Journal of intensive medicine最新文献

{"title":"Post-traumatic vasospasm: Epidemiology, specificities, risk factors, and therapeutics","authors":"Clara Perrault ,&nbsp;Audrey Melcus ,&nbsp;Etienne Lefevre ,&nbsp;Eimad Shotar ,&nbsp;David Ditchi ,&nbsp;Lamine Abdennour ,&nbsp;Vincent Degos ,&nbsp;Alice Jacquens","doi":"10.1016/j.jointm.2025.05.004","DOIUrl":"10.1016/j.jointm.2025.05.004","url":null,"abstract":"<div><div>Post-traumatic vasospasm (PTV) of intracranial arteries is a serious complication of traumatic brain injury (TBI) that can lead to significant neurological deficits and ischemic brain lesions. Despite its clinical relevance, the pathogenesis of PTV is not fully understood, and effective management strategies remain a challenge. This review aims to synthesize the current knowledge on pathophysiology, risk factors, detection, prevention, and treatment of PTV. Early detection of PTV is made difficult by the complexity of TBI and its management. The gold standard for vasospasm detection remains digital subtraction angiography (DSA). However, noninvasive techniques such as transcranial Doppler (TCD) and S100 protein monitoring may assist in detecting PTV. Compared with vasospasm associated with aneurysmal subarachnoid hemorrhage (aSAH), PTV appears to occur earlier and to resolve more quickly. Several risk factors have been identified, including the severity of TBI, younger age, SAH, or the presence of other hematomas. Treatment options include nimodipine and endovascular therapies, such as angioplasty and milrinone, though these require careful management due to their invasive nature and potential hypotensive effect. PTV represents a critical complication of TBI, requiring early detection and timely intervention to prevent secondary brain injuries. Although current strategies, such as nimodipine and intra-arterial therapies, have shown promise, further research is needed to refine these approaches and improve outcomes. Enhanced understanding of PTV’s pathophysiology, along with the development of more effective diagnostic and therapeutic tools, is essential for advancing patient care in TBI.</div></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"5 4","pages":"Pages 313-322"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145335101","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":"Comparison of hydrocortisone 100 mg bolus plus 200 mg/day infusion vs. infusion alone in refractory septic shock","authors":"Ukrit Jiradechpitak,&nbsp;Theerapon Tangsuwanaruk,&nbsp;Patipan Sitthiprawiat,&nbsp;Borwon Wittayachamnankul","doi":"10.1016/j.jointm.2025.02.002","DOIUrl":"10.1016/j.jointm.2025.02.002","url":null,"abstract":"<div><h3>Background</h3><div>Current guidelines recommend the addition of hydrocortisone 200 mg/day for the treatment of septic shock unresponsive to fluids and vasopressors. However, the benefits of adding a 100 mg bolus to this regimen remain unclear. The study assessed the efficacy of the administration of hydrocortisone 200 mg/day with or without a 100 mg bolus in refractory septic shock.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included adult patients with refractory septic shock treated at a tertiary care center between 2019 and 2023. Patients were divided into bolus group (receiving a 100 mg hydrocortisone bolus followed by a 200 mg/day continuous infusion) and non-bolus group (receiving a continuous infusion of 200 mg/day without the addition of a bolus) based on physician decision. The primary outcomes were the duration of vasopressor and shock reversal. Secondary outcomes included 28-day mortality and length of hospital stay. Comparisons between groups were performed using chi-squared tests, <em>t</em>-tests, and Kaplan–Meier survival analysis.</div></div><div><h3>Results</h3><div>A total of 184 patients were included, 149 patients in the bolus group and 35 patients in the non-bolus group. The median vasopressor duration was 1 (interquartile range [IQR]: 1–2) days in both groups (<em>P</em>=0.967). Shock reversal occurred in 79.9 % of the bolus group and 82.9 % of the non-bolus group (OR=0.82, 95% CI: 0.30 to 2.23, <em>P</em>=0.688). Secondary outcomes in the bolus group and non-bolus group, including 28-day mortality (30.2 % <em>vs.</em> 22.9 %, OR=1.46, 95% CI: 0.62 to 3.43, <em>P</em>=0.745) and hospital length of stay (9 [IQR: 6-17] days <em>vs</em>. 11 [IQR: 5-15] days, <em>P</em>=0.875), did not show any significant differences. Kaplan–Meier survival analysis showed no difference in 28-day survival between groups (HR=1.29, 95% CI: 0.73 to 2.30, <em>P</em>=0.373).</div></div><div><h3>Conclusion</h3><div>The addition of a 100 mg bolus to a 200 mg/day hydrocortisone regimen may not impact clinical outcomes in refractory septic shock.</div></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"5 4","pages":"Pages 344-349"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145335106","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":"Initial fluid resuscitation in septic shock: Reassessing the 30 mL/kg paradigm","authors":"Jean-Louis Teboul ,&nbsp;Jiao Liu ,&nbsp;Olfa Hamzaoui","doi":"10.1016/j.jointm.2025.08.001","DOIUrl":"10.1016/j.jointm.2025.08.001","url":null,"abstract":"","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"5 4","pages":"Pages 298-300"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145332370","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":"Sex-related differences in antimicrobial dosing for sepsis: Bridging the equity gap","authors":"Helena Barrasa ,&nbsp;Goiatz Balziskueta ,&nbsp;Jordi Rello","doi":"10.1016/j.jointm.2025.08.004","DOIUrl":"10.1016/j.jointm.2025.08.004","url":null,"abstract":"","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"5 4","pages":"Pages 301-303"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145332371","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":"Redefining ARDS phenotypes: Challenges in the precision medicine era","authors":"Raffaele Merola ,&nbsp;Denise Battaglini","doi":"10.1016/j.jointm.2025.08.002","DOIUrl":"10.1016/j.jointm.2025.08.002","url":null,"abstract":"","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"5 4","pages":"Pages 333-335"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145335107","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":"Corticosteroids in sepsis","authors":"Jihene Mahmoud ,&nbsp;Marie Alice Bovy ,&nbsp;Nicholas Heming ,&nbsp;Djillali Annane","doi":"10.1016/j.jointm.2025.08.006","DOIUrl":"10.1016/j.jointm.2025.08.006","url":null,"abstract":"<div><div>Sepsis is a major health and socioeconomic burden worldwide. Although international guidelines have helped reduce crude mortality rates from sepsis by optimizing infection control and support of vital organ function, there are still no specific therapies for sepsis, other than corticosteroids. The aims of this narrative review were to provide readers with the most recent data on corticosteroids, as well as up-to-date evidence regarding their effects in patients with sepsis. Corticosteroids regulate the function of most cell types involved in host response to infections, through both genomic and non-genomic effects, reprogramming immune cells (via regulation of mitochondrial metabolism) toward anti-inflammatory types, restoring endothelial cell function and endothelium integrity, facilitating epithelium repair, and restoring vascular smooth muscle function, as well as organ perfusion. In patients with sepsis, these effects are achieved using supraphysiological doses of corticosteroids, equating to approximately 200 mg/day of hydrocortisone equivalent for 5–15 days, depending on the clinical context. The molecular and cellular effects of corticosteroids translate into prevention and reversal of the need for vasopressor, respiratory, and renal supportive therapies, as well as acceleration of organ function resolution, shorter intensive care unit (ICU) and hospital stays, and improved short- and mid-term survival. Remaining gaps in knowledge and evidence to inform practice include insufficient data about the effects of corticosteroids in children, a lack of reliable biomarkers to distinguish those patients who can benefit from treatment, and inadequate information about the effects of corticosteroids on the long-term sequelae of sepsis.</div></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"5 4","pages":"Pages 304-312"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145335102","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":"Dynamic alterations of lymphocyte subsets following sepsis in octogenarian and elder patients","authors":"Jiahui Zhang ,&nbsp;Wei Cheng ,&nbsp;Dongkai Li ,&nbsp;Ran Guo ,&nbsp;Guoyu Zhao ,&nbsp;Na Cui","doi":"10.1016/j.jointm.2025.04.002","DOIUrl":"10.1016/j.jointm.2025.04.002","url":null,"abstract":"<div><h3>Background</h3><div>Sepsis is defined as a life-threatening organ dysfunction caused by dysregulated host responses to infections. This study aimed to investigate the early and dynamic changes in peripheral lymphocyte subsets following sepsis in octogenarian and elder patients and whether these changes were related to 28-day mortality.</div></div><div><h3>Methods</h3><div>A prospective cohort study of 3601 consecutive patients admitted to the intensive care unit (ICU) was performed between March 2017 and January 2023. Peripheral blood samples were collected on admission, Day 3, and Day 7 for patients with sepsis and on enrollment for patients without sepsis. Lymphocyte subsets were detected by flow cytometry. The 28-day mortality was determined using Kaplan–Meier analysis, while Cox regression identified prognostic factors.</div></div><div><h3>Results</h3><div>All enrolled patients were divided into three groups: adult (18–64 years), elder (65–79 years), and octogenarian (≥80 years). Sepsis induced a numerical reduction in lymphocytes (median=0.653 [IQR: 0.500–1.038] <em>vs</em>. median=0.840 [IQR: 0.579–1.142] × 10⁹/L, <em>P</em>=0.043) and CD3⁺ T-cell counts (median=0.461 [IQR: 0.312–0.759] <em>vs</em>. median=0.590 [IQR: 0.417–0.789] × 10⁹/L, <em>P</em>=0.021) in octogenarian patients. Kaplan–Meier survival curves showed that in the elder (<em>P</em> [log-rank test] &lt; 0.001) and octogenarian (<em>P</em> [log-rank test]=0.02) groups, patients with CD3⁺ T-cell nonrecovery on Day 3 and Day 7 had the highest mortality, followed by those with late recovery, and the lowest mortality was observed in the early recovery group. Multivariate Cox regression analysis demonstrated that age (hazard ratio [HR]=1.217, 95% confidence interval [CI]: 1.050 to 1.410, <em>P</em>=0.009) and CD3⁺T-cell counts (HR=0.999, 95% CI: 0.999 to 1.000, <em>P</em> &lt; 0.001) were independent risk factors associated with 28-day mortality in patients with sepsis.</div></div><div><h3>Conclusions</h3><div>Sepsis induced a numerical reduction in lymphocytes and CD3⁺ T-cell counts in octogenarian patients (≥80 years). The persistent decrease of CD3⁺ T-cell counts on Day 3 and Day 7 following sepsis was associated with higher mortality in elder and octogenarian patients.</div><div><strong>Trial registration</strong> Chinese Clinical Trial Registry identifier: ChiCTR-ROC-17010750.</div></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"5 4","pages":"Pages 359-366"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145335150","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":"High-flow nasal oxygen is the reference treatment in acute hypoxemic respiratory failure: Con","authors":"Gabriel Kemoun ,&nbsp;Alexandre Demoule","doi":"10.1016/j.jointm.2024.12.005","DOIUrl":"10.1016/j.jointm.2024.12.005","url":null,"abstract":"<div><div>Over the past decade and boosted by the coronavirus disease 2019 (COVID-19) pandemic, high-flow nasal oxygen (HFNO) has been increasingly used in the intensive care unit (ICU) to treat acute hypoxemic respiratory failure (AHRF). In this review, we show that despite this wide and rapid increase in the use of HFNO to treat AHRF, HFNO does not fulfill all the criteria of a “reference treatment”. First, there are some inconsistencies between the studies that provided a positive signal toward the possible benefit of HFNO in AHRF. The two high-quality studies were negative in terms of primary outcome although they provided promising signals in favor of HFNO in terms of secondary outcomes or unplanned secondary analysis. The significance of the only positive study suffers from notable limitations and other trials, conducted in COVID-19 and in immunocompromised patients, are definitely negative and do not even provide promising signals in favor of HFNO. Of note, authors of some of the large randomized controlled trials (RCTs) on HFNO have received grants or personal fees from manufacturers of HFNO devices. Second, meta-analyses do not show positive results regarding the efficacy of HFNO on mortality and recent guidelines do not support its use to improve this outcome, although they recommend HFNO use to reduce intubation rate. Third, HFNO is associated with risks that should be accounted for. There are concerns that HFNO may delay intubation, which is in turn associated with higher mortality and prolonged length of stay. In addition, with HFNO, high inspiratory effort may generate high lung strain and overstretch, a phenomenon termed patient self-inflicted lung injury (P-SILI). Fourth, there are concerns regarding access to HFNO in resource-limited settings. Fifth, there are also concerns regarding the deleterious environmental impact of HFNO due to the high volume of consumables and high oxygen flow, which remain to be precisely quantified and balanced with the potential reduction in intubation rate. Considering all these limitations, HFNO is not yet the reference treatment for AHRF.</div></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"5 3","pages":"Pages 230-236"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144522356","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":"Free flow Helmet continuous positive airway pressure: The devil is in the “valve's” details!","authors":"Sergio Lassola ,&nbsp;Eleonora Balzani ,&nbsp;Silvia De Rosa ,&nbsp;Marta Turella ,&nbsp;Giacomo Bellani","doi":"10.1016/j.jointm.2025.03.003","DOIUrl":"10.1016/j.jointm.2025.03.003","url":null,"abstract":"","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"5 3","pages":"Pages 219-221"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144522612","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":"High-flow nasal oxygen is the reference treatment in acute hypoxemic respiratory failure: Pro","authors":"Jean-Pierre Frat ,&nbsp;Sylvain Le Pape","doi":"10.1016/j.jointm.2024.12.003","DOIUrl":"10.1016/j.jointm.2024.12.003","url":null,"abstract":"<div><div>In patients with hypoxemic acute respiratory failure (ARF), the first-line treatment is oxygen therapy, which may include the administration of high-flow nasal oxygen (HFNO), noninvasive ventilation (NIV), or continuous positive airway pressure (CPAP). In addition to improving oxygenation, HFNO and NIV reduce the work of breathing as compared to standard oxygen, while CPAP does not. However, tolerance to NIV and CPAP is clinically challenging, resulting in treatment interruption in 10 %–20 % of cases. Compared to standard oxygen, HFNO has been shown to reduce the risk of intubation, while the benefits of NIV or CPAP, even when delivered via a helmet, require further evaluation. Although evidence for the efficacy of HFNO in reducing mortality remains inconclusive, HFNO has emerged as the reference treatment and is recommended for patients with hypoxemic ARF given its benefit in reducing the risk of intubation.</div></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"5 3","pages":"Pages 222-229"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144522355","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}