Annals of Intensive Care最新文献

{"title":"Use of preload responsiveness tests in pediatric intensive care units: A nationwide prospective clinical practice analysis.","authors":"Julien Gotchac, Alice Lecomte, Yaniss Belaroussi, Pierre Bourgoin, Solene Denante, Roman Klifa, Elodie Perdreau, Julian San Geroteo, Olivier Brissaud, Arthur Gavotto, Pascal Amedro","doi":"10.1016/j.aicoj.2026.100066","DOIUrl":"https://doi.org/10.1016/j.aicoj.2026.100066","url":null,"abstract":"<p><strong>Background: </strong>To avoid unnecessary volume expansions (VE), several preload-responsiveness tests exist in children but most have strict validity conditions, or are time-consuming. Although underuse or misuse of these tests could lead to inappropriate VE and fluid overload, their actual use in pediatric intensive care units (PICU) has never been evaluated. This study aimed to assess the use of preload-responsiveness tests before VE in PICU, identify clinical factors associated with their use, and document misuse when validity conditions, as defined in the literature, were not met.</p><p><strong>Methods: </strong>We conducted a prospective nationwide observational study in 34 French PICU. VE prescriptions to children ≤15 years were collected during a 6-week period. Exclusion criteria were preterm neonates, mechanical circulatory support, and single-ventricle physiology. For each VE, physicians completed a questionnaire at bedside, focusing on preload-responsiveness test use before VE. Relevant data to interpret tests validity were also collected, including spontaneous breathing and ventilation parameters. The use of preload-responsiveness test, their misuse and the characteristics associated with their use were analyzed. Misuse of a test was defined as its application when validity criteria were not met, regardless of the method used to perform the test which was not recorded.</p><p><strong>Results: </strong>A total of 471 VE were analyzed, prescribed to children with a median age of 7.9 months, on catecholamine support in 202/471 (42.9%) cases, and intubated in 292/471 (62.0%) cases. The median volume was 10 ml.kg^-1. A preload-responsiveness test was performed before 296/471 (62.8%) VE (95%CI=[58.5%-67.2%]). Inferior vena cava visual analysis was the most common test, performed before 165 VE, followed by the respiratory variability of the peak aortic velocity (ΔVPeak), a dynamic index, measured before 92 VE. Among 294 dynamic indices (i.e., based on respiratory variation in hemodynamic signals) or preload challenges performed, misuse was observed in 188/294 (63.9%) cases. Performing a preload-responsiveness test was independently associated with mechanical ventilation (OR = 3.73, 95%CI=[1.95-7.15], <i>p</i> < 0.001) and catecholamine support (OR=4.08, 95%CI=[2.00-8.31], <i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>In this large national prospective study, preload-responsiveness tests were routinely used before VE in PICU, especially in severe patients. However, the selected tests were often either poorly reliable or misused.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100066"},"PeriodicalIF":5.5,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13099507/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147760122","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-frequency oscillation improves mucus clearance and airway resistance in mechanically ventilated patients: a randomized clinical trial.","authors":"Yuxuan Wang, Dongyu Chen, Wei Xie, Rui Zhang, Xinxin Guo, Haiying Wu, Ling Liu, Xueyan Yuan","doi":"10.1016/j.aicoj.2026.100062","DOIUrl":"https://doi.org/10.1016/j.aicoj.2026.100062","url":null,"abstract":"<p><strong>Background: </strong>Mechanical ventilation is associated with both impaired ciliary function and a weakened cough, which further impair secretion clearance. Continuous high-frequency oscillation (CHFO) is a promising technique to reduce respiratory muscle loading and facilitate secretion clearance in mechanically ventilated patients. The aim of this study was to assess the effect of CHFO on airway resistance (Raw).</p><p><strong>Methods: </strong>This is a prospective, randomized controlled trial conducted in a 60-bed ICU between April 2023 and March 2024. Mechanically ventilated patients with excessive airway secretions (defined as the sputum volume exceeding 150 ml within the past 24 hours) were randomly assigned to either receive CHFO for 10 minutes followed by secretion aspiration (CHFO group), or to undergo secretion aspiration alone (control group). Throughout the study, only the study intervention and necessary suctioning were performed, and patient positioning and ventilator settings were kept constant. Arterial blood gases, respiratory mechanics, and the percentage of dorsal lung ventilation (assessed by electrical impedance tomography) were measured in both groups at four timepoints: pre-intervention (baseline), immediately post-intervention (T0), one-hour post-intervention (T1), and three-hours post-intervention (T3). The primary outcome was the change in Raw from baseline at each time point (ΔRaw: R_{post-intervention} - R_baseline). Change in respiratory system compliance (Crs), and ventilation distribution were also recorded.</p><p><strong>Results: </strong>46 patients, with a median sputum volume of 160 ml over the last 24 hours, were enrolled. Baseline characteristics were well-balanced in the two groups. CHFO group showed a significantly larger decrease in Raw compared to control group at T1 (CHFO: -2.4 ± 1.8 vs. control: -0.1 ± 1.6 cmH₂O/L·s, p < 0.001) and T3 (CHFO: -1.8 ± 2.4 vs. control: -0.5 ± 1.9 cmH₂O/L·s, p < 0.05). Increase in Crs from baseline was greater in the CHFO group than control group at T1 (CHFO: 4.9 ± 8.8 vs. control: 0.3 ± 4.2 ml/cmH₂O, p < 0.05) and T3 (CHFO: 4.3 ± 9.6 vs. control: 1.0 ± 5.8 ml/cmH₂O, p < 0.05). Increase in dorsal lung ventilation from baseline was greater in the CHFO group compared to control group to T1 (p < 0.05). No differences in oxygenation were observed between the two groups at any time point.</p><p><strong>Conclusions: </strong>In mechanically ventilated patients with excessive airway secretions, the reduction in Raw from baseline was significantly greater in the CHFO group than control group at one-hour and three-hour post-intervention.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100062"},"PeriodicalIF":5.5,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13091533/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147721562","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 trajectories of antibiotic exposure and colonization pressure and risk of ICU-acquired carbapenem-resistant Gram-negative bacteria: A prospective cohort study.","authors":"Zhihui Chen, Xiangru Ye, Jing Wu, Zhonghua Li, Sen Wang, Jing Wang, Yueru Tian, Shirong Li, Lei Zhou, Jie Ni, Yue Qu, Jialin Jin, Wenhong Zhang","doi":"10.1016/j.aicoj.2026.100063","DOIUrl":"https://doi.org/10.1016/j.aicoj.2026.100063","url":null,"abstract":"<p><strong>Background: </strong>Carbapenem-resistant Gram-negative bacteria (CR-GNB) pose a critical threat in intensive care units (ICUs), with antibiotic exposure and colonization pressure identified as key associated factors. Prior studies have analyzed these two time-varying factors as static cumulative variables, obscuring heterogeneity in temporal patterns and their joint evolution. How distinct early trajectories of these factors jointly relate to CR-GNB acquisition risk remains unclear.</p><p><strong>Methods: </strong>In this prospective cohort study conducted at four ICUs in a tertiary-care center in China from March 2024 to January 2025, we enrolled consecutive patients with systematic rectal surveillance cultures. We used group-based multi-trajectory modeling to identify distinct joint trajectories of daily antibiotic exposure (dose, duration, spectrum) and colonization pressure during the first five ICU days. Continuous-time Markov multi-state models with Day-5 landmark analysis were adopted to assess associations between trajectory groups and subsequent ICU-acquired CR-GNB, adjusting for baseline and cumulative covariates.</p><p><strong>Results: </strong>Among 533 patients entering the Day-5 landmark analysis, three distinct trajectory groups were identified: Low exposure/low pressure (34.1%), escalating exposure/intermediate pressure (54.4%), and high exposure/high pressure (11.4%). CR-GNB acquisition occurred in 124 patients (23.3%), with rates of 9.3%, 26.2%, and 50.8% across trajectory groups, respectively. Compared with the low-exposure trajectory, adjusted hazard ratios were 1.68 (95% confidence interval [CI] 1.24-2.28) for escalating-exposure and 2.82 (95% CI, 1.53-5.19) for high-exposure trajectories (both <i>P</i> < 0.001).</p><p><strong>Conclusions: </strong>This study identified distinct early trajectories of antibiotic exposure and colonization pressure that were associated with differential CR-GNB acquisition risk. This trajectory-based framework for early association-based risk stratification may inform targeted prevention strategies, but external validation is required before clinical implementation.</p><p><strong>Trial registration: </strong>Chinese Clinical Trial Registry Identifier: ChiCTR2400081352. Registered 28 February 2024.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100063"},"PeriodicalIF":5.5,"publicationDate":"2026-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13090519/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147721656","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 subphenotypes and molecular endotypes in sepsis: toward an integrated and dynamic framework.","authors":"Guiyu Zhang, Xiaojing Wu, Songqiao Liu, Hongyang Xu, Chenglong Cai, Jiawei Liu, Siqi Liu, Pufeng Wang, Jianfeng Xie","doi":"10.1016/j.aicoj.2026.100060","DOIUrl":"10.1016/j.aicoj.2026.100060","url":null,"abstract":"<p><p>Sepsis is a highly heterogeneous and life-threatening syndrome associated with high morbidity and mortality worldwide. The repeated failure of large randomized trials underscores the urgent need for precise patient stratification. Recent advances in machine learning and multi-omics technologies have facilitated the identification of distinct clinical subphenotypes and molecular endotypes. Clinical subphenotypes, typically derived from routinely available clinical variables and circulating biomarkers, reflect aggregated downstream manifestations of underlying biological processes; however, the absence of clearly identifiable pathobiological mechanisms specific to each subgroup may limit their utility as actionable treatable traits. In contrast, molecular endotyping leverages multi-omics data to elucidate the pathophysiological drivers of sepsis, offering a foundation for mechanism-based interventions. However, most endotypes remain insufficiently actionable for individualized treatment decisions at the bedside. Furthermore, existing classification frameworks rely predominantly on static assessments, which do not adequately reflect the dynamic evolution of sepsis pathophysiology. Increasing evidence underscores that sepsis is inherently dynamic, with immune responses, metabolic states, and organ dysfunction fluctuating over time. Integrating longitudinal clinical and molecular data to capture the temporal evolution of host responses and organ dysfunction through dynamic subtyping offers a promising approach to optimize patient stratification. In this narrative review, we summarize recent advances in static and dynamic subphenotyping, discuss omics-derived endotypes, and outline strategies to integrate these dimensions into clinically actionable frameworks for precision medicine in sepsis.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100060"},"PeriodicalIF":5.5,"publicationDate":"2026-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13090521/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147721627","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":"Improving sleep in ICUs through real-time sleep monitoring: a proof-of-concept study.","authors":"Xavier Drouot, Quentin Heraud, Marie-Anne Melone, Stéphanie Ragot, Jean Pierre Frat, Remi Coudroy, Florence Boissier, Anne Veinstein, Delphine Chatellier, François Arrivé, Sylvain Le Pape, Laura Marchasson, Christophe Rault, Arnaud W Thille","doi":"10.1016/j.aicoj.2026.100059","DOIUrl":"https://doi.org/10.1016/j.aicoj.2026.100059","url":null,"abstract":"<p><strong>Background: </strong>Sleep disturbances are associated with a poor prognosis in intensive care units (ICUs). Nursing care during the night can further disturb patient sleep. We hypothesized that nursing rounds and care would be less harmful to sleep if guided by a real-time sleep monitoring system.</p><p><strong>Methods: </strong>This was a quasi-experimental, prospective, before-after study including non-sedated ICU patients. In the usual care group (first group recruited), nursing rounds and care were performed every four hours as daily practice, regardless of the patient's sleep/wake status. In the sleep-guided care group (second group recruited), nursing rounds and care were guided by a sleep-EEG monitoring system indicating the patient's sleep status in real time on a tablet positioned at the entrance of the room. When patients fell asleep, the tablet displayed a symbol asking caregivers to postpone non-urgent care. Otherwise (patient awake), nursing care was encouraged. The number of room entries was measured using an entry-exit counter, synchronized with sleep-EEG recorder. The system stored EEG in both groups. Two experts, blind to the patients' groups, provided consensual sleep scoring. Primary outcome was continuous sleep (i.e. time spent in long sleep episodes).</p><p><strong>Results: </strong>Forty-six patients mainly admitted for acute respiratory failure (72% of cases) were analysed. Patients' characteristics did not significantly differ between groups. The proportion of room entries while patients were asleep decreased from 22% [4-32] in usual care group to 6% [0-13] in sleep-guided care group (p = 0.015). Continuous sleep was longer in the sleep-guided care group (20 patients) compared to the usual care group (26 patients): 170 min [75-240] vs. 80 min [53-128] (p = 0.03). Deep sleep was likewise longer in the sleep-guided care group.</p><p><strong>Conclusion: </strong>Our study reports for the first time that real-time sleep monitoring can guide nursing care and improve sleep quality in ICUs.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100059"},"PeriodicalIF":5.5,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13081676/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147697234","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":"Experts' recommendations for the management of adult patients with cardiogenic shock.","authors":"Nadia Aissaoui, Clement Delmas, Hamid Merdji, Guillaume Schurtz, Guillaume Baudry, Antoine Beurton, Florence Boissier, Laurent Bonello, Bernard Cholley, Nicolas Combaret, Alain Combes, Charles-Henri David, Daniel De Backer, Pierre Grégoire Guinot, Olfa Hamzaoui, Brahim Harbaoui, Julien Imbault, Nicolas Nesseler, Antoine Kimmoun, Michel Kindo, Guillaume Lebreton, Guillaume Leurent, Bruno Levy, Stéphane Manzo-Silberman, Anne-Céline Martin, Armand Mekontso-Dessap, Imane Adda, Joy Mootien, Alexandre Ouattara, Matteo Pozzi, Etienne Puymirat, Francois Roubille, Antonin Trimaille, Aurore Ughetto, Eric Van Belle, Eric Bonnefoy, Khaldoun Kuteifan","doi":"10.1016/j.aicoj.2026.100038","DOIUrl":"https://doi.org/10.1016/j.aicoj.2026.100038","url":null,"abstract":"<p><p>The last specific international European recommendations regarding the management of cardiogenic shock (CS) regardless of the etiology were issued over 10 years ago. We present herein recommendations for the management of CS in adults, developed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system by an expert group of from the French Intensive Care Society [Société de Réanimation de Langue Française (SRLF)] and the French Society of Cardiology [Société Française de Cardiologie (SFC)], with the participation of the French Society of Anesthesia and Intensive Care [Société Française d'Anesthésie et de Réanimation (SFAR)], and the French Society of Thoracic and Cardiovascular Surgery [Société Française de Chirurgie Thoracique et Cardio-Vasculaire (SFCTCV)]. The recommendations covered six fields of application: CS teams and expert centers, symptomatic medical management, etiological management, organ support, temporary circulatory support and de-escalation and early post-CS management. Twenty-three \"Patient Intervention Comparator Outcome\" (PICO) questions were identified, leading to 41 recommendations regarding management of CS in adult patients. Seven recommendations were scored with high level of evidence (Grade 1), 11 with moderate level of evidence (Grade 2) and 17 with low level of evidence (Expert opinion). In 6 cases, the experts were not able to give an answer. All of the recommendations obtained strong agreement from the expert committee. The experts highlight the fact that optimal management of CS requires organization including a structured, multidisciplinary shock team and regional referral network, applying standardized protocols for diagnosis and staging. Early etiological treatment-such as culprit-lesion revascularization or urgent valve intervention-is central to improve outcomes. Hemodynamic support should prioritize norepinephrine as first-line vasopressor and privilege selective inotrope use. Temporary mechanical circulatory support (Impella, VA-ECMO) should be reserved for carefully selected patients following discussion by the expert team.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100038"},"PeriodicalIF":5.5,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13081668/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147697139","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":"Pulmonary pulsatility quantified by electrical impedance tomography in severe acute respiratory distress syndrome patients undergoing extracorporeal membrane oxygenation support.","authors":"Marco Leali, Elena Spinelli, Marco Giani, Bertrand Pavlovsky, Michela Di Pierro, Stefania Crotti, Alfredo Lissoni, Giuseppe Foti, Giacomo Grasselli, Tommaso Mauri, Douglas Slobod","doi":"10.1016/j.aicoj.2026.100058","DOIUrl":"https://doi.org/10.1016/j.aicoj.2026.100058","url":null,"abstract":"<p><strong>Background: </strong>The cardiac-related pulsatility signal from electrical impedance tomography (EIT) correlates with stroke volume in mechanically ventilated patients with acute respiratory distress syndrome (ARDS). However, in swine models, regional pulsatility amplitude was also shown to increase with downstream flow obstruction. We aimed to investigate the relationship between regional pulsatility and pulmonary hemodynamics in a cohort of severe ARDS patients on veno-venous extracorporeal membrane oxygenation (ECMO).</p><p><strong>Methods: </strong>We reanalysed data obtained from 20 ARDS patients receiving ECMO support. EIT was recorded 30 min after adjusting ECMO blood flow to target three ranges of mixed venous oxygen saturation (SvO₂) (70-75 %; 75-80 %; >80%), applied in random order. Ventilation was protective with PEEP 15[12-16] cmH₂O, Vt 4 ± 1 ml/kg PBW. Quality of EIT tracings allowed for separate modelling of pulsatility and ventilation in 16/20 patients. EIT units were calibrated to millilitres of tidal volume (ml*) using synchronised tidal volume measurements, allowing for between-patient comparisons. Mixed-effects modelling was employed to account for repeated measurements.</p><p><strong>Results: </strong>Across blood flow steps, pulsatility amplitude was directly related to stroke volume (SV) (β = 0.28 (0.06 - 0.5) ml*/mL, p = 0.014) and systolic pulmonary artery pressure (PAPs) (β = 0.47 (0.14 - 0.81) ml*/mmHg, p = 0.008) and inversely related to mixed venous oxygen tension (PvO₂) (β = -0.41 (-0.79--0.03) ml*/mmHg, p = 0.039). Changes in pulsatility had an 80% concordance rate with changes in SV and 83% with PAPs. At each ECMO blood flow step, there was a decrease in ventral lung pulsatility during inspiration (p < 0.01 for all steps). Moderate to strong correlations were observed between dorsal pulsatility and pulmonary artery pressure (ρ = 0.72, p = 0.001 at Low SvO₂; ρ = 0.59, p = 0.017 at Intermediate SvO₂; ρ = 0.81, p < 0.001 at High SvO₂).</p><p><strong>Conclusion: </strong>n severe ARDS patients on ECMO, pulsatility amplitude reflects stroke volume changes induced by positive intrathoracic pressures and mixed venous saturation targets. However, downstream flow obstruction appears to be the leading determinant in the dorsal lung and may be useful to monitor right heart loading in patients with ARDS.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100058"},"PeriodicalIF":5.5,"publicationDate":"2026-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13062515/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147670158","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":"Toward precision in diagnosing necrotic bowel: Gold standards and weighted risk stratification.","authors":"Xue Liu, Peng Liu","doi":"10.1016/j.aicoj.2026.100056","DOIUrl":"https://doi.org/10.1016/j.aicoj.2026.100056","url":null,"abstract":"","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100056"},"PeriodicalIF":5.5,"publicationDate":"2026-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13050025/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147621508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Authors' reply to Liu and Liu: Toward precision in diagnosing necrotic bowel.","authors":"Stefan Andrei, Philippe Montravers, Pascal Augustin","doi":"10.1016/j.aicoj.2026.100055","DOIUrl":"https://doi.org/10.1016/j.aicoj.2026.100055","url":null,"abstract":"","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100055"},"PeriodicalIF":5.5,"publicationDate":"2026-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13050027/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147621517","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 the PaO₂/FiO₂ ratio: Rethinking ARDS severity through the Lens of physiology.","authors":"Lou'i Al-Husinat, Raghad Khamis, Saif Azzam, Mohammad Trdeh, Basil Jouryyeh, Sarah Al Sharie, Mudhaffer Touqan, Ala' Alomari, Prashant Nasa, Marcus J Schultz, Patricia Rm Rocco, Denise Battaglini","doi":"10.1016/j.aicoj.2026.100057","DOIUrl":"https://doi.org/10.1016/j.aicoj.2026.100057","url":null,"abstract":"<p><p>Acute Respiratory Distress Syndrome (ARDS) is a heterogeneous clinical syndrome encompassing distinct physiological and biological patterns of lung injury. Despite this heterogeneity, the ratio of arterial oxygen partial pressure to inspired oxygen fraction (PaO₂/FiO₂) remains the cornerstone of ARDS definitions, severity classification, and clinical decision-making. While its simplicity has facilitated widespread use, the PaO₂/FiO₂ ratio incompletely reflects the underlying physiological mechanisms of hypoxemia and should not be interpreted as a stand-alone marker of disease severity. The PaO₂/FiO₂ ratio is highly sensitive to ventilator settings, particularly positive end-expiratory pressure (PEEP), exhibits nonlinear behavior at high inspired oxygen fractions, and provides only a static assessment of gas-exchange. Consequently, it fails to capture key dimensions of ARDS pathophysiology, including lung recruitability, mechanical heterogeneity, and the temporal evolution of injury and response to therapy. These limitations are increasingly relevant in contemporary intensive care, where ventilatory strategies and adjunctive therapies actively modify oxygenation independent of structural lung injury. In this narrative review, we critically re-examine the physiological assumptions underlying the PaO₂/FiO₂ ratio and evaluate its role in current ARDS practice. We synthesize evidence supporting alternative and complementary oxygenation metrics, such as PEEP-adjusted indices, the oxygenation index, and composite measures including the ROX index (SpO₂/FiO₂ adjusted for respiratory rate), emphasizing their physiological rationale, clinical interpretability, and practical limitations at the bedside. These metrics are discussed not as replacements, but as tools that may refine the contextual interpretation of hypoxemia. Beyond static oxygenation measures, we explore emerging paradigms that conceptualize ARDS severity as a dynamic, multidimensional construct, integrating longitudinal oxygenation trajectories with respiratory mechanics, imaging-based assessment of lung aeration, and biomarker-informed biological subphenotypes. Repositioning the PaO₂/FiO₂ ratio within this integrated physiological and biological framework may improve patient stratification, enhance the coherence of therapeutic decision-making, in line with the translational goals of modern intensive care.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100057"},"PeriodicalIF":5.5,"publicationDate":"2026-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13050034/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147621461","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}