Pub Date : 2024-11-12DOI: 10.1007/s00134-024-07694-z
Ignacio Martin-Loeches, Mervyn Singer, Marc Leone
This review explores the current landscape and evolving understanding of sepsis, highlighting both challenges and future directions. Sepsis remains a major global health burden, with diverse clinical presentations complicating timely diagnosis and management. Existing definitions, including the Sepsis-3 criteria, emphasize the importance of organ dysfunction, yet early sepsis detection remains limited by available tools. The Sequential Organ Failure Assessment (SOFA) score, though widely used, may not fully capture early stages of infection or account for complex presentations like noncatecholamine-resistant shock. Additionally, the review underscores the pressing need for standardized terminology across sepsis and shock characterization to ensure consistency in diagnosis and treatment strategies. Accessible, resource-adapted solutions are particularly crucial in low- and middle-income countries where sepsis-related mortality rates are higher due to limited resources. Future research should focus on developing and validating integrated, multi-parameter tools that combine clinical, biochemical, and microbiological data to improve sepsis outcomes globally. Advancing sepsis care will require both technological innovation and collaborative, globally consistent guidelines to bridge disparities in healthcare delivery.
{"title":"Sepsis: key insights, future directions, and immediate goals. A review and expert opinion","authors":"Ignacio Martin-Loeches, Mervyn Singer, Marc Leone","doi":"10.1007/s00134-024-07694-z","DOIUrl":"https://doi.org/10.1007/s00134-024-07694-z","url":null,"abstract":"<p>This review explores the current landscape and evolving understanding of sepsis, highlighting both challenges and future directions. Sepsis remains a major global health burden, with diverse clinical presentations complicating timely diagnosis and management. Existing definitions, including the Sepsis-3 criteria, emphasize the importance of organ dysfunction, yet early sepsis detection remains limited by available tools. The Sequential Organ Failure Assessment (SOFA) score, though widely used, may not fully capture early stages of infection or account for complex presentations like noncatecholamine-resistant shock. Additionally, the review underscores the pressing need for standardized terminology across sepsis and shock characterization to ensure consistency in diagnosis and treatment strategies. Accessible, resource-adapted solutions are particularly crucial in low- and middle-income countries where sepsis-related mortality rates are higher due to limited resources. Future research should focus on developing and validating integrated, multi-parameter tools that combine clinical, biochemical, and microbiological data to improve sepsis outcomes globally. Advancing sepsis care will require both technological innovation and collaborative, globally consistent guidelines to bridge disparities in healthcare delivery.</p>","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"147 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142599807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-11DOI: 10.1007/s00134-024-07715-x
Radhouane Toumi, Mohamed Boussarsar
{"title":"End-of-life care awareness in a low-middle-income country: a plea for improvement.","authors":"Radhouane Toumi, Mohamed Boussarsar","doi":"10.1007/s00134-024-07715-x","DOIUrl":"https://doi.org/10.1007/s00134-024-07715-x","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":""},"PeriodicalIF":27.1,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142619761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Landiolol in patients with septic shock.","authors":"Vassilios Vazgiourakis, Konstantinos Mantzarlis, Demosthenes Makris","doi":"10.1007/s00134-024-07706-y","DOIUrl":"https://doi.org/10.1007/s00134-024-07706-y","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":""},"PeriodicalIF":27.1,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142619764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-11DOI: 10.1007/s00134-024-07721-z
Sebastian Rehberg, Frantisek Duska
{"title":"Heart rate control in septic shock-\"every journey begins with a first step\" (Confucius).","authors":"Sebastian Rehberg, Frantisek Duska","doi":"10.1007/s00134-024-07721-z","DOIUrl":"https://doi.org/10.1007/s00134-024-07721-z","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":""},"PeriodicalIF":27.1,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142619763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-11DOI: 10.1007/s00134-024-07695-y
Tommaso Mauri, Domenico L. Grieco, Elena Spinelli, Marco Leali, Joaquin Perez, Valentina Chiavieri, Tommaso Rosà, Pierluigi Ferrara, Gaetano Scaramuzzo, Massimo Antonelli, Savino Spadaro, Giacomo Grasselli
Purpose
Personalized positive end-expiratory pressure (PEEP) might foster lung and diaphragm protection in patients with acute respiratory distress syndrome (ARDS) who are undergoing pressure support ventilation (PSV). We aimed to compare the physiologic effects of personalized PEEP set according to synchronized electrical impedance tomography (EIT) and driving transpulmonary pressure (∆PL) monitoring against a classical lower PEEP/FiO2 table in intubated ARDS patients undergoing PSV.
Methods
A cross-over randomized multicenter study was conducted in 30 ARDS patients with simultaneous recording of the airway, esophageal and transpulmonary pressure, together with EIT during PSV. Following a decremental PEEP trial (18 cmH2O to 4 cmH2O), PEEPEIT-∆PL was identified as the level with the smallest difference between lung overdistension and collapse. A low PEEP/FiO2 table was used to select PEEPTABLE. Each PEEP strategy was applied for 20 min, and physiologic data were collected at the end of each step.
Results
The PEEP trial was well tolerated. Median PEEPEIT-∆PL was higher than PEEPTABLE (10 [8–12] vs. 8 [5–10] cmH2O; P = 0.021) and, at the individual patient level, PEEPEIT-∆PL level differed from PEEPTABLE in all patients. Overall, PEEPEIT-∆PL was associated with lower dynamic ∆PL (P < 0.001) and pressure–time product (P < 0.001), but there was variability among patients. PEEPEIT-∆PL also decreased respiratory drive and effort (P < 0.001), improved regional lung mechanics (P < 0.05) and reversed lung collapse (P = 0.007) without increasing overdistension (P = 0.695).
Conclusion
Personalized PEEP selected using synchronized EIT and transpulmonary pressure monitoring could be associated with reduced dynamic lung stress and metabolic work of breathing in ARDS patients undergoing PSV.
目的个性化呼气末正压（PEEP）可促进正在接受压力支持通气（PSV）的急性呼吸窘迫综合征（ARDS）患者的肺和膈肌保护。我们的目的是在接受 PSV 的插管 ARDS 患者中，比较根据同步电阻抗断层扫描（EIT）和肺动脉转压（ΔPL）监测设定的个性化 PEEP 与传统的较低 PEEP/FiO2 表的生理效果。方法在 30 名 ARDS 患者中开展了一项交叉随机多中心研究，在 PSV 期间同时记录气道、食道和肺动脉转压以及 EIT。经过递减 PEEP 试验（18 cmH2O 至 4 cmH2O），确定 PEEPEIT-∆PL 为肺过度张力与塌陷之间差异最小的水平。使用低 PEEP/FiO2 表选择 PEEPTABLE。每种 PEEP 策略应用 20 分钟，并在每个步骤结束时收集生理数据。中位 PEEPEIT-∆PL 高于 PEEPTABLE（10 [8-12] vs. 8 [5-10] cmH2O；P = 0.021），在患者个体水平上，所有患者的 PEEPEIT-∆PL 水平均不同于 PEEPTABLE。总体而言，PEEPEIT-∆PL 与较低的动态∆PL（P < 0.001）和压力-时间乘积（P < 0.001）相关，但患者之间存在差异。结论使用同步 EIT 和跨肺压力监测选择个性化 PEEP 可降低接受 PSV 治疗的 ARDS 患者的动态肺压力和呼吸代谢功。
{"title":"Personalized positive end-expiratory pressure in spontaneously breathing patients with acute respiratory distress syndrome by simultaneous electrical impedance tomography and transpulmonary pressure monitoring: a randomized crossover trial","authors":"Tommaso Mauri, Domenico L. Grieco, Elena Spinelli, Marco Leali, Joaquin Perez, Valentina Chiavieri, Tommaso Rosà, Pierluigi Ferrara, Gaetano Scaramuzzo, Massimo Antonelli, Savino Spadaro, Giacomo Grasselli","doi":"10.1007/s00134-024-07695-y","DOIUrl":"https://doi.org/10.1007/s00134-024-07695-y","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose</h3><p>Personalized positive end-expiratory pressure (PEEP) might foster lung and diaphragm protection in patients with acute respiratory distress syndrome (ARDS) who are undergoing pressure support ventilation (PSV). We aimed to compare the physiologic effects of personalized PEEP set according to synchronized electrical impedance tomography (EIT) and driving transpulmonary pressure (∆PL) monitoring against a classical lower PEEP/FiO<sub>2</sub> table in intubated ARDS patients undergoing PSV.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>A cross-over randomized multicenter study was conducted in 30 ARDS patients with simultaneous recording of the airway, esophageal and transpulmonary pressure, together with EIT during PSV. Following a decremental PEEP trial (18 cmH<sub>2</sub>O to 4 cmH<sub>2</sub>O), PEEP<sub>EIT-∆PL</sub> was identified as the level with the smallest difference between lung overdistension and collapse. A low PEEP/FiO<sub>2</sub> table was used to select PEEP<sub>TABLE</sub>. Each PEEP strategy was applied for 20 min, and physiologic data were collected at the end of each step.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>The PEEP trial was well tolerated. Median PEEP<sub>EIT-∆PL</sub> was higher than PEEP<sub>TABLE</sub> (10 [8–12] vs. 8 [5–10] cmH<sub>2</sub>O; <i>P</i> = 0.021) and, at the individual patient level, PEEP<sub>EIT-∆PL</sub> level differed from PEEP<sub>TABLE</sub> in all patients. Overall, PEEP<sub>EIT-∆PL</sub> was associated with lower dynamic ∆PL (<i>P</i> < 0.001) and pressure–time product (<i>P</i> < 0.001), but there was variability among patients. PEEP<sub>EIT-∆PL</sub> also decreased respiratory drive and effort (<i>P</i> < 0.001), improved regional lung mechanics (<i>P</i> < 0.05) and reversed lung collapse (<i>P</i> = 0.007) without increasing overdistension (<i>P</i> = 0.695).</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>Personalized PEEP selected using synchronized EIT and transpulmonary pressure monitoring could be associated with reduced dynamic lung stress and metabolic work of breathing in ARDS patients undergoing PSV.</p>","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"245 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142598507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-06DOI: 10.1007/s00134-024-07702-2
Michael J O'Leary
{"title":"Comment on: European Society of Intensive Care Medicine guidelines on end of life and palliative care in the intensive care unit.","authors":"Michael J O'Leary","doi":"10.1007/s00134-024-07702-2","DOIUrl":"https://doi.org/10.1007/s00134-024-07702-2","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":""},"PeriodicalIF":27.1,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142581386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-04DOI: 10.1007/s00134-024-07707-x
Rodrigo A Cornejo, Roberto Brito, Daniel H Arellano, Caio C A Morais
{"title":"Non-synchronized unassisted spontaneous ventilation may minimize the risk of high global tidal volume and transpulmonary pressure, but it is not free from pendelluft.","authors":"Rodrigo A Cornejo, Roberto Brito, Daniel H Arellano, Caio C A Morais","doi":"10.1007/s00134-024-07707-x","DOIUrl":"https://doi.org/10.1007/s00134-024-07707-x","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":""},"PeriodicalIF":27.1,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142568375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-04DOI: 10.1007/s00134-024-07710-2
Yuxian Wang, Shengyu Hao, Jieqiong Song, Ming Zhong
{"title":"Reflections on awake prone positioning in COVID-19: considerations on body inclination, respiratory support, and patient variability.","authors":"Yuxian Wang, Shengyu Hao, Jieqiong Song, Ming Zhong","doi":"10.1007/s00134-024-07710-2","DOIUrl":"https://doi.org/10.1007/s00134-024-07710-2","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":""},"PeriodicalIF":27.1,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142568381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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