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Annals of Intensive Care
Journal Prestige (SJR): 1.819

Citation Impact (citeScore): 4
Number of Followers: 40

This is an Open Access Journal

Open Access journal
ISSN (Online) 2110-5820
Published by SpringerOpen

[229 journals]

Alcohol related hepatitis in intensive care units: clinical and biological
spectrum and mortality risk factors: a multicenter retrospective study
- Abstract: Background Alcohol related hepatitis is responsible for high morbidity and mortality, but little is known about the management of patients with hepatitis specifically in intensive care units (ICU). Methods Retrospective study including patients with alcohol related hepatitis hospitalized in 9 French ICUs (2006–2017). Alcohol related hepatitis was defined histologically or by an association of clinical and biological criteria according to current guidelines. Results 187 patients (median age: 53 [43–60]; male: 69%) were included. A liver biopsy was performed in 51% of cases. Patients were admitted for impaired consciousness (71%), sepsis (64%), shock (44%), respiratory failure (37%). At admission, median SOFA and MELD scores were 10 [7–13] and 31 [26–40] respectively. 63% of patients received invasive mechanical ventilation, 62% vasopressors, and 36% renal replacement therapy. 66% of patients received corticosteroids, and liver transplantation was performed in 16 patients (8.5%). ICU and in-hospital mortality were 37% and 53% respectively. By multivariate analysis, ICU mortality was associated with SOFA score (without total bilirubin) (SHR 1.08 [1.02–1.14] per one-point increase), arterial lactate (SHR 1.08 [1.03–1.13] per 1 mmol/L) and MELD score (SHR 1.09 [1.04–1.14] per 1 point), while employment was associated with increased survival (HR 0.49 [0.28–0.86]). After propensity score weighting, the use of corticosteroids did not affect ICU mortality in the overall population but had a beneficial effect in the subgroup of patients with histological proof. Patient prognosis was also better in responders assessed by Lille score at day 7 (OR 6.67 [2.44–20.15], p
  PubDate: 2025-04-15
Impact of aminoglycosides on survival rate and renal outcomes in patients
with urosepsis: a multicenter retrospective study
- Abstract: Background Combination therapy with a beta-lactam and an aminoglycoside is currently recommended for the empirical treatment of urosepsis. Nephrotoxicity is the most common adverse effect of aminoglycosides and acute kidney injury (AKI) has a significant prognostic impact in septic shock. This study aimed to evaluate the impact of empirical antibiotic therapy with or without an aminoglycoside on survival and renal outcomes in patients admitted to the intensive care unit (ICU) with urosepsis. Methods This multicenter, retrospective, comparative study included all adults admitted to the ICU for urinary sepsis or septic shock between January 2015 and May 2022 in four ICUs of three university hospitals within the Assistance Publique—Hôpitaux de Paris (APHP). The primary outcome was mortality on day 30 after ICU admission. Secondary endpoints included the lack of renal recovery, the need for new renal replacement therapy (RRT), the Major Adverse Kidney Events at day 30 (MAKE 30) and ICU length of stay. Confounding by indication was taken into account using propensity score weighting. Results A total of 580 patients were included, median age was 69 years (interquartile: 58–77) and 53.6% were male. Overall, 335 patients (57.8%) were in septic shock and 448 (79.2%) had AKI on admission. A total of 579 patients (99.8%) received a beta-lactam as empirical therapy (with (n = 444) or without (n = 136) aminoglycosides). The overall 30-day mortality rate was 10.5% (61/580). After propensity score weighting, the mortality rate in patients receiving aminoglycosides was 7.7% (7/91) compared to 12.1% (11/91) in those not receiving aminoglycosides (adjusted hazard ratio (aHR) = 0.65 [0.35; 1.23], p = 0.19). No significant differences were found in the lack of renal recovery at day 30 (aHR = 0.88 [0.49; 1.58], p = 0.67), the need for new RRT within 30 days (aHR = 1.01 [0.54; 1.88], p = 0.97), MAKE 30 (aHR = 0.94 [0.60; 1.50], p = 0.81), and ICU length of stay among survivors (aHR = 1.07 [0.87; 1.31], p = 0.53). Conclusions Including aminoglycosides in the empirical antibiotic therapy did not significantly improve 30-day survival in patients admitted to the ICU for urosepsis. However, the use of aminoglycosides was not associated with worse renal outcomes.
  PubDate: 2025-04-12
Comparison of all-cause mortality with different blood glucose control
strategies in patients with diabetes in the ICU: a network meta-analysis
of randomized controlled trials
- Abstract: Background The optimal glucose control strategy for intensive care unit (ICU) patients with diabetes remains a topic of debate. This study aimed to compare the effects of strict glucose control, intermediate strict glucose control, liberal glucose control, and very liberal glucose control on reducing all-cause mortality in ICU patients with diabetes through a network meta-analysis. Methods We conducted a search in PubMed, Cochrane Library, Embase, and Web of Science for randomized controlled trials comparing different glucose control strategies in ICU patients with diabetes up to October 1, 2024. The primary outcome was all-cause 90-day mortality. The Risk of Bias 2 tool was used to assess bias in the included studies. Data analysis was performed using Stata (version 17). Results A total of 12 randomized controlled trials involving 5,297 participants were included in the final analysis. The results showed that there was no statistically significant difference between the four glucose control strategies in reducing all-cause 90-day mortality. The surface under the cumulative ranking (SUCRA), which was used to rank the strategies and display the probability of each strategy being ranked first, showed the following: intermediate strict control (SUCRA 88%), liberal control (SUCRA 55.3%), very liberal control (SUCRA 40.3%), and strict control (SUCRA 16.5%). The cumulative probability of each strategy’s rank in reducing all-cause mortality, from best to worst, showed that the most likely ranking was intermediate strict control, liberal control, very liberal control, and strict control. Conclusions In ICU patients with diabetes, no significant statistical difference was observed among the four glucose control strategies in reducing all-cause 90-day mortality. The SUCRA rankings are hypothesis-generating and require further validation. Therefore, the current evidence is insufficient to definitively conclude that any one strategy is superior to the others in reducing mortality.
  PubDate: 2025-04-09
Visual coronary artery calcification score to predict significant coronary
artery stenosis in patients presenting with cardiac arrest without
ST-segment elevation myocardial infarction
- Abstract: Background Emergency coronary angiogram after a cardiac arrest without ST-segment elevation myocardial infarction (STEMI) is still a matter of debate. To better select patients who may benefit from this procedure, we tested a visual coronary artery calcification (VCAC) score available in chest CT to predict significant coronary artery stenosis and/or culprit lesion or ad hoc or delayed percutaneous coronary intervention (PCI). Results A total of 113 patients with cardiac arrest and without STEMI who had a coronary angiogram and chest CT (January 2013 to March 2023, Croix-Rousse Hospital, Lyon, France) were retrospectively included. VCAC was scored from 0 (no calcification) to 3 (diffuse calcification) for each 4 four main arteries (left main, left anterior descending, circumflex, and right coronary artery). At baseline the median [interquartile range] age was 65.8 years [53.4–75.7], 61.9% were male, and 59.3% presented with ventricular fibrillation. Coronary angiogram identified at least one significant coronary artery stenosis in 32.7%, and ad hoc and delayed PCI were performed in 12.4% and 6.2% of the patients, respectively. VCAC score was an excellent predictor of significant coronary artery stenosis with an area under the ROC curve (AUC) of 0.95 (95%CI [0.90-1.00]) and the optimal threshold was ≥ 4 (specificity 94.7%, sensitivity 91.9%). For the detection of culprit coronary artery stenosis, the AUC was at 0.90 (95%CI [0.85–0.96]) and the optimal threshold was ≥ 5 (specificity 83.5%, sensitivity 87.5%). The AUC was 0.886 [0.823–0.948] (specificity 81.8%, sensitivity 85.7%) for ad hoc PCI and 0.921 [0.872–0.972] (specificity 85.3%, sensitivity 88.9%) for both delayed and ad hoc PCI with a same optimal threshold of VCAC ≥ 5. A VCAC score ≥ 4 had a sensitivity at 100% to predict a significant or culprit coronary artery stenosis and ad hoc or delayed PCI. Conclusions The present study found that a non-dedicated CT thorax may be useful to measure VCAC and if this is scored ≥ 4 it allows physicians to better select patients resuscitated from cardiac arrest with non-STEMI and without history of coronary artery disease who may benefit from an emergency coronary angiogram to detect a significant or culprit coronary artery stenosis and had PCI if appropriate.
  PubDate: 2025-04-07
Impact of early versus conventional kidney replacement therapy initiation
in tumor lysis syndrome: a target trial emulation
- Abstract: Background In the context of tumor lysis syndrome (TLS), the optimal timing and criteria for initiating kidney replacement therapy (KRT) remain unclear. This study aims to assess the effect of initiating KRT at various phosphatemia thresholds on Major Adverse Kidney Events at day 30 (MAKE30). Methods and results We retrospectively emulated a pragmatic clinical trial comparing the effect of KRT initiation at various phosphatemia thresholds versus a conventional approach during TLS on MAKE30. All consecutive patients admitted to the ICU at Saint-Louis University hospital in Paris and Angers University hospital between January 2007 and June 2020, presenting with laboratory TLS were included. The design criteria of a clinical trial were mimicked by using the cloning, censoring and weighting method. The primary outcome was the MAKE30 composite outcome, considering only KRT requirement between day 7 and day 30 for the dialysis criteria. We evaluated multiple phosphatemia thresholds to guide KRT initiation, ranging from 6.20 mg.dL-1 to 9.30 mg.dL-1. Among the initial population of 220 patients, 192 were included in the emulated trial (median age 60 years old, with non-Hodgkin Lymphoma and Acute Leukemia being the most frequent hematological malignancies). TLS-related AKI occurred in 140 patients, and 75 patients met the criteria for MAKE30. Regardless of the phosphate threshold considered, KRT initiation based on phosphate level was not associated with a significant difference in the MAKE30 rate. KRT requirement during the first 7 days (Odd Ratio [OR] 4.01 [1.65–4.86], p = 0.003) and non-renal SOFA (OR 1.39 per 1 point increment [1.25–1.57], p
  PubDate: 2025-04-04
Does Levosimendan hasten veno-arterial ECMO weaning' A propensity
score matching analysis
- Abstract: Background Preliminary evidence from small, single-center studies suggests levosimendan may improve the likelihood of successful venoarterial extracorporeal membrane oxygenation (VA-ECMO) weaning in patients with cardiogenic shock. However, the literature is limited and presents conflicting results. We aimed to assess the benefits of levosimendan on VA-ECMO for time to successful ECMO weaning, using a pragmatic and rigorous definition of successful VA-ECMO weaning in patients with potential for cardiac function recovery. Methods A retrospective bicentric study over 6 years was conducted, including patients who received levosimendan during their ECMO course. Patients with post-cardiotomy cardiogenic shock or end-stage chronic heart failure were excluded. Patients receiving levosimendan while on VA-ECMO were matched to those not receiving levosimendan during the same period, based on pre-specified variables and time from ECMO initiation. The primary endpoint was successful VA-ECMO weaning, defined as survival without death, heart transplantation, or LVAD within 30 days after VA-ECMO withdrawal. Results Over the study period, 320 patients treated with VA-ECMO for refractory cardiogenic shock were included, of whom 68 received levosimendan during their ECMO course. Propensity score matching yielded 47 unique pairs of patients with comparable characteristics. After matching, successful ECMO weaning was achieved in 16 out of 47 patients (34%) in the no-levosimendan group and 21 out of 47 patients (45%) in the levosimendan group (sHR, 1.45 [95% CI, 0.77–2.70]; P = 0.25). Similarly, there were no significant differences between the groups in terms of bridge-to-heart transplant, LVAD, or death. Left ventricular ejection fraction and aortic velocity time integral improved significantly after levosimendan in all patients, regardless of their VA-ECMO weaning status. Conclusion In patients with non-postoperative cardiogenic shock supported by peripheral VA-ECMO, levosimendan was not associated with increased rates of successful VA-ECMO weaning or improved 30-day and 6-month bridge-free survival. Results from double-blinded randomized controlled trials are urgently needed to clarify the effectiveness and optimal timing of levosimendan in this specific population.
  PubDate: 2025-04-03
Automatic continuous P0.1 measurements during weaning from mechanical
ventilation: a clinical study
- Abstract: Background In critically ill patients, weaning from mechanical ventilation (MV) includes spontaneous breathing trial (SBT) usually followed by a reventilation period in order to recover from the alveolar derecruitement induced by the SBT. The measurement of occlusion pressure during the first 100 ms of an airway occlusion (P0.1) one of the non-invasive tools available for estimating the respiratory drive, is a determinant of patient respiratory effort. This clinical study explores the use of non-invasive continuous monitoring of occlusion pressure automatically calculated by ventilators in the first 100 ms of airway occlusion (P0.1 vent) during SBT and reventilation periods. The study aimed to investigate patient or respirator factors influencing P0.1 vent as well as the association of P0.1 vent values with extubation success or failure. Patients and Methods This prospective observational study, conducted from February 2022 to April 2023, included adult patients intubated for more than 24 h and screened for extubation weaning. SBTs were performed for one hour with zero pressure support and zero end-expiratory pressure (PS0 ZEEP). Reventilation followed for an hour with pressure support (8–12 cmH2O) and PEEP (5 cmH2O). Data included patient characteristics, ventilator parameters and extubation outcomes. Results The study involved 224 measurements from 212 patients, with 157 successful extubations, 46 extubation failures at day 7 and 21 SBT failures. P0.1 vent mean values were significantly higher for extubation failures and SBT failures compared to successful extubations (p
  PubDate: 2025-04-01
Time-dependent effects of prone position on ventilation-perfusion matching
assessed by electrical impedance tomography in patients with COVID-19
ARDS: sub-analysis of a prospective physiological study
- Abstract: Background Prone positioning (PP) has been shown to improve oxygenation in patients with acute respiratory distress syndrome (ARDS); with a focus on its early physiological effects. However, the time-dependent effects of PP on ventilation-perfusion (V/Q) matching have not been fully investigated. In this study we aimed to investigate the longitudinal effects of PP on regional V/Q matching and the distribution of ventilation and perfusion in patients with coronavirus disease 2019 (COVID-19)-associated ARDS. Methods This study analyzed patients with COVID-19 ARDS who were mechanically ventilated and underwent their first PP treatment. V/Q mismatching was assessed using electrical impedance tomography (EIT). At five intervals during the initial PP session PaO2/FiO2 measurements and EIT evaluations were performed including: before the initiation of PP while in the supine position (SP), 1 h after PP (PP1), 3 h after PP (PP3), 16 h after PP (PPend), and 3 h after reverting to the supine position (RE-SP3). Results In this study eighteen COVID-19 ARDS patients were enrolled. In comparison with SP, PP led to significant improvements in oxygenation, with PaO2/FiO2 consistently increasing at each PP time point and peaking at PPend. Dorsal ventilation significantly increased at PP1 (P = .047), and steadily rose during PP, with a higher increase at PPend than PP1 (P
  PubDate: 2025-03-31
Combination of urinary biomarkers can predict cardiac surgery-associated
acute kidney injury: a systematic review and meta-analysis
- Abstract: Introduction Acute kidney injury (AKI) develops in 20–50% of patients undergoing cardiac surgery (CS). We aimed to assess the predictive value of urinary biomarkers (UBs) for predicting CS-associated AKI. We also aimed to investigate the accuracy of the combination of UB measurements and their incorporation in predictive models to guide physicians in identifying patients developing CS-associated AKI. Methods All clinical studies reporting on the diagnostic accuracy of individual or combined UBs were eligible for inclusion. We searched three databases (MEDLINE, EMBASE, and CENTRAL) without any filters or restrictions on the 11th of November, 2022 and reperformed our search on the 3rd of November 2024. Random and mixed effects models were used for meta-analysis. The main effect measure was the area under the Receiver Operating Characteristics curve (AUC). Our primary outcome was the predictive values of each individual UB at different time point measurements to identify patients developing acute kidney injury (KDIGO). As a secondary outcome, we calculated the performance of combinations of UBs and clinical models enhanced by UBs. Results We screened 13,908 records and included 95 articles (both randomised and non-randomised studies) in the analysis. The predictive value of UBs measured in the intraoperative and early postoperative period was at maximum acceptable, with the highest AUCs of 0.74 [95% CI 0.68, 0.81], 0.73 [0.65, 0.82] and 0.74 [0.72, 0.77] for predicting severe CS-AKI, respectively. To predict all stages of CS-AKI, UBs measured in the intraoperative and early postoperative period yielded AUCs of 0.75 [0.67, 0.82] and 0.73 [0.54, 0.92]. To identify all and severe cases of acute kidney injury, combinations of UB measurements had AUCs of 0.82 [0.75, 0.88] and 0.85 [0.79, 0.91], respectively. Conclusion The combination of urinary biomarkers measurements leads to good accuracy.
  PubDate: 2025-03-29
Correction: Effect of early and later prone positioning on outcomes in
invasively ventilated COVID-19 patients with acute respiratory distress
syndrome: analysis of the prospective COVID-19 critical care consortium
cohort study
- PubDate: 2025-03-28
Ability of diastolic arterial pressure to better characterize the severity
of septic shock when adjusted for heart rate and norepinephrine dose
- Abstract: Background Septic shock is commonly associated with reduction in vasomotor tone, mainly due to vascular hyporesponsiveness to norepinephrine (NE). Although the diastolic arterial pressure (DAP)/heart rate (HR) ratio reflects vasomotor tone, it cannot be a reliable index of vascular responsiveness to NE (VNERi). We hypothesized that adjusting DAP/HR for the NE dose could yield a VNERi value (VNERi = DAP/(NE dose x HR)), knowledge of which can help guiding therapeutic strategies in cases of persistent hypotension despite NE (e.g., increasing NE doses vs. introducing additional vasopressors). For our hypothesis be valid, at least VNERi should demonstrate a stronger association with patient outcome than DAP, DAP/HR or mean arterial pressure (MAP)/NE dose, a global marker of NE responsiveness. Methods We conducted a post-hoc analysis of the ANDROMEDA-SHOCK database. Hemodynamic variables and initial NE doses were recorded at the randomization time-point, within 4 h of septic shock diagnosis. NE doses were expressed in µg/kg/min (using the bitartrate NE formulation). A multivariate model was employed to compare the associations between these variables and key clinical outcomes, including in-hospital mortality, numbers of vasopressor-free days and of renal replacement therapy (RRT)-free days up to day 28. Results The ANDROMEDA-SHOCK database included 424 patients with septic shock receiving NE. The median DAP was 52 mmHg [IQR: 45–50] and the median NE dose at inclusion was 0.2 µg/kg/min [IQR: 01-0.4]. In-hospital mortality was 43%. VNERi demonstrated the strongest association with in-hospital mortality compared to DAP, DAP/HR, and MAP/NE dose, emerging as the most significant covariate in the multivariate model. Similar findings were found for the associations with numbers of vasopressor-free days and RRT-free days up to day 28. The model revealed an inverted J-shaped relationship between in-hospital mortality and VNERi, with a nadir point at 6.7, below which mortality increased. Conclusions In patients receiving NE during early septic shock, VNERi demonstrated the strongest association with outcome compared to DAP, DAP/HR, and MAP/NE dose. Due to its physiological basis and robust association with outcomes, VNERi may serve as a valuable bedside marker of the vascular responsiveness to NE. This index could potentially be integrated into decision-making of early septic shock.
  PubDate: 2025-03-26
Amikacin use in critically ill patients requiring renal replacement
therapy: the AMIDIAL-ICU study
- Abstract: Background Acute kidney injury (AKI) requiring renal replacement therapy (RRT) is common in intensive care units (ICUs), yet optimal amikacin dosing in this context remains poorly understood. Methods We conducted a prospective observational study across 18 French hospitals from April 2020 to January 2022. Adult ICU patients (aged > 18 years) receiving their first amikacin dose while on RRT were included. Data on demographics, RRT modalities, amikacin dosing, and therapeutic drug monitoring were collected. Using a pharmacokinetic modeling approach, we evaluated various amikacin regimens and simulated target attainment probabilities across different minimum inhibitory concentrations (MICs). Results A total of 111 patients were included, with approximately two-thirds receiving continuous RRT. The median amikacin dose was 27 (25–30) mg/kg. Amikacin peak (Cmax) and trough concentrations were monitored in 53 (47.8%) and 76 (68.5%) patients, respectively. Continuous RRT and a history of chronic kidney disease reduced dialytic clearance. For a MIC ≤ 4 mg/L, a 15 mg/kg amikacin dose achieved Cmax/MIC and AUC/MIC targets in ≥ 90% of patients on intermittent dialysis, while 20 mg/kg was required for those on continuous dialysis. For a MIC = 8 mg/L, a 30 mg/kg dose was necessary to achieve Cmax/MIC ≥ 8. Conclusions Our findings highlight suboptimal adherence to amikacin monitoring guidelines in ICU patients on RRT. Using pharmacokinetic modeling, we identified amikacin dosing recommendations ranging from 15 to 35 mg/kg to optimize efficacy and minimize risks, depending on MIC and dialysis modality.
  PubDate: 2025-03-26
Selective decontamination regimens in French ICUs: association with
reduced infection and resistance emergence
- Abstract: Background Despite randomized controlled trials with favorable results, few intensive care units (ICUs) implemented selective decontamination (SD) for ICU-acquired infection prevention. We aimed to evaluate, SD implementation and associated-effects in a large network of French ICUs. Methods This study was conducted using the healthcare-associated infection surveillance cohort “REA-REZO” involving 193 participating ICUs. All patients receiving invasive mechanical ventilation for > 24 h were included. In addition to standard of care (SOC), six ICUs applied a SD strategy during the study period. The primary endpoint was the rate of ICU-acquired infection. A propensity-score matched analysis was conducted using non-parsimonious regression model. The secondary endpoint was the rate of colonization by multidrug resistant organisms (MDRO) during the ICU stay. Results Among 81,661 patients with invasive mechanical ventilation for longer than 24 h, 2727 patients receiving SD were matched with 2 727 receiving SOC. The ICU-acquired infection incidence was lower in the SD group as compared with the SOC group (Incidence Rate Ratio = 0.66 [0.60–0.73]; p
  PubDate: 2025-03-25
Anti-RNApol3-Associated myocarditis: an emerging disease linking
autoimmunity and infection
- Abstract: Background Fulminant myocarditis (FM) is a severe condition primarily triggered by viruses. Anti-RNA polymerase III autoantibodies (RNApol3) which are typically found in patients with severe systemic sclerosis, have been reported in patients with influenza-related FM. Our objective is to provide additional insight into RNApol3-associated FM. Methods We retrospectively included all patients admitted to our institution between January 2013 and June 2023 with acute myocarditis and positive serum RNApol3. We compared their characteristics, etiologies, and outcomes with those of a cohort of RNApol3 negative acute myocarditis. Results Twenty-nine RNApol3-positive patients, comprising 83% females with a mean age of 39 ± 12 years, were included in this study. Each patient was admitted to the intensive care unit at least once and 11 (38%) relapsed. Triggers included influenza virus in 55% and SARS-CoV-2 virus in 48% of cases. The lowest left ventricular ejection fraction was 10 [5-10] % and the highest troponin value was 82 [22–360] times the ULN. Patients required dobutamine (94%), veno-arterial extracorporeal membrane oxygenation (85%) and pericardiocentesis (38%). At the last follow-up, 76% of patients were still alive, while 7% had undergone cardiac transplantation, and 3% required a left ventricular assist device. Compared to RNApol3-negative cases, RNApol3-positive myocarditis was associated with female gender, fulminant evolution, tamponade, a higher likelihood of being caused by a proven viral infection, and a higher rate of relapse. Conclusion RNApol3-associated myocarditis is an emerging disease linking autoimmunity and infection and a unique cause of acquired, pathogen-specific, organ-specific immunodeficiency. RNApol3 should be screened in all cases of FM, especially in young women infected by RNA viruses. The risk of FM in RNApol3-positive systemic sclerosis needs further investigation.
  PubDate: 2025-03-24
Alterations in the renin-angiotensin system during septic shock
- Abstract: Background Alterations in the classical Renin-Angiotensin Aldosterone System (RAAS) have been described during septic shock and are associated with patient outcomes. Since the alternative RAAS has also been reported to be altered in critically ill patients, and given that the RAAS can be modulated by specific therapeutics, such as angiotensin II, understanding its pathophysiology is of primary interest. Objective To describe the alterations in the classical and alternative RAAS during septic shock in comparison with healthy controls. Methods This prospective, monocentric, controlled study enrolled 20 patients fulfilling the septic shock diagnosis, as defined by the Sepsis-3 criteria, along with 30 controls. The main exclusion criteria were the use of any prior medication modifying the RAAS, prior liver failure (Child-Pugh score > 9), or chronic kidney disease (estimated glomerular filtration rate
  PubDate: 2025-03-24
Effect of manual decongestive therapy on cardiac preload in critically ill
patients: a randomized controlled trial
- Abstract: Background Capillary leakage is common in critical illness and can lead to intravascular hypovolemia and edema. Fluid balance, however, is crucial to optimize cardiac preload, vascular filling and tissue perfusion. Intravenously administered fluids are rapidly distributed to the extravascular spaces and further increase edema with consecutive harm for impeded wound healing, weakness, distribution of pharmaceutics to the third space and patient discomfort. We hypothesized that manual decongestive therapy (MDT) followed by elastic bandaging increases cardiac preload and reduces interstitial edema and thus, offers a promising approach to restore the imbalance in fluid distribution between the interstitium and the intravascular space in critically ill patients. Methods From November 2021 to May 2023, 34 critical ill requiring advanced hemodynamic monitoring with thermodilution-calibrated pulse contour analysis were randomized to either standard care or MDT followed by elastic bandaging for 24 h. Global end-diastolic volume index (GEDI) as a marker of the cardiac preload was measured 15, 30, 60 min and 24 h after MDT. Wrist and ankle circumferences were measured as markers of the extent of local interstitial edema. Results In the intervention group, a significant increase in Δ GEDI was observed 15 min [median 48 (IQR 82) to median −19 (IQR 39)], 60 min [median 75 (IQR 106.5) to median −11 (IQR80)] and 24 h [median 107 (IQR 153) to median −16 (IQR 114)] after the study intervention compared to the control group. After 24 h ankle [median 23.5 (IQR 5) cm to median 24 (IQR 6) cm, p
  PubDate: 2025-03-24
Management of severe acute encephalopathy in the ICU: an expert consensus
statement from the french society of intensive care medicine
- Abstract: Introduction Acute encephalopathy in the ICU poses significant diagnostic, therapeutic, and prognostic challenges. Standardized expert guidelines on acute encephalopathy are needed to improve diagnostic methods, therapeutic decisions, and prognostication. Methods The experts conducted a review of the literature, analysed it according to the GRADE (Grading of Recommendation, Assessment, Development and Evaluation) methodology and made proposals for guidelines, which were rated by other experts. Only expert opinions with strong agreement were selected. Results The synthesis of expert work and the application of the GRADE method resulted in 39 recommendations. Among the 39 formalized recommendations, 1 had a high level of evidence (GRADE 1 +) and 10 had a low level of evidence (GRADE 2 + or 2-). These recommendations describe indication for ICU admission, use of clinical scores and EEG for diagnosis, detection of complications, and prognostication. The remaining 28 recommendations were based on expert consensus. These recomandations describe common indications for blood and CSF studies, neuroimaging, use of neuromonitoring, and provide guidelines for management in the acute phase. Conclusion This expert consensus statement aims to provide a structured framework to enhance the consistency and quality of care for ICU patients presenting with acute encephalopathy. By integrating high-quality evidence with expert opinion, it offers a pragmatic approach to addressing the complex nature of acute encephalopathy in the ICU, promoting best practices in patient care and facilitating future research in the field.
  PubDate: 2025-03-21
Characteristics and outcomes of ECMO cannula-related infections: a
European multicenter retrospective study
- Abstract: Objective Only few data regarding epidemiology and management of ECMO cannula-related infections (ECMO-CRIs) exist. The aim of our study was to describe their epidemiology and prognosis, and to evaluate factors associated with outcome. Methods We performed a multicenter retrospective study in 12 European ICUs, including patients with ECMO-CRI, defined as a clinical suspicion plus a positive bacterial sample of ECMO-cannulation site. Primary objective was to describe ECMO-CRI characteristics and outcomes. Secondary objectives were to evaluate the rates of infection recurrence, their risk factors, and to evaluate the impact of antimicrobial treatment duration on outcome. Results During the study period, 109 patients with ECMO-CRI (78 having concomitant positive blood culture with the same pathogen) were included. Pathogens responsible for infections were predominantly Enterobacteriaceae, coagulase-negative Staphylococcus and Enterococcus spp., and 42% of episodes were polymicrobial. Rates of infection recurrence was 13% and ICU-mortality rate was 51%. Risk factors for death were concomitant bloodstream infection with same pathogen and septic shock Patients with antibiotic course ≤ 8 days had similar infection recurrence rate and outcomes (including mortality) than patients with prolonged (> 8 days) antibiotic course. Conclusion ECMO-CRIs are frequently associated with BSI and frequently polymicrobial. Duration of antimicrobial treatment for ECMO-CRI ≤ 8 days does not seem to be associated with an increased risk of recurrence or death, as compared to longer treatment.
  PubDate: 2025-03-20
Severe hemoptysis associated with lung cancer in the ICU: recurrence and
outcome
- Abstract: Background Hemoptysis is a life-threatening event in the course of lung cancer (LC). The management of the most severe episodes of hemoptysis include medical measures and vascular interventional radiology (VIR). There are few data on initial clinical and radiological features associated with early bleeding recurrence, and its prognostic significance. Methods A monocenter retrospective study involving patients admitted to the intensive care unit (ICU) between 2009 and 2020 for severe hemoptysis (SH) associated with LC and requiring VIR. Results During the study period, 130 patients (85% males; 59.5 ± 5.3 yrs) with SH and non-small cell (78%) or small-cell (18%) LC were analysed. SH was inaugural in half of cases. A lower respiratory tract infection (LRTI) was microbiologically documented in 39% of cases. All patients received a first-line VIR, including systemic bronchial and non-bronchial arteriography with embolisation (n = 117) and/or pulmonary arterial vaso-occlusion (n = 20). Bleeding recurred in 34% cases, after 1 day [1–3] of initial VIR attempt. Overall, the 28-day, 6-month and 12-month mortality rates were 25.3%, 47.7% and 63%, respectively. Intravenous terlipressin prior to VIR (OR 4.43, p = 0.001) and LRTI (OR 2.93; p = 0.007) were independently associated with bleeding recurrence. Tumoral cavitation (HR 3.37; p = 0.004), Staphylococcus aureus infection (HR 8.3; p = 0.005) and bleeding recurrence (HR 2.68; p = 0.01) were independently associated with one-year mortality. Conclusion Lung cancer-related SH is associated with a high rate of bleeding recurrence and a poor prognosis. The association of Staphylococcus aureus infection with recurrence and mortality raises the potential interest of the administration of antibacterial treatment in that context.
  PubDate: 2025-03-20
Which carbon footprint for my ICU' Benchmark, hot spots and
perspectives
- Abstract: Background The purpose of this study was to identify the main greenhouse gas (GHG) emitting activities or products among the medical devices (MD) and medicines used in a polyvalent Intensive Care Unit (ICU). Methods A pragmatic eco-audit was conducted in a 21-beds polyvalent ICU, in Saint-Brieuc, Bretagne, France. It consisted of estimating GHG emissions of products or activities, considering process-based life cycle analysis (LCA), economic input–output analysis (EIO) and hybrid-LCA. Results were expressed as Carbon Dioxide Equivalent (CO2e) emissions per patient-day considering each medication and MD (including personal protective equipment). Results With remaining uncertainty, GHG emissions were estimated at 61.1 kgCO2e per patient-day. Two hundred and two individual MD were used per patient-day, equivalent to 5.1 kgCO2e per patient-day (process-based LCA). Gloves accounted for the main part of kgCO2e emissions (representing 1.8 kgCO2e per patient-day). Then, syringes (1.1 kgCO2e per patient-day), perfusion tubings (1.0 per patient-day) and gauze pads (0.4 kgCO2e per patient-day) were the most important sources of MD related GHG emissions. Forty-seven individual medicines were used per patient-day. Most consumed medications were sterile water for injection, propofol, and sodium chlorure. The GHG emissions of medications were estimated with EIO-LCA at 21.5 kgCO2e per patient-day, mostly due to injectable medicines (15.3 kgCO2e per patient-day). Conclusion Upcoming studies focusing on actions on these particular hot spots would be of interest in order to significantly decrease GHG emissions but also to increase resilience of critical care.
  PubDate: 2025-03-20

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