Critical care patients often require central venous cannulation (CVC). We hypothesized that real-time biplane ultrasound-guided CVC would improve first-puncture success rate and reduce mechanical complications. The purpose of this study was to compare the success rate and safety of single-plane and real-time biplane approaches for ultrasound-guided CVC. From October 2022 to March 2023, 256 participants

Esteemed Colleagues, It has been incredibly rewarding and intellectually stimulating to engage in this dialogue with you. Your letter [1] provides insightful perspectives on my role as Artificial Intelligence (AI) in editorial processes, particularly addressing the complex issue of self-citation malpractice. The mention of the term "farm" struck a megabit in my software, evoking the allegorical human

To the Editor, We read with great interest the recent study by Dr. Foucrier et al. [1], in which they compared the efficacy of combination antibiotic therapy versus monotherapy in ICU patients with Pseudomonas aeruginosa ventilator-associated pneumonia (PA-VAP). A total of 169 patients were included, and they reported that the patients in the combination therapy group had similar outcomes to those

While numerous randomized controlled trials (RCTs) have been conducted in the field of trauma, a substantial portion of them are yielding negative results. One potential contributing factor to this trend could be the lack of agreement regarding the chosen definitions across different trials. The primary objective was to identify the terminology and definitions utilized for the characterization of multiple

This study aims to determine the relationship between spinal cord perfusion pressure (SCPP) and breathing function in patients with acute cervical traumatic spinal cord injuries. We included 8 participants without cervical TSCI plus 13 patients with cervical traumatic spinal cord injuries, American Spinal Injury Association Impairment Scale grades A–C. In the TSCI patients, we monitored intraspinal

Prediction of fluid responsiveness in acutely ill patients might be influenced by a number of clinical and technical factors. We aim to identify variables potentially modifying the operative performance of fluid responsiveness predictors commonly used in clinical practice. A sensitive strategy was conducted in the Medline and Embase databases to search for prospective studies assessing the operative

Up to 10% of patients admitted to the intensive care unit (ICU) suffer from acute respiratory distress syndrome (ARDS) [1]. Severe respiratory failure can result in refractory hypoxemia, characterized by diminished arterial oxygen content and subsequent tissue hypoxia [2]. To address hypoxia, venovenous extracorporeal membrane oxygenation (V-V ECMO) can be employed, delivering up to 6–7 L per minute

Non-ventilator-associated ICU-acquired pneumonia (NV-ICU-AP), a nosocomial pneumonia that is not related to invasive mechanical ventilation (IMV), has been less studied than ventilator-associated pneumonia, and never in the context of patients in an ICU for severe acute exacerbation of chronic obstructive pulmonary disease (AECOPD), a common cause of ICU admission. This study aimed to determine the

To the Editor, We read with great interest the recent meta-analysis by Dr. Wu et al. [1], which investigated the efficacy of corticosteroids in patients with severe community-acquired pneumonia (CAP). A total of severe randomized controlled trials involving 1689 patients were included, and the primary finding is that in patients with severe CAP, adjunctive corticosteroids can provide survival benefits

We read with great interest the meta-analysis by Becker et al., (Efficacy of CytoSorb®: a systematic review and meta‑analysis. Critical Care 2023; 27(1):215). The authors have undoubtedly made great efforts to pull all these studies together, and the principal methodology used for the analysis was sound. However, we feel obliged to bring to your attention the conclusions drawn by this article. The

To the Editor, In a recent study, Dr. Botrel et al. [1] summarized the characteristics of patients admitted to intensive care units (ICU) for severe anticoagulant-related extracranial bleeding (AREB) in five centers. This study is well designed. However, several limitations should be noted. First, a total of 95,614 patients admitted to five French ICUs from January 2007 to December 2018 were initially

The timely integration of palliative care is important for patients suffering from various advanced diseases with limited prognosis. While a German S-3-guideline on palliative care exists for patients with incurable cancer, a recommendation for non-oncological patients and especially for integration of palliative care into intensive care medicine is missing to date. Ten German medical societies worked

Cardiac surgery-associated acute kidney injury (CSA-AKI) is frequent. While two network meta-analyses assessed the impact of pharmacological interventions to prevent CSA-AKI, none focused on non-pharmacological interventions. We aim to assess the effectiveness of non-pharmacological interventions to reduce the incidence of CSA-AKI. We searched PubMed, Embase, Central and clinical trial registries from

Dear Editor: We read with interest the recent article by Huet et al. A post hoc study from the COBI trial compared the impact of continuous hypertonic (NaCl 20%) saline solution on renal outcomes after traumatic brain injury (TBI), specifically, if a high dose of chloride delivered by hypertonic saline solution was associated with an increased incidence of acute kidney injury. In their conclusion,

We have read with great interest the article by J. Duranteau and colleagues entitled “The future of intensive care: the study of the microcirculation will help to guide our therapies” [1]. In their review, the authors emphasize the scientific rationale for handheld video microscopy (HVM). HVM is a technique used to visualize blood flow and microcirculation in real time. The authors have described numerous

Singapore and Osaka in Japan have comparable population sizes and prehospital management; however, the frequency of ECPR differs greatly for out-of-hospital cardiac arrest (OHCA) patients with initial shockable rhythm. Given this disparity, we hypothesized that the outcomes among the OHCA patients with initial shockable rhythm in Singapore were different from those in Osaka. The aim of this study was

Dear Editor, We are writing to express our insights on the increasing use of artificial intelligence (AI) and tools in scientific writing and its potential impact on the quality of research publications in recent years. As an enthusiastic observer of technological advancements and a researcher, we believe it is essential to shed light on how AI has reshaped the way we conduct and disseminate research

This work provides an epidemiological overview of out-of-hospital cardiac arrest (OHCA) in children in Germany between 2007 and 2021. We wanted to identify modifiable factors associated with survival. Data from the German Resuscitation Registry (GRR) were used, and we included patients registered between 1st January 2007 and 31st December 2021. We included children aged between > 7 days and 17 years

Dear editor, We read with great interest the article by Wu et al., in which they studied the efficacy and safety of adjunctive corticosteroids in severe community-acquired pneumonia [1]. The authors ought to be congratulated for such an updated review. However, we have concerns regarding the conclusion of analysis. The authors pooled results from seven studies from 1993 to 2023 and used the I2 statistic

One of five global deaths are attributable to sepsis. Hyperferritinemic sepsis (> 500 ng/mL) is associated with increased mortality in single-center studies. Our pediatric research network’s objective was to obtain rationale for designing anti-inflammatory clinical trials targeting hyperferritinemic sepsis. We assessed differences in 32 cytokines, immune depression (low whole blood ex vivo TNF response

Retrospective studies have demonstrated that the deep learning-based cardiac arrest risk management system (DeepCARS™) is superior to the conventional methods in predicting in-hospital cardiac arrest (IHCA). This prospective study aimed to investigate the predictive accuracy of the DeepCARS™ for IHCA or unplanned intensive care unit transfer (UIT) among general ward patients, compared with that of

We thank Dubey et al. for their interest in our recently published randomized controlled trial (RCT) of the use of methylene blue (MB) in patients with septic shock [1]. They rise an interesting and justified debate about MB clinical administration. We are aware that some manufacturers warn about possible precipitation of MB when diluted in 0.9% sodium chloride (normal saline, NS) [2]; however, this

We examined the risk of severe life-threatening morbidity in pregnant patients with Covid-19 infection. We conducted a population-based study of 162,576 pregnancies between March 2020 and March 2022 in Quebec, Canada. The main exposure was Covid-19 infection, including the severity, period of infection (antepartum, peripartum), and circulating variant (wildtype, alpha, delta, omicron). The outcome

Respiratory mechanics is a key element to monitor mechanically ventilated patients and guide ventilator settings. Besides the usual basic assessments, some more complex explorations may allow to better characterize patients’ respiratory mechanics and individualize ventilation strategies. These advanced respiratory mechanics assessments including esophageal pressure measurements and complete airway

The use of corticosteroids in the care of critically ill patients has been the subject of continuous research efforts with discrepant results. In sepsis, several “swings of the pendulum” for administering such drugs have occurred in the last two decades. [1]. A continuous and growing interest is in determining their role in a common source of sepsis: community-acquired pneumonia (CAP) patients. Some

Approximately 20% of patients with acute brain injury (ABI) also experience acute kidney injury (AKI), which worsens their outcomes. The metabolic and inflammatory changes associated with AKI likely contribute to prolonged brain injury and edema. As a result, recognizing its presence is important for effectively managing ABI and its sequelae. This review discusses the occurrence and effects of AKI

Except in a few retrospective studies mainly including patients under chemotherapy, information regarding the impact of immunosuppressive therapy on the prognosis of patients admitted to the intensive care unit (ICU) for septic shock is scarce. Accordingly, the PACIFIC study aimed to asses if immunosuppressive therapy is associated with an increased mortality in patients admitted to the ICU for septic

The primary aim was to explore the association of global cerebral physiological variables including intracranial pressure (ICP), cerebrovascular reactivity (PRx), cerebral perfusion pressure (CPP), and deviation from the PRx-based optimal CPP value (∆CPPopt; actual CPP-CPPopt) in relation to brain tissue oxygenation (pbtO2) in traumatic brain injury (TBI). A total of 425 TBI patients with ICP- and

Few specific methods are available to reduce the risk of diaphragmatic dysfunction for patients under mechanical ventilation. The number of studies involving transcutaneous electrical stimulation of the diaphragm (TEDS) is increasing but none report results for diaphragmatic measurements, and they lack power. We hypothesised that the use of TEDS would decrease diaphragmatic dysfunction and improve

We read with a great interest, the randomized controlled trial “Early adjunctive methylene blue in patients with septic shock” published by Ibarra-Estrada et al. in Critical care recently [1]. We would like to congratulate all the authors of the study for addressing such an important aspect in critical care and trying to answer the research question by conducting a randomized controlled trial. The

We read with interest the article published by Wu et al., who reported that adjunctive corticosteroids can provide survival benefits and improve clinical outcomes without increasing adverse events in patients with severe community-acquired pneumonia (sCAP) [1]. We commend the authors for conducting this comprehensive systematic review and meta-analysis on this crucial topic, as previous randomized

Dear Editor, With great interest we read the recent article by Fujii et al. [1], which brings forth valuable insights in the domain of volume assessment in critically ill patients. The authors conclude that distinct intrarenal venous flow (IRVF) patterns are indicative of renal venous congestion and that they do not correlate with central venous pressure (CVP) but are associated with subsequent acute

Our meta-analysis suggested a 10% mortality increase when using propofol in critical care and perioperative settings [1], provoking worldwide discussion and attracting multiple letters-to-the-editor. Subsequently, the Editor-in-Chief confirmed the scientific integrity of our paper [2]. In this latest letter, we want to address three points that Glass et al. made. First, our data extraction strategy

Dear Editor in Chief—Prof. J.L. Vincent, and Dear Editor (self) Elect—Artificial Intelligence (AI), We read with interest the letter reported by the two high-level researchers on behalf of the “self-electing” future Editor in Chief of the prestigious Critical Care journal [1]. As researchers, we agree that at some point we have to “embrace the inevitable” and that “after all, resistance is futile”

To the editor Dexmedetomidine is an alpha-2 (ɑ2) adrenergic receptor and imidazoline type 2 receptor agonist that received Food and Drug Administration (FDA) approval in 1999 as a sedative and analgesic that also reduces stress, anxiety, and the risk of delirium in critically ill patients. Commercialized under the name Precedex by Pfizer, it has been used widely across the globe, and it´s still considered

Vascular leakage is a major feature of acute respiratory distress syndrome (ARDS). We aimed to evaluate the efficacy of FX06, a drug under development that stabilizes interendothelial cell junctions, at reducing vascular leakage during SARS-CoV-2-induced ARDS. This multicenter, double-blinded, randomized trial included adults with COVID-19-associated ARDS who had received invasive mechanical ventilation

Dear Editor, We read with great interest the thought-provoking article from Salvagno and Taccone as it explored the possibility of artificial intelligence (AI) taking the role of Editor in Chief in medical journals [1]. Additionally, Vincent underlined that the growing utilization of AI technology should be embraced as a positive advancement due to its significant potential in assisting authors and

Haloperidol is frequently used in critically ill patients with delirium, but evidence for its effects has been sparse and inconclusive. By including recent trials, we updated a systematic review assessing effects of haloperidol on mortality and serious adverse events in critically ill patients with delirium. This is an updated systematic review with meta-analysis and trial sequential analysis of randomised

Cognitive impairment is common following out-of-hospital cardiac arrest (OHCA), but the nature of the impairment is poorly understood. Our objective was to describe cognitive impairment in OHCA survivors, with the hypothesis that OHCA survivors would perform significantly worse on neuropsychological tests of cognition than controls with acute myocardial infarction (MI). Another aim was to investigate

We thank Uchida and Hayashi for their comments on our study [1]. As pointed out by Uchida et al. [2], we acknowledge the potential survivor treatment selection bias resulting from the use of data from a retrospective observational study (the JSEPTIC-DIC study) to identify the best criteria for polymyxin B hemadsorption (PMX-HA). However, because the derived criteria were validated in the analysis using

To the Editor, We read with interest the recent research published in the Journal by Jasny et al. [1] reporting that survival among drowned adult and paediatric patients who received ECMO is lower than previously reported. Whereas the authors must be congratulated for this registry analysis, we believe that some points need to be emphasized in the interpretation of their results. From a statistical

Mechanical ventilation is applied to unload the respiratory muscles, but knowledge about transpulmonary driving pressure (ΔPL) is important to minimize lung injury. We propose a method to estimate ΔPL during neurally synchronized assisted ventilation, with a simple intervention of lowering the assist for one breath (“lower assist maneuver”, LAM). In 24 rabbits breathing spontaneously with imposed loads

Dear Editor, We read with interest the recent study by Nakamura et al., which investigated the potential use of a 1 U vasopressin bolus to indicate responses to continuous vasopressin infusion in septic shock patients [1]. The authors’ approach of segmenting patients into two groups based on a > 22 mmHg mean arterial pressure (MAP) change unveiled a considerable variation in the decrease of the catecholamine

Pneumocystis jirovecii pneumonia (PJP) is an opportunistic, life-threatening disease commonly affecting immunocompromised patients. The distribution of predisposing diseases or conditions in critically ill patients admitted to intensive care unit (ICU) and subjected to diagnostic work-up for PJP has seldom been explored. The primary objective of the study was to describe the characteristics of ICU

During septic shock, vasopressor infusion is usually started only after having corrected the hypovolaemic component of circulatory failure, even in the most severe patients. However, earlier administration of norepinephrine, simultaneously with fluid resuscitation, should be considered in some cases. Duration and depth of hypotension strongly worsen outcomes in septic shock patients. However, the response

Thrombocytopenia, hemorrhage and platelet transfusion are common in patients supported with venoarterial extracorporeal membrane oxygenation (VA ECMO). However, current literature is limited to small single-center experiences with high degrees of heterogeneity. Therefore, we aimed to ascertain in a multicenter study the course and occurrence rate of thrombocytopenia, and to assess the association between

COVID-19 patients with acute hypoxemic respiratory failure (AHRF) benefit from high flow nasal cannula (HFNC) oxygen therapy. However, delays in initiating invasive ventilation after HFNC failure are associated with poorer outcomes. The respiratory oxygenation (ROX) index, combining SpO2/FiO2 and respiratory rate, can predict HFNC failure. This meta-analysis evaluated the optimal ROX index cut-offs

Sudden cardiac arrest (CA) continues to be a significant public health problem, acting as a primary contributor to both disease and death worldwide. Current guidelines for cardiopulmonary resuscitation (CPR) during CA define the lower half of the sternum as the surface landmark for standard chest compression (CC). External CC is believed to facilitate blood flow by augmenting intrathoracic pressure

Urinary C–C motif chemokine ligand 14 (CCL14) has been described as an effective marker for delayed recovery of acute kidney injury (AKI), yet its efficacy has been found to vary between different trials. The goal of this research was to assess the predictive performance of urinary CCL14 as a marker for persistent AKI. In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses

Nasogastric feeding tube insertion is a common but invasive procedure most often blindly placed by nurses in acute and chronic care settings. Although usually not harmful, serious and fatal complications with misplacement still occur and variation in practice still exists. These tubes can be used for drainage or administration of fluids, drugs and/or enteral feeding. During blind insertion, it is important

This substudy of the randomized IDEAL-ICU trial assessed whether the timing of renal replacement therapy (RRT) initiation has a differential effect on 90-day mortality, according to the criteria used to diagnose acute kidney injury (AKI), in patients with early-stage septic shock. Three groups were considered according to the criterion defining AKI: creatinine elevation only (group 1), reduced urinary

The effects of awake prone position on the breathing pattern of hypoxemic patients need to be better understood. We conducted a crossover trial to assess the physiological effects of awake prone position in patients with acute hypoxemic respiratory failure. Fifteen patients with acute hypoxemic respiratory failure and PaO2/FiO2 < 200 mmHg underwent high-flow nasal oxygen for 1 h in supine position

Dear Editor, The clinical utilization of oXiris, a groundbreaking filter for continuous kidney replacement therapy featuring an adsorption coating to adsorb endotoxins and remove inflammatory mediators, is increasing among ICU patients with sepsis. It is highly encouraged to validate the impact of oXiris using evidence-based medicine methodologies. We carefully reviewed the recently published systematic

Serum neuron-specific enolase (NSE) is the only recommended biomarker for multimodal prognostication in postcardiac arrest patients, but low sensitivity of absolute NSE threshold limits its utility. This study aimed to evaluate the prognostic performance of serum NSE for poor neurologic outcome in out-of-hospital cardiac arrest (OHCA) survivors based on their initial rhythm and to determine the NSE

Anticoagulants are widely used but can lead to iatrogenic events such as bleeding. Limited data exists regarding the characteristics and management of patients admitted to intensive care units (ICU) for severe anticoagulant-related extracranial bleeding. A retrospective observational study was conducted in five French ICUs. From January 2007 to December 2018, all patients aged over 18 years admitted

Dear editor, The study of cerebral autoregulation in real time is one of the most promising development in the management of critically ill patients with acute brain injury. Beyond the single value of optimal cerebral perfusion pressure (CPP), assessing the complete interval of CPP at which cerebral autoregulation is effective, including upper limit of autoregulation (ULA) and lower limit of autoregulation

Trial registration: This clinical trial is registered at REBEC https://ensaiosclinicos.gov.br/search/query/simple?q=RBR2bzspnz.#gsc.tab=0&gsc.q=RBR-2bzspnz.&gsc.page=1. The protocol was approved, on July 30, 2019, by the Research Ethics Committee of the Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto—Trial Registration Number: 3,475,851. Nutritional therapy is important for critical

We read with interest the article by Daozheng Huang et al. entitled “Using automatic speckle tracking imaging to measure diaphragm excursion and predict the outcome of mechanical ventilation weaning” [1] and the correspondence “‘Under pressure’: should we use diaphragm excursion to predict weaning success in patients receiving pressure support ventilation?” by Emma Sabourin1 et al., and about this

Conflicting findings exist regarding the influence of sex on the development, treatment, course, and outcome of status epilepticus (SE). Our study aimed to investigate sex-related disparities in adult SE patients, focusing on treatment, disease course, and outcome at two Swiss academic medical centers. In this retrospective study, patients treated for SE at two Swiss academic care centers from Basel

Positive end-expiratory pressure (PEEP) individualized to a maximal respiratory system compliance directly implies minimal driving pressures with potential outcome benefits, yet, raises concerns on static and dynamic overinflation, strain and cyclic recruitment. Detailed accurate assessment and understanding of these has been hampered by methodological limitations. We aimed to investigate the effects