Annals of Intensive Care最新文献

{"title":"Do diabetes and poor control of acute stress-related hyperglycemia increase the risk of ICU-acquired infections? A retrospective assessment in patients with septic shock.","authors":"Alice Friol, Clément Devautour, Anna Semenov, Juliette Pelle, Marie Renaudier, Sarah Benghanem, Alain Cariou, Jean-Paul Mira, Julien Charpentier, Frédéric Pène","doi":"10.1186/s13613-025-01596-z","DOIUrl":"https://doi.org/10.1186/s13613-025-01596-z","url":null,"abstract":"<p><strong>Background: </strong>Patients with septic shock who survive the early resuscitation phase are prone to ICU-acquired infections. Although hyperglycemia harbors potent immunomodulatory properties, the impact of preexisting diabetes and the control of acute stress-induced hyperglycemia on the risk of further infections remains unclear.</p><p><strong>Materials and methods: </strong>We conducted a retrospective (2008-2023) single-center study in patients with septic shock who remained alive in the ICU after 72 h. Glycemic control was assessed during the first 72 h. Mild and severe hyperglycemia were defined by blood glucose levels > 8 mmol/L and > 10 mmol/L, respectively. Poor glycemic control was defined when blood glucose levels were above 8 mmol/L for more than 20% of time. The primary outcome was ICU-acquired infections.</p><p><strong>Results: </strong>The study involved 901 patients, with preexisting diabetes present in 22% of them. Most patients (71%) experienced hyperglycemic episodes > 8 mmol/L, prompting fast-acting insulin treatment. ICU-acquired infections developed in 243 patients (26.9%), with median time from ICU admission to diagnosis of 9 days, interquartile range [6-13]. There was no association between preexisting diabetes and ICU-acquired infections. Patients with further ICU-acquired infections displayed poorer control of stress-induced hyperglycemia, with longer exposure to hyperglycemia (78% with mild or severe hyperglycemia for more than 20% of time compared to 68% of patients without subsequent infections (p = 0.005)). Poor glycemic control was independently associated with the development of ICU-acquired infections.</p><p><strong>Conclusion: </strong>72-hour poor glycemic control, but not preexisting diabetes, was independently associated with an increased risk of ICU-acquired infections in septic shock patients and may therefore contribute to the post-aggressive immunosuppressive response. This argues for effective glycemic management to improve outcomes in this setting.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"168"},"PeriodicalIF":5.5,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145342567","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":"Neuromuscular blockade and their monitoring in the intensive care unit: a multicenter observational prospective study.","authors":"Bertrand Hermann, Guillaume Decormeille, Tiphanie Gobé, Nathanaël Mangeard, Adel Maamar, Saria Sayadi, Bénédicte Pernod, Nadine Robquin, Jean-Pierre Ponthus, Sophie Le Potier, Pierre Bouju, Angélique Balabanian, Antoine Frouin, Sébastien Moschietto, Gwenaelle Jacq, Emeline Villemont, Clémence Houbé, Anaïs Queyreau, Célina Morand, Florence Boissier, Jean-Baptiste Lascarrou, Sabine Valera, Sami Hraiech, Laure Clouet, Gaël Piton, Cindérella Noël, Anne Joosten, Cécilia Tabra Osorio, Adrien Constan, Jérôme Cecchini, Gwennaelle Mercier, Arnaud Bruyneel, Chloé Villamaux, François Pousset, Nicholas Heming, Laurent Poiroux, Jean-François Llitjos, Saber Davide Barbar","doi":"10.1186/s13613-025-01591-4","DOIUrl":"https://doi.org/10.1186/s13613-025-01591-4","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Neuromuscular blocking agents may improve outcomes in specific conditions, including the early phase of acute respiratory distress syndrome. However, neuromuscular blocking agents are associated with side effects and uncertainty persists regarding their optimal dosing and efficacy. Our objective was to describe the use of neuromuscular blocking agents in a real-world setting.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a multicenter, prospective observational study, including adult patients who underwent invasive mechanical ventilation and received a continuous infusion of neuromuscular blocking agents. Patients were recruited across 19 intensive care units in France and Belgium.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;From November 16, 2019, to February 19, 2020, a total of 2248 patients were hospitalized and mechanically ventilated in 19 participating ICUs. Of these, 270 (12%) patients received at least one dose of neuromuscular blocking agents, and 232 (10.3%) received a continuous infusion. The main indications for neuromuscular blocking agents use were acute respiratory distress syndrome (61%), prevention of shivering during therapeutic hypothermia (16%) and patient-ventilator asynchrony (12%). Infusion was initiated in median at 0 [0-2] days after ICU admission, with a median duration of 38 [22-71] hours. Cisatracurium was the preferred agent (74%). Neuromuscular blocking agents monitoring by train-of-four was employed in 48% of patients. Intensive care unit-acquired weakness was diagnosed in 25% of patients, pressure ulcers in 14% and ventilator-associated pneumonia in 26%. The median lengths of mechanical ventilation and ICU stay were 9 [4-16] and 13 [6-22] days, and ICU mortality was 41%. In multivariable analyses, a duration of neuromuscular blocking agents infusion exceeding 48 hours was associated with a lower cumulative incidence of weaning success (SHR 0.83 [0.76, 0.91], p &lt; 0.001) and higher incidences of ventilator-associated pneumonia, while neuromuscular blocking agents monitoring was associated with both increased intensive care unit-acquired weakness (OR 2.90 [1.2, 7.01], p = 0.018) and reduced ICU mortality (HR 0.55 [95%CI 0.32, 0.95], p = 0.032).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;In our study, the prevalence of continuous neuromuscular blocking agents infusion among mechanically ventilated patients in the intensive care unit was 10.3%. While acute respiratory distress syndrome was the main indication, over one-third of patients received neuromuscular blocking agents for other reasons. A duration of neuromuscular blocking agents infusion exceeding 48 hours was associated with longer mechanical ventilation and increased complications. The role of neuromuscular blocking agents monitoring remains unclear. Trial registration ClinicalTrials.gov: NCT04028362 Registered on 18 July 2019, https://clinicaltrials.gov/study/NCT04028362 . The study was conducted by the French Intensive Care Society/Société de Réa","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"167"},"PeriodicalIF":5.5,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145342609","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":"Associations between long-term exposure to air pollutants and mortality risk of critically ill patients: a multi-center cohort study in central China.","authors":"Lu Ye, Chen Li, Kun Qin, Liang Xu, Ping Jin, Zhanpeng Wang, Cong Zhang, Chun Yin, Yaolin Liu, Zhicheng Fang, Jingjun Lv, Peng Jia","doi":"10.1186/s13613-025-01527-y","DOIUrl":"10.1186/s13613-025-01527-y","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Study objective: &lt;/strong&gt;Air pollutants have been known as the most persistent environmental risk factors of all-cause mortality in general populations. However, few studies focused on such associations in critically ill patients who usually suffer from multiple comorbidities and even organ dysfunctions, and thus have lower resistance to external risk factors. For the first time, this study examined associations between long-term exposure to air pollutants and mortality risk of critically ill patients, also relative contribution of each pollutant to their joint health effect.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The 7,562 critically ill patients admitted to intensive care units (ICU) in a Hubei Province Medical Treatment Alliance in China were used in this study. Patient's death within 28 days after ICU admission was used as the outcome. Daily concentrations of air pollutants, including PM&lt;sub&gt;2.5&lt;/sub&gt;, PM&lt;sub&gt;10&lt;/sub&gt;, NO&lt;sub&gt;2&lt;/sub&gt;, SO&lt;sub&gt;2&lt;/sub&gt;, O&lt;sub&gt;3&lt;/sub&gt; and CO, over their residence were estimated at a spatial resolution of 1 km by a newly developed multi-output LightGBM model, with better accuracy than all existing products. Logistic regression models were fit to estimate associations between individual air pollutants and mortality risk. Weighted quantity sum (WQS) regression was used to estimate relative contribution of each air pollutant to their joint effect on mortality risk.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The 7,222 patients were included in the study and had a mortality rate of 39.1%, with about half staying in ICU for ≤ 6 days. An increased risk for mortality was associated with a higher concentration of PM&lt;sub&gt;2.5&lt;/sub&gt; (OR = 1.007 [1.003, 1.011]), PM&lt;sub&gt;10&lt;/sub&gt; (OR = 1.002 [1.000, 1.004]), NO&lt;sub&gt;2&lt;/sub&gt; (OR = 1.020 [1.015, 1.024]), SO&lt;sub&gt;2&lt;/sub&gt; (OR = 1.025 [1.001, 1.050]), O&lt;sub&gt;3&lt;/sub&gt; (OR = 1.005 [1.001, 1.009]), and CO (OR = 4.336 [2.952, 6.457]). These associations varied across subgroups. For example, stronger associations were observed in males (PM&lt;sub&gt;2.5&lt;/sub&gt;: OR = 1.010 [1.005, 1.015], PM&lt;sub&gt;10&lt;/sub&gt;: OR = 1.004 [1.001, 1.007], NO&lt;sub&gt;2&lt;/sub&gt;: OR = 1.026 [1.021, 1.032], and CO: OR = 6.224 [3.867, 10.019]), smokers (SO&lt;sub&gt;2&lt;/sub&gt;: OR = 1.132 [1.078, 1.189], O&lt;sub&gt;3&lt;/sub&gt;: OR = 1.014 [1.006, 1.022]), alcohol drinkers (SO&lt;sub&gt;2&lt;/sub&gt;: OR = 1.147 [1.082, 1.215], O&lt;sub&gt;3&lt;/sub&gt;: OR = 1.020 [1.010, 1.029]), and patients with a SAPS II of &gt; 33 (SO&lt;sub&gt;2&lt;/sub&gt;: OR = 1.168 [1.130, 1.207], CO: OR = 3.557 [2.165, 5.843]). The largest contribution to their joint effect on mortality risk was from O&lt;sub&gt;3&lt;/sub&gt; (43.8%), followed by NO&lt;sub&gt;2&lt;/sub&gt; (25.1%), CO (20.9%), PM&lt;sub&gt;2.5&lt;/sub&gt; (9.1%), SO&lt;sub&gt;2&lt;/sub&gt; (1.0%), and PM&lt;sub&gt;10&lt;/sub&gt; (0.1%).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Exposure to air pollutants was positively associated with the mortality risk of critically ill patients, with O&lt;sub&gt;3&lt;/sub&gt; being the main contributor to their joint effect. The findings would help multiple stakeholders, including researchers, ","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"165"},"PeriodicalIF":5.5,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12537634/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145336289","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":"Venous congestion and the geometry of Guyton.","authors":"Jon-Emile S Kenny, Per Werner Moller","doi":"10.1186/s13613-025-01593-2","DOIUrl":"10.1186/s13613-025-01593-2","url":null,"abstract":"","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"166"},"PeriodicalIF":5.5,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12537621/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145336312","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":"Does obesity impact on weaning from invasive ventilation: a secondary analysis of the WEAN SAFE study.","authors":"Alison Bell, Akira Kuriyama, Omid Khazaei, Bairbre A McNicholas, Tài Pham, Leo Heunks, Giacomo Bellani, Laurent Brochard, Andrew J Simpkin, John G Laffey","doi":"10.1186/s13613-025-01586-1","DOIUrl":"10.1186/s13613-025-01586-1","url":null,"abstract":"<p><strong>Objective: </strong>To understand the impact of obesity on outcomes of weaning from invasive mechanical ventilation (MV).</p><p><strong>Methods: </strong>The study population consisted of patients enrolled in the WEAN SAFE study. We defined 4 groups based on body mass index (BMI), namely: Normal weight (BMI 18.5-24.9 kg/m²), Overweight (BMI 25-29.9 kg/m²), Obesity Class I (BMI 30-34.9 kg/m²), and obesity classes II and III (BMI ≥ 35 kg/m²). The primary outcome was the rate of successful extubation in patients in each BMI group. Secondary outcomes included the ICU and hospital survival, and PEEP levels at time of weaning eligibility in patients in each BMI group.</p><p><strong>Results: </strong>In the study population, 1728 (38.2%) were of normal weight, 1395 (30.8%) were overweight, 590 (13.1%) were class I Obesity, and 431 (9.5%) were obesity classes II and III. Patients with obesity were more likely to be female, to be a medical admission, and to have comorbidities. Patients with grade II-III obesity had lower levels of sedation, later timing of the first separation attempt, longer time to weaning success, they received more noninvasive ventilation post extubation, and they had a longer ICU stay. In contrast, weaning success, and ICU and hospital mortality rates were not different in obese patients. There was no independent relationship between obesity and weaning delay, weaning success, or with overall survival outcomes. Higher PEEP at weaning eligibility was associated with weaning failure in normal and overweight patients but not in patients with obesity.</p><p><strong>Conclusions: </strong>Patients with obesity had a more complex and longer weaning process, but obesity per se was not independently associated with adverse weaning outcomes.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"164"},"PeriodicalIF":5.5,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12537622/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145336340","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":"Hemostatic abnormalities after trauma resuscitation: challenges and strategies in caring for the critically injured patient.","authors":"Christopher R Reed, Nicola Curry, Nicole P Juffermans, Matthew D Neal","doi":"10.1186/s13613-025-01587-0","DOIUrl":"10.1186/s13613-025-01587-0","url":null,"abstract":"<p><p>Severe polytrauma and hemorrhage is a common and life-threatening condition often leading to intensive care unit admission for those who survive their initial injury. The injury itself, hypoperfusion from hemorrhagic shock, and resuscitative efforts introduce a complex set of hemostatic derangements collectively referred to as trauma-induced coagulopathy (TIC). Although the trauma population is notoriously heterogenous, TIC can generally be divided into an \"early\" hypocoagulable phase and then a \"late\" hypercoagulable, prothrombotic phase. Existing literature on TIC focuses heavily on reversing and preventing hypocoagulation in the early, acute phase. However, intensivists commonly manage patients throughout the later post-acute resuscitation phase of TIC, during which thrombotic complications are common and may lead to major morbidity and mortality. Derangements in platelet activation, endothelial dysfunction, suppression of fibrinolysis, and crosstalk between the innate immune and coagulation systems all contribute to the prothrombotic late TIC phenotype. Deep venous thrombosis and other macrovascular thrombotic complications also commonly occur after trauma. Thrombosis prophylaxis and treatment present a challenge for patients still at high risk for bleeding. An in-depth understanding of risk factors specific to trauma patients, including iatrogenic contributions from resuscitation and hemostatic efforts in the pre-intensive care phase, can help stratify thromboembolic risk and optimize prophylaxis and surveillance efforts. We stress the importance of an individualized approach to assessment of hemorrhagic and thrombotic risks for each patient. Here, we summarize the underlying contributors to the prothrombotic phenotype in late TIC, including a description of emerging roles for HMGB1, extracellular vesicles, and endogenous inhibitors. Additionally, a general approach to thromboprophylaxis, monitoring, and anticoagulation in this patient population are discussed. Finally, we summarize relevant risk stratification systems and guidelines for clinical management of thromboembolic risk among trauma patients, and highlight limitations in these systems and guidelines as areas for future research.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"163"},"PeriodicalIF":5.5,"publicationDate":"2025-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12534623/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145311920","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":"Comment on \"immunosuppressive therapy management during sepsis in kidney transplant recipients: a prospective multicenter study\".","authors":"Shuo Lin, Jianjie Ju, Zhouhua Wang","doi":"10.1186/s13613-025-01598-x","DOIUrl":"10.1186/s13613-025-01598-x","url":null,"abstract":"","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"161"},"PeriodicalIF":5.5,"publicationDate":"2025-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12534638/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145311902","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":"Outcomes of carbapenem-resistant Acinetobacter baumannii bloodstream infections in intensive care units and prognostic effect of different antimicrobial regimens.","authors":"Chieh-Lung Chen, Kuang-Yao Yang, Chung-Kan Peng, Ming-Cheng Chan, Chau-Chyun Sheu, Jia-Yih Feng, Sheng-Huei Wang, Wei-Hsuan Huang, Chia-Min Chen, How-Yang Tseng, Yu-Chao Lin","doi":"10.1186/s13613-025-01580-7","DOIUrl":"10.1186/s13613-025-01580-7","url":null,"abstract":"<p><strong>Background: </strong>Carbapenem-resistant Acinetobacter baumannii (CRAB) poses a significant global threat due to limited therapeutic options and high rates of associated mortality. CRAB-related bloodstream infections (BSIs) in intensive care units (ICUs) represent a major clinical challenge. This study aimed to investigate the clinical outcomes of CRAB-BSIs in ICU settings and evaluate the prognostic effect of different antimicrobial regimens.</p><p><strong>Methods: </strong>This multicenter, retrospective observational study was conducted at five medical centers in Taiwan and included 393 critically ill patients with CRAB-BSIs between January 2015 and December 2019. Clinical and microbiological outcomes were analyzed. Multivariable regression analysis was used to identify independent prognostic factors for day-28 mortality.</p><p><strong>Results: </strong>The most common causes of CRAB-BSIs were pneumonia (42.5%) and catheter-related infections (38.7%). The day-28 mortality rate following BSI onset was 56.5%. A higher sequential organ failure assessment (SOFA) score independently predicted increased day-28 mortality. Colistin-based therapy was associated with improved survival outcomes in the original (adjusted hazard ratio [aHR], 0.56; 95% confidence intervals (CI), 0.35-0.88) and time-window bias-adjusted (aHR, 0.59; 95% CI, 0.37-0.94) cohorts. Among patients with pneumonia-related CRAB-BSIs, colistin-based therapy did not significantly improve day-28 survival, whereas sulbactam-based therapy showed survival benefit (aHR, 0.37; 95% CI, 0.15-0.91). Neither carbapenem-based nor tigecycline-based therapies demonstrated a mortality benefit on day 28.</p><p><strong>Conclusion: </strong>CRAB-BSIs are associated with high mortality in critically ill patients. In settings where novel antibiotics are not available, colistin-based therapy was associated with improved clinical outcomes. Among patients with pneumonia-related CRAB-BSIs, sulbactam-based therapy was associated with lower mortality.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"162"},"PeriodicalIF":5.5,"publicationDate":"2025-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12534662/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145311928","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":"Incidence and outcomes of extubation failure in mechanically ventilated patients with cirrhosis: a post-hoc analysis of a prospective multicenter study.","authors":"Yassir Aarab, Joris Pensier, Fanny Garnier, Clement Monet, Ines Lakbar, Gerald Chanques, Audrey de Jong, Mathieu Capdevila, Samir Jaber","doi":"10.1186/s13613-025-01576-3","DOIUrl":"10.1186/s13613-025-01576-3","url":null,"abstract":"<p><strong>Background: </strong>Patients with comorbidities who are liberated from invasive mechanical ventilation could be at risk of extubation failure in the intensive care unit (ICU). Incidence and associated outcomes of reintubation in patients with cirrhosis have been poorly studied. We aimed to evaluate the incidence, causes and mortality of reintubation in patients with cirrhosis.</p><p><strong>Methods: </strong>We conducted a post hoc analysis of the French prospective multicenter observational trial (FREE-REA) evaluating the incidence and risk factors of extubation failure in 26 ICUs. The primary outcome was the incidence of extubation failure defined as the need for reintubation within 7 days after extubation. Secondary outcomes were the incidence of reintubation at 48 h, the causes and risk factors of extubation failure, ICU length of stay and in-hospital mortality. We compared patients with cirrhosis and patients without cirrhosis.</p><p><strong>Results: </strong>Of the 1,443 analyzed patients, 165 (11%) had cirrhosis. The incidence of reintubation within 7 days was 21% (34/165) in patients with cirrhosis and 13% (167/1278) in patients without cirrhosis (p < 0.01). Reintubation at 48 h was not significantly different between patients with cirrhosis and patients without cirrhosis (9% versus 10%, p = 0.55). Admission for shock was identified as the only independent risk factor for extubation failure in multivariate analysis [OR 3.24, 95% CI (1.24-8.44), p = 0.02]. In patients with extubation failure, ICU length of stay was significantly longer in patients with cirrhosis compared to those without (28 ± 25 versus 18 ± 12 days, p < 0.01); In-hospital mortality was higher in extubation failure patients with cirrhosis in comparison to patients without cirrhosis without reaching significance (16/34 (47%) versus 51/167 (31%), p = 0.06).</p><p><strong>Conclusion: </strong>Extubation failure was significantly higher in patients with cirrhosis compared to patients without cirrhosis. A trend for higher in-hospital mortality was observed in reintubatedpatients with cirrhosis. Neurologic failure was the main cause for reintubation at 48 h in patients with cirrhosis.</p><p><strong>Clinical trials: </strong>The study was registered on clinicaltrials.gov (identifier no. NCT02450669). Registered 01/12/2013.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"160"},"PeriodicalIF":5.5,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12532547/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145298560","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":"Carbon dioxide elimination as a guide to venoarterial extracorporeal membrane oxygenation weaning: a prospective observational study.","authors":"Yazhu Yang, Liangshan Wang, Chenglong Li, Hong Wang, Xin Hao, Yan Wang, Yiwen Wang, Ruike Lu, Xiaotong Hou, Zhongtao Du","doi":"10.1186/s13613-025-01583-4","DOIUrl":"10.1186/s13613-025-01583-4","url":null,"abstract":"<p><strong>Background: </strong>Despite the increasing use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) in cardiogenic shock (CS), reliable predictors of successful weaning remain poorly defined. This study investigated the role of carbon dioxide elimination parameters in VA-ECMO weaning.</p><p><strong>Methods and results: </strong>To assess the potential role of end-tidal carbon dioxide (EtCO₂) in predicting successful VA-ECMO weaning, we conducted a prospective observational study at Anzhen Hospital between January 2023 and December 2024. The primary endpoint was the predictive performance of EtCO₂ and VCO₂NL ratio for successful VA-ECMO weaning. Real-time EtCO₂ monitoring was performed using infrared capnography in mechanically ventilated patients, and the ratio of native lung carbon dioxide elimination (VCO₂NL) to total carbon dioxide elimination (VCO₂TOT) was calculated as the VCO₂NL ratio. Dynamic changes in these parameters were analysed in relation to weaning outcomes. Among 294 patients receiving VA-ECMO for refractory CS during the study period, 91 were included, yielding 562 data points. Both EtCO₂ (odds ratio [OR] = 1.26, 95% confidence interval [CI] 1.17-1.37, p < 0.0001) and the VCO₂NL ratio (1.14, 95% CI 1.09-1.21, p < 0.0001) showed significant correlations with successful weaning. A VCO₂NL ratio > 79% and EtCO₂ > 34 mmHg showed strong predictive value for successful weaning (area under the receiver operating characteristics (ROC) curve values of 0.85 [95% CI 0.80-0.89] and 0.84 [95% CI 0.79-0.89], p < 0.0001).</p><p><strong>Conclusions: </strong>EtCO₂ and the VCO₂NL ratio may be valuable indicators for predicting successful VA-ECMO weaning. Higher EtCO₂ and VCO₂NL ratio values are associated with a greater likelihood of successful weaning.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"157"},"PeriodicalIF":5.5,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12521700/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145285290","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}