Journal of intensive medicine最新文献

{"title":"Perfusion index and fluid responsiveness: Are we asking the right question?","authors":"Osama Abou-Arab , Christopher Lai , Jihad Mallat","doi":"10.1016/j.jointm.2025.10.001","DOIUrl":"10.1016/j.jointm.2025.10.001","url":null,"abstract":"","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"6 1","pages":"Pages 19-21"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147286430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between ICU rehabilitation parameters and recovery of activities of daily living in mechanically ventilated patients: A multicenter prospective observational study","authors":"Shinichi Watanabe ,&nbsp;Kota Yamauchi ,&nbsp;Yuji Naito ,&nbsp;Tomohiro Yoshikawa ,&nbsp;Daisetsu Yasumura ,&nbsp;Yoshie Hirota ,&nbsp;Yasunari Morita","doi":"10.1016/j.jointm.2025.08.003","DOIUrl":"10.1016/j.jointm.2025.08.003","url":null,"abstract":"<div><h3>Background</h3><div>Recovery of activities of daily living (ADL) is a key outcome for critically ill patients following intensive care unit (ICU) admission. However, the relationship between early rehabilitation parameters and ADL recovery remains unclear.</div></div><div><h3>Methods</h3><div>This <em>post hoc</em> secondary analysis of the IPAM study (UMIN000047578), a multicenter prospective cohort, included adult ICU patients who required mechanical ventilation. Patients with pre-existing walking dependence, neurological or mental disorders, or terminal conditions were excluded. Five rehabilitation parameters were assessed during ICU stay: dose (mean Mobilization Quantification Score [MQS]), intensity (highest ICU mobility scale [IMS]), duration, frequency, and start time. The primary outcome was the Barthel index (BI), measured at five time points: prehospitalization, ICU discharge, day 7, day 14, and hospital discharge or day 28, whichever came first. Patients were categorized into three groups based on ADL recovery: early recovery (BI ≥85 within 14 days post-ICU), recovery (BI ≥ 85 by discharge), and delayed recovery (BI &lt;85 by discharge). Multinomial logistic regression was used to assess associations.</div></div><div><h3>Results</h3><div>Among 121 eligible patients, 28.9% achieved early recovery, 28.9% recovery, and 42.2% delayed recovery. Patients in the early recovery group had significantly higher mean MQS (median=6.7, interquartile range [IQR]: 4.1–12.6 <em>vs.</em> median=2.3, IQR: 0.8–3.3 in the delayed group; <em>P</em> &lt;0.001) and Medical Research Council (MRC) scores (median=54.0, IQR: 48.0–58.0 <em>vs.</em> median=39.5, IQR: 24.0–50.5; <em>P</em> &lt;0.001), and shorter ICU (median=7.2 days,IQR: 5.5–9.8<em>vs.</em> median=9.3 days, IQR: 6.0–17.2 ) and hospital stays (median=20.9 days, IQR: 17.0–28.5 <em>vs.</em> median=50.9 days,IQR: 35.9–80.0; <em>P</em> &lt;0.001) compared to delayed recovery. Delayed recovery was independently and significantly associated with lower mean MQS (odds ratio [OR] = 0.51, 95% CI: 0.37 to 0.68, <em>P</em> &lt;0.001) and lower highest IMS (OR=0.86, 95% CI: 0.75 to 0.96, <em>P</em>=0.001), whereas no significant associations with any rehabilitation parameters were found in the early recovery group.</div></div><div><h3>Conclusions</h3><div>Higher rehabilitation dose and intensity during ICU stay were associated with a reduced risk of delayed ADL recovery. Optimizing these parameters may improve functional outcomes in critically ill patients. These findings should be interpreted with caution, as the analysis was <em>post hoc</em> and exploratory in nature.</div></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"6 1","pages":"Pages 53-60"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147286214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing vascular tone and vascular responsiveness to norepinephrine: How simple tools can help?","authors":"Olfa Hamzaoui ,&nbsp;Antoine Goury ,&nbsp;Jean-Louis Teboul","doi":"10.1016/j.jointm.2025.09.001","DOIUrl":"10.1016/j.jointm.2025.09.001","url":null,"abstract":"","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"6 1","pages":"Pages 16-18"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147286246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond one-size-fits-all: Addressing patient heterogeneity through precision-based oxygen therapy research in critical care","authors":"Wenqi Huang ,&nbsp;Li Lu","doi":"10.1016/j.jointm.2025.10.004","DOIUrl":"10.1016/j.jointm.2025.10.004","url":null,"abstract":"","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"6 1","pages":"Pages 25-27"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147286290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of 6-hour urine creatinine clearance as the kidney component in the SOFA score: An observational cohort study","authors":"Liran Statlender ,&nbsp;Tzippy Shochat ,&nbsp;Mzia Moshiashvili ,&nbsp;Eyal Robinson ,&nbsp;Moran Hellerman Itzhaki ,&nbsp;Itai Bendavid ,&nbsp;Guy Fishman ,&nbsp;Pierre Singer ,&nbsp;Ilya Kagan","doi":"10.1016/j.jointm.2025.08.009","DOIUrl":"10.1016/j.jointm.2025.08.009","url":null,"abstract":"<div><h3>Background</h3><div>The Sequential Organ Failure Assessment (SOFA) score, originally designed to reflect disease severity, is now recognized as a prognostic tool for critically ill patients. Recently, calls have emerged to update the score to better align it with contemporary clinical practice.</div></div><div><h3>Methods</h3><div>This single-center, prospective, observational study was conducted in a general intensive care unit (ICU) of a university-affiliated tertiary hospital from September 10, 2023, to January 7, 2025. Urinary creatinine clearance (CrCl) was calculated daily using 6-h urine collection (CrCl_6h) obtained during the first five nights after admission. Based on CrCl and Kidney Disease: ImprovingGlobal Outcomes (KDIGO) chronic kidney disease criteria, patients were categorized into five groups (0−4), with subsequent calculation of a modified SOFA score according to this grouping. The predictive ability of serum creatinine (Scr), urine output, CrCl_6h, the original SOFA score, and the modified SOFA score for ICU and 90-day mortality was compared by evaluating their area under the receiver operating characteristic (AUROC) values.</div></div><div><h3>Results</h3><div>A total of 200 patients were included in the study. The ICU mortality for these patients was 12.0% while the 90-day mortality reached 29.5%. Compared with Scr, CrCl_6h displayed significantly higher AUROC values for mortality prediction on almost all days examined. For example, on day 3, the AUROC values were 0.821 <em>vs.</em> 0.730 (<em>P</em>=0.003) for ICU mortality, and 0.760 <em>vs.</em> 0.662 (<em>P</em>=0.002) for 90-day mortality. Similarly, the modified SOFA score showed significantly greater predictive performance on most days assessed. On day 3, the AUROC values were 0.791 <em>vs.</em> 0.706 (<em>P</em>=0.046) for ICU mortality, and 0.741 <em>vs.</em> 0.655 (<em>P</em>=0.007) for 90-day mortality.</div></div><div><h3>Conclusion</h3><div>The categorization of urinary CrCl based on a 6-h urine collection can improve the ability of the SOFA score for predicting mortality.</div><div><strong>Trial Registration:</strong> <span><span>Clinicaltrials.gov</span><svg><path></path></svg></span> Identifier: NCT06779331</div></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"6 1","pages":"Pages 69-74"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147286286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Guidelines for the construction and management of critical care medicine in China (2025 Edition)","authors":"","doi":"10.1016/j.jointm.2025.09.004","DOIUrl":"10.1016/j.jointm.2025.09.004","url":null,"abstract":"<div><div>Critical care medicine is a clinical medical discipline that studies the pathogenesis, progression, diagnosis, and management of life-threatening diseases caused by various etiological factors. The Intensive Care Unit (ICU), as the core clinical setting of critical care medicine, is responsible for the full-cycle management of critically ill patients, covering a series of comprehensive measures from early warning to rehabilitation. In 2024, the National Health Commission and seven other ministries jointly issued the “Opinions on Strengthening the Capacity Building of Critical Care Medical Services”, promoting the discipline into a new stage of high‑quality development. Based on this, the Chinese Society of Critical Care Medicine (CSCCM) organized domestic experts to discuss and formulate the “Guidelines for the Construction and Management of Critical Care Medicine in China (2025 Edition).” The guidelines focus on core elements of discipline organization and development, covering nine areas: ICU ward construction, ICU admission criteria, staffing and technical requirements for professionals, equipment configuration, quality management, professional training and continuing education, scientific research, response to public health emergencies, and improved service models. The working group initially formed recommended entries through initiation, literature search and screening, and synthesis of medical evidence. The preliminary recommendations were then revised through expert panel reviews, remote and face-to-face meetings, revisions, and finally finalized by voting at the Standing Committee of CSCCM, resulting in the establishment of foundational and developmental discipline construction guidelines. The guidelines apply to ICUs in secondary and above healthcare institutions, providing a scientific framework for discipline planning, construction, and management to enhance the quality of critical care services.</div><div>Practice guideline registration: Practice Guideline Registration for Transparency (PREPARE-2025CN972).</div></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"6 1","pages":"Pages 1-15"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147286499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Causal deep learning to personalize medicine: Which intensive care patients with sepsis will benefit from corticosteroid therapy?","authors":"Ameet Jagesar ,&nbsp;Louk Smalbil ,&nbsp;Etienne Galea ,&nbsp;Tristan Struja ,&nbsp;Tariq Dam ,&nbsp;Paul Hilders ,&nbsp;Martijn Otten ,&nbsp;Laurens Biesheuvel ,&nbsp;Armand Girbes ,&nbsp;Patrick Thoral ,&nbsp;Mark Hoogendoorn ,&nbsp;Paul Elbers","doi":"10.1016/j.jointm.2025.07.002","DOIUrl":"10.1016/j.jointm.2025.07.002","url":null,"abstract":"<div><h3>Background</h3><div>Sepsis, defined as life-threatening organ dysfunction due to dysregulated host response to an infection, often requiring intensive care treatment. There is a strong rationale for the administration of corticosteroids for immunomodulation; however, clinical trials are inconclusive, which may be attributable to heterogeneity in therapeutic effects between individual patients. Leveraging deep learning within a causality framework, we aimed to identify for which intensive care patients with sepsis corticosteroids lead to improved survival.</div></div><div><h3>Methods</h3><div>We trained the treatment agnostic representation network (TARNet) to estimate the reduction in predicted probability of 28-day mortality following initiation of corticosteroid treatment of intensive care patients with sepsis. We used the freely available and public AmsterdamUMCdb ICU database for causal model development, considering 19 predictor variables from the first 24 h of admission, and validated the model with Medical Information Mart for Intensive Care (MIMIC-IV) version 2.2 data. A cut-off of 10% reduction in predicted probability of mortality was used to classify treatment responders.</div></div><div><h3>Results</h3><div>According to the Sepsis-3 criteria, a total of 2920 admissions in AmsterdamUMCdb were eligible. Of these, 1378 were assigned to the intervention group and 1542 to the control group. Internal validation of predictions of the observed outcomes showed an area under the receiver operating characteristic curve (AUROC) of 0.79, while external validation yielded an AUROC of 0.71. Covariate balance of the TARNet model latent representation, as measured by the Wasserstein distance, was 3.6 × 10⁻⁷ for the internal data set and 4.2 × 10⁻⁷ for the external data set. Based on the estimated reduction of predicted mortality, a distinction was made between treatment responders (<em>n</em>=245), non-responders (<em>n</em>=2098), and those predicted to be harmed by corticosteroid treatment (<em>n</em>=577).</div></div><div><h3>Conclusions</h3><div>Corticosteroid treatment responders were those with severe metabolic acidosis and impaired circulation, whereas patients who were less ill based on these parameters were more likely to have increased mortality rates by corticosteroid treatment. There was also a notable discrepancy between the model’s suggestions and the physicians’ treatment that was carried out, implying improvements in the clinical assessment of patients with sepsis are necessary. Given recent years have not yielded new treatments for sepsis, computational clinical decision-support systems are worth exploring.</div></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"6 1","pages":"Pages 61-68"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147286304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When should we start vasopressin in septic shock? Revisiting an old question","authors":"Javier Muñoz ,&nbsp;Jamil Antonio Cedeño","doi":"10.1016/j.jointm.2025.08.007","DOIUrl":"10.1016/j.jointm.2025.08.007","url":null,"abstract":"","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"6 1","pages":"Pages 22-24"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147286435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global, regional, and national burdens of pancreatitis in adults aged ≥65 years from 1992 to 2021: A trends analysis using data from the 2021 Global Burden of Disease Study","authors":"Hang Qian ,&nbsp;Weifeng Shang ,&nbsp;Sheng Zhang ,&nbsp;Xiaojun Pan,&nbsp;Sisi Huang,&nbsp;Hui Li,&nbsp;Zhenliang Wen,&nbsp;Jiao Liu,&nbsp;Dechang Chen","doi":"10.1016/j.jointm.2025.08.010","DOIUrl":"10.1016/j.jointm.2025.08.010","url":null,"abstract":"<div><h3>Background</h3><div>As the global population ages, pancreatitis in older adults has become a public health issue. Nonetheless, detailed information on its global impact and changing patterns is limited. We sought to explore the epidemiological trends of pancreatitis among older adults (aged ≥65 years) from 1992 to 2021.</div></div><div><h3>Methods</h3><div>Data for pancreatitis incidence and mortality across seven age brackets (65–69, 70–74, 75–79, 80–84, 85–89, 90–94, and ≥95 years) were sourced from the 2021 Global Burden of Diseases, Injuries, and Risk Factors Study. The age-standardized incidence and mortality rates for pancreatitis in older adults were calculated using the direct method of age standardization. Joinpoint regression analysis was used to examine the evolution of age-standardized incidence and mortality rates from 1992 to 2021. Age–period–cohort analysis was conducted to determine the distinct impacts of age, period, and birth cohorts. In addition, Nordpred analysis was applied to forecast global epidemiological trends through 2044.</div></div><div><h3>Results</h3><div>In 2021, the estimated global age-standardized incidence and mortality rates of pancreatitis among older adults were 85.20% (95% confidence interval [CI]: 59.10 to 118.00) per 100,000 population and 7.97% (95% CI: 6.84 to 9.41) per 100,000 population, respectively. The disease burden of incidence and mortality was greatest in Eastern Europe. From 1992 to 2021, both the estimated global age-standardized incidence and mortality rates of pancreatitis among older adults demonstrated significant declining trends. The evolution of trends varied significantly across different regions and 204 countries, with an increased trend of age-standardized incidence rates in the Sociodemographic Index (SDI) regions. The age–period–cohort analysis results showed that the relative risk of incidence and mortality generally exhibited unfavorable trends over time in low-middle and low SDI regions. In addition, the age-standardized incidence and mortality rates were predicted to decrease annually, whereas case numbers of these metrics were predicted to keep increasing until 2044.</div></div><div><h3>Conclusions</h3><div>There are strong heterogeneities in the incidence and mortality trends of older pancreatitis across the world, including both growing case numbers and distributive disparities, which may be instructive for future explorations in the prevention and treatment of this disease.</div></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"6 1","pages":"Pages 42-52"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147286257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"N6-methyladenosine methylation in acute lung injury: Mechanisms and research progress","authors":"Yating Hu,&nbsp;Yijie Wang,&nbsp;Xiyue Liu,&nbsp;Xiaoli Xue,&nbsp;Binbin Li,&nbsp;Fangwei Li","doi":"10.1016/j.jointm.2025.07.001","DOIUrl":"10.1016/j.jointm.2025.07.001","url":null,"abstract":"<div><div>N6-methyladenosine (m6A) methylation is the most prevalent and abundant internal post-transcriptional RNA modification in eukaryotic cells, playing an important regulatory role in various biological processes. The biological functions of m6A modification are dynamically and reversibly mediated by methyltransferases (writers), demethylases (erasers), and m6A binding proteins (readers). Acute lung injury (ALI) is a common critical condition characterized by diffuse edema within the pulmonary interstitium and alveoli, and is associated with high morbidity and mortality. Recent studies have identified that aberrant expression of m6A regulators is closely associated with ALI development. This review highlights the progress in research on m6A writers, erasers, and readers in ALI, focusing on their molecular regulatory mechanisms. Elucidating the molecular mechanisms of m6A and its associated proteins in ALI may reveal new therapeutic strategies and targets.</div></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"6 1","pages":"Pages 28-33"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147286493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}