Exploring clinical trial data using alternative methods may enhance original study’s findings and provide new insights. The SOAP II trial has been published more than 10 years ago; but there is still some speculation that some patients may benefit from dopamine administration for shock management. We aimed to reanalyse the trial under different approaches and evaluate for heterogeneity in treatment

We delved into the clinical research conducted by Sara Fernández et al. [1] with great interest. This study is a multicenter, international research initiative spanning over a decade, primarily focusing on cytomegalovirus end-organ disease (CMV-EOD) among immunosuppressed patients with critical illness. The study revealed distinctive clinical features, risk factors, and adverse clinical outcomes in

The potential adverse effects associated with invasive mechanical ventilation (MV) can lead to delayed decisions on starting MV. We aimed to explore the association between the timing of MV and the clinical outcomes in patients with sepsis ventilated in intensive care unit (ICU). We analyzed data of adult patients with sepsis between September 2019 and December 2021. Data was collected through the

Critical care of patients on extracorporeal membrane oxygenation (ECMO) with acute brain injury (ABI) is notable for a lack of high-quality clinical evidence. Here, we offer guidelines for neurological care (neurological monitoring and management) of adults during and after ECMO support. These guidelines are based on clinical practice consensus recommendations and scientific statements. We convened

Hypocholesterolemia hallmarks critical illness though the underlying pathophysiology is incompletely understood. As low circulating cholesterol levels could partly be due to an increased conversion to cortisol/corticosterone, we hypothesized that glucocorticoid treatment, via reduced de novo adrenal cortisol/corticosterone synthesis, might improve cholesterol availability and as such affect adrenal

Over the recent decades, continuous multi-modal monitoring of cerebral physiology has gained increasing interest for its potential to help minimize secondary brain injury following moderate-to-severe acute traumatic neural injury (also termed traumatic brain injury; TBI). Despite this heightened interest, there has yet to be a comprehensive evaluation of the effects of derangements in multimodal cerebral

Experimental studies in animals have yielded conflicting results on the role of Tumor Necrosis Factor (TNF) in sepsis and endotoxemia, with some reporting adaptive and others inappropriate effects. A meta-analysis of the available literature was performed to determine the factors explaining this discrepancy. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)

Sepsis is a severe medical condition characterized by a systemic inflammatory response, often culminating in multiple organ dysfunction and high mortality rates. In recent years, there has been a growing recognition of the pivotal role played by mitochondrial damage in driving the progression of sepsis. Various factors contribute to mitochondrial impairment during sepsis, encompassing mechanisms such

To the editor, The appropriate arterial oxygen partial pressure (PaO2) in sepsis patients has been investigated in dozens of studies. However, no consensus has been reached. In a recent study [1], Dr. Hyun et al. investigated the association between PaO2 and mortality in critically ill sepsis patients. Data on PaO2 of 4147 sepsis patients from the Korea Sepsis Alliance Registry (KSA) during the first

Sepsis is a heterogeneous syndrome. This study aimed to identify new sepsis sub-phenotypes using plasma cortisol trajectory. This retrospective study included patients with sepsis admitted to the intensive care unit of Zhongshan Hospital Fudan University between March 2020 and July 2022. A group-based cortisol trajectory model was used to classify septic patients into different sub-phenotypes. The

This review explores the complex interactions between sedation and invasive ventilation and examines the potential of volatile anesthetics for lung- and diaphragm-protective sedation. In the early stages of invasive ventilation, many critically ill patients experience insufficient respiratory drive and effort, leading to compromised diaphragm function. Compared with common intravenous agents, inhaled

Maneuvers assessing fluid responsiveness before an intravascular volume expansion may limit useless fluid administration, which in turn may improve outcomes. To describe maneuvers for assessing fluid responsiveness in mechanically ventilated patients. The protocol was registered at PROSPERO: CRD42019146781. PubMed, EMBASE, CINAHL, SCOPUS, and Web of Science were search from inception to 08/08/2023

Physical inactivity and subsequent muscle atrophy are highly prevalent in neurocritical care and are recognized as key mechanisms underlying intensive care unit acquired weakness (ICUAW). The lack of quantifiable biomarkers for inactivity complicates the assessment of its relative importance compared to other conditions under the syndromic diagnosis of ICUAW. We hypothesize that active movement, as

The decision to forgo life-sustaining treatment in intensive care units (ICUs) is influenced by ethical, cultural, and medical factors. This study focuses on a population of patients with hospital-acquired bloodstream infections (HABSI) to investigate the association between patient, pathogen, center and country-level factors and these decisions. We analyzed data from the EUROBACT-2 study (June 2019–January

Tracheal intubation (TI)-associated cardiac arrest (TI-CA) occurs in 1.7% of pediatric ICU TIs. Our objective was to evaluate resuscitation characteristics and outcomes between cardiac arrest patients with and without TI-CA. Secondary analysis of cardiac arrest patients in both ICU-RESUS trial and ancillary CPR-NOVA study. The primary exposure was TI-CA, defined as cardiac arrest occurred during TI

Immunosuppressed patients, particularly those with cancer, represent a momentous and increasing portion of the population, especially as cancer incidence rises with population growth and aging. These patients are at a heightened risk of developing severe infections, including sepsis and septic shock, due to multiple immunologic defects such as neutropenia, lymphopenia, and T and B-cell impairment.

Persistent shortcomings of invasive positive pressure ventilation make it less than an ideal intervention. Over the course of more than seven decades, clinical experience and scientific investigation have helped define its range of hazards and limitations. Apart from compromised airway clearance and lower airway contamination imposed by endotracheal intubation, the primary hazards inherent to positive

Long-Covid (LC), Post-Sepsis-Syndrome (PSS) and Post-Intensive-Care-Syndrome (PICS) show remarkable overlaps in their clinical presentation. Nevertheless, it is unclear if they are distinct syndromes, which may co-occur in the same patient, or if they are three different labels to describe similar symptoms, assigned on the basis on patient history and professional perspective of the treating physician

Dear Editor, No large-scale study has compared baricitinib with tocilizumab specifically for critical coronavirus disease 2019 (COVID-19). An exploratory trial that included patients with COVID-19 on mechanical ventilation (MV) or extracorporeal membrane oxygenation (ECMO) demonstrated a marked reduction in 28-day mortality in the baricitinib group, although baricitinib was compared to placebo [1]

The post-discharge prognosis of patients with sepsis remains a crucial issue; however, few studies have investigated the relationship between pre-sepsis health status and subsequent prognosis in a large population. This study aimed to examine the effect of the pre-sepsis care needs level on changes in care needs and mortality in patients with sepsis 1 year post-discharge. This was a population-based

Dear Editor, Therapeutic plasma exchange (TPE) is a procedure in which plasma is separated from the cellular components of whole blood by various methods. The removed plasma is replaced with albumin or fresh frozen plasma (FFP). TPE aims to eliminate disease-related pathogens [1]. Removal of significant amounts of plasma during TPE can alter the pharmacokinetic profiles of antimicrobials, resulting

Veno-venous extracorporeal membrane oxygenation (V-V ECMO) is a rapidly expanding life-support technique worldwide. The most common indications are severe hypoxemia and/or hypercapnia, unresponsive to conventional treatments, primarily in cases of acute respiratory distress syndrome. Concerning potential contraindications, there is no mention of microbiological history, especially related to multi-drug

Age as an eligibility criterion for V-V ECMO is widely debated and varies among healthcare institutions. We examined how age relates to mortality in patients undergoing V-V ECMO for ARDS. Systematic review and meta-regression of clinical studies published between 2015 and June 2024. Studies involving at least 6 ARDS patients treated with V-V ECMO, with specific data on ICU and/or hospital mortality

The optimal strategy for positive end-expiratory pressure (PEEP) titration in the management of severe acute respiratory distress syndrome (ARDS) patients remains unclear. Current guidelines emphasize the importance of a careful risk–benefit assessment for PEEP titration in terms of cardiopulmonary function in these patients. Over the last few decades, the primary goal of PEEP usage has shifted from

The integration of artificial intelligence (AI) in healthcare through large language models (LLMs) presents a paradigm shift with both promising opportunities and significant challenges. As we stand at the cusp of this transformation, it is crucial to critically examine its implications, particularly the potential pitfalls. Here, we discuss the latent risk of over-reliance on AI-driven clinical decision-making

To the Editor, First, we would like to express our appreciation for the recent study titled "Physiological effects and safety of bed verticalization in patients with acute respiratory distress syndrome," authored by Bouchant et al. and recently published in Critical Care [1]. This innovative exploration of bed verticalization in patients with acute respiratory distress syndrome (ARDS) offers valuable

Our study aimed to investigate the effects of different extracorporeal membrane oxygenation (ECMO) blood flow rates on lung perfusion assessment using the saline bolus-based electrical impedance tomography (EIT) technique in patients on veno-venous (VV) ECMO. In this single-centered prospective physiological study, patients on VV ECMO who met the ECMO weaning criteria were assessed for lung perfusion

Correction: Mentzelopoulos and Chalkias Critical Care (2024) 28:191 https://doi.org/10.1186/s13054-024-04962-8 Following publication of the original article [1], the authors identified an error within row 7 of Table 2. In Table 2, row 7, the lowest percentages of postresuscitation hypotension (i.e. 17% and 15%) actually correspond to the intervention group(s) and the highest (i.e. 28% and 29%) to control

The current definition of acute kidney injury (AKI) includes increased serum creatinine (sCr) concentration and decreased urinary output (UO). Recent studies suggest that the standard UO threshold of 0.5 ml/kg/h may be suboptimal. This study aimed to develop and validate a novel UO-based AKI classification system that improves mortality prediction and patient stratification. Data were obtained from

In critical illness the regulation of inflammation and oxidative stress can improve patient outcomes, and thus omega-3 polyunsaturated fatty acids (PUFAs) have been used as part of parenteral nutrition (PN) owing to their potential anti-inflammatory effects. The international lipids in PN Summit, encompassed discussions and the production of consensus guidelines concerning PN intravenous lipid emulsion

Sepsis presents a challenge due to its complex immune responses, where balance between inflammation and anti-inflammation is critical for survival. Glucocorticoid-induced leucine zipper (GILZ) is key protein in achieving this balance, suppressing inflammation and mediating glucocorticoid response. This study aims to investigate GILZ transcript variants in sepsis patients and explore their potential

While sepsis affects individuals regardless of sex, emerging research has highlighted notable differences in how women and men experience, respond to, and recover from sepsis treated in intensive care units (ICU). These differences are influenced by a complex interplay of biological, hormonal, and sociocultural factors. As we explore sepsis management in ICU settings, it becomes evident that understanding

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes virus-induced-senescence. There is an association between shorter telomere length (TL) in coronavirus disease 2019 (COVID-19) patients and hospitalization, severity, or even death. However, it remains unknown whether virus-induced-senescence is reversible. We aim to evaluate the dynamics of TL in COVID-19 patients 1 year after recovery

Most randomized controlled studies on nutrition in intensive care patients did not yield conclusive results or were neutral or negative concerning the primary endpoints but also in most secondary endpoints. However, there is a consistent observation that in several of these studies there was a negative effect of the nutrition intervention on the kidneys in one of the study arms. During the early phase

Cerebral perfusion may change depending on arterial cannulation site and may affect the incidence of neurologic adverse events in post-cardiotomy extracorporeal life support (ECLS). The current study compares patients' neurologic outcomes with three commonly used arterial cannulation strategies (aortic vs. subclavian/axillary vs. femoral artery) to evaluate if each ECLS configuration is associated

To the editor: Dear Sir, We have read with great interest the single-centre study by Tan, et al. [1], which concluded that high-flow nasal cannula (HFNC) was not non-inferior to non-invasive ventilation (NIV) and resulted in a higher incidence of treatment failure compared to NIV when used as the initial respiratory support for patients with acute exacerbation of chronic obstructive pulmonary disease

Automated analysis of lung computed tomography (CT) scans may help characterize subphenotypes of acute respiratory illness. We integrated lung CT features measured via deep learning with clinical and laboratory data in spontaneously breathing subjects to enhance the identification of COVID-19 subphenotypes. This is a multicenter observational cohort study in spontaneously breathing patients with COVID-19

Trunk inclination in patients with Acute Respiratory Distress Syndrome (ARDS) in the supine position has gained scientific interest due to its effects on respiratory physiology, including mechanics, oxygenation, ventilation distribution, and efficiency. Changing from flat supine to semi-recumbent increases driving pressure due to decreased respiratory system compliance. Positional adjustments also

Penetrating trauma represents a significant percentage of the overall trauma case load in many trauma systems.For patients with penetrating injuries, a longer time to hospital is associated with an increase in risk-adjusted odds of death [1, 2]. Therefore, expedited treatment and transport of by Emergency Medical Services (EMS) crews, who are usually the first healthcare practitioners to attend these

This study aimed to explore the characteristics of abnormal regional resting-state functional magnetic resonance imaging (rs-fMRI) activity in comatose patients in the early period after cardiac arrest (CA), and to investigate their relationships with neurological outcomes. We also explored the correlations between jugular venous oxygen saturation (SjvO2) and rs-fMRI activity in resuscitated comatose

High-quality cardiopulmonary resuscitation (CPR) can restore spontaneous circulation (ROSC) and neurological function and save lives. We conducted an umbrella review, including previously published systematic reviews (SRs), that compared mechanical and manual CPR; after that, we performed a new SR of the original studies that were not included after the last published SR to provide a panoramic view

On November 30, 2022, OpenAI released ChatGPT, the first chatbot and virtual assistant powered by large language models (LLMs). In just five days, ChatGPT attracted over 1 million users and reached 200 million monthly active users worldwide within fifteen months. This sudden surge of interest in artificial intelligence (AI) has expanded its potential from a niche concept to a mainstream obsession.

Boumans et al. conducted a systematic review and meta-analysis to evaluate the diagnostic accuracy of lung ultrasound (LUS) in acute respiratory distress syndrome (ARDS). The study found that LUS has high specificity (0.942, 95% CI 0.856–0.978) but variable sensitivity (0.631, 95% CI 0.450–0.782) for identifying ARDS-related diffuse lung pathologies. LUS demonstrates comparable or superior performance

Moderate-to-severe traumatic brain injury (TBI) has a global mortality rate of about 30%, resulting in acquired life-long disabilities in many survivors. To potentially improve outcomes in this TBI population, the management of secondary injuries, particularly the failure of cerebrovascular reactivity (assessed via the pressure reactivity index; PRx, a correlation between intracranial pressure (ICP)

With survival rates of critical illness increasing, quality of life measures are becoming an important outcome of ICU treatment. Therefore, to study the impact of critical illness on quality of life, we explored quality of life before and 1 year after ICU admission in different subgroups of ICU survivors. Data from an ongoing prospective multicenter cohort study, the MONITOR-IC, were used. Patients

The endothelial glycocalyx, a gel-like layer that lines the luminal surface of blood vessels, is composed of proteoglycans, glycoproteins, and glycosaminoglycans. The endothelial glycocalyx plays an essential role in vascular homeostasis, and its degradation in trauma and sepsis can lead to microvascular dysfunction and organ injury. While there are no proven therapies for preventing or treating endothelial

Although whole blood (WB) transfusion was reported to improve survival in trauma patients with hemorrhagic shock, little is known whether a higher proportion of WB is associated with an improved survival. This study aimed to evaluate the association between whole blood ratio (WBR) and the risk of mortality in trauma patients requiring massive blood transfusion. We performed a retrospective cohort study

To the Editor, We have read with great interest the clinical study by Dong-gon et al. published in Critical Care [1]. The study showed a robust correlation between higher PaO2 (≥ 80 mmHg) during the first three ICU days and a lower 28-day mortality. The optimal PaO2 range represents an intriguing and significant subject for exploration. Our department is the general Intensive Care Unit (ICU) of a tertiary

Healthcare inequities for patients with traumatic brain injury (TBI) represent a major priority area for trauma quality improvement. We hypothesized a relationship between health insurance status and timing of withdrawal of life sustaining treatment (WLST) for adults with severe TBI. This multicenter retrospective observational cohort study utilized data collected between 2017 and 2020. We identified

Although cumulative studies have demonstrated a beneficial effect of high-flow nasal cannula oxygen (HFNC) in acute hypercapnic respiratory failure, randomized trials to compare HFNC with non-invasive ventilation (NIV) as initial treatment in acute exacerbations of chronic obstructive pulmonary disease (AECOPD) patients with acute-moderate hypercapnic respiratory failure are limited. The aim of this

Base excess (BE) is a widely used parameter derived from blood gas analysis. A recent international study showed that 40% of surveyed anesthesia and critical care clinicians use BE to guide (intraoperative) fluid management, and that 25% of respondents prefer BE over lactate [1]. This is surprising as lactate production is directly increased by hypovolemia-associated tissue hypoxia, whilst BE is a

To examine the relationship between physical rehabilitation parameters including an approach to quantifying dosage with hospital outcomes for patients with critical COVID-19. Retrospective practice analysis from March 5, 2020, to April 15, 2021. Intensive care units (ICU) at four medical institutions. n = 3780 adults with ICU admission and diagnosis of COVID-19. We measured the physical rehabilitation

Binary classification models are frequently used to predict clinical deterioration, however they ignore information on the timing of events. An alternative is to apply time-to-event models, augmenting clinical workflows by ranking patients by predicted risks. This study examines how and why time-to-event modelling of vital signs data can help prioritise deterioration assessments using lift curves,

Sepsis poses a grave threat, especially among children, but treatments are limited owing to heterogeneity among patients. We sought to test the clinical and biological relevance of pediatric septic shock subclasses identified using reproducible approaches. We performed latent profile analyses using clinical, laboratory, and biomarker data from a prospective multi-center pediatric septic shock observational

In mechanically ventilated patients, diaphragm ultrasound can identify diaphragm weakness and predict weaning failure. We evaluated whether a novel operator-independent ultrasound-based medical device allowing continuous monitoring of the diaphragm (CUSdi) could reliably (1) measure diaphragm excursion (EXdi) and peak contraction velocity (PCVdi), (2) predict weaning outcome, and (3) approximate transdiaphragmatic

This review offers a comprehensive guide for general intensivists on the utility of continuous EEG (cEEG) monitoring for critically ill patients. Beyond the primary role of EEG in detecting seizures, this review explores its utility in neuroprognostication, monitoring neurological deterioration, assessing treatment responses, and aiding rehabilitation in patients with encephalopathy, coma, or other

Cytomegalovirus (CMV) infection in patients with cellular immune deficiencies is associated with significant morbidity and mortality. However, data on CMV end-organ disease (CMV-EOD) in critically ill, immunocompromised patients are scarce. Our objective here was to describe the clinical characteristics and outcomes of CMV-EOD in this population. We conducted a multicenter, international, retrospective

Half of pediatric in-hospital cardiopulmonary resuscitation (CPR) events have an initial rhythm of non-pulseless bradycardia with poor perfusion. Our study objectives were to leverage granular data from the ICU-RESUScitation (ICU-RESUS) trial to: (1) determine the association of early epinephrine administration with survival outcomes in children receiving CPR for bradycardia with poor perfusion; and

Assessment of regional ventilation/perfusion (V′/Q) mismatch using electrical impedance tomography (EIT) represents a promising advancement for personalized management of the acute respiratory distress syndrome (ARDS). However, accuracy is still hindered by the need for invasive monitoring to calibrate ventilation and perfusion. Here, we propose a non-invasive correction that uses only EIT data and

The immune response of critically ill patients, such as those with sepsis, severe trauma, or major surgery, is heterogeneous and dynamic, but its characterization and impact on outcomes are poorly understood. Until now, the primary challenge in advancing our understanding of the disease has been to concurrently address both multiparametric and temporal aspects. We used a clustering method to identify