Annals of Intensive Care最新文献

{"title":"Temporal trends and social determinants of sepsis knowledge in Brazil: findings from three national cross-sectional surveys.","authors":"Flávia Ribeiro Machado, Luciano Cesar Pontes Azevedo, Larissa Romeiro Pellozo, Josiane Francisca Ferreira, Juliana Lubarino Diniz de Souza, Thiago Lisboa, Rafael Barberena Moraes, Reinaldo Salomao, Tiago Mendonça Dos Santos, Regis Rosa, Daniela Carla de Souza","doi":"10.1016/j.aicoj.2026.100128","DOIUrl":"https://doi.org/10.1016/j.aicoj.2026.100128","url":null,"abstract":"<p><strong>Background: </strong>Public awareness of sepsis is essential for early recognition of warning signs and timely healthcare seeking behavior, but data from resource-limited settings remain scarce.</p><p><strong>Methods: </strong>We evaluated sepsis knowledge in Brazil using cross-sectional surveys conducted in 2014, 2017, and 2026. Standardized questionnaires were administered through face-to-face interviews using random sampling stratified by age, sex, and geographic region. Adequate basic knowledge was defined as having heard the term sepsis and correctly identifying it as a severe host response to infection. In 2026, we additionally assessed knowledge of sepsis time-dependent nature and long-term disability after sepsis. Multivariable logistic regression identified factors associated with knowledge.</p><p><strong>Results: </strong>A total of 6,312 participants were interviewed (2014: n = 2,126; 2017: n = 2,100; 2026: n = 2,086). Adequate basic knowledge increased from 2.6% in 2014 to 5.8% in 2017 (OR 2.25, 95% CI 1.63-3.16; p < 0.001) and 10.3% in 2026 (OR 3.45, 95% CI 2.54-4.75; p < 0.001). In 2026, 70.0% of participants acknowledged that earlier diagnosis and treatment improve survival. Awareness of long-term disabilities was lower (24.4%). Higher educational attainment was the strongest determinant of knowledge across all domains. Younger age, male sex, residence outside state capitals, and lower household income were independently associated with lower knowledge.</p><p><strong>Conclusion: </strong>Public awareness of sepsis in Brazil has improved substantially over the past decade, suggesting a positive impact of national and international awareness initiatives. Nevertheless, important knowledge gaps persist, and awareness continues to be strongly influenced by socioeconomic factors, highlighting the need for continued efforts to improve sepsis awareness and promote equitable access to health information.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100128"},"PeriodicalIF":6.9,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13486371/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787399","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":"Venous excess and lung ultrasound during continuous renal replacement therapy in critically ill patients (VExLUS-RRT): a prospective observational study.","authors":"Thanphisit Trakarnvanich, Anyarin Wannakittirat, Sadudee Peerapornratana, Yingyos Avihingsanon, Marlies Ostermann, Nattachai Srisawat, Nuttha Lumlertgul","doi":"10.1016/j.aicoj.2026.100129","DOIUrl":"https://doi.org/10.1016/j.aicoj.2026.100129","url":null,"abstract":"<p><strong>Background: </strong>No gold standard currently exists to evaluate fluid status during continuous renal replacement therapy (CRRT). We aimed to describe systemic venous congestion by using venous excess ultrasound (VExUS) and pulmonary congestion by lung ultrasound (LUS) in critically ill patients with acute kidney injury (AKI) who received CRRT.</p><p><strong>Methods: </strong>This was a single-centre prospective cohort study. Adult patients with AKI undergoing CRRT underwent serial ultrasound assessments on Day 1 and 3 by two independent operators. VExUS score and its individual components, including an inferior vena cava (IVC) diameter (≥2 cm), hepatic vein, portal vein, as well as intrarenal vein Doppler flow patterns, and 6-zone lung ultrasound (LUS) scores (ranged from 0 to 20 points), were collected. An exploratory modified VExUS (mVExUS) grading was derived by incorporating an IVC distensibility index (<18%) or collapsibility index (<50%). Venous congestion was defined as VExUS or mVExUS Grade ≥2. The primary descriptive outcome was the prevalence of venous congestion and serial LUS score changes. The principal clinical endpoint was the association between ultrasound parameters and 90-day mortality <b>(NCT06254703).</b></p><p><strong>Results: </strong>Among 100 enrolled patients (median age 66 years, male 58%), baseline venous congestion was documented in 20% by VExUS score and 35% by mVExUS scores. The median LUS score was 4 (interquartile range 1-9). Baseline VExUS Grade 2-3 (Log rank p = 0.049) and mVExUS Grade 2-3 (Log rank p = 0.01) were associated with lower 90-day survival. In time-updated Cox models after adjustment for baseline Sequential Organ Failure Assessment score, hepatic vein Doppler Grade 2-3 (adjusted hazard ratio (aHR) 1.78; 95% confidence interval (CI) 1.05-3.01, p = 0.01) and higher LUS scores (aHR 1.04; 95% CI 1.001-1.08, p = 0.04) were independently associated with 90-day mortality. Unchanged or worsening LUS scores between Day 1 and Day 3 were associated with a significantly higher cumulative fluid balance compared to improved scores (p = 0.01).</p><p><strong>Conclusion: </strong>Systemic and pulmonary congestion assessed by multiorgan point-of-care ultrasound was associated with increased 90-day mortality in AKI patients receiving CRRT. Future studies should explore the utility of these tools in guiding individualised fluid management during CRRT.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100129"},"PeriodicalIF":6.9,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13475691/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148757631","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":"Airway tracers and biomarkers for aspiration detection and VAP prediction in ICU patients with tracheal tubes: a systematic review and diagnostic accuracy meta-analysis.","authors":"Suwen Li, Chenxin Ye, Luying Chen, Yuting Wu, Gendi Lu","doi":"10.1016/j.aicoj.2026.100122","DOIUrl":"10.1016/j.aicoj.2026.100122","url":null,"abstract":"<p><strong>Background: </strong>Ventilator-associated pneumonia (VAP) remains an important complication in mechanically ventilated patients in intensive care units (ICUs). Early subglottic microleakage may precede overt infection but remains difficult to detect at the bedside. Airway tracers and biochemical biomarkers have been proposed as bedside tools for detecting upstream microleakage and predicting downstream VAP, but their diagnostic value remains uncertain because studies differ in sampling matrices, thresholds, reference standards, and endpoints.</p><p><strong>Methods: </strong>Six databases were systematically searched from inception to 1 March 2026. Studies evaluating airway tracers or biomarkers in critically ill adults receiving invasive mechanical ventilation or with artificial airways were included under a dual-endpoint framework, comprising upstream microleakage or aspiration-related event detection and downstream VAP prediction. Study data were extracted, and risk of bias was assessed using the QUADAS-2 tool. For markers with sufficient clinical and methodological comparability, quantitative analyses included bivariate random-effects pooling, variance decomposition, stepwise sensitivity analyses, and Bayes' theorem-based post-test probability projection.</p><p><strong>Results: </strong>Sixteen studies were included. Blue-dye-based visual methods were summarized descriptively because the available studies represented distinct aspiration paradigms and did not meet the criteria for quantitative pooling. FEES-validated tracheostomy studies reported relatively high sensitivity for swallowing-related transglottic aspiration, whereas enteral-tracer or reflux-aspiration monitoring studies were limited by surrogate reference standards and/or low visual detectability for continuous, low-volume microleakage. One mechanically ventilated enteral-feeding cohort was retained as narrative evidence only because it did not provide a direct 2 × 2 diagnostic accuracy comparison of visual blue-dye detection against the microsphere reference standard. For VAP prediction, airway α-amylase showed a pooled sensitivity of 78.1%, specificity of 70.3%, and an area under the curve of 0.811.</p><p><strong>Conclusions: </strong>Current airway tracers and biomarkers do not appear suitable as standalone diagnostic triggers for VAP. However, airway α-amylase may have potential as a negative-predictive screening tool. Future research should standardize volumetric airway sampling and prospectively validate clinically actionable rule-out algorithms to support early antimicrobial de-escalation.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100122"},"PeriodicalIF":6.9,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13463812/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148720948","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":"Effects of direct tracheostomy on ventilator weaning in patients intubated for Guillain-Barré syndrome.","authors":"Arnaud W Thille, Constance Bayon, Marie Gauvrit, Clément Saccheri, Marie Labruyere, Gaetan Beduneau, Guilhem Wattecamps, Matthieu Henry, Eddine Bendiab, Benjamin Swinyard, Arnaud Gacouin, Adam Celier, Benjamin Foucou, Suzanne Champion, Anne-Fleur Haudebourg, Laurence Dangers, Olivier Plateker, Cedric Daubin, Lucie Fromont, Charlotte Guesdon, Emmanuel Vivier, Lev Volkov, Cyril Potier, Jeremy Bourenne, Charlotte Chiquet, Valentin Pointurier, Louis Chauvelot, Pierre Bailly, David Schnell, Nicholas Sedillot, Florian Reizine, Laurent Argaud, Faustine Reynaud, Juliette Pelle, Olivier Lesieur, Adrien Auvet, Guillaume Lacave, Marion Kernevez, Damien Contou, Guillaume Grillet, Arnaud Delahaye, Julio Badie, Jerome Devaquet, Hermine Chauvin, Alexandra Beurton, Emanuele Turbil, Jean-Philippe Rigaud, Stéphanie Ragot, Louis Chamblet, Sylvain Le Pape, Rémi Coudroy","doi":"10.1016/j.aicoj.2026.100124","DOIUrl":"10.1016/j.aicoj.2026.100124","url":null,"abstract":"<p><strong>Background: </strong>Whether or not a direct tracheostomy without any prior weaning attempt is beneficial in patients intubated for Guillain-Barré syndrome (GBS) remains to be determined. Our objective was to determine whether direct tracheostomy results in earlier or later ventilator weaning compared to standard weaning.</p><p><strong>Methods: </strong>Multicenter, retrospective cohort study including all patients intubated for GBS over a 10-year period (2014-2023). We compared patients having undergone direct tracheostomy without any prior weaning attempt with those having undergone standard weaning (spontaneous-breathing trial or extubation attempt). We also compared direct tracheostomy with tracheostomy after weaning failure. The primary outcome was the proportion of patients alive and free from mechanical ventilation 28 days after weaning initiation.</p><p><strong>Results: </strong>Overall, 221 patients (45%) underwent direct tracheostomy and 273 (55%) standard weaning. Compared to patients with standard weaning, those with direct tracheostomy were less likely to be alive and free from mechanical ventilation at day 28 (43% vs. 83%, p < 0.001). Using G-computation to estimate the marginal causal effect of the weaning strategy, standard weaning was more effective than direct tracheostomy in reducing the risk of remaining under mechanical ventilation at day 28: -39.5% [95% Confidence Interval, -47.3% to -31.5%]. Even when compared to patients having undergone tracheostomy after weaning failure, those with direct tracheostomy were less likely to be alive and free from mechanical ventilation 28 days after the tracheostomy procedure.</p><p><strong>Interpretation: </strong>A direct tracheostomy without any prior weaning attempt might significantly delay the ventilator weaning process in patients intubated for GBS.</p><p><strong>Clinical trial registration: </strong>NCT07022028.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100124"},"PeriodicalIF":6.9,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13463968/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148720101","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":"Characteristics and outcomes of pediatric extracorporeal cardiopulmonary resuscitation (E-CPR): a nationwide retrospective analysis from the French pediatric ECMO Network.","authors":"R Bernardon, N C Bulescu, T Blache, C Pavy, M Grimaud, J Rambaud, E Langouet, A Clairaz, S Delangue, L Berthomieu, S Denante, N Joram, A Chenouard, A Gaultier, P Bourgoin","doi":"10.1016/j.aicoj.2026.100126","DOIUrl":"https://doi.org/10.1016/j.aicoj.2026.100126","url":null,"abstract":"<p><strong>Objective: </strong>To report the incidence and outcomes of E-CPR for intra or extra-hospital pediatric refractory cardiac arrest (CA) within the French national pediatric ECMO (Extra Corporeal Membrane Oxygenation) network.</p><p><strong>Methods: </strong>Retrospective study. Children (0-18 years) who underwent E-CPR for intra or extra-hospital cardiac arrest over a 5-year period (2019-2023) in one of the centers belonging to the network were included for analysis.</p><p><strong>Results: </strong>A total of 164 patients were included for analysis. Centers reported a median of 6 cases (range: 0-21). Most patients received E-CPR for intra-hospital CA (150, 91.5%), with cardiac origin suspected in 134 (84.3%) patients. Preexistent cardiac disease was reported in 94 patients (57.3%). Survival rate at PICU discharge, hospital discharge and after one-year was 29.9%, 29.3% and 27.4% respectively. We identified male gender (aOR 2.74, 95%CI 1.22 to 6.14, p = 0.014) and higher serum lactate 24 h after CA (aOR 1.11 per mol/L, 95%CI 1.03-1.18, p = 0.003) as independent factors associated with poor prognosis whereas femoral cannulation site (aOR 0.18, 95%CI 0.06 to 0.52, p = 0.002) was associated with favorable outcome.</p><p><strong>Conclusion: </strong>E-CPR is mostly performed in children with heart disease, with limited use in out-of-hospital settings. Efforts should be made to identify patients in need of ECMO before CA, as the outcome after E-CPR remains poor.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100126"},"PeriodicalIF":6.9,"publicationDate":"2026-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13476720/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148761682","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":"Venous congestion in critical care: combining VExUS, lung ultrasound, and echocardiography.","authors":"Karel Huard, Jean Deschamps, Etienne J Couture, Marc-Antoine Lepage, William Beaubien-Souligny, Yoan Lamarche, André Y Denault","doi":"10.1016/j.aicoj.2026.100127","DOIUrl":"10.1016/j.aicoj.2026.100127","url":null,"abstract":"<p><p>Venous congestion is an important pathophysiological mechanism impacting organ function in critically ill patients. However, congestion physiology is complex, can affect multiple organ systems, and is subject to change rapidly over time. Contemporary multimodal assessment integrates both traditional approaches and emerging technologies to refine our understanding and improve clinical evaluation of this dynamic process. In this review, we explore how combining various ultrasound assessments can enhance the evaluation of congestion in critically ill patients. Topics include diastolic function evaluation with echocardiography, the Venous Excess Ultrasound (VExUS) assessment, and lung ultrasound.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100127"},"PeriodicalIF":6.9,"publicationDate":"2026-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13463979/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148719973","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":"Early red blood cell transfusion burden, hemoglobin at first transfusion, and in-hospital mortality in patients supported with veno-arterial ECMO: a multicenter cohort study.","authors":"Min Ho Ju, Seulgi Ju, In Seok Jeong, Hyoung Soo Kim, Yang Hyun Cho, Jae-Seung Jung, Jung-Hoon Shin, Sunghyun Sim, Hee Jung Kim","doi":"10.1016/j.aicoj.2026.100125","DOIUrl":"10.1016/j.aicoj.2026.100125","url":null,"abstract":"<p><strong>Background: </strong>Red blood cell (RBC) transfusion is common during venoarterial extracorporeal membrane oxygenation (VA-ECMO), but the prognostic relevance of early cumulative transfusion burden and hemoglobin (Hb) at transfusion initiation remains uncertain. We examined associations of ECMO day-1 RBC dose and, among transfused patients, first-transfusion Hb and transfusion-pattern phenotype with in-hospital mortality.</p><p><strong>Methods: </strong>Adults aged ≥18 years initiating peripheral VA-ECMO at six Korean centers between January 2018 and March 2025 were analyzed. The primary analysis used a 24 -h landmark cohort of patients alive and still receiving ECMO beyond 24 h. Day-1 RBC dose was categorized as 0, 1-2, 3-4, or ≥5 units and modeled per 2-unit increase. Adjusted risk ratios (RRs) were estimated using modified Poisson regression. Secondary analyses assessed first-transfusion Hb and consistent- versus variable threshold phenotypes among transfused complete cases.</p><p><strong>Results: </strong>Among 2,020 included patients, 1,708 entered the 24-h landmark cohort, and 1,140 complete cases comprised the adjusted primary analysis. Compared with no day-1 transfusion, adjusted RRs for in-hospital mortality were 1.20 (95% confidence interval [CI], 1.02-1.40) for 1-2 units, 1.37 (95% CI, 1.17-1.59) for 3-4 units, and 1.48 (95% CI, 1.28-1.71) for ≥5 units. Each 2-unit increase was associated with higher mortality (adjusted RR, 1.08; 95% CI, 1.05-1.11), with concordant findings over ECMO days 1-2 (adjusted RR, 1.06; 95% CI, 1.04-1.08). Among 1,043 transfused complete cases with qualifying pretransfusion Hb, each 1 g/dL decrease in first-transfusion Hb was associated with higher mortality (adjusted RR, 1.15; 95% CI, 1.10-1.20). The association was evident in the consistent-threshold phenotype (adjusted RR, 1.16; 95% CI, 1.10-1.22) but not in the variable-threshold phenotype (adjusted RR, 1.02; 95% CI, 0.92-1.12).</p><p><strong>Conclusions: </strong>In adults receiving peripheral VA-ECMO, early RBC transfusion burden showed a graded association with in-hospital mortality, whereas lower first-transfusion Hb was a prognostic marker chiefly within the consistent-threshold phenotype. These findings support dose- and threshold-aware prognostic assessment but do not establish causality or define an optimal transfusion threshold.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100125"},"PeriodicalIF":6.9,"publicationDate":"2026-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13452410/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148697010","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 clinical picture of ICANS after CAR-T cell therapy in critically ill patients: A retrospective clustering analysis of a multicentre multinational cohort study.","authors":"Ana Vagos-Mata, Pedro Castro, Sandrine Valade, Antoine F Carpentier, Alice Gallo de Moraes, Adel Maamar, Muriel Picard, Anne-Sophie Moreau, Sanjay Chawla, Florent Wallet, Kada Klouche, Victoria Metaxa, Nicolas Boissel, Andry Van De Louw, Amélie Seguin, Djamel Mokart, Boris Böll, Roberta Di Blasi, Catherine Thieblemont, Nahema Issa, Sara Fernandez, Laveena Munshi, Philippe R Bauer, Michael Joannidis, Gabriel Moreno-Gonzalez, Lara Zafrani, Michael Darmon, Elie Azoulay","doi":"10.1016/j.aicoj.2026.100123","DOIUrl":"10.1016/j.aicoj.2026.100123","url":null,"abstract":"<p><p>CAR T-cell therapy carries significant risks, including ICANS. There is limited data on ICANS presentation and outcomes in patients admitted to ICU and it is still challenging to predict those who will have severe ICANS. This is a pre-planned substudy of an international, multicenter, observational cohort study of 241 CAR T-cell recipients for hematological malignancies, admitted to the ICU, focusing on those who developed ICANS. We aimed for a detailed description of symptoms and hierarchical clustering analysis was used to identify distinct patterns of neurological symptom presentation. ICANS was identified in 100 patients (41.5%), median age of 61 years. Most patients (93%) had non-Hodgkin lymphoma. Severe ICANS occurred in 38% of patients, associated with longer duration of symptoms (<i>p</i> = 0.02). On the whole cohort, the median duration of neurological symptoms was 5 (IQR 1-8) days and was also longer for patients with isolated ICANS (median of 16 days (IQR 11-24, <i>p</i> = 0.001)). Hierarchical clustering revealed four distinct clusters with minimal symptom overlap: Cluster 1: Mild or no symptoms, primarily confusion (11.2%); Cluster 2: High incidence of confusion (78.9%) and drowsiness (47.4%), with significant risks of seizures (42.1%) and coma (21.1%); Cluster 3: Predominantly tremor (75%) and attention deficit (37.5%); Cluster 4: High incidence of aphasia (70.3%), dysgraphia (37.8%), and disorientation (27%). The clustering of neurological symptoms was statistically significant (<i>p</i> < 0.001). This study provides a detailed characterization of ICANS, highlighting distinct patterns of neurological symptoms. These findings could inform clinicians, particularly regarding the risk and timing of ICU admission.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100123"},"PeriodicalIF":6.9,"publicationDate":"2026-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13464376/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148719750","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":"Toward a fuller statistical picture: a complementary analysis of HFNC versus NIV.","authors":"Aurio Fajardo-Campoverdi, Adrián Gallardo, Ângelo Roncalli Miranda Rocha","doi":"10.1016/j.aicoj.2026.100121","DOIUrl":"10.1016/j.aicoj.2026.100121","url":null,"abstract":"","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100121"},"PeriodicalIF":6.9,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13450236/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148696910","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":"Diuretic therapy for critically ill patients: a systematic review and network meta-analysis.","authors":"Akira Kuriyama, Kamil Polok, Nikita Malhotra, Naoyuki Kuse, Tyler Pitre, Devan Lakhanpal, Rao Sun, Kapil Dev Soni, Kaitryn Campbell, Lisa D Burry, Edward G Clark, Kimberley Lewis, Morten Hylander Møller, Hayley B Gershengorn, Bram Rochwerg","doi":"10.1016/j.aicoj.2026.100120","DOIUrl":"https://doi.org/10.1016/j.aicoj.2026.100120","url":null,"abstract":"<p><strong>Background: </strong>Fluid overload is common in critically ill patients and is associated with worse outcomes. Diuretics are the mainstay of active fluid removal in patients with preserved renal function. The optimal diuretic strategy for fluid removal remains uncertain.</p><p><strong>Methods: </strong>We conducted a systematic review and Bayesian random-effects network meta-analysis of randomized controlled trials comparing two or more diuretic strategies for fluid removal in critically ill adults. We searched MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials via Ovid, as well as trial registries, from inception to November 20, 2025. Two reviewers independently extracted data and assessed risk of bias using ROBUST-RCT. Certainty of evidence was evaluated using the GRADE approach for network meta-analysis. Treatment effects were summarized as odds ratios (ORs) or mean differences (MDs) with 95% credible intervals (CrIs).</p><p><strong>Results: </strong>Twenty-six randomized controlled trials involving 1,652 participants were included. Evaluated interventions included bolus loop diuretics (19 studies), continuous loop infusion (15 studies), oral loop diuretics (5 studies), and loop diuretics combined with tolvaptan (8 studies), spironolactone (3 studies), thiazides (2 studies), acetazolamide (1 study), or triamterene (1 study). Compared with bolus loop diuretics, continuous loop infusion had an uncertain effect on mortality (OR 1.26; 95% CrI 0.62 to 2.55; very low certainty) and may increase ICU length of stay (MD 1.56 days; 95% CrI -0.02 to 3.16; low certainty). Tolvaptan monotherapy may reduce acute kidney injury compared with bolus or continuous loop diuretics (OR 0.12; 95% CrI 0.01 to 0.87; low certainty), although no studies evaluated its effect on the need for renal replacement therapy. For most other comparisons and outcomes, the certainty of evidence was low or very low.</p><p><strong>Conclusions: </strong>Available evidence comparing diuretic strategies for fluid removal during ICU-level care is limited, clinically heterogeneous, and derived largely from heart failure and post-cardiovascular surgery populations. Bolus loop diuretics were at least comparable to alternate diuretic strategies for patient important outcomes in critically ill adults, but this was based mostly on low or very low certainty evidence. Tolvaptan monotherapy may decrease acute kidney injury, but its effect on subsequent need for RRT and mortality remains uncertain.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100120"},"PeriodicalIF":6.9,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13476641/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148757607","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}