Annals of Intensive Care最新文献

{"title":"Organ crosstalk and dysfunction in sepsis","authors":"André Borges, Luís Bento","doi":"10.1186/s13613-024-01377-0","DOIUrl":"https://doi.org/10.1186/s13613-024-01377-0","url":null,"abstract":"<p>Sepsis is a dysregulated immune response to an infection that leads to organ dysfunction. Sepsis-associated organ dysfunction involves multiple inflammatory mechanisms and complex metabolic reprogramming of cellular function. These mechanisms cooperate through multiple organs and systems according to a complex set of long-distance communications mediated by cellular pathways, solutes, and neurohormonal actions. In sepsis, the concept of organ crosstalk involves the dysregulation of one system, which triggers compensatory mechanisms in other systems that can induce further damage. Despite the abundance of studies published on ​​organ crosstalk in the last decade, there is a need to formulate a more comprehensive framework involving all organs to create a more detailed picture of sepsis. In this paper, we review the literature published on organ crosstalk in the last 10 years and explore how these relationships affect the progression of organ failure in patients with septic shock. We explored these relationships in terms of the heart–kidney–lung, gut-microbiome–liver–brain, and adipose tissue–muscle–bone crosstalk in sepsis patients. A deep connection exists among these organs based on crosstalk. We also review how multiple therapeutic interventions administered in intensive care units, such as mechanical ventilation, antibiotics, anesthesia, nutrition, and proton pump inhibitors, affect these systems and must be carefully considered when managing septic patients. The progression to multiple organ dysfunction syndrome in sepsis patients is still one of the most frequent causes of death in critically ill patients. A better understanding and monitoring of the mechanics of organ crosstalk will enable the anticipation of organ damage and the development of individualized therapeutic strategies.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":null,"pages":null},"PeriodicalIF":8.1,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142247803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Respiratory effects of prone position in COVID-19 acute respiratory distress syndrome differ according to the recruitment-to-inflation ratio: a prospective observational study","authors":"Christopher Lai, Rui Shi, Ludwig Jelinski, Florian Lardet, Marta Fasan, Soufia Ayed, Hugo Belotti, Nicolas Biard, Laurent Guérin, Nicolas Fage, Quentin Fossé, Thibaut Gobé, Arthur Pavot, Guillaume Roger, Alex Yhuel, Jean-Louis Teboul, Tai Pham, Xavier Monnet","doi":"10.1186/s13613-024-01375-2","DOIUrl":"https://doi.org/10.1186/s13613-024-01375-2","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background</h3><p>Improvements in oxygenation and lung mechanics with prone position (PP) in patients with acute respiratory distress syndrome (ARDS) are inconstant. The objectives of the study were (i) to identify baseline variables, including the recruitment-to-inflation ratio (R/I), associated with a positive response to PP in terms of oxygenation (improvement of the ratio of arterial oxygen partial pressure over the inspired oxygen fraction (PaO₂/FiO₂) ≥ 20 mmHg) and lung mechanics; (ii) to evaluate whether the response to the previous PP session is associated with the response to the next session.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>In this prospective, observational, single-center study in patients who underwent PP for ARDS due to COVID-19, respiratory variables were assessed just before PP and at the end of the session. Respiratory variables included mechanical ventilation settings and respiratory mechanics variables, including R/I, an estimate of the potential for lung recruitment compared to lung overinflation.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>In 50 patients, 201 PP sessions lasting 19 ± 3 h were evaluated. Neuromuscular blockades were used in 116 (58%) sessions. The PaO₂/FiO₂ ratio increased from 109 ± 31 mmHg to 165 ± 65 mmHg, with an increase ≥ 20 mmHg in 142 (71%) sessions. In a mixed effect logistic regression, only pre-PP PaO₂/FiO₂ (OR 1.12 (95% CI [1.01–1.24])/every decrease of 10 mmHg, <i>p</i> = 0.034) in a first model and improvement in oxygenation at the previous PP session (OR 3.69 (95% CI [1.27–10.72]), <i>p</i> = 0.017) in a second model were associated with an improvement in oxygenation with PP. The R/I ratio (<i>n</i> = 156 sessions) was 0.53 (0.30–0.76), separating lower- and higher-recruiters. Whereas PaO₂/FiO₂ improved to the same level in both subgroups, driving pressure and respiratory system compliance improved only in higher-recruiters (from 14 ± 4 to 12 ± 4 cmH₂O, <i>p</i> = 0.027, and from 34 ± 11 to 38 ± 13 mL/cmH₂O, respectively, <i>p</i> = 0.014).</p><h3 data-test=\"abstract-sub-heading\">Conclusions</h3><p>A lower PaO₂/FiO₂ at baseline and a positive O₂-response at the previous PP session are associated with a PP-induced improvement in oxygenation. In higher-recruiters, lung mechanics improved along with oxygenation. Benefits of PP could thus be greater in these patients.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":null,"pages":null},"PeriodicalIF":8.1,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142247804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biomarkers in acute kidney injury","authors":"Marlies Ostermann, Matthieu Legrand, Melanie Meersch, Nattachai Srisawat, Alexander Zarbock, John A. Kellum","doi":"10.1186/s13613-024-01360-9","DOIUrl":"https://doi.org/10.1186/s13613-024-01360-9","url":null,"abstract":"<p>Acute kidney injury (AKI) is a multifactorial syndrome with a high risk of short- and long-term complications as well as increased health care costs. The traditional biomarkers of AKI, serum creatinine and urine output, have important limitations. The discovery of new functional and damage/stress biomarkers has enabled a more precise delineation of the aetiology, pathophysiology, site, mechanisms, and severity of injury. This has allowed earlier diagnosis, better prognostication, and the identification of AKI sub-phenotypes. In this review, we summarize the roles and challenges of these new biomarkers in clinical practice and research.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":null,"pages":null},"PeriodicalIF":8.1,"publicationDate":"2024-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142247805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term major events after hospital discharge for out-of-hospital cardiac arrest","authors":"Sofia Ortuno, Wulfran Bougouin, Sebastian Voicu, Marine Paul, Jean-Baptiste Lascarrou, Sarah Benghanem, Florence Dumas, Frankie Beganton, Nicole Karam, Eloi Marijon, Xavier Jouven, Alain Cariou, Nadia Aissaoui","doi":"10.1186/s13613-024-01371-6","DOIUrl":"https://doi.org/10.1186/s13613-024-01371-6","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background</h3><p>Cardiac arrest remains a global health issue with limited data on long-term outcomes, particularly regarding recurrent cardiovascular events in patients surviving out-of-hospital cardiac arrest. (OHCA). We aimed to describe the long-term occurrence of major cardiac event defined by hospital admission for cardiovascular events or death in OHCA hospital survivors, whichever came first. Our secondary objective were to assess separately occurrence of hospital admission and death, and to identify the factors associated with major event occurrence. We hypothesized that patients surviving an OHCA has a protracted increased risk of cardiovascular events, due to both presence of the baseline conditions that lead to OHCA, and to the cardiovascular consequences of OHCA induced acute ischemia-reperfusion.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>Consecutive OHCA patients from three hospitals of Sudden Death Expertise Center (SDEC) Registry, discharged alive from 2011 to 2015 were included. Long-term follow-up data were obtained using national inter-regime health insurance information system (SNIIRAM) database and the national French death registry. The primary endpoint was occurrence of a major event defined by hospital admission for cardiovascular events and death, whichever came first during the follow-up. The starting point of the time-to-event analysis was the date of hospital discharge. The follow-up was censored on the date of the first event. For patients without event, follow-up was censored on the date of December, 29th, 2016.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>A total of 306 patients (mean age 57; 77% male) were analyzed and followed over a median follow-up of 3 years for hospital admission for cardiovascular event and 6 years for survival. During this period, 38% patients presented a major event. Hospital admission for cardiovascular events mostly occurred during the first year after the OHCA whereas death occurred more linearly during the all period. A previous history of chronic heart failure and coronary artery disease were independently associated with the occurrence of major event (HR 1.75, 95%CI[1.06-2.88] and HR 1.70, 95%CI[1.11-2.61], respectively), whereas post-resuscitation myocardial dysfunction, cardiogenic shock and cardiologic cause of cardiac arrest did not.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>Survivors from OHCA must to be considered at high risk of cardiovascular event occurrence whatever the etiology, mainly during the first year following the cardiac arrest and should require closed monitoring.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":null,"pages":null},"PeriodicalIF":8.1,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142183863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute respiratory distress syndrome in patients with hematological malignancies: a one-year retrospective nationwide cohort study","authors":"Pierre-Nicolas Bris, Vanessa Pauly, Véronica Orleans, Jean-Marie Forel, Pascal Auquier, Laurent Papazian, Laurent Boyer, Sami Hraiech","doi":"10.1186/s13613-024-01373-4","DOIUrl":"https://doi.org/10.1186/s13613-024-01373-4","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background</h3><p>Acute respiratory distress syndrome (ARDS) occurring in patients with hematological malignancies (HM) is a life-threatening condition with specific features. Mortality rate remains high but improvement has been described over the past several years. We aimed to describe characteristics and outcomes of ARDS in HM patients admitted in French ICUs (Intensive Care Units) during a one year-period. Data for this nationwide cohort study were collected from the French national hospital database (Programme de Médicalisation des Systèmes d’Information (PMSI)). All patients (18 years or older) admitted to French ICUs in 2017 and with a diagnosis of ARDS were included. Three groups were compared according to the presence of an HM, a solid cancer or no cancer. The primary endpoint was 90-day mortality. Secondary endpoints were the description of ICU management, etiologies of ARDS and mortality risk factors.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>A total of 12 846 patients with ARDS were included. Among them, 990 had HM and 2744 had a solid cancer. The main malignancies were non-Hodgkin lymphoma (NHL) (28.5%), acute myeloid leukemia (AML) (20.4%) and multiple myeloma (19.7%). Day-90 mortality in patients with HM was higher than in patients with no cancer (64.4% vs. 46.6% <i>p</i> = 0.01) but was not different from that of patients with solid cancer (64.4% vs. 61.4%,<i>p</i> = 0.09). Intubation rate was lower in patients with HM in comparison with both groups (87.7% vs. 90.4% <i>p</i> = 0.02 for patients with solid cancer and 87.7% vs. 91.3%; <i>p</i> &lt; 0.01 with no cancer). Independent predictors of mortality for patients with HM were a diagnosis of lymphoma or acute leukemia, age, a high modified SAPS II score, a renal replacement therapy, invasive fungal infection, and a septic shock. Bacterial pneumonia, extrapulmonary infections and non-invasive ventilation were protective.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>Mortality remains high in patients with HM admitted in ICU with ARDS in comparison with patients without cancer. Mortality predictors for this population were a diagnosis of lymphoma or acute leukemia, age, a high modified SAPS II score, a renal replacement therapy, invasive fungal infection and a septic shock.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":null,"pages":null},"PeriodicalIF":8.1,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142183864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of critical illness on continuation of anticancer treatment and prognosis of patients with aggressive hematological malignancies","authors":"Swann Bredin, Justine Decroocq, Clément Devautour, Julien Charpentier, Clara Vigneron, Frédéric Pène","doi":"10.1186/s13613-024-01372-5","DOIUrl":"https://doi.org/10.1186/s13613-024-01372-5","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background</h3><p>Maintaining the dose-intensity of cancer treatment is an important prognostic factor of aggressive hematological malignancies. The objective of this study was to assess the long-term outcomes of intensive care unit (ICU) survivors with acute myeloid leukemia (AML) or aggressive B-cell non-Hodgkin lymphoma (B-NHL) with emphasis on the resumption of the intended optimal regimen of cancer treatment.</p><h3 data-test=\"abstract-sub-heading\">Patients and methods</h3><p>We conducted a retrospective (2013–2021) single-center observational study where we included patients with AML and B-NHL discharged alive from the ICU after an unplanned admission. The primary endpoint was the change in the intended optimal cancer treatment following ICU discharge. Secondary endpoints were 1-year progression-free survival and overall survival rates. Determinants associated with modifications in cancer treatment were assessed through multivariate logistic regression.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Over the study period, 366 patients with AML or B-NHL were admitted to the ICU, of whom 170 survivors with AML (<i>n</i> = 92) and B-NHL (<i>n</i> = 78) formed the cohort of interest. The hematological malignancy was recently diagnosed in 68% of patients. The admission Sequential Organ Failure Assessment (SOFA) score was 5 (interquartile range 4–8). During the ICU stay, 30 patients (17.6%) required invasive mechanical ventilation, 29 (17.0%) vasopressor support, and 16 (9.4%) renal replacement therapy. The one-year survival rate following ICU discharge was 59.5%. Further modifications in hematologic treatment regimens were required in 72 patients (42%). In multivariate analysis, age &gt; 65 years (odds ratio (OR) 3.54 [95%-confidence interval 1.67–7.50], <i>p</i> &lt; 0.001), ICU-discharge hyperbilirubinemia &gt; 20 µmol/L (OR 3.01 [1.10–8.15], <i>p</i> = 0.031), and therapeutic limitations (OR 16.5 [1.83–149.7], <i>p</i> = 0.012) were independently associated with modifications in cancer treatment. Post-ICU modifications of cancer treatment had significant impact on in-hospital, 1-year overall survival and progression-free survival.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>The intended cancer treatment could be resumed in 58% of ICU survivors with aggressive hematological malignancies. At the time of ICU discharge, advanced age, persistent liver dysfunction and decisions to limit further life-support therapies were independent determinants of cancer treatment modifications. These modifications were associated with worsened one-year outcomes.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":null,"pages":null},"PeriodicalIF":8.1,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142183880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to: Impact of intensive prone position therapy on outcomes in intubated patients with ARDS related to COVID-19.","authors":"Christophe Le Terrier, Thaïs Walter, Said Lebbah, David Hajage, Florian Sigaud, Claude Guérin, Luc Desmedt, Steve Primmaz, Vincent Joussellin, Chiara Della Badia, Jean Damien Ricard, Jérôme Pugin, Nicolas Terzi","doi":"10.1186/s13613-024-01374-3","DOIUrl":"https://doi.org/10.1186/s13613-024-01374-3","url":null,"abstract":"","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11390987/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142279565","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":"Oxygen therapy in acute hypoxemic respiratory failure: guidelines from the SRLF-SFMU consensus conference.","authors":"Julie Helms, Pierre Catoire, Laure Abensur Vuillaume, Héloise Bannelier, Delphine Douillet, Claire Dupuis, Laura Federici, Melissa Jezequel, Mathieu Jozwiak, Khaldoun Kuteifan, Guylaine Labro, Gwendoline Latournerie, Fabrice Michelet, Xavier Monnet, Romain Persichini, Fabien Polge, Dominique Savary, Amélie Vromant, Imane Adda, Sami Hraiech","doi":"10.1186/s13613-024-01367-2","DOIUrl":"10.1186/s13613-024-01367-2","url":null,"abstract":"<p><strong>Introduction: </strong>Although largely used, the place of oxygen therapy and its devices in patients with acute hypoxemic respiratory failure (ARF) deserves to be clarified. The French Intensive Care Society (Société de Réanimation de Langue Française, SRLF) and the French Emergency Medicine Society (Société Française de Médecine d'Urgence, SFMU) organized a consensus conference on oxygen therapy in ARF (excluding acute cardiogenic pulmonary oedema and hypercapnic exacerbation of chronic obstructive diseases) in December 2023.</p><p><strong>Methods: </strong>A committee without any conflict of interest (CoI) with the subject defined 7 generic questions and drew up a list of sub questions according to the population, intervention, comparison and outcomes (PICO) model. An independent work group reviewed the literature using predefined keywords. The quality of the data was assessed using the GRADE methodology. Fifteen experts in the field from both societies proposed their own answers in a public session and answered questions from the jury (a panel of 16 critical-care and emergency medicine physicians, nurses and physiotherapists without any CoI) and the public. The jury then met alone for 48 h to write its recommendations.</p><p><strong>Results: </strong>The jury provided 22 statements answering 11 questions: in patients with ARF (1) What are the criteria for initiating oxygen therapy? (2) What are the targets of oxygen saturation? (3) What is the role of blood gas analysis? (4) When should an arterial catheter be inserted? (5) Should standard oxygen therapy, high-flow nasal cannula oxygen therapy (HFNC) or continuous positive airway pressure (CPAP) be preferred? (6) What are the indications for non-invasive ventilation (NIV)? (7) What are the indications for invasive mechanical ventilation? (8) Should awake prone position be used? (9) What is the role of physiotherapy? (10) Which criteria necessarily lead to ICU admission? (11) Which oxygenation device should be preferred for patients for whom a do-not-intubate decision has been made?</p><p><strong>Conclusion: </strong>These recommendations should optimize the use of oxygen during ARF.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11377397/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142131670","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":"Innate immune response in acute critical illness: a narrative review.","authors":"Laure Stiel, Alexandre Gaudet, Sara Thietart, Hélène Vallet, Paul Bastard, Guillaume Voiriot, Mehdi Oualha, Benjamine Sarton, Hatem Kallel, Nicolas Brechot, Louis Kreitmann, Sarah Benghanem, Jérémie Joffre, Youenn Jouan","doi":"10.1186/s13613-024-01355-6","DOIUrl":"10.1186/s13613-024-01355-6","url":null,"abstract":"<p><strong>Background: </strong>Activation of innate immunity is a first line of host defense during acute critical illness (ACI) that aims to contain injury and avoid tissue damages. Aberrant activation of innate immunity may also participate in the occurrence of organ failures during critical illness. This review aims to provide a narrative overview of recent advances in the field of innate immunity in critical illness, and to consider future potential therapeutic strategies.</p><p><strong>Main text: </strong>Understanding the underlying biological concepts supporting therapeutic strategies modulating immune response is essential in decision-making. We will develop the multiple facets of innate immune response, especially its cellular aspects, and its interaction with other defense mechanisms. We will first describe the pathophysiological mechanisms of initiation of innate immune response and its implication during ACI. We will then develop the amplification of innate immunity mediated by multiple effectors. Our review will mainly focus on myeloid and lymphoid cellular effectors, the major actors involved in innate immune-mediated organ failure. We will third discuss the interaction and integration of innate immune response in a global view of host defense, thus considering interaction with non-immune cells through immunothrombosis, immunometabolism and long-term reprogramming via trained immunity. The last part of this review will focus on the specificities of the immune response in children and the older population.</p><p><strong>Conclusions: </strong>Recent understanding of the innate immune response integrates immunity in a highly dynamic global vision of host response. A better knowledge of the implicated mechanisms and their tissue-compartmentalization allows to characterize the individual immune profile, and one day eventually, to develop individualized bench-to-bedside immunomodulation approaches as an adjuvant resuscitation strategy.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11371990/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142124594","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":"Mechanical ventilation settings during weaning from venovenous extracorporeal membrane oxygenation.","authors":"Maria Teresa Passarelli, Matthieu Petit, Roberta Garberi, Guillaume Lebreton, Charles Edouard Luyt, Marc Pineton De Chambrun, Juliette Chommeloux, Guillaume Hékimian, Emanuele Rezoagli, Giuseppe Foti, Alain Combes, Marco Giani, Matthieu Schmidt","doi":"10.1186/s13613-024-01359-2","DOIUrl":"10.1186/s13613-024-01359-2","url":null,"abstract":"<p><strong>Background: </strong>The optimal timing of weaning from venovenous extracorporeal membrane oxygenation (VV ECMO) and its modalities have been rarely studied.</p><p><strong>Methods: </strong>Retrospective, multicenter cohort study over 7 years in two tertiary ICUs, high-volume ECMO centers in France and Italy. Patients with ARDS on ECMO and successfully weaned from VV ECMO were classified based on their mechanical ventilation modality during the sweep gas-off trial (SGOT) with either controlled mechanical ventilation or spontaneous breathing (i.e. pressure support ventilation). The primary endpoint was the time to successful weaning from mechanical ventilation within 90 days post-ECMO weaning.</p><p><strong>Results: </strong>292 adult patients with severe ARDS were weaned from controlled ventilation, and 101 were on spontaneous breathing during SGOT. The 90-day probability of successful weaning from mechanical ventilation was not significantly different between the two groups (sHR [95% CI], 1.23 [0.84-1.82]). ECMO-related complications were not statistically different between patients receiving these two mechanical ventilation strategies. After adjusting for covariates, older age, higher pre-ECMO sequential organ failure assessment score, pneumothorax, ventilator-associated pneumonia, and renal replacement therapy, but not mechanical ventilation modalities during SGOT, were independently associated with a lower probability of successful weaning from mechanical ventilation after ECMO weaning.</p><p><strong>Conclusions: </strong>Time to successful weaning from mechanical ventilation within 90 days post-ECMO was not associated with the mechanical ventilation strategy used during SGOT. Further research is needed to assess the optimal ventilation strategy during weaning off VV ECMO and its impact on short- and long-term outcomes.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11374948/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142124595","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}