Annals of Intensive Care最新文献

{"title":"Selective decontamination regimens in French ICUs: author's response.","authors":"Nicolas Massart, Marc Leone, Alain Lepape","doi":"10.1186/s13613-025-01571-8","DOIUrl":"10.1186/s13613-025-01571-8","url":null,"abstract":"","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"145"},"PeriodicalIF":5.5,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12463800/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145147526","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 intricate relationship between capillary refill time and systemic hemodynamics in septic shock.","authors":"Glenn Hernandez, Eduardo Kattan, Gustavo Ospina-Tascón, Sebastian Morales, Nicolás Orozco, Gustavo García-Gallardo, Macarena Amthauer, Jing-Chao Luo, Jan Bakker","doi":"10.1186/s13613-025-01563-8","DOIUrl":"10.1186/s13613-025-01563-8","url":null,"abstract":"<p><p>The emergence and validation of capillary refill time (CRT) as a resuscitation target together with its rapid kinetics of response to increases in systemic blood flow makes it the ideal variable to assess clinical reperfusion and the status of macro-to-microcirculatory coupling in septic shock. Moreover, previous studies have shown that resuscitation can be safely stopped after CRT normalization, thus decreasing the risk of over-resuscitation. From a physiological point of view, CRT is a complex variable integrating microvascular flow and reactivity. Additionally, it may be understood as a dynamic test that evaluates the preservation or disruption of normal responses of the microcirculation to maintain blood flow after transient ischemic challenges. The relationship between systemic hemodynamics and CRT is complex. Indeed, single time-point asssessments of CRT are not able to predict absolute cardiac output values and this is logical since they belong to different phsyiological categories. An abnormal CRT may be explained by insufficient macrohemodynamic resuscitation but also by several derangements at the microvascular level that may preclude CRT normalization, thus signaling a state of macro-to-microcirculatory uncoupling. CRT response to an acute fluid or mean arterial pressure challenge, may not only reveal the adequacy of systemic blood flow but also contribute to tailor interventions to personalize septic shock resuscitation. The lack of CRT response to these challenges discloses a more complex pathophysiological condition that is associated with higher mortality. Further research efforts should be focused on better understanding the factors associated with CRT non-response as a first step to develop a more phsyiologically-based resuscitation, that could eventually improve outcomes.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"135"},"PeriodicalIF":5.5,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12463805/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145147585","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":"Bereavement interventions for families in the ICU: a scoping review informed by a core outcome set.","authors":"Sarah Foran, Mah Rukh, Alison Knapp, Jennifer M O'Brien, Carol Brons, Janelle Glessman, Joann Kawchuk, Donna Goodridge, Sabira Valiani","doi":"10.1186/s13613-025-01557-6","DOIUrl":"10.1186/s13613-025-01557-6","url":null,"abstract":"<p><strong>Background: </strong>Families confronting the death of a loved one in the intensive care unit (ICU) are at greater risk of experiencing complicated grief than families bereaved in other circumstances. The primary objective of this scoping review was to identify interventions that have been explored in the literature for supporting ICU bereaved families. Secondary objectives were to map the findings to a core outcome set (COS) developed to measure bereavement interventions for adults, and to identify existing knowledge gaps, with particular attention to considerations of equity, diversity, and inclusion (EDI).</p><p><strong>Methods: </strong>We searched five electronic databases: Web of Science, CINAHL, EMBASE, APA PsycInfo, and MEDLINE. Primary research articles that described bereavement program(s) and/or support(s) for bereaved loved ones in the setting of an adult ICU were included. We extracted data on study aims, methods, setting, patient and bereaved loved one demographics, design, analysis, and results. Four reviewers independently screened references and performed data extraction.</p><p><strong>Findings: </strong>We identified 11 bereavement interventions, including memorial services, condolence letters/sympathy cards, mementos, ICU diaries completed by staff or family, storytelling interventions, personalized/individual final wishes, information booklets/referrals to resources, meetings with ICU professionals, follow up telephone calls, training for staff, and other specific interventions. Most studies (35 out of 39) reported outcomes that aligned with a previously developed COS. Only three studies addressed cultural diversity in the development or implementation of bereavement interventions.</p><p><strong>Conclusions: </strong>This scoping review summarizes the range of bereavement interventions described in the literature and highlights key areas for future development, including cultural inclusivity in the development and implementation of interventions, and the use of standardized outcomes for evaluation.</p><p><strong>Registration: </strong>The protocol is registered on the Open Science Framework ( https://osf.io/ue7t9 ).</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"146"},"PeriodicalIF":5.5,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12463810/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145147484","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":"Exogenous corticosteroid-induced modulation of RAAS: potential implications for septic shock biomarker analysis.","authors":"Thomas Uslar, Benjamin Sanfuentes, Rene Baudrand, Glenn Hernández, Eduardo Kattan","doi":"10.1186/s13613-025-01567-4","DOIUrl":"10.1186/s13613-025-01567-4","url":null,"abstract":"","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"144"},"PeriodicalIF":5.5,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12463738/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145147510","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":"Use of CO₂-derived variables in critically ill patients.","authors":"Jihad Mallat, Mathieu Jozwiak, Nicolás Orozco, Olfa Hamzaoui, Xavier Monnet, Jean-Louis Teboul, Daniel De Backer, Gustavo A Ospina-Tascón","doi":"10.1186/s13613-025-01569-2","DOIUrl":"10.1186/s13613-025-01569-2","url":null,"abstract":"<p><p>A fundamental objective of hemodynamic resuscitation is to reverse tissue hypoperfusion and prevent progression to multiorgan failure and death. Conventional tools such as clinical examination, lactate levels, and central or mixed venous oxygen saturation (ScvO₂ and SvO₂, respectively) have intrinsic limitations. These drawbacks can be mitigated by incorporating additional markers of tissue hypoperfusion and altered tissue metabolism, such as carbon dioxide (CO₂)-derived variables, into other multimodal macro and micro hemodynamic monitoring. Specifically, the mixed or central venous-to-arterial difference in partial pressure of CO₂ (Pv-aCO₂ or Pcv-aCO₂) reflects the adequacy of blood flow to transport CO₂ from peripheral tissues to the lungs for its elimination. Consequently, Pv-aCO₂ serves as a reliable marker for assessing the adequacy of blood flow relative to CO₂ production. Importantly, unlike SvO₂ and ScvO₂, Pv-aCO₂ remains informative even when oxygen extraction is impaired, as commonly occurs in septic conditions. However, Pv-aCO₂ and Pcv-aCO₂ in isolation are not direct markers of anaerobic metabolism, as these can also be influenced by oxygen consumption rates. Conversely, the ratio between Pv-aCO₂ (or Pcv-aCO₂) and the arteriovenous oxygen content difference may provide a more reliable indication of ongoing anaerobic metabolism. This review discusses the physiological foundations, prognostic significance, clinical implications, and potential applications of CO₂-derived parameters in patient management.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"142"},"PeriodicalIF":5.5,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12463780/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145147632","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":"Impact of early PaCO₂ and pH fluctuations on neurological outcomes in ARDS patients receiving VV ECMO: a retrospective cohort study from the CSECLS registry.","authors":"Xiaoli Chen, Jinquan Xie, Ya Wang, Zhongtao Du, Xinyi Luo, Zitao Zeng, Haixiu Xie, Jinxiang Ma, Zhangwei Liang, Yin Xi, Jie Zhang, Weibo Liang, Chenglong Li, Zhenting Liang, Jiao Li, Weiqun He, Xiaoqing Liu, Yimin Li, Xiaotong Hou, Yonghao Xu","doi":"10.1186/s13613-025-01570-9","DOIUrl":"10.1186/s13613-025-01570-9","url":null,"abstract":"<p><strong>Background: </strong>Neurological complications significantly contributed to mortality in patients with acute respiratory distress syndrome (ARDS) supported by venovenous extracorporeal membrane oxygenation (VV ECMO). Early fluctuations in arterial partial pressure of carbon dioxide (PaCO₂) during ECMO initiation may have affected cerebral perfusion and increased the risk of brain injury. This study investigated the association between early changes in PaCO₂ and pH levels and subsequent neurological outcomes in patients with ARDS receiving VV ECMO.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using data from adult ARDS patients who underwent VV ECMO between January 2018 and December 2022, sourced from the Chinese Society of Extracorporeal Life Support (CSECLS) Registry. Patients were stratified into clusters based on absolute changes in PaCO₂ and pH using K-means clustering. Logistic regression models and restricted cubic splines were used to evaluate the associations between these clusters and the occurrence of neurological complications, adjusting for potential confounders.</p><p><strong>Results: </strong>Among 983 patients included, the incidence of neurological complications was 2.95%. Cluster 1, characterized by significant reductions in PaCO₂ (median: -50 mmHg, relative reduction: -58%), exhibited the highest rate of neurological complications (11.94%). Cluster 3, with substantial increases in pH and minimal reductions in PaCO₂, showed a relatively lower rate of neurological complications (3.96%), suggesting that PaCO₂ fluctuations, rather than pH changes, were primarily associated with neurological complications.</p><p><strong>Conclusions: </strong>Excessive reductions in PaCO₂ during the early initiation of VV ECMO, rather than pH elevation, were associated with an increased risk of neurological complications in ARDS patients. Close monitoring and management of PaCO₂ during ECMO initiation may mitigate this risk.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"143"},"PeriodicalIF":5.5,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12463811/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145147486","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":"Advancing future research on sepsis outcomes in adolescents with SUD: integrating AI, accounting for temporal trends, and enhancing exposure classification.","authors":"Havell Markus, Gary D Ceneviva, Neal J Thomas, Conrad Krawiec","doi":"10.1186/s13613-025-01556-7","DOIUrl":"10.1186/s13613-025-01556-7","url":null,"abstract":"","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"134"},"PeriodicalIF":5.5,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12413348/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145005767","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":"Harnessing artificial intelligence to address substance use disorders in critically ill adolescents: a synergistic approach.","authors":"Zekai Yu","doi":"10.1186/s13613-025-01553-w","DOIUrl":"10.1186/s13613-025-01553-w","url":null,"abstract":"","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"133"},"PeriodicalIF":5.5,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12408869/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939592","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":"Reconsidering early RRT in leptospirosis AKI: a question of timing criteria.","authors":"Pei-Chen Wu, Thomas Tao-Min Huang","doi":"10.1186/s13613-025-01544-x","DOIUrl":"10.1186/s13613-025-01544-x","url":null,"abstract":"","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"132"},"PeriodicalIF":5.5,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12405087/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939650","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":"From leptospirosis-induced AKI to AKI at large: the ongoing search for biomarkers to guide RRT initiation.","authors":"Marie Julien, Yannis Lombardi, Julien Jabot, Cédric Rafat","doi":"10.1186/s13613-025-01549-6","DOIUrl":"10.1186/s13613-025-01549-6","url":null,"abstract":"","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"131"},"PeriodicalIF":5.5,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12405105/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939654","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}