Annals of Intensive Care最新文献

{"title":"Renal microcirculation in acute kidney injury: bridging haemodynamics, inflammation and repair.","authors":"Stanislas Abrard, John R Prowle, Philippe Guerci, Didier Payen, Thomas Rimmelé","doi":"10.1016/j.aicoj.2026.100169","DOIUrl":"10.1016/j.aicoj.2026.100169","url":null,"abstract":"<p><strong>Background: </strong>The kidneys receive a disproportionately high share of cardiac output relative to their mass, reflecting their central role in solute clearance and fluid regulation. The renal microcirculation is anatomically complex and regionally heterogeneous, with steep gradients in perfusion and oxygen tension from cortex to medulla. This architecture supports efficient filtration and reabsorption but renders specific nephron segments supply-dependent and susceptible to injury during haemodynamic instability, hypoxia, inflammation, or exposure to toxins. These vulnerabilities can lead to acute kidney injury (AKI), where microvascular dysfunction often precedes changes in global renal perfusion.</p><p><strong>Main body: </strong>The renal microvasculature comprises glomerular capillaries followed by efferent arterioles supplying either cortical peritubular capillaries or the medullary vasa recta. Regional endothelial heterogeneity, limited medullary oxygen availability, countercurrent oxygen shunting, and the high metabolic demand of tubular sodium transport create intrinsic susceptibility to injury. In AKI, sepsis, ischaemia-reperfusion, surgery, nephrotoxins, and venous congestion may trigger early endothelial activation and glycocalyx injury, promoting increases permeability, leukocyte and platelet adhesion, altered vascular tone, capillary obstruction, and interstitial oedema. These changes impair perfused capillary density and oxygen diffusion. Microvascular dysfunction may persist despite normalisation of systemic haemodynamics, reflecting a loss of haemodynamic coherence and contributing to regional hypoxia and reduced glomerular filtration.Tubular injury further amplifies these abnormalities. Reduced NaCl reabsorption increases delivery to the macula densa, activates tubuloglomerular feedback, and promotes afferent vasoconstriction, while tubular obstruction, filtrate backleak, and interstitial pressure oppose filtration and compromise peritubular perfusion. The relative contribution of these mechanisms differs across sepsis-associated, ischaemia-reperfusion, perioperative, nephrotoxic, congestive, and predominantly haemodynamic AKI phenotypes.When repair is incomplete, persistent endothelial dysfunction, pericyte detachment, capillary rarefaction, chronic hypoxia, and fibrosis promote nephron dropout, loss of renal functional reserve, and progression from AKI to chronic kidney disease. Clinical assessment currently relies on complementary surrogates, including perfusion imaging, venous congestion assessment, oxygenation monitoring, and endothelial or tubular biomarkers.</p><p><strong>Conclusion: </strong>Renal microvascular dysfunction contributes to the initiation, functional expression, persistence, and long-term consequences of AKI. A phenotype-oriented approach integrating perfusion, congestion, oxygenation, endothelial injury, and tubulo-vascular interactions may improve mechanistic understanding and support the d","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100169"},"PeriodicalIF":6.9,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13673365/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149214994","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 relevance of ventriculo-arterial coupling and how to assess it at the bedside.","authors":"Fabio Guarracino, Paul Elbers, Michel Slama, Michael R Pinsky","doi":"10.1016/j.aicoj.2026.100170","DOIUrl":"10.1016/j.aicoj.2026.100170","url":null,"abstract":"<p><p>This review describes ventriculo-arterial coupling (VAC), its clinical relevance and how to access it at the bedside. VAC refers to the interaction between the contractility of the ejecting ventricles and the load exerted by the arteries. It integrates cardiac performance with the properties of the vascular system to assess cardiovascular efficiency and workload ending in a stroke volume and energy required to create that work. This relationship is quantitatively expressed as the ratio between arterial elastance (Ea) and end-systolic ventricular elastance (Ees). VAC offers valuable insights into hemodynamic status that go beyond traditional parameters like blood pressure, stroke volume or ejection fraction and independently predicts outcome from critical illness. Optimal VAC reflects maximal efficiency of stroke work and preserved cardiovascular reserve, while uncoupling indicates impaired reserve and is associated with worse prognosis. Uncoupling can occur in both acute and chronic settings, can affect either the right ventricle and pulmonary circulation or left ventricle and systemic circulation or both, and is observed across most forms of shock. While VAC has traditionally been analyzed through invasive pressure-volume methods, it can now be approximated at the bedside using echocardiography and simplified elastance calculations. These approaches allow for dynamic assessments of therapeutic interventions, including fluids, vasopressors, inotropes, and mechanical circulatory support. By incorporating VAC into clinical practice, healthcare professionals can enhance hemodynamic phenotyping and support individualized, physiology-guided management of critically ill patients.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100170"},"PeriodicalIF":6.9,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13673359/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215002","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":"Vasopressin for hypotensive paediatric intensive care patients: an ESPNIC endorsed international survey: the P-PRESS survey.","authors":"Vladimir L Cousin, Akash Deep, Mathieu Jozwiak, Pierre Tissieres","doi":"10.1016/j.aicoj.2026.100168","DOIUrl":"10.1016/j.aicoj.2026.100168","url":null,"abstract":"<p><p>NAD, noradrenalin; MAP, mean arterial pressure; DAP, diastolic arterial pressure; UI, International unit. *Noradrenalin tartrate.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100168"},"PeriodicalIF":6.9,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13673358/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149214978","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":"National variation in acute kidney injury diagnosis and monitoring across adult intensive care units in china: a nationwide cross-sectional survey.","authors":"Xinran Wang, Xiuhua Zhang, Weiting Zhang, Yu Xin, Pengfei Huang, Yanqi Liu, Kai Zeng, Xianglin Meng, Zhiyong Peng, Wenxiong Li, Zhenjie Hu, Yingzi Huang, Meili Duan, Mingyan Zhao, Kaijiang Yu, Changsong Wang","doi":"10.1016/j.aicoj.2026.100166","DOIUrl":"10.1016/j.aicoj.2026.100166","url":null,"abstract":"<p><strong>Background: </strong>Acute kidney injury (AKI) is common in critically ill patients and strongly associated with adverse outcomes, yet national ICU-level evidence on AKI diagnosis and monitoring in China remains limited.</p><p><strong>Methods: </strong>We conducted a nationwide anonymous cross-sectional web survey of adult ICUs in China from June 25 to September 26, 2025. The survey assessed AKI diagnosis and staging, UO and SCr monitoring across clinical scenarios, biomarker use, early warning systems, and changes in UO monitoring after AKI. We used multivariable logistic regression to identify factors associated with UO-monitoring practices, with FDR correction for multiple comparisons. An exploratory 0-100-point AKI-MIS summarised ICU-level monitoring implementation, with higher scores indicating broader implementation.</p><p><strong>Results: </strong>Of 2,002 responses, 1,896 unique adult ICU units were included. AKI diagnosis was reported by 97.9% of ICUs, whereas 63.2% explicitly implemented staging and 75.9% used both UO and SCr for diagnosis. Hourly UO monitoring increased from 49.6% in routine practice to 74.1% in sepsis, 75.0% in AKI, and 77.7% in sepsis-associated AKI. Dynamic UO monitoring was implemented in 14.8% of ICUs; 83.5% reported increased nursing workload, and 69.9% identified workload or insufficient staffing as the main barrier. After FDR correction, geographic region, nurse-to-bed ratio, and baseline monitoring intensity were associated with UO-monitoring practices. The median AKI-MIS was 68.1 (IQR, 60.3-74.9), with higher adjusted scores in teaching hospitals.</p><p><strong>Conclusions: </strong>Among participating adult ICU units across all 31 provincial-level administrative regions of mainland China, AKI diagnosis and monitoring were widely reported, but substantial heterogeneity remained across monitoring systems. These findings provide a broad descriptive benchmark and identify priorities for strengthening standardisation, risk-responsive escalation, and closed-loop response pathways.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100166"},"PeriodicalIF":6.9,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13673355/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effects of hemoadsorption in patients with sepsis-associated persistent severe AKI who require CRRT: A prospective, randomized controlled pilot study.","authors":"Keran Shi, Wei Jiang, Lin Song, Yuchen Wang, Xianghui Li, Jing Wang, Ying Shi, Zhixiang Yang, Xing Cai, Wei Han, Jiujiang Liu, Jingjing Yin, Xiaohua Gu, Qingquan Lyu, Xiaolan Xu, Renyan Zhao, Haixia Wang, Qiaoping Chen, Qingjie Zhu, Xiaoyan Wu, Jiangquan Yu, Ruiqiang Zheng","doi":"10.1016/j.aicoj.2026.100167","DOIUrl":"https://doi.org/10.1016/j.aicoj.2026.100167","url":null,"abstract":"<p><strong>Background: </strong>Sepsis-associated persistent severe acute kidney injury (S-PAKI) is marked by a sustained hyperinflammatory response and is associated with a poor prognosis. Hemoadsorption functions by removing circulating cytokines and other inflammatory mediators. This study aims to evaluate the impact of CVVH combined with hemoadsorption on the prognosis of patients with S-PAKI who need CRRT.</p><p><strong>Methods: </strong>This prospective, randomized, single-center pilot study involved 76 S-PAKI patients who required CRRT. Participants were randomly assigned to receive either CVVH combined with hemoadsorption (CVVH + HA group, n = 38) or conventional CVVH therapy (CVVH group, n = 38). The primary endpoint was 30-day all-cause mortality. Secondary endpoints included changes in Acute Physiology and Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment (SOFA) scores, renal functional prognosis, alterations in biomarker and cytokine levels, changes in hemodynamic parameters, as well as the duration of renal replacement therapy, mechanical ventilation, ICU stay, and overall hospital stay among survivors.</p><p><strong>Results: </strong>The CVVH + HA group showed a statistically non-significant trend to lower 30-day all-cause mortality compared to the CVVH group (36.8% vs. 52.6%, P = 0.159). A post hoc exploratory subgroup analysis revealed that among patients with Chemokine (C-C motif) ligand 14 (CCL14) levels greater than 1.3 ng/ml, the mortality risk in the CVVH + HA group was lower than that in the CVVH group. In terms of secondary outcomes, hemoadsorption therapy significantly decreased APACHE II and SOFA scores, enhanced cytokine clearance, and improved hemodynamic status; however, it did not lead to significant improvements in renal functional prognosis, nor did it shorten the duration of mechanical ventilation, renal replacement therapy, ICU stay, or overall hospital stay among survivors.</p><p><strong>Conclusions: </strong>In this pilot trial, hemoadsorption therapy did not significantly reduce 30-day mortality across the entire cohort. However, a post hoc exploratory subgroup analysis suggested a potential association with improved survival in patients with elevated urinary CCL14 levels. These exploratory, hypothesis-generating findings require confirmation in adequately powered, biomarker-guided randomized trials.</p><p><strong>Trial registration: </strong>ChiCTR2400093572, registered at the Chinese Clinical Trial Registry (ChiCTR) on December 09, 2024.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100167"},"PeriodicalIF":6.9,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13656966/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178980","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":"Comparison of the approaches to combine Renal Replacement Therapy with Extracorporeal Membrane Oxygenation - a Scoping Review.","authors":"Eden Kharrouba, Quentin Moyon, Matthew E Cove, Jutta Arens, Ana Martins Costa, John F Fraser, Jacky Y Suen","doi":"10.1016/j.aicoj.2026.100165","DOIUrl":"https://doi.org/10.1016/j.aicoj.2026.100165","url":null,"abstract":"<p><strong>Introduction: </strong>Extracorporeal membrane oxygenation (ECMO) is increasingly used for cardiac and respiratory failure and is associated with high rates of acute kidney injury (AKI) and fluid overload requiring renal replacement therapy (RRT). ECMO and RRT can be run independently in parallel, or RRT hemofilter or device can be integrated into the ECMO circuit. Several parallel and integrated ECMO-RRT configurations have been described, but the optimal approach remains uncertain.This scoping review mapped the available literature comparing at least two ECMO-RRT configurations, summarized reported outcomes, and identified knowledge gaps.</p><p><strong>Methods: </strong>We searched PubMed, Cochrane Library, Web of Science, Embase, and ClinicalTrials.gov without restrictions, with the final search conducted on February 9, 2026. Eligible studies compared at least 2 ECMO-RRT configurations linked to reported outcomes. Data on study characteristics, configurations, outcomes, and anticoagulation were extracted and synthesized.</p><p><strong>Results: </strong>Of 6,806 records, 20 studies were included: 12 were clinical including 1 randomized controlled trial, 3 in vitro, 1 in silico, and 4 surveys. More than 8 ECMO-RRT connection schemes have been described by clinical studies since 2013. No consistent differences in efficiency or clinical outcomes were observed between the configurations compared. Integrated methods were associated with longer or comparable hemofilter lifespan. Surveys confirmed heterogeneous medical practices, and 2 safety concerns (unstoppable pressure alarms and air embolism) were reported.</p><p><strong>Conclusion: </strong>Evidence on ECMO-RRT configurations is limited and heterogeneous. Future systematic and rigorous comparison of all the configurations through preclinical and clinical studies is needed to harmonize medical practices and inform the development of guidelines.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100165"},"PeriodicalIF":6.9,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13656946/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178985","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":"Early piperacillin exposure during continuous infusion in critically ill patients: the impact of renal and liver dysfunctions.","authors":"Matthieu Conseil, Inès Lakbar, Alina Laurino, Suheda Evsen, Adeline Mathieu, Clément Monet, Fouad Belafia, Mathieu Capdevila, Jean-Joseph Bendjilali-Sabiani, Gérald Chanques, Audrey De Jong, Yoann Cazaubon, Samir Jaber","doi":"10.1016/j.aicoj.2026.100164","DOIUrl":"https://doi.org/10.1016/j.aicoj.2026.100164","url":null,"abstract":"<p><strong>Objective: </strong>To assess early piperacillin exposure in critically ill patients receiving continuous infusion piperacillin-tazobactam, identify clinical determinants of underexposure and overexposure, and evaluate piperacillin concentrations across organ dysfunction phenotypes.</p><p><strong>Design: </strong>Retrospective, single-center observational study.</p><p><strong>Setting: </strong>A 20-bed medical-surgical intensive care unit of a university hospital.</p><p><strong>Patients: </strong>All consecutive adult critically ill patients receiving continuous-infusion piperacillin-tazobactam with at least one total plasma piperacillin concentration measurement.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Observed plasma piperacillin concentrations were measured at predefined time points (day 1, day 3 and day 7). Target attainment was defined as total plasma concentrations of 80-160 mg/L, corresponding to 4-8 times the minimum inhibitory concentration of <i>Pseudomonas aeruginosa</i>.A total of 350 patients were included, contributing 775 piperacillin measurements. At first sampling (day 1), 30% of patients were underexposed, 35% achieved the target range, and 35% were overexposed. In multivariable analyses, underexposure was less frequent in older patients and in those with renal dysfunction or shock, while male sex was independently associated with a higher risk of underexposure. Overexposure was strongly associated with renal dysfunction, higher bilirubin concentrations, and higher daily piperacillin dose. Piperacillin concentrations were highest in patients with combined hepato-renal dysfunction.</p><p><strong>Conclusions: </strong>Only one-third of critically ill patients achieved target piperacillin exposure at initial therapeutic drug monitoring during continuous infusion. Early deviations from target concentrations were frequent and primarily determined by renal dysfunction despite routine dose adjustment. These findings support early individualized dosing strategies integrating organ function assessment and therapeutic drug monitoring to optimize piperacillin exposure.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100164"},"PeriodicalIF":6.9,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13656968/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178937","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":"Pre-admission prescription of selective serotonin reuptake inhibitors and mortality in critical illness: a national cohort study from 2020 to 2023.","authors":"Tak Kyu Oh, In-Ae Song","doi":"10.1016/j.aicoj.2026.100161","DOIUrl":"https://doi.org/10.1016/j.aicoj.2026.100161","url":null,"abstract":"<p><strong>Background: </strong>We aimed to determine whether selective serotonin reuptake inhibitor (SSRI) prescription within 30 days before intensive care unit (ICU) admission was associated with 30-day and 90-day mortality in critically ill adults, and to evaluate effect modification by underlying psychiatric disorders.</p><p><strong>Methods: </strong>We conducted a nationwide retrospective cohort study of adults with a first ICU admission in South Korea from 2020 through 2023. Pre-admission SSRI prescription was defined using prescription supply records during the 30 days before ICU admission. Propensity score matching and Cox proportional hazards models were used to evaluate 30-day and 90-day mortality.</p><p><strong>Results: </strong>Pre-admission SSRI prescription was associated with lower 30-day and 90-day mortality after propensity score matching. Similar associations were observed in the full cohort and when prescription coverage included the day immediately before ICU admission. The associations appeared stronger among patients with documented psychiatric disorders.</p><p><strong>Conclusions: </strong>Pre-admission SSRI prescription was associated with lower short- and intermediate-term mortality in critically ill adults. These observational findings do not establish a causal protective effect and should be interpreted in light of potential residual confounding.</p><p><strong>Trial registration: </strong>None.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100161"},"PeriodicalIF":6.9,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13634290/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149102782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of timely assessment of appropriate care in reducing greenhouse gas emissions in intensive care medicine.","authors":"Paul-Simon Pugliesi, Lucas Mathey, Jean-Philippe Rigaud, Eliott Teston, Dima Siblani, Romain Ter Schiphorst, Marie Labruyère, Caroline Abdul Malak, Serge Ribes, Christine Binquet, Catherine Lejeune, Thomas Maldiney, Jean-Pierre Quenot","doi":"10.1016/j.aicoj.2026.100162","DOIUrl":"https://doi.org/10.1016/j.aicoj.2026.100162","url":null,"abstract":"<p><strong>Background: </strong>Our era is characterized by the significant impact of anthropogenic activity, resulting in the paradox of short-term benefits, such as improved health, alongside potentially devastating long-term consequences for our species and the living world. Critical care, by attempting to preserve human lives through the massive mobilization of human, energy, and material resources, is a quintessential example of this paradox. It is therefore an ideal setting to explore the necessary compromise between care provided for the benefit of patients and the requirement to protect future ecological viability. The objective of our study was twofold: first, to evaluate whether conducting ethical reflections that lead to the early limitations, withdrawal, or non-initiation of certain invasive treatments to avoid disproportionate care would result in a reduction of greenhouse gas (GHG) emissions associated with critical care stays; and second, to quantify such a reduction.</p><p><strong>Results: </strong>We conducted a retrospective study analyzing both the medical activity and GHG emissions of a French critical care department throughout the year 2023. Our analysis found that one day of hospitalization required an average atmospheric emission of 194 kg CO₂ equivalent (CO₂eq) in the Intensive Care Unit (ICU) and 160 kg CO₂eq in the Intermediate Care Unit (IMCU). Procurement (medications, medical devices, medical equipment) and transport (employees and patients) represented the primary sources of GHG emissions. The analysis of medical activity covered 828 patient stays, corresponding to 2913 patient-days in the ICU and 1225 in the IMCU. The overall mortality rate in critical care was 17% (31% in ICU, 5% in IMCU). In the subgroup for which a total or partial limitation of invasive care was decided within 48 h of admission (240 stays or 29%), each stay required an average atmospheric emission of 586 kg CO₂eq, compared to 1055 kg CO₂eq for the remainder of the cohort (<i>p</i> = 0.004).</p><p><strong>Conclusion: </strong>An ethical approach consisting of a timely assessment of the appropriate level of care for each patient, with the goal of avoiding disproportionate care, appears to significantly reduce GHG emissions per stay. This approach could constitute a vital component of sustainability within critical care services.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100162"},"PeriodicalIF":6.9,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13634266/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149102787","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 practice guidelines: management of non-post-operative supra-ventricular tachycardia in neonates and children less than 18 years old hospitalized in a Pediatric Intensive Care Unit.","authors":"Sophie Breinig, Romain Amadieu, Agathe Béranger, Yves Dulac, Isabelle Goyer, Marion Grimaud, Maiwenn Le Ny, Yael Levy, Alice Maltret, Christopher Marquis, Soizic Paranon, Morgan Recher, Louise-Marie Jandeaux, Khaldoun Kuteifan, Julie Starck","doi":"10.1016/j.aicoj.2026.100160","DOIUrl":"https://doi.org/10.1016/j.aicoj.2026.100160","url":null,"abstract":"<p><strong>Purpose: </strong>We present guidelines in the form of pragmatic recommendations for management of neonates and children less than 18 years old presenting with non-post-operative supraventricular tachycardia (SVT) and hospitalized in a Paediatric Intensive Care Unit (PICU).</p><p><strong>Methods: </strong>Thirteen French-speaking experts, all of them members of the Groupe Francophone de Réanimation et Urgence Pédiatriques (French-speaking group of paediatric intensive and emergency care; GFRUP), collaborated from 2024 to 2025 through teleconferences and face-to-face meetings. The guidelines cover four areas: (1) epidemiology and criteria for admission to a PICU, (2) paraclinical assessment, (3) non-specific rhythm management, and (4) specific rhythm management. The questions were formulated in the Patient-Intervention-Comparison-Outcome (PICO) format. An extensive Anglophone and Francophone literature search indexed in the MEDLINE database via PubMed, Cochrane and Embase was performed using pre-established keywords. The texts were analyzed and classified according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. When this method was not applicable, an expert opinion was given. Each of the recommendations was voted on by all the experts according to the Delphi methodology.</p><p><strong>Results: </strong>The group proposes 21 recommendations. The GRADE methodology could be applied for five of them, and an expert opinion was given for the remaining 16. All of the recommendations received strong approval.</p><p><strong>Conclusion: </strong>These guidelines cover different aspects in the management of non-post-operative SVT in children hospitalized in PICUs including non-specific and specific rhythm management.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100160"},"PeriodicalIF":6.9,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13654474/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164828","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}