Annals of Intensive Care最新文献

{"title":"Characteristics and outcomes of ECMO cannula-related infections: a European multicenter retrospective study.","authors":"Sofia Ortuno, Nicolas Massart, Charles Vidal, Etienne de Montmollin, Adrien Bouglé, Nicolas Nesseler, Frank Bidar, Benjamin Assouline, Paul Masi, Samuel Henri, Sami Hraiech, Hadrien Rozé, Francesca Manicone, Charles-Edouard Luyt","doi":"10.1186/s13613-025-01446-y","DOIUrl":"10.1186/s13613-025-01446-y","url":null,"abstract":"<p><strong>Objective: </strong>Only few data regarding epidemiology and management of ECMO cannula-related infections (ECMO-CRIs) exist. The aim of our study was to describe their epidemiology and prognosis, and to evaluate factors associated with outcome.</p><p><strong>Methods: </strong>We performed a multicenter retrospective study in 12 European ICUs, including patients with ECMO-CRI, defined as a clinical suspicion plus a positive bacterial sample of ECMO-cannulation site. Primary objective was to describe ECMO-CRI characteristics and outcomes. Secondary objectives were to evaluate the rates of infection recurrence, their risk factors, and to evaluate the impact of antimicrobial treatment duration on outcome.</p><p><strong>Results: </strong>During the study period, 109 patients with ECMO-CRI (78 having concomitant positive blood culture with the same pathogen) were included. Pathogens responsible for infections were predominantly Enterobacteriaceae, coagulase-negative Staphylococcus and Enterococcus spp., and 42% of episodes were polymicrobial. Rates of infection recurrence was 13% and ICU-mortality rate was 51%. Risk factors for death were concomitant bloodstream infection with same pathogen and septic shock Patients with antibiotic course ≤ 8 days had similar infection recurrence rate and outcomes (including mortality) than patients with prolonged (> 8 days) antibiotic course.</p><p><strong>Conclusion: </strong>ECMO-CRIs are frequently associated with BSI and frequently polymicrobial. Duration of antimicrobial treatment for ECMO-CRI ≤ 8 days does not seem to be associated with an increased risk of recurrence or death, as compared to longer treatment.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"36"},"PeriodicalIF":5.7,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11926307/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143668749","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":"Relative faecal abundance to predict extended-spectrum β-lactamase-producing Enterobacterales related ventilator‑associated pneumonia.","authors":"Pierre Bay, Paul-Louis Woerther, Vincent Fihman, Ségolène Gendreau, Pascale Labedade, Antoine Gaillet, Florian Jolly, Guillaume Carteaux, Nicolas de Prost, Jean-Winoc Decousser, Armand Mekontso-Dessap, Keyvan Razazi","doi":"10.1186/s13613-025-01456-w","DOIUrl":"10.1186/s13613-025-01456-w","url":null,"abstract":"<p><strong>Background: </strong>Antimicrobial stewardship (AMS) for ventilator-associated pneumonia (VAP) in carriers of extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E) presents significant challenges. The abundance of ESBL-E rectal carriage has emerged as a potentially valuable tool for predicting ESBL-E-related VAP.</p><p><strong>Methods: </strong>This single-center, retrospective study was conducted between October 2019 and April 2023 in the medical ICU of a university hospital. The relative abundance of ESBL-E rectal carriage (RAC) was calculated as the ratio of ESBL-E counts to the total number of aerotolerant bacteria. The aim was to evaluate the predictive value of RAC for diagnosing ESBL-E-related VAP in patients with confirmed VAP who were ESBL-E carriers.</p><p><strong>Results: </strong>During the study period, 478 patients with ESBL-E carriage were admitted to the ICU, of whom 231 (48%) required mechanical ventilation. Eighty-three patients (17%) developed a total of 131 confirmed VAP episodes, of which 62 episodes (47%) were ESBL-E-related VAP. The median interval between the last rectal screening and VAP occurrence was 4 [3-7] days. RAC was not associated with ESBL-E-related VAP in the entire cohort (p = 0.39). Similar findings were observed in several sensitivity analyses, including the following subsets: recent and high-quality screening (interval between screening and VAP ≤ 7 days and bacterial load on rectal swab > 10⁴ CFU/mL, p = 0.21); first VAP episodes only (p = 0.41); cases involving Escherichia coli exclusively (p = 0.08) or other ESBL-E strains (p = 0.29); and VAP associated with Gram-negative bacteria (p = 0.26) or Enterobacterales (p = 0.34). However, in a multivariable model, rectal colonization with non-Escherichia coli ESBL strains was independently associated with ESBL-E-related VAP (adjusted odds ratio [aOR] 1.213 [95% CI 1.005-1.463], p = 0.045).</p><p><strong>Conclusion: </strong>RAC was not associated with confirmed VAP in ESBL-E carriers. Further studies are needed to explore effective strategies for improving AMS in ESBL-E carriers with suspected VAP.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"34"},"PeriodicalIF":5.7,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11925845/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143668757","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":"Which carbon footprint for my ICU? Benchmark, hot spots and perspectives.","authors":"Pierre Bardoult, Elodie Cadic, Olivier Brichory, Véronique Marie, Caroline Rouxel, Christophe Millet, Magalie Daudin, Elodie Peguet, Nicolas Massart","doi":"10.1186/s13613-025-01445-z","DOIUrl":"10.1186/s13613-025-01445-z","url":null,"abstract":"<p><strong>Background: </strong>The purpose of this study was to identify the main greenhouse gas (GHG) emitting activities or products among the medical devices (MD) and medicines used in a polyvalent Intensive Care Unit (ICU).</p><p><strong>Methods: </strong>A pragmatic eco-audit was conducted in a 21-beds polyvalent ICU, in Saint-Brieuc, Bretagne, France. It consisted of estimating GHG emissions of products or activities, considering process-based life cycle analysis (LCA), economic input-output analysis (EIO) and hybrid-LCA. Results were expressed as Carbon Dioxide Equivalent (CO₂e) emissions per patient-day considering each medication and MD (including personal protective equipment).</p><p><strong>Results: </strong>With remaining uncertainty, GHG emissions were estimated at 61.1 kgCO₂e per patient-day. Two hundred and two individual MD were used per patient-day, equivalent to 5.1 kgCO₂e per patient-day (process-based LCA). Gloves accounted for the main part of kgCO₂e emissions (representing 1.8 kgCO₂e per patient-day). Then, syringes (1.1 kgCO₂e per patient-day), perfusion tubings (1.0 per patient-day) and gauze pads (0.4 kgCO₂e per patient-day) were the most important sources of MD related GHG emissions. Forty-seven individual medicines were used per patient-day. Most consumed medications were sterile water for injection, propofol, and sodium chlorure. The GHG emissions of medications were estimated with EIO-LCA at 21.5 kgCO₂e per patient-day, mostly due to injectable medicines (15.3 kgCO₂e per patient-day).</p><p><strong>Conclusion: </strong>Upcoming studies focusing on actions on these particular hot spots would be of interest in order to significantly decrease GHG emissions but also to increase resilience of critical care.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"35"},"PeriodicalIF":5.7,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11925816/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143668853","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":"Optimising fluid therapy during venoarterial extracorporeal membrane oxygenation: current evidence and future directions.","authors":"Ali Jendoubi, Quentin de Roux, Solène Ribot, Victor Desauge, Tom Betbeder, Lucile Picard, Bijan Ghaleh, Renaud Tissier, Matthias Kohlhauer, Nicolas Mongardon","doi":"10.1186/s13613-025-01458-8","DOIUrl":"10.1186/s13613-025-01458-8","url":null,"abstract":"<p><p>Venoarterial extracorporeal membrane oxygenation (VA-ECMO) offers an immediate and effective mechanical cardio-circulatory support for critically ill patients with refractory cardiogenic shock or selected refractory cardiac arrest. As fluid therapy is routinely performed as a component of initial hemodynamic resuscitation of ECMO supported patients, this narrative review intends to summarize the rationale and the evidence on the fluid resuscitation strategy in terms of fluid type and dosing, the impact of fluid balance on outcomes and fluid responsiveness assessment in VA-ECMO patients. Several observational studies have shown a deleterious impact of positive fluid balance on survival and renal outcomes. With regard to the type of crystalloids, further studies are needed to evaluate the safety and efficacy of saline versus balanced solutions in terms of hemodynamic stability, renal outcomes and survival in VA-ECMO setting. The place and the impact of albumin replacement, as a second-line option, should be investigated. During VA-ECMO run, the fluid management approach could be divided into four phases: rescue or salvage, optimization, stabilization, and evacuation or de-escalation. Echocardiographic assessment of stroke volume changes following a fluid challenge or provocative tests is the most used tool in clinical practice to predict fluid responsiveness. This review underscores the need for high-quality evidence regarding the optimal fluid strategy and the choice of fluid type in ECMO supported patients. Pending specific data, fluid therapy needs to be personalized and guided by dynamic hemodynamic approach coupled to close monitoring of daily weight and fluid balance in order to provide adequate ECMO flow and tissue perfusion while avoiding harmful effects of fluid overload.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"32"},"PeriodicalIF":5.7,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11923310/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143662070","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":"Triggers of viral encephalitis: a brain teaser to be solved!","authors":"Romain Sonneville, Annie Lannuzel, Cyrille Mathieu, Daniel Gonzalez-Dunia, Raphael Gaudin","doi":"10.1186/s13613-025-01451-1","DOIUrl":"10.1186/s13613-025-01451-1","url":null,"abstract":"","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"31"},"PeriodicalIF":5.7,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11920475/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143655882","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":"High-dose intravenous vitamin C reduce C-reactive protein levels, fluid retention, and APACHE II scores in patients with moderately severe acute pancreatitis: a prospective, randomized, double-blinded, placebo-controlled study.","authors":"Bing Zhao, Wenwu Sun, Yihui Wang, Li Ma, Menglu Gui, Jiaoyan Li, Xianxian Yu, Xing Qi, Ning Ning, Silei Sun, Mengjiao Li, Yi Yao, Tongtian Ni, Juan He, Zhitao Yang, Ying Chen, Huiqiu Sheng, Meihua Shen, Jian Li, Jun Huang, Enqiang Mao","doi":"10.1186/s13613-025-01437-z","DOIUrl":"10.1186/s13613-025-01437-z","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study was to investigate whether high-dose intravenous vitamin C (HDIVC) could decrease the mortality rate within 28 days among patients moderately severe acute pancreatitis (MSAP) and severe acute pancreatitis (SAP).</p><p><strong>Methods: </strong>In this randomized, placebo-controlled trial, patients diagnosed with predicted MSAP or SAP within 72 h of symptom onset were enrolled to receive either a vitamin C infusion (200 mg/kg/24 h) or a matched placebo for 7 days. The primary outcome was 28-day mortality.</p><p><strong>Results: </strong>212 adults including 155 MSAP and 57 SAP were enrolled from September 2019 to June 2023. The trial was terminated prematurely due to a lower than expected 28-day mortality rate which showed no difference between the HDIVC and Control group (3/109 vs. 4/103, unadjusted OR: 0.70, 95% CI, 0.15-3.21, p = 0.647). Among patients with MSAP, the HDIVC group exhibited a more pronounced reduction in C-reactive protein levels compared to the Control group (Day0 to Day3, median 72 mg/L vs. 46 mg/L, p = 0.003; Day0 to Day7, median 168 mg/L vs. 121 mg/L, p = 0.013); The volume of fluid retention was lower in the HDIVC group compared to the Control group (Day0-Day1, median 676.5 ml vs. 1130 ml, P = 0.04; Day0-Day2, median 511 ml vs. 1290 ml, P = 0.02; Day0-Day3, median 692 ml vs. 1534 ml, P = 0.04). The APACHE II scores reduction from Day0 to Day7 was significantly greater in the HDIVC group in APACHE II scores (median change of 3 vs. 2, P = 0.01). No significant difference was observed among patients with SAP.</p><p><strong>Conclusion: </strong>HDIVC did not significantly reduce 28-day mortality in MSAP and SAP patients. While it showed potential benefits in reducing CRP, fluid retention, and APACHE II scores in MSAP patients, these effects may not be directly related to the study drug, and no similar changes were observed in SAP patients.</p><p><strong>Trial registration: </strong>ChiCTR.org.cn, ChiCTR1900022022. Registered March 21 2019, https//www.chictr.org.cn/showproj.html?proj=37,106 .</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"30"},"PeriodicalIF":5.7,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11911288/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143647203","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":"End-of-life decision disparities according to the gross national income in critically ill patients: a secondary analysis of the ETHICUS-2 study.","authors":"Ignacio Martin-Loeches, Charles L Sprung, Eric Wolsztynski, Rachael Cusack, Suzana Margareth Lobo, Alessandro Protti, Alexander Avidan","doi":"10.1186/s13613-025-01419-1","DOIUrl":"10.1186/s13613-025-01419-1","url":null,"abstract":"<p><strong>Aim: </strong>This study aimed to evaluate the association of end-of-life decisions and time to death in a global cohort of critically ill patients who participated in the international study on end-of-life practices in intensive care units (ICU) (Ethicus-2 study).</p><p><strong>Methods: </strong>A post hoc analysis was conducted on data from a worldwide observational study that prospectively recruited adult ICU patients who died between September 1, 2015, and September 30, 2016, from 199 ICUs in 36 countries.</p><p><strong>Results: </strong>The end-of-life pathways of 10,547 ICU non-survivors were s analysed. Patients in high-income countries exhibited a significantly shorter time to death compared to those from middle-income countries. Additionally, therapeutic decisions were found to have a significant but varied association with the length of ICU stay across gross national income (GNI) groups. Specifically, patients in high-income countries with no decision had the shortest length of stay (LOS) overall. However, withdrawing or withholding life-sustaining treatment led to longer LOS in both middle and high GNI countries.</p><p><strong>Conclusion: </strong>This study's findings highlight the need for uniformity in global end-of-life decision-making. Outcomes are significantly associated with gross national income (GNI). Moreover, patients in high-income nations tend to have shorter ICU stays before death.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"29"},"PeriodicalIF":5.7,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11889315/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143584389","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 trajectory of sleep after critical illness: a 24-month follow-up study.","authors":"Mario Henríquez-Beltrán, Iván D Benítez, Rafaela Vaca, Sally Santisteve, Maria Aguilà, Anna Vila, Olga Minguez, Carlos Rodríguez-Muñoz, Anna Galán-González, Sulamita Carvalho-Brugger, Paula González, Paula Rodríguez, Jesús Caballero, Carme Barberà, Gerard Torres, Gonzalo Labarca, Mar Malla-Banyeres, Anna Moncusí-Moix, Antoni Torres, David de Gonzalo-Calvo, Ferran Barbé, Jessica González, Adriano D S Targa","doi":"10.1186/s13613-025-01449-9","DOIUrl":"10.1186/s13613-025-01449-9","url":null,"abstract":"<p><strong>Background: </strong>Survivors of critical illness endure long-lasting physical and mental challenges. Despite the persistence of poor sleep quality in a considerable proportion of patients at the 12-month follow-up, studies with assessments exceeding this period are limited. We aimed to investigate the trajectory of sleep over the 24 months following critical illness.</p><p><strong>Methods: </strong>Observational, prospective study. Patients diagnosed with SARS-CoV-2 infection were recruited during the intensive care unit stay. Evaluations of sleep (Pittsburgh Sleep Quality Index [PSQI]), mental health (Hospital Anxiety and Depression Scale [HADS]), quality of life (12-item Short Form Survey [SF-12]), and other factors were performed in the short-term, and at 12 and 24 months after hospital discharge. Good sleep quality was defined as a PSQI score of ≤ 5. Minimal clinically important improvement (MCII) was defined as a decrease of ≥ 4 points in the PSQI score between the short-term assessment and the 24-month follow-up.</p><p><strong>Results: </strong>The cohort included 196 patients (69.9% males), with a median [p₂₅;p₇₅] age of 62.0 [53.0;67.2] years. The global population showed a mean (95% CI) change of - 0.91 ( - 1.50 to - 0.31) points in the PSQI score from the short-term assessment to the 24-month follow-up. Based on PSQI score trajectories, three distinct groups of patients were identified: (i) the healthy group, consisting of patients with good sleep quality in the short-term that was maintained throughout the follow-up period; (ii) the MCII group, consisting of patients with poor sleep quality in the short-term, but with improvement over time, ultimately reaching levels comparable to the healthy group; (iii) the non-MCII group, consisting of those with consistently poor sleep quality across the entire follow-up. Further analyses revealed that PSQI score trajectories were closely aligned with those of the HADS and SF-12 mental scores.</p><p><strong>Conclusions: </strong>Our findings reveal that a subset of critical illness survivors requires up to 24 months after the acute phase to fully restore their sleep quality, while a significant proportion does not experience a clinically significant improvement in sleep quality over this period. These distinct sleep trajectories are strongly correlated with mental health status, highlighting the importance of addressing sleep alongside mental health within the framework of post-intensive care syndrome.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"28"},"PeriodicalIF":5.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11871202/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522515","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 is not associated with mortality in COVID-19 mechanically ventilated patients.","authors":"Enric Barbeta, Cláudia Barreiros, Edoardo Forin, Amedeo Guzzardella, Anna Motos, Laia Fernández-Barat, Albert Gabarrús, Adrián Ceccato, Ricard Ferrer, Jordi Riera, Oscar Peñuelas, José Ángel Lorente, David de Gonzalo-Calvo, Jessica Gonzalez, Rosario Amaya-Villar, José Manuel Añón, Ana Balan, Carme Barberà, José Barberán, Aaron Blandino, Maria Victoria Boado, Elena Bustamante-Munguira, Jesús Caballero, María Luisa Cantón-Bulnes, Cristina Carbajales, Nieves Carbonell, Mercedes Catalán-González, Nieves Franco, Cristóbal Galbán, Víctor D Gumucio-Sanguino, Maria Del Carmen de la Torre, Emilio Díaz, Ángel Estella, Elena Gallego, José Manuel Gómez, Arturo Huerta, Ruth Noemí Jorge García, Ana Loza-Vázquez, Judith Marin-Corral, María Cruz Martin Delgado, Amalia Martínez, Ignacio Martínez, Juan Lopez, Guillermo M Albaiceta, María Teresa Nieto, Mariana Andrea Novo, Yhivian Peñasco, Felipe Pérez-García, Pilar Ricart, Alejandro Rodríguez, Victor Sagredo, Angel Sánchez-Miralles, Susana Sancho, Ferran Roche-Campo, Lorenzo Socias, Jordi Solé-Violan, Luis Tamayo, José Trenado, Alejandro Úbeda, Luis Jorge Valdivia, Pablo Vidal, Ferran Barbé, Jordi Vallverdú, Antoni Torres","doi":"10.1186/s13613-025-01430-6","DOIUrl":"10.1186/s13613-025-01430-6","url":null,"abstract":"<p><strong>Background: </strong>The relative contribution of the different components of mechanical power to mortality is a subject of debate and has not been studied in COVID-19. The aim of this study is to evaluate both the total and the relative impact of each of the components of mechanical power on mortality in a well-characterized cohort of patients with COVID-19-induced acute respiratory failure undergoing invasive mechanical ventilation. This is a secondary analysis of the CIBERESUCICOVID project, a multicenter observational cohort study including fifty Spanish intensive care units that included COVID-19 mechanically ventilated patients between February 2020 and December 2021. We examined the association between mechanical power and its components (elastic static, elastic dynamic, total elastic and resistive power) with 90-day mortality after adjusting for confounders in seven hundred ninety-nine patients with COVID-19-induced respiratory failure undergoing invasive mechanical ventilation.</p><p><strong>Results: </strong>At the initiation of mechanical ventilation, the PaO₂/FiO₂ ratio was 106 (78; 150), ventilatory ratio was 1.69 (1.40; 2.05), and respiratory system compliance was 35.7 (29.2; 44.5) ml/cmH₂O. Mechanical power at the initiation of mechanical ventilation was 24.3 (18.9; 29.6) J/min, showing no significant changes after three days. In multivariable regression analyses, mechanical power and its components were not associated with 90-day mortality at the start of mechanical ventilation. After three days, total elastic and elastic static power were associated with higher 90-day mortality, but this relationship was also found for positive end-expiratory pressure.</p><p><strong>Conclusions: </strong>Neither mechanical power nor its components were independently associated with mortality in COVID-19-induced acute respiratory failure at the start of MV. Nevertheless, after three days, static elastic power and total elastic power were associated with lower odds of survival. Positive end-expiratory pressure and plateau pressure, however, captured this risk in a similar manner.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"27"},"PeriodicalIF":5.7,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11861844/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490540","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":"AI for the hemodynamic assessment of critically ill and surgical patients: focus on clinical applications.","authors":"Frederic Michard, Marijn P Mulder, Filipe Gonzalez, Filippo Sanfilippo","doi":"10.1186/s13613-025-01448-w","DOIUrl":"10.1186/s13613-025-01448-w","url":null,"abstract":"<p><p>Several artificial intelligence (AI)-driven tools have emerged for the hemodynamic evaluation of critically ill and surgical patients. This article provides an overview of current developments and potential clinical applications of machine learning (ML) for blood pressure measurements, hypotension prediction, hemodynamic profiling, and echocardiography. ML algorithms have shown promise in enabling continuous, non-invasive blood pressure monitoring by analyzing pulse oximetry waveforms, though these methods require periodic calibration with traditional oscillometric brachial cuffs. Additionally, a variety of ML models have been trained to forecast impending hypotension. However, clinical research indicates that these algorithms often primarily rely on mean arterial pressure, leading to questions about their added predictive value. The issue of false-positive alerts is also significant and can result in unwarranted clinical interventions. In terms of hemodynamic profiling, ML algorithms have been proposed to automatically classify patients into specific hemodynamic endotypes. However, current evidence suggests these models tend to replicate conventional hemodynamic profiles found in medical textbooks or depicted on advanced hemodynamic monitors. This raises questions about their practical clinical utility, especially given occasional discrepancies that could impact treatment decisions. Point-of-care ultrasound (POCUS) has gained traction for evaluating cardiac function in patients experiencing circulatory shock. ML algorithms now embedded in some POCUS systems can assist by recognizing ultrasound images, guiding users for optimal imaging, automating and reducing the variability of key echocardiographic measurements. These capabilities are especially beneficial for novice operators, potentially enhancing accuracy and confidence in clinical decision-making. In conclusion, while several AI-based technologies show promise for refining hemodynamic assessment in both critically ill and surgical patients, their clinical value varies. Comprehensive validation studies and real-world testing are essential to identify which innovations will genuinely contribute to improving the quality of care.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"26"},"PeriodicalIF":5.7,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11850697/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143481824","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}