Annals of Intensive Care最新文献

{"title":"Combination of urinary biomarkers can predict cardiac surgery-associated acute kidney injury: a systematic review and meta-analysis.","authors":"Nikolett Kiss, Márton Papp, Caner Turan, Tamás Kói, Krisztina Madách, Péter Hegyi, László Zubek, Zsolt Molnár","doi":"10.1186/s13613-025-01459-7","DOIUrl":"https://doi.org/10.1186/s13613-025-01459-7","url":null,"abstract":"<p><strong>Introduction: </strong>Acute kidney injury (AKI) develops in 20-50% of patients undergoing cardiac surgery (CS). We aimed to assess the predictive value of urinary biomarkers (UBs) for predicting CS-associated AKI. We also aimed to investigate the accuracy of the combination of UB measurements and their incorporation in predictive models to guide physicians in identifying patients developing CS-associated AKI.</p><p><strong>Methods: </strong>All clinical studies reporting on the diagnostic accuracy of individual or combined UBs were eligible for inclusion. We searched three databases (MEDLINE, EMBASE, and CENTRAL) without any filters or restrictions on the 11th of November, 2022 and reperformed our search on the 3rd of November 2024. Random and mixed effects models were used for meta-analysis. The main effect measure was the area under the Receiver Operating Characteristics curve (AUC). Our primary outcome was the predictive values of each individual UB at different time point measurements to identify patients developing acute kidney injury (KDIGO). As a secondary outcome, we calculated the performance of combinations of UBs and clinical models enhanced by UBs.</p><p><strong>Results: </strong>We screened 13,908 records and included 95 articles (both randomised and non-randomised studies) in the analysis. The predictive value of UBs measured in the intraoperative and early postoperative period was at maximum acceptable, with the highest AUCs of 0.74 [95% CI 0.68, 0.81], 0.73 [0.65, 0.82] and 0.74 [0.72, 0.77] for predicting severe CS-AKI, respectively. To predict all stages of CS-AKI, UBs measured in the intraoperative and early postoperative period yielded AUCs of 0.75 [0.67, 0.82] and 0.73 [0.54, 0.92]. To identify all and severe cases of acute kidney injury, combinations of UB measurements had AUCs of 0.82 [0.75, 0.88] and 0.85 [0.79, 0.91], respectively.</p><p><strong>Conclusion: </strong>The combination of urinary biomarkers measurements leads to good accuracy.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"45"},"PeriodicalIF":5.7,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11953499/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143741867","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: Effect of early and later prone positioning on outcomes in invasively ventilated COVID-19 patients with acute respiratory distress syndrome: analysis of the prospective COVID-19 critical care consortium cohort study.","authors":"Andrew J Simpkin, Bairbre A McNicholas, David Hannon, Robert Bartlett, Davide Chiumello, Heidi J Dalton, Kristen Gibbons, Nicole White, Laura Merson, Eddy Fan, Mauro Panigada, Giacomo Grasselli, Anna Motos, Antoni Torres, Ferran Barbé, Pauline Yeung Ng, Jonathon P Fanning, Alistair Nichol, Jacky Y Suen, Gianluigi Li Bassi, John F Fraser, John G Laffey","doi":"10.1186/s13613-025-01466-8","DOIUrl":"10.1186/s13613-025-01466-8","url":null,"abstract":"","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"44"},"PeriodicalIF":5.7,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11950453/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143727517","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":"Amikacin use in critically ill patients requiring renal replacement therapy: the AMIDIAL-ICU study.","authors":"Vincent Dupont, Bruno Mourvillier, Coralie Barbe, Vincent Legros, Mathieu Jozwiak, Hamid Merdji, Claire Dupuis, Hadrien Winiszewski, Antoine Marchalot, Guillaume Lacave, Mathilde Neuville, Anne Sagnier, François Barbier, Carine Thivilier, Stéphanie Ruiz, Roland Smonig, Jeremy Rosman, Laurent Argaud, Steven Grangé, Benjamine Sarton, Patrick Chillet, Guillaume Voiriot, Lukshe Kanagaratnam, Zoubir Djerada","doi":"10.1186/s13613-025-01461-z","DOIUrl":"10.1186/s13613-025-01461-z","url":null,"abstract":"<p><strong>Background: </strong>Acute kidney injury (AKI) requiring renal replacement therapy (RRT) is common in intensive care units (ICUs), yet optimal amikacin dosing in this context remains poorly understood.</p><p><strong>Methods: </strong>We conducted a prospective observational study across 18 French hospitals from April 2020 to January 2022. Adult ICU patients (aged > 18 years) receiving their first amikacin dose while on RRT were included. Data on demographics, RRT modalities, amikacin dosing, and therapeutic drug monitoring were collected. Using a pharmacokinetic modeling approach, we evaluated various amikacin regimens and simulated target attainment probabilities across different minimum inhibitory concentrations (MICs).</p><p><strong>Results: </strong>A total of 111 patients were included, with approximately two-thirds receiving continuous RRT. The median amikacin dose was 27 (25-30) mg/kg. Amikacin peak (Cmax) and trough concentrations were monitored in 53 (47.8%) and 76 (68.5%) patients, respectively. Continuous RRT and a history of chronic kidney disease reduced dialytic clearance. For a MIC ≤ 4 mg/L, a 15 mg/kg amikacin dose achieved Cmax/MIC and AUC/MIC targets in ≥ 90% of patients on intermittent dialysis, while 20 mg/kg was required for those on continuous dialysis. For a MIC = 8 mg/L, a 30 mg/kg dose was necessary to achieve Cmax/MIC ≥ 8.</p><p><strong>Conclusions: </strong>Our findings highlight suboptimal adherence to amikacin monitoring guidelines in ICU patients on RRT. Using pharmacokinetic modeling, we identified amikacin dosing recommendations ranging from 15 to 35 mg/kg to optimize efficacy and minimize risks, depending on MIC and dialysis modality.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"42"},"PeriodicalIF":5.7,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11937451/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708130","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":"Ability of diastolic arterial pressure to better characterize the severity of septic shock when adjusted for heart rate and norepinephrine dose.","authors":"Antoine Goury, Zoubir Djerada, Glenn Hernandez, Eduardo Kattan, Romain Griffon, Gustavo Ospina-Tascon, Jan Bakker, Jean-Louis Teboul, Olfa Hamzaoui","doi":"10.1186/s13613-025-01454-y","DOIUrl":"10.1186/s13613-025-01454-y","url":null,"abstract":"<p><strong>Background: </strong>Septic shock is commonly associated with reduction in vasomotor tone, mainly due to vascular hyporesponsiveness to norepinephrine (NE). Although the diastolic arterial pressure (DAP)/heart rate (HR) ratio reflects vasomotor tone, it cannot be a reliable index of vascular responsiveness to NE (VNERi). We hypothesized that adjusting DAP/HR for the NE dose could yield a VNERi value (VNERi = DAP/(NE dose x HR)), knowledge of which can help guiding therapeutic strategies in cases of persistent hypotension despite NE (e.g., increasing NE doses vs. introducing additional vasopressors). For our hypothesis be valid, at least VNERi should demonstrate a stronger association with patient outcome than DAP, DAP/HR or mean arterial pressure (MAP)/NE dose, a global marker of NE responsiveness.</p><p><strong>Methods: </strong>We conducted a post-hoc analysis of the ANDROMEDA-SHOCK database. Hemodynamic variables and initial NE doses were recorded at the randomization time-point, within 4 h of septic shock diagnosis. NE doses were expressed in µg/kg/min (using the bitartrate NE formulation). A multivariate model was employed to compare the associations between these variables and key clinical outcomes, including in-hospital mortality, numbers of vasopressor-free days and of renal replacement therapy (RRT)-free days up to day 28.</p><p><strong>Results: </strong>The ANDROMEDA-SHOCK database included 424 patients with septic shock receiving NE. The median DAP was 52 mmHg [IQR: 45-50] and the median NE dose at inclusion was 0.2 µg/kg/min [IQR: 01-0.4]. In-hospital mortality was 43%. VNERi demonstrated the strongest association with in-hospital mortality compared to DAP, DAP/HR, and MAP/NE dose, emerging as the most significant covariate in the multivariate model. Similar findings were found for the associations with numbers of vasopressor-free days and RRT-free days up to day 28. The model revealed an inverted J-shaped relationship between in-hospital mortality and VNERi, with a nadir point at 6.7, below which mortality increased.</p><p><strong>Conclusions: </strong>In patients receiving NE during early septic shock, VNERi demonstrated the strongest association with outcome compared to DAP, DAP/HR, and MAP/NE dose. Due to its physiological basis and robust association with outcomes, VNERi may serve as a valuable bedside marker of the vascular responsiveness to NE. This index could potentially be integrated into decision-making of early septic shock.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"43"},"PeriodicalIF":5.7,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11937472/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708129","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":"Selective decontamination regimens in French ICUs: association with reduced infection and resistance emergence.","authors":"Nicolas Massart, Marc Leone, Florian Reizine, Gary Duclos, Anaïs Machut, Charles-Hervé Vacheron, Anne Savey, Emmanuelle Hammad, Arnaud Friggeri, Alain Lepape","doi":"10.1186/s13613-025-01465-9","DOIUrl":"10.1186/s13613-025-01465-9","url":null,"abstract":"<p><strong>Background: </strong>Despite randomized controlled trials with favorable results, few intensive care units (ICUs) implemented selective decontamination (SD) for ICU-acquired infection prevention. We aimed to evaluate, SD implementation and associated-effects in a large network of French ICUs.</p><p><strong>Methods: </strong>This study was conducted using the healthcare-associated infection surveillance cohort \"REA-REZO\" involving 193 participating ICUs. All patients receiving invasive mechanical ventilation for > 24 h were included. In addition to standard of care (SOC), six ICUs applied a SD strategy during the study period. The primary endpoint was the rate of ICU-acquired infection. A propensity-score matched analysis was conducted using non-parsimonious regression model. The secondary endpoint was the rate of colonization by multidrug resistant organisms (MDRO) during the ICU stay.</p><p><strong>Results: </strong>Among 81,661 patients with invasive mechanical ventilation for longer than 24 h, 2727 patients receiving SD were matched with 2 727 receiving SOC. The ICU-acquired infection incidence was lower in the SD group as compared with the SOC group (Incidence Rate Ratio = 0.66 [0.60-0.73]; p < 0.001) although the ICU mortality was similar (31.9% vs 32.5%, respectively p = 0.689). Acquisition of MDRO was lower in the SD group than in the SOC group (40 (1.5%) patients vs. 139 (5.1%) patients p < 0.001).</p><p><strong>Conclusions: </strong>These results showed that a strategy of SD was associated with reduced ICU-acquired infection incidence and decreased emergence of MDRO, while the mortality was not affected.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"41"},"PeriodicalIF":5.7,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11936853/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708184","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":"Anti-RNApol3-Associated myocarditis: an emerging disease linking autoimmunity and infection.","authors":"Paul Quentric, Jean-Luc Charuel, Quentin Moyon, Guillaume Hékimian, Karim Dorgham, François Lifermann, Mathieu Kerneis, Alexis Mathian, Karim Aacha, Isabelle Melki, Juliette Chommeloux, Matthieu Petit, Melchior Gautier, Pierre Bay, Philippe Rouvier, Etienne Charpentier, Omaira da Mata-Jardin, Lucie Lefevre, Christophe Parizot, Ouriel Saura, David Levy, Sofia Ortuno, Matthieu Schmidt, Charles-Edouard Luyt, Guy Gorochov, Zahir Amoura, Alain Combes, Marc Pineton de Chambrun","doi":"10.1186/s13613-025-01443-1","DOIUrl":"10.1186/s13613-025-01443-1","url":null,"abstract":"<p><strong>Background: </strong>Fulminant myocarditis (FM) is a severe condition primarily triggered by viruses. Anti-RNA polymerase III autoantibodies (RNApol3) which are typically found in patients with severe systemic sclerosis, have been reported in patients with influenza-related FM. Our objective is to provide additional insight into RNApol3-associated FM.</p><p><strong>Methods: </strong>We retrospectively included all patients admitted to our institution between January 2013 and June 2023 with acute myocarditis and positive serum RNApol3. We compared their characteristics, etiologies, and outcomes with those of a cohort of RNApol3 negative acute myocarditis.</p><p><strong>Results: </strong>Twenty-nine RNApol3-positive patients, comprising 83% females with a mean age of 39 ± 12 years, were included in this study. Each patient was admitted to the intensive care unit at least once and 11 (38%) relapsed. Triggers included influenza virus in 55% and SARS-CoV-2 virus in 48% of cases. The lowest left ventricular ejection fraction was 10 [5-10] % and the highest troponin value was 82 [22-360] times the ULN. Patients required dobutamine (94%), veno-arterial extracorporeal membrane oxygenation (85%) and pericardiocentesis (38%). At the last follow-up, 76% of patients were still alive, while 7% had undergone cardiac transplantation, and 3% required a left ventricular assist device. Compared to RNApol3-negative cases, RNApol3-positive myocarditis was associated with female gender, fulminant evolution, tamponade, a higher likelihood of being caused by a proven viral infection, and a higher rate of relapse.</p><p><strong>Conclusion: </strong>RNApol3-associated myocarditis is an emerging disease linking autoimmunity and infection and a unique cause of acquired, pathogen-specific, organ-specific immunodeficiency. RNApol3 should be screened in all cases of FM, especially in young women infected by RNA viruses. The risk of FM in RNApol3-positive systemic sclerosis needs further investigation.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"38"},"PeriodicalIF":5.7,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11930900/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143690918","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":"Effect of manual decongestive therapy on cardiac preload in critically ill patients: a randomized controlled trial.","authors":"Matthias J Posch, Christian I Schwer, Johannes Kalbhenn, Joachim Bansbach","doi":"10.1186/s13613-025-01453-z","DOIUrl":"10.1186/s13613-025-01453-z","url":null,"abstract":"<p><strong>Background: </strong>Capillary leakage is common in critical illness and can lead to intravascular hypovolemia and edema. Fluid balance, however, is crucial to optimize cardiac preload, vascular filling and tissue perfusion. Intravenously administered fluids are rapidly distributed to the extravascular spaces and further increase edema with consecutive harm for impeded wound healing, weakness, distribution of pharmaceutics to the third space and patient discomfort. We hypothesized that manual decongestive therapy (MDT) followed by elastic bandaging increases cardiac preload and reduces interstitial edema and thus, offers a promising approach to restore the imbalance in fluid distribution between the interstitium and the intravascular space in critically ill patients.</p><p><strong>Methods: </strong>From November 2021 to May 2023, 34 critical ill requiring advanced hemodynamic monitoring with thermodilution-calibrated pulse contour analysis were randomized to either standard care or MDT followed by elastic bandaging for 24 h. Global end-diastolic volume index (GEDI) as a marker of the cardiac preload was measured 15, 30, 60 min and 24 h after MDT. Wrist and ankle circumferences were measured as markers of the extent of local interstitial edema.</p><p><strong>Results: </strong>In the intervention group, a significant increase in Δ GEDI was observed 15 min [median 48 (IQR 82) to median -19 (IQR 39)], 60 min [median 75 (IQR 106.5) to median -11 (IQR80)] and 24 h [median 107 (IQR 153) to median -16 (IQR 114)] after the study intervention compared to the control group. After 24 h ankle [median 23.5 (IQR 5) cm to median 24 (IQR 6) cm, p < 0.0001] and wrist] median 18 (IQR 2) cm to median 19 (IQR 2) cm, p < 0.0001] circumferences were increased significantly in the control group. In the intervention group a significant reduction in the ankle circumference [median 24.5 (IQR 5) cm to median 24 (IQR 4.5) cm, p < 0.0001] and a significant reduction in the wrist circumference [median 20 (IQR 3.8) cm to median 18 (IQR 3.5) cm, p < 0.0001], was observed after 24 h.</p><p><strong>Conclusions: </strong>MDT increases cardiac preload and helps to reduce interstitial fluid overload and edema in critically ill patients.</p><p><strong>Trial registration: </strong>This prospective randomized controlled trial was registered at the German Clinical Trials Register DRKS00026226 on 17/09/2021.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"39"},"PeriodicalIF":5.7,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11933644/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143699385","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":"Alterations in the renin-angiotensin system during septic shock.","authors":"Camille Benaroua, Fabrizio Pucci, Marianne Rooman, Adrien Picod, Raphaël Favory, Matthieu Legrand, Jean-Louis Vincent, Jacques Creteur, Fabio Silvio Taccone, Filippo Annoni, Bruno Garcia","doi":"10.1186/s13613-025-01463-x","DOIUrl":"10.1186/s13613-025-01463-x","url":null,"abstract":"<p><strong>Background: </strong>Alterations in the classical Renin-Angiotensin Aldosterone System (RAAS) have been described during septic shock and are associated with patient outcomes. Since the alternative RAAS has also been reported to be altered in critically ill patients, and given that the RAAS can be modulated by specific therapeutics, such as angiotensin II, understanding its pathophysiology is of primary interest.</p><p><strong>Objective: </strong>To describe the alterations in the classical and alternative RAAS during septic shock in comparison with healthy controls.</p><p><strong>Methods: </strong>This prospective, monocentric, controlled study enrolled 20 patients fulfilling the septic shock diagnosis, as defined by the Sepsis-3 criteria, along with 30 controls. The main exclusion criteria were the use of any prior medication modifying the RAAS, prior liver failure (Child-Pugh score > 9), or chronic kidney disease (estimated glomerular filtration rate < 30 ml/min/1.73 m²). Equilibrium concentrations of RAAS peptides were analyzed using a liquid chromatography-mass spectrometry method from heparinized plasma. Circulating angiotensin-converting enzyme (cACE), cACE type 2 (cACE2) activities, and circulating dipeptidyl peptidase 3 (cDPP3) concentrations were assessed. Values were measured at diagnosis, 6 h after diagnosis and on days 1 and 3. The main timepoint of interest was 6 h after diagnosis. Values 6 h after diagnosis were compared to 30 controls.</p><p><strong>Results: </strong>In septic shock patients, increased concentrations of the main peptides of the classical and alternative RAAS were observed compared to controls, particularly angiotensin I (Ang I) and angiotensin-(1-7) (Ang-(1-7)). Additionally, there was a significant increase in the Ang I/Ang II ratio (1.16 [0.74-3.31] vs. 0.34 [0.25-0.43], p < 0.05) and the Ang-(1-7)/Ang II ratio (0.15 [0.08-1.30] vs. 0.03 [0.02-0.04], p < 0.05). We also observed a significant reduction in cACE activity (3.38 [2.29-6.8] vs. 7.89 [6.39-9.05] nmol Ang II/L/h), an increase in cACE2 activity (814 [669-1987] vs. 214 [132-293] pmol Ang-(1-7)/L/h), and increased cDPP3 concentrations (54.6 [35-142.2] ng/mL vs. 13.7 [11.9-15.4] ng/mL, all p < 0.05).</p><p><strong>Conclusions: </strong>Septic shock was associated with increased Ang I/Ang II and Ang-(1-7)/Ang II ratios, along with reduced cACE activity, increased cACE2 activity, and elevated cDPP3 concentrations compared to healthy controls.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"40"},"PeriodicalIF":5.7,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11933633/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143699372","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 of severe acute encephalopathy in the ICU: an expert consensus statement from the french society of intensive care medicine.","authors":"Romain Sonneville, Eric Azabou, Pierre Bailly, Sarah Benghanem, Gilles De Almeida Cardoso, Pierre Claquin, David Cortier, Augustin Gaudemer, Bertrand Hermann, Pierre Jaquet, Virginie Lambrecq, Camille Legouy, Stéphane Legriel, Thomas Rambaud, Benjamin Rohaut, Benjamine Sarton, Stein Silva, Tarek Sharshar, Fabio Silvio Taccone, Dominique Vodovar, Nicolas Weiss, Charles Cerf","doi":"10.1186/s13613-025-01436-0","DOIUrl":"10.1186/s13613-025-01436-0","url":null,"abstract":"<p><strong>Introduction: </strong>Acute encephalopathy in the ICU poses significant diagnostic, therapeutic, and prognostic challenges. Standardized expert guidelines on acute encephalopathy are needed to improve diagnostic methods, therapeutic decisions, and prognostication.</p><p><strong>Methods: </strong>The experts conducted a review of the literature, analysed it according to the GRADE (Grading of Recommendation, Assessment, Development and Evaluation) methodology and made proposals for guidelines, which were rated by other experts. Only expert opinions with strong agreement were selected.</p><p><strong>Results: </strong>The synthesis of expert work and the application of the GRADE method resulted in 39 recommendations. Among the 39 formalized recommendations, 1 had a high level of evidence (GRADE 1 +) and 10 had a low level of evidence (GRADE 2 + or 2-). These recommendations describe indication for ICU admission, use of clinical scores and EEG for diagnosis, detection of complications, and prognostication. The remaining 28 recommendations were based on expert consensus. These recomandations describe common indications for blood and CSF studies, neuroimaging, use of neuromonitoring, and provide guidelines for management in the acute phase.</p><p><strong>Conclusion: </strong>This expert consensus statement aims to provide a structured framework to enhance the consistency and quality of care for ICU patients presenting with acute encephalopathy. By integrating high-quality evidence with expert opinion, it offers a pragmatic approach to addressing the complex nature of acute encephalopathy in the ICU, promoting best practices in patient care and facilitating future research in the field.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"37"},"PeriodicalIF":5.7,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11926322/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143668753","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":"Severe hemoptysis associated with lung cancer in the ICU: recurrence and outcome.","authors":"Raphael Salvayre, Clément Hanotin, Antoine Parrot, Julien Dessajan, Alexandre Elabbadi, Nicolas Pasquier-Meunier, Muriel Fartoukh, Matthias Barral, Aude Gibelin","doi":"10.1186/s13613-025-01421-7","DOIUrl":"10.1186/s13613-025-01421-7","url":null,"abstract":"<p><strong>Background: </strong>Hemoptysis is a life-threatening event in the course of lung cancer (LC). The management of the most severe episodes of hemoptysis include medical measures and vascular interventional radiology (VIR). There are few data on initial clinical and radiological features associated with early bleeding recurrence, and its prognostic significance.</p><p><strong>Methods: </strong>A monocenter retrospective study involving patients admitted to the intensive care unit (ICU) between 2009 and 2020 for severe hemoptysis (SH) associated with LC and requiring VIR.</p><p><strong>Results: </strong>During the study period, 130 patients (85% males; 59.5 ± 5.3 yrs) with SH and non-small cell (78%) or small-cell (18%) LC were analysed. SH was inaugural in half of cases. A lower respiratory tract infection (LRTI) was microbiologically documented in 39% of cases. All patients received a first-line VIR, including systemic bronchial and non-bronchial arteriography with embolisation (n = 117) and/or pulmonary arterial vaso-occlusion (n = 20). Bleeding recurred in 34% cases, after 1 day [1-3] of initial VIR attempt. Overall, the 28-day, 6-month and 12-month mortality rates were 25.3%, 47.7% and 63%, respectively. Intravenous terlipressin prior to VIR (OR 4.43, p = 0.001) and LRTI (OR 2.93; p = 0.007) were independently associated with bleeding recurrence. Tumoral cavitation (HR 3.37; p = 0.004), Staphylococcus aureus infection (HR 8.3; p = 0.005) and bleeding recurrence (HR 2.68; p = 0.01) were independently associated with one-year mortality.</p><p><strong>Conclusion: </strong>Lung cancer-related SH is associated with a high rate of bleeding recurrence and a poor prognosis. The association of Staphylococcus aureus infection with recurrence and mortality raises the potential interest of the administration of antibacterial treatment in that context.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"33"},"PeriodicalIF":5.7,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11925840/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143668849","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}