Annals of Intensive Care最新文献

{"title":"High blood pressure-targeted management associated with reduced benefits of higher body mass index in elderly patients with septic shock: a post hoc analysis of a multicenter randomized controlled trial.","authors":"Takashi Shimazui, Tadanaga Shimada, Takehiko Oami, Akira Endo, Kazuma Yamakawa, Takashi Tagami, Yutaka Umemura, Keiichiro Shimoyama, Taka-Aki Nakada","doi":"10.1016/j.aicoj.2026.100157","DOIUrl":"https://doi.org/10.1016/j.aicoj.2026.100157","url":null,"abstract":"<p><strong>Background: </strong>Body mass index (BMI) is an important prognostic factor in sepsis, and an obesity paradox has been reported. A higher mean arterial pressure (MAP) target has been associated with worse outcomes in elderly patients with septic shock. However, whether MAP target strategy alters the association between BMI and outcomes in this population is unknown.</p><p><strong>Methods: </strong>We conducted a post hoc analysis of the OPTPRESS trial, a multicenter randomized controlled trial at 29 Japanese centers reporting worse outcomes with a high MAP target in elderly patients with septic shock. A total of 489 patients aged ≥65 years with septic shock were assigned to a control MAP target of 65-70 mmHg (n = 245) or high target of 80-85 mmHg (n = 244). Patients were categorized using Asian BMI cutoffs into underweight (<18.5 kg/m²), normal-weight (18.5-22.9 kg/m²), and higher-BMI (≥23 kg/m²) categories. The primary outcome was 90-day mortality. The primary analysis assessed the interaction between BMI category and MAP target strategy.</p><p><strong>Results: </strong>In the control group, mortality decreased across increasing BMI categories (P = 0.03 for the trend), while no trend was observed in the high-target group (P = 0.26 for the trend). After adjustment for age, sex, APACHE II score, Clinical Frailty Scale, and site of infection, MAP target strategy significantly interacted with the higher-BMI category (P = 0.02), but not with underweight (P = 0.41). In the high-target group, both underweight and higher-BMI patients had higher mortality than those with normal BMI (underweight, adjusted HR 1.74 [95% CI 1.02-2.98], P = 0.04; higher BMI, adjusted HR 1.72 [95% CI 1.02-2.87], P = 0.04). Fluid volume per body weight decreased across increasing BMI categories in both groups. The proportion of patients receiving vasopressin increased across BMI categories only in the control group, whereas the body weight-adjusted vasopressin dose among recipients showed no significant trend in either group.</p><p><strong>Conclusions: </strong>In elderly patients with septic shock, mortality decreased across increasing BMI categories under a standard MAP target, whereas patients in the higher-BMI category had higher mortality under a high MAP target. High MAP targets may attenuate the survival benefit of higher BMI, possibly in association with BMI-related patterns in fluid and vasopressor management.</p><p><strong>Trial registration: </strong>Not registered. The original OPTPRESS trial was registered at UMIN Clinical Trials Registry (UMIN000041775) on 13 September 2020.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100157"},"PeriodicalIF":6.9,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13634275/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149102741","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 ventilator weaning: rethinking the role of tracheostomy in Guillain-Barré syndrome.","authors":"Clémence Marois, François Beloncle, Djillali Annane","doi":"10.1016/j.aicoj.2026.100155","DOIUrl":"https://doi.org/10.1016/j.aicoj.2026.100155","url":null,"abstract":"","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100155"},"PeriodicalIF":6.9,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13634294/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149102768","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":"Guidelines for the management of atrial fibrillation in adult patients admitted to an intensive care unit.","authors":"Vincent Labbé, Nadia Aissaoui, Pierre Asfar, François Bagate, Simon Bourcier, Stephane Ederhy, Julie Helms, Sami Hraiech, Jérémie Joffre, Adrien Joseph, Khaldoun Kuteifan, Armand Mekontso Dessap, Sebastien Preau, Louise-Marie Jandeaux","doi":"10.1016/j.aicoj.2026.100159","DOIUrl":"10.1016/j.aicoj.2026.100159","url":null,"abstract":"<p><p>Most existing recommendations for atrial fibrillation are derived from cardiology settings. However, atrial fibrillation is also highly prevalent among patients admitted to intensive care units and is associated with adverse clinical outcomes. Therefore, its management in this specific context warrants dedicated guidance. To address this need, The French Intensive Care Society has developed formalized expert recommendations using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. Twenty-four questions addressing the management of atrial fibrillation were evaluated in adult patients admitted to intensive care units. Of these, twenty-one focused specifically on new-onset atrial fibrillation, one addressed pre-existing atrial fibrillation, and two were applicable to both conditions. The assessment encompassed the role of transthoracic and transesophageal echocardiography, the management of potentially reversible triggers (optimization of fluid status, magnesium supplementation, serum potassium targets, and screening for thyroid dysfunction…), strategies for mitigating hemodynamic risk (indications and modalities for rhythm and rate control), and the management of thrombotic risk (indications, regimens, and duration of therapeutic anticoagulation). Eighteen recommendations were formulated, all of which achieved strong agreement among the expert panel. Only two recommendations were supported by a low level of evidence (GRADE 2+), whereas the remaining sixteen relied on evidence that could not be classified within the GRADE framework and were therefore issued as expert opinions. For six additional aspects of atrial fibrillation management, the experts concluded that the available evidence was insufficient to support the formulation of a reliable recommendation.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100159"},"PeriodicalIF":6.9,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13676918/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149219697","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":"Hypertensive crisis in the critically ill.","authors":"Julien Demiselle, Nans Florens, Sabrina Garnier-Kepka, Antonin Trimaille, Hamid Merdji","doi":"10.1016/j.aicoj.2026.100158","DOIUrl":"https://doi.org/10.1016/j.aicoj.2026.100158","url":null,"abstract":"<p><p>Hypertensive crises encompass a spectrum of clinical presentations ranging from severe asymptomatic blood pressure (BP) elevation to life-threatening hypertensive emergencies and represent a frequent and challenging situation in the critically ill. While hypertensive urgency, defined as a marked elevation in blood pressure without acute organ damage, can generally be managed in the outpatient setting, hypertensive emergencies require immediate in-hospital management. Hypertensive emergencies are defined by a BP ≥180/110 mmHg associated with acute target-organ damage. Malignant hypertension represents a distinct and severe subset, further characterized by microvascular complications including hypertensive retinopathy and fibrinoid necrosis affecting multiple organs. Initial evaluation is critical to decipher between hypertensive urgency and emergency, with a systematic screening for end-organ damage: cardiovascular system (heart, aorta, and large vessels), central nervous system, retina, and kidneys. The acuity of BP rise, rather than its absolute level alone, largely determines the risk of organ injury, underscoring the importance of a thorough clinical and paraclinical assessment. Once a hypertensive emergency is identified, prompt initiation of intravenous antihypertensive therapy is mandatory. Drug selection, target BP, and the rate of BP reduction must be individualized according to the specific type of end-organ damage. In this narrative review, we summarize current definitions and epidemiology of hypertensive emergencies, detail the clinical approach to initial assessment, and provide an etiology-based overview of management strategies with a focus on intravenous antihypertensive agents and BP targets. Finally, we emphasize the importance of structured long-term follow-up after the acute phase, including etiological workup and optimization of antihypertensive therapy, to prevent recurrence and target-organ failure.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100158"},"PeriodicalIF":6.9,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13634295/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149102736","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":"Prediction of noninvasive ventilation failure: a narrative review.","authors":"Xiaoqian Guo, Yifan Xia, Mengyi Ma, Yiwei Min, Jun Duan","doi":"10.1016/j.aicoj.2026.100156","DOIUrl":"https://doi.org/10.1016/j.aicoj.2026.100156","url":null,"abstract":"<p><p>With the increasing clinical application of noninvasive ventilation (NIV) and the accumulation of evidence-based medical data, NIV has become an important therapeutic intervention for various types of respiratory failure. However, a subset of patients still experience NIV failure. Compared with those with successful NIV, patients who develop NIV failure tend to have a poorer prognosis and an elevated risk of mortality. Therefore, the accurate identification and early prediction of NIV failure risk are crucial for guiding clinical decision-making and optimizing treatment strategies. This article reviews recent advances in research on the risk prediction of NIV failure, covering single-variable prediction approaches, simple variable combination-based prediction, weight-based multivariable prediction models, and emerging artificial intelligence algorithm-driven prediction models. Despite the progress made in NIV failure prediction, existing models still have limitations, such as insufficient generalizability, complex calculation of some multivariable scoring systems, and poor interpretability of artificial intelligence (AI) models. The core contribution of this review is to systematically sort out the advantages and limitations of various prediction methods, integrate prediction indicators and models suitable for different patient populations, and provide practical guidance for clinical practice and direction for future research.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100156"},"PeriodicalIF":6.9,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13656954/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178989","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":"When does IAPA begin? Interpreting corticosteroid dose thresholds in a target trial emulation.","authors":"Dilek Kuzukıran Kocataş","doi":"10.1016/j.aicoj.2026.100151","DOIUrl":"10.1016/j.aicoj.2026.100151","url":null,"abstract":"","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100151"},"PeriodicalIF":6.9,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13594628/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149023712","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":"Adherence to French guidelines on cuff leak test use across French intensive care units: a national survey.","authors":"Aimé Sao Cordiez, Benjamin Popoff, Dominique Vodovar, Gaëtan Beduneau","doi":"10.1016/j.aicoj.2026.100153","DOIUrl":"10.1016/j.aicoj.2026.100153","url":null,"abstract":"","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100153"},"PeriodicalIF":6.9,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13586743/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149007718","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":"Factors associated with treatment resumption and long-term outcomes after ICU discharge in patients with hematological malignancies.","authors":"Ondine Messéant, Mathilde Guégan, Benoît Painvin, Adel Maamar, Jean-Baptiste Mear, Jean Reignier, Emmanuel Canet, Jean-Marc Tadié, Soraya Benguerfi","doi":"10.1016/j.aicoj.2026.100152","DOIUrl":"https://doi.org/10.1016/j.aicoj.2026.100152","url":null,"abstract":"<p><strong>Purpose: </strong>Post-intensive care syndrome may result in persistent functional impairments that may jeopardize the feasibility of anticancer therapy in patients with hematological malignancies (HMs), thereby adversely affecting long-term survival. Our purpose was to identify factors associated with anticancer therapy resumption after ICU discharge and to assess five-year survival.</p><p><strong>Methods: </strong>This single-center retrospective observational study included consecutive adults with HMs admitted to intensive care unit (ICU) between 2014 and 2019. Multivariable analyses were performed to identify factors associated with anticancer treatment resumption and with survival.</p><p><strong>Results: </strong>We included 252 patients. The most common malignancies were aggressive lymphoma (n = 71, 28.2%), acute leukemia (n = 47, 18.7%), and multiple myeloma (n = 42, 16.7%). Performance status worsened significantly during the ICU stay (median change, -1.0; 95%CI, -1.0 to -1.0; <i>P</i> < 0.001). Of the 171 patients (67.9%) discharged alive from the ICU, 119 had an indication for further anticancer therapy; among them, 106 (89.1%) resumed treatment, although modifications of the regimen were required in 20/103 (19.4%). By multivariable analysis, cardiovascular disease was independently associated with a lower likelihood of treatment resumption (hazard ratio [HR], 0.41; 95%CI, 0.20-0.84; <i>P</i> = 0.014) and diagnosis of the HM during the ICU stay with a higher likelihood of treatment resumption (HR, 3.03; 95%CI, 1.53-6.01; <i>P</i> = 0.002). Survival rates after ICU admission were 50.0% at six months, 46.0% at one year, 41.3% at two years, 38.9% at three years, and 36.1% at five years. Factors independently associated with a lower risk of five-year mortality were infection (HR, 0.54; 95%CI, 0.33-0.87; <i>P</i> = 0.011), HM diagnosed during the ICU stay (HR, 0.31; 95%CI, 0.12-0.81; <i>P</i> = 0.018), and classification as other HMs (HR, 0.40; 95%CI, 0.19-0.86; <i>P</i> = 0.019).</p><p><strong>Conclusions: </strong>In patients with HMs, ICU survival was substantial and most deaths occurred during the ICU stay or within the first post-ICU year. Most survivors were able to resume anticancer therapy despite exhibiting functional decline. Long-term outcomes in survivors were primarily related to the nature of the underlying disease and to cardiovascular comorbidities. Both the oncological prognosis and the cardiovascular status should be considered when making intensive-care decisions.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100152"},"PeriodicalIF":6.9,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13598578/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149036044","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":"An augmented rehabilitation package incorporating immersive virtual reality during early recovery after ARDS: A randomized controlled trial.","authors":"Mengsun Li, Maoxian Yang, Han Sheng, Qianqian Wang, Ya Shen, Liyan Yang, Xuwen Wu, Zewei Jiang","doi":"10.1016/j.aicoj.2026.100154","DOIUrl":"https://doi.org/10.1016/j.aicoj.2026.100154","url":null,"abstract":"<p><strong>Background: </strong>Survivors of acute respiratory distress syndrome (ARDS) frequently experience cognitive impairment, psychological symptoms, and reduced health-related quality of life after intensive care. Immersive virtual reality (VR) may provide an engaging, multimodal adjunct to conventional rehabilitation, but evidence in the ARDS recovery population remains limited.</p><p><strong>Methods: </strong>In this single-center, parallel-group randomized controlled trial, 88 ARDS patients in the rehabilitation phase were randomized 1:1 to a 4-week augmented rehabilitation package incorporating immersive VR in addition to usual care (n = 44) or usual care alone (n = 44). One control participant was lost to follow-up, and 87 participants were included in the available-case analysis. The primary outcome was change in Montreal Cognitive Assessment (MoCA) score from baseline to 4 weeks. Secondary outcomes included the 36-Item Short Form Health Survey (SF-36) and Hospital Anxiety and Depression Scale (HADS) scores. The main between-group analysis used analysis of covariance (ANCOVA), with follow-up score as the dependent variable and baseline score as the covariate.</p><p><strong>Results: </strong>Baseline imbalances were observed for age, MoCA, SF-36, and HADS-A scores. After adjustment for corresponding baseline scores, the VR group showed greater improvement in MoCA score than the control group (adjusted between-group effect: 1.42, 95% CI 0.86-1.98; <i>p <</i> 0.001). The VR group also showed higher SF-36 scores (adjusted effect: 13.20, 95% CI 11.85-14.54; <i>p <</i> 0.001) and lower HADS-A scores (adjusted effect: -2.55, 95% CI -3.23 to -1.88; <i>p <</i> 0.001). In the VR group, 29 of 44 participants (65.9%) reported being very satisfied or satisfied with the intervention.</p><p><strong>Conclusions: </strong>An augmented rehabilitation package incorporating immersive VR was associated with short-term improvements in cognition, health-related quality of life, and anxiety symptoms during early ARDS recovery. Because the package also entailed additional structured rehabilitation exposure, staff attention, interaction, repeated activity, feedback, and treatment time, and because the control condition was not time- or attention-matched, the observed differences cannot be attributed specifically to VR. These single-center, short-term, hypothesis-generating findings require confirmation in larger studies with time- and attention-matched controls. Trial registration: Chinese Clinical Trial Registry, ChiCTR2600122078; retrospectively registered on 8 April 2026, after completion of participant recruitment.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100154"},"PeriodicalIF":6.9,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13634264/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149102795","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":"Author's reply: When does IAPA begin? Interpreting corticosteroid dose thresholds in a target trial emulation.","authors":"Peng Li","doi":"10.1016/j.aicoj.2026.100149","DOIUrl":"10.1016/j.aicoj.2026.100149","url":null,"abstract":"","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100149"},"PeriodicalIF":6.9,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13594638/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149023739","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}