Weaning from mechanical ventilation is a critical process in the intensive care unit (ICU), and extubation failure remains associated with poor outcomes. ICU-acquired weakness has been identified as a risk factor for delayed weaning. Maximal handgrip strength (HGS) is a simple bedside measure proposed as a surrogate marker of global muscle strength. This systematic review and meta-analysis aimed to

Prolonged mechanical ventilation (MV) frequently results in inspiratory and peripheral muscle weakness, impairing recovery. These conditions can be identified at the bedside using respectively Maximal Inspiratory Pressure (MIP) measurement and Medical Research Council (MRC) score. This study investigated the evolution over the acute-care hospital stay of MIP and MRC score in patients with documented

Mechanical ventilation provides life-saving support to patients with respiratory failure, but inadequately tailored settings can lead to respiratory muscle dysfunction and poor patient outcomes. Surface electromyography (sEMG) offers a non-invasive modality to monitor respiratory muscle function. However, variability in acquisition setups limits the comparability of study findings and hinders broad

Prolonged prone positioning (PPP) for ≥ 24 h may enhance outcomes in moderate to severe acute respiratory distress syndrome (ARDS), but may also increase risks such as pressure injuries and complications. Despite clinical rationale, high-quality evidence for PPP’s safety and efficacy remains scarce. We conducted a systematic review and meta-analysis of randomized controlled trials (RCT) and observational

Volume overload is the primary pathophysiological mechanism underlying signs and symptoms in acute heart failure (AHF). However, evidence-based strategies for optimal loop diuretic dosing and monitoring remain limited. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of natriuresis-guided protocols for titrating diuretic therapy in patients with AHF. We searched Cochrane

We read with interest the recent study by Erlebach et al. [1] in Critical Care, which comprehensively assessed the concordance between SpO2/FiO2 (SF) and PaO2/FiO2 (PF) ratios in ARDS classification. The authors found that SF resulted in misclassification of ARDS severity in 33% of data points, with 84% being “overestimations” (SF classification higher than PF).While Erlebach et al. thoroughly analyzed

The Venous Excess Ultrasound (VExUS) score has been developed to grade venous congestion and predict acute kidney injury in cardiac surgical setting by combining inferior vena cava diameter with hepatic, portal, and renal venous Doppler patterns. While initial studies demonstrated associations with acute kidney injury, subsequent non cardiac setting ICU studies yielded contradictory results, prompting

The recent systematic review by Ho et al. on the use of sevoflurane in refractory status asthmaticus in adults represents a valuable contribution to the literature and provides important clinical insights into this salvage therapeutic option. Nevertheless, several aspects merit further consideration [1].In their discussion of adverse effects, the authors mainly emphasized hypotension and cases of nephrogenic

Robust evidence supports the use of preemptive non-invasive ventilation (NIV) after extubation in selected high-risk patient cohorts. In contrast, current guidelines discourage the use of NIV as a rescue therapy for respiratory failure that develops later after extubation, based on earlier studies indicating a potential increase in hospital mortality due to delayed reintubation. Nonetheless, NIV continues

Long-term opioid dependence after critical illness is an emerging concern, yet the incidence and predictors of persistent opioid use among intensive care unit (ICU) survivors remain incompletely characterized. We aimed to estimate the six-month incidence of new persistent opioid use in opioid-naïve ICU survivors and to identify associated risk factors. We conducted a retrospective, nationwide cohort

Regional citrate anticoagulation (RCA) is the recommended anticoagulation strategy for continuous kidney replacement therapy (CKRT). However, the safety of RCA in patients with liver dysfunction and/or shock remains controversial due to the risk of citrate accumulation. This study assesses the associations of citrate accumulation with liver dysfunction, circulatory shock, and mortality, and investigates

In mechanically ventilated patients, extubation is decided after passing a spontaneous breathing trial (SBT). Supplementary motor area, which can be non-invasively assessed by measuring amplitude of pre-inspiratory potentials (PIPs), is recruited in case of increased respiratory effort. Weaning failure may be accompanied by increased respiratory effort. We hypothesized that early increased PIP amplitude

“GRADE is an excellent way to exhaust all the volunteers on the guideline committee but probably will not help much in putting together the final recommendations.”, exclaimed a respected intensivist during a clinical practice guideline panel meeting. The remark underscored how guideline development is often slow and resource intensive. Yet, on reflection, most people acknowledge that the benefits of

Muscle mass loss is a major contributor to morbidity and mortality in Intensive Care Unit (ICU) patients, but the role of metabolic state - particularly energy expenditure - in this process remains unclear. This study investigates the association between metabolic status and muscle mass loss in critically ill adults using indirect calorimetry and CT imaging assessed muscle quantification. In this observational

Identifying high-probability deterioration individuals at the time of admission remains a challenge in normotensive patients with acute pulmonary embolism (PE). Ventricular septum (VS) deviation, as observed on computed tomography pulmonary angiography (CTPA), has been associated with poor prognosis in acute PE patients. However, the quantitative relationship between the VS curvature ratio and clinical

Extracorporeal cardiopulmonary resuscitation (eCPR) is a highly resource-intensive procedure, and its cost-effectiveness remains a subject of debate [1]. Hospital-based eCPR for refractory out-of-hospital cardiac arrest has been shown to have a low probability of cost-effectiveness compared to conventional cardiopulmonary resuscitation (cCPR) [2]. A recent cost-effectiveness analysis reported an incremental

Amatoxin-related acute liver failure (AT-ALF) carries high mortality without liver transplantation (LTX). While therapeutic plasma exchange (PEX) might improve LTX-free survival in other ALF cases, its role in AT-ALF is unclear. Clinical practice varies, and, given the rarity of this ALF entity, the feasibility of conducting a randomized controlled trial to investigate PEX in AT-ALF is more or less

Contrast-enhanced ultrasound (CEUS) is a promising tool to assess renal microcirculation. However, its reproducibility has never been formally assessed. We aimed to assess the reproducibility and precision of CEUS measurements in critically ill patients. We conducted an observational study in 20 critically ill patients in stable cardio-pulmonary condition. In group 1 (n = 10), to assess CEUS reproducibility

While mortality for critically ill patients has decreased, many survivors face persistent physical, cognitive, and psychological impairments, collectively known as post-intensive care syndrome, which significantly reduce health-related quality of life (HRQoL). Nutrition is a crucial component of recovery, yet evidence-based strategies for post-intensive care unit (ICU) nutritional management remain

Kim et al. [1] recently reported that both extracorporeal cardiopulmonary resuscitation (ECPR) initiation time and age are independent predictors of survival to discharge in out-of-hospital cardiac arrest (OHCA) patients, emphasizing the need for more rapid ECPR initiation in elderly individuals.The authors should be congratulated for their very interesting results in the utmost important field of

Adjusting trunk inclination in patients with acute respiratory distress syndrome directly affects physiological variables such as respiratory mechanics and PaCO2 levels. These effects may vary according to the body mass index (BMI) due to differences in lung and chest wall mechanics, highlighting the need for further investigation to clarify the clinical relevance of body position across patient subgroups

In hypoxemic patients, the respective effects of noninvasive respiratory support strategies on lung injury determinants remain unclear, primarily due to the difficulty of obtaining standardized measurements for all interventions within the same study. We conducted a systematic review and network meta-analysis to assess the effects of noninvasive strategies on transpulmonary driving pressure and inspiratory

The Lower Limit Margin, defined as the difference between the autoregulation-informed optimal cerebral perfusion (CPP) target (CPPopt) and the lower limit of autoregulation (LLA), was recently introduced as a potential dynamic prognostic marker after traumatic brain injury (TBI). Conceptually, CPPopt marks the CPP associated with “optimal” autoregulatory function, while LLA represents the CPP at which

Sepsis is a major global health problem and one of the leading causes of death in intensive care units (ICUs). Nearly 50 million cases and 11 million deaths occur annually, representing 20% of global mortality [1]. This burden is most pronounced in low- and middle-income countries (LMICs), where weak health systems, limited resources, and socio-economic vulnerabilities contribute to disproportionately

Sepsis is a life-threatening condition that stems from a dysregulated host response to an infection, leading to multi-organ dysfunction and death. Sepsis has a remarkably high global burden and accounts for 20% of all deaths worldwide. Nonetheless, possibilities for treatment are limited mainly to early administration of broad-spectrum antibiotics and providing fluid resuscitation. Innovative strategies

Sepsis-induced cardiomyopathy (SICM) is a transient cardiac dysfunction that occurs in a substantial proportion of patients with sepsis and is associated with poor prognosis. However, preventive strategies remain limited. This study aimed to assess whether baseline use of sodium-glucose co-transporter 2 inhibitors (SGLT2is) compared to dipeptidyl peptidase-4 inhibitors (DPP4is) is associated with a

Intensive Care Unit (ICU) readmissions are associated with increased morbidity, mortality, and healthcare costs. Therefore, determining an appropriate timing of ICU discharge is critical. In this context, deep learning (DL) approaches have attracted significant attention. We conducted a systematic review of studies developing or validating DL models for ICU readmission prediction, published up to March

To the editor, We read with great interest the report on left-digit bias (LDB)Footnote 1and invasive treatments among out-of-hospital cardiac arrest patients with shockable rhythm [1]. This prospective, multicenter observational study included data from approximately 140 hospitals and a total of 5,943 patients across Japan. The authors identified a significant LDB affecting ECMO implementation at age

Correction: Critical Care (2024) 28:381https://doi.org/10.1186/s13054-024-05180-yFollowing the publication of the original article [1], the authors identified an error in the author name of Kostoula Arvaniti and that the equal contribution was missing for Luis Felipe Reyes and Cristian C. Serrano‑Mayorga.The incorrect author name is:Kostoula Avanti.The correct author name is:Kostoula Arvaniti.The author

We read with great interest the recent systematic review by McDonald et al. in which they evaluate the available clinical trial evidence regarding the impact of vasopressor selection on renal outcomes in septic shock and provide guidance for the future of trial design in this arena [1]. We agree with the authors that norepinephrine salt formulations are an important issue in shock research, but for

Combined nutrition and rehabilitation is a top research priority for ICU-acquired weakness, yet the optimal strategy and clinical benefits remain unclear. This study aimed to evaluate the independent and combined effects of resistance training (RT) and β-hydroxy-β-methylbutyrate (HMB) in critically ill adults. We conducted a multicenter, open-label, 2 × 2 factorial randomized controlled trial with

Although goal-concordant care is central to patient-centered medicine, determining treatment preferences for incapacitated patients remains a challenge. Nearly two decades ago, algorithms were proposed to estimate the most likely treatment preferences in the absence of advance directives, aiming to support surrogate decision-making. This idea has evolved into a race toward increasingly complex models

To assess heterogeneous treatment effects of high fresh frozen plasma (FFP) to red blood cell (RBC) transfusion ratios in patients with severe blunt trauma and to identify subgroups that derive the greatest survival benefit. This multicenter retrospective cohort study used data from the Japan Trauma Data Bank (2019–2023). Adults with severe blunt trauma (Injury Severity Score ≥ 16) who received transfusions

Dear editor,ICU sedation represents a cornerstone of critical care management, balancing patient comfort and safety against the risks of oversedation, prolonged mechanical ventilation, and drug-related adverse effects. We read with great interest the recent meta-analysis by Yamamoto et al. examining volatile sedation in critically ill adults receiving mechanical ventilation [1]. Surprisingly, their

Antibiotic resistance has emerged as one of the most important factors influencing the outcomes of patients with life-threatening infections in the ICU. The increasing prevalence of antibiotic-resistant infections globally highlights the importance of this issue for all intensivists. Antibiotic utilization in the ICU should be optimized to ensure that timely appropriate treatment is administered in

Dear Editor,Contrast-enhanced computed tomography (CECT) is a key diagnostic procedure in critically ill patients, in whom contrast media (CM) is injected most of the time through central venous catheter (CVC). The quality of contrast enhancement relies on patient-dependent (cardiac output, weight and size) or patient-independent (technology of CT-scan, type of catheter, site of injection, CM volume

Elevated circulating endothelial cells (CECs), released from monolayers after insult, have been implicated in worse outcomes in ARDS and COVID-19, however there is no consensus proteomic phenotype that define CECs. We queried whether a transcriptomic approach would alternatively support the presence of endothelial cells in circulation and correlate with worsening respiratory failure. To test whether

Necrotizing soft tissue infections (NSTIs) are uncommon, yet rapidly progressive and potentially fatal conditions. However, evidence-based guidance on antibiotic therapy remains limited. Current recommendations emphasize the need for broad-spectrum empirical coverage, including gram-positive, gram-negative, anaerobes, and Streptococcus pyogenes when clinically indicated. We aimed at developing a practical

The interpretation of brain tissue oxygen tension (PbtO₂) in neurocritical care remains controversial, particularly during hyperoxemic conditions. In this comment on the article by Bögli et al., we propose that the observed rise in PbtO₂ following increased FiO₂ may be better explained by the conformational transition of hemoglobin from the relaxed (R) to the tense (T) state at the end of cerebral

To the Editor,For patients who remain comatose after cardiac arrest and return of spontaneous circulation (ROSC), the benefits and indications of sedatives and hypothermia remain unclear. The latest guidelines recommend continuous core-temperature monitoring and active fever (>37.7 °C) prevention for at least 72 h [1], with no adjustments according to the severity of hypoxic-ischemic brain injury (HIBI)

Dear editorWe read with great interest the recent systematic review and meta-analysis by Paulus MC et al. evaluating the role of the urea-to-creatinine ratio (UCR) as a biomarker of protein catabolism in critically ill patients [1]. The authors should be commended for this comprehensive and methodologically rigorous synthesis, and for underscoring the potential value of an inexpensive, widely available

Acute kidney injury (AKI) is a significant complication among critically ill patients, particularly those with sepsis, yet no specific therapies exist. Progress in some diseases has been achieved by analyzing individuals who appear resistant. This study sought to develop a framework to investigate AKI resistance using clinical phenotyping and biomarkers and applied this framework to a large cohort

Sepsis remains a leading cause of global mortality, primarily driven by microvascular collapse stemming from severe vascular endothelial injury. Within this pathology, the dramatic depletion of Apolipoprotein A1 (ApoA1) and its carrier, high-density lipoprotein (HDL), is a hallmark feature. Despite being recognized as a prognostic biomarker, a comprehensive understanding of the ApoA1/HDL axis as an

Dear editor,We read with great interest the manuscript by Contier et al. published in Critical Care [1]. This is a valuable study that highlights the use of rapid molecular pathogen detection in immunocompromised patients—a population in urgent need of early and accurate diagnostic strategies. However, we would like to raise several concerns for consideration by the authors and the readership of Critical

Delirium is a prevalent neuropsychiatric syndrome during critical illness and is associated with prolonged hospitalization, increased mortality, and post-ICU cognitive decline. It is hypothesized to result from systemic inflammation, disrupted neurotransmission, and failure of cerebral energy metabolism. This narrative review highlights the key role of altered neurometabolism and neuroinflammation

Burn injuries are complex and devastating traumas that trigger a profound systemic metabolic response, characterized by hyperglycemia, insulin resistance, and a hypermetabolic state. Notably, hyperglycemia is a critical determinant of worse prognoses in burn patients. While insulin has long been the gold standard for managing post-burn hyperglycemia, its therapy is associated with a risk of hypoglycemic

We read with great interest the response letter by Brasil et al. [1] to our recent study [2], as it raised several important points regarding the management of invasive intracranial pressure (ICP) monitoring.We fully agree that the choice of monitoring technique should be guided by clinical needs, since conditions such as hydrocephalus and subarachnoid or intraventricular hemorrhage usually require

Advances in critical care have shifted the focus from survival alone to addressing Post-Intensive Care Syndrome (PICS), which includes persistent physical, cognitive, and psychological challenges after discharge from the intensive care unit (ICU). While post-ICU clinics have been established in high-income countries (HICs), their adoption in low- and middle-income countries (LMICs) remains limited

It has been demonstrated that patient-specific intracranial pressure (ICP) thresholds are possible to derive using the function intersectionality between ICP and cerebrovascular reactivity (CVR). Such individualized ICP (iICP) thresholds represent a potential personalized medicine approach to neurocritical care management. However, it is currently unknown how various CVR thresholds compare in regard

Over the past decade, more than 80% of randomized controlled trials (RCTs) in septic shock have failed to identify effective pharmacologic therapies (Supplemental Content 1) [1], underscoring the urgent need for effective treatments. Xuebijing (XBJ) has demonstrated promising efficacy in two recent large-scale RCTs, the EXIT-SEP (n = 1817) [2] and XBJ-SCAP (n = 710) [3] trials, by significantly reducing

Post-sepsis syndrome (PSS) encompasses a range of long-term complications, including immune dysregulation, chronic inflammation, and neuromuscular impairment, that persist beyond the resolution of the acute septic episode. While these clinical phenotypes are increasingly recognized, the underlying molecular mechanisms remain incompletely defined. Mitochondrial dysfunction, particularly in the form

Patients with septic shock are high risk for developing acute kidney injury (AKI), with its associated morbidity. This systematic review assessed the evidence for an effect on renal outcomes from choice of vasopressor. Searches were conducted on Medline, Embase, Cochrane Central, congress abstracts and trial registries. The search strategy included septic shock, vasopressor agents and renal impairment

Early recognition of critical illness is crucial for timely intervention and improved prognosis. However, conventional diagnostic methods are often invasive and time-consuming, limiting their utility for rapid screening in critical care. Breath analysis has recently emerged as a promising approach in metabolomics due to its non-invasive, repeatable, and rapid-response characteristics. Volatile organic

Weaning from veno-arterial extracorporeal membrane oxygenation (V-A ECMO) and determining the optimal timing for liberation from mechanical circulatory support (MCS) remain critical yet complex. Although multiple weaning protocols exist, focusing on hemodynamic and echocardiographic parameters [1], no direct comparative studies have clarified which approach best reflects true cardiopulmonary reserve

Aneurysmal subarachnoid hemorrhage is a critical condition with high case-fatality and lasting impacts on survivors. Acute events that are the direct result of aneurysm rupture, such as acute ischemia, elevated intracranial pressure, cerebral edema, seizures, and hydrocephalus, lead to early brain injury. A delayed cascade of processes, including a prominent systemic inflammatory response, may lead

Hypomagnesemia is frequently encountered in patients admitted to the intensive care unit (ICU) [1, 2]. Several reports have shown that hypomagnesemia on the ICU is associated with critical illness and ICU outcome, but it is unclear whether this concerns a causal relation [1, 3]. While total magnesium is often used in routine care, ionized magnesium appears to be the best possible test [2]. Understanding

Autoimmune hemolytic anemia (AIHA) is a rare but potentially life-threatening condition requiring intensive care unit (ICU) admission in severe cases. While corticosteroids and immunosuppressants are standard treatments, their delayed efficacy limits their utility in critical settings requiring rapid hemolysis control. Plasma exchange (PlEx) may offer a rapid intervention, but its effectiveness in

It is difficult to determine the optimal timing of salvage therapies, such as initiation of renal replacement therapies (RRT), using non-experimental designs. Therefore, using timing of RRT as a motivating example, we performed meta-analyses comparing observational and experimental studies assessing timing of RRT and timing of invasive mechanical ventilation (IMV). We performed two meta-analyses of

The Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) order. aims to prevent the initiation of inappropriate, aggressive interventions in patients with a poor prognosis, highlighting the need to assess intensive care unit (ICU) resource utilization in such cases. Therefore, our study aimed to evaluate the resources utilized by DNACPR patients and compare them with those utilized by non-DNACPR patients