Annals of Intensive Care最新文献

{"title":"Management of hypercapnic acute respiratory failure with high-flow nasal cannula therapy: A narrative review.","authors":"Christophe Girault, Elise Artaud-Macari, Pierre-Louis Declercq, Jean-Pierre Frat, Jean-Damien Ricard, Arnaud W Thille, Gaëtan Béduneau","doi":"10.1016/j.aicoj.2026.100053","DOIUrl":"https://doi.org/10.1016/j.aicoj.2026.100053","url":null,"abstract":"<p><p>Hypercapnic acute respiratory failure (ARF) is a life-threatning condition and a leading cause of hospital admission, mainly in acute exacerbation of chronic obstructive pulmonary disease (COPD). Although non-invasive ventilation (NIV) currently represents the first-line ventilatory strategy in patients exhibiting hypercapnic ARF, NIV may fail primarily due to worsening of ARF, patient-ventilator asynchrony, interface intolerance, even cardiovascular instability. Consequently, the operating principles and physiological effects of HFNC could be interesting and useful for applying this technique to the management of hypercapnic ARF. Therefore, from a clinical point of view, HFNC could be used alone continuously as an alternative to standard oxygen therapy or NIV, either at the initial phase of hypercapnic ARF or after extubation. In addition, according to the severity and etiology of the underlying hypercapnic ARF, HFNC could also be used in combination with NIV during breaks of spontaneous breathing. In this narrative review, we aimed therefore to provide an updated overview of the physiological rationale and clinical evidence for using HFNC in patients with hypercapnic ARF, with a particular focus on acute exacerbations of COPD.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100053"},"PeriodicalIF":5.5,"publicationDate":"2026-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13051969/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147632132","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":"\"It changed the atmosphere, but how long will it last?\": healthcare professionals' experiences of an intervention to improve positive communication in intensive care.","authors":"Anita Barth, Maurizio Cecconi, Carole Boulanger, Elie Azoulay, Nancy Kentish Barnes","doi":"10.1016/j.aicoj.2026.100047","DOIUrl":"10.1016/j.aicoj.2026.100047","url":null,"abstract":"<p><strong>Background: </strong>Burnout among healthcare professionals (HCPs) working in intensive care units (ICUs) has reached alarming levels, with detrimental effects on staff well-being, patient care, and organizational functioning. The HELLO randomized controlled trial (RCT) tested a multicomponent intervention aimed at reducing burnout by promoting positive communication and teamwork. This qualitative study complemented the RCT by exploring participants' experiences and perceptions of the intervention, identifying barriers, facilitators, and factors influencing sustainability.</p><p><strong>Methods: </strong>This qualitative component was conducted alongside the HELLO cluster-RCT in ICUs across multiple countries. Data sources included (1) 1,155 pictures of messages placed in \"HELLO\" boxes and on noticeboards, and (2) 26 semi-structured interviews with 27 ICU professionals from 18 ICUs, conducted 4-5 months after the intervention. Data were analysed using thematic analysis.</p><p><strong>Results: </strong>Box messages from 26 ICUs in 20 countries revealed recurrent themes of appreciation, recognition, kindness, teamwork, and motivation, often expressed through short, personal notes of gratitude or encouragement. Interviews identified six overarching themes: understanding of the intervention and initial reactions; facilitators and barriers to implementation; focus on messages; local adaptations; immediate positive outcomes; and long-term potential outcomes. Participants reported improved team cohesion, communication, and workplace atmosphere, with leadership engagement emerging as a key facilitator. Barriers included scepticism, workload, and pre-existing workplace tensions. Although many perceived short-term benefits, most noted that the effects diminished over time unless reinforced through continued initiatives.</p><p><strong>Conclusions: </strong>This qualitative study provides insight into healthcare professionals' experiences of the HELLO intervention, highlighting perceived improvements in communication and team atmosphere, as well as challenges related to engagement, workload, and sustainability. These findings can inform future adaptations and implementation strategies for similar low-cost interventions in intensive care units.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov NCT06453616 (June 18, 2024).</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100047"},"PeriodicalIF":5.5,"publicationDate":"2026-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13015744/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147519676","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":"Systematic review, meta-analysis, and meta-regression of the association of serial leukocyte counts in critically ill patients and mortality.","authors":"Nishkantha Arulkumaran, Fiona Dewar, Gareth Ambler, Maria Del Pilar Arias Lopez, Claudia Dos Santos, Jan J De Waele, Jeffrey Lipman, José-Artur Paiva, Jean-Francois Timsit","doi":"10.1016/j.aicoj.2026.100054","DOIUrl":"10.1016/j.aicoj.2026.100054","url":null,"abstract":"<p><strong>Background: </strong>Serial leukocyte counts have been investigated as a prognostic marker in critical illness. Our aim was to explore which immune cell type (total leukocytes, neutrophils, lymphocytes or neutrophil: lymphocyte ration (NLR)) best predicted mortality in critically ill patients. To address this, we conducted a systematic review, meta-analysis, and meta-regression of studies published within the past 10 years, archived on PubMed and Embase. Only studies reporting immune cell counts in critically ill patients on admission and within the subsequent week were included. Meta-regression was conducted to assess the effect of illness severity (reflected by study mortality rate) and underlying diagnosis (with 'general ICU patients' as a reference group) on the difference between immune cell counts between survivors and non-survivors. Meta-analysis and meta-regression were performed using Stata (version 19.5, StataCorp) and data presented as mean difference with (95% confidence intervals).</p><p><strong>Results: </strong>Thirty studies including 26,441 reporting patient mortality were included. Neutrophil: lymphocyte ratio (NLR) best predicted mortality and was lower among survivors at on days 0-1 (-0.29 (-0.45 to -0.12), p = 0.001), 2-4 (-1.02 (-1.57 to -0.48), p < 0.001), and 5-7 (-0.69 (-1.00 to -0.38), p < 0.001). Lymphocyte count was higher at equivalent time points. Meta-regression of NLR suggest that heterogeneity between studies was partly explained by underlying illness severity on days 0-1 (mean difference decreases by 0.13 (0.05, 0.20) for a 10% increase in mortality, p = 0.001), but not at other time points. Underlying diagnosis did not explain heterogeneity between studies. We were unable to perform a meta-analysis investigating the association between leukocyte counts and secondary infections as only three studies reported this data.</p><p><strong>Conclusion: </strong>A higher NLR count was associated with increased mortality throughout the first week of critical illness. Further work is required to define of cut- off values using an ordinal scale of lymphocyte count that accurately reflects immune dysfunction and risk of mortality.</p><p><strong>Prospero registration number: </strong>: CRD42024514115.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100054"},"PeriodicalIF":5.5,"publicationDate":"2026-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13015758/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147519726","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 International, Prospective COSMOS (CytOSorb® TreatMent Of Critically Ill PatientS) Registry: Interim Results in Patients with Septic Shock.","authors":"Ricard Ferrer, Thomas Kirschning, Moritz Unglaube, Ulf Guenther, Julian Kreutz, Matthias Thielmann, Andreas Baumann, Andreas Kribben, Dietrich Henzler, Nuno Germano, Aschraf El-Essawi, Filippo Aucella, Thomas Guenther, Martin Bellgardt, Bartosz Tyczynski, P Christian Schulze, Gabriella Bottari, Jorge Hidalgo, Jean-Louis Teboul, Dana Tomescu, Teresa Klaus, Weihong Fan, Joerg Scheier, Efthymios N Deliargyris, Fabio Silvio Taccone","doi":"10.1016/j.aicoj.2026.100052","DOIUrl":"10.1016/j.aicoj.2026.100052","url":null,"abstract":"<p><strong>Background: </strong>The international prospective COSMOS Registry (NCT05146336) collects real-world data on CytoSorb® (CS) hemoadsorption utilization patterns and outcomes in critically ill patients. This analysis focuses on patients with septic shock.</p><p><strong>Methods: </strong>Following informed consent, data was systematically collected before, during, and after CS treatment. Time frame of data collection was from the initiation of COSMOS study enrollment (July 15, 2022) to date of data extraction (May 7, 2025). Study follow-up extended to 90 days. We compared details on vasopressor requirements, fluid balance, and P/F ratio before and after CS treatment. APACHE II was assessed at ICU admission, while SOFA scores were determined at the start and end of CS therapy. Safety of the device was assessed based on investigator-reported device-related adverse effects. Data are presented as either mean ± standard deviation or as median with interquartile ranges (IQR).</p><p><strong>Results: </strong>A total of 140 patients (mean age of 61 ± 15 years, 33% female) at 18 study sites treated for septic shock was analyzed. On admission, median APACHE II score was 24 [18,30], SOFA score was 13 [11,15] and Charlson scores of 4 [2,6]. CS therapy was applied as part of kidney replacement therapy (KRT, 85%), standalone hemoperfusion (10%) or extracorporeal membrane oxygenation (ECMO, 5%). On average, each patient received 2.8 ± 2.2 adsorbers, with 47% receiving three or more. CS therapy was associated with a significant reduction in interleukin (IL)-6 levels (from 2,013 [219, 39,988] to 108 [75, 1,662] pg/mL, p < 0.0001) and noradrenaline requirement (0.23 [0.09, 0.43] to 0.07 [0.02, 0.22] µg/kg/min, p < 0.0001), reduced fluid balance (+1,386 [-15, 2,960] to +59 [-738, 1,614] mL, p < 0.0001), and improved oxygenation (P/F ratio 120 [70, 208] to 172 [114, 257], p = 0.0003). CS therapy was also associated with a significantly reduced platelet count (123 [86, 182] to 66 [37, 121] ×10⁹/L, p < 0.0001). Overall SOFA score did not change significantly (p = 0.65), however, system-specific SOFA scores improved significantly for respiratory, cardiovascular and renal sub-scores, while coagulation worsened. Observed ICU mortality was 32.4%. No serious adverse device effects or dysfunctions were reported.</p><p><strong>Conclusions: </strong>In this Registry, CytoSorb® therapy was associated with significant early clinical benefits in patients with septic shock, including hemodynamic stabilization and improved fluid balance. Further systematic research is needed to optimize its use and identify patient populations that benefit most.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100052"},"PeriodicalIF":5.5,"publicationDate":"2026-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13015761/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147519774","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":"Relation between initial hypothermia, course of the hypothermia and mortality in patients with septic shock: a post-hoc analysis of the SEPSISPAM randomized trial.","authors":"Louis Bordeau, Valérie Seegers, Julien Demiselle, Frédérique Schortgen, Fabien Grelon, Bruno Mégarbane, Nadia Anguel, Jean-Paul Mira, Pierre-François Dequin, Soizic Gergaud, Nicolas Weiss, François Legay, Yves Le Tulzo, Marie Conrad, Remi Coudroy, Frédéric Gonzalez, Christophe Guitton, Fabienne Tamion, Jean-Marie Tonnelier, Jean Pierre Bedos, Thierry Van Der Linden, Antoine Vieillard-Baron, Eric Mariotte, Gaël Pradel, Olivier Lesieur, Jean-Damien Ricard, Fabien Hervé, Damien du Cheyron, Claude Guerin, Alain Mercat, Jean-Louis Teboul, Peter Radermacher, Pierre Asfar, Nicolas Fage","doi":"10.1016/j.aicoj.2026.100051","DOIUrl":"10.1016/j.aicoj.2026.100051","url":null,"abstract":"<p><strong>Background: </strong>In patients with septic shock as well as in the critically ill, the impact of hypothermia and core temperature changes during the first 24 h on mortality remains uncertain. In this <i>post-hoc</i> analysis of the SEPSISPAM trial, we investigated the association between hypothermia at inclusion, hypothermia trajectories and 90-day mortality in patients with septic shock.</p><p><strong>Methods: </strong>This <i>post-hoc</i> analysis of the SEPSISPAM trial included patients with septic shock enrolled within 6 h of vasopressors initiation. Core temperature was assessed every 2 h during the first 24 h. Hypothermia was defined by a temperature <36 °C. Mortality was assessed at day 90.</p><p><strong>Results: </strong>We included 691 patients from the SEPSISPAM trial, of whom 103 (14.9%) presented with hypothermia at inclusion. After adjustment for confounding factors, as compared with patients without hypothermia at inclusion, patients with hypothermia at inclusion had a higher mortality (HR 1.92, 95% CI [1.38-2.67], p < 0.001). Three groups of patients were identified according to the evolution of their core temperature: \"without hypothermia\" (86.6%), i.e., patients without any hypothermia during the first 24 h; \"transient hypothermia\" (10%), i.e., patients with hypothermia at inclusion and becoming normothermic during the first 24 h, and \"persistent hypothermia\" (3.4%), i.e., patients with sustained hypothermia both at inclusion and during the first 24 h. Compared with patients without hypothermia, the \"persistent hypothermia\" group had the highest mortality rate at day 90 (78.3%, HR 2.83 [1.62-4.95], p < 0.0001). Mortality at day 90 increased according to temperature trajectories, being highest in patients with persistent hypothermia (78%), followed by those with transient hypothermia (49%), and lowest in patients without hypothermia (40%).</p><p><strong>Conclusion: </strong>In patients with septic shock, hypothermia at inclusion and persistence of hypothermia during the first 24 h were associated with higher mortality at day 90. Mortality increased according to the course of hypothermia during the first 24 h, being highest in patients with persistent hypothermia, followed by those with transient hypothermia, and lowest in patients who never developed hypothermia.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100051"},"PeriodicalIF":5.5,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13015728/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147519664","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":"Determinants of time to decannulation and predictors of early weaning from tracheostomy: a multicenter, retrospective Italian cohort study.","authors":"Dejan Radovanovic, Fabiano Di Marco, Michele Mondoni, Claudia Crimi, Andrea Gramegna, Marina Gatti, Juan Camilo Signorello, Federico Raimondi, Cristina Albrici, Giorgio Morana, Francesco Bruno Arturo Blasi, Pierachille Santus","doi":"10.1016/j.aicoj.2026.100050","DOIUrl":"10.1016/j.aicoj.2026.100050","url":null,"abstract":"<p><strong>Background: </strong>Weaning from tracheostomy is largely left to experts' opinion. Shared and validated protocols for decannulation are lacking, and procedures during the weaning process depend upon clinical judgement. Determinants of tracheostomy decannulation in real life are largely unknown.</p><p><strong>Methods: </strong>This was a retrospective, observational, multicenter study. Patients that underwent endotracheal intubation, percutaneous or surgical tracheostomy and at least a decannulation trial between 2017 and 2023 were recruited from five academic hospitals in Italy. Clinical characteristics, procedures, pre-decannulation respiratory and biochemistry parameters, respiratory support, Quantitative semi-Quantitative clinical score (QsQ), and in-hospital outcomes were collected. Patients were operationally divided in early (<20), average (20-40), and late (>40 days) decannulation. The aim was to assess predictors of faster decannulation. Secondary outcomes included: weaning failure, instrumental procedures during weaning, accuracy of QsQ criteria for decannulation failure.</p><p><strong>Results: </strong>The final analysis included 191 patients (26.7% males, median age 63 years), of which 79.6% had at least one comorbidity and 61.2% were intubated for Coronavirus Disease 2019 pneumonia. Decannulation was successful in 183 patients (95.8%) and failed in 8 (4.2%). Early, average and late decannulation was observed in 23.3, 31.7 and 45% of patients, respectively. Weaning was faster if patients underwent bronchoscopy (Log-rank P = 0.044), and longer if swallowing efficiency was assessed (Log-rank P = 0.001). Reduction of cannula caliber (OR 4.224, 95%CI: 1.037-17.207; P = 0.044) predicted earlier decannulation, while swallowing assessment predicted slower decannulation (OR 0.161, 95%CI: 0.037-0.694; P = 0.014). Patients' baseline clinical characteristics and instrumental procedures didn't differ in patients that failed and that succeeded weaning. Successes had a lower bronchial secretion burden (P = 0.012) and tended to develop less frequently tracheal stenosis (P = 0.072). Sufficient data availability for QsQ score calculation were limited to some of the major and minor criteria.</p><p><strong>Conclusions: </strong>Specific procedures were associated with reduced time to decannulation, however weaning rarely failed likely because of late weaning initiation. Results generalizability could be limited by younger age, low comorbidity burden and high prevalence of COVID-19 pneumonia. Trials investigating per-protocol weaning to detect the most performant screening procedures are required.</p><p><strong>Trial registration: </strong>The study protocol has been registered and approved by ClinicalTrials.gov February the 28th 2022 (NCT05271786).</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100050"},"PeriodicalIF":5.5,"publicationDate":"2026-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13011248/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147508821","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":"Personalized positive-end expiratory pressure using electrical impedance tomography in ARDS patients: a systematic review and meta-analysis.","authors":"Michela Rauseo, Danila Azzolina, Gaetano Scaramuzzo, Mohd Rashid Khan, Paolo Vetuschi, Francesco Paolo Padovano, Antonello Discenza, Lucia Distaso, Lucia Mirabella, Antonella Cotoia, Savino Spadaro, Gilda Cinnella","doi":"10.1016/j.aicoj.2026.100049","DOIUrl":"10.1016/j.aicoj.2026.100049","url":null,"abstract":"<p><strong>Objective: </strong>Personalized mechanical ventilation strategies can improve outcomes in patients with Acute Respiratory Distress Syndrome (ARDS). However, the optimal method for titrating positive end-expiratory pressure (PEEP) remains controversial. Electrical Impedance Tomography (EIT), by enabling real-time, regional assessment of lung regional characteristics, offers potential advantages to guiding PEEP titration as compared to conventional methods.</p><p><strong>Data sources and study selection: </strong>We conducted a systematic review and meta-analysis of randomized clinical trials and observational studies comparing EIT-guided versus conventional PEEP titration in adult ARDS. The review was conducted according to the PRISMA 2020 guidelines. Moreover, the review was conducted in accordance with the MOOSE (Meta-analysis of Observational Studies in Epidemiology) recommendations, where applicable, and with the registered protocol (PROSPERO ID: CRD420251015187). The primary outcomes were the PaO₂/FiO₂ ratio and respiratory system compliance (Crs). Secondary outcomes included driving pressure (ΔP), mechanical power (MP), and mortality. Random-effects meta-analysis was performed. Risk of bias and GRADE assessments were conducted using the ROB 2.0 and ROBINS-I tools, depending on the study design.</p><p><strong>Data extraction and data synthesis: </strong>Nine studies (n = 356 patients) were included. EIT-guided PEEP titration was associated with an improvement in oxygenation, expressed as PaO₂/FiO₂ ratio, in the EIT guided PEEP group (MD + 60.81; 95% CI 30.37-91.25), with low heterogeneity. Furthermore, significant improvement in respiratory system compliance was observed in EIT guided PEEP (MD + 6.81 mL/cm H₂O; 95% CI 3.73-9.89). No statistically significant difference was observed in driving pressure between groups (MD -0.78 cm H₂O; 95% CI -1.63 to 0.07). Mechanical power showed a non-significant difference across groups (MD -0.76 J/min; 95% CI -2.30 to 0.78). Mortality did not differ between groups (risk ratio 0.88; 95% CI 0.45-1.72).</p><p><strong>Conclusion: </strong>EIT-guided PEEP titration improves oxygenation and respiratory system compliance in patients with ARDS, supporting its role as a physiology-based strategy for ventilatory personalization. Further evidence are needed to determine whether these physiological improvements translate into better clinical outcomes.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100049"},"PeriodicalIF":5.5,"publicationDate":"2026-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13010124/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147508807","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":"Acute kidney injury in immunocompromised patients with acute respiratory failure: insights from the HIGH clinical trial and relation with mechanical ventilation.","authors":"Adrien Joseph, Michael Darmon, Laurent Argaud, Kada Klouche, François Barbier, Emmanuel Canet, Guillaume Louis, Alexandre Demoule, Christophe Girault, Samir Jaber, Christine Lebert, Frédéric Pène, Virginie Lemiale, Elie Azoulay","doi":"10.1016/j.aicoj.2026.100048","DOIUrl":"https://doi.org/10.1016/j.aicoj.2026.100048","url":null,"abstract":"<p><strong>Background: </strong>Critically ill immunocompromised patients are particularly susceptible to acute kidney injury (AKI) due to various underlying mechanisms. Although invasive mechanical ventilation has been associated with an increased risk of AKI, its specific impact on immunocompromised patients with acute respiratory failure has not been explored. This study aims to describe the prevalence of AKI in this patient population and evaluate the potential risk associated with invasive mechanical ventilation, using causal inference models adjusted for the likelihood of requiring ventilation.</p><p><strong>Results: </strong>We conducted a post-hoc analysis of 734 immunocompromised patients from the HIGH clinical trial. Of these, 302 (41%) required invasive mechanical ventilation, and 542 (74%) developed AKI. Notably, AKI frequently occurred before the initiation of invasive mechanical ventilation, with the median day of peak KDIGO stage being 2 days (IQR 1-4 days), compared to 3 days (IQR 2-4 days) for initiation of mechanical ventilation. While univariate analysis showed a significant association between invasive mechanical ventilation and AKI (OR = 1.08, 95% CI = 1.02-1.16, p = 0.014), this association was not significant in the multivariate model (OR = 1.05, 95% CI = 0.98-1.13, p = 0.185). Similar findings were observed after adjusting for the risk of invasive mechanical ventilation using overlap weighting and in a competing risk model. Among patients who received mechanical ventilation, 59 (19%) developed AKI after initiation of mechanical ventilation.</p><p><strong>Conclusion: </strong>Immunocompromised patients with acute respiratory failure face a significant risk of developing AKI, driven by a combination of factors such as their underlying conditions and disease severity. In contrast, the direct impact of invasive mechanical ventilation appears to be limited, suggesting that mechanical ventilation may not be a primary driver of AKI in this vulnerable patient population.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100048"},"PeriodicalIF":5.5,"publicationDate":"2026-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12997334/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147484264","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":"Expert consensus-based clinical practice guidelines for Care and weaning procedures in tracheostomized ICU patients after invasive mechanical ventilation: a joint statement by the Intensive Care Physiotherapy Society (SKR) and the French Intensive Care Society (SRLF).","authors":"Clément Medrinal, Julie Delemazure, Manon Billard, Dorothée Carpentier, Gérald Choukroun, Yann Combret, Anne-Claire De Crouy, Carlos Díaz López, Jonathan Dugernier, Muriel Farcy, Adela Foudhaili, Thomas Gallice, Peggy Gatignol, Zina Ghelab, Marie-Hélène Houze, Mélissa Jezequel, Anne-Claire Latiers, Mehdi Marzouk, Elise Morawiec, Lise Piquilloud, Aude Ruttimann, Perrine Sanchez, Nicolas Terzi, Arnaud W Thille, Matthieu Reffienna","doi":"10.1016/j.aicoj.2026.100045","DOIUrl":"10.1016/j.aicoj.2026.100045","url":null,"abstract":"","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100045"},"PeriodicalIF":5.5,"publicationDate":"2026-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12995824/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147484286","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":"Impact of PEEP on V/Q mismatch according to patient position and recruitability: a clinical prospective study.","authors":"Zhiqian Zha, Zhichang Wang, Qiyu Cheng, Shanshan Meng, Jingyuan Xu, Jianfeng Xie, Haibo Qiu, Yi Yang, Fengmei Guo","doi":"10.1016/j.aicoj.2026.100046","DOIUrl":"https://doi.org/10.1016/j.aicoj.2026.100046","url":null,"abstract":"<p><strong>Background: </strong>High positive end-expiratory pressure (PEEP) may improve ventilation-perfusion (V/Q) mismatch in acute respiratory distress syndrome (ARDS) patients with high recruitability in supine position. However, impacts of PEEP on V/Q mismatch in prone position relative to supine position remain poorly understood. We aimed to compare PEEP effects between positions, and evaluate its relationship with lung recruitability.</p><p><strong>Methods: </strong>A total of 50 patients with moderate-to-severe ARDS were consecutively enrolled. Recruitment-to-inflation (R/I) ratio was used to measure baseline lung recruitability. V/Q mismatch, gas exchange, and respiratory mechanics were evaluated at PEEP 5 cm H₂O and PEEP 15 cm H₂O in supine position, followed by PEEP 5 cm H₂O and PEEP 15 cm H₂O in prone position.</p><p><strong>Results: </strong>Median R/I ratio was 0.60 [0.38, 0.72], separating patients with higher and lower R/I ratio. In patients with higher R/I ratio, PEEP 15 cm H₂O (compared to PEEP 5 cm H₂O) reduced shunt without significantly increasing dead space in both supine and prone positions, thereby improving V/Q mismatch (supine: 30.7 [28.6, 36.8]% at PEEP 15 cm H₂O vs.38.0 [34.9, 45.4]% at PEEP 5 cm H₂O, <i>P <</i> 0.001; prone: 25.7 [21.4, 30.4]% at PEEP 15 cm H₂O vs. 32.8 [27.5, 36.7]% at PEEP 5 cm H₂O, <i>P <</i> 0.001). However, in patients with lower R/I ratio, PEEP 15 cm H₂O (compared to PEEP 5 cm H₂O) in supine position did not improve V/Q mismatch (37.8 [34.7, 42.1]% at PEEP 15 cm H₂O vs. 41.3 [34.8, 45.4]% at PEEP 5 cm H₂O, <i>P =</i> 0.078), as the reduction in shunt was accompanied by a significant increase in dead space; in prone position, PEEP 15 cm H₂O significantly worsened V/Q mismatch (35.9 [28.3, 43.4]% at PEEP 15 cm H₂O vs. 31.7 [24.3, 37.6]% at PEEP 5 cm H₂O, <i>P <</i> 0.001), as it failed to reduce shunt while significantly increasing dead space.</p><p><strong>Conclusions: </strong>In patients with higher R/I ratio, PEEP 15 cm H₂O improved V/Q mismatch in both supine and positions. In patients with lower R/I ratio, PEEP 15 cm H₂O did not impact V/Q mismatch in supine position but significantly worsened it in prone position.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100046"},"PeriodicalIF":5.5,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12993242/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147479524","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}