Annals of Intensive Care最新文献

{"title":"Rethinking the \"transition phase\" in ARDS: can we afford to overlook the physiology behind NMBA weaning and PSV failure??","authors":"Nan Xiong, Yinde Huang","doi":"10.1186/s13613-025-01565-6","DOIUrl":"10.1186/s13613-025-01565-6","url":null,"abstract":"","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"147"},"PeriodicalIF":5.5,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12480303/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145190713","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 power normalisation methods to predict ICU mortality: a retrospective cohort study.","authors":"Reza Khorasanee, Barnaby Sanderson, Emilia Tomarchio, Patrick D Collins, Riccardo Del Signore, Sridevi Shetty, Mara Chioccola, Francesca Pugliese, Francesca Collino, Louise Rose, Lorenzo Giosa, Luigi Camporota","doi":"10.1186/s13613-025-01562-9","DOIUrl":"10.1186/s13613-025-01562-9","url":null,"abstract":"<p><strong>Background: </strong>The optimal mechanical ventilation strategy to minimise ventilator-induced lung injury (VILI) remains uncertain. Mechanical power (MP) is a key VILI determinant, but whether and how MP should be normalised to individual patient characteristics is unclear. In this study, we aimed to evaluate whether the discriminatory accuracy of MP for ICU mortality in mechanically ventilated patients improves when normalised to physiologically relevant variables that reflect individual susceptibility to VILI. We also explored whether the relationship between MP, MP_ratio, and mortality is linear or exhibits a threshold effect.</p><p><strong>Methods: </strong>In this retrospective observational study, we extracted granular electronic healthcare record data for mechanically ventilated adults in a single centre over a seven-year period. Primary exposures were MP with five normalisations: for dead space (expressed as corrected minute ventilation, ventilatory ratio, or end-tidal to arterial CO₂ ratio); aerated lung size (compliance), and normal idealised MP (MP_ratio). We used logistic regression to assess associations with ICU mortality. We calculated the Area Under the Receiver Operating Characteristic Curve (AUROC) to compare discriminative accuracy of individual models. Additionally, we evaluated the linearity or presence of a threshold for the relationships between MP, MP_ratio and ICU mortality.</p><p><strong>Result: </strong>We included 3,578 patients in our analyses. We found MP normalised to compliance (AUROC 0.71, 95% confidence interval (CI) 0.69-0.73, p = 0.007 (DeLong's test)) and MP_ratio (AUROC 0.71, 95% CI 0.68-0.73, p = 0.0014) performed better than MP alone (AUROC 0.69, 95% CI 0.66-0.71) for predicting ICU mortality. Other methods of MP normalisation were no more discriminative than MP without normalisation. The relationship between MP and MP_ratio with ICU mortality showed a statistically significant but small departure from linearity.</p><p><strong>Conclusions: </strong>Mechanical power normalised to compliance and MP_ratio had better discrimination for ICU mortality than MP, although the difference was modest and absolute predictive power remained limited.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"149"},"PeriodicalIF":5.5,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12480304/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145190753","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 assessment in post-cardiac arrest care: are physiological targets sufficient? : Author.","authors":"George Mannu","doi":"10.1186/s13613-025-01559-4","DOIUrl":"10.1186/s13613-025-01559-4","url":null,"abstract":"","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"136"},"PeriodicalIF":5.5,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12463786/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145147503","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":"Hitting the target or missing the point? A closer look at post-cardiac arrest guideline adherence.","authors":"Giulia Merigo, Fabiana Madotto, Aurora Magliocca, Giuseppe Ristagno","doi":"10.1186/s13613-025-01560-x","DOIUrl":"10.1186/s13613-025-01560-x","url":null,"abstract":"","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"139"},"PeriodicalIF":5.5,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12463790/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145147491","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: etiologies, management, and outcomes from a single-center experience over the last decade.","authors":"Julien Dessajan, Aude Gibelin, Matthias Barral, Nina de Montmollin, Vincent Labbé, Michel Djibré, Guillaume Voiriot, Matthieu Turpin, Antoine Parrot, Muriel Fartoukh","doi":"10.1186/s13613-025-01558-5","DOIUrl":"10.1186/s13613-025-01558-5","url":null,"abstract":"<p><strong>Background: </strong>Data on severe hemoptysis (SH) in the intensive care unit (ICU) remain scarce. We aimed to describe its clinical characteristics, etiologies, management strategies, and outcomes. This retrospective observational study analyzed patients admitted for SH to a referral center between 2009 and 2019. Data were compared to a historical cohort (1995-2009) using the Cochran-Armitage test.</p><p><strong>Results: </strong>A total of 945 patients (75% males; median age 55 years [IQR 42-65]) were analyzed; 67% had respiratory comorbidities. Invasive mechanical ventilation was required in 13% within 24 h of ICU admission. Lung cancer was the leading cause of SH, followed by bronchiectasis, tuberculosis, pneumonia, and aspergillosis. Compared with the historical cohort, pneumonia-related hemoptysis increased (11% vs. 5%; P < 0·001), as did pulmonary arterial involvement (12% vs. 5%; P < 0·001), mainly associated with pneumonia (23%), cancer, or aspergillosis (each 20%). Vascular interventional radiology (VIR) was first attempted in 81% of cases, achieving bleeding control in more than 90% of cases. Major adverse events occurred in 4.4% of cases. Emergent surgical lung resection (within 72 h) was performed in 2% of cases, all after VIR. In-hospital mortality rate increased slightly (8.7% vs. 6.5%; P = 0.08).</p><p><strong>Conclusions: </strong>Over the past decade, lung cancer became the leading cause of SH, with pneumonia increasingly contributing to pulmonary arterial involvement, reinforcing the need for multi-detector computed tomography angiography (MDCTA) screening. The high success rate of VIR confirms its key role, while surgery remains limited to rare cases. In-hospital mortality slightly increased, driven by a higher proportion of lung cancer.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"137"},"PeriodicalIF":5.5,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12463777/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145147577","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":"Sepsis-induced myocardial dysfunction diagnosed with strain versus non-strain echocardiography parameters: incidence, evolution and association with prognosis.","authors":"Filipe André Gonzalez, Jacobo Bacariza, Ana Rita Varudo, João Leote, Ricardo Meireles Mateus, Cristina Maia Martins, Maria Inês Ribeiro, Filippo Sanfilippo, Luís Rocha Lopes, Ana G Almeida","doi":"10.1186/s13613-025-01561-w","DOIUrl":"10.1186/s13613-025-01561-w","url":null,"abstract":"<p><strong>Background: </strong>Sepsis-induced myocardial dysfunction (SIMD) remains poorly defined due to scarce longitudinal studies with advanced echocardiography. We characterized SIMD progression using speckle tracking echocardiography (STE).</p><p><strong>Methods: </strong>Prospective single-center study in septic shock patients admitted to intensive care. SIMD was defined as any left ventricular (LV, systolic and/or diastolic) and/or right ventricular (RV) systolic dysfunction, using STE or non-STE criteria, on days 1, 7 and 30. We studied prevalence, evolution and prognosis of SIMD classified with either criteria using Cox regression.</p><p><strong>Results: </strong>Ninety-eight consecutive patients were included. On day 1, SIMD was identified in n = 57/98 (58.2%) and n = 70/98 (71.4%;p = 0.072) by non-STE and STE parameters, respectively. No significant difference in diagnosis was seen for LV diastolic dysfunction: n = 50/98 (51.0%, non-STE) vs. n = 51/98 (52.0%, STE; p = 1.00). Prevalences of LV and RV systolic dysfunction were not significantly higher with STE criteria: n = 59/98 (60.2%, STE) vs. n = 47/98 (48.0%, non-STE; p = 0.115) for LV; n = 39/98 (39.8%, STE) vs. n = 27/98 (27.6%, non-STE; p = 0.096) for RV. More patients recovered from SIMD when evaluated with non-STE criteria at day 7 (35.3% vs. 17.5% STE; p = 0.033), but not at day 30 (24.5% vs. 18.8% STE; p = 0.501). The 30-day mortality (n = 33/98, 33.7%) was associated with SIMD diagnosed using non-STE (p = 0.010), but not with STE (p = 0.057). In Cox regression, only LVDD by non-STE criteria predicted 30-day mortality (p = 0.005).</p><p><strong>Conclusions: </strong>The incidence of SIMD in septic shock is higher when using STE criteria, with lower reversibility in the first week. A broad definition of SIMD utilizing STE criteria does not seem to provide additional prognostic value.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov: NCT05552521 registered on the 20th of September 2022.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"141"},"PeriodicalIF":5.5,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12463772/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145147440","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":"Authors reply in response to a letter on \"impact of aminoglycosides on survival rate and renal outcomes in patients with urosepsis: a multicenter retrospective study\".","authors":"David Rozenblat, François Dépret, Matthieu Lafaurie","doi":"10.1186/s13613-025-01505-4","DOIUrl":"10.1186/s13613-025-01505-4","url":null,"abstract":"","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"140"},"PeriodicalIF":5.5,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12463773/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145147470","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: author's response.","authors":"Nicolas Massart, Marc Leone, Alain Lepape","doi":"10.1186/s13613-025-01571-8","DOIUrl":"10.1186/s13613-025-01571-8","url":null,"abstract":"","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"145"},"PeriodicalIF":5.5,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12463800/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145147526","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 intricate relationship between capillary refill time and systemic hemodynamics in septic shock.","authors":"Glenn Hernandez, Eduardo Kattan, Gustavo Ospina-Tascón, Sebastian Morales, Nicolás Orozco, Gustavo García-Gallardo, Macarena Amthauer, Jing-Chao Luo, Jan Bakker","doi":"10.1186/s13613-025-01563-8","DOIUrl":"10.1186/s13613-025-01563-8","url":null,"abstract":"<p><p>The emergence and validation of capillary refill time (CRT) as a resuscitation target together with its rapid kinetics of response to increases in systemic blood flow makes it the ideal variable to assess clinical reperfusion and the status of macro-to-microcirculatory coupling in septic shock. Moreover, previous studies have shown that resuscitation can be safely stopped after CRT normalization, thus decreasing the risk of over-resuscitation. From a physiological point of view, CRT is a complex variable integrating microvascular flow and reactivity. Additionally, it may be understood as a dynamic test that evaluates the preservation or disruption of normal responses of the microcirculation to maintain blood flow after transient ischemic challenges. The relationship between systemic hemodynamics and CRT is complex. Indeed, single time-point asssessments of CRT are not able to predict absolute cardiac output values and this is logical since they belong to different phsyiological categories. An abnormal CRT may be explained by insufficient macrohemodynamic resuscitation but also by several derangements at the microvascular level that may preclude CRT normalization, thus signaling a state of macro-to-microcirculatory uncoupling. CRT response to an acute fluid or mean arterial pressure challenge, may not only reveal the adequacy of systemic blood flow but also contribute to tailor interventions to personalize septic shock resuscitation. The lack of CRT response to these challenges discloses a more complex pathophysiological condition that is associated with higher mortality. Further research efforts should be focused on better understanding the factors associated with CRT non-response as a first step to develop a more phsyiologically-based resuscitation, that could eventually improve outcomes.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"135"},"PeriodicalIF":5.5,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12463805/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145147585","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":"Mental health outcomes at intensive care unit discharge: prevalence, mediators and risk factors.","authors":"Maryline Couette, Segolene Gendreau, Marie Charlotte Boishardy, Anne-Fleur Jean Baptiste, Paula Xavier, Keyvan Razazi, Romain Arrestier, Guillaume Carteaux, Nicolas De Prost, Stephane Mouchabac, Florian Ferreri, Armand Mekontso Dessap","doi":"10.1186/s13613-025-01545-w","DOIUrl":"10.1186/s13613-025-01545-w","url":null,"abstract":"<p><strong>Background: </strong>Intensive Care Unit (ICU) patients often experience significant discomfort and distress due to both the medical environment and the nature of their stay. While long-term sequelae such as depression, anxiety, and post-traumatic stress are well-documented, few studies have examined psychological disorders present at the time of ICU discharge. Based on the model of Post-Intensive Care Syndrome, specifically the mental component (PICS-M), we defined DICS-M (Discharge Intensive Care Syndrome - Mental component). This study aimed to estimate the prevalence of psychological disorders at ICU discharge and to identify potential mediators and risk factors.</p><p><strong>Methods: </strong>We conducted a prospective observational study involving 243 patients admitted between January 2023 and April 2024.</p><p><strong>Results: </strong>The prevalence of DICS-M was 53% [95% CI: 46-59], with acute stress, anxiety, and depression observed in 37%, 36%, and 23% of patients, respectively. The analyses revealed an overlap among these psychological components. Peritraumatic distress acted as the main mediator of DICS-M. Univariate and multivariable analyses identified female gender and a history of psychiatric and cardiac conditions as risk factors of DICS-M.</p><p><strong>Conclusion: </strong>Psychological disorders are common at ICU discharge, mediated by peritraumatic distress, and associated with identifiable risk factors. These findings may help guide interventions to prevent long-term sequelae of ICU stays.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"138"},"PeriodicalIF":5.5,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12463781/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145147472","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}