Annals of Intensive Care最新文献

{"title":"Awareness, knowledge and practices related to intra-abdominal hypertension and abdominal compartment syndrome among intensive care providers: a systematic scoping review.","authors":"ZhiRu Li, FangYan Lu, JingYun Wu, YanHong Dai, Yan Wang, Li Zheng, HuaFen Wang","doi":"10.1186/s13613-025-01521-4","DOIUrl":"10.1186/s13613-025-01521-4","url":null,"abstract":"<p><strong>Objectives: </strong>To provide a comprehensive overview of current research on intensive care providers' awareness, knowledge, and practices regarding IAP/IAH/ACS, as well as barriers to IAP measurement.</p><p><strong>Methods: </strong>This scoping review was guided by the framework of Arksey and Malley. Eight databases were searched to identify research published after 2007, including MEDLINE Complete, EMBASE, Web of Science, Cochrane Library, CINAHL Complete, ProQuest Health & Medical Complete, CNKI, and WANFANG. Two researchers reviewed and screened potentially relevant studies based on title and abstract. Full-text articles were independently assessed for eligibility based on predefined inclusion criteria.</p><p><strong>Results: </strong>Nineteen articles were included. Overall, pediatric intensive care providers demonstrated a lower awareness and knowledge of IAH/ACS compared to adult intensive care providers, particularly regarding the consensus definitions of IAH/ACS in critically ill children. IAP measurement has not been adequately integrated into clinical practice, with 18.0-73.0% of intensive care providers reporting they have never measured it. The frequency of IAP measurements and the criteria for determining which patients necessitate such measurements exhibited significant variability across different hospitals. The most frequently mentioned barriers to IAP measurement include a lack of knowledge regarding IAP measurement among adult intensivists, an overreliance on physical examination among pediatric intensivists, uncertainty in interpreting IAP data among adult intensive care nurses, and challenges in identifying populations at high risk of IAH among pediatric intensive care nurses. Diuretics were mentioned most often in the management of IAH/ACS, followed by administration of vasopressors and inotropes, decompressive laparotomy, and judicious administration of fluids and blood products. 37.0-66.3% of adult intensivists would choose a decompressive laparotomy in cases of ACS, whereas pediatric intensivists were less inclined to opt for the same approach.</p><p><strong>Conclusions: </strong>Since the publication of the WSACS consensus in 2007, there has been an improvement in awareness and knowledge regarding IAP/IAH/ACS among intensive care providers. Nevertheless, the understanding of the consensus definitions regarding IAH/ACS remains inadequate, particularly among pediatric intensive care providers. It is imperative to advocate for the implementation of WSACS guidelines in hospitals through targeted training programs and to promote the routine practice of IAP measurement in clinical settings.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"106"},"PeriodicalIF":5.5,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12290161/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144697444","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":"Angiotensin II, conventional vasopressor therapy, and mortality in shock: a large, multicenter, propensity score-weighted analysis.","authors":"Laurence W Busse, Caitlin Ten Lohuis, Han Xu, Cooper Jannuzzo, Robert H Lyles, J Pedro Teixeira, Ishan Mehta, Yuan Liu","doi":"10.1186/s13613-025-01522-3","DOIUrl":"10.1186/s13613-025-01522-3","url":null,"abstract":"<p><strong>Background: </strong>Angiotensin II (Ang II) is typically used in addition to adrenergic agents and vasopressin (conventional therapy) in patients with shock, but whether its use improves outcomes is unknown.</p><p><strong>Research question: </strong>We evaluated whether Ang II, when added to conventional therapy at different norepinephrine equivalent (NE) doses, was associated with mortality.</p><p><strong>Methods: </strong>We performed a retrospective analysis of 811 patients admitted to four centers in a single healthcare system who received vasopressors for shock, including 275 who received Ang II plus conventional therapy and 536 who received only conventional therapy. Age, gender, sequential organ failure assessment score, serum lactate, background NE dose, corticosteroid use, pre-morbid angiotensin-converting enzyme inhibitor or angiotensin receptor blocker use, and Charlson Comorbidity Index were calculated at initiation of Ang II or at an equivalent point of acuity in the conventional therapy cohort. We used propensity scores with inverse probability of treatment weighting (IPTW) to achieve covariate balance and multivariable logistic regression to compare 30-day mortality, further stratifying patients by 0.10 mcg/kg/min NE increments.</p><p><strong>Results: </strong>Overall 30-day mortality was 56.4%. Groups statistically differed by all baseline variables. In multivariable logistic regression, Ang II treatment was associated with lower 30-day mortality compared to conventional therapy alone (odds ratio [OR] 0.65, 95% confidence interval [CI] 0.45-0.95, p = 0.025). After IPTW, Ang II use was independently associated with lower mortality (OR 0.74, 95% CI 0.55-0.99, p = 0.040). When stratifying by increments of background NE dose, Ang II initiation was associated with lower 30-day mortality compared to conventional therapy alone in patients on background NE doses > 0.4, > 0.5, and ≤ 0.6 mcg/kg/min. Ang II use in patients on background NE dose > 0.6 was not significantly associated with mortality.</p><p><strong>Conclusions: </strong>Ang II administration was associated with a lower risk of death in unadjusted and adjusted analyses. This effect was preserved only with patients receiving NE at doses ranging from 0.4 to 0.6 mcg/kg/min. Though additional prospective studies are required, these findings suggest that Ang II may be beneficial across a specific range of background vasopressor doses.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"104"},"PeriodicalIF":5.5,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12286902/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144688614","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":"Association between the Venous Excess Ultrasound (VExUS) score and acute kidney injury in critically ill patients with sepsis: a multicenter prospective observational study.","authors":"Jia Song, Gongze Chen, Detian Lai, Li Zhong, Haozhe Fan, Weihang Hu, Minjia Wang, Caibao Hu, Wenwei Chen, Ziqiang Ming, Shijin Gong, Qiancheng Luo","doi":"10.1186/s13613-025-01529-w","DOIUrl":"10.1186/s13613-025-01529-w","url":null,"abstract":"<p><strong>Background: </strong>Venous congestion is associated with adverse clinical outcomes in critically ill patients, yet its assessment remains challenging. Recently, the Venous Excess Ultrasound (VExUS) score has shown great potential as a non-invasive tool for assessing venous congestion in cardiac patients. However, the relationship between VExUS and clinical outcomes in patients with sepsis remains understudied. This study aims to evaluate the incidence of venous congestion based on VExUS assessment within the first 5 days of intensive care unit (ICU) admission in critically ill patients with sepsis, and to investigate the association between VExUS and clinical outcomes.</p><p><strong>Methods: </strong>We conducted a prospective, observational study in four ICUs, enrolling adult patients with sepsis who stayed in the ICU for at least 24 h. VExUS assessments were performed on days 1 (within 24 h), 3 (48-72 h), and 5 (96-120 h) following ICU admission. Patients were classified according to VExUS score ≥ 2 or < 2. The primary outcome was the prevalence of acute kidney injury (AKI) during ICU stay, while secondary outcomes included 30-day mortality, ICU mortality, and requirement for renal replacement therapy (RRT).</p><p><strong>Results: </strong>Among the 108 patients included, 18% (19 patients) showed VExUS score ≥ 2 on day 1 of ICU admission, and the prevalence progressively decreased to 15% (15 patients) by day 3 and 6% (6 patients) by day 5. The VExUS score ≥ 2 was not associated with AKI (OR 1.82, 95% CI 0.62-5.31, p = 0.274), 30-day mortality (OR 0.82, 95% CI 0.28-2.4, p = 0.711), ICU mortality (OR 1.12, 95% CI 0.41-3.04, p = 0.82), or requirement for RRT (OR 2.29, 95% CI 0.68-7.64, p = 0.179). There was no significant correlation between VExUS and central venous pressure (coefficient: - 0.019, 95% CI -0.01 to 0.05, p = 0.204).</p><p><strong>Conclusion: </strong>In critically ill patients with sepsis, approximately 20% exhibit early (within 24 h of ICU admission) venous congestion, with the prevalence progressively decreasing over the subsequent 5 days. Venous congestion assessed by VExUS was not associated with the occurrence of AKI or with mortality.</p><p><strong>Trial registration: </strong>Chinese Clinical Trial Registry, ChiCTR2200066987. Registered 22 December 2022, https://www.chictr.org.cn/.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"105"},"PeriodicalIF":5.7,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12287484/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144688615","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":"How should spontaneous breathing trials be performed in the light of recent literature?","authors":"Arnaud W Thille, Gonzalo Hernández","doi":"10.1186/s13613-025-01507-2","DOIUrl":"10.1186/s13613-025-01507-2","url":null,"abstract":"","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"102"},"PeriodicalIF":5.7,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12267760/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144648370","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":"Neuroimaging for prognosis of central nervous system infections: a systematic review and meta-analysis.","authors":"Augustin Gaudemer, Netanel Covier, Marie-Cécile Henry-Feugeas, Jean-François Timsit, Philippa Catherine Lavallée, Etienne de Montmollin, Augustin Lecler, Antoine Khalil, Romain Sonneville, Camille Couffignal","doi":"10.1186/s13613-025-01516-1","DOIUrl":"10.1186/s13613-025-01516-1","url":null,"abstract":"<p><strong>Background: </strong>Central nervous system (CNS) infections carry a severe prognosis and often require intensive care unit (ICU) admission. This study evaluated the prognostic value of neuroimaging in patients with all-type CNS infections.</p><p><strong>Methods: </strong>Using a predefined strategy, we first conducted a systematic search of PubMed/MEDLINE, PubMed Central, Embase, Cochrane and Google Scholar. Eligible studies published between January 1st, 2000, and June 1st, 2023, were included. We considered randomized controlled trials, non-randomized trials, cohort studies, excluding abstracts, cost-effectiveness analyses, letters, conference proceedings, systematic reviews, and meta-analyses. Two authors independently screened publications and extracted data. The meta-analysis was performed using a random-effects model. The main outcomes were (1) unfavorable outcome, defined as severe functional disability or death, and (2) mortality. Pooled odds ratios (OR) and 95% confidence intervals (95%CI) were calculated for each neuroimaging feature. We performed prespecified subgroup analyses depending on type of CNS infection (bacterial meningitis, CNS tuberculosis, CNS cryptococcosis, viral encephalitis, and brain abscess), country income, and ICU admission status.</p><p><strong>Results: </strong>Of 7,864 studies identified, 83 met the inclusion criteria, with 48 studies (6,434 patients) included in the meta-analysis. Abnormal MRI (OR: 3.55; 95%CI: 1.81-6.96; I²=0%), brain ischemia (OR: 4.65; 95%CI: 3.14-6.88; I²=28.5%), and hydrocephalus (OR: 4.56; 95%CI: 2.49-8.36; I²=61.5%) were significantly associated with unfavorable outcome. Hydrocephalus (OR, 3.99; 95%CI 1.83-8.70; I²=61%) and brain ischemia (OR, 3.51; 95%CI, 2.22-5.54; I²=16.4%) were associated with mortality. These associations remained consistent in patients with bacterial meningitis and in patients with CNS tuberculosis, but not in other CNS infections. Subgroup analyses depending on country income and ICU admission status revealed similar findings.</p><p><strong>Conclusion: </strong>Neuroimaging provides essential prognostic information in patients with CNS infections. Abnormal MRI findings, cerebral ischemia, and hydrocephalus are associated with unfavorable outcome, particularly in bacterial meningitis and CNS tuberculosis. These neuroimaging features should be considered when discussing prognosis in affected patients.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"101"},"PeriodicalIF":5.7,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12267735/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144648371","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 nutritional support in the intensive care unit: the French Intensive Care Society (SRLF) and the French-Speaking Group of Pediatric Emergency Physicians and Intensivists (GFRUP).","authors":"Jean Reignier, Benedicte Gaillard-Le Roux, Pierre François Dequin, Valeria A Bertoni Maluf, Julien Bohe, Michael P Casaer, Agathe Delbove, Claire Dupuis, Eric Fontaine, Prescillia Gamon, Coralie Grange, Nicholas Heming, Melissa Jezequel, Adam Jirka, Corinne Jotterand Chaparro, Michael Landais, Nolwenn Letouze, Claire Morice, Olivier Pantet, Julie Pellecer, Gael Piton, Shancy Rooze, Julie Starck, Jean-Marc Tadie, Fabienne Tamion, Ronan Thibault, Frédéric Valla, Thierry Vanderlinden, Arnaud W Thille, Nadia Aissaoui","doi":"10.1186/s13613-025-01509-0","DOIUrl":"10.1186/s13613-025-01509-0","url":null,"abstract":"<p><p>The objective of this work was to develop guidelines for nutritional support in critically ill adults and children (excluding neonates and burn patients) unable to maintain an adequate oral intake. We aimed to provide up-to-date recommendations based on high-level evidence including the results of recent landmark randomized controlled trials. Experts from the French Intensive Care Society (SRLF), the French Society of Clinical Nutrition and Metabolism (SFNCM), and the French-Speaking Group of Pediatric Emergency Physicians and Intensivists (GFRUP) used the GRADE methodology to develop the guidelines. Twenty-four Patient Intervention Comparator Outcome (PICO) questions were identified, resulting in 34 adult and 29 pediatric recommendations. Of the 34 recommendations for adults, three were based on high-level evidence, 12 on moderate-level evidence, and 19 on expert opinion. The corresponding numbers for the 29 pediatric recommendations were one, five, and 23. All recommendations achieved strong agreement among the experts. These guidelines emphasize the importance of individualized nutritional support strategies that incorporate recent high-quality evidence to optimize the outcomes of critically ill patients.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"99"},"PeriodicalIF":5.5,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12263543/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144641592","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":"Hyperglycemia and insulin use in patients with COVID-19 and severe hypoxemia allocated to 12 mg vs. 6 mg of dexamethasone: a secondary analysis of the COVID STEROID 2 randomized trial.","authors":"Clara Lundetoft Clausen, Thomas Bryrup, Christian Leo Hansen, Daniel Faurholt-Jepsen, Alessandra Meddis, Thomas Peter Almdal, Ole Snorgaard, Henrik Løvendahl Jørgensen, Marie Helleberg, Margit Smitt, Christian Aage Warmberg, Klaus Tjelle, Charlotte Suppli Ulrik, Anne Sofie Andreasen, Morten Bestle, Lone Poulsen, Klaus Vennick Marcussen, Lothar Wiese, Marie Warrer Munch, Anders Perner, Rikke Krogh-Madsen, Thomas Benfield","doi":"10.1186/s13613-025-01512-5","DOIUrl":"10.1186/s13613-025-01512-5","url":null,"abstract":"<p><strong>Background: </strong>While dexamethasone has been shown to improve survival in COVID-19, its dose-response relationship with plasma glucose (PG) levels and insulin requirements is poorly understood. This study investigated the impact of 12 mg (higher dose) versus 6 mg (standard dose) of dexamethasone on hyper- or hypoglycemic events and the use of insulin.</p><p><strong>Methods: </strong>A secondary analysis of a subpopulation of the COVID STEROID 2 trial. Glycemic outcomes were assessed by time-to-event analysis of a hyperglycemic (two PG measurements ≥ 11.1 mmol/L), severe hyperglycemic (PG > 20 mmol/L), hypoglycemic (< 3.8 mmol/L) event or use of insulin, adjusted for age, diabetes status, hospital site, and mechanical ventilation. PG levels were compared before and after treatment allocation with linear mixed models to estimate changes in average PG levels over time.</p><p><strong>Results: </strong>Of 321 participants, 170 were allocated to the higher dose and 151 to the standard dose of dexamethasone. Time to a hyperglycemic event did not differ between groups, whereas severe hyperglycemic events were more frequent in the higher dose group (36%) than in the standard dose group (31%) with an adjusted subdistributional hazard ratio of 1.76 (95% CI [1.22-2.54], p = 0.003). Insulin use and hypoglycemic events did not differ between groups. The higher vs. standard dose group had an average PG increase of 0.5 mmol/L (95% CI [- 0.2 to 1.4], p = 0.149).</p><p><strong>Conclusion: </strong>Higher vs. standard doses of dexamethasone were associated with a higher incidence of severe hyperglycemia in patients with COVID-19 and severe hypoxemia, but the average increase in PG was similar between groups.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"98"},"PeriodicalIF":5.7,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12263535/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144641593","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":"Weaning from mechanical ventilation in myasthenic crisis according to WEAN safe: most patients experience intermediate or prolonged weaning with no differences between early and late-onset compared to very-late onset myasthenia Gravis.","authors":"Clémence Marois, Arthur Combes, Meriem Bouguerra, Alexandra Grinea, Lucas Di Meglio, Thomas Rambaud, Loïc Le Guennec, Francis Bolgert, Benjamin Rohaut, Sophie Demeret, Nicolas Weiss","doi":"10.1186/s13613-025-01515-2","DOIUrl":"10.1186/s13613-025-01515-2","url":null,"abstract":"<p><strong>Background: </strong>Myasthenic crisis often requires prolonged mechanical ventilation and complex weaning, yet data remain scarce. The objective of this study was to describe the weaning characteristics in patients with myasthenic crisis using the WEAN Safe classification. Secondary aims included assessment of long-term outcome and comparison between early- and late-onset (< 65 years) versus very-late-onset MG (≥ 65 years) myasthenia gravis.</p><p><strong>Methods: </strong>This single-center retrospective study included patients admitted for myasthenic crisis to a tertiary neuro-intensive care unit between January 2008 and December 2023. Clinical characteristics, ventilatory support parameters, timing of weaning events, complications, and outcomes were recorded. Weaning was classified according to WEAN Safe definitions: no separation attempt, short wean (successful weaning within 1 day), intermediate wean (2-6 days), prolonged wean (≥ 7 days), or failed wean (persistent invasive ventilation at discharge or death).</p><p><strong>Results: </strong>Among 698 ICU hospitalizations (405 patients) for myasthenia gravis, 131 (120 patients) received invasive mechanical ventilation. Fifty hospitalizations (39 patients) were excluded due to non-MC-related intubation, insufficient weaning data or patients with multiple ICU admissions. The final analysis included 81 patients (median age 70 years [54-81]; 43% female; 64% with very-late-onset myasthenia gravis (≥ 65 years). The median duration of mechanical ventilation was 20 days [11-38], and the median time from the first separation attempt to successful weaning was 7 days [3-19]. According to the WEAN Safe classification, 3% had a short wean, 40% intermediate, 55% prolonged, and 3% failed weaning. Four patients (5%) required reintubation within 48 h. Ventilator-associated pneumonia occurred in 15% of patients before the first separation attempt. In multivariate analysis, the presence of thymoma (OR 3.02, 95% CI 1.01-9.07) and absence of MG-specific immunosuppressive treatment at ICU admission (OR 3.70, 95% CI 1.22-11.23) were independently associated with prolonged weaning. Intensive care unit mortality was 7%, and 12-month mortality was 19%. The median myasthenic muscle score at 1 year was 94/100 [80-100]. No significant differences in weaning parameters nor outcome were found between early- and late-onset versus very-late-onset MG, despite more comorbidities in the very-late-onset group.</p><p><strong>Conclusions: </strong>In this retrospective study from a single expert center, most patients with myasthenic crisis underwent intermediate or prolonged weaning, but extubation failure rate was very low. Thymoma and lack of MG-specific immunosuppressive treatment at ICU admission are associated with prolonged weaning, while age alone is not. Despite initial challenges, long-term outcomes are generally favorable, highlighting the reversibility of myasthenic crisis with expert care.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"95"},"PeriodicalIF":5.7,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12259497/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144625293","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":"Sex differences in advance directives and their clinical translation among critically ill adults: results from the ADVISE study.","authors":"Simon A Amacher, Sira M Baumann, Paulina S C Kliem, Dominik Vock, Yasmin Erne, Pascale Grzonka, Sebastian Berger, Martin Lohri, Sabina Hunziker, Caroline E Gebhard, Mathias Nebiker, Luca Cioccari, Raoul Sutter","doi":"10.1186/s13613-025-01518-z","DOIUrl":"10.1186/s13613-025-01518-z","url":null,"abstract":"<p><strong>Background: </strong>Advance directives (ADs) are legally binding documents outlining individual preferences for medical care in the event of incapacitation. Evidence regarding their significance and implementation in critical care is scarce. Thus, this retrospective cohort study assesses sex differences in ADs' frequency, content, clinical translation, and associated outcomes in critically ill adults. The study was performed in two interdisciplinary tertiary Swiss intensive care units (ICUs). It included patients with ADs treated in the ICUs for > 48 h. The primary endpoint was the frequency of ADs. Secondary endpoints included the content of ADs, sex differences in baseline and treatment characteristics, the clinical implementation of ADs, and in-hospital outcomes.</p><p><strong>Results: </strong>5242 patients were treated for > 48 h in the ICUs, of which 313 (6.0%) had ADs (124 females [6.8% of 1813 females] and 189 males [5.5% of 3429 males], p = 0.054). No sex-related differences were observed regarding baseline characteristics except that females with ADs were more frequently single, divorced, or widowed (57% vs. 37%, p = 0.001), more frequently had acute stroke as main diagnosis (13% vs. 3%, p = 0.001), and more often refused cardiopulmonary resuscitation (CPR) (42% vs. 25%, p = 0.002) than males with ADs. In multivariable analyses, female sex was associated with refusing CPR independent of relationship status. Compared to males, females' ADs were more frequently violated (24% vs. 10%, p < 0.001), primarily by receiving unwanted treatments (24% vs. 8%, p < 0.001) and/or undesired ICU admission (10.5% vs 2.1%, p = 0.002). Despite these differences, treatment adaptations during intensive care, in-hospital outcomes, and discharge destinations did not differ between sexes.</p><p><strong>Conclusions: </strong>This study revealed sex disparities in the content and translation of ADs between females and males admitted to ICUs. Females' ADs were more frequently violated, indicating a potential sex bias in the interpretation and translation of ADs in critical care. Clinicians must remain vigilant against violations of ADs and strive to deliver equitable care. Further prospective research is needed to investigate the causes of disparities in ICU end-of-life decision-making, integrating both qualitative and quantitative measures, to ensure equal treatment for all patients, regardless of sex or gender.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"94"},"PeriodicalIF":5.7,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12259517/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144625280","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":"Vascular hyporesponsiveness to norepinephrine is a major but not exclusive determinant of mortality in septic shock.","authors":"Antoine Goury, Zoubir Djerada, Jean-Louis Teboul, Olfa Hamzaoui","doi":"10.1186/s13613-025-01520-5","DOIUrl":"10.1186/s13613-025-01520-5","url":null,"abstract":"","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"96"},"PeriodicalIF":5.7,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12260132/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144625281","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}