Annals of Intensive Care最新文献

{"title":"Association between socio-economic status and outcomes among critically ill Covid-19 adult patients in France.","authors":"Diane Naouri, Naïke Bigé, Tai Pham, Martin Dres, Gaëtan Béduneau, Alain Combes, Antoine Kimmoun, Alain Mercat, Albert Vuagnat, Matthieu Schmidt, Alexandre Demoule, Matthieu Jamme","doi":"10.1186/s13613-025-01590-5","DOIUrl":"10.1186/s13613-025-01590-5","url":null,"abstract":"<p><strong>Introduction: </strong>Socio-economic inequalities have been identified as a potential risk factor for adverse outcomes in patients with Covid-19. In the specific setting of critical care, data are currently more controversial. The aim of our study is to assess the impact of social inequalities on the outcome of patients admitted to intensive care unit (ICU) for Covid-19 through a national French observational study.</p><p><strong>Methods: </strong>Based on the French administrative health care database, we identified all adults living in metropolitan France admitted in ICU for COVID-19 between March 1, 2020 and December 31, 2021. Two covariates were used to measure social vulnerability: an ecological deprivation index, the French deprivation index (Fdep), categorized in quintile (Q5 represented the most deprivated localization), and being a beneficiary of a complementary health coverage for the most deprived (CSS/AME beneficiary status). Primary outcome was in-hospital death. Secondary outcome was need for mechanical ventilation and post-acute care transfer in rehabilitation unit. Fine-Gray survival analysis or logistic regression were used according the competitive risk context. Three sensitivity analyses were performed: (1) restriction to patients admitted after January 1, 2021, adjusting for vaccination status; (2) multilevel logistic regression with a hospital-level random intercept; and (3) sex-stratified analyses.</p><p><strong>Results: </strong>There were 120 191 patients admitted to ICU with Covid-19 across metropolitan France. Among them, 29 580 (24.6%) patients lived in the most disadvantage areas and 12 462 (10.4%) were CSS/AME beneficiaries. In multivariate analysis, Fdep and CSS/AME beneficiary status were both associated with higher likelihood of in-hospital death (aSHR = 1,21 ; 95%CI = 1,16 - 1,27 for Fdep-Q5 and aSHR = 1,06 ; 95%CI = 1,01-1,11 for being beneficiary of CSS/AME) and need for invasive mechanical ventilation (aSHR = 1,16 ; 95%CI = 1,12 - 1,20 for Fdep-Q5 and aSHR = 1,06 ; 95%CI = 1,02 - 1,09 for being beneficiary of CSS/AME). Among survivors, a post-acute care transfer was negatively associated Fdep-Q5 in patients above 60 years (OR = 0.88; 95%CI = 0.81-0.94), in CSS/AME beneficiaries under 60 years (OR = 0.87; 95%CI = 0.80-0.98) as well as above 60 years (aSHR = 0.81; 95%CI = 0.74-0.88). Results were consistent across all sensitivity analyses.</p><p><strong>Conclusion: </strong>Social vulnerability was associated with higher hospital mortality, higher use of invasive mechanical ventilation and lower post-acute care transfer in rehabilitation unit in patients admitted to the ICU for COVID-19.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"159"},"PeriodicalIF":5.5,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12521692/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145285473","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-course changes in energy expenditure in sepsis: a prospective observational study.","authors":"Weronika Wasyluk, Robert Fiut, Izabela Świetlicka, Magdalena Szukała, Agnieszka Zwolak, Joop Jonckheer, Wojciech Dąbrowski","doi":"10.1186/s13613-025-01592-3","DOIUrl":"10.1186/s13613-025-01592-3","url":null,"abstract":"<p><strong>Background: </strong>Sepsis is associated with dynamic metabolic alterations influencing energy expenditure and substrate utilization. This study aimed to evaluate time-course changes in energy metabolism in critically ill patients with sepsis and identify clinical and nutritional predictors of resting energy expenditure (REE) and respiratory quotient (RQ).</p><p><strong>Methods: </strong>In this prospective observational study, 30 mechanically ventilated adult patients with sepsis were assessed using indirect calorimetry on days 1, 2, 3, 5, and 7 following diagnosis. Nutritional treatment, biochemical markers, and clinical variables were recorded. Linear mixed-effects models were applied to evaluate temporal changes and identify predictors of REE and RQ.</p><p><strong>Results: </strong>REE increased by Day 5 versus Day 1 (+ 163.7 kcal/day; p = 0.049), with a concurrent rise in RQ (p = 0.013). Higher body temperature, higher arterial pH, a greater protein-to-non-protein calorie ratio, and higher protein intake were associated with higher REE, whereas higher lactate concentrations and use of CRRT were associated with lower REE. RQ was positively associated with energy intake, REE coverage, and blood glucose. Clinical-severity scores and inflammatory markers showed no significant associations with REE or RQ.</p><p><strong>Conclusions: </strong>Energy metabolism in sepsis evolves dynamically, with significant changes in REE and substrate utilization over time. Temperature, acid-base balance, CRRT, and nutritional strategies were associated with variability in energy expenditure. These findings support the need for individualised metabolic assessment and targeted nutritional strategies in critically ill patients with sepsis.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"158"},"PeriodicalIF":5.5,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12521711/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145285245","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":"Where does the fluid go?","authors":"Robert G Hahn","doi":"10.1186/s13613-025-01579-0","DOIUrl":"10.1186/s13613-025-01579-0","url":null,"abstract":"<p><strong>Background: </strong>Liberal administration of crystalloid fluid is often required to maintain adequate tissue perfusion when treating life-threatening conditions. Current knowledge indicates that either overhydration or underhydration can promote complications. This review describes how fluid distributes between body compartments, with the aim of finding insights into pathophysiological mechanisms that can explain why fluid overload may cause complications and even be fatal.</p><p><strong>Main text: </strong>The skin, intestinal wall, and lungs are known primary locations of excess amounts of crystalloid fluid in humans. Microscopic studies in animals show that infusion of > 100 mL/kg of crystalloid fluid also causes interstitial dilatation and swelling of the heart, tissue breakup, and cardiac hypoxia. Volume kinetic analysis has identified several factors that promote peripheral edema during general anesthesia. Volume kinetics also shows that increasing volumes of crystalloid fluid sequentially expands three body fluid compartments: the plasma, a fast-exchange interstitial volume, and a more remote slow-exchange interstitial volume (in scientific jargon called \"the third fluid space\"). In settings of overhydration, the slow-exchange space operates as an overflow reservoir and quickly begins to accumulate fluid when the fast-exchange compartment has increased by 600-800 mL, which corresponds to infusing approximately 1.3-1.5 L of crystalloid fluid into the plasma over 30 min. Apart from overhydration, accumulation of fluid in the slow-exchange space occurs in inflammatory conditions, whereby cytokines and vasoactive molecules create a suction pressure that withdraws fluid from the fast-exchange space. This suction decreases lymphatic flow, causing hypovolemia and hypoalbuminemia in addition to peripheral edema. Preeclampsia and sepsis are examples of this complex kinetic situation. Albumin (20%), a hyper-oncotic colloid, might be used to modify peripheral edema by recruiting interstitial (lymphatic) fluid and stimulating diuresis.</p><p><strong>Conclusion: </strong>Excess amounts of crystalloid fluid accumulate in body regions, such as the skin and intestinal walls, that have a high compliance for volume expansion. The heart is potentially a key trouble spot in severe overhydration. Accumulation of fluid in an interstitial fluid space that equilibrates slowly with the plasma volume occurs in settings of overhydration and inflammation. Pathophysiological mechanisms that explain the complications and fatal outcomes of overhydration are insufficiently known in humans.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"156"},"PeriodicalIF":5.5,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12521718/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145285313","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":"Correction: Transplant-free survival in acute liver failure patients receiving MARS^®, plasma exchange or no liver support. A real-life 21-year retrospective cohort study in a referral center.","authors":"Kieran Pinceaux, Félicie Bélicard, Valentin Coirier, Estelle Le Pabic, Pauline Guillot, Flora Delamaire, Benoît Painvin, Quentin Quelven, Mathieu Lesouhaitier, Adel Maamar, Arnaud Gacouin, Pauline Houssel-Debry, Karim Boudjema, Edouard Bardou-Jacquet, Jean-Marc Tadié, Florian Reizine, Christophe Camus","doi":"10.1186/s13613-025-01574-5","DOIUrl":"10.1186/s13613-025-01574-5","url":null,"abstract":"","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"155"},"PeriodicalIF":5.5,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12514073/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145273505","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":"Management and monitoring strategies for severe cerebral malaria: a guide for the intensivist.","authors":"Sonila Vathi, Alberto Corriero, Edith Elianna Rodríguez, Anthony Moreau, Elisa Gouvea Bogossian, Marta Baggiani, Maya Hites, Romain Sonneville, Fabio Silvio Taccone, Michele Salvagno","doi":"10.1186/s13613-025-01584-3","DOIUrl":"10.1186/s13613-025-01584-3","url":null,"abstract":"<p><p>Severe malaria, caused by Plasmodium falciparum, poses a critical public health challenge, with cerebral malaria (CM) representing its most severe and life-threatening neurological manifestation. Defined by impaired consciousness (Glasgow Coma Score < 11) after the exclusion of other causes of encephalopathy, CM remains a critical condition with a mortality rate of 15-25% and long-term neurological sequelae in survivors. CM pathogenesis involves parasitized erythrocyte sequestration in cerebral microvasculature, immune hyperactivation, blood-brain barrier disruption, and cerebral edema, potentially leading to elevated intracranial pressure (ICP) and cerebral ischemia. These processes culminate in severe neurological injury, emphasizing the importance of ICP management in minimizing secondary brain damage. Neuromonitoring (NM) strategies, including invasive and non-invasive techniques, are critical yet underutilized in adults with CM due to limited evidence and logistical challenges. Treatment relies on antimalarial therapy, with intravenous artesunate as the first-line drug, supported by targeted interventions to manage seizures and systemic complications. Adjunctive therapies remain experimental, with no proven benefit in routine care. Emerging evidence from pediatric studies offers valuable insights, though significant gaps in adult-focused research persist. This review, which examines severe CM pathophysiology, clinical manifestations, and management, focusing on adult populations, underscores the need for tailored NM approaches, protocolized management strategies, and further investigation to improve outcomes in adults with CM, advocating for a multidisciplinary approach within the intensive care setting.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"154"},"PeriodicalIF":5.5,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12508328/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145249313","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":"Tidal volume and mortality during extracorporeal membrane oxygenation for acute respiratory distress syndrome: a multicenter observational cohort study.","authors":"Torben M Rixecker, Jeannine L Kühnle, Johannes Herrmann, Christopher Lotz, Christian Kühn, Frederik Seiler, Carlos Metz, Armin Kalenka, Oxana Mazuru, Kai Borchardt, Ralf M Muellenbach, Robert Bals, Matthieu Schmidt, Patrick Meybohm, Vitalie Mazuru, Philipp M Lepper","doi":"10.1186/s13613-025-01538-9","DOIUrl":"10.1186/s13613-025-01538-9","url":null,"abstract":"<p><strong>Background: </strong>Approximately half of the patients with acute respiratory distress syndrome (ARDS) receiving extracorporeal membrane oxygenation (ECMO) remain ECMO-dependent beyond 14 days after ECMO initiation. The identification of factors associated with mortality during an ECMO run may update prognostic assessment and focus clinical interventions.</p><p><strong>Methods: </strong>In this observational study, data from 1137 patients with COVID-19 ARDS receiving ECMO support in 29 German centers between January 1st 2020 and July 31st 2021 were analyzed. Multivariable stepwise logistic regression analyses were performed to build survival prediction models with day-by-day data during the first 14 days of an ECMO run. The primary endpoint was all-cause mortality in the intensive care unit.</p><p><strong>Results: </strong>Mortality in this cohort was high (75%). Patients who remained ECMO-dependent on day 14 of their ECMO run showed comparable mortality to all patients receiving ECMO support on day 1. Yet, factors associated with mortality changed during the first 14 days of ECMO support. On day 1 of ECMO support, only patient age and lactate remained in the final mortality prediction model. On day 14 of an ECMO run, tidal volume was independently associated with mortality (adjusted Odds Ratio 0.693 (95%CI 0.564-0.851), p < 0.001 for 1 mL/kg increase in tidal volume per predicted body weight). The adjusted mortality for patients with a tidal volume below 2 mL/kg on day 14 of their ECMO run was above 80% (lower limit of the 95%CI interval). Higher tidal volume was mainly based on higher respiratory system compliance. Yet, the benefit of higher compliance was not observed in some patients who were still ventilated with very low driving pressures despite remaining ECMO-dependent on day 14 of ECMO support.</p><p><strong>Conclusions: </strong>Mortality predictors change during the course of an ECMO run. In a cohort with high mortality, on day 14 of ECMO support for ARDS, tidal volume may be an independent predictor of mortality. Further analyses on ventilation strategies in patients who remain ECMO-dependent are needed.</p><p><strong>Trial registration number: </strong>DRKS00022964, retrospectively registered.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"151"},"PeriodicalIF":5.5,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12500509/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231318","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":"A reassessment of the impact of substance use disorder on outcomes in adolescent sepsis.","authors":"Xueneng Yang, Ruijuan Li","doi":"10.1186/s13613-025-01555-8","DOIUrl":"10.1186/s13613-025-01555-8","url":null,"abstract":"","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"153"},"PeriodicalIF":5.5,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12500482/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231090","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 history of substance abuse disorder in critically ill septic adolescent patients is associated with increased utilization of critical care resources and organ dysfunction.","authors":"Ning Zhuo","doi":"10.1186/s13613-025-01554-9","DOIUrl":"10.1186/s13613-025-01554-9","url":null,"abstract":"","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"152"},"PeriodicalIF":5.5,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12501077/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231241","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":"Transition phase in acute respiratory distress syndrome: paving the way for our next major challenge.","authors":"Anne-Fleur Haudebourg, Guillaume Carteaux","doi":"10.1186/s13613-025-01566-5","DOIUrl":"10.1186/s13613-025-01566-5","url":null,"abstract":"","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"148"},"PeriodicalIF":5.5,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12480186/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145190700","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":"Circulating biomarkers of vasoplegia: a systematic review.","authors":"Naomi Boyer, Prateek Upadhyay, Megan H Hicks, Alexander Zarbock, Ashish K Khanna, Lui G Forni, Benedict C Creagh-Brown","doi":"10.1186/s13613-025-01564-7","DOIUrl":"10.1186/s13613-025-01564-7","url":null,"abstract":"<p><strong>Background: </strong>Vasoplegia is characterised by persistent hypotension and reduced systemic vascular resistance despite preserved cardiac output, commonly arising in sepsis, following major surgery, and within systemic inflammatory responses. Despite its clinical significance and association with poor outcomes, there is no universally accepted definition or standardised biomarker, impeding early diagnosis, stratification, and targeted therapy. While individual studies have examined biomarkers within specific clinical contexts such as septic shock or cardiac surgery, no comprehensive synthesis across all aetiologies of vasoplegia has previously been undertaken.</p><p><strong>Objectives: </strong>To systematically evaluate and synthesise the current evidence regarding circulating biomarkers associated with the incidence, severity, prediction, and progression of vasoplegia across diverse critical care and perioperative populations. As well as review definitions used across literature.</p><p><strong>Methods: </strong>This systematic review was conducted in accordance with PRISMA 2020 guidelines and registered on PROSPERO (CRD42024438786). Studies were included if they investigated adult patients in critical care or perioperative settings with vasoplegia defined by reduced vascular resistance and hypotension requiring vasopressors.</p><p><strong>Results: </strong>A total of 43 studies met inclusion criteria. The included studies examined 39 unique biomarkers, with renin and adrenomedullin being the most frequently studied. Heterogeneity in definitions of vasoplegia, outcome measures, and comparator populations precluded meta-analysis. However, several biomarkers demonstrated potential clinical utility: elevated renin levels correlated with vasopressor requirements and haemodynamic instability, while adrenomedullin levels were predictive of vasoplegia development and duration.</p><p><strong>Conclusions: </strong>The lack of standardisation in biomarker assay methods and vasoplegia definitions remains a significant barrier to comparative analysis. Whilst this review highlights renin and adrenomedullin as promising candidate biomarkers for vasoplegia, the heterogeneity in study design, biomarker measurement, and diagnostic criteria underscores the urgent need for a consensus definition of vasoplegia, standardised sampling protocols, and unified outcome measures. Future research should focus on biomarker-guided risk stratification and personalised therapies, with an emphasis on validating predictive and mechanistic roles across diverse vasoplegic phenotypes.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"150"},"PeriodicalIF":5.5,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12480150/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145190731","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}