Pub Date : 2026-02-05DOI: 10.1007/s00134-026-08317-5
Gregory L Hundemer, Asnake Y Dumicho, Greg A Knoll, Ron Wald, Samuel A Silver, Oleksa G Rewa, Shannon M Fernando, Margaret Herridge, Ann Bugeja, Manish M Sood, Luana L T N Porto, Deena Fremont, Tim Ramsay, Edward G Clark
Purpose: The presence and severity of acute kidney injury (AKI) upon ICU admission provides important short- and long-term prognostic information. Existing reports have been limited by inadequate baseline kidney function assessment, incomplete outcome capture, limited adjustment for illness severity, and small sample sizes.
Methods: We conducted a population-level study of all adult (≥ 18 years) Ontario, Canada residents with available outpatient baseline creatinine measurements admitted to the ICU from 2009-2021. AKI at the time of ICU admission was determined according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria. Outcomes included death and kidney replacement therapy (KRT). Multivariable logistic regression modeling was used to estimate adjusted odds ratios (aOR).
Results: The study cohort included 484,956 adults (43% female) admitted to the ICU. Mean (SD) age and baseline eGFR were 68 (15) years and 77 (25) mL/min/1.73 m2, respectively. AKI was present in 105,671 (22%). Relative to no AKI, stage 1 AKI was associated with approximately twofold higher odds for 90-day mortality (aOR 1.89 [95% CI 1.85-1.93]) while stages 2 and 3 AKI were associated with approximately 2.5-fold higher odds (stage 2 aOR 2.64 [95% CI 2.54-2.73], stage 3 aOR 2.54 [95% CI 2.45-2.63]). Relative to no AKI, there was a progressively increased risk for KRT dependence at 90 days: stage 1 (aOR 2.05 [95% CI 1.79-2.34]), stage 2 (aOR 4.28 [95% CI 3.40-5.40]), and stage 3 (aOR 8.61 [95% CI 7.71-9.62]).
Conclusion: The presence and severity of AKI at the time of ICU admission are strongly associated with adverse health outcomes. Stage 2 and 3 AKI portend a similarly high risk of mortality.
目的：急性肾损伤（AKI）在ICU入院时的存在和严重程度提供了重要的短期和长期预后信息。现有的报告受到不充分的基线肾功能评估、不完整的结果捕获、对疾病严重程度的有限调整和小样本量的限制。方法：我们对2009-2021年加拿大安大略省所有有门诊基线肌酐测量数据的成年（≥18岁）居民进行了一项人口水平的研究。ICU入院时AKI是根据肾脏疾病改善总体结局（KDIGO）标准确定的。结果包括死亡和肾脏替代治疗（KRT）。采用多变量logistic回归模型估计调整优势比（aOR）。结果：研究队列包括484,956名入住ICU的成年人（43%为女性）。平均（SD）年龄和基线eGFR分别为68（15）岁和77 (25)mL/min/1.73 m2。105671例（22%）存在AKI。与无AKI患者相比，1期AKI患者90天死亡率高约2倍（aOR 1.89 [95% CI 1.85-1.93]），而2期和3期AKI患者90天死亡率高约2.5倍（2期aOR 2.64 [95% CI 2.54-2.73]， 3期aOR 2.54 [95% CI 2.45-2.63]）。与无AKI相比，90天KRT依赖的风险逐渐增加：1期（aOR 2.05 [95% CI 1.79-2.34]）， 2期（aOR 4.28 [95% CI 3.40-5.40]）和3期（aOR 8.61 [95% CI 7.71-9.62]）。结论：ICU入院时AKI的存在和严重程度与不良健康结局密切相关。2期和3期AKI预示着同样高的死亡率。
{"title":"Health outcomes according to severity of acute kidney injury at ICU admission: a population-based cohort study.","authors":"Gregory L Hundemer, Asnake Y Dumicho, Greg A Knoll, Ron Wald, Samuel A Silver, Oleksa G Rewa, Shannon M Fernando, Margaret Herridge, Ann Bugeja, Manish M Sood, Luana L T N Porto, Deena Fremont, Tim Ramsay, Edward G Clark","doi":"10.1007/s00134-026-08317-5","DOIUrl":"https://doi.org/10.1007/s00134-026-08317-5","url":null,"abstract":"<p><strong>Purpose: </strong>The presence and severity of acute kidney injury (AKI) upon ICU admission provides important short- and long-term prognostic information. Existing reports have been limited by inadequate baseline kidney function assessment, incomplete outcome capture, limited adjustment for illness severity, and small sample sizes.</p><p><strong>Methods: </strong>We conducted a population-level study of all adult (≥ 18 years) Ontario, Canada residents with available outpatient baseline creatinine measurements admitted to the ICU from 2009-2021. AKI at the time of ICU admission was determined according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria. Outcomes included death and kidney replacement therapy (KRT). Multivariable logistic regression modeling was used to estimate adjusted odds ratios (aOR).</p><p><strong>Results: </strong>The study cohort included 484,956 adults (43% female) admitted to the ICU. Mean (SD) age and baseline eGFR were 68 (15) years and 77 (25) mL/min/1.73 m<sup>2</sup>, respectively. AKI was present in 105,671 (22%). Relative to no AKI, stage 1 AKI was associated with approximately twofold higher odds for 90-day mortality (aOR 1.89 [95% CI 1.85-1.93]) while stages 2 and 3 AKI were associated with approximately 2.5-fold higher odds (stage 2 aOR 2.64 [95% CI 2.54-2.73], stage 3 aOR 2.54 [95% CI 2.45-2.63]). Relative to no AKI, there was a progressively increased risk for KRT dependence at 90 days: stage 1 (aOR 2.05 [95% CI 1.79-2.34]), stage 2 (aOR 4.28 [95% CI 3.40-5.40]), and stage 3 (aOR 8.61 [95% CI 7.71-9.62]).</p><p><strong>Conclusion: </strong>The presence and severity of AKI at the time of ICU admission are strongly associated with adverse health outcomes. Stage 2 and 3 AKI portend a similarly high risk of mortality.</p>","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":""},"PeriodicalIF":21.2,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146124718","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}
Background: The estimated incidence of acute kidney injury requiring renal replacement therapy (RRT), mainly continuous RRT (CRRT), in patients necessitating extracorporeal membrane oxygenation (ECMO) is approximately 50%. Currently, two well-known techniques, integration and separation, are utilized for combining CRRT and ECMO circuits, neither of which is considered a standard treatment.
Purpose: This study aimed to compare circuit lifespan of CRRT between these two techniques during ECMO support.
Methods: A multicentered randomized controlled trial was conducted from May 2021 to March 2025. ECMO patients who required CRRT support were enrolled. Primary outcome was CRRT circuit lifespan.
Results: Eighty patients were recruited, with 40 allocated to the integration group and 40 to the separation group. Median circuit lifespan did not significantly differ between the groups (72 h [IQR 45-96.5] vs. 71 h [IQR 45-84]; p = 0.52). Twenty-eight-day mortality rates were also comparable (32.5% vs. 35%; p = 0.81). No significant differences were observed in the incidence of serious adverse events, including air embolism. Transmembrane pressure and CRRT machine alarm frequencies were similar between groups.
Conclusion: Among critically ill ECMO patients receiving CRRT, there is no significant difference in filter lifespan and serious adverse events between integrating the CRRT circuit into the ECMO circuit and using a separate circuit.
Trial registration: NCT05036616.
背景：在需要体外膜氧合（ECMO）的患者中，估计需要肾替代治疗（RRT），主要是持续肾替代治疗（CRRT）的急性肾损伤发生率约为50%。目前，CRRT和ECMO电路的结合采用了两种众所周知的技术，即集成和分离，但这两种技术都不是标准的治疗方法。目的：本研究旨在比较两种技术在ECMO支持下的CRRT回路寿命。方法：于2021年5月至2025年3月进行多中心随机对照试验。纳入需要CRRT支持的ECMO患者。主要终点为CRRT回路寿命。结果：共纳入80例患者，其中整合组40例，分离组40例。中位神经回路寿命组间无显著差异（72小时[IQR 45-96.5] vs. 71小时[IQR 45-84]； p = 0.52）。28天死亡率也具有可比性（32.5%对35%；p = 0.81）。在严重不良事件（包括空气栓塞）的发生率方面没有观察到显著差异。两组间跨膜压力和CRRT机报警频率相似。结论：在接受CRRT的危重症ECMO患者中，将CRRT回路整合到ECMO回路与单独使用回路在滤器寿命和严重不良事件方面无显著差异。试验注册：NCT05036616。
{"title":"The comparison of circuit lifespan between integration and separation approach in extracorporeal membrane oxygenation patients requiring continuous renal replacement therapy support: a randomized controlled trial (E-CRRT Trial).","authors":"Prasittiporn Tangjitaree, Peerapat Thanapongsatorn, Tanyapim Sinjira, Ekkapong Surinrat, Pongpon Suttiruk, Nattachai Srisawat","doi":"10.1007/s00134-026-08302-y","DOIUrl":"https://doi.org/10.1007/s00134-026-08302-y","url":null,"abstract":"<p><strong>Background: </strong>The estimated incidence of acute kidney injury requiring renal replacement therapy (RRT), mainly continuous RRT (CRRT), in patients necessitating extracorporeal membrane oxygenation (ECMO) is approximately 50%. Currently, two well-known techniques, integration and separation, are utilized for combining CRRT and ECMO circuits, neither of which is considered a standard treatment.</p><p><strong>Purpose: </strong>This study aimed to compare circuit lifespan of CRRT between these two techniques during ECMO support.</p><p><strong>Methods: </strong>A multicentered randomized controlled trial was conducted from May 2021 to March 2025. ECMO patients who required CRRT support were enrolled. Primary outcome was CRRT circuit lifespan.</p><p><strong>Results: </strong>Eighty patients were recruited, with 40 allocated to the integration group and 40 to the separation group. Median circuit lifespan did not significantly differ between the groups (72 h [IQR 45-96.5] vs. 71 h [IQR 45-84]; p = 0.52). Twenty-eight-day mortality rates were also comparable (32.5% vs. 35%; p = 0.81). No significant differences were observed in the incidence of serious adverse events, including air embolism. Transmembrane pressure and CRRT machine alarm frequencies were similar between groups.</p><p><strong>Conclusion: </strong>Among critically ill ECMO patients receiving CRRT, there is no significant difference in filter lifespan and serious adverse events between integrating the CRRT circuit into the ECMO circuit and using a separate circuit.</p><p><strong>Trial registration: </strong>NCT05036616.</p>","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":""},"PeriodicalIF":21.2,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146124746","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 : 2026-02-04DOI: 10.1007/s00134-026-08329-1
Marc Ghannoum, Dominique Vodovar, Christoph Hüser, Bruno Mégarbane
{"title":"Critical care management of the patient with pharmaceutical poisoning: author's reply.","authors":"Marc Ghannoum, Dominique Vodovar, Christoph Hüser, Bruno Mégarbane","doi":"10.1007/s00134-026-08329-1","DOIUrl":"https://doi.org/10.1007/s00134-026-08329-1","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":" ","pages":""},"PeriodicalIF":21.2,"publicationDate":"2026-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146118913","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":"Publisher Correction: Weaning practices from veno-venous ECMO: the international ESICM-endorsed WEAN-ECMO survey","authors":"Maria Teresa Passarelli, Matthieu Schmidt, Marco Giani","doi":"10.1007/s00134-025-08277-2","DOIUrl":"https://doi.org/10.1007/s00134-025-08277-2","url":null,"abstract":"<b>Publisher Correction: Intensive Care Medicine</b> <b>https://doi.org/10.1007/s00134-025-08266-5</b>","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"81 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146097908","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 : 2026-01-29DOI: 10.1007/s00134-025-08286-1
Mariachiara Ippolito,Yasser B Abulhasan,Katarzyna Kotfis
{"title":"Melatonin to prevent delirium in the ICU: revisiting the evidence.","authors":"Mariachiara Ippolito,Yasser B Abulhasan,Katarzyna Kotfis","doi":"10.1007/s00134-025-08286-1","DOIUrl":"https://doi.org/10.1007/s00134-025-08286-1","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"65 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146073058","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 : 2026-01-28DOI: 10.1007/s00134-026-08311-x
Denise Battaglini, Audrey De Jong, Federico Gordo
Early mobilisation (EM) has emerged as a cornerstone of modern intensive care unit (ICU) care. Its use is grounded in a clear physiological rationale, and evidence suggested that initiating mobilisation soon after ICU admission could enhance functional recovery, limit ICU-acquired weakness (ICUAW), mitigate the debilitating effects of the post-intensive care syndrome, prevent delirium, and reduce time on mechanical ventilation [1,2,3]. EM is integrated into standardised care bundles, such as the ABCDEF approach [4]. Despite its widespread implementation, the strength and consistency of the evidence remain mixed. The recently published TEAM randomised clinical trial, the largest trial of higher-dose EM to date, reported no difference in its primary composite outcome of days alive and out of hospital by day 180 when comparing enhanced EM with usual care, challenging long-standing assumptions about the universal efficacy of aggressive mobilisation strategies in the ICU [5]. These findings emphasise that EM is not a homogenous intervention. Its physiological effects and clinical outcomes may differ depending on the timing of initiation, sedation depth, haemodynamic stability, vasopressor use, neuromuscular reserve, and the cumulative burden of comorbidities [6,7,8]. Such heterogeneity raises the concern that certain patient subgroups could benefit while others may experience detrimental effects.
{"title":"Early mobilisation in the ICU: when one size no longer fits all","authors":"Denise Battaglini, Audrey De Jong, Federico Gordo","doi":"10.1007/s00134-026-08311-x","DOIUrl":"https://doi.org/10.1007/s00134-026-08311-x","url":null,"abstract":"Early mobilisation (EM) has emerged as a cornerstone of modern intensive care unit (ICU) care. Its use is grounded in a clear physiological rationale, and evidence suggested that initiating mobilisation soon after ICU admission could enhance functional recovery, limit ICU-acquired weakness (ICUAW), mitigate the debilitating effects of the post-intensive care syndrome, prevent delirium, and reduce time on mechanical ventilation [1,2,3]. EM is integrated into standardised care bundles, such as the ABCDEF approach [4]. Despite its widespread implementation, the strength and consistency of the evidence remain mixed. The recently published TEAM randomised clinical trial, the largest trial of higher-dose EM to date, reported no difference in its primary composite outcome of days alive and out of hospital by day 180 when comparing enhanced EM with usual care, challenging long-standing assumptions about the universal efficacy of aggressive mobilisation strategies in the ICU [5]. These findings emphasise that EM is not a homogenous intervention. Its physiological effects and clinical outcomes may differ depending on the timing of initiation, sedation depth, haemodynamic stability, vasopressor use, neuromuscular reserve, and the cumulative burden of comorbidities [6,7,8]. Such heterogeneity raises the concern that certain patient subgroups could benefit while others may experience detrimental effects.","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"39 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146056089","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 : 2026-01-28DOI: 10.1007/s00134-026-08292-x
Yulan Meng,Juan Yang,Qian Wang,Yang Zhao
{"title":"What is your diagnosis? A recurrent seizure….","authors":"Yulan Meng,Juan Yang,Qian Wang,Yang Zhao","doi":"10.1007/s00134-026-08292-x","DOIUrl":"https://doi.org/10.1007/s00134-026-08292-x","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"388 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146056890","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 : 2026-01-28DOI: 10.1007/s00134-025-08288-z
Patrick M. Honore, Laurent Bitker, Alexander Zarbock
Metabolic acidosis is a common complication of acute kidney injury (AKI) associated with worse outcome [1,2,3,4,5]. Conversely, metabolic alkalosis is also common in the critically ill patients, and has been associated with worst prognosis, indicative that alkalosis prevention represents a goal-of-care [6].
{"title":"Bicarbonate level in replacement fluid during CVVH: less is more!","authors":"Patrick M. Honore, Laurent Bitker, Alexander Zarbock","doi":"10.1007/s00134-025-08288-z","DOIUrl":"https://doi.org/10.1007/s00134-025-08288-z","url":null,"abstract":"Metabolic acidosis is a common complication of acute kidney injury (AKI) associated with worse outcome [1,2,3,4,5]. Conversely, metabolic alkalosis is also common in the critically ill patients, and has been associated with worst prognosis, indicative that alkalosis prevention represents a goal-of-care [6].","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"35 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146056088","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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