Annals of Intensive Care最新文献

{"title":"Target-controlled infusion for analgesia and sedation in the intensive care unit: a scoping review.","authors":"Alessandro Zambianchi, Tommaso Pettenuzzo, Francesco Zarantonello, Domenico Ruggerini, Gianluca Lumetti, Lorenzo Beria, Giulia Aviani Fulvio, Nicola Rebellato, Giulia Ometto, Valentina Fincati, Mara Bassi, Giulia Mormando, Elisa Pistollato, Arianna Peralta, Alessandro De Cassai, Nicolò Sella, Annalisa Boscolo, Paolo Navalesi","doi":"10.1016/j.aicoj.2026.100035","DOIUrl":"https://doi.org/10.1016/j.aicoj.2026.100035","url":null,"abstract":"<p><strong>Background: </strong>Target-controlled infusion (TCI) is widely used for total intravenous anesthesia; however, its role in the intensive care unit (ICU) for analgesia and sedation remains insufficiently defined. We performed a scoping review to describe the existing evidence on the applications of TCI in critically ill adults.</p><p><strong>Methods: </strong>In accordance with a registered protocol (Open Science Framework, April 3, 2025), we systematically searched major databases for randomized and non-randomized studies evaluating TCI in the ICU. Eight independent reviewers conducted study screening, data extraction, and risk of bias assessment.</p><p><strong>Results: </strong>Thirty-three articles comprising 1,273 patients met the inclusion criteria, 1,142 1 patients receiving TCI-based analgosedation and 106 receiving conventional strategies. Reported indications for TCI-based analgosedation included postoperative ventilation, postoperative pain control, and procedures associated with discomfort and pain. Only four studies directly compared TCI-based to conventional analgosedation strategies. Overall, TCI was feasible, safe, and allowed precise titration of analgesia and sedation. Most studies were judged to have a moderate risk of bias.</p><p><strong>Conclusions: </strong>Available data suggest that TCI-based analgosedation in the ICU is feasible and safe in the short term. Most available data are descriptive or exploratory and robust comparative clinical benefit has not yet been demonstrated. Further high-quality research is therefore needed to validate existing pharmacological models for prolonged infusions and to compare TCI with standard analgosedation practices regarding safety and patient-centered outcomes.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100035"},"PeriodicalIF":5.5,"publicationDate":"2026-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12934426/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147363825","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":"Assessing venous congestion in critical illness: advantages of the inferior vena cava shape change index over diameter.","authors":"Lizhi Li, Yuehua Xu, Xiukai Chen, Wei Huang","doi":"10.1016/j.aicoj.2026.100032","DOIUrl":"https://doi.org/10.1016/j.aicoj.2026.100032","url":null,"abstract":"<p><strong>Background: </strong>The traditional Venous Excess Ultrasound (VExUS) scoring system relies on inferior vena cava (IVC) diameter measurements, which are affected by multiple confounding factors. The Shape Change Index (SCI) of IVC, defined as the ratio of short-axis diameter to long-axis diameter, may provide a more stable morphological indicator of venous filling.</p><p><strong>Methods: </strong>In this prospective study, trained operators performed bedside ultrasonography to measure IVC diameter and calculate the SCI of IVC (short-axis diameter/long-axis diameter). Hepatic, portal, and renal venous Doppler waveforms were used to grade venous congestion (Grade 0-3). Diagnostic performance of SCI and IVC diameter for detecting venous congestion was evaluated using receiver operating characteristic(ROC) analysis, with additional exploratory analyses performed to further characterize incremental diagnostic value.</p><p><strong>Results: </strong>A total of 116 venous Doppler examinations from 84 critically ill adults were analyzed. The SCI of IVC demonstrated a stronger correlation with venous congestion grade than IVC diameter (Spearman's ρ = 0.691 vs 0.490, both p < 0.001). For detecting any venous congestion (VExUS Grade ≥1 vs Grade 0), the SCI of IVC showed significantly better diagnostic discrimination than IVC diameter, with an area under the curve of 0.864 compared with 0.767, respectively (p = 0.044). The diagnostic advantage of SCI appeared to be more evident in examinations without advanced venous congestion. Higher SCI values were associated with greater disease severity.</p><p><strong>Conclusions: </strong>The SCI of IVC demonstrates superior diagnostic performance compared with IVC diameter for the identification of venous congestion in critically ill patients, particularly at earlier or less advanced stages. These findings support the use of SCI as a complementary screening tool within the existing VExUS framework. Further multicenter studies are required to confirm its clinical utility and generalizability.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100032"},"PeriodicalIF":5.5,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12934418/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147363643","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":"Characterizing ICU-like profiles of very old patients hospitalized in medical intermediate care units in France: A clustering analysis of a nationwide population-based study.","authors":"Arthur Kassa-Sombo, Adrien Migeon, Lucile Godillon, Emeline Laurent, Leslie Grammatico-Guillon, Antoine Guillon","doi":"10.1016/j.aicoj.2026.100031","DOIUrl":"https://doi.org/10.1016/j.aicoj.2026.100031","url":null,"abstract":"<p><strong>Purpose: </strong>The population aging has a growing impact on intensive care. The admission policies for critically ill very old patients in intermediate care units (IMCUs) are unclear. This study aimed to identify clusters of very old patients hospitalized in IMCUs in France, and to compare \"ICU-like\" profiles among these patients with matched very old patients admitted to ICU patients, in order to better understand the factors influencing admission to an IMCU rather than an ICU.</p><p><strong>Methods: </strong>We conducted a nationwide study and examined all hospitalisations in IMCUs in France over a two-year period. We studied the utilization of medical IMCU for all critically ill patients ≥80 y.o and reported patient characteristics, including the Charlson comorbidity index and Hospital Frailty Risk Score. Latent class analysis identified distinct IMCU phenotypes. Clusters with high-use organ support (≥5%) and high mortality (≥40%) were considered \"ICU-like.\" Logistic regression compared \"ICU-like\" IMCU patients with propensity-matched ICU patients to identify factors associated with IMCU admission.</p><p><strong>Results: </strong>Among the 202,976 very old individuals hospitalized in IMCU, seven phenotypes were identified. The \"ICU-like\" population accounted for 11.6% of the cohort (<i>n</i> = 23,508). After propensity score matching, the multivariate logistic regression identified age as the strongest determinant to IMCU admission, with very old patients being significantly more likely to be admitted to the IMCU over the ICU. Comorbidity status was also an independent predictor for admission to IMCU. Frailty status showed only a marginal effect, and no association was detectable for sex.</p><p><strong>Conclusion: </strong>A substantial number of very old patients were admitted to IMCU despite meeting ICU-level criteria. Clearer admission criteria and objectives for IMCU care in older critically ill patients are urgently needed.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100031"},"PeriodicalIF":5.5,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12934429/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147363766","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":"Beyond contact precautions: unmasking environmental and antibiotic drivers of ESBL-E in the ICU.","authors":"Peng Liu, Yongkui Ren","doi":"10.1016/j.aicoj.2026.100029","DOIUrl":"https://doi.org/10.1016/j.aicoj.2026.100029","url":null,"abstract":"","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100029"},"PeriodicalIF":5.5,"publicationDate":"2026-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12934416/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147363742","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":"Mortality in children with fulminant myocarditis: a six-year multicenter retrospective study.","authors":"Lijun Yang, Wenting Zhao, Xuming Mo, Yucai Zhang, Jie Wang, Yanqin Cui, Zhenhua Liang, Yuxiong Guo, Wei Wang, Zhigang Liu, Daqing Ma, Ru Lin, Qiang Shu","doi":"10.1016/j.aicoj.2026.100030","DOIUrl":"https://doi.org/10.1016/j.aicoj.2026.100030","url":null,"abstract":"<p><strong>Background: </strong>Fulminant myocarditis (FM) in children can progress rapidly to cardiogenic shock, with high risk of mortality. Early recognition of prognostic markers is critical to guide timely escalation of circulatory support. This multicenter study sought to characterize clinical features and identify early predictors of in-hospital mortality in pediatric FM.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of patients <18 years with FM admitted to eight ECMO-capable pediatric intensive care units between January 2018 and August 2023. Clinical, biochemical, electrocardiographic, and echocardiographic variables were analyzed. Logistic regression was used to identify predictors of mortality, and receiver operating characteristic (ROC) curves were generated to assess discriminatory performance.</p><p><strong>Results: </strong>A total of 187 children were included; 157 (84.0%) required ECMO. In-hospital mortality was 16.6% (31/187). Univariate analysis identified elevated CK-MB, higher peak lactate, and ventricular tachycardia as associated with mortality. In multivariate analysis, peak lactate (AUC 0.791) and CK-MB (AUC 0.774) remained independent predictors. A combined model of peak lactate and ventricular tachycardia demonstrated moderate discrimination (AUC 0.772), whereas a composite model incorporating CK-MB, peak lactate, and ventricular tachycardia achieved the best predictive performance (AUC 0.815). Elevated lactate measured 12 h after initiation of extracorporeal membrane oxygenation or intensive conventional therapy further increased mortality risk (OR 1.219, 95% CI 1.004-1.481).</p><p><strong>Conclusion: </strong>Peak lactate, CK-MB, and ventricular tachycardia are early independent predictors of in-hospital mortality in pediatric FM. Persistent hyperlactatemia within 12 h of advanced support provides additional prognostic value and may assist clinicians in early risk stratification.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100030"},"PeriodicalIF":5.5,"publicationDate":"2026-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12934420/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147363797","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 role of cytokines in septic myocardial dysfunction: a translational systematic review and meta-analysis.","authors":"Thomas Frapard, Ségolène Gendreau, Agathe Kasbi, Antoine Meyer, Keyvan Razazi, Nicolas de Prost, Jean Rémi Lavillegrand, Armand Mekontso Dessap","doi":"10.1016/j.aicoj.2026.100027","DOIUrl":"https://doi.org/10.1016/j.aicoj.2026.100027","url":null,"abstract":"<p><strong>Background: </strong>Septic myocardial dysfunction is a frequent complication of sepsis, commonly defined by impaired cardiac contractility. Despite its clinical significance, its pathophysiology remains poorly understood and no targeted therapy is currently available. Pro-inflammatory cytokines have been implicated in experimental models, but their causal role and therapeutic relevance in septic myocardial dysfunction remain uncertain. We aimed to systematically review and meta-analyze the impact of cytokine addition or blockade on myocardial function in sepsis across in vitro, in vivo, and human studies.</p><p><strong>Methods: </strong>We performed a systematic search of MEDLINE, Embase, Cochrane, and PubMed databases up to December 2024. We included all cellular, animal, and human studies (descriptive or interventional) assessing the effect of cytokine modulation on myocardial contractility in sepsis. Studies lacking contractility assessment were excluded from the meta-analysis but retained in the systematic review. Standardized mean differences (SMDs) were pooled using a random-effects model. Risk of bias was assessed using dedicated tools adapted to each study design.</p><p><strong>Results: </strong>A total of 39 studies were included in the systematic review, and 21 in the meta-analysis. Eleven in vitro or ex vivo studies showed that cardiomyocyte contractility was significantly reduced after exposure to IL-1 (SMD 5.62 [5.01;6.23]), IL-6 (4.24 [1.49;6.99]) and TNF-α (4.45 [3.17;5.72]); all were included in the meta-analysis. Seventeen in vivo animal studies were reviewed, of which six were eligible for meta-analysis: TNF-α (5.06 [1.46;8.65]) and IL-18 (1.56 [0.77;2.36]) were associated with significant cardiac depression, whereas IL-1 showed a non-significant effect (2.58 [-0.90;6.07]). Among eleven human studies, four were included in the meta-analysis. Patients with septic myocardial dysfunction had higher circulating levels of IL-6 (SMD 0.51 [0.06;0.97]), IL-1 (0.67 [0.11;1.23]), IL-8 (0.59 [0.35;0.83]) and IL-10 (0.57 [0.34;0.80]) than controls, while the difference for TNF-α was not significant (0.63 [-0.02;1.28]). Two small interventional studies suggested potential benefits from cytokine-targeting therapies.</p><p><strong>Conclusions: </strong>This translational review supports a cytokine-mediated contribution to septic myocardial dysfunction. While mechanistic evidence is strong in preclinical models, clinical data remain observational. These findings justify further interventional studies targeting cytokines in septic myocardial dysfunction.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100027"},"PeriodicalIF":5.5,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12934446/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147363828","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 challenging diagnosis of ICU-related Mesenteric Ischaemia: a prospective, observational, multicentre cohort.","authors":"Stefan Andrei, Jerome Allyn, Nicolas Allou, Sonia Yung, Gabriel Stefan, Peter Matthews, Mathieu Desmard, Laura Federici, Yves Castier, Lara Ribeiro Parenti, Philippe Montravers, Pascal Augustin","doi":"10.1016/j.aicoj.2026.100028","DOIUrl":"https://doi.org/10.1016/j.aicoj.2026.100028","url":null,"abstract":"<p><strong>Background: </strong>The diagnosis of acute mesenteric ischemia (AMI) is challenging, especially in the intensive care unit (ICU), where non-occlusive mesenteric ischemia (NOMI) predominates. In ICU patients, contrast-enhanced computed tomography (CT) provides limited diagnostic accuracy, and no single biomarker is sufficiently reliable. Transmural digestive necrosis, revealed as necrotic bowel (NB) during surgical exploration, is irreversible and requires bowel resection. We proposed an approach combining several clinical, biological, and therapeutic parameters to predict the presence of NB in ICU patients with high suspicion of AMI.</p><p><strong>Methods: </strong>We conducted a prospective observational study in three ICUs. All consecutive patients with suspected AMI were enrolled. Patients with NB identified during surgical exploration were compared with those without NB. Patients who survived without undergoing surgery were considered not to have NB. Multivariable logistic regression analysis was used to identify parameters independently associated with NB.</p><p><strong>Results: </strong>A total of 202 patients were included. Among them, 74 (37%) had NB (including 70 with NOMI and 4 with occlusive AMI), while 128 (63%) did not. In the multivariable analysis, age (OR 1.068, 95% CI 1.027-1.111, p = 0.001), active fluid removal (OR 3.148 (1.19-8.33), p = 0.021), signs of gastrointestinal injury (3.432 (1.082-10.885), p = 0.036), need for renal replacement therapy (OR 3.834 (1.457-10.01), p = 0.006), and lactate dehydrogenase (log) at the time of AMI suspicion (OR 7.135 (2.1-24.235) p = 0.002) were independently associated with NB. Among biomarkers, lactate dehydrogenase, showed the highest area under the ROC curve.</p><p><strong>Conclusions: </strong>This is the first study to propose a combined approach for predicting NB in ICU patients with suspected AMI. When AMI is highly suspected, surgical exploration should be considered in patients presenting with signs of gastrointestinal injury in a context of fluid removal or renal replacement therapy, as these findings are strongly suggestive of necrotic bowel.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100028"},"PeriodicalIF":5.5,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12934417/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147363861","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":"Guidelines for the Initial Assessment of Respiratory Distress in the Emergency Department.","authors":"P Le Borgne, A W Thille, J Guenezan, N Aissaoui, A-S Boureau, C Bally, F Balen, A Basset, P Bilbault, F Boissier, Y-E Claessens, M Decavèle, J-L Diehl, D Douillet, A Guillon, P Hausfater, F Javaudin, M Jezequel, K Kuteifan, E L'Her, N Marjanovic, E Maury, M Ohana, C Pichereau, P Ray, P-G Reuter, N Tiberti, G Voiriot, Y Yordanov, P Le Conte, N Terzi","doi":"10.1016/j.aicoj.2025.100005","DOIUrl":"https://doi.org/10.1016/j.aicoj.2025.100005","url":null,"abstract":"<p><strong>Objective: </strong>The French Society of Emergency Medicine (SFMU) and the French Intensive Care Society (SRLF) present formalized expert recommendations from a multidisciplinary panel on the initial assessment of respiratory distress in adult patients presenting to the Emergency Department.</p><p><strong>Design: </strong>A group of 30 French experts from the SFMU and FICS was assembled. Any potential conflicts of interest were officially declared at the start of the guidelines development process, which was conducted independently of any industry funding. The authors followed the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) methodology to assess the level of evidence from the literature.</p><p><strong>Methods: </strong>The aim of this expert panel was to define evidence-based recommendations for the initial assessment of respiratory distress in the emergency setting. Three key areas were defined: (1) assessment of severity in respiratory distress; (2) initial assessment and triage in respiratory distress; (3) diagnostic approach for respiratory distress. For each area, the goal of the recommendations was to address a set of questions formulated by the experts following the PICO model (\"Population, Intervention, Comparison, Outcome\"). Based on these questions, a comprehensive literature search was conducted for the last 20 years using predefined keywords according to PRISMA guidelines. The quality of the data was analyzed using the GRADE method. The recommendations were formulated using the GRADE methodology, and then voted on by all experts using the GRADE Grid method.</p><p><strong>Results: </strong>The expert consensus process, based on the GRADE methodology, resulted in 13 clinical questions yielding 20 recommendations. For three of these questions, however, no recommendation could be issued due to insufficient evidence. After two rounds of voting and several amendments, a strong consensus was reached on the recommendations. Among these, two were supported by high-quality evidence and resulted in a strong recommendation (GRADE 1); six were based on moderate-quality evidence and led to a conditional recommendation (GRADE 2); and twelve were based on expert opinion, reflecting a low level of evidence. Finally, for 3 questions, no recommendation could be formulated.</p><p><strong>Conclusion: </strong>A strong consensus was reached among the experts on 20 of the recommendations. This work provides updated recommendations for the initial assessment of respiratory distress in adult patients presenting to the Emergency Department.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100005"},"PeriodicalIF":5.5,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12934415/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147363758","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":"Emerging role of nucleic acid aptamers in sepsis-induced coagulopathy: Future perspectives in diagnostics and therapeutics.","authors":"Maeva Martin, Marine Tschirhart, Cyril Auger, Florence Toti, Julie Helms, Laurence Choulier","doi":"10.1016/j.aicoj.2025.100014","DOIUrl":"https://doi.org/10.1016/j.aicoj.2025.100014","url":null,"abstract":"<p><p>Sepsis-induced coagulopathy is a severe complication of sepsis and septic shock, contributing significantly to organ dysfunction and increased mortality. Currently, there is no effective treatment for coagulopathy, highlighting a critical need for new therapeutic options to improve patient outcomes. This review explores the potential use of nucleic acid aptamers for septic-induced coagulopathy. Aptamers are short single-stranded oligonucleotides, known for their high affinity and specificity towards targets. They offer several advantages over antibodies, including smaller size, synthetic production, lower immunogenicity, and greater flexibility in targeting a wide range of molecules and cells. Due to these properties, aptamers have emerged as promising tools for the diagnosis and treatment of various diseases, with several currently ongoing clinical trials and others already available on the pharmaceutical market. This illustrated and thoroughly documented review provides a comprehensive overview of the key aspects of sepsis pathophysiology, emphasizing the significant roles aptamers can play, including: the targeting of endothelial dysfunction where aptamers could protect vascular integrity and inhibit leukocyte adhesion to the endothelium thereby limiting local inflammation; the targeting of dysregulated coagulation pathways by preventing platelet adhesion and aggregation, as well as blocking coagulation factors, helping to limit thrombus formation; the restoration of fibrinolytic function by targeting direct inhibitors of plasmin generation; the targeting of neutrophil extracellular traps to decrease excessive coagulation activation and restore fibrinolysis; the inhibition of complement system in sepsis-induced disseminated intravascular coagulation. This review also includes a chapter on the use of aptamers as diagnostic and prognostic tools for sepsis-induced coagulopathy.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100014"},"PeriodicalIF":5.5,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12934434/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147363711","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":"Fluid therapy in adults having non-cardiac surgery: A narrative review.","authors":"Michael Eichlseder, Romina Schweikert, Abdelkader Serir, Bernd Saugel","doi":"10.1016/j.aicoj.2025.100006","DOIUrl":"https://doi.org/10.1016/j.aicoj.2025.100006","url":null,"abstract":"<p><strong>Background: </strong>Adequate intraoperative fluid therapy is essential, as both uncorrected fluid loss and excessive fluid administration are associated with increased complications. However, current practice varies widely. In this narrative review, we examine current concepts of intraoperative fluid therapy in adults having non-cardiac surgery, focusing on fluid type, volume of fluid, and fluid administration strategy.</p><p><strong>Results: </strong>Balanced crystalloids, compared to unbalanced crystalloids, more closely resemble the body's natural electrolyte composition. However, moderate intraoperative volumes of 0.9% saline do not seem to increase complications. Colloid fluids additionally contain larger molecules exerting colloid osmotic pressure and can be divided into synthetic and natural colloids. While concerns about synthetic colloids, especially hydroxyethyl starch, persist in intensive care medicine, intraoperative trials suggest that giving moderate volumes of hydroxyethyl starch is safe. The natural colloid human albumin theoretically offers a more favorable safety profile than synthetic colloids, but large randomized trials justifying the increased costs through improved outcomes are missing. Fluid administration strategies include calculation-based strategies, the concept of fluid responsiveness, and goal-directed fluid therapy. Calculation-based strategies rely on formulas to estimate fluid requirements. For patients having elective major non-cardiac surgery, a mildly positive intraoperative fluid balance (1-2 liters at the end of the procedure) is generally recommended. The concept of fluid responsiveness aims to assess the current hemodynamic status and evaluate whether a patient's cardiac output increases after fluid administration. However, even if fluid responsive, fluids should only be administered if there are additional clinical or metabolic signs of hypovolemia or tissue hypoperfusion. Goal-directed fluid therapy aims to optimize hemodynamics via treatment strategies by titrating fluids, vasoactive drugs, and inotropes to predefined hemodynamic target variables. Yet, goal-directed fluid therapy did not reduce complications compared to routine care in patients having non-cardiac surgery in recent multicenter trials.</p><p><strong>Conclusion: </strong>The optimal type of fluid for intraoperative fluid therapy remains uncertain and limited volumes of unbalanced crystalloids and hydroxyethyl starch appear to be safe in surgical patients. A mildly positive intraoperative fluid balance is generally recommended for patients having major non-cardiac surgery. Fluid responsiveness can help guide fluid administration, but should not be the only factor leading to fluid administration.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100006"},"PeriodicalIF":5.5,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12934445/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147363703","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}