Annals of Intensive Care最新文献

{"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}

{"title":"Crosstalk between lung and extrapulmonary organs in sepsis-related acute lung injury/acute respiratory distress syndrome.","authors":"Bingyu Li, Weishan Lin, Ruomeng Hu, Songjie Bai, Yejiao Ruan, Yushi Fan, Shuya Qiao, Xuehuan Wen, Ruishan Liu, Heyu Chen, Wei Cui, Zhijian Cai, Gensheng Zhang","doi":"10.1186/s13613-025-01513-4","DOIUrl":"10.1186/s13613-025-01513-4","url":null,"abstract":"<p><p>Sepsis-related acute lung injury/acute respiratory distress syndrome (ALI/ARDS) is associated with considerable morbidity and mortality, yet the efficacy of current treatments is limited. Previous studies have predominantly focused on the lung itself as an isolated organ, whereas the role of organ crosstalk in the pathogenesis of sepsis-related ALI/ARDS cannot be overlooked. Meanwhile, neglecting the discussion of heterogeneity in sepsis caused by different sources of infection may be another important obstacle to translating previous studies into clinical efficacy. In this review, we initially delineated the distinctions in pathogenesis between pulmonary and extrapulmonary sepsis-related ALI/ARDS in microbial species, pathogenesis, host response, and clinical manifestations. Additionally, systemic organ crosstalk mechanisms are summarized, including the commonality and specificity of systemic inflammation, lung and gut microbiome, as well as cascade cell injury and death in distant organs. Subsequently, organ crosstalk between lung and extrapulmonary in pulmonary sepsis and extrapulmonary sepsis-related ALI/ARDS are discussed by organs, including immunity, neuroendocrine, metabolism, and so forth. Furthermore, extracellular vesicles represent a promising avenue of research as potential players and targets in organ-lung crosstalk in sepsis. While the complexity of multi-organ interactions and the heterogeneity of septic patients present significant challenges, these issues are expected to be addressed by the emergence of organ-on-a-chip platforms, 3D organoid cultures, and multi-omics techniques.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"97"},"PeriodicalIF":5.7,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12259525/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144625279","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":"Intra-hospital transport of adult critically ill patients treated with high flow nasal cannula oxygen: a prospective observational multicenter study.","authors":"Mai-Anh Nay, Alice Bisson, Adrien Auvet, Agathe Delbove, Aziz Berrouba, Toufik Kamel, Maxime Desgrouas, Thierry Boulain","doi":"10.1186/s13613-025-01502-7","DOIUrl":"10.1186/s13613-025-01502-7","url":null,"abstract":"<p><strong>Background: </strong>Acute respiratory failure is a common reason for admission to the intensive care unit, and patients are frequently treated with high-flow nasal cannula oxygen therapy (HFNC). Intra-hospital transport of critically ill patients, such as between hospital wards and the intensive care unit or for diagnostic exams, is common. Transportable HFNC can be used during these intra-hospital transports. We aimed to evaluate the complications associated with intra-hospital transport of patients treated with HFNC.</p><p><strong>Methods: </strong>We conducted a prospective, descriptive multicenter study between May 2022 and May 2024, involving critically ill adult patients who were treated with HFNC prior to transport and required intra-hospital transport for any reason, accompanied by an intensive care unit team. The primary objective was to evaluate the incidence of severe adverse events including severe hypoxemia (with pulse oxygen saturation of less than 80%), need for intubation, need for non-invasive ventilation or cardiorespiratory arrest during transport. Secondary objectives were to assess the incidence of non-severe adverse events, defined as the need for increased inspired oxygen fraction, switching HFNC for standard oxygen therapy, nasal cannula removal or dysfunction of the HFNC device.</p><p><strong>Results: </strong>We included 165 patients and analyzed 187 transports. Eight (4.3%) severe adverse events occurred in 7 patients including 6 cases of severe transient hypoxemia and 2 cases of non-invasive ventilation. All of them were transient severe hypoxemia that occurred during the first transport. Forty-three (23%) non-severe adverse events occurred, including 29(15.6%) cases of increased inspired oxygen fraction requirement, 7/187 (3.74%) cases of nasal cannula removal, 6/187 (3.2%) cases of HFNC device dysfunction, and 1 (0.5%) case involved replacing HFNC with standard oxygen therapy.</p><p><strong>Conclusion: </strong>HFNC during intra-hospital transport of critically ill patients had a low incidence of severe adverse events. Non-severe adverse events were more frequent, but their potential impact could not be assessed in this study and warrants further investigation.</p><p><strong>Trial registration: </strong>Clinicalstrials.gov, NCT05311007, registered 23 March 2022, https://clinicaltrials.gov/study/NCT05311007?term=hospiflow&rank=1 .</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"93"},"PeriodicalIF":5.7,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12238688/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144590197","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":"Endotoxin removal by the OXIRIS filter for cardiogenic shock requiring veno-arterial extra-corporeal life support: the ECMORIX randomized controlled trial.","authors":"Maxime Nguyen, Marvin Alvarez, Corentin Evezard, Vivien Berthoud, Damien Leleu, Jean-Paul Pais-De-Barros, Olivier Bouchot, Osama Abou-Arab, Belaid Bouhemad, David Masson, Thomas Gautier, Pierre-Grégoire Guinot","doi":"10.1186/s13613-025-01499-z","DOIUrl":"10.1186/s13613-025-01499-z","url":null,"abstract":"<p><strong>Background: </strong>Most severe cardiogenic shock requires veno-arterial extracorporeal membrane oxygenation (VA-ECMO). The OXIRIS filter, has shown potential in reducing lipopolysaccharide (LPS) levels. Our objective was to compare the efficacy of the OXIRIS filter versus the ST-150 filter in reducing LPS plasma concentration. We hypothesized that the OXIRIS filter would reduce the endotoxin burden.</p><p><strong>Methods: </strong>We conducted an open-label randomized prospective study in the cardiac intensive care unit of Dijon University Hospital. Forty patients with refractory cardiogenic shock requiring VA-ECMO and renal replacement therapy (RRT) were randomized to receive either OXIRIS filter or ST-150 filter. Blood samples were collected at multiple time points. The primary outcome was LPS mass (measured 24 h after the initiation of treatment). Secondary outcomes included LPS activity, cytokine levels, and clinical outcomes.</p><p><strong>Results: </strong>20 patients were allocated to each group and analyzed. LPS plasma concentrations were not different between the OXIRIS filter and ST-150 filter groups at H24 (599 pmol/ml of esterified 3-OH fatty acids [450;734] vs 520 [456;835], p = 0.983) or when analyzing all time-points by linear mixed modelling (538 [469;723] vs 507 [434;671] at H26, 576 [513;614] vs 624 [503;724] at H48 and 632 [513;660] vs 586 [538;776] at H72, p = 0.882). No significant between groups differences were found in LPS activity, inflammation markers (IL-6, TNF-α, IL-10, MCP-1), SOFA scores, VIS scores, or 28-day mortality (13 (65%) vs 9 (45%) p = 0.21). There was high variability in LPS concentrations, suggesting heterogeneity in endotoxemia.</p><p><strong>Conclusions: </strong>In patients with cardiogenic shock supported by VA-ECMO and requiring renal replacement therapy, we could not evidence any reduction in LPS blood concentration in patients treated with treatment with OXIRIS filter in comparison to ST-150 filter. Further research is required to confirm these findings and optimize endotoxin removal in this population.</p><p><strong>Trials registration: </strong>NCT04886180. Registered 10 May 2021.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"92"},"PeriodicalIF":5.7,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12238705/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144582869","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":"Platelet transfusion practice in the intensive care unit: the Nine-I international platelet transfusion survey.","authors":"Lene Russell, Elie Azoulay, Carl Thomas Anthon, Frédéric Pène, Padmastuti Akella, Asma Mabrouki, Kathryn Puxty, Lene Bjerregaard Nielsen, Jo Bønding Andreasen, Thomas Kander, Fredrik Sjövall, Johanna Hästbacka, Christine Lodberg Hvas, Andry Van De Louw, Sanjay Chawla, Philippe R Bauer, Pedro Castro, Pedro Povoa, Luis Coelho, Sara Fernandez, Arzu Topeli, Andreas Barratt-Due, Caterina Barbaglio, Matthias Kochanek, Ignacio Martin-Loeches, Nancy Kentish-Barnes","doi":"10.1186/s13613-025-01494-4","DOIUrl":"10.1186/s13613-025-01494-4","url":null,"abstract":"<p><strong>Background: </strong>Platelet transfusions are frequent in the Intensive Care Unit (ICU), either as prophylaxis against bleeding complications or as treatment for bleeding. The European Society of Intensive Care Medicine guidelines for ICU patients generally recommend not using prophylactic platelet transfusions unless the platelet count falls below 10 × 10⁹ cells/L in non-bleeding patients and make no recommendation for platelet transfusion threshold in non-massively bleeding patients with thrombocytopenia. Therefore, the decision to transfuse platelets is often left to clinical assessment by the treating physician. This study aims to describe current platelet transfusion preferences among ICU physicians.</p><p><strong>Methods: </strong>An online, anonymous survey consisting of 43 items was produced in two languages (French and English) and distributed by investigators in the Nine-I research network to ICU physicians in Europe and the United States of America. The survey evaluated platelet transfusion practices in ICU patients with and without bleeding, the presence of local guidelines, and factors influencing the decisions to transfuse platelets. Only completed surveys were analysed.</p><p><strong>Results: </strong>We received 997 surveys completed by ICU physicians. Overall, there was large heterogeneity in platelet transfusion practices between and within countries. In non-bleeding, thrombocytopenic medical ICU patients, most would transfuse prophylactic platelets at a platelet count threshold of 10 × 10⁹ cells/L. Thirty percent would change their strategy in patients with bone marrow failure and either be more liberal (60%; 95% Confidence Limits 0.54, 0.66), more restrictive (31%; 0.26,0.36) or seek assistance. Higher thresholds were preferred in surgical patients, prior to procedures and in patients with bleeding. Only 173 (17%; 0.15,0.19) responded that they were confident about the clinical indications every time they prescribed a platelet transfusion. As for existing guidelines, only 123 (12%; 0.10,0.15) responded that they always read them. Colleagues' attitudes and departmental culture were important influencers on transfusion practice.</p><p><strong>Conclusion: </strong>Platelet transfusion practice in the ICU is heterogeneous, both between and within countries; guidelines are often not used, and there is often uncertainty about the clinical indication.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"91"},"PeriodicalIF":5.7,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12237844/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144582871","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}