Annals of Intensive Care最新文献

{"title":"Thrombocytopenia in the intensive care unit: diagnosis and management.","authors":"Frédéric Pène, Lene Russell, Cécile Aubron","doi":"10.1186/s13613-025-01447-x","DOIUrl":"10.1186/s13613-025-01447-x","url":null,"abstract":"<p><strong>Background: </strong>This narrative review aims to describe the epidemiology and aetiologies of thrombocytopenia in critically ill patients, the bleeding risk assessment in thrombocytopenic patients, and provide an update on platelet transfusion indications.</p><p><strong>Results: </strong>Thrombocytopenia is a common disorder in critically ill patients. The classic definition relies on an absolute platelet count below 150 × 10⁹/L. Alternatively, the definition has extended to a relative decrease in platelet count (typically within a range of >30->50% decrease) from baseline, yet remaining above 150 × 10⁹/L. Thrombocytopenia may result from multiple mechanisms depending upon the underlying conditions and the current clinical setting. Regardless of the causes, thrombocytopenia accounts as an independent determinant of poor outcomes in critically ill patients, albeit often of unclear interpretation. Nevertheless, it is well established that thrombocytopenia is associated with an increased incidence of bleeding complications. However, alternative factors also contribute to the risk of bleeding, making it difficult to establish definite links between nadir platelet counts at the expense of potential adverse events. Platelet transfusion represents the primary supportive treatment of thrombocytopenia to prevent or treat bleeding. As randomised controlled trials comparing different platelet count thresholds for prophylactic platelet transfusion in the ICU are lacking, the prophylactic transfusion strategy is largely derived from studies performed in stable haematology patients. Similarly, the platelet count transfusion threshold to secure invasive procedures remains based on a low level of evidence. Indications of platelet transfusions for the treatment of severe bleeding in thrombocytopenic patients remain largely empirical, with platelet count thresholds ranging from 50 to 100 × 10⁹/L. In addition, early and aggressive platelet transfusion is part of massive transfusion protocols in the setting of severe trauma-related haemorrhage.</p><p><strong>Conclusion: </strong>Thrombocytopenia in critically ill patients is very frequent with various etiologies, and is associated with worsened prognosis, with or without bleeding complications. Interventional trials focused on critically ill patients are eagerly needed to better delineate the benefits and harms of platelet transfusions.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"25"},"PeriodicalIF":5.7,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11846794/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476214","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":"[¹⁸F]FDG PET/CT identifies infectious and inflammatory foci in persistent critical illness.","authors":"Bram van Leer, Jelle L G Haitsma Mulier, Cornelis P van Stee, Kiki M Demenaga, Riemer H J A Slart, Matijs van Meurs, Andor W J M Glaudemans, Maarten W N Nijsten, Lennie P G Derde, Janesh Pillay","doi":"10.1186/s13613-025-01444-0","DOIUrl":"10.1186/s13613-025-01444-0","url":null,"abstract":"<p><strong>Purpose: </strong>Some ICU patients remain critically ill despite reversal of the original admission diagnosis, driven by a cascade of events resulting in new and persistent organ failure. Secondary infections and systemic inflammation are important components of this cascade and may be visualised using [¹⁸F]FDG PET/CT. The aim of this dual centre retrospective study was to assess the ability of [¹⁸F]FDG PET/CT to identify infectious and inflammatory foci in patients with persistent critical illness and to evaluate its impact on subsequent therapy management.</p><p><strong>Methods: </strong>We included patients admitted to the ICU between 2017 and 2024, in whom a [¹⁸F]FDG PET/CT scan was performed ten days or more after ICU admission. [¹⁸F]FDG PET/CT reports were reviewed for diagnoses, and clinical records were reviewed to determine if this diagnosis was new, which diagnostics were performed before the PET/CT, and which therapeutic changes were made directly after the PET/CT. The relation between inflammatory parameters and [¹⁸F]FDG PET/CT findings were studied using t-test or ANOVA.</p><p><strong>Results: </strong>Forty-seven patients with persistent critical illness were included from two university medical centres. The median interval between admission and PET/CT was 21 days (IQR 14-28). In 43 patients (91%) a potential infectious or inflammatory focus was detected, of which 34 (72%) were previously unknown. The [¹⁸F]FDG PET/CT was utilized late in the diagnostic work-up since a median of 7 (IQR 6.0-8.0) diagnostic procedures were performed prior to the PET/CT. In 26 (55%) patients therapy change was reported within 48 h after the PET/CT.</p><p><strong>Conclusion: </strong>[¹⁸F]FDG PET/CT detected a considerable number of (new) infectious and inflammatory foci in patients with persistent critical illness, often followed by a change in therapy. Further research is needed to establish the role of [¹⁸F]FDG PET/CT in these patients.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"24"},"PeriodicalIF":5.7,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11842666/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143466550","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":"Sepsis-induced coagulopathy (SIC) in the management of sepsis.","authors":"Yun Ji","doi":"10.1186/s13613-025-01441-3","DOIUrl":"10.1186/s13613-025-01441-3","url":null,"abstract":"","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"23"},"PeriodicalIF":5.7,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11839958/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143447755","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":"Effect of early and later prone positioning on outcomes in invasively ventilated COVID-19 patients with acute respiratory distress syndrome: analysis of the prospective COVID-19 critical care consortium cohort study.","authors":"Andrew J Simpkin, Bairbre A McNicholas, David Hannon, Robert Bartlett, Davide Chiumello, Heidi J Dalton, Kristen Gibbons, Nicole White, Laura Merson, Eddy Fan, Mauro Panigada, Giacomo Grasselli, Anna Motos, Antoni Torres, Ferran Barbé, Pauline Yeung Ng, Jonathon P Fanning, Alistair Nichol, Jacky Y Suen, Gianluigi Li Bassi, John F Fraser, John G Laffey","doi":"10.1186/s13613-025-01422-6","DOIUrl":"10.1186/s13613-025-01422-6","url":null,"abstract":"<p><strong>Background: </strong>Prone positioning of patients with COVID-19 undergoing invasive mechanical ventilation (IMV) is widely used, but evidence of efficacy remains sparse. The COVID-19 Critical Care Consortium has generated one of the largest global datasets on the management and outcomes of critically ill COVID-19 patients. This prospective cohort study investigated the association between prone positioning and mortality and in particular focussed on timing of treatment.</p><p><strong>Methods: </strong>We investigated the incidence, demographic profile, management and outcomes of proned patients undergoing IMV for COVID-19 in the study. We compared outcomes between patients prone positioned within 48 h of IMV to those (i) never proned, and (ii) proned only after 48 h.</p><p><strong>Results: </strong>3131 patients had data on prone positioning, 1482 (47%) were never proned, 1034 (33%) were proned within 48 h and 615 (20%) were proned only after 48 h of commencement of IMV. 28-day (hazard ratio 0.82, 95% confidence interval [CI] 0.68, 0.98, p = 0.03) and 90-day (hazard ratio 0.81, 95% CI 0.68, 0.96, p = 0.02) mortality risks were lower in those patients proned within 48 h of IMV compared to those never proned. However, there was no evidence for a statistically significant association between prone positioning after 48 h with 28-day (hazard ratio 0.93, 95% CI 0.75, 1.14, p = 0.47) or 90-day mortality (hazard ratio 0.95, 95% CI 0.78, 1.16, p = 0.59).</p><p><strong>Conclusions: </strong>Prone positioning is associated with improved outcomes in patients with COVID-19, but timing matters. We found no association between later proning and patient outcome.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"22"},"PeriodicalIF":5.7,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11810853/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143389777","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: Fluid accumulation syndrome in sepsis and septic shock: pathophysiology, relevance and treatment-a comprehensive review.","authors":"Carmen Andrea Pfortmueller, Wojciech Dabrowski, Rob Wise, Niels van Regenmortel, Manu L N G Malbrain","doi":"10.1186/s13613-024-01403-1","DOIUrl":"10.1186/s13613-024-01403-1","url":null,"abstract":"","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"21"},"PeriodicalIF":5.7,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11785843/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143062980","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 viscoelastic tests in the diagnosis of sepsis-induced coagulopathy (SIC).","authors":"Toshiaki Iba, Julie Helms, Jerrold H Levy","doi":"10.1186/s13613-025-01442-2","DOIUrl":"10.1186/s13613-025-01442-2","url":null,"abstract":"","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"19"},"PeriodicalIF":5.7,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11775350/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143051399","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":"Oxygenation improvement and duration of prone positioning are associated with ICU mortality in mechanically ventilated COVID-19 patients.","authors":"Silvia De Rosa, Nicolò Sella, Giacomo Bellani, Giuseppe Foti, Andrea Cortegiani, Giulia Lorenzoni, Dario Gregori, Annalisa Boscolo, Lucia Cattin, Muhammed Elhadi, Giorgio Fullin, Eugenio Garofalo, Leonardo Gottin, Alberto Grassetto, Salvatore Maurizio Maggiore, Elena Momesso, Mario Peta, Daniele Poole, Roberto Rona, Ivo Tiberio, Andrea Zanoletti, Emanuele Rezoagli, Paolo Navalesi","doi":"10.1186/s13613-025-01438-y","DOIUrl":"10.1186/s13613-025-01438-y","url":null,"abstract":"<p><strong>Background: </strong>Prone position has been diffusely applied in mechanically ventilated COVID-19 patients. Our aim is ascertaining the association between the physiologic response and the length of the first cycle of prone position and intensive care unit (ICU) mortality.</p><p><strong>Methods: </strong>International registry including COVID-19 adult patients who underwent prone positioning. We measured the difference for arterial partial pressure of oxygen to inspired fraction of oxygen ratio (PaO2/FiO2), ventilatory ratio, and respiratory system compliance (Crs) between baseline supine position and at either the end of the first cycle of prone position (Delta-PP) or re-supination (Delta-PostPP).</p><p><strong>Results: </strong>We enrolled 1816 patients from 53 centers. Delta-PP and Delta-PostPP for PaO2/FiO2 were both associated with ICU mortality [OR (95% CI) 0.48 (0.38, 0.59), and OR (95% CI) 0.60 (0.52, 0.68), respectively]. Ventilatory ratio had a non-linear relationship with ICU mortality for Delta-PP (p = 0.022) and Delta-PostPP (p = 0.004). Delta-PP, while not Delta-PostPP, for Crs was associated with ICU mortality [OR (95% CI) 0.80 (0.65, 0.98)]. The length of the first cycle of prone position showed an inverse relationship with ICU mortality [OR (95% CI) 0.82 (0.73, 0.91)]. At the multivariable analysis, the duration of the first cycle of prone position, Delta-PP and Delta-PostPP for PaO2/FiO2, and Delta-PostPP for ventilatory ratio were independently associated with ICU mortality.</p><p><strong>Conclusion: </strong>In COVID-19 patients with acute respiratory failure receiving invasive mechanical ventilation and prone positioning, the physiological response to prone position is associated with ICU mortality. Prolonging the duration of the first cycle of prone position is associated with improved survival.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"20"},"PeriodicalIF":5.7,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11775368/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143057707","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":"Extremely early initiation of vasopressors might not decrease short-term mortality for adults with septic shock: a systematic review and meta-analysis.","authors":"Cheng-Hsin Ma, Jack Healy, Ebrima Kinteh, Cheng-Chin Ma, Ching-Fang Tiffany Tzeng, Eric H Chou, Chin-Chieh Wu, Shih-Chieh Shao, Kuan-Fu Chen","doi":"10.1186/s13613-025-01428-0","DOIUrl":"10.1186/s13613-025-01428-0","url":null,"abstract":"<p><strong>Background: </strong>The optimal timing for initiating vasopressor therapy in patients with septic shock remains unclear. This study aimed to assess the impact of early versus late vasopressor initiation on clinical outcomes.</p><p><strong>Methods: </strong>A systematic review and meta-analysis were conducted by searching PubMed, Embase, and Cochrane databases. Studies comparing early and late vasopressor administration in septic shock patients were included. The primary outcome was short-term mortality, and subgroup analyses were performed based on different initiation timings.</p><p><strong>Results: </strong>Eleven studies with 6,661 patients were included. Different studies define the 'early administration' timeframe variously, ranging from one to seven hours. No significant difference in short-term mortality was observed between early and late administration in the combined analysis of 3,757 patients from two RCTs and three quasi-experimental studies (OR: 0.66, 95% CI: [0.36, 1.19], I²: 82%). However, lower mortality was found in subgroups with early but not extremely early initiation (one to three hours, OR: 0.70, 95% CI: [0.60, 0.82], I²: 0%), and those using septic shock diagnosis as time zero (OR: 0.64, 95% CI: [0.48, 0.85], I²: 39%).</p><p><strong>Conclusion: </strong>Our findings found that earlier initiation of vasopressor therapy, particularly within one to three hours after the diagnosis of septic shock, may be associated with reduced short-term mortality in certain subgroups. However, due to the heterogeneity in study definitions and potential confounding factors, these results should be interpreted cautiously. Further standardized investigations are warranted to precisely determine the optimal timing for vasopressor initiation to maximize survival outcomes in patients with septic shock.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"18"},"PeriodicalIF":5.7,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11769887/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143045248","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":"Impact of mechanical ventilation on severe acute kidney injury in critically ill patients with and without COVID-19 - a multicentre propensity matched analysis.","authors":"Fabian Perschinka, Timo Mayerhöfer, Teresa Engelbrecht, Alexandra Graf, Paul Zajic, Philipp Metnitz, Michael Joannidis","doi":"10.1186/s13613-025-01424-4","DOIUrl":"10.1186/s13613-025-01424-4","url":null,"abstract":"<p><strong>Background: </strong>Acute kidney injury (AKI) is common in critically ill patients and is associated with increased morbidity and mortality. Its complications often require renal replacement therapy (RRT). Invasive mechanical ventilation (IMV) and infections are considered risk factors for the occurrence of AKI. The use of IMV and non-invasive ventilation (NIV) has changed over the course of the pandemic. Concomitant with this change in treatment a reduction in the incidences of AKI and RRT was observed. We aimed to investigate the impact of IMV on RRT initiation by comparing critically ill patients with and without COVID-19. Furthermore, we wanted to investigate the rates and timing of RRT as well as the outcome of patients, who were treated with RRT.</p><p><strong>Results: </strong>A total of 8,678 patients were included, of which 555 (12.8%) in the COVID-19 and 554 (12.8%) in the control group were treated with RRT. In the first week of ICU stay the COVID-19 patients showed a significantly lower probability for RRT initiation (day 1: p < 0.0001, day 2: p = 0.021). However, after day 7 a reversed HR was found. In mechanically ventilated patients the risk was significantly higher for the initiation of RRT over the entire stay. While in non-COVID-19 patients this was a non-significant trend, in COVID-19 patients the risk for RRT was significantly increased. The median delay between initiation of IMV and requirement of RRT was observed to be longer in COVID-19 patients (5 days [IQR: 2-11] vs. 2 days [IQR: 1-5]). The analysis restricted to patients with RRT showed a significantly higher risk for ICU death in patients requiring IMV compared to patients without IMV.</p><p><strong>Conclusion: </strong>The analysis demonstrated that IMV as well as COVID-19 are associated with an increased risk for initiation of RRT. The association between IMV and risk of RRT initiation was given for all investigated time intervals. Additionally, COVID-19 patients showed an increased risk for RRT initiation during the entire ICU stay within patients admitted to an ICU due to respiratory disease. In COVID-19 patients treated with RRT, the risk of death was significantly higher compared to non-COVID-19 patients.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"17"},"PeriodicalIF":5.7,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11762028/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143035986","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: Identification and validation of respiratory subphenotypes in patients with COVID-19 acute respiratory distress syndrome undergoing prone position.","authors":"Monica R da Cruz, Pedro Azambuja, Katia S C Torres, Fernanda Lima-Setta, Andre M Japiassu, Denise M Medeiros","doi":"10.1186/s13613-024-01417-9","DOIUrl":"10.1186/s13613-024-01417-9","url":null,"abstract":"","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"16"},"PeriodicalIF":5.7,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11751344/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142998754","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}