (MP_ratio). We used logistic regression to assess associations with ICU mortality. We calculated the Area Under the Receiver Operating Characteristic Curve (AUROC) to compare discriminative accuracy of individual models. Additionally, we evaluated the linearity or presence of a threshold for the relationships between MP, MP_ratio and ICU mortality.</p><p><strong>Result: </strong>We included 3,578 patients in our analyses. We found MP normalised to compliance (AUROC 0.71, 95% confidence interval (CI) 0.69-0.73, p = 0.007 (DeLong's test)) and MP_ratio (AUROC 0.71, 95% CI 0.68-0.73, p = 0.0014) performed better than MP alone (AUROC 0.69, 95% CI 0.66-0.71) for predicting ICU mortality. Other methods of MP normalisation were no more discriminative than MP without normalisation. The relationship between MP and MP_ratio with ICU mortality showed a statistically significant but small departure from linearity.</p><p><strong>Conclusions: </strong>Mechanical power normalised to compliance and MP_ratio had better discrimination for ICU mortality than MP, although the difference was modest and absolute predictive power remained limited.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"149"},"PeriodicalIF":5.5,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12480304/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145190753","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":"Adherence assessment in post-cardiac arrest care: are physiological targets sufficient? : Author.","authors":"George Mannu","doi":"10.1186/s13613-025-01559-4","DOIUrl":"10.1186/s13613-025-01559-4","url":null,"abstract":"","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"136"},"PeriodicalIF":5.5,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12463786/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145147503","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":"Sepsis-induced myocardial dysfunction diagnosed with strain versus non-strain echocardiography parameters: incidence, evolution and association with prognosis.","authors":"Filipe André Gonzalez, Jacobo Bacariza, Ana Rita Varudo, João Leote, Ricardo Meireles Mateus, Cristina Maia Martins, Maria Inês Ribeiro, Filippo Sanfilippo, Luís Rocha Lopes, Ana G Almeida","doi":"10.1186/s13613-025-01561-w","DOIUrl":"10.1186/s13613-025-01561-w","url":null,"abstract":"<p><strong>Background: </strong>Sepsis-induced myocardial dysfunction (SIMD) remains poorly defined due to scarce longitudinal studies with advanced echocardiography. We characterized SIMD progression using speckle tracking echocardiography (STE).</p><p><strong>Methods: </strong>Prospective single-center study in septic shock patients admitted to intensive care. SIMD was defined as any left ventricular (LV, systolic and/or diastolic) and/or right ventricular (RV) systolic dysfunction, using STE or non-STE criteria, on days 1, 7 and 30. We studied prevalence, evolution and prognosis of SIMD classified with either criteria using Cox regression.</p><p><strong>Results: </strong>Ninety-eight consecutive patients were included. On day 1, SIMD was identified in n = 57/98 (58.2%) and n = 70/98 (71.4%;p = 0.072) by non-STE and STE parameters, respectively. No significant difference in diagnosis was seen for LV diastolic dysfunction: n = 50/98 (51.0%, non-STE) vs. n = 51/98 (52.0%, STE; p = 1.00). Prevalences of LV and RV systolic dysfunction were not significantly higher with STE criteria: n = 59/98 (60.2%, STE) vs. n = 47/98 (48.0%, non-STE; p = 0.115) for LV; n = 39/98 (39.8%, STE) vs. n = 27/98 (27.6%, non-STE; p = 0.096) for RV. More patients recovered from SIMD when evaluated with non-STE criteria at day 7 (35.3% vs. 17.5% STE; p = 0.033), but not at day 30 (24.5% vs. 18.8% STE; p = 0.501). The 30-day mortality (n = 33/98, 33.7%) was associated with SIMD diagnosed using non-STE (p = 0.010), but not with STE (p = 0.057). In Cox regression, only LVDD by non-STE criteria predicted 30-day mortality (p = 0.005).</p><p><strong>Conclusions: </strong>The incidence of SIMD in septic shock is higher when using STE criteria, with lower reversibility in the first week. A broad definition of SIMD utilizing STE criteria does not seem to provide additional prognostic value.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov: NCT05552521 registered on the 20th of September 2022.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"141"},"PeriodicalIF":5.5,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12463772/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145147440","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":"Hitting the target or missing the point? A closer look at post-cardiac arrest guideline adherence.","authors":"Giulia Merigo, Fabiana Madotto, Aurora Magliocca, Giuseppe Ristagno","doi":"10.1186/s13613-025-01560-x","DOIUrl":"10.1186/s13613-025-01560-x","url":null,"abstract":"","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"139"},"PeriodicalIF":5.5,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12463790/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145147491","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":"Severe hemoptysis: etiologies, management, and outcomes from a single-center experience over the last decade.","authors":"Julien Dessajan, Aude Gibelin, Matthias Barral, Nina de Montmollin, Vincent Labbé, Michel Djibré, Guillaume Voiriot, Matthieu Turpin, Antoine Parrot, Muriel Fartoukh","doi":"10.1186/s13613-025-01558-5","DOIUrl":"10.1186/s13613-025-01558-5","url":null,"abstract":"<p><strong>Background: </strong>Data on severe hemoptysis (SH) in the intensive care unit (ICU) remain scarce. We aimed to describe its clinical characteristics, etiologies, management strategies, and outcomes. This retrospective observational study analyzed patients admitted for SH to a referral center between 2009 and 2019. Data were compared to a historical cohort (1995-2009) using the Cochran-Armitage test.</p><p><strong>Results: </strong>A total of 945 patients (75% males; median age 55 years [IQR 42-65]) were analyzed; 67% had respiratory comorbidities. Invasive mechanical ventilation was required in 13% within 24 h of ICU admission. Lung cancer was the leading cause of SH, followed by bronchiectasis, tuberculosis, pneumonia, and aspergillosis. Compared with the historical cohort, pneumonia-related hemoptysis increased (11% vs. 5%; P < 0·001), as did pulmonary arterial involvement (12% vs. 5%; P < 0·001), mainly associated with pneumonia (23%), cancer, or aspergillosis (each 20%). Vascular interventional radiology (VIR) was first attempted in 81% of cases, achieving bleeding control in more than 90% of cases. Major adverse events occurred in 4.4% of cases. Emergent surgical lung resection (within 72 h) was performed in 2% of cases, all after VIR. In-hospital mortality rate increased slightly (8.7% vs. 6.5%; P = 0.08).</p><p><strong>Conclusions: </strong>Over the past decade, lung cancer became the leading cause of SH, with pneumonia increasingly contributing to pulmonary arterial involvement, reinforcing the need for multi-detector computed tomography angiography (MDCTA) screening. The high success rate of VIR confirms its key role, while surgery remains limited to rare cases. In-hospital mortality slightly increased, driven by a higher proportion of lung cancer.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"137"},"PeriodicalIF":5.5,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12463777/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145147577","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":"Authors reply in response to a letter on \"impact of aminoglycosides on survival rate and renal outcomes in patients with urosepsis: a multicenter retrospective study\".","authors":"David Rozenblat, François Dépret, Matthieu Lafaurie","doi":"10.1186/s13613-025-01505-4","DOIUrl":"10.1186/s13613-025-01505-4","url":null,"abstract":"","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"140"},"PeriodicalIF":5.5,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12463773/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145147470","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":"Mental health outcomes at intensive care unit discharge: prevalence, mediators and risk factors.","authors":"Maryline Couette, Segolene Gendreau, Marie Charlotte Boishardy, Anne-Fleur Jean Baptiste, Paula Xavier, Keyvan Razazi, Romain Arrestier, Guillaume Carteaux, Nicolas De Prost, Stephane Mouchabac, Florian Ferreri, Armand Mekontso Dessap","doi":"10.1186/s13613-025-01545-w","DOIUrl":"10.1186/s13613-025-01545-w","url":null,"abstract":"<p><strong>Background: </strong>Intensive Care Unit (ICU) patients often experience significant discomfort and distress due to both the medical environment and the nature of their stay. While long-term sequelae such as depression, anxiety, and post-traumatic stress are well-documented, few studies have examined psychological disorders present at the time of ICU discharge. Based on the model of Post-Intensive Care Syndrome, specifically the mental component (PICS-M), we defined DICS-M (Discharge Intensive Care Syndrome - Mental component). This study aimed to estimate the prevalence of psychological disorders at ICU discharge and to identify potential mediators and risk factors.</p><p><strong>Methods: </strong>We conducted a prospective observational study involving 243 patients admitted between January 2023 and April 2024.</p><p><strong>Results: </strong>The prevalence of DICS-M was 53% [95% CI: 46-59], with acute stress, anxiety, and depression observed in 37%, 36%, and 23% of patients, respectively. The analyses revealed an overlap among these psychological components. Peritraumatic distress acted as the main mediator of DICS-M. Univariate and multivariable analyses identified female gender and a history of psychiatric and cardiac conditions as risk factors of DICS-M.</p><p><strong>Conclusion: </strong>Psychological disorders are common at ICU discharge, mediated by peritraumatic distress, and associated with identifiable risk factors. These findings may help guide interventions to prevent long-term sequelae of ICU stays.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"138"},"PeriodicalIF":5.5,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12463781/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145147472","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}