Annals of Intensive Care最新文献

{"title":"Use of procalcitonin in therapeutic decisions in the pediatric intensive care unit.","authors":"Pierre Tissières, Elisabeth Esteban Torné, Johannes Hübner, Adrienne G Randolph, Corsino Rey Galán, Scott L Weiss","doi":"10.1186/s13613-025-01470-y","DOIUrl":"https://doi.org/10.1186/s13613-025-01470-y","url":null,"abstract":"<p><p>Procalcitonin (PCT) is frequently used by clinicians in children with suspected bacterial infections and sepsis. However interpretation in the critically ill child may be challenging due to the complexity of underlying conditions and its impact on PCT values. Herein, we propose a guidance for the use of procalcitonin in critically ill children, supported by a comprehensive analysis of the literature, to help the clinician for interpreting PCT in the various clinical conditions encountered in pediatric intensive care units. We describe the importance of the clinical context, timing of measurement and evidence on PCT values in diagnosing sepsis and to guide antibiotic therapy in critically ill children.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"55"},"PeriodicalIF":5.7,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12018671/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143957974","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":"Stewart's theory and acid-base changes induced by crystalloid infusion in humans: a randomized physiological trial.","authors":"Antonio Maria Dell'Anna, Domenico Luca Grieco, Cristina Dominedò, Marta Cicetti, Irene Cisterna, Rossano Festa, Rosa Lamacchia, Giuseppina Giannì, Nicoletta Filetici, Teresa Michi, Cristina Rossi, Francesca Danila Alcaro, Alessandro Mele, Aurora Rocchi, Demetrio Del Prete, Maria Concetta Meluzio, Francesco Ciro Tamburrelli, Marco Rossi, Massimo Antonelli","doi":"10.1186/s13613-025-01473-9","DOIUrl":"https://doi.org/10.1186/s13613-025-01473-9","url":null,"abstract":"<p><strong>Background: </strong>Stewart's acid-base theory states that, under isocapnic conditions, crystalloid infusion affects plasma pH due to changes in strong ion difference and total weak acid concentration: a comprehensive study also assessing renal response and hemodilution effects has not been conducted in humans. We aimed to evaluate Stewart's approach during crystalloid infusion in humans.</p><p><strong>Methods: </strong>In this randomized trial, patients undergoing surgery with minimal blood losses were randomized to receive to normal saline (chloride content 154 mEq/L, strong ion difference 0 mEq/L), lactated Ringer's (chloride content 112 mEq/L, strong ion difference 29 mEq/L) or Crystalsol (chloride content 98 mEq/L, strong ion difference 50 mEq/L): patients received 10 ml/kg immediately after intubation, and 20 ml/kg after 2 h. Plasma/urinary acid-base and electrolytes were measured before study start and then at prespecified timepoints. The primary endpoint was pH one hour after the second fluid bolus: secondary outcomes included urinary/plasmatic electrolyte concentrations and strong ion difference during the study.</p><p><strong>Results: </strong>Forty-five patients were enrolled (15 in each group). The extent of hemodilution achieved with the first (median [Interquartile range]: saline 9% [6-15], Ringer's 7% [4-9], Crystalsol 8% [5-12]) and the second fluid bolus (saline 13% [5-17], Ringer's 12% [9-15], Crystalsol 15% [10-20]) was not different between groups (p = 0.39 and p = 0.19, respectively). Patients in saline group received more chloride (449 mEq [383-495]) vs. Ringer's (358 mEq [297-419]) and Crystalsol groups (318 mEq [240-366]) (p = 0.001). One hour after the second bolus, pH was lower in saline group (7.34 [7.32-7.36]) vs. Ringer's (7.40 [7.35-7.43) and Crystalsol groups (7.42 [7.38-7.44]) (both p < 0.01), since plasma chloride increased significantly over time in saline group but not in Ringer's and Crystalsol groups. Overall chloride urinary excretion was not different between study groups (saline 36 mEq [28-64], Ringer's 42 mEq [29-68], Crystalsol 44 mEq [27-56], p = 0.60) but, at the end of experiments, urinary chloride concentration was higher and diuresis was lower in saline group vs. Ringer's and Crystalsol groups (p = 0.01, p = 0.04, respectively).</p><p><strong>Conclusions: </strong>Consistent with Stewart's approach, crystalloid solutions with high chloride content lower pH due to reduced strong ion difference, progressive hemodilutional acidosis and limited renal response to chloride load.</p><p><strong>Trial registration: </strong>Registered on clinicaltrials.gov (NCT03507062) on April, 24th 2018.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"54"},"PeriodicalIF":5.7,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12014888/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143959393","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":"Alcohol related hepatitis in intensive care units: clinical and biological spectrum and mortality risk factors: a multicenter retrospective study.","authors":"Maxime Gasperment, Léa Duhaut, Nicolas Terzi, Côme Gerard, Luc Haudebourg, Alexandre Demoule, Mialy Randrianarisoa, Vincent Castelain, Sacha Sarfati, Fabienne Tamion, Charlene Le Moal, Christophe Guitton, Gabriel Preda, Arnaud Galbois, Thibault Vieille, Gaël Piton, Marika Rudler, Guillaume Dumas, Hafid Ait-Oufella","doi":"10.1186/s13613-025-01450-2","DOIUrl":"https://doi.org/10.1186/s13613-025-01450-2","url":null,"abstract":"<p><strong>Background: </strong>Alcohol related hepatitis is responsible for high morbidity and mortality, but little is known about the management of patients with hepatitis specifically in intensive care units (ICU).</p><p><strong>Methods: </strong>Retrospective study including patients with alcohol related hepatitis hospitalized in 9 French ICUs (2006-2017). Alcohol related hepatitis was defined histologically or by an association of clinical and biological criteria according to current guidelines.</p><p><strong>Results: </strong>187 patients (median age: 53 [43-60]; male: 69%) were included. A liver biopsy was performed in 51% of cases. Patients were admitted for impaired consciousness (71%), sepsis (64%), shock (44%), respiratory failure (37%). At admission, median SOFA and MELD scores were 10 [7-13] and 31 [26-40] respectively. 63% of patients received invasive mechanical ventilation, 62% vasopressors, and 36% renal replacement therapy. 66% of patients received corticosteroids, and liver transplantation was performed in 16 patients (8.5%). ICU and in-hospital mortality were 37% and 53% respectively. By multivariate analysis, ICU mortality was associated with SOFA score (without total bilirubin) (SHR 1.08 [1.02-1.14] per one-point increase), arterial lactate (SHR 1.08 [1.03-1.13] per 1 mmol/L) and MELD score (SHR 1.09 [1.04-1.14] per 1 point), while employment was associated with increased survival (HR 0.49 [0.28-0.86]). After propensity score weighting, the use of corticosteroids did not affect ICU mortality in the overall population but had a beneficial effect in the subgroup of patients with histological proof. Patient prognosis was also better in responders assessed by Lille score at day 7 (OR 6.67 [2.44-20.15], p < 0.001).</p><p><strong>Conclusion: </strong>Alcohol related hepatitis is a severe condition leading to high mortality in ICU patients. Severity of organ failure at admission are mortality risk factors. Outcome was significantly better in responders to corticosteroids therapy according to Lille score. Early referral to tertiary centers to discuss liver transplantation should more widely be considered.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"53"},"PeriodicalIF":5.7,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11996726/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143952828","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 aminoglycosides on survival rate and renal outcomes in patients with urosepsis: a multicenter retrospective study.","authors":"David Rozenblat, Arnaud Serret-Larmande, Alexis Maillard, Romain Arrestier, Sarah Benghanem, Julien Charpentier, Michael Darmon, Vincent Das, François Dépret, Jean Luc Donay, Hervé Jacquier, Hélène Poupet, Jean-Michel Molina, Matthieu Lafaurie","doi":"10.1186/s13613-025-01469-5","DOIUrl":"https://doi.org/10.1186/s13613-025-01469-5","url":null,"abstract":"<p><strong>Background: </strong>Combination therapy with a beta-lactam and an aminoglycoside is currently recommended for the empirical treatment of urosepsis. Nephrotoxicity is the most common adverse effect of aminoglycosides and acute kidney injury (AKI) has a significant prognostic impact in septic shock. This study aimed to evaluate the impact of empirical antibiotic therapy with or without an aminoglycoside on survival and renal outcomes in patients admitted to the intensive care unit (ICU) with urosepsis.</p><p><strong>Methods: </strong>This multicenter, retrospective, comparative study included all adults admitted to the ICU for urinary sepsis or septic shock between January 2015 and May 2022 in four ICUs of three university hospitals within the Assistance Publique-Hôpitaux de Paris (APHP). The primary outcome was mortality on day 30 after ICU admission. Secondary endpoints included the lack of renal recovery, the need for new renal replacement therapy (RRT), the Major Adverse Kidney Events at day 30 (MAKE 30) and ICU length of stay. Confounding by indication was taken into account using propensity score weighting.</p><p><strong>Results: </strong>A total of 580 patients were included, median age was 69 years (interquartile: 58-77) and 53.6% were male. Overall, 335 patients (57.8%) were in septic shock and 448 (79.2%) had AKI on admission. A total of 579 patients (99.8%) received a beta-lactam as empirical therapy (with (n = 444) or without (n = 136) aminoglycosides). The overall 30-day mortality rate was 10.5% (61/580). After propensity score weighting, the mortality rate in patients receiving aminoglycosides was 7.7% (7/91) compared to 12.1% (11/91) in those not receiving aminoglycosides (adjusted hazard ratio (aHR) = 0.65 [0.35; 1.23], p = 0.19). No significant differences were found in the lack of renal recovery at day 30 (aHR = 0.88 [0.49; 1.58], p = 0.67), the need for new RRT within 30 days (aHR = 1.01 [0.54; 1.88], p = 0.97), MAKE 30 (aHR = 0.94 [0.60; 1.50], p = 0.81), and ICU length of stay among survivors (aHR = 1.07 [0.87; 1.31], p = 0.53).</p><p><strong>Conclusions: </strong>Including aminoglycosides in the empirical antibiotic therapy did not significantly improve 30-day survival in patients admitted to the ICU for urosepsis. However, the use of aminoglycosides was not associated with worse renal outcomes.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"52"},"PeriodicalIF":5.7,"publicationDate":"2025-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11992283/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143972553","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 all-cause mortality with different blood glucose control strategies in patients with diabetes in the ICU: a network meta-analysis of randomized controlled trials.","authors":"Xi Li, Jiahao Meng, Xingui Dai, Pan Liu, Yumei Wu, Shuhao Wang, Heng Yin, Shuguang Gao","doi":"10.1186/s13613-025-01471-x","DOIUrl":"https://doi.org/10.1186/s13613-025-01471-x","url":null,"abstract":"<p><strong>Background: </strong>The optimal glucose control strategy for intensive care unit (ICU) patients with diabetes remains a topic of debate. This study aimed to compare the effects of strict glucose control, intermediate strict glucose control, liberal glucose control, and very liberal glucose control on reducing all-cause mortality in ICU patients with diabetes through a network meta-analysis.</p><p><strong>Methods: </strong>We conducted a search in PubMed, Cochrane Library, Embase, and Web of Science for randomized controlled trials comparing different glucose control strategies in ICU patients with diabetes up to October 1, 2024. The primary outcome was all-cause 90-day mortality. The Risk of Bias 2 tool was used to assess bias in the included studies. Data analysis was performed using Stata (version 17).</p><p><strong>Results: </strong>A total of 12 randomized controlled trials involving 5,297 participants were included in the final analysis. The results showed that there was no statistically significant difference between the four glucose control strategies in reducing all-cause 90-day mortality. The surface under the cumulative ranking (SUCRA), which was used to rank the strategies and display the probability of each strategy being ranked first, showed the following: intermediate strict control (SUCRA 88%), liberal control (SUCRA 55.3%), very liberal control (SUCRA 40.3%), and strict control (SUCRA 16.5%). The cumulative probability of each strategy's rank in reducing all-cause mortality, from best to worst, showed that the most likely ranking was intermediate strict control, liberal control, very liberal control, and strict control.</p><p><strong>Conclusions: </strong>In ICU patients with diabetes, no significant statistical difference was observed among the four glucose control strategies in reducing all-cause 90-day mortality. The SUCRA rankings are hypothesis-generating and require further validation. Therefore, the current evidence is insufficient to definitively conclude that any one strategy is superior to the others in reducing mortality.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"51"},"PeriodicalIF":5.7,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11982002/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143972278","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":"Visual coronary artery calcification score to predict significant coronary artery stenosis in patients presenting with cardiac arrest without ST-segment elevation myocardial infarction.","authors":"Maxence Brunel, Brahim Harbaoui, Laurent Bitker, Carole Chambonnet, Matthieu Aubry, Loïc Boussel, Cyril Besnard, Jean-Christophe Richard, Pierre Lantelme, Pierre-Yves Courand","doi":"10.1186/s13613-025-01423-5","DOIUrl":"10.1186/s13613-025-01423-5","url":null,"abstract":"<p><strong>Background: </strong>Emergency coronary angiogram after a cardiac arrest without ST-segment elevation myocardial infarction (STEMI) is still a matter of debate. To better select patients who may benefit from this procedure, we tested a visual coronary artery calcification (VCAC) score available in chest CT to predict significant coronary artery stenosis and/or culprit lesion or ad hoc or delayed percutaneous coronary intervention (PCI).</p><p><strong>Results: </strong>A total of 113 patients with cardiac arrest and without STEMI who had a coronary angiogram and chest CT (January 2013 to March 2023, Croix-Rousse Hospital, Lyon, France) were retrospectively included. VCAC was scored from 0 (no calcification) to 3 (diffuse calcification) for each 4 four main arteries (left main, left anterior descending, circumflex, and right coronary artery). At baseline the median [interquartile range] age was 65.8 years [53.4-75.7], 61.9% were male, and 59.3% presented with ventricular fibrillation. Coronary angiogram identified at least one significant coronary artery stenosis in 32.7%, and ad hoc and delayed PCI were performed in 12.4% and 6.2% of the patients, respectively. VCAC score was an excellent predictor of significant coronary artery stenosis with an area under the ROC curve (AUC) of 0.95 (95%CI [0.90-1.00]) and the optimal threshold was ≥ 4 (specificity 94.7%, sensitivity 91.9%). For the detection of culprit coronary artery stenosis, the AUC was at 0.90 (95%CI [0.85-0.96]) and the optimal threshold was ≥ 5 (specificity 83.5%, sensitivity 87.5%). The AUC was 0.886 [0.823-0.948] (specificity 81.8%, sensitivity 85.7%) for ad hoc PCI and 0.921 [0.872-0.972] (specificity 85.3%, sensitivity 88.9%) for both delayed and ad hoc PCI with a same optimal threshold of VCAC ≥ 5. A VCAC score ≥ 4 had a sensitivity at 100% to predict a significant or culprit coronary artery stenosis and ad hoc or delayed PCI.</p><p><strong>Conclusions: </strong>The present study found that a non-dedicated CT thorax may be useful to measure VCAC and if this is scored ≥ 4 it allows physicians to better select patients resuscitated from cardiac arrest with non-STEMI and without history of coronary artery disease who may benefit from an emergency coronary angiogram to detect a significant or culprit coronary artery stenosis and had PCI if appropriate.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"50"},"PeriodicalIF":5.7,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11977084/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802332","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 versus conventional kidney replacement therapy initiation in tumor lysis syndrome: a target trial emulation.","authors":"Justine Serre, Guillaume Mulier, Charlotte Boud'hors, Marie Lemerle, Moustafa Abdel-Nabey, Corentin Orvain, Anis Chaba, Lucie Biard, Julien Demiselle, Lara Zafrani","doi":"10.1186/s13613-025-01439-x","DOIUrl":"10.1186/s13613-025-01439-x","url":null,"abstract":"<p><strong>Background: </strong>In the context of tumor lysis syndrome (TLS), the optimal timing and criteria for initiating kidney replacement therapy (KRT) remain unclear. This study aims to assess the effect of initiating KRT at various phosphatemia thresholds on Major Adverse Kidney Events at day 30 (MAKE30).</p><p><strong>Methods and results: </strong>We retrospectively emulated a pragmatic clinical trial comparing the effect of KRT initiation at various phosphatemia thresholds versus a conventional approach during TLS on MAKE30. All consecutive patients admitted to the ICU at Saint-Louis University hospital in Paris and Angers University hospital between January 2007 and June 2020, presenting with laboratory TLS were included. The design criteria of a clinical trial were mimicked by using the cloning, censoring and weighting method. The primary outcome was the MAKE30 composite outcome, considering only KRT requirement between day 7 and day 30 for the dialysis criteria. We evaluated multiple phosphatemia thresholds to guide KRT initiation, ranging from 6.20 mg.dL^-1 to 9.30 mg.dL^-1. Among the initial population of 220 patients, 192 were included in the emulated trial (median age 60 years old, with non-Hodgkin Lymphoma and Acute Leukemia being the most frequent hematological malignancies). TLS-related AKI occurred in 140 patients, and 75 patients met the criteria for MAKE30. Regardless of the phosphate threshold considered, KRT initiation based on phosphate level was not associated with a significant difference in the MAKE30 rate. KRT requirement during the first 7 days (Odd Ratio [OR] 4.01 [1.65-4.86], p = 0.003) and non-renal SOFA (OR 1.39 per 1 point increment [1.25-1.57], p < 0.001) were identified as factors associated with MAKE30 (multivariable analysis).</p><p><strong>Conclusion: </strong>Our results do not support the strategy of KRT initiation based on a sole critical phosphatemia level in TLS patients.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"49"},"PeriodicalIF":5.7,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11968619/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143778746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does Levosimendan hasten veno-arterial ECMO weaning? A propensity score matching analysis.","authors":"Nicolas Paulo, Antoine Kimmoun, David Hajage, Pierre Hubert, David Levy, Marc Pineton de Chambrun, Juliette Chommeloux, Ouriel Saura, Grégoire Del Marmol, Quentin Moyon, Guillaume Hékimian, Melchior Gautier, Charles Edouard Luyt, Guillaume Lebreton, Bruno Levy, Alain Combes, Matthieu Schmidt","doi":"10.1186/s13613-025-01457-9","DOIUrl":"10.1186/s13613-025-01457-9","url":null,"abstract":"<p><strong>Background: </strong>Preliminary evidence from small, single-center studies suggests levosimendan may improve the likelihood of successful venoarterial extracorporeal membrane oxygenation (VA-ECMO) weaning in patients with cardiogenic shock. However, the literature is limited and presents conflicting results. We aimed to assess the benefits of levosimendan on VA-ECMO for time to successful ECMO weaning, using a pragmatic and rigorous definition of successful VA-ECMO weaning in patients with potential for cardiac function recovery.</p><p><strong>Methods: </strong>A retrospective bicentric study over 6 years was conducted, including patients who received levosimendan during their ECMO course. Patients with post-cardiotomy cardiogenic shock or end-stage chronic heart failure were excluded. Patients receiving levosimendan while on VA-ECMO were matched to those not receiving levosimendan during the same period, based on pre-specified variables and time from ECMO initiation. The primary endpoint was successful VA-ECMO weaning, defined as survival without death, heart transplantation, or LVAD within 30 days after VA-ECMO withdrawal.</p><p><strong>Results: </strong>Over the study period, 320 patients treated with VA-ECMO for refractory cardiogenic shock were included, of whom 68 received levosimendan during their ECMO course. Propensity score matching yielded 47 unique pairs of patients with comparable characteristics. After matching, successful ECMO weaning was achieved in 16 out of 47 patients (34%) in the no-levosimendan group and 21 out of 47 patients (45%) in the levosimendan group (sHR, 1.45 [95% CI, 0.77-2.70]; P = 0.25). Similarly, there were no significant differences between the groups in terms of bridge-to-heart transplant, LVAD, or death. Left ventricular ejection fraction and aortic velocity time integral improved significantly after levosimendan in all patients, regardless of their VA-ECMO weaning status.</p><p><strong>Conclusion: </strong>In patients with non-postoperative cardiogenic shock supported by peripheral VA-ECMO, levosimendan was not associated with increased rates of successful VA-ECMO weaning or improved 30-day and 6-month bridge-free survival. Results from double-blinded randomized controlled trials are urgently needed to clarify the effectiveness and optimal timing of levosimendan in this specific population.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"48"},"PeriodicalIF":5.7,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11968594/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143778740","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":"Automatic continuous P_0.1 measurements during weaning from mechanical ventilation: a clinical study.","authors":"Delamaire Flora, Maamar Adel, Guillot Pauline, Quelven Quentin, Coirier Valentin, Painvin Benoit, Tadie Jean-Marc, Terzi Nicolas, Gacouin Arnaud","doi":"10.1186/s13613-025-01455-x","DOIUrl":"10.1186/s13613-025-01455-x","url":null,"abstract":"<p><strong>Background: </strong>In critically ill patients, weaning from mechanical ventilation (MV) includes spontaneous breathing trial (SBT) usually followed by a reventilation period in order to recover from the alveolar derecruitement induced by the SBT. The measurement of occlusion pressure during the first 100 ms of an airway occlusion (P_0.1) one of the non-invasive tools available for estimating the respiratory drive, is a determinant of patient respiratory effort. This clinical study explores the use of non-invasive continuous monitoring of occlusion pressure automatically calculated by ventilators in the first 100 ms of airway occlusion (P_0.1 vent) during SBT and reventilation periods. The study aimed to investigate patient or respirator factors influencing P_{0.1 vent} as well as the association of P_{0.1 vent} values with extubation success or failure.</p><p><strong>Patients and methods: </strong>This prospective observational study, conducted from February 2022 to April 2023, included adult patients intubated for more than 24 h and screened for extubation weaning. SBTs were performed for one hour with zero pressure support and zero end-expiratory pressure (PS0 ZEEP). Reventilation followed for an hour with pressure support (8-12 cmH₂O) and PEEP (5 cmH₂O). Data included patient characteristics, ventilator parameters and extubation outcomes.</p><p><strong>Results: </strong>The study involved 224 measurements from 212 patients, with 157 successful extubations, 46 extubation failures at day 7 and 21 SBT failures. P_{0.1 vent} mean values were significantly higher for extubation failures and SBT failures compared to successful extubations (p < 0.001). Delta P_{0.1 vent} ((P_{0.1 vent} reventilation - P_{0.1 vent} SBT)/ P_{0.1 vent} SBT) was significantly different according to whether extubation was a success or a failure: 0.21 (0.02-0.62) cm H₂O vs. P_{0.1 vent} vs. 1.12 (0.54-2.38) cm H₂O; p < 0.0001 respectively. Values significantly differed in both the SBT and the reventilation periods whether or not patients had previous ARDS: 1.08 (0.70; 2.02) cmH₂O vs. 0.80 (0.54; 1.28) cmH₂O respectively (p = 0.003). Noteworthy, P_{0.1 vent} values were influenced by airway humidification systems (0.92 (0.57; 1.54) cmH₂O with humidification vs. 1.27 (0.91; 2.24) cmH₂O without, p = 0.003).</p><p><strong>Conclusion: </strong>The delta of P_0.1vent values between SBT and reventilation are higher for patients who fail extubation, especially for those who had ARDS. While elevated P_{0.1 vent} values were associated with extubation failure, the overlap in values limits its usefulness as a reliable predictor.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"47"},"PeriodicalIF":5.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11961779/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750781","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":"Time-dependent effects of prone position on ventilation-perfusion matching assessed by electrical impedance tomography in patients with COVID-19 ARDS: sub-analysis of a prospective physiological study.","authors":"Yuxian Wang, Yaxiaerjiang Muhetaer, Xin Zheng, Wei Wu, Jiale Tao, Ling Zhu, Jieqiong Song, Zhanqi Zhao, Ming Zhong","doi":"10.1186/s13613-025-01452-0","DOIUrl":"10.1186/s13613-025-01452-0","url":null,"abstract":"<p><strong>Background: </strong>Prone positioning (PP) has been shown to improve oxygenation in patients with acute respiratory distress syndrome (ARDS); with a focus on its early physiological effects. However, the time-dependent effects of PP on ventilation-perfusion (V/Q) matching have not been fully investigated. In this study we aimed to investigate the longitudinal effects of PP on regional V/Q matching and the distribution of ventilation and perfusion in patients with coronavirus disease 2019 (COVID-19)-associated ARDS.</p><p><strong>Methods: </strong>This study analyzed patients with COVID-19 ARDS who were mechanically ventilated and underwent their first PP treatment. V/Q mismatching was assessed using electrical impedance tomography (EIT). At five intervals during the initial PP session PaO₂/FiO₂ measurements and EIT evaluations were performed including: before the initiation of PP while in the supine position (SP), 1 h after PP (PP₁), 3 h after PP (PP₃), 16 h after PP (PP_end), and 3 h after reverting to the supine position (RE-SP₃).</p><p><strong>Results: </strong>In this study eighteen COVID-19 ARDS patients were enrolled. In comparison with SP, PP led to significant improvements in oxygenation, with PaO₂/FiO₂ consistently increasing at each PP time point and peaking at PP_end. Dorsal ventilation significantly increased at PP₁ (P = .047), and steadily rose during PP, with a higher increase at PP_end than PP₁ (P < .001). Dorsal perfusion remained unchanged during the first three hours of PP; however, significantly increased by PP_end. Ventilation and perfusion returned to their baseline levels at RE-SP₃. PP increased normal V/Q (%), and decreased non-perfused (%), low V/Q (%), particularly in the dorsal lung regions, compared with SP. At RE-SP₃, there was a marked increase in the non-ventilated (%), low V/Q (%), and non-perfused (%) compared with PP. The global inhomogeneity (GI)-V/Q ratio was noted to have decreased during PP and correlated with an increase in PaO₂/FiO₂.</p><p><strong>Conclusions: </strong>In COVID-19-induced ARDS patients, prone positioning initially improves oxygenation and V/Q matching by enhancing ventilation distribution and decreasing low V/Q (%). Over time, perfusion changes further improve V/Q matching, but these benefits diminish once the patient returns to the supine position, leading to increased V/Q mismatch. Trial registration Clinical Trials.gov, NCT04725227. Registered 25 January 2021, https://clinicaltrials.gov/study/NCT04725227?cond=NCT04725227&rank=1.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"46"},"PeriodicalIF":5.7,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11958859/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750782","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}