Annals of Intensive Care最新文献

{"title":"Impact of substance use disorders on critical care management and health outcomes in septic adolescents.","authors":"Havell Markus, Gary D Ceneviva, Neal J Thomas, Conrad Krawiec","doi":"10.1186/s13613-025-01482-8","DOIUrl":"https://doi.org/10.1186/s13613-025-01482-8","url":null,"abstract":"<p><strong>Background: </strong>Adult septic patients with substance abuse disorder (SUD) are at increased risk of poor outcomes, but the impact on adolescents is unknown. We aimed to determine if pre-existing SUD is associated with increased adverse outcomes and critical care resources in critically ill adolescents hospitalized with sepsis. We hypothesize that SUD is associated with increased risk of adverse outcomes and usage of critical care resources in this adolescent patient population.</p><p><strong>Methods: </strong>This was a retrospective cohort study utilizing the TriNetX© electronic health record (EHR) database, which consists of EHR from participating healthcare organizations predominantly in the United States. Critically ill adolescents with sepsis aged 12-21 years were divided into two groups (SUD history and no-SUD history). Data related to demographics, diagnostic, procedural, and medication codes were analyzed. The primary outcomes were organ dysfunction, critical care therapies, and all-cause 1-year mortality.</p><p><strong>Results: </strong>We included 5,436 critically ill adolescents with sepsis [730 (13.43%) SUD history and 4706 (86.57%) no-SUD history]. SUD history was associated with increased odds of organ dysfunction (adjusted odds ratio [aOR] 1.84; 95% confidence interval [CI] 1.56-2.16; p < 0.001), vasoactive/inotropic drug usage (aOR 1.29; 95% CI 1.10-1.52; p = 0.002), mechanical ventilation (aOR 2.19; 95% CI 1.85-2.59; p < 0.001), but not mortality (aOR 1.03; 95% CI 0.76-1.41; p = 0.83).</p><p><strong>Conclusions: </strong>Our retrospective analysis suggests history of SUD in critically ill septic adolescent patients is associated with increased utilization of critical care resources and organ dysfunction. Further study is needed to determine if substance abuse represents a potentially modifiable risk factor for critical illness in adolescent patients.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"63"},"PeriodicalIF":5.7,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12065691/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143952748","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":"Right atrial presssure and intra-abdominal pressure: the elephant in the room.","authors":"Ngan Hoang Kim Trieu","doi":"10.1186/s13613-025-01478-4","DOIUrl":"https://doi.org/10.1186/s13613-025-01478-4","url":null,"abstract":"","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"62"},"PeriodicalIF":5.7,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12064508/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143960504","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":"Nosocomial lower respiratory tract infections in patients with immunosuppression: a cohort study.","authors":"Luis Felipe Reyes, Natalia Sanabria-Herrera, Saad Nseir, Otavio T Ranzani, Pedro Povoa, Emilio Diaz, Marcus J Schultz, Alejandro Rodríguez, Cristian C Serrano-Mayorga, Gennaro De Pascale, Paolo Navalesi, Szymon Skoczynski, Mariano Esperatti, Luis Miguel Coelho, Andrea Cortegiani, Stefano Aliberti, Anselmo Caricato, Helmut J F Salzer, Adrian Ceccato, Rok Civljak, Paolo Maurizio Soave, Charles-Edouard Luyt, Pervin Korkmaz Ekren, Fernando Rios, Joan Ramon Masclans, Judith Marin, Silvia Iglesias-Moles, Stefano Nava, Davide Chiumello, Lieuwe D J Bos, Antonio Artigas, Filipe Froes, David Grimaldi, Mauro Panigada, Fabio Silvio Taccone, Massimo Antonelli, Antoni Torres, Ignacio Martin-Loeches","doi":"10.1186/s13613-025-01462-y","DOIUrl":"https://doi.org/10.1186/s13613-025-01462-y","url":null,"abstract":"<p><strong>Background: </strong>This post-hoc analysis of a multinational, multicenter study aimed to describe and compare clinical characteristics, microbiology, and outcomes between immunosuppressed and non-immunosuppressed patients with nosocomial lower respiratory tract infections (nLRTI). The study utilized data from the European Network for ICU-related Respiratory Infections, including 1,060 adult ICU patients diagnosed with nLRTI. Descriptive statistics were used to compare baseline characteristics and pathogen distribution between groups. A Cox proportional hazards model stratified by immunosuppression status was applied to assess 28-day mortality risk, adjusting for disease severity and key clinical variables.</p><p><strong>Results: </strong>Immunosuppression was observed in 24.9% (264/1060) of the patients, and oncological conditions were the most common etiology of immunosuppression. Chronic pulmonary and cardiovascular diseases were the most frequent comorbidities. In both groups, Pseudomonas aeruginosa was the predominant microorganism, particularly affecting patients with immunosuppression (25.3% vs. 16.7%, p = 0.032). Cox regression model adjusted for disease severity (SAPS II), polytraumatized status, altered consciousness, and postoperative status, SAPS II remained a strong independent predictor of mortality, with each one-point increase associated with a 2.3% higher risk of death (HR: 1.023, 95% CI 1.017-1.030, p < 0.001). The analysis also revealed significant heterogeneity in mortality risk among immunosuppressed patients, with hematological malignancies, recent chemotherapy, and bone marrow transplantation associated with the highest mortality.</p><p><strong>Conclusions: </strong>Immunosuppressed patients had a lower adjusted survival probability compared to non-immunosuppressed patients. Moreover, P. aeruginosa was the most frequently identified etiological pathogen in immunosuppressed patients.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"61"},"PeriodicalIF":5.7,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12055687/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143957973","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":"Predicting intrathecal immunoglobulin synthesis in the ICU: a comparative study of IgG-based indexes.","authors":"Alexander Balcerac, Clémence Marois, Delphine Sterlin, Benjamin Rohaut, Sophie Demeret, Nicolas Weiss, Loic Le Guennec","doi":"10.1186/s13613-025-01475-7","DOIUrl":"https://doi.org/10.1186/s13613-025-01475-7","url":null,"abstract":"<p><strong>Background: </strong>Central nervous system autoimmune diseases (CNS-AD) such as autoimmune encephalitis and myelitis are severe conditions, often requiring ICU admission. Early diagnosis is crucial but difficult, as initial steps facing sub-acute neurological disorders try to exclude non-immune causes such as stroke or infections through MRI and multiplex PCR assays. Current acute-phase autoimmune identifiers are lacking, with definitive diagnosis hinging on delayed tests like antibody detection or intrathecal immunoglobulin synthesis (ISI) identification via iso-electric focalization (IEF). This study evaluates surrogate markers, such as the IgG quotient (QIgG), IgG index, and Reiber's formula, which are rapidly obtainable, to quickly predict ISI in the ICU setting, aiming to expedite treatment initiation.</p><p><strong>Methods: </strong>We screened all neuro-ICU admissions from 2008 to 2022 in our center, including patients who underwent a lumbar puncture (LP) and were tested for ISI via IEF. We excluded those lacking concomitant CSF/serum albumin and IgG data. Patients were categorized by final diagnosis as \"CNS-AD\" or \"other\", and whether ISI was present. We calculated QIgG, IgG index, and Reiber's formula, comparing their performance to IEF for sensitivity (Se) and specificity (Sp).</p><p><strong>Results: </strong>ISI was detected in 35% of patients (93/266). In the \"CNS-AD\" group, 54% were ISI-positive, while 21% of patients in the \"Other\" group also showed ISI. Among the three indexes, only the IgG index showed strong specificity (95%) but moderate sensitivity (56%). QIgG and Reiber's formula had similar sensitivity (67% and 66%) but lower specificity (41% for both). Multivariable analysis identified age < 50 years (OR 2.5 [95% CI 1.3-4.7]) and an IgG index > 0.7 (OR 14.2 [95% CI 6.6-32.0]) as factors independently associated with ISI positivity. Using the Youden index and likelihood ratio, we recalibrated thresholds to improve performance. A \"grey zone\" was defined for the IgG index (0.67-0.80), below which ISI was unlikely and above which it was considered probable.</p><p><strong>Conclusion: </strong>While the IgG index's low sensitivity limits its standalone diagnostic use, its high specificity makes this index a good one when positive, to weigh in the decision-making process to treat or not a patient with suspected CNS-AD, while awaiting IEF results, which can take days or even weeks in some centers.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"60"},"PeriodicalIF":5.7,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12043554/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143962797","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":"Hemodynamic effects of adjunct arginine vasopressin to norepinephrine in septic shock: insights from a prospective multicenter registry study.","authors":"Max Melchers, Vivienne de Smet, Chrissie Rooijakkers, Jonathan Huising, Wander Vermeulen, Beyza Nur Nisa Köktaş, Karlijn Johanna van de Vusse, Kimia Milani Sabzewar, Shakti Bedanta Mishra, Carina Bethlehem, Dirk P Boer, Nedim Cimic, Mirella van Duijnhoven, Tim Frenzel, Jordi Liesveld, Gianluca Paternoster, Susanne Stads, Jan J Weenink, Barbara Festen-Spanjer, Peter Pickkers, Arthur Raymond Hubert van Zanten","doi":"10.1186/s13613-025-01472-w","DOIUrl":"https://doi.org/10.1186/s13613-025-01472-w","url":null,"abstract":"<p><strong>Background: </strong>The Surviving Sepsis Campaign guidelines suggest adding arginine vasopressin (AVP) when norepinephrine (NE) doses reach 0.25-0.50 µg/kg/min in septic shock patients. However, relying solely on a NE threshold has limitations, as other factors may be valuable in guiding AVP therapy during septic shock. Therefore, we aimed to identify additional patient characteristics associated with AVP hemodynamic responsiveness.</p><p><strong>Methods: </strong>A multicenter, prospective, observational study was conducted among adult ICU patients who met the predefined criteria for septic shock (not reaching the individual target mean arterial pressure despite adequate fluid resuscitation and NE base dose > 0.25 µg/kg/min) and received AVP therapy. AVP hemodynamic responsiveness was the primary study outcome, defined as stabilization or decrease of NE infusion rate two hours after initiating AVP. Secondary outcomes included shock duration and rebound hypotension following termination of AVP infusion. Univariate and multivariable regression analyses were performed to detect associations between characteristics and outcomes.</p><p><strong>Results: </strong>Between May 2020 and October 2023, 200 septic shock patients originating from 11 different ICUs were included. Of these, 153 (79%) met the definition for AVP hemodynamic responsiveness. Obesity and hyperlactatemia was negatively associated with AVP-response (adjusted Odds Ratio [aOR] 0.30, 95%CI 0.14-0.65 and aOR 0.86, 95%CI 0.75-0.99, respectively), while a NE infusion rate ≥ 0.30 µg/kg/min showed positive odds of AVP response (aOR 2.33, 95%CI 1.06-5.14). Incidence of new-onset atrial fibrillation was lower in AVP responders than non-responders (4% vs. 14%, p = 0.013). Higher body mass index (BMI) , NE infusion rate and duration prior to AVP initiation was associated with longer shock duration (aOR 1.06, 95%CI 1.02-1.11, aOR 1.12, 95%CI 1.01-1.25, and 1.01 95% CI 1.00-1.03, respectively), while higher pH associated with lower likelihood of prolonged shock (aOR 0.80, 95%CI 0.64-0.99). Rebound hypotension occurred in 9% when AVP was terminated, and AVP duration > 24 h was negatively associated with rebound hypotension (OR 0.22, 95%CI 0.05-0.85).</p><p><strong>Conclusions: </strong>Arterial lactate, pH, BMI, and NE duration and dose were associated with AVP responsiveness and shock duration during septic shock, and rebound hypotension occurred in 9% during recovery. Our findings suggest that beyond NE thresholds, specific factors could be considered to optimize adjunctive AVP therapy in septic shock patients.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"59"},"PeriodicalIF":5.7,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12040798/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143963549","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":"Epidemiology and prediction of non-targeted bacteria by the filmarray pneumonia plus panel in culture-positive ventilator-associated pneumonia: a retrospective multicentre analysis.","authors":"F Berteau, A Kouatchet, Y Le Gall, C Pouplet, A Delbove, C Darreau, J Lemarie, F Jarousseau, F Reizine, C Giacardi, G Allo, C Aubron, M Eveillard, V Dubee, R Mahieu","doi":"10.1186/s13613-025-01468-6","DOIUrl":"https://doi.org/10.1186/s13613-025-01468-6","url":null,"abstract":"<p><strong>Background: </strong>Ventilator-associated pneumonia (VAP) is a prevalent nosocomial infection in intensive care units (ICUs) with significant impacts on patient outcomes and healthcare costs. Multiplex PCR could allow for personalized empirical treatment of VAP and optimize antibiotic therapy.</p><p><strong>Methods: </strong>This multicenter retrospective study analyzed culture-positive VAP cases from January 2016 to March 2021 across 12 ICUs in France. The prevalence of non-targeted bacteria was evaluated according to the bacterial species included in the BioFire^® FilmArray^® Pneumonia Panel (FAPPP), and associated risk factors were identified. A non-targeted bacteria was defined as a bacterial species isolated during VAP, not included in the FilmArray panel, but considered by the clinician in the final antibiotic therapy.</p><p><strong>Results: </strong>Among 332 patients with 385 culture-positive VAP episodes, non-targeted pathogens were observed in 23% of cases (87/385) and represented 21% (110/534) of isolated bacteria (After excluding bacteria with low pathogenicity, the rate of VAP with a non-targeted bacterium was 21%). The most common non-targeted bacteria identified were Stenotrophomonas maltophilia (22%), Citrobacter koseri, and Hafnia alvei. Gram stain results poorly correlated with definitive cultures (42% of concordance). The proportion of culture-positive VAP with non-targeted bacteria varied significantly between ICUs, ranging from 12 to 37%, (p = 0.013). Polymicrobial culture-positive VAP had a twofold higher risk of non-targeted bacteria (47% vs. 25%, p < 0.001). In the multivariate analysis, in-ICU antibiotic exposure was associated with a twofold increased risk of non-targeted bacteria (25.3% vs. 12.9%, p = 0.042), and age over 70 years was associated with a threefold increased risk (p = 0.027). Among the 48 culture-positive VAP cases with ineffective empiric treatment, Pseudomonas aeruginosa (22%), Stenotrophomonas maltophilia (14%), and Enterobacter cloacae complex (8%) were the most frequent bacteria. Additionally, 67% of the culture-positive VAP cases with ineffective empirical antibiotic therapy involved targeted bacteria, of which 59% could have received effective empirical antibiotic therapy if panel results had been available, according to bacterial species identification and current guidelines.</p><p><strong>Conclusions: </strong>A significant rate of culture-positive VAP cases with non-targeted bacteria was observed in this study, raising concerns about the interpretation of FAPPP results. Only positive FAPPP results may assist clinicians in the early personalization of antibiotic therapy for VAP.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"57"},"PeriodicalIF":5.7,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12037957/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143957255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: Impact of frailty and older age on weaning from invasive ventilation: a secondary analysis of the WEAN SAFE study.","authors":"Caoimhe M Laffey, Rionach Sheerin, Omid Khazaei, Bairbre A McNicholas, Tài Pham, Leo Heunks, Giacomo Bellani, Laurent Brochard, Dana Tomescu, Andrew J Simpkin, John G Laffey","doi":"10.1186/s13613-025-01467-7","DOIUrl":"https://doi.org/10.1186/s13613-025-01467-7","url":null,"abstract":"","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"58"},"PeriodicalIF":5.7,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12037443/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143973467","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":"Nirsevimab prophylaxis on pediatric intensive care hospitalization for severe acute bronchiolitis: a clinical and economic analysis.","authors":"Sarah Touati, Alexandre Debs, Luc Morin, Laure Jule, Caroline Claude, Pierre Tissieres","doi":"10.1186/s13613-025-01460-0","DOIUrl":"https://doi.org/10.1186/s13613-025-01460-0","url":null,"abstract":"<p><strong>Background: </strong>Severe acute viral bronchiolitis is a common cause of admissions to pediatric intensive care units (PICUs), resulting in a significant organizational burden each winter. The recent introduction of generalized neonatal prophylactic therapies using Nirsevimab, a monoclonal antibody targeting the respiratory syncytial virus (RSV), has significantly reduced consultations and hospitalizations. However, its impact on the medico-economic aspects of the PICU remains poorly defined.</p><p><strong>Methods: </strong>We analyzed all infants admitted to our unit for severe acute bronchiolitis over six consecutive epidemic periods (September to March) and examined the effect of Nirsevimab generalized prophylaxis on PICU admissions during the 2023-2024 period.</p><p><strong>Results: </strong>Between 2018 and 2024, 572 out of, 3728 infants under 6 months of age were admitted to the PICU for severe acute bronchiolitis during six epidemic periods. The average percentage of infants with bronchiolitis admitted to the PICU was 15.3% (95% CI 14.2-16.5), with a net decrease during the 2023-2024 period (8.5%) compared to the 2022-2023 period (17.6%). Patients' characteristics were similar, as were the supporting therapies. The causes of bronchiolitis were identical, with 83% and 77% secondary to RSV. PICU duration was significantly reduced during the last period from 4.4 days (95% CI 3.8-5.9) to 3.3 days (95% CI 2.6-4). The medico-economic impact was significant, with a cost reduction for acute severe viral bronchiolitis PICU total stays from €210,105 to €121,044 per annual epidemic without a change in the return on investment.</p><p><strong>Conclusions: </strong>The introduction of generalized neonatal prophylaxis with Nirsevimab significantly impacts the burden of severe acute bronchiolitis in the PICU.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"56"},"PeriodicalIF":5.7,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12031698/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143956775","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":"Use of procalcitonin in therapeutic decisions in the pediatric intensive care unit.","authors":"Pierre Tissières, Elisabeth Esteban Torné, Johannes Hübner, Adrienne G Randolph, Corsino Rey Galán, Scott L Weiss","doi":"10.1186/s13613-025-01470-y","DOIUrl":"https://doi.org/10.1186/s13613-025-01470-y","url":null,"abstract":"<p><p>Procalcitonin (PCT) is frequently used by clinicians in children with suspected bacterial infections and sepsis. However interpretation in the critically ill child may be challenging due to the complexity of underlying conditions and its impact on PCT values. Herein, we propose a guidance for the use of procalcitonin in critically ill children, supported by a comprehensive analysis of the literature, to help the clinician for interpreting PCT in the various clinical conditions encountered in pediatric intensive care units. We describe the importance of the clinical context, timing of measurement and evidence on PCT values in diagnosing sepsis and to guide antibiotic therapy in critically ill children.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"55"},"PeriodicalIF":5.7,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12018671/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143957974","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":"Stewart's theory and acid-base changes induced by crystalloid infusion in humans: a randomized physiological trial.","authors":"Antonio Maria Dell'Anna, Domenico Luca Grieco, Cristina Dominedò, Marta Cicetti, Irene Cisterna, Rossano Festa, Rosa Lamacchia, Giuseppina Giannì, Nicoletta Filetici, Teresa Michi, Cristina Rossi, Francesca Danila Alcaro, Alessandro Mele, Aurora Rocchi, Demetrio Del Prete, Maria Concetta Meluzio, Francesco Ciro Tamburrelli, Marco Rossi, Massimo Antonelli","doi":"10.1186/s13613-025-01473-9","DOIUrl":"https://doi.org/10.1186/s13613-025-01473-9","url":null,"abstract":"<p><strong>Background: </strong>Stewart's acid-base theory states that, under isocapnic conditions, crystalloid infusion affects plasma pH due to changes in strong ion difference and total weak acid concentration: a comprehensive study also assessing renal response and hemodilution effects has not been conducted in humans. We aimed to evaluate Stewart's approach during crystalloid infusion in humans.</p><p><strong>Methods: </strong>In this randomized trial, patients undergoing surgery with minimal blood losses were randomized to receive to normal saline (chloride content 154 mEq/L, strong ion difference 0 mEq/L), lactated Ringer's (chloride content 112 mEq/L, strong ion difference 29 mEq/L) or Crystalsol (chloride content 98 mEq/L, strong ion difference 50 mEq/L): patients received 10 ml/kg immediately after intubation, and 20 ml/kg after 2 h. Plasma/urinary acid-base and electrolytes were measured before study start and then at prespecified timepoints. The primary endpoint was pH one hour after the second fluid bolus: secondary outcomes included urinary/plasmatic electrolyte concentrations and strong ion difference during the study.</p><p><strong>Results: </strong>Forty-five patients were enrolled (15 in each group). The extent of hemodilution achieved with the first (median [Interquartile range]: saline 9% [6-15], Ringer's 7% [4-9], Crystalsol 8% [5-12]) and the second fluid bolus (saline 13% [5-17], Ringer's 12% [9-15], Crystalsol 15% [10-20]) was not different between groups (p = 0.39 and p = 0.19, respectively). Patients in saline group received more chloride (449 mEq [383-495]) vs. Ringer's (358 mEq [297-419]) and Crystalsol groups (318 mEq [240-366]) (p = 0.001). One hour after the second bolus, pH was lower in saline group (7.34 [7.32-7.36]) vs. Ringer's (7.40 [7.35-7.43) and Crystalsol groups (7.42 [7.38-7.44]) (both p < 0.01), since plasma chloride increased significantly over time in saline group but not in Ringer's and Crystalsol groups. Overall chloride urinary excretion was not different between study groups (saline 36 mEq [28-64], Ringer's 42 mEq [29-68], Crystalsol 44 mEq [27-56], p = 0.60) but, at the end of experiments, urinary chloride concentration was higher and diuresis was lower in saline group vs. Ringer's and Crystalsol groups (p = 0.01, p = 0.04, respectively).</p><p><strong>Conclusions: </strong>Consistent with Stewart's approach, crystalloid solutions with high chloride content lower pH due to reduced strong ion difference, progressive hemodilutional acidosis and limited renal response to chloride load.</p><p><strong>Trial registration: </strong>Registered on clinicaltrials.gov (NCT03507062) on April, 24th 2018.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"54"},"PeriodicalIF":5.7,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12014888/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143959393","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}