Critical Care最新文献

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 merely improving oxygenation to emphasizing lung protection, with a growing focus on the individual pattern of lung injury, lung and chest wall mechanics, and the hemodynamic consequences of PEEP. In moderate-to-severe ARDS patients, prone positioning (PP) is recommended as part of a lung protective ventilation strategy to reduce mortality. However, the physiologic changes in respiratory mechanics and hemodynamics during PP may require careful re-assessment of the ventilation strategy, including PEEP. For the most severe ARDS patients with refractory gas exchange impairment, where lung protective ventilation is not possible, veno-venous extracorporeal membrane oxygenation (V-V ECMO) facilitates gas exchange and allows for a "lung rest" strategy using "ultraprotective" ventilation. Consequently, the importance of lung recruitment to improve oxygenation and homogenize ventilation with adequate PEEP may differ in severe ARDS patients treated with V-V ECMO compared to those managed conservatively. This review discusses PEEP management in severe ARDS patients and the implications of management with PP or V-V ECMO with respect to respiratory mechanics and hemodynamic function.

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.

Table 2 row 7 currently reads:

]

Table 2 row 7 should read:

]

Table 2 has been updated in this correction and the original article [1] has been corrected.

1. Mentzelopoulos SD, Chalkias A. A critical reappraisal of vasopressin and steroids in in-hospital cardiac arrest. Crit Care. 2024;28:191. https://doi.org/10.1186/s13054-024-04962-8.

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Authors and Affiliations

1. First Department of Intensive Care Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece

   Spyros D. Mentzelopoulos

2. Department of Intensive Care Medicine, Evaggelismos General Hospital, 45‑47 Ipsilandou St, 10675, Athens, Greece

   Spyros D. Mentzelopoulos

3. Institute for Translational Medicine and Therapeutics, University of Pennsylvania Perelman School of Medicine, Phil

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 the factors contributing to these sex-based variations is important for tailoring therapeutic approaches and improving overall patient outcomes. Moreover, for a nuanced interpretation of current evidence, it is worth noting the distinction between the terms gender and sex: gender refers to the socially constructed roles and behaviors that a given society considers appropriate, while sex pertains to biological characteristics.

The ICU sepsis patient population comprises individuals of all ages and with diverse comorbidities and clinical conditions, leading to acute organ failure. Efforts have been made to identify distinct phenotypes and establish correlations with host-response patterns and clinical outcomes [1]. As clinicians, it is increasingly clear that personalized treatment and prognostication strategies are essential for optimizing patient care, but somewhat limited by our current diagnostic and therapeutic tools. While patient sex is often a readily available characteristic, the extent to which we incorporate it as a variable into our comprehensive clinical assessments for critically ill sepsis patients could warrant further consideration and refinement. Are we taking it into account as thoroughly as we should? In their recent publication in this journal, Zimmermann and colleagues conducted a retrospective study on sex differences in the sequential organ failure assessment (SOFA) score among ICU patients with sepsis or septic shock, analyzing data from 85 ICUs across Switzerland [2]. They concluded that significant variations exist, although the full clinical implications remain to be elucidated. Notably, they found no disparity in ICU mortality rates between male and female patients. The authors suggested that reevaluation of sex-specific thresholds for SOFA score components could potentially refine future individualized classifications, addressing a current oversight in the consideration of patient sex within the SOFA scoring system.

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