Annals of Intensive Care最新文献

{"title":"Impact of gender on how intensive care medicine residents experience their medical studies and training and perceive their specialty: a national survey.","authors":"Cécile Aubron, Cécile Plaud, Florian Reizine, Caroline Hauw-Berlemont, Charlotte Salmon Gandonnière, Laetitia Bodet-Contentin, Muriel Sarah Fartoukh, Mercedes Jourdain, Julien Le Marec, Fabienne Tamion, Nadia Aissaoui, Stephan Ehrmann, Florence Boissier, Olfa Hamzaoui","doi":"10.1016/j.aicoj.2026.100099","DOIUrl":"10.1016/j.aicoj.2026.100099","url":null,"abstract":"<p><strong>Background: </strong>Parity has been reached among French residents in the intensive care medicine (ICM) specialty; however, concerns about underrepresentation of women in leadership position and gender discriminations remain. We hypothesised that perception of gender inequity differs between female and male ICM residents and increases along the ICM training.</p><p><strong>Methods: </strong>This nationwide observational closed-survey investigated how ICM residents experienced their medical curriculum, how they perceived the ICM specialty, and the potential reasons for women to be underrepresented in leadership position.</p><p><strong>Results: </strong>Among 113 residents who responded to the survey, 63 (55.6%) were females, and 85 (75.2%) were beginners. Twenty-nine (25.7%) answered to be always or often self-confident, and this number was lower in female than in male residents (14.3% versus 40.8%, p = 0.003). Women had less often than men the feeling to keep up with the situation along their medical training (39.7% versus 70.8%, p = 0.004). Societal injunctions to prioritise family over professional responsibilities were more often considered as barriers to leadership position by women than by men (75.8% versus 51.1%, p = 0.015). Fully trained residents agreed more frequently than beginners with the 2 following reasons associated with gender gap in ICM leadership position: men being more ambitious (31.1% versus 9.4%, p = 0.024) and professional environment discriminating against women (64% versus 46.2%, p = 0.017). Experience of non-physical sexual harassment was very common in female residents, with 74.6% of them reporting to have been directly subjected to jokes of a sexual nature (versus 28.6% of men, p = 0.001) and 49.2% of them to have been victims of allegations with humiliating connotation (versus 22.4% of men, p = 0.007).</p><p><strong>Conclusions: </strong>Female ICM residents reported more often the feeling of not coping with their medical training, the lack of self-confidence, and non-physical sexual harassment than men. Reported awareness of a less supportive institutional environment to women academic career and of difference in assertiveness between men and women increased along advancement in ICM training suggesting room for interventions.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100099"},"PeriodicalIF":6.9,"publicationDate":"2026-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13284425/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148306587","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 increasing respiratory rate on ventilatory efficiency and mechanical costs during low-tidal-volume ventilation: a prospective physiological pilot study.","authors":"Carolin Jung, Erietta Markou, Kai Florian Storch, Jona Wassong, Hans-Joerg Gillmann, Thomas Stueber","doi":"10.1016/j.aicoj.2026.100098","DOIUrl":"10.1016/j.aicoj.2026.100098","url":null,"abstract":"<p><strong>Background: </strong>During lung-protective ventilation, respiratory rate (RR) is frequently increased to compensate for hypercapnia. Despite its widespread use, however, the physiological consequences of this strategy remain incompletely understood. We aimed to characterize the physiological trade-offs of stepwise RR escalation at fixed tidal volume during controlled ventilation, with a particular focus on dead space partitioning, ventilatory efficiency, and energetic burden.</p><p><strong>Methods: </strong>In this prospective physiological crossover pilot study, 30 mechanically ventilated ICU patients underwent stepwise RR increases from 15 to 33 min^-1 (primary analysis restricted to ≤27 min^-1) at constant tidal volume (6 mL·kg^-1 ideal body weight (IBW)) under two protocols: complete expiration and fixed I:E ratio (1:1.9). Dead space was assessed using the Enghoff modification of the Bohr equation at two predefined minute ventilation targets (100 and 150 mL·kg^-1 IBW), with capnographic variables derived from quadratic mixed-effects models. Ventilatory efficiency was quantified using the ventilatory ratio (VR), the expected-to-observed PaCO₂ response derived from the alveolar ventilation equation, and the incremental CO₂ elimination per unit additional minute ventilation (ΔV̇CO₂/ΔMV).</p><p><strong>Results: </strong>A 50% increase in minute ventilation (RR 17→25 min^-1) reduced PaCO₂ by 5.1 mmHg (95% CI 4.2-5.9), systematically less than predicted under the assumption of constant dead space fraction. Alveolar dead space increased from 132 to 189 mL (p < 0.001) and dead space fraction rose from 0.60 to 0.65. Incremental CO₂ elimination efficiency declined with increasing RR (β = -0.95 ml CO₂/L MV per min^-1, 95% CI -1.41 to -0.49), suggesting plateau formation under complete expiration. Mechanical power increased exponentially, reaching +181% under complete expiration versus +122% under fixed I:E at 27 min^-1. Baseline VR moderated V̇CO₂ trajectories: patients with high VR tended to show declining CO₂ elimination beyond 21-24 min^-1, whereas low-VR-patients showed approximately linear increases.</p><p><strong>Conclusions: </strong>In this physiological study, RR escalation during low-tidal volume ventilation was associated with progressive decline in ventilatory efficiency, driven by increasing dead space fraction and compounded by rising CO₂ rebreathing. These effects were most pronounced in patients with elevated baseline VR, supporting future investigation of individualized ventilation approaches that balance gas exchange efficiency against mechanical cost.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100098"},"PeriodicalIF":6.9,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13266209/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148262895","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":"Diagnosis and management of Children with Post-Intensive Care Syndrome in Paediatrics: Clinical Practice Guidelines by the French National Authority for Health (HAS).","authors":"Judith Chareyre, Marie Pouletty, Luc Morin, Mehdi Aoun Sebaiti, Julie Brosolo, Chloé Berthaud, Anne Chevé, Violaine Deneux, Lucie Eches, Caroline Genet, Karine Kolev, Antoinette Lejeune, Céline Ricignuolo, Jean-Charles Rossi, Denis Tiberghien, Delphine Micaelli, Albane Mainguy, Michael Levy","doi":"10.1016/j.aicoj.2026.100097","DOIUrl":"10.1016/j.aicoj.2026.100097","url":null,"abstract":"<p><strong>Objective: </strong>Advances in paediatric intensive care have resulted in a growing population of survivors exposed to long-term morbidity. Paediatric post-intensive care syndrome (PICS-p) encompasses new or worsened physical, cognitive, psychological/psychiatric, and socio-familial impairments that may affect children and their families after discharge from the paediatric intensive care unit (PICU). Despite increasing recognition of PICS-p, post-PICU follow-up remains highly heterogeneous worldwide, and systematic screening and management strategies are rarely integrated into routine care. These guidelines were issued at the initiative of the French national health authority (Haute Autorité de Santé: HAS) to improve the prevention, identification, and management of PICS-p.</p><p><strong>Design: </strong>Clinical practice guidelines developed following the HAS standardized methodology (Recommandations de Bonne Pratique), including systematic literature review, multidisciplinary expert elaboration, formal external review, and HAS board approval. Reporting follows the AGREE II framework.</p><p><strong>Methods: </strong>Clinical questions were predefined by HAS project leads. A systematic literature search ([dates]) was conducted across Embase, EmCare, Medline, and the Cochrane Library, prioritising guidelines, meta-analyses, and systematic reviews. Two field experts drafted initial recommendations, graded A (established evidence) to Expert Opinion (absence of evidence). An 18-member multidisciplinary working group refined the draft through two in-person meetings. A 52-member external review panel formally voted on agreement for each recommendation. The final version was approved by the HAS board.</p><p><strong>Results: </strong>Fourty recommendations were issued: 5 with a moderate level of evidence (grade B), 8 low level (grade C) and 27 very low (expert opinion). Strong agreement by the panel of experts was achieved for all recommendations except for one (moderate). The recommendations define PICS-p as a prevalent, multidimensional condition and emphasize systematic, repeated screening of children and families from PICU admission through the first year after discharge. Key preventive strategies include implementation of ABCDEFGH bundle, early mobilization, optimized analgesia and sedation, delirium prevention, and family-centred psychological support. Structured care pathways and pragmatic screening tools are proposed to ensure continuity of care.</p><p><strong>Conclusion: </strong>These guidelines emphasize the importance of structured, multidisciplinary, and family-centred strategies, to improve the prevention, early identification, and management of PICS-p and optimize long-term outcomes for children and their families.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100097"},"PeriodicalIF":6.9,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13273204/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148275701","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":"Is arterial hypotension the real enemy in septic shock or is it just cosmetic?","authors":"Patrick M Wieruszewski, Mathieu Jozwiak","doi":"10.1016/j.aicoj.2026.100096","DOIUrl":"10.1016/j.aicoj.2026.100096","url":null,"abstract":"","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100096"},"PeriodicalIF":6.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13266211/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148262830","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":"Absolute, weight-based, fixed-dose, or phenotype-guided? Rethinking the meaning of vasopressor dose in critical care.","authors":"Carlos Sanchez-Escalante, Patrick M Wieruszewski","doi":"10.1016/j.aicoj.2026.100094","DOIUrl":"10.1016/j.aicoj.2026.100094","url":null,"abstract":"","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100094"},"PeriodicalIF":6.9,"publicationDate":"2026-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13254564/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148248953","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":"When mechanical power remains high despite conventional lung-protective settings: a physiology-driven bedside framework.","authors":"Tomasz Urbankowski, Marek Darowski","doi":"10.1016/j.aicoj.2026.100095","DOIUrl":"10.1016/j.aicoj.2026.100095","url":null,"abstract":"<p><p>Mechanical power integrates ventilatory pressure, tidal volume, flow, and respiratory rate into a single estimate of the energy transferred to the respiratory system per unit time. Higher mechanical power has been associated with ventilator-induced lung injury and worse outcomes. A common bedside dilemma arises when mechanical power remains high despite conventional lung-protective settings, because further reduction of ventilator intensity may compromise gas exchange. This narrative, physiology-driven review addresses how to respond when persistently elevated mechanical power may reflect physiological constraint rather than easily modifiable ventilator settings. We outline a bedside approach in which clinicians first verify conventional lung-protective settings and then look for the main physiological factor that prevents further ventilator reduction. Reduced end-expiratory lung volume should prompt individualized positive end-expiratory pressure (PEEP) titration aimed at restoring and stabilizing lung volume while avoiding overdistension and derecruitment. In mechanically heterogeneous lungs, prone positioning and patient-specific pressure optimization may improve the physiological conditions associated with injurious ventilation, even when the global value of mechanical power cannot be safely lowered. During assisted ventilation, excessive respiratory drive and inspiratory effort should be assessed and treated when present. When high mechanical power remains unavoidable despite optimized settings and targeted physiological interventions, extracorporeal support may be required to enable ultra-protective ventilation.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100095"},"PeriodicalIF":6.9,"publicationDate":"2026-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13254567/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148248941","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":"Revisiting the fluid challenge and stroke volume optimisation after induction of general anaesthesia.","authors":"Terry O'Brien, Robert G Hahn","doi":"10.1016/j.aicoj.2026.100093","DOIUrl":"10.1016/j.aicoj.2026.100093","url":null,"abstract":"<p><strong>Background: </strong>To be clinically useful in goal-directed fluid therapy, a fluid challenge (FC) must achieve a large enough blood volume change (ΔBV) to materially change ventricular preload and stroke volume (ΔSV). The same % change in BV for all the subsequent FCs must also be achieved. We explored under what circumstances these prerequisites can be met by referring to data from a clinical trial where 111 patients underwent three successive intravenous FCs using crystalloid (Ringer´s lactate) or colloid (hydroxyethyl starch), involving a total of 9 mL/kg of fluid, just after induction of general anaesthesia.</p><p><strong>Results: </strong>The three FC using crystalloid fluid increased SV by 2.5% while the colloid increased the SV by 29.2% (medians, <i>P</i> < 0.001). Moreover, crystalloid expanded the BV by 20.8% while the corresponding expansion by colloid was 29.5% (<i>P</i> < 0.001). The cardiac response to increased BV was normalized by calculating the ΔSV%/ΔBV% ratio, which was much lower at 0.12 for the crystalloid fluid versus 0.98 for colloid (<i>P</i> < 0.001). The poor SV response can possibly be explained by the underlying changes in the mean circulatory filling pressure, which suggest crystalloid FCs was less effective in increasing the stressed blood volume (preload). On the other hand, the inferior BV expanding effect of crystalloid is likely due to the fast tissue redistribution pharmacokinetic profile of administered boluses. Finally, the cardiac response to the first FC and impact on oxygen delivery became falsely low in both groups due to a reflex redistribution of a substantial volume of interstitial fluid into the circulation after anaesthetic induction.</p><p><strong>Conclusion: </strong>Differences in effectiveness between crystalloid and colloid fluid when providing repeated FCs increase the risk of false negative indications of fluid non-responsiveness when crystalloid is used.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100093"},"PeriodicalIF":6.9,"publicationDate":"2026-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13250664/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148222871","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":"Outcomes of critically ill patients with newly diagnosed Burkitt's lymphoma: a monocentric retrospective study.","authors":"Fabiola Cammarota, Charlotte Degoutte, Laure Calvet, Dara Chean, Claire Fieschi, Catherine Thieblemont, Gennaro De Pascale, Michael Darmon, Lara Zafrani, Massimo Antonelli, Elie Azoulay, Thibault Dupont","doi":"10.1016/j.aicoj.2026.100084","DOIUrl":"10.1016/j.aicoj.2026.100084","url":null,"abstract":"<p><strong>Background: </strong>Burkitt's lymphoma (BL) can lead to intensive care unit (ICU) admission at diagnosis and treatment initiation for management of disease-related complications such as tumor lysis syndrome (TLS) and acute kidney injury (AKI). Data on the outcomes and prognostic factors in this population of critically ill patients remain limited. We conducted a retrospective single-center study including 124 patients admitted to the ICU of Saint-Louis Hospital with newly diagnosed BL between January 1, 2002 and December 31, 2023. Univariate and multivariate survival analyses were performed to determine factors associated with 3 months and 12 months mortality.</p><p><strong>Results: </strong>124 patients with a median age of 47.5 years (IQR, 34-58.5) were included, of which 60% (74/124) had HIV infection and a majority had advanced stage disease. Chemotherapy was administered during the ICU stay in 84% (104/124) of patients and 59% (73/124) developed TLS. Ninety-day and one-year mortality were respectively 34% (42/124) and 50% (60/119). Among the 50% (60/119) of patients who survived at one year, 98% (59/60) had achieved complete remission and 90% (52/58) had good functional outcomes (performance status of 0 or 1). In multivariate analysis, TLS, vasopressors, HIV infection, male sex, and increasing age were independently associated with one-year mortality.</p><p><strong>Conclusions: </strong>Patients with BL admitted to the ICU during the early phase of their disease present with high rates of TLS, HIV co-infection, and organ failures. Despite low severity scores at admission, short-term and long-term survival remain poor, with half of patients dying within one year. However, among one-year survivors, nearly all achieved complete remission with good functional outcomes. TLS, vasopressor use, HIV infection, male sex, and increasing age were independently associated with one-year mortality.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100084"},"PeriodicalIF":6.9,"publicationDate":"2026-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13218120/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148136605","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":"Clinical spectrum, outcome and impact of nephrectomy in critically-ill adult patients with emphysematous pyelonephritis: the PYELEMPHY observational retrospective multicenter Study.","authors":"Keyvan Razazi, Pierre Louis Blot, Amélie Renou, Yannis Lombardi, Hugo Hille, Jérôme Devaquet, François Perier, Juliette Pocquet, Laurent Camous, Fréderic Pène, Sébastien Besset, Flora Delamaire, Anahita Rouze, Béatrice La Combe, Matthieu Petit, Laurent Laine, Jérémy Rosman, Romain Sonneville, Nicolas Mongardon, Alexy Tran Dinh, Stéphanie Houcke, Florence Boissier, Marc Pineton de Chambrun, Gregoire Jolly, Pierre Bailly, Pierrick Cronier, Malo Emery, Nahema Issa, Jean Loup Augy, Sébastien Jochmans, Jean Dellamonica, Claire Dupuis, Emmanuel Canet, Morgan Benais, Tomas Urbina, Antoine Goury, Damien Roux, Bastien Peiffer, Elsa Moncomble, Romain Arrestier, Igor Duquesne, Armand Mekontso Dessap","doi":"10.1016/j.aicoj.2026.100086","DOIUrl":"10.1016/j.aicoj.2026.100086","url":null,"abstract":"<p><strong>Background: </strong>Emphysematous pyelonephritis (EPN) is a rare, life-threatening necrotizing urinary tract infection marked by gas formation in the renal parenchyma and perirenal tissues. Evidence on its management and outcomes in the intensive care unit (ICU) remains limited. We aimed to describe the clinical profile, outcomes, and effect of nephrectomy in adults admitted to the ICU for infectious EPN.</p><p><strong>Main results: </strong>A national, multicenter, retrospective cohort study including adults admitted with infectious EPN to 48 French ICUs from 2001 to 2021 was conducted. A total of 109 patients were included. Median age was 62 years [IQR 54-72], and 64% were women. Overweight or obesity was present in 74%, and diabetes in 63%. Septic shock occurred in 72%. Urinary tract obstruction was identified in 46%. Initial management relied on antibiotics and/or minimally invasive drainage in 53% of cases. Early nephrectomy (≤24 h after ICU admission) was performed in 14 patients (14%), and delayed nephrectomy in eight (7%) at a median of 4 days [IQR 3-9]. Among the 75 patients discharged from the ICU without nephrectomy, four (4%) required subsequent nephrectomy. ICU mortality was 15% (n = 16). At day 90, vital status was known for 105 patients; 18 had died. In multivariable analysis, higher Simplified Acute Physiology Score II independently predicted increased 90-day mortality (HR per point 1.08; 95% CI 1.05-1.12; p < 0.001). Early nephrectomy was associated with lower mortality (HR 0.18; 95% CI 0.04-0.90; p = 0.037). Major adverse kidney events at day 90 occurred in 40%. Using the propensity-weighted model, early nephrectomy showed a trend toward lower MAKE90, although the association did not reach statistical significance (adjusted OR = 0.32; 95% CI: 0.10-1.02; p = 0.054).</p><p><strong>Conclusion: </strong>EPN requiring ICU admission carries substantial mortality. Early nephrectomy may improve survival, without increasing long-term renal complications.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100086"},"PeriodicalIF":6.9,"publicationDate":"2026-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13218113/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148136509","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":"Alveolar dysregulation of host response in pneumonia and ARDS: implications for immune modulation and infection.","authors":"L S Boers, L Maessen, J Wauters, E D Morrell, A Sarma, A Conway Morris, L D J Bos","doi":"10.1016/j.aicoj.2026.100085","DOIUrl":"10.1016/j.aicoj.2026.100085","url":null,"abstract":"<p><strong>Background: </strong>Respiratory failure due to pneumonia and acute respiratory distress syndrome (ARDS) remains a major cause of morbidity and mortality in the intensive care unit. The alveolar compartment plays a central role in both pathogen clearance and tissue injury, yet its biology is poorly captured by systemic measurements. Growing evidence shows that dysregulation of alveolar host responses drives disease progression, shapes susceptibility to secondary infections, and influences recovery.</p><p><strong>Main body: </strong>Community-, hospital-, and ventilator-associated pneumonia differ in microbial drivers and host responses, but all share a pattern of localized inflammation. In most cases, pathogens are rapidly controlled following antimicrobial treatment, while alveolar inflammation persists. This persistence likely reflects self-reinforcing cycles between epithelial injury, neutrophil activity, and monocyte-macrophage dysfunction. Mechanical ventilation further disrupts local defenses, promoting microbial overgrowth and ventilator-associated pneumonia.In ARDS, diffuse alveolar damage initiates an early influx of neutrophils and monocyte-derived macrophages. Although peripheral blood has been used to identify systemic inflammatory subphenotypes, molecular signatures in the alveolar compartment often differ and may provide complementary biological information. Patients may diverge into distinct alveolar immune trajectories, ranging from sustained alveolar hyperinflammation to immune exhaustion. These divergent trajectories influence downstream repair, determining whether patients achieve epithelial recovery or develop fibrotic remodeling.Alveolar immune dysregulation also creates a permissive niche for viral and fungal pathogens. Pulmonary reactivation of herpes simplex virus or cytomegalovirus and fungal infections with Aspergillus frequently occur in critically ill patients and may reflect impaired local host defense. These processes are associated with prolonged mechanical ventilation and illustrate how impaired alveolar defenses may sustain injury and propagate complications.</p><p><strong>Conclusion: </strong>Pneumonia and ARDS share common pathways of alveolar immune dysregulation that are not adequately captured by systemic profiling alone. Integrating systemic and alveolar immune assessment, including their concordance and discordance, may improve patient stratification, facilitate identification of treatable traits, and support the development of more personalized, compartment-informed therapeutic strategies, including both immunomodulatory and pathogen-directed interventions. A more refined understanding of compartment-specific host responses will be key to advancing these approaches.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100085"},"PeriodicalIF":6.9,"publicationDate":"2026-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13214341/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148051918","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}