Annals of Intensive Care最新文献

{"title":"In Memory of Professor Charles Mayaud.","authors":"Muriel Fartoukh","doi":"10.1016/j.aicoj.2026.100150","DOIUrl":"https://doi.org/10.1016/j.aicoj.2026.100150","url":null,"abstract":"","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100150"},"PeriodicalIF":6.9,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13586738/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149007683","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":"Aeromedical transport of patients receiving extracorporeal membrane oxygenation: a 12-year experience from a regional mobile ECMO network in the French Caribbean.","authors":"Florian Negrello, Tanous Aoun, Alexis Fremery, Camille Almeras, Astrid Monfort, Rishika Banydeen, François Roques, Dabor Resiere, Marc Licker, Papa Gueye","doi":"10.1016/j.aicoj.2026.100148","DOIUrl":"https://doi.org/10.1016/j.aicoj.2026.100148","url":null,"abstract":"<p><strong>Background: </strong>The use of extracorporeal Membrane Oxygenation (ECMO) increases for patients with refractory cardiac and/or respiratory failure. To ensure broader access to this life-saving therapy, regional ECMO networks have been developed worldwide, enabling the transfer of patients supported with ECMO to specialized referral centers. At the University Hospital of Martinique, a Mobile Circulatory Support Unit provides 24 h/7 coverage for inter-hospital aeromedical transport of patients receiving ECMO across the French Departments of the America and to mainland France. This study aimed to describe the characteristics, transport modalities, and transport-related adverse events of patients undergoing ECMO-supported aeromedical transfer within this regional mobile ECMO network, as well as their short-term and in-hospital outcomes.</p><p><strong>Methods: </strong>We conducted a retrospective, observational, single-centre study including patients who underwent ECMO-supported aeromedical transfer coordinated by the Mobile Circulatory Support Unit and Emergency Medical Service between January 2010 and December 2021. We collected data on patient characteristics, ECMO configuration and indication, transport modalities, transport-related adverse events, and short-term and in-hospital outcomes.</p><p><strong>Results: </strong>Of the 520 patients supported with ECMO during the study period, only the 126 who underwent aeromedical evacuation were included in the analysis, including 87 intra-Caribbean and 39 transatlantic transfers. Patients were predominantly male (61.1%), with a mean age of 43 [29.25-56] years, and at least one comorbidity present in 60.3% of cases. Veno-venous ECMO was predominantly used for intra-Caribbean transfers (80.5%), mainly for acute respiratory distress syndrome, whereas veno-arterial ECMO for refractory cardiogenic shock predominated in transatlantic transfers (87.2%). In-transfer complications occurred in 18.3% of cases and were mainly related to hemodynamic instability, with one transport-related death reported. Overall in-hospital mortality was 54.7%, with no significant difference between intra-Caribbean and transatlantic patients.</p><p><strong>Conclusion: </strong>Aeromedical transport of critically-ill patients under ECMO support appears feasible and relatively safe in our experience, with a low incidence of serious adverse events. The high in-hospital mortality reflects the acute cardiac and/or pulmonary failure, as well as the burden of comorbidities in this population. Prospective studies using standardized adverse-event collection are needed to more accurately evaluate transport-related risks and longer-term outcomes in this high-risk population.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100148"},"PeriodicalIF":6.9,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13578958/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148987629","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":"Short-term outcomes across sedation practice patterns in mechanically ventilated patients with bacterial pneumonia: a nationwide cohort study.","authors":"Wataru Yajima, Shotaro Aso, Hiroki Matsui, Kiyohide Fushimi, Hideo Yasunaga","doi":"10.1016/j.aicoj.2026.100146","DOIUrl":"https://doi.org/10.1016/j.aicoj.2026.100146","url":null,"abstract":"<p><strong>Background: </strong>Although guidelines recommend light sedation with propofol or dexmedetomidine in mechanically ventilated patients, appropriate management with monotherapy is often challenging. Whether combined sedation reduces dose-dependent adverse effects of each agent or causes additive harm remains unclear. We investigated short-term outcomes associated with early sedation practice patterns in mechanically ventilated patients with bacterial pneumonia.</p><p><strong>Methods: </strong>Using the Japanese Diagnosis Procedure Combination database, we identified adult intensive care unit patients with bacterial pneumonia requiring mechanical ventilation between April 2018 and March 2023 and classified them into combined sedation, propofol-based sedation, and dexmedetomidine-based sedation groups. The composite outcome included in-hospital death and functional decline at discharge. Propensity-score matching-weight analyses adjusted for measured confounders.</p><p><strong>Results: </strong>Among 3,302 eligible patients, 1,135 (34.4%) were classified into the combined-sedation group, 1,067 (32.3%) into the propofol-based sedation group, and 1,100 (33.3%) into the dexmedetomidine-based sedation group. Combined sedation was not associated with a lower risk of the composite outcome compared with propofol-based sedation (26.3 % vs. 30.0 %; risk difference [RD] -3.7 %; 95% confidence interval [CI] -8.0 to 0.7) but was associated with a lower risk of the composite outcome compared with dexmedetomidine-based sedation (26.3 % vs. 33.1 %; RD -6.7%; 95% CI -11.2 to -2.3). In-hospital mortality was lower with combined sedation than propofol-based (22.4% vs. 26.7%; RD, -4.2%; 95% CI, -8.5 to -0.03) or dexmedetomidine-based (22.4% vs. 30.1%; RD, -7.7%; 95% CI, -12.1 to -3.3) sedation, although the comparison with propofol-based sedation was not robust in sensitivity analyses and was not supported by 28-day or 90-day in-hospital mortality. The in-hospital mortality difference between combined sedation and dexmedetomidine-based sedation was consistent across sensitivity analyses and 28-day and 90-day in-hospital mortality. Functional decline at discharge did not differ among groups. Tracheostomy was more frequent with combined sedation than with both comparators, whereas 28-day ventilator-free days did not differ.</p><p><strong>Conclusions: </strong>Combined sedation was not associated with a lower risk of the composite outcome of in-hospital death and functional decline at discharge, compared with propofol-based sedation; however, a lower risk was observed compared with dexmedetomidine-based sedation.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100146"},"PeriodicalIF":6.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13578952/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148987613","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":"Efficacy and safety of sedation induced with cipepofol alone versus a dexmedetomidine plus propofol regimen for patients requiring mechanical ventilation: a randomized, open-label, non-inferiority trial.","authors":"Caihong Yan, Hui Ouyang, Rongfan Zhai, Bo Li, Zhijia Huang, Qunfeng Zhang, Zhengmao Wu, Xianxun Jiang, Yi Lv, Ying Zhang, Junbiao Luo, Peng Li, Zhoucheng Lu, Song Liu, Shuwu Zhong, Peng Xie, Junfa Zeng, Hong Xiao","doi":"10.1016/j.aicoj.2026.100147","DOIUrl":"https://doi.org/10.1016/j.aicoj.2026.100147","url":null,"abstract":"<p><strong>Objective: </strong>This randomized, open-label, non-inferiority trial aimed to compare the safety and efficacy of cipepofol vs. a dexmedetomidine plus propofol regimen for sedating intensive care unit (ICU) patients requiring mechanical ventilation (MV).</p><p><strong>Methods: </strong>This single-center study randomly assigned Chinese adult patients to cipepofol or dexmedetomidine/propofol groups (1:1 ratio). Cipepofol was infused intravenously at a loading dose of 0.1 mg/kg (over 4 min ± 30 s) and an initial maintenance dose of 0.3 mg/kg/h, which was adjusted within the range 0.06-0.8 mg/kg/h to produce sedation in the range of 0 to -4 on the Richmond Agitation-Sedation Scale. Propofol and dexmedetomidine were infused intravenously at initial dosages of 0.3 mg/kg/h and 0.2 μg/kg/h, respectively (neither drug required a loading dose). When the maximum dexmedetomidine dose (0.7 μg/kg/h) was insufficient to achieve the target sedation depth or intolerance developed, the propofol dose was modified within the range 0.3-4.0 mg/kg/h. The primary endpoint was sedation success rate, and the non-inferiority margin was set as 10%.</p><p><strong>Results: </strong>Of 72 patients enrolled for the intention-to-treat (ITT) analysis, 71 patients were included in the full analysis set/per-protocol set (FAS/PPS). The sedation success rates for the cipepofol and dexmedetomidine/propofol groups were 100% and 97.2%, respectively, in the ITT analysis and 100% for both in the FAS/PPS. Non-inferiority was established, and the lower limit of the 95% confidence interval (CI) for the inter-group difference was -1.34% for the ITT analysis and -9.64% for the FAS/PPS. There were no differences between groups in sedation compliance rate, extubation and recovery times, MV duration, or length of ICU stay (all <i>P</i> > 0.05). Cipepofol was associated with lower incidences of treatment-emergent adverse events (TEAEs; 33.3% vs. 66.7%) and drug-related TEAEs (30.6% vs. 63.9%) than dexmedetomidine/propofol (all <i>P</i> < 0.05). Notably, hypotension incidence was lower in the cipepofol group than in the dexmedetomidine/propofol group (30.6% vs. 61.1%, <i>P</i> = 0.017).</p><p><strong>Conclusion: </strong>Cipepofol was not inferior to dexmedetomidine/propofol for >24-h sedation in Chinese adult patients receiving MV in the ICU. Furthermore, cipepofol elicited fewer hypotensive events than dexmedetomidine/propofol. Large-scale, multicenter studies are warranted to confirm our findings.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100147"},"PeriodicalIF":6.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13579693/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148987626","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":"Consensus statement for managing patients with ARDS in low-resource settings: a Delphi study.","authors":"Pedja Kovacevic, Jesús Villar, Boris Tomic, Fabio Silvio Taccone, Giacomo Grasselli, Luigi Camporota, Marlies Ostermann, Ivan Palibrk, Rajesh Mishra, Sasa Dragic, Jose Diaz-Gomez, Danica Momcicevic, Ali Ait Hssain, Biljana Zlojutro, Jihad Mallat, Milka Jandric, Owoniya Temitope, Roman Zahorec, Omar Shahed, Mohamed Boussarsar, F Joachim Meyer, Ahmed Mukhtar, Marko Kutlesa, Vladimir Krajinovic, John Laffey, Radmilo Jankovic, Samir Jaber, Dejan Markovic, Oluwayemisi Esther Ekor, Rotimi Muyiwa, Rihard Knafelj, Matija Jurjevic, Natasa Milivojevic, Ahmed El Masry, Jasminka Persec, Anusha Cherian, Younes Aissaoui, Oguz Kilickaya, Kent Doi, Daniel Lovric, Wael Alqassem, Natasa Gocic, Aderonke Adesiyan, Reuben Okioma, Ayalew Zewdie, Mumbere Kigayi Jean Pierre, Subhash Acharya, Ognjen Gajic","doi":"10.1016/j.aicoj.2026.100144","DOIUrl":"10.1016/j.aicoj.2026.100144","url":null,"abstract":"<p><strong>Background: </strong>Despite decades of research and advances in critical care, mortality of the Acute Respiratory Distress Syndrome (ARDS) remains high, ranging from 30 to 45% in high-income countries and markedly higher in low-resource settings (LRS), where management guidelines implementation is constrained. An international consensus aimed to provide statements for ARDS management tailored to LRS.</p><p><strong>Methods: </strong>Since management of critically ill patients is a major public health problem in LRS, the Bosnia and Herzegovina Society of Intensive Care Medicine convened an international, multidisciplinary Steering Committee with expertise in ARDS management. The committee appointed an international panel of clinicians and investigators specialized in the field of ARDS. Through an iterative Delphi process, a panel of 52 experts developed several consensus statements.</p><p><strong>Results: </strong>After three Delphi rounds, consensus was reached on 44 out of 56 of statements (79%). The survey covered eight domains related to ARDS management in LRS related to: critical care infrastructure, diagnostic tools, respiratory support, other supportive therapies, sedation strategies, weaning, nutrition, and management of complications. Statements were compared with recent ESICM guidelines, highlighting specific LRS considerations.</p><p><strong>Conclusion: </strong>Using the Delphi method, international experts developed clinical practice statements guiding clinicians on ARDS management in LRS. These statements complemented existing guidelines by addressing areas where evidence is limited, and highlight aspects of ARDS management pertinent for LRS not covered by current international recommendations. Future studies are needed to evaluate the adherence and impact of these statements and to address remaining uncertainties.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100144"},"PeriodicalIF":6.9,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13564132/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148954653","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":"Pulmonary vascular dysfunction in ARDS Pathophysiology and therapeutic implications.","authors":"Hao Zheng, Shunqin Fan, Chunfeng He, Yan Zhang, Shike Geng, Hanbing Chen, Yan Xue, Yan Wu, Wenyu Ren, Chunbo Zhang, Ling Liu, Yingzi Huang, Haibo Qiu","doi":"10.1016/j.aicoj.2026.100145","DOIUrl":"10.1016/j.aicoj.2026.100145","url":null,"abstract":"<p><p>Pulmonary vascular dysfunction is increasingly recognized as a clinically important component of acute respiratory distress syndrome (ARDS). Beyond alveolar epithelial injury, ARDS involves endothelial and alveolar-capillary barrier disruption, dysregulated hypoxic pulmonary vasoconstriction, thrombo-inflammatory activation, microvascular thrombosis, pulmonary vascular remodeling, increased pulmonary vascular resistance, and impaired right ventricle pulmonary circulation coupling. Together, these abnormalities aggravate ventilation perfusion mismatch, impair gas exchange, increase right ventricular afterload, and contribute to hemodynamic instability and adverse clinical outcomes. This review synthesizes current understanding of these mechanisms, critically evaluates pulmonary vascular-targeted interventions according to the strength of available evidence, and considers the clinical implications of biological and physiological heterogeneity in ARDS. Lung-protective ventilation remains the foundation of ARDS management, and early prolonged prone positioning improves outcomes in appropriately selected patients with moderate-to-severe disease. In addition to limiting lung injury and improving oxygenation, these strategies may reduce pulmonary vascular stress and right ventricular afterload. Inhaled pulmonary vasodilators can produce transient improvements in oxygenation or pulmonary hemodynamics, but no survival benefit has been established. Anticoagulant and fibrinolytic strategies, mesenchymal stromal cells, extracellular vesicles, and biologic therapies have likewise not consistently improved patient-centered outcomes and therefore remain investigational. Pulmonary vascular dysfunction nevertheless provides a clinically relevant framework for understanding gas-exchange abnormalities, cardiopulmonary interactions, and right ventricular complications in ARDS. Future studies should determine whether integrating biomarkers, pulmonary hemodynamic monitoring, imaging, respiratory mechanics, and right ventricular assessment can identify reproducible vascular, inflammatory, right ventricular, or recruitability-based phenotypes, and whether phenotype-guided pulmonary vascular management improves patient-centered outcomes.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100145"},"PeriodicalIF":6.9,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13564137/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148954682","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":"Access to and perceived value of post-ICU follow-up: an international cross-sectional survey of ICU professionals and adult critical illness survivors.","authors":"Anne-Françoise Rousseau, Susannah Leaver, Kristina Fuest, Victoria Metaxa, Guy François, Bernard Lambermont, Stefan J Schaller, Richard Rezar, Margo M C van Mol, Michael Beil","doi":"10.1016/j.aicoj.2026.100141","DOIUrl":"10.1016/j.aicoj.2026.100141","url":null,"abstract":"<p><strong>Background: </strong>Post-intensive care syndrome (PICS) is a frequent and debilitating consequence of critical illness, yet access to structured post-ICU follow-up remains inconsistent.</p><p><strong>Methods: </strong>We conducted an ESICM-endorsed, international, cross-sectional online survey using two complementary questionnaires to explore the perspectives of ICU healthcare professionals (ICU-HP) and adult ICU survivors (ICU-S), disseminated through ESICM communication channels, professional networks, patient associations, and social media. Both surveys explored post-ICU follow-up practices, access to care, perceived benefits, and unmet needs.</p><p><strong>Results: </strong>A total of 276 ICU-HP from 242 hospitals across 43 countries and 106 ICU-S from 47 ICUs across 6 countries participated in the survey. Post-ICU follow-up was reported to be available by 45% of ICUs and accessed by 58.5% of patients. Among ICU survivors, 55.7% reported having received information about PICS, while 86.2% of those not informed indicated it would have been useful. Follow-up practices showed marked heterogeneity in patient selection, timing, content, and duration. Among patients who had access to post-ICU follow-up, screening of all three core PICS domains (physical, cognitive and psychological functions) was performed in only 40.7% of cases. Nevertheless, 56.4% reported feeling better following follow-up, mainly due to perceived support and improved understanding of their condition. Among ICU-HPs offering follow-up, 55.1% reported that this activity had led to changes in clinical practice within their ICU, and 97.4% expressed intent to continue their programs although limited training opportunities and a lack of formal guidance were reported by a substantial proportion of respondents.</p><p><strong>Conclusions: </strong>This survey demonstrates inconsistent access to post-ICU follow-up and information about PICS, despite the perceived value of post-ICU follow-up among both ICU-S and ICU-HP. Improving post-ICU care will require dedicated training and structured guidelines, highlighting the key role of scientific societies in ICU survivorship care.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100141"},"PeriodicalIF":6.9,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13564131/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148954675","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":"Personalised fluid therapy in septic shock.","authors":"Antonio Messina, Andrea Brunati, Maurizio Cecconi","doi":"10.1016/j.aicoj.2026.100142","DOIUrl":"https://doi.org/10.1016/j.aicoj.2026.100142","url":null,"abstract":"<p><p>Fluid management remains a cornerstone of early septic shock resuscitation; an accumulating body of evidence highlights the substantial risks associated with excessive fluid administration. Fluid overload is consistently associated to organ dysfunction and adverse outcomes, underscoring the need for a personalized approach to intravenous fluid therapy. Over the past decade, research has progressively refined the concepts of fluid responsiveness and the fluid challenge, moving from fixed-volume boluses guided by static measures to individualized, dynamic assessments supported by multimodal monitoring. Recent, large multicenter trials demonstrated that CRT-guided strategies reduce fluid administration, accelerate recovery, and decrease the duration of organ support, despite not significantly affecting mortality. The 2025 European society of intensive medicine Shock Consensus reflects these advances recommending dynamic tests (<i>i.e.</i> mainly passive leg raising and end-expiratory occlusion) for predicting fluid responsiveness, while discouraging reliance on static preload indices and isolated inferior vena cava measurements. The guidelines also emphasize the growing role of mini-fluid challenges, microcirculatory evaluation, and integration of metabolic markers to ensure that increased cardiac output translates into improved tissue perfusion. Personalizing therapy across the four phases of shock (resuscitation, optimization, stabilization, and evacuation) forms the foundation of fluid stewardship. Central to this concept is the optimization phase, where determining the need for continuous monitoring and identifying fluid responsiveness prevent unnecessary fluid administration.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100142"},"PeriodicalIF":6.9,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13578956/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148987589","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":"Early assessment of fluid tolerance (VExUS) and stroke volume (LVOT-VTI) to predict adverse outcomes in emergency department patients with suspected sepsis.","authors":"Daniel M Rolston, John P Forrester, Elizabeth A Young, Margaret Gorlin, Amanda Dalpiaz, Nicholas Bielawa, Timmy Li, Kate van Loveren, Daniel Jafari, Mathew Nelson, Allison L Cohen","doi":"10.1016/j.aicoj.2026.100143","DOIUrl":"10.1016/j.aicoj.2026.100143","url":null,"abstract":"<p><strong>Background: </strong>To determine if early Doppler ultrasound assessments of venous congestion with Venous Excess Ultrasound (VExUS) and stroke volume with left ventricular outflow tract velocity time integral (LVOT-VTI) are associated with 24-h adverse outcomes and fluid-responsiveness in Emergency Department (ED) suspected sepsis patients prior to substantial fluid administration.</p><p><strong>Methods: </strong>A single-center, prospective cohort study of adult ED patients with suspected sepsis recruited between 5/2020 and 12/2023 (exclusions: receipt of >500 mL fluid, intubated, on vasopressors, or existing do not resuscitate/intubate). The primary outcome was a 24-h ordinal measure of mortality, intensive care unit (ICU) admission, or rapid response team (RRT) activation; and the secondary outcome was fluid-responsiveness (increase in LVOT-VTI ≥10% after a 500 mL fluid bolus). Multivariable ordinal and multinomial regression models were used.</p><p><strong>Results: </strong>545 patients had VExUS and 493 had LVOT-VTI measurements. 24.7% of VExUS 0 versus 56.5% of VExUS 3 patients died/admitted to ICU within 24 h. VExUS scores ≥1 were associated with increased mortality or ICU admission: VExUS 1: OR 2.37 (95%CI: 1.29-4.36); VExUS 2: OR 2.84 (95%CI: 1.64-4.92); VExUS 3: OR 4.09 (95%CI: 2.24-7.45). VTI alone was not associated with increased adverse outcomes. 23.5% of VExUS 0/VTI ≥ 17 cm patients died/admitted to ICU within 24 h versus 57.3% of VExUS 2-3/VTI < 17 cm (OR 3.67 [95%CI: 2.04-6.61]). 63.7% of VExUS 0 versus 21.1% of VExUS 3 were fluid-responsive. VExUS score ≥1 were associated with decreased odds of fluid-responsiveness: VExUS 1: OR 0.35 (95%CI: 0.19-0.63); VExUS 2: OR 0.20 (95%CI: 0.11-0.37); VExUS 3 OR 0.16 (95%CI: 0.07-0.36). 62.1% of LVOT-VTIs 17-20 cm were fluid-responsiveness (OR 2.01; 95%CI: 1.20-3.37) versus 47.3% in the VTI > 20 cm reference group and 45.8% in the VTI < 17 cm group. 62.1% of VExUS 0/VTI ≥ 17 cm patients were fluid-responsive (reference) versus 16.7% of VExUS 2-3/VTI < 17 cm (OR 0.16; 95% CI 0.07-0.34).</p><p><strong>Conclusion: </strong>In non-ventilated ED patients with suspected sepsis, VExUS scores ≥1 were associated with increased odds of 24-h mortality/ICU admission and RRT activation and decreased odds of fluid-responsiveness. Combining VExUS and LVOT-VTI assessments early in sepsis may improve prediction of adverse outcomes and better characterize fluid tolerance/responsiveness to guide individualized resuscitation, but further research is needed.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100143"},"PeriodicalIF":6.9,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13564126/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148954685","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":"Prognostic impact of <i>Candida</i> spp. isolation and early antifungal therapy in ICU patients with peritonitis: A multicenter cohort study.","authors":"Mattéo Mauget, Charly Angebault, Melchior Bardoul, Pierre Fillâtre, Pierre Bouju, Agathe Delbove, Guillaume Rieul, Yannick Fedun, Renaud Prével, Jean-Pierre Gangneux, Yoann Launey, Florian Reizine","doi":"10.1016/j.aicoj.2026.100140","DOIUrl":"10.1016/j.aicoj.2026.100140","url":null,"abstract":"<p><strong>Background: </strong><i>Candida</i> spp. is frequently isolated in critically ill patients with peritonitis. Guidelines recommend empirical antifungal therapy in high-risk cases, but the clinical significance of <i>Candida</i> spp. isolation in peritoneal fluid and the benefit of early antifungal therapy remain uncertain.</p><p><strong>Methods: </strong>We conducted a retrospective multicenter cohort study including all consecutive adults admitted with peritonitis to the ICUs of four hospitals in Western France between 2020 and 2022. Risk factors for <i>Candida</i> spp. isolation in peritoneal fluid were assessed using multivariate logistic regression. Outcomes were compared according to <i>Candida</i> spp. isolation in peritoneal fluid and, among affected patients, according to early antifungal therapy. Survival up to day-90 after peritonitis onset were compared using Inverse Probability Treatment-weighted Cox proportional hazards models.</p><p><strong>Results: </strong>Among 378 patients, <i>Candida</i> spp. was isolated in 81 (21.4%). Independent risk factors included antimicrobial therapy within the last 3 months (adjusted OR 2.15, 95% CI 1.20-3.81; p = 0.009), malnutrition (adjusted OR 1.84, 95% CI 1.10-3.14; p = 0.022), upper gastrointestinal origin (adjusted OR 2.04, 95% CI 1.20-3.44; p = 0.008) and diffuse peritonitis (adjusted OR 1.75, 95% CI 1.01-3.13; p = 0.049). <i>Candida</i> spp. isolation in peritoneal fluid was not associated with 90-day mortality (weighted HR 1.00, 95% CI 0.62-1.59; p = 0.991) and clinical courses were similar between groups. Among patients with <i>Candida</i> spp. in peritoneal fluid isolation, early antifungal therapy was not associated with 90-day mortality (weighted HR 1.37, 95% CI 0.58-3.22; p = 0.470) or clinical outcomes.</p><p><strong>Conclusions: </strong>In ICU patients with peritonitis, <i>Candida</i> spp. isolation in peritoneal fluid was not associated with 90-day mortality, and early antifungal therapy did not improve 90-day survival among patient with isolated <i>Candida</i> spp. in peritoneal fluid.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100140"},"PeriodicalIF":6.9,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13572066/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148966312","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}