Annals of Intensive Care最新文献

{"title":"When mechanical power remains high despite conventional lung-protective settings: a physiology-driven bedside framework.","authors":"Tomasz Urbankowski, Marek Darowski","doi":"10.1016/j.aicoj.2026.100095","DOIUrl":"10.1016/j.aicoj.2026.100095","url":null,"abstract":"<p><p>Mechanical power integrates ventilatory pressure, tidal volume, flow, and respiratory rate into a single estimate of the energy transferred to the respiratory system per unit time. Higher mechanical power has been associated with ventilator-induced lung injury and worse outcomes. A common bedside dilemma arises when mechanical power remains high despite conventional lung-protective settings, because further reduction of ventilator intensity may compromise gas exchange. This narrative, physiology-driven review addresses how to respond when persistently elevated mechanical power may reflect physiological constraint rather than easily modifiable ventilator settings. We outline a bedside approach in which clinicians first verify conventional lung-protective settings and then look for the main physiological factor that prevents further ventilator reduction. Reduced end-expiratory lung volume should prompt individualized positive end-expiratory pressure (PEEP) titration aimed at restoring and stabilizing lung volume while avoiding overdistension and derecruitment. In mechanically heterogeneous lungs, prone positioning and patient-specific pressure optimization may improve the physiological conditions associated with injurious ventilation, even when the global value of mechanical power cannot be safely lowered. During assisted ventilation, excessive respiratory drive and inspiratory effort should be assessed and treated when present. When high mechanical power remains unavoidable despite optimized settings and targeted physiological interventions, extracorporeal support may be required to enable ultra-protective ventilation.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100095"},"PeriodicalIF":6.9,"publicationDate":"2026-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13254567/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148248941","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":"Revisiting the fluid challenge and stroke volume optimisation after induction of general anaesthesia.","authors":"Terry O'Brien, Robert G Hahn","doi":"10.1016/j.aicoj.2026.100093","DOIUrl":"10.1016/j.aicoj.2026.100093","url":null,"abstract":"<p><strong>Background: </strong>To be clinically useful in goal-directed fluid therapy, a fluid challenge (FC) must achieve a large enough blood volume change (ΔBV) to materially change ventricular preload and stroke volume (ΔSV). The same % change in BV for all the subsequent FCs must also be achieved. We explored under what circumstances these prerequisites can be met by referring to data from a clinical trial where 111 patients underwent three successive intravenous FCs using crystalloid (Ringer´s lactate) or colloid (hydroxyethyl starch), involving a total of 9 mL/kg of fluid, just after induction of general anaesthesia.</p><p><strong>Results: </strong>The three FC using crystalloid fluid increased SV by 2.5% while the colloid increased the SV by 29.2% (medians, <i>P</i> < 0.001). Moreover, crystalloid expanded the BV by 20.8% while the corresponding expansion by colloid was 29.5% (<i>P</i> < 0.001). The cardiac response to increased BV was normalized by calculating the ΔSV%/ΔBV% ratio, which was much lower at 0.12 for the crystalloid fluid versus 0.98 for colloid (<i>P</i> < 0.001). The poor SV response can possibly be explained by the underlying changes in the mean circulatory filling pressure, which suggest crystalloid FCs was less effective in increasing the stressed blood volume (preload). On the other hand, the inferior BV expanding effect of crystalloid is likely due to the fast tissue redistribution pharmacokinetic profile of administered boluses. Finally, the cardiac response to the first FC and impact on oxygen delivery became falsely low in both groups due to a reflex redistribution of a substantial volume of interstitial fluid into the circulation after anaesthetic induction.</p><p><strong>Conclusion: </strong>Differences in effectiveness between crystalloid and colloid fluid when providing repeated FCs increase the risk of false negative indications of fluid non-responsiveness when crystalloid is used.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100093"},"PeriodicalIF":6.9,"publicationDate":"2026-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13250664/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148222871","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 critically ill patients with newly diagnosed Burkitt's lymphoma: a monocentric retrospective study.","authors":"Fabiola Cammarota, Charlotte Degoutte, Laure Calvet, Dara Chean, Claire Fieschi, Catherine Thieblemont, Gennaro De Pascale, Michael Darmon, Lara Zafrani, Massimo Antonelli, Elie Azoulay, Thibault Dupont","doi":"10.1016/j.aicoj.2026.100084","DOIUrl":"10.1016/j.aicoj.2026.100084","url":null,"abstract":"<p><strong>Background: </strong>Burkitt's lymphoma (BL) can lead to intensive care unit (ICU) admission at diagnosis and treatment initiation for management of disease-related complications such as tumor lysis syndrome (TLS) and acute kidney injury (AKI). Data on the outcomes and prognostic factors in this population of critically ill patients remain limited. We conducted a retrospective single-center study including 124 patients admitted to the ICU of Saint-Louis Hospital with newly diagnosed BL between January 1, 2002 and December 31, 2023. Univariate and multivariate survival analyses were performed to determine factors associated with 3 months and 12 months mortality.</p><p><strong>Results: </strong>124 patients with a median age of 47.5 years (IQR, 34-58.5) were included, of which 60% (74/124) had HIV infection and a majority had advanced stage disease. Chemotherapy was administered during the ICU stay in 84% (104/124) of patients and 59% (73/124) developed TLS. Ninety-day and one-year mortality were respectively 34% (42/124) and 50% (60/119). Among the 50% (60/119) of patients who survived at one year, 98% (59/60) had achieved complete remission and 90% (52/58) had good functional outcomes (performance status of 0 or 1). In multivariate analysis, TLS, vasopressors, HIV infection, male sex, and increasing age were independently associated with one-year mortality.</p><p><strong>Conclusions: </strong>Patients with BL admitted to the ICU during the early phase of their disease present with high rates of TLS, HIV co-infection, and organ failures. Despite low severity scores at admission, short-term and long-term survival remain poor, with half of patients dying within one year. However, among one-year survivors, nearly all achieved complete remission with good functional outcomes. TLS, vasopressor use, HIV infection, male sex, and increasing age were independently associated with one-year mortality.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100084"},"PeriodicalIF":6.9,"publicationDate":"2026-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13218120/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148136605","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":"Clinical spectrum, outcome and impact of nephrectomy in critically-ill adult patients with emphysematous pyelonephritis: the PYELEMPHY observational retrospective multicenter Study.","authors":"Keyvan Razazi, Pierre Louis Blot, Amélie Renou, Yannis Lombardi, Hugo Hille, Jérôme Devaquet, François Perier, Juliette Pocquet, Laurent Camous, Fréderic Pène, Sébastien Besset, Flora Delamaire, Anahita Rouze, Béatrice La Combe, Matthieu Petit, Laurent Laine, Jérémy Rosman, Romain Sonneville, Nicolas Mongardon, Alexy Tran Dinh, Stéphanie Houcke, Florence Boissier, Marc Pineton de Chambrun, Gregoire Jolly, Pierre Bailly, Pierrick Cronier, Malo Emery, Nahema Issa, Jean Loup Augy, Sébastien Jochmans, Jean Dellamonica, Claire Dupuis, Emmanuel Canet, Morgan Benais, Tomas Urbina, Antoine Goury, Damien Roux, Bastien Peiffer, Elsa Moncomble, Romain Arrestier, Igor Duquesne, Armand Mekontso Dessap","doi":"10.1016/j.aicoj.2026.100086","DOIUrl":"10.1016/j.aicoj.2026.100086","url":null,"abstract":"<p><strong>Background: </strong>Emphysematous pyelonephritis (EPN) is a rare, life-threatening necrotizing urinary tract infection marked by gas formation in the renal parenchyma and perirenal tissues. Evidence on its management and outcomes in the intensive care unit (ICU) remains limited. We aimed to describe the clinical profile, outcomes, and effect of nephrectomy in adults admitted to the ICU for infectious EPN.</p><p><strong>Main results: </strong>A national, multicenter, retrospective cohort study including adults admitted with infectious EPN to 48 French ICUs from 2001 to 2021 was conducted. A total of 109 patients were included. Median age was 62 years [IQR 54-72], and 64% were women. Overweight or obesity was present in 74%, and diabetes in 63%. Septic shock occurred in 72%. Urinary tract obstruction was identified in 46%. Initial management relied on antibiotics and/or minimally invasive drainage in 53% of cases. Early nephrectomy (≤24 h after ICU admission) was performed in 14 patients (14%), and delayed nephrectomy in eight (7%) at a median of 4 days [IQR 3-9]. Among the 75 patients discharged from the ICU without nephrectomy, four (4%) required subsequent nephrectomy. ICU mortality was 15% (n = 16). At day 90, vital status was known for 105 patients; 18 had died. In multivariable analysis, higher Simplified Acute Physiology Score II independently predicted increased 90-day mortality (HR per point 1.08; 95% CI 1.05-1.12; p < 0.001). Early nephrectomy was associated with lower mortality (HR 0.18; 95% CI 0.04-0.90; p = 0.037). Major adverse kidney events at day 90 occurred in 40%. Using the propensity-weighted model, early nephrectomy showed a trend toward lower MAKE90, although the association did not reach statistical significance (adjusted OR = 0.32; 95% CI: 0.10-1.02; p = 0.054).</p><p><strong>Conclusion: </strong>EPN requiring ICU admission carries substantial mortality. Early nephrectomy may improve survival, without increasing long-term renal complications.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100086"},"PeriodicalIF":6.9,"publicationDate":"2026-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13218113/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148136509","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":"Alveolar dysregulation of host response in pneumonia and ARDS: implications for immune modulation and infection.","authors":"L S Boers, L Maessen, J Wauters, E D Morrell, A Sarma, A Conway Morris, L D J Bos","doi":"10.1016/j.aicoj.2026.100085","DOIUrl":"10.1016/j.aicoj.2026.100085","url":null,"abstract":"<p><strong>Background: </strong>Respiratory failure due to pneumonia and acute respiratory distress syndrome (ARDS) remains a major cause of morbidity and mortality in the intensive care unit. The alveolar compartment plays a central role in both pathogen clearance and tissue injury, yet its biology is poorly captured by systemic measurements. Growing evidence shows that dysregulation of alveolar host responses drives disease progression, shapes susceptibility to secondary infections, and influences recovery.</p><p><strong>Main body: </strong>Community-, hospital-, and ventilator-associated pneumonia differ in microbial drivers and host responses, but all share a pattern of localized inflammation. In most cases, pathogens are rapidly controlled following antimicrobial treatment, while alveolar inflammation persists. This persistence likely reflects self-reinforcing cycles between epithelial injury, neutrophil activity, and monocyte-macrophage dysfunction. Mechanical ventilation further disrupts local defenses, promoting microbial overgrowth and ventilator-associated pneumonia.In ARDS, diffuse alveolar damage initiates an early influx of neutrophils and monocyte-derived macrophages. Although peripheral blood has been used to identify systemic inflammatory subphenotypes, molecular signatures in the alveolar compartment often differ and may provide complementary biological information. Patients may diverge into distinct alveolar immune trajectories, ranging from sustained alveolar hyperinflammation to immune exhaustion. These divergent trajectories influence downstream repair, determining whether patients achieve epithelial recovery or develop fibrotic remodeling.Alveolar immune dysregulation also creates a permissive niche for viral and fungal pathogens. Pulmonary reactivation of herpes simplex virus or cytomegalovirus and fungal infections with Aspergillus frequently occur in critically ill patients and may reflect impaired local host defense. These processes are associated with prolonged mechanical ventilation and illustrate how impaired alveolar defenses may sustain injury and propagate complications.</p><p><strong>Conclusion: </strong>Pneumonia and ARDS share common pathways of alveolar immune dysregulation that are not adequately captured by systemic profiling alone. Integrating systemic and alveolar immune assessment, including their concordance and discordance, may improve patient stratification, facilitate identification of treatable traits, and support the development of more personalized, compartment-informed therapeutic strategies, including both immunomodulatory and pathogen-directed interventions. A more refined understanding of compartment-specific host responses will be key to advancing these approaches.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100085"},"PeriodicalIF":6.9,"publicationDate":"2026-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13214341/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148051918","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":"Beyond PaO₂/FiO₂ at altitude: are we correcting the ratio in the wrong direction?","authors":"Pablo Álvarez-Maldonado, Lucero A Torres-Alarcón, Ulises W Cerón-Díaz","doi":"10.1016/j.aicoj.2026.100087","DOIUrl":"10.1016/j.aicoj.2026.100087","url":null,"abstract":"","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100087"},"PeriodicalIF":6.9,"publicationDate":"2026-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13214548/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148051962","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":"Risk Stratification in Predicting Cardiogenic Shock 30-Day Mortality admitted to ICU: beyond the Prognostic Performance of SHARC and SCAI Classifications.","authors":"Pierre-Grégoire Guinot, Thomas Hanquiez, Maxime Nguyen, Osama Abou-Ara, Laurent Leborgne, Yazine Mahjoub, Bélaïd Bouhemad, Christophe Beyls","doi":"10.1016/j.aicoj.2026.100090","DOIUrl":"10.1016/j.aicoj.2026.100090","url":null,"abstract":"<p><strong>Background: </strong>Cardiogenic shock (CS) remains a leading cause of mortality in intensive care units (ICU) despite advances in management. The Shock Academic Research Consortium (SHARC) classification provides an etiological framework complementing severity-based systems such as the Society for Cardiovascular Angiography and Interventions (SCAI) classification. This study evaluated the association between SHARC classes and 30-day mortality in a contemporary ICU population and compared their prognostic value with SCAI classification.</p><p><strong>Methods: </strong>This bicentric retrospective cohort study included 1366 consecutive adults admitted with CS. Patients were classified according to SHARC criteria: acute myocardial infarction (AMI)-CS (n = 303, 22.5%), heart failure (HF)-CS (n = 56, 5.0%), secondary-CS (n = 433, 29.9%), and post-cardiotomy-CS (n = 574, 42.7%). The primary outcome was 30-day all-cause mortality. Multivariable logistic regression models assessed independent predictors of mortality and comparative prognostic performance using Akaike Information Criterion, Bayesian Information Criterion, and discrimination indices.</p><p><strong>Results: </strong>Thirty-day mortality varied significantly across SHARC classes: AMI-CS (48.7%), HF-CS (45.6%), secondary-CS (39.0%), and post cardiotomy-CS (17.3%) (<i>p</i> < 0.001). Multivariable analysis identified age, epinephrine use, vasopressin use, arterial lactate, right ventricular dysfunction, and SHARC classification as independent mortality predictors (all P < 0.05). Adding SHARC classification to clinical variables provided greater incremental prognostic value (ΔAIC = -48.3; AUC=0.734; R² = 0.198) than SCAI classification alone (ΔAIC = -20.0; AUC = 0.723; R² = 0.172). The combined model integrating SHARC, SCAI, and hemodynamic parameters demonstrated the best performance (AUC = 0.819; R² = 0.355).</p><p><strong>Conclusions: </strong>SHARC etiological classification provides complementary discrimination for 30-day mortality compared with SCAI staging alone, suggesting that shock pathophysiology influences patient outcomes. Integration of both classifications may improve risk stratification and enable more personalized therapeutic approaches in cardiogenic shock management.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100090"},"PeriodicalIF":6.9,"publicationDate":"2026-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13218115/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148136189","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":"High-flow nasal cannula versus noninvasive ventilation in stabilized hypercapnic exacerbation: a physiological crossover trial.","authors":"Fernando Vieira, Annia Schreiber, Mattia Docci, Antenor Rodrigues, Vorakamol Phoophiboon, Carles Subira, Matthew Ko, Mayson L A Sousa, Tai Pham, Thomas Piraino, Remi Coudroy, Giulia Cavalot, Irene Telias, Detajin Junhasavasdikul, Martin Dres, Michael C Sklar, Laurent Brochard","doi":"10.1016/j.aicoj.2026.100092","DOIUrl":"10.1016/j.aicoj.2026.100092","url":null,"abstract":"<p><strong>Background: </strong>Evidence comparing high-flow nasal cannula (HFNC) and non-invasive ventilation (NIV) in acute hypercapnic respiratory failure remains controversial. We compared their short-term effects on breathing effort, ventilation, CO₂ clearance, and preference.</p><p><strong>Methods: </strong>A randomized, crossover, non-inferiority trial was conducted in patients with stabilized hypercapnic exacerbation requiring NIV or HFNC. Baseline oxygen therapy was followed by a randomized sequence of NIV and HFNC at 30 and 50 L.min^-1. The primary endpoint was to assess non-inferiority of HFNC 50 L.min^-1 compared to NIV. Diaphragm, parasternal intercostal, and transversus abdominis muscle activity were assessed using thickening fraction (TF) and the product of TF and respiratory rate (TF•RR). Ventilation was evaluated using electrical impedance tomography and transcutaneous partial pressure of carbon dioxide (tcCO₂).</p><p><strong>Results: </strong>21 patients (mean ± SD age 69 ± 11 years, 82% COPD) were enrolled. In 17, diaphragm thickening fraction (TFdi) was available: HFNC 50 L.min^-1 was non-inferior to NIV in reducing TFdi (p = 0.122, 95% CI: -19.1-3.4), as was HFNC at 30 L.min^-1 (p = 0.413, 95% CI: -17.0-5.7). Only HFNC 50 L.min^-1 reduced TFdi•RR (p = 0.036) and respiratory rate compared to baseline (p = 0.001). HFNC at 50 L.min^-1 decreased the baseline TFdi by 18% ± 36% (p = 0.033), whereas NIV did not decrease it. HFNC and NIV reduced tcCO₂ compared to baseline. Minute ventilation and the estimated ventilatory ratio were lower with HFNC than NIV (p < 0.01). HFNC was the preferred strategy by the patients.</p><p><strong>Conclusions: </strong>In stabilized hypercapnic exacerbation, HFNC and NIV reduced tcCO₂, but only HFNC lowered ventilatory ratio and minute ventilation. HFNC at 50 L.min^-1 reduced diaphragm activity and was non-inferior to NIV in this regard, while being preferred by patients.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100092"},"PeriodicalIF":6.9,"publicationDate":"2026-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13233617/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148196977","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":"Association between opioid infusion use and duration of mechanical ventilation and related outcomes in critically ill adults: a systematic review and meta-analysis.","authors":"Jia Pei Ong, John W Devlin, David Culliford, Rebecca Cusack, Michael Grocott, Kinda Ibrahim, Cathrine A McKenzie","doi":"10.1016/j.aicoj.2026.100089","DOIUrl":"10.1016/j.aicoj.2026.100089","url":null,"abstract":"<p><strong>Background: </strong>We performed a systematic review with meta-analysis to examine the relationship between sedation including a continuous IV opioid infusion and duration of mechanical ventilation (MV) and relevant secondary outcomes in MV critically ill adults.</p><p><strong>Methods: </strong>We searched MEDLINE, EMBASE, and Cochrane CENTRAL database up to March 2025. We included randomized controlled trials in MV critically ill adults comparing use of sedation including a continuous IV opioid versus sedation without. We assessed MV duration, pain, delirium and coma occurrence, ICU/hospital length of stay (LOS) and 28-day mortality. Study risk of bias was evaluated (PROSPERO: CRD42024498555). We pooled data using a Restricted Maximum Likelihood Estimation random-effects model and followed PRISMA guidelines.</p><p><strong>Results: </strong>Eight studies (n = 803 patients) published between 2006 and 2021 were included. Sedation including a continuous IV opioid (vs. sedation without) may increase MV duration (3 studies, 425 patients, mean difference (MD) = 3.63 h, 95% confidence interval (CI) 2.27-4.99, very low certainty), reduce pain (2 studies, VAS score at 24 h MD = -0.44 mm, 95% CI - 0.82 to -0.07, low certainty), reduce delirium (3 studies, odds ratio (OR) = 0.28, 95% CI 0.16 to 0.47, very low certainty) and reduce mortality (3 studies, OR = 0.41, 95% CI 0.21 to 0.80, very low certainty). Sedation including a continuous IV opioid does not increase coma or reduce ICU/ hospital LOS. Risk of bias was critical for most studies.</p><p><strong>Conclusion: </strong>The effect of sedation including a continuous IV opioid on MV duration, pain delirium, coma, mortality and LOS remain uncertain. The role for continuous IV opioids as a part of ICU sedation regimens requires additional evaluation.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100089"},"PeriodicalIF":6.9,"publicationDate":"2026-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13218110/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148136560","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":"Dyspnea as a marker of prognosis in immunocompromised patients with acute respiratory failure.","authors":"Alexandre Demoule, Maxens Decavèle, Sangeeta Mehta, Philippe R Bauer, Victoria Metaxa, Frédéric Pène, Christophe Girault, Laveena Munshi, Fabio Silvio Taccone, Massimo Antonelli, Francois Barbier, Andreas Barratt-Due, Gaston Burghi, Emmanuel Canet, Achille Kouatchet, Virginie Lemiale, Ignacio Martin-Loeches, Djamel Mokart, Anne-Sophie Moreau, Luca Montini, Peter Pickkers, Jordi Rello, Peter Schellongowski, Nicolas Terzi, Miia Valkonen, Andry van de Louw, Elie Azoulay, Michael Darmon","doi":"10.1016/j.aicoj.2026.100091","DOIUrl":"10.1016/j.aicoj.2026.100091","url":null,"abstract":"<p><strong>Background: </strong>Acute hypoxemic respiratory failure (AHRF) is the leading cause of intensive care unit (ICU) admission in immunocompromised patients, in whom both intubation and mortality rates are higher than in the general ICU population. This study explores dyspnea on admission as it relates to clinical outcomes.</p><p><strong>Methods: </strong>Secondary analysis of the Efraim study, a prospective multinational cohort study of immunocompromised patients with AHRF admitted to the ICU. Dyspnea was quantified by a numeric rating scale (dyspnea-NRS) from zero to 10. Factors associated with dyspnea-NRS were assessed with linear regression. Hierarchical model was used to assess factors independently associated with invasive mechanical ventilation (intubation) and hospital mortality.</p><p><strong>Results: </strong>547 patients were included. On ICU admission, median dyspnea-NRS was 5 (interquartile range 4-7). Variables independently associated with dyspnea-NRS were underlying immune defect unrelated to hematological malignancy, chronic heart failure, high SOFA score and respiratory rate. Intubation rate was 41 %. Variables independently associated with intubation were dyspnea-NRS ≥5 (odds ratio [OR] 2.61, p < 0.001), high SOFA (OR per point 1.10, p = 0.006) and fungal infection (OR 2.02, p = 0.020)., while respiratory rate and PaO₂/FiO₂ were not. Hospital mortality was 37 %. Variables independently associated with hospital mortality were age (OR per year 1.02, P = 0.009), SOFA score (OR per point, 1.13, P < 0.001) and dyspnea-NRS (OR per point 1.19, P < 0.001).</p><p><strong>Conclusions: </strong>In immunocompromised patients admitted to the ICU for AHRF, dyspnea at admission is moderate to severe and is associated with clinical outcomes. Dyspnea-NRS ≥5 is associated with an increase in intubation rate and hospital mortality.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100091"},"PeriodicalIF":6.9,"publicationDate":"2026-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13241896/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148196906","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}