Annals of Intensive Care最新文献

{"title":"Authors' reply to \"CO₂-derived variables as surrogates for tissue perfusion and oxygenation\".","authors":"Jihad Mallat, Jean-Louis Teboul, Daniel De Backer, Gustavo A Ospina-Tascón","doi":"10.1016/j.aicoj.2025.100011","DOIUrl":"https://doi.org/10.1016/j.aicoj.2025.100011","url":null,"abstract":"","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100011"},"PeriodicalIF":5.5,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12934428/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147363677","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 Technology: What Defines Meaningful Multimodal Monitoring at the Bedside?","authors":"Xingzhan Zhang, Ling Zhao, Jie Peng","doi":"10.1016/j.aicoj.2025.100020","DOIUrl":"https://doi.org/10.1016/j.aicoj.2025.100020","url":null,"abstract":"","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100020"},"PeriodicalIF":5.5,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12934409/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147363718","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":"Physiopathology of fibrinolysis in sepsis-induced disseminated intravascular coagulation: Emerging mechanisms and pharmacological targets.","authors":"Marine Tschirhart, Maeva Martin, Anaïs Curtiaud, Eduardo Angles-Cano, Ferhat Meziani, Florence Toti, Julie Helms","doi":"10.1016/j.aicoj.2025.100008","DOIUrl":"https://doi.org/10.1016/j.aicoj.2025.100008","url":null,"abstract":"<p><p>Septic shock represents the most severe form of an infection, marked by a dysregulated host response that can lead to multiple organ failure and death. Among these patients, 30-40% develop disseminated intravascular coagulation (DIC), a life-threatening complication associated with a 60% increase in mortality. DIC is characterized by widespread activation of the coagulation cascade, resulting in disseminated microthrombi and a hypercoagulable state. This prothrombotic profile arises from the upregulated expression of tissue factor by endothelial cells, monocytes, and neutrophils, combined with insufficient regulation by endogenous anticoagulant pathways. In addition, a profound impairment of fibrinolysis further contributes to this imbalance. Initially, this fibrinolytic insufficiency was attributed to elevated plasma levels of plasminogen activator inhibitor-1 and thrombin-activatable fibrinolysis inhibitor. More recently, it has been shown that DIC-associated fibrinolytic insufficiency during septic shock involves plasminogen degradation driven by neutrophil elastase carried by neutrophil extracellular traps circulating in patients' plasma. The failure to resolve this hypercoagulable state and restore hemostatic balance has emerged as a key determinant of poor outcomes in DIC. Therefore, elucidating the mechanisms underlying fibrinolytic insufficiency is very important both to identify at-risk patients and to treat DIC. This review provides an overview of the most recent advances in our understanding of fibrinolytic dysregulation in sepsis-induced DIC, with a particular focus on emerging molecular mechanisms and their implications for the identification of novel pharmacological targets.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100008"},"PeriodicalIF":5.5,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12934427/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147363872","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":"Assessment of soluble PD-L1 in septic shock in relation to immunosuppressive phenotypes.","authors":"Camille Bonnet, Anne-Perrine Foray, Eléonore Micoud, Thomas Lafon, Morgane Gossez, Anne-Claire Lukaszewicz, Fabienne Venet, Guillaume Monneret","doi":"10.1016/j.aicoj.2025.100007","DOIUrl":"https://doi.org/10.1016/j.aicoj.2025.100007","url":null,"abstract":"<p><strong>Background: </strong>Septic shock triggers a complex immune response characterized by the coexistence of hyperinflammation and immunosuppression, the latter being a major driver of ICU-acquired infections and increased mortality. Currently, the most established biomarkers for assessing sepsis-induced immunosuppression rely on flow cytometry-a technique not universally available in clinical practice. In contrast, soluble biomarkers are, in principle, easier to measure. Although assays for soluble PD-L1 (sPD-L1) are not yet standardized, sPD-L1 concentrations may represent a pragmatic alternative, given the putative role of PD-1/PD-L1 signaling in immunosuppressive pathways during sepsis. In this study, we investigated sPD-L1 in relation to established cellular markers of immunosuppression in a cohort of 161 patients with septic shock. sPD-L1 levels were measured using the ELLA microfluidic platform during the first week of ICU admission. We assessed their association with clinical outcomes and explored the relationship between sPD-L1 and immunosuppressive profiles defined by low monocytic HLA-DR expression (mHLA-DR) and absolute lymphocyte count.</p><p><strong>Results: </strong>Upon admission, patients exhibited elevated sPD-L1 levels compared to healthy controls (medians: 179 vs. 54 pg/mL, p < 0.001). No correlation was observed between sPD-L1 levels and severity scores (SOFA, SAPS II). Elevated sPD-L1 was independently and significantly associated with increased mortality at both 28 and 90 days. Longitudinal analysis using K-means clustering revealed that the cluster with consistently highest sPD-L1 levels was associated with unfavorable outcomes. Overall, and at any single time point, sPD-L1 concentrations did not correlate with mHLA-DR expression or lymphopenia. However, the combined presence of high sPD-L1 and low mHLA-DR levels at the end of the first week identified a subgroup of patients with particularly poor clinical outcomes.</p><p><strong>Conclusions: </strong>These findings highlight the potential of sPD-L1 as a clinically relevant biomarker in the context of sepsis immunopathology. Further studies are warranted to elucidate its role in the mechanisms underlying sepsis-induced immunosuppression. Such insights could support the integration of sPD-L1 into multimodal biomarker panels for immune monitoring and risk stratification in patients with septic shock.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100007"},"PeriodicalIF":5.5,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12934443/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147363676","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":"CO₂-derived variables are misleading surrogates for tissue perfusion and oxygenation.","authors":"Arnaldo Dubin, Mario O Pozo","doi":"10.1016/j.aicoj.2025.100010","DOIUrl":"https://doi.org/10.1016/j.aicoj.2025.100010","url":null,"abstract":"","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100010"},"PeriodicalIF":5.5,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12934432/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147363698","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":"Environmental and economic impact of ten commonly used intensive care unit medications depending on administration route.","authors":"Marie Renaudier, Aude Ruttimann, Davuth Tan, Olivier Puig","doi":"10.1016/j.aicoj.2026.100025","DOIUrl":"https://doi.org/10.1016/j.aicoj.2026.100025","url":null,"abstract":"","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100025"},"PeriodicalIF":5.5,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12934431/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147363724","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":"Discharging patients directly home from an ICU: a FAREWELL checklist approach.","authors":"Donald A Redelmeier, Barbara Haas, William K Silverstein","doi":"10.1016/j.aicoj.2026.100026","DOIUrl":"https://doi.org/10.1016/j.aicoj.2026.100026","url":null,"abstract":"","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100026"},"PeriodicalIF":5.5,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12934448/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147363764","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":"What new renal biomarkers tell us about renal physiology: Collection: physiology applied to ICU.","authors":"Melanie Meersch-Dini, Michael Joannidis, Silvia De Rosa, Zoltan Endre, Marlies Ostermann","doi":"10.1016/j.aicoj.2025.100017","DOIUrl":"https://doi.org/10.1016/j.aicoj.2025.100017","url":null,"abstract":"<p><p>The kidney plays a vital role in maintaining internal homeostasis through waste elimination, electrolyte and acid-base regulation, and endocrine functions. Recent advances in renal biomarkers have expanded our understanding of kidney physiology by providing detailed insights into the complex mechanisms underlying renal function and injury, beyond traditional measures like serum creatinine and urine output. These novel biomarkers reflect distinct physiological processes, including glomerular filtration, tubular cell stress response, tubular cell damage, inflammation and repair processes within the kidney. Markers such as cystatin C and proenkephalin serve as more reliable indicators of glomerular filtration rate (GFR), almost unaffected by confounding factors like muscle mass, thus offering more reliable information about renal function than serum creatinine. Biomarkers including Tissue inhibitor of metalloproteinases-2 and insulin like growth factor binding protein 7 (TIMP-2 and IGFBP7) reveal early cellular responses to stress by indicating G1 cell cycle arrest in tubular epithelial cells, a process intended to provide protection against injury. Neutrophil gelatinase-associated lipocalin (NGAL) and related molecules provide information on tubular damage and the kidney's acute damage responses. Chemokines like C-C motif chemokine ligand 14 (CCL14) and CXCL9 highlight the role of immune cells in kidney inflammation and tissue repair, reflecting immune-mediated aspects of renal physiology. In addition to molecular and cellular biomarkers, urine microscopy can provide insightful information about tubular cell health. Further, advanced imaging techniques such as multiparametric magnetic resonance imaging (mpMRI) enable non-invasive evaluation of renal perfusion, oxygenation, and fibrosis. mpMRI provides spatial and functional data that deepen our understanding of renal tissue dynamics and the progression from acute injury to chronic kidney disease (CKD). Together, these biomarkers offer a multidimensional view of kidney physiology, distinguishing between functional changes, cellular stress responses, and structural injury. By illuminating the diverse biological pathways in both healthy and injured kidneys, they enhance our knowledge of renal pathophysiology, indicate underlying mechanisms, enable the identification of specific types of AKI, and provide opportunities to stratify patients for intervention trials.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100017"},"PeriodicalIF":5.5,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12934425/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147363421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Gliflozins Use and Outcomes in Adults with Sepsis: A Multicenter Retrospective Cohort Study Among Veterans.","authors":"Justine Tang, Bocheng Jing, Krystal Karunungan, Anusha Badathala, Arthur Wallace, Matthieu Legrand","doi":"10.1016/j.aicoj.2025.100021","DOIUrl":"https://doi.org/10.1016/j.aicoj.2025.100021","url":null,"abstract":"<p><strong>Background: </strong>Sodium-glucose-cotransporter-2 inhibitors (SGLT2i) improve cardiorenal outcomes in patients with diabetes, chronic heart failure or kidney disease, but their effects in acute settings are unknown. This study evaluated the impact of SGLT2i use on 90-day mortality, major adverse cardiovascular events (MACE), and acute kidney injury (AKI) in patients with sepsis.</p><p><strong>Methods: </strong>A propensity-matched, multicenter retrospective cohort study was conducted using the Veterans Affairs Healthcare System (VAHCS) National Registry from January 1, 2017, to December 31, 2023. Adult veterans with sepsis using SGLT2i in the year prior to admission were compared to a 1:4 matched control group, adjusting for demographics, comorbidities, medications, and sepsis characteristics. We conducted a sensitivity analysis using SuperLearner to estimate the propensity score and perform matching. Chronic SGLT2i use was defined as ≥3 outpatient fills or <180-day gap from the last fill according to the VAHCS pharmacy registries. Primary outcome was 90-day mortality; secondary outcomes included MACE within 90 days, AKI, MAKE-30, EDKA, and hospital length of stay.</p><p><strong>Results: </strong>Among 197,879 eligible patients, 5.15% were SGLT2i prior users and 94.85% were non-users. After propensity-matching, 10,200 SGLT2i users (mean [SD] age: 70.0 [9.1]; 97.5% male, and 72.4% white) were compared to 37,785 controls (mean [SD] age: 70.2 [9.4]; 97.3% male, and 72.5% white). SGLT2i prior use was associated with a significantly reduced risk of 90-day mortality (OR = 0.591, 95% CI: 0.557-0.628), AKI (OR = 0.862, 95% CI: 0.809-0.918), and MAKE-30 (OR = 0.725, 95% CI: 0.683-0.771). There was no association between SGLT2i use and MACE (OR = 0.986, 95% CI: 0.931-1.044). SGLT2i users had shorter hospital stays (13.4 vs. 18.1 days). However, SGLT2i use was associated with a significantly increased risk of EDKA (OR = 2.371, 95% CI: 2.106-2.671).</p><p><strong>Conclusion: </strong>SGLT2i users prior to hospitalization for sepsis had reduced risk of 90-day mortality and AKI, suggesting chronic organ protection decreases the risk of organ failure when sepsis develops.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100021"},"PeriodicalIF":5.5,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12934444/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147363637","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":"Comparison between regional citrate anticoagulation and systemic heparin anticoagulation in patients undergoing continuous renal replacement therapy and venoarterial extracorporeal membrane oxygenation: A retrospective multicentric study.","authors":"Axel Hirwe, Edris Omar, Pierre-Grégoire Guinot, Antoine Beurton, Nicolas Nesseler, Alexandre Mansour, Vivien Berthoud, Alexandre Ouattara, Stéphanie Rouanet, Guillaume Lebreton, Geoffroy Hariri, Adrien Bouglé","doi":"10.1016/j.aicoj.2025.100013","DOIUrl":"https://doi.org/10.1016/j.aicoj.2025.100013","url":null,"abstract":"<p><strong>Introduction: </strong>Regional citrate anticoagulation (RCA) is the recommended first-line strategy for continuous renal replacement therapy (CRRT) circuits. Acute kidney injury is common in patients undergoing venoarterial extracorporeal membrane oxygenation (VA-ECMO), and CRRT is frequently required. However, the use of RCA in this setting remains debated due to concerns about metabolic complications and limited evidence. This study aimed to compare the efficacy and safety of RCA versus unfractionated heparin (UFH) anticoagulation in this high-risk population.</p><p><strong>Materials and methods: </strong>In this retrospective multicentric study, we included adult patients receiving simultaneous VA-ECMO and CRRT between January 2019 and December 2021 in four French intensive care units. The primary outcome was CRRT filter thrombosis, defined as unplanned circuit cessation due to clotting. Filter lifespan, defined as the time from CRRT initiation to cessation for any reason, was recorded as a secondary outcome. Additional secondary outcomes included bleeding events, transfusion requirements, coagulation parameters, and metabolic complications. Association of CRRT filter thrombosis with anticoagulation modality was assessed using a Fine-Gray regression model accounting for competing events, and adjusted for coagulation parameters and CRRT site. Missing data were handled using multiple imputation.</p><p><strong>Results: </strong>Among the 253 patients included (77.9% male, median age 61 years), 599 CRRT sessions were analyzed (RCA: 106; UFH: 493). Median filter lifespan did not differ significantly between groups (RCA: 47 [IQR 21-90] vs UFH: 44 [IQR 20-72] hours, p = 0.144). The estimated cumulative incidence of filter thrombosis at 72 h was 17.0% (95% CI, 10.5-24.8%) in the RCA group versus 26.6% (95% CI, 22.8-30.5%) in the UFH group; p = 0.033. RCA was associated with a significantly lower risk of filter thrombosis compared to UFH (aHR = 0.35 (95% CI, 0.21-0.59; p < 0.001)), after adjustment for coagulation parameters and CRRT site. RCA was not associated with decreased bleeding events (33.3% vs 37.6%, p = 0.417) and did not increase the incidence of severe metabolic complications.</p><p><strong>Conclusion: </strong>In patients receiving VA-ECMO and CRRT, RCA was safe and effective. RCA was associated with a significantly lower risk of filter thrombosis, despite similar median filter lifespan, without increasing bleeding or severe metabolic complications. These findings support the use of RCA as a promising anticoagulation strategy in this high-risk population.</p><p><strong>Specialty: </strong>Critical Care.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100013"},"PeriodicalIF":5.5,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12934447/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147363771","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}