The assessment of fluid responsiveness (FR) is critical during the initial management of acute circulatory failure (ACF). However, in resource-limited settings or emergency situations, advanced hemodynamic monitoring is often unavailable. The plethysmographic perfusion index (PPI), a non-invasive parameter derived from pulse oximetry, has been proposed as a surrogate marker for changes in cardiac output. The objective of this study was to evaluate the ability of the PPI to detect FR in critically ill patients with ACF during early resuscitation.
Methods
This was a prospective observational study conducted over seven months (February to September 2024) in a 10-bed intensive care unit. Adult patients with ACF requiring a 500-mL fluid bolus were enrolled. FR was assessed by transthoracic echocardiography, defined as a ≥ 15% increase in left ventricular outflow tract velocity-time integral (VTI). VTI and PPI values were obtained before and immediately after the completion of fluid administration. The diagnostic performance of changes in PPI (ΔPPI) was assessed using receiver operating characteristic (ROC) curve analysis and a gray zone approach.
Results
Fifty patients (29 males and 21 females) were included, with a median age of 65 years (interquartile range [IQR]: 57–77). Sepsis-related ACF accounted for 60% of cases. FR was observed in 33 patients (66%). The area under the ROC curve (AUC) for ΔPPI was 0.778 (95% CI: 0.638 to 0.883, P = 0.004). A ΔPPI threshold of 33% yielded 70% sensitivity and 82% specificity. The gray zone ranged from 0% to 88%, encompassing 30% of the cohort.
Conclusion
The PPI demonstrated moderate accuracy in detecting FR during early resuscitation of ACF. As a simple, non-invasive, and widely accessible tool, PPI holds promise for informing fluid management decisions in emergency and critical care settings. Further technological refinements may enhance its diagnostic performance and broaden its clinical applicability.
背景：在急性循环衰竭（ACF）的初始治疗中，液体反应性（FR）的评估是至关重要的。然而，在资源有限的情况下或紧急情况下，往往无法进行先进的血流动力学监测。容积血流灌注指数（PPI）是一种由脉搏血氧测定法衍生的无创参数，已被提议作为心输出量变化的替代指标。本研究的目的是评估急性心衰危重患者早期复苏时PPI检测FR的能力。方法：这是一项前瞻性观察研究，为期7个月（2024年2月至9月），在10张床位的重症监护病房进行。纳入需要500毫升液体丸的ACF成年患者。FR通过经胸超声心动图评估，定义为左心室流出道速度-时间积分（VTI）增加≥15%。在给药前和结束后立即测量VTI和PPI值。采用受试者工作特征（ROC）曲线分析和灰色地带法评估PPI变化的诊断性能（ΔPPI）。结果：纳入50例患者，其中男性29例，女性21例，中位年龄65岁（四分位数间距[IQR]: 57-77）。败血症相关ACF占60%。33例（66%）患者发生FR。ΔPPI的ROC曲线下面积为0.778 （95% CI: 0.638 ~ 0.883, P = 0.004）。33%的ΔPPI阈值产生70%的敏感性和82%的特异性。灰色地带的范围从0%到88%不等，包括30%的队列。结论：在ACF早期复苏过程中，PPI检测FR的准确性中等。作为一种简单、无创、可广泛使用的工具，PPI有望为急诊和重症监护环境中的流体管理决策提供信息。进一步的技术改进可能会提高其诊断性能并扩大其临床适用性。临床试验。gov标识符：NCT06313671。
{"title":"The reliability of the plethysmographic perfusion index for detecting fluid responsiveness in critically ill patients","authors":"Younes Aissaoui, Ayoub Bouchama, Chaimae Abouelkemhe, Abdellah Enourhbi, Bassam Bencharfa, Mehdi Didi, Hatim Aguena, Ayoub Belhadj","doi":"10.1016/j.jointm.2025.07.004","DOIUrl":"10.1016/j.jointm.2025.07.004","url":null,"abstract":"<div><h3>Background</h3><div>The assessment of fluid responsiveness (FR) is critical during the initial management of acute circulatory failure (ACF). However, in resource-limited settings or emergency situations, advanced hemodynamic monitoring is often unavailable. The plethysmographic perfusion index (PPI), a non-invasive parameter derived from pulse oximetry, has been proposed as a surrogate marker for changes in cardiac output. The objective of this study was to evaluate the ability of the PPI to detect FR in critically ill patients with ACF during early resuscitation.</div></div><div><h3>Methods</h3><div>This was a prospective observational study conducted over seven months (February to September 2024) in a 10-bed intensive care unit. Adult patients with ACF requiring a 500-mL fluid bolus were enrolled. FR was assessed by transthoracic echocardiography, defined as <em>a</em> ≥ 15% increase in left ventricular outflow tract velocity-time integral (VTI). VTI and PPI values were obtained before and immediately after the completion of fluid administration. The diagnostic performance of changes in PPI (ΔPPI) was assessed using receiver operating characteristic (ROC) curve analysis and a gray zone approach.</div></div><div><h3>Results</h3><div>Fifty patients (29 males and 21 females) were included, with a median age of 65 years (interquartile range [IQR]: 57–77). Sepsis-related ACF accounted for 60% of cases. FR was observed in 33 patients (66%). The area under the ROC curve (AUC) for ΔPPI was 0.778 (95% CI: 0.638 to 0.883, <em>P</em> = 0.004). A ΔPPI threshold of 33% yielded 70% sensitivity and 82% specificity. The gray zone ranged from 0% to 88%, encompassing 30% of the cohort.</div></div><div><h3>Conclusion</h3><div>The PPI demonstrated moderate accuracy in detecting FR during early resuscitation of ACF. As a simple, non-invasive, and widely accessible tool, PPI holds promise for informing fluid management decisions in emergency and critical care settings. Further technological refinements may enhance its diagnostic performance and broaden its clinical applicability.</div><div><strong>Trial registration</strong> Clinical Trials.gov Identifier: NCT06313671.</div></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"6 1","pages":"Pages 34-41"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147286489","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}
Pub Date : 2026-02-01Epub Date: 2025-10-17DOI: 10.1016/j.jointm.2025.08.008
Robert G. Hahn , Yuhong Li , Randal O. Dull
Background
Crystalloid fluid is combined with vasoactive drugs when treating acute sepsis. We used kinetic analysis to compare the effects of vasoactive drugs on the hemodynamics and the volume kinetics of crystalloid fluid in non-septic and septic sheep. Specific attention was given to the effects of drugs and sepsis on fluid distribution to the “third fluid space.”
Methods
Forty-nine sheep were studied, of which 25 were made septic by cecal puncture and administration of lipopolysaccharide. A bolus infusion of 20–25 mL/kg of crystalloid fluid was given 1 h later, together with therapeutic doses of phenylephrine, norepinephrine, isoprenaline, dopamine, or esmolol. Central hemodynamics were monitored, and blood samples for the calculation of volume kinetics were taken. The distribution and elimination of the infused volume were calculated using mixed-model kinetics with extensive covariate analyses based on 1134 measurements of the hemoglobin-derived plasma dilution (23 per experiment) and 193 measurements of urine output collected over 180 min.
Results
Sepsis induced a hyperkinetic, hypotensive, and vasodilatory state. Cardiac output averaged 12.1 L/min in septic sheep vs. 7.6 L/min in non-septic sheep, and mean arterial pressure was 72 vs. 109 mmHg, respectively. Differences in hemodynamic variables between the non-septic and septic sheep were all statistically significant (P <0.001). However, the modifying influences of vasopressors on hemodynamics and fluid distribution were weakened in the septic state. The rate constant for urine output (k10) was strongly decreased by sepsis, modestly reduced by β1-adrenergic stimulation, and increased by α1-adrenergic stimulation. Fluid was able to access the remote slow-exchange interstitial fluid space (“third fluid space”) only during sepsis. In theory, fluid accumulation in this space would decrease by α1-adrenergic stimulation and increase by β1-adrenergic stimulation, but differences were small due to the overall weak effects of adrenergic drugs in the septic sheep. We hypothesize that the changeover from brisk urine flow in the non-septic sheep to marked accumulation of fluid in the “third fluid space” was due to inflammation-induced alterations in the interstitial matrix.
Conclusion
Vasoactive drugs were less effective in septic compared to non-septic sheep. Most importantly, acute sepsis was characterized by a marked accumulation of fluid in an interstitial fluid space with slow turnover.
{"title":"Vasoactive drugs and the distribution of crystalloid fluid during acute sepsis","authors":"Robert G. Hahn , Yuhong Li , Randal O. Dull","doi":"10.1016/j.jointm.2025.08.008","DOIUrl":"10.1016/j.jointm.2025.08.008","url":null,"abstract":"<div><h3>Background</h3><div>Crystalloid fluid is combined with vasoactive drugs when treating acute sepsis. We used kinetic analysis to compare the effects of vasoactive drugs on the hemodynamics and the volume kinetics of crystalloid fluid in non-septic and septic sheep. Specific attention was given to the effects of drugs and sepsis on fluid distribution to the “third fluid space.”</div></div><div><h3>Methods</h3><div>Forty-nine sheep were studied, of which 25 were made septic by cecal puncture and administration of lipopolysaccharide. A bolus infusion of 20–25 mL/kg of crystalloid fluid was given 1 h later, together with therapeutic doses of phenylephrine, norepinephrine, isoprenaline, dopamine, or esmolol. Central hemodynamics were monitored, and blood samples for the calculation of volume kinetics were taken. The distribution and elimination of the infused volume were calculated using mixed-model kinetics with extensive covariate analyses based on 1134 measurements of the hemoglobin-derived plasma dilution (23 per experiment) and 193 measurements of urine output collected over 180 min.</div></div><div><h3>Results</h3><div>Sepsis induced a hyperkinetic, hypotensive, and vasodilatory state. Cardiac output averaged 12.1 L/min in septic sheep <em>vs</em>. 7.6 L/min in non-septic sheep, and mean arterial pressure was 72 <em>vs</em>. 109 mmHg, respectively. Differences in hemodynamic variables between the non-septic and septic sheep were all statistically significant (<em>P</em> <0.001). However, the modifying influences of vasopressors on hemodynamics and fluid distribution were weakened in the septic state. The rate constant for urine output (<em>k</em><sub>10</sub>) was strongly decreased by sepsis, modestly reduced by β<sub>1</sub>-adrenergic stimulation, and increased by α<sub>1</sub>-adrenergic stimulation. Fluid was able to access the remote slow-exchange interstitial fluid space (“third fluid space”) only during sepsis. In theory, fluid accumulation in this space would decrease by α<sub>1</sub>-adrenergic stimulation and increase by β<sub>1</sub>-adrenergic stimulation, but differences were small due to the overall weak effects of adrenergic drugs in the septic sheep. We hypothesize that the changeover from brisk urine flow in the non-septic sheep to marked accumulation of fluid in the “third fluid space” was due to inflammation-induced alterations in the interstitial matrix.</div></div><div><h3>Conclusion</h3><div>Vasoactive drugs were less effective in septic compared to non-septic sheep. Most importantly, acute sepsis was characterized by a marked accumulation of fluid in an interstitial fluid space with slow turnover.</div></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"6 1","pages":"Pages 75-82"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147286507","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}
Pub Date : 2025-10-01Epub Date: 2025-09-23DOI: 10.1016/j.jointm.2025.07.003
Xiangyu Chen , Siyi Yuan , Elias Baedorf Kassis , Song Zhang , Yi Chi , Shengjun Liu , Fuhong Cai , Yue Ma , Yan Li , Longxiang Su , Yun Long
Background
Patient-ventilator asynchrony (PVA) is common in critically ill patients undergoing mechanical ventilation and may adversely affect clinical outcomes. Traditional bedside assessment methods are subjective and intermittent. We developed a real-time digital platform to continuously monitor ventilator waveforms and quantify overall asynchrony burden of severe pneumonia patients.
Methods
The study retrospectively analyzed mechanically ventilated coronavirus disease 2019 (COVID-19 patients admitted to the Department of Critical Care Medicine of Peking Union Medical College Hospital (PUMCH) from December 2022 to August 2023. Ventilator waveforms were continuously collected and processed using the remote ventilate view platform, which automatically identified eight PVA subtypes and calculated the Overall Asynchrony Index (OAI) across the full ventilation course. Respiratory mechanics were also extracted. Primary outcomes included intensive care unit (ICU) mortality and 28-day ventilator-free days (VFDs), while secondary outcomes included the length of ICU stay and duration of mechanical ventilation. The study used R, Jamovi, and Python for statistical analysis.
Results
Twenty-three mechanically ventilated COVID-19 patients admitted to the ICU at Peking Union Medical College Hospital were included in this study. No correlation was found between the index and ventilatory parameters, compliance, and disease severity. Patients with an OAI ≥10 % were more likely to have fewer 28-day VFDs (1.3 days vs. 11.4 days, P = 0.027) and were demonstrated to have a higher ICU mortality (66.7 % vs. 18.2 %, P = 0.036). Among eight types of PVA, flow insufficiency was found to be associated with prognosis (P = 0.012). OAI correlated with the prognosis of COVID-19 patients. Patients with an OAI ≥10 % were more likely to have fewer 28-day VFDs and higher ICU mortality.
Conclusions
A higher OAI and increased flow insufficiency were associated with worse outcomes in COVID-19 patients receiving mechanical ventilation. This study demonstrates the feasibility and clinical potential of a real-time, platform-based approach for automated detection and longitudinal monitoring of PVA.
患者-呼吸机不同步（PVA）在接受机械通气的危重患者中很常见，并可能对临床结果产生不利影响。传统的床边评估方法是主观的和间歇性的。我们开发了一个实时数字平台来连续监测呼吸机波形并量化重症肺炎患者的总体非同步负担。方法回顾性分析2022年12月至2023年8月北京协和医院重症医学科收治的2019冠状病毒病（COVID-19）患者。使用远程通气视图平台连续收集和处理呼吸机波形，自动识别8种PVA亚型并计算整个通气过程中的总体异步指数（OAI）。同时提取呼吸力学。主要结局包括重症监护病房（ICU）死亡率和28天无呼吸机天数（vfd），次要结局包括ICU住院时间和机械通气持续时间。本研究使用R、Jamovi和Python进行统计分析。结果入选北京协和医院重症监护病房机械通气的新冠肺炎患者23例。该指数与通气参数、依从性和疾病严重程度之间没有相关性。OAI≥10%的患者28天vfd更少（1.3天vs. 11.4天，P = 0.027）， ICU死亡率更高（66.7% vs. 18.2%, P = 0.036）。在8种PVA类型中，血流不足与预后相关（P = 0.012）。OAI与COVID-19患者预后相关。OAI≥10%的患者更有可能出现较少的28天vfd和较高的ICU死亡率。结论采用机械通气的COVID-19患者OAI升高和血流不全加重与预后较差相关。本研究证明了实时、基于平台的PVA自动检测和纵向监测方法的可行性和临床潜力。
{"title":"Methodological development of the remote ventilate view platform for real-time monitoring of patient-ventilator asynchrony and respiratory parameters in severe pneumonia patients","authors":"Xiangyu Chen , Siyi Yuan , Elias Baedorf Kassis , Song Zhang , Yi Chi , Shengjun Liu , Fuhong Cai , Yue Ma , Yan Li , Longxiang Su , Yun Long","doi":"10.1016/j.jointm.2025.07.003","DOIUrl":"10.1016/j.jointm.2025.07.003","url":null,"abstract":"<div><h3>Background</h3><div>Patient-ventilator asynchrony (PVA) is common in critically ill patients undergoing mechanical ventilation and may adversely affect clinical outcomes. Traditional bedside assessment methods are subjective and intermittent. We developed a real-time digital platform to continuously monitor ventilator waveforms and quantify overall asynchrony burden of severe pneumonia patients.</div></div><div><h3>Methods</h3><div>The study retrospectively analyzed mechanically ventilated coronavirus disease 2019 (COVID-19 patients admitted to the Department of Critical Care Medicine of Peking Union Medical College Hospital (PUMCH) from December 2022 to August 2023. Ventilator waveforms were continuously collected and processed using the remote ventilate view platform, which automatically identified eight PVA subtypes and calculated the Overall Asynchrony Index (OAI) across the full ventilation course. Respiratory mechanics were also extracted. Primary outcomes included intensive care unit (ICU) mortality and 28-day ventilator-free days (VFDs), while secondary outcomes included the length of ICU stay and duration of mechanical ventilation. The study used R, Jamovi, and Python for statistical analysis.</div></div><div><h3>Results</h3><div>Twenty-three mechanically ventilated COVID-19 patients admitted to the ICU at Peking Union Medical College Hospital were included in this study. No correlation was found between the index and ventilatory parameters, compliance, and disease severity. Patients with an OAI ≥10 % were more likely to have fewer 28-day VFDs (1.3 days <em>vs</em>. 11.4 days, <em>P</em> = 0.027) and were demonstrated to have a higher ICU mortality (66.7 % <em>vs</em>. 18.2 %, <em>P</em> = 0.036). Among eight types of PVA, flow insufficiency was found to be associated with prognosis (<em>P</em> = 0.012). OAI correlated with the prognosis of COVID-19 patients. Patients with an OAI ≥10 % were more likely to have fewer 28-day VFDs and higher ICU mortality.</div></div><div><h3>Conclusions</h3><div>A higher OAI and increased flow insufficiency were associated with worse outcomes in COVID-19 patients receiving mechanical ventilation. This study demonstrates the feasibility and clinical potential of a real-time, platform-based approach for automated detection and longitudinal monitoring of PVA.</div></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"5 4","pages":"Pages 367-376"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145335065","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}
Pub Date : 2025-10-01Epub Date: 2025-07-03DOI: 10.1016/j.jointm.2025.05.002
Ruyuan Zhang, Lei Li, Yaoqing Tang, Dechang Chen
Background
The anatomical configuration of the anterior scalene muscle, inserting between the subclavian vein and artery, creates a space between them. By placing an ultrasound probe in the infraclavicular area, an optimal longitudinal view of both the proximal part of the axillary and the distal part of the subclavian vein and artery can be obtained, while the pleura is out of view. This Seeing Artery and VEin Simultaneously in the long axis (SAVES) method for ultrasound-guided infraclavicular axillary/subclavian vein cannulation offers theoretical advantages because it may avoid iatrogenic pneumothorax and reduce the risk of arterial damage. The objective of the present study was, to our knowledge, for the first time, to determine the safety and efficacy of the SAVES method for ultrasound-guided infraclavicular axillary/subclavian vein cannulation in adult critically ill patients.
Methods
A retrospective study was performed on consecutive adult critically ill patients who underwent ultrasound-guided infraclavicular axillary/subclavian vein cannulation performed by the same physician in a medical/surgical intensive care unit (12 beds) between 20 August 2021 and 20 December 2024. The overall success rate, the first-pass success rate, the access time and number of attempts, the incidence of difficulty with insertion of the guidewire/dilator/catheter, and the mechanical complication rate were analyzed.
Results
A total of 111 adult critically ill patients required 142 ultrasound-guided infraclavicular axillary/subclavian vein punctures using the SAVES method. The overall success rate was 100%, and the first-pass success rate was 75.4%. The access time was 38.5 (interquartile range: 21.5–80.0) s. The proportions of different numbers (1, 2, and 3) of attempted catheterizations were 88.7%, 9.2%, and 2.1%, respectively. The incidence of difficulty with guidewire insertion was 15.5%, while no difficulty with insertion of the dilator or catheter was experienced. No instance of pneumothorax, hemothorax, arterial puncture, brachial plexus injury, or cardiac tamponade was recorded. The incidence of hematoma formation was 2.1%. The occurrence rate of posterior venous wall penetration was 3.5%. The catheter malposition rate was 5.6%.
Conclusions
The SAVES technique may be a safe and effective approach for ultrasound-guided infraclavicular axillary/subclavian vein cannulation. A larger controlled prospective study is warranted to confirm these findings.
{"title":"Seeing Artery and VEin Simultaneously in the long axis (SAVES) for ultrasound-guided infraclavicular axillary/subclavian vein cannulation: A retrospective analysis","authors":"Ruyuan Zhang, Lei Li, Yaoqing Tang, Dechang Chen","doi":"10.1016/j.jointm.2025.05.002","DOIUrl":"10.1016/j.jointm.2025.05.002","url":null,"abstract":"<div><h3>Background</h3><div>The anatomical configuration of the anterior scalene muscle, inserting between the subclavian vein and artery, creates a space between them. By placing an ultrasound probe in the infraclavicular area, an optimal longitudinal view of both the proximal part of the axillary and the distal part of the subclavian vein and artery can be obtained, while the pleura is out of view. This Seeing Artery and VEin Simultaneously in the long axis (SAVES) method for ultrasound-guided infraclavicular axillary/subclavian vein cannulation offers theoretical advantages because it may avoid iatrogenic pneumothorax and reduce the risk of arterial damage. The objective of the present study was, to our knowledge, for the first time, to determine the safety and efficacy of the SAVES method for ultrasound-guided infraclavicular axillary/subclavian vein cannulation in adult critically ill patients.</div></div><div><h3>Methods</h3><div>A retrospective study was performed on consecutive adult critically ill patients who underwent ultrasound-guided infraclavicular axillary/subclavian vein cannulation performed by the same physician in a medical/surgical intensive care unit (12 beds) between 20 August 2021 and 20 December 2024. The overall success rate, the first-pass success rate, the access time and number of attempts, the incidence of difficulty with insertion of the guidewire/dilator/catheter, and the mechanical complication rate were analyzed.</div></div><div><h3>Results</h3><div>A total of 111 adult critically ill patients required 142 ultrasound-guided infraclavicular axillary/subclavian vein punctures using the SAVES method. The overall success rate was 100%, and the first-pass success rate was 75.4%. The access time was 38.5 (interquartile range: 21.5–80.0) s. The proportions of different numbers (1, 2, and 3) of attempted catheterizations were 88.7%, 9.2%, and 2.1%, respectively. The incidence of difficulty with guidewire insertion was 15.5%, while no difficulty with insertion of the dilator or catheter was experienced. No instance of pneumothorax, hemothorax, arterial puncture, brachial plexus injury, or cardiac tamponade was recorded. The incidence of hematoma formation was 2.1%. The occurrence rate of posterior venous wall penetration was 3.5%. The catheter malposition rate was 5.6%.</div></div><div><h3>Conclusions</h3><div>The SAVES technique may be a safe and effective approach for ultrasound-guided infraclavicular axillary/subclavian vein cannulation. A larger controlled prospective study is warranted to confirm these findings.</div></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"5 4","pages":"Pages 350-358"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145335105","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}
Pub Date : 2025-10-01Epub Date: 2025-09-19DOI: 10.1016/j.jointm.2025.08.005
Dechang Chen
{"title":"History of the Chinese medical association-Chinese society of critical care medicine","authors":"Dechang Chen","doi":"10.1016/j.jointm.2025.08.005","DOIUrl":"10.1016/j.jointm.2025.08.005","url":null,"abstract":"","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"5 4","pages":"Pages 295-297"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145332369","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}
Pub Date : 2025-10-01Epub Date: 2025-04-10DOI: 10.1016/j.jointm.2025.02.001
Tomer Arad , Sabina Kalinchuk , Dina Grinas , Moran Hellerman-Itzhaki , Guy Fishman , Itai Bendavid , Liran Statlender , Ilya Kagan , Pierre Singer
Background
This study sought to evaluate the role of videoart in decreasing the risk of stress symptoms in patients hospitalized in the intensive care unit (ICU).
Methods
This is a prospective observational cohort study conducted in a general ICU in which 8 of 18 rooms are equipped with a videoart system. Competent patients who spent at least 48 h in the ICU were asked to complete an Impact of Events Scale (IES) questionnaire during hospitalization and at least 1 year after discharge. Patients were recruited from April 2017 until June 2020, and follow-up phone calls were made from June to August 2021. The primary outcome was an IES score indicative of significant stress symptoms during hospitalization. Secondary outcomes were IES scores indicative of significant stress symptoms after discharge and clinical parameters during hospital stay. The cut-off value for high-risk stress symptoms was 26. However, because there is uncertainty in the literature regarding the desired cut-off value, two other values were also analyzed. Outcomes that were found statistically significant were further examined using a logistic regression model for the control of confounders.
Results
Eighty-one patients completed the questionnaire during hospital stay and 24 patients after discharge. At home, patients who were exposed to videoart had a marginally lower mean IES score (median=6 [interquartile range: 0–18] vs. median=32 [interquartile range:10–45], P = 0.054) and a significantly lower rate of high-risk stress symptoms using the primary cut-off value (11.8 % vs. 57.1 %, P=0.038; odds ratio=10.00 95 % CI: 1.22 to 81.80, P=0.03). However, statistical significance was lost after adjustment for confounders (odds ratio=12.00, 95 % CI: 0.67 to 222.00, P=0.09) . There was no difference in the mean IES score, significant stress symptoms rate, or in any of the other endpoints examined during the hospital stay.
Conclusions
There is a trend toward the beneficial effect of videoart for the alleviation of stress symptoms among ICU patients. However, further study is needed to examine the role of this technology.
{"title":"Videoart in the intensive care unit: A prospective observational study","authors":"Tomer Arad , Sabina Kalinchuk , Dina Grinas , Moran Hellerman-Itzhaki , Guy Fishman , Itai Bendavid , Liran Statlender , Ilya Kagan , Pierre Singer","doi":"10.1016/j.jointm.2025.02.001","DOIUrl":"10.1016/j.jointm.2025.02.001","url":null,"abstract":"<div><h3>Background</h3><div>This study sought to evaluate the role of videoart in decreasing the risk of stress symptoms in patients hospitalized in the intensive care unit (ICU).</div></div><div><h3>Methods</h3><div>This is a prospective observational cohort study conducted in a general ICU in which 8 of 18 rooms are equipped with a videoart system. Competent patients who spent at least 48 h in the ICU were asked to complete an Impact of Events Scale (IES) questionnaire during hospitalization and at least 1 year after discharge. Patients were recruited from April 2017 until June 2020, and follow-up phone calls were made from June to August 2021. The primary outcome was an IES score indicative of significant stress symptoms during hospitalization. Secondary outcomes were IES scores indicative of significant stress symptoms after discharge and clinical parameters during hospital stay. The cut-off value for high-risk stress symptoms was 26. However, because there is uncertainty in the literature regarding the desired cut-off value, two other values were also analyzed. Outcomes that were found statistically significant were further examined using a logistic regression model for the control of confounders.</div></div><div><h3>Results</h3><div>Eighty-one patients completed the questionnaire during hospital stay and 24 patients after discharge. At home, patients who were exposed to videoart had a marginally lower mean IES score (median=6 [interquartile range: 0–18] <em>vs.</em> median=32 [interquartile range:10–45], <em>P</em> = 0.054) and a significantly lower rate of high-risk stress symptoms using the primary cut-off value (11.8 % <em>vs.</em> 57.1 %, <em>P</em>=0.038; odds ratio=10.00 95 % CI: 1.22 to 81.80, <em>P</em>=0.03). However, statistical significance was lost after adjustment for confounders (odds ratio=12.00, 95 % CI: 0.67 to 222.00, <em>P</em>=0.09) . There was no difference in the mean IES score, significant stress symptoms rate, or in any of the other endpoints examined during the hospital stay.</div></div><div><h3>Conclusions</h3><div>There is a trend toward the beneficial effect of videoart for the alleviation of stress symptoms among ICU patients. However, further study is needed to examine the role of this technology.</div></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"5 4","pages":"Pages 400-406"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145335104","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}
The potential role of aerosol drug therapy (ADT) in patients with acute respiratory distress syndrome (ARDS) remains uncertain. The objective of this study is to determine the prevalence and practice patterns of ADT in patients with ARDS.
Methods
This secondary analysis of a prospective observational multi-centric cohort study done in critically ill patients to know the ADT practice pattern was conducted in nine participating intensive care units (ICUs) across India between November 2022 and March 2023. The study recruited newly admitted adult patients (age >18 years) who had an artificial airway and required mechanical ventilation (invasive or non‑invasive). These patients were followed up for the next 14 days or until ICU discharge or death. This secondary analysis collected data about screened patients with ARDS, related to each aerosol therapy including ongoing respiratory support, type of drug, and aerosol‑generating device, including ongoing respiratory support, type of drug, and aerosol‑generating device.
Results
Fifty-three (24.3%) of the 218 patients had ARDS, with a mean age of (60.2±14.8) years. At admission, the acute physiology and chronic health evaluation (APACHE II) and sequential organ failure assessment (SOFA) score of the recruited patients were 17.4±7.1 and 7.7±4.0, respectively. Respiratory support was provided with invasive mechanical ventilation (IMV) alone, non-invasive ventilation (NIV) alone, or both in 45.3%, 24.5%, and 30.2% of patients, respectively. The mean duration of the ICU stay was (6.4 ± 4.0) days. Of the 53 patients with ARDS, 51 (96.2%) received 1285 aerosol sessions during follow-up for 330 patient days. Of all patients with ARDS who received aerosol therapy, 71.4% were prescribed while on IMV and 25.7% on NIV. A single drug was used in 60.7% of the aerosol sessions used a single drug, and 39.3% were prescribed combination drugs. Shorter-acting bronchodilators were the predominant drugs, with jet nebulizers (55.4%) being the most commonly used aerosol generators. These were followed by ultrasonic (23.1%) and vibrating-mesh nebulizers (21.5 %). During IMV, only in 50.1% of aerosol sessions (460 out of 918) was an aerosol generator placed at the optimum position (15–30 cm away from the Y-junction).
Conclusions
Aerosol therapy is frequently used in ARDS, with bronchodilators being the most common drug. The jet nebulizer is the most familiar aerosol-generating device, but only half of the aerosol sessions are at the optimum position during invasive mechanical ventilation.
{"title":"Practice pattern of aerosol drug therapy in ARDS patients: A secondary analysis of the Aero-in-ICU study","authors":"Sanjay Singhal , Sai Saran , Krupal Joshi , Mohan Gurjar , Parnandi Bhaskar Rao , Jyoti Narayan Sahoo , Ruchi Dua , Alok Kumar Sahoo , Ankur Sharma , Sonika Agarwal , Arun Sharma , Pralay Shankar Ghosh , Nikhil Kothari , Kunal Deokar , Sudipta Mukherjee , Prakhar Sharma , BPS Sreedevi , Prakash Sivaramakrishnan , Umadri Singh , Dhivya Sundaram , Avinash Agrawal","doi":"10.1016/j.jointm.2025.05.003","DOIUrl":"10.1016/j.jointm.2025.05.003","url":null,"abstract":"<div><h3>Background</h3><div>The potential role of aerosol drug therapy (ADT) in patients with acute respiratory distress syndrome (ARDS) remains uncertain. The objective of this study is to determine the prevalence and practice patterns of ADT in patients with ARDS.</div></div><div><h3>Methods</h3><div>This secondary analysis of a prospective observational multi-centric cohort study done in critically ill patients to know the ADT practice pattern was conducted in nine participating intensive care units (ICUs) across India between November 2022 and March 2023. The study recruited newly admitted adult patients (age >18 years) who had an artificial airway and required mechanical ventilation (invasive or non‑invasive). These patients were followed up for the next 14 days or until ICU discharge or death. This secondary analysis collected data about screened patients with ARDS, related to each aerosol therapy including ongoing respiratory support, type of drug, and aerosol‑generating device, including ongoing respiratory support, type of drug, and aerosol‑generating device.</div></div><div><h3>Results</h3><div>Fifty-three (24.3%) of the 218 patients had ARDS, with a mean age of (60.2±14.8) years. At admission, the acute physiology and chronic health evaluation (APACHE II) and sequential organ failure assessment (SOFA) score of the recruited patients were 17.4±7.1 and 7.7±4.0, respectively. Respiratory support was provided with invasive mechanical ventilation (IMV) alone, non-invasive ventilation (NIV) alone, or both in 45.3%, 24.5%, and 30.2% of patients, respectively. The mean duration of the ICU stay was (6.4 ± 4.0) days. Of the 53 patients with ARDS, 51 (96.2%) received 1285 aerosol sessions during follow-up for 330 patient days. Of all patients with ARDS who received aerosol therapy, 71.4% were prescribed while on IMV and 25.7% on NIV. A single drug was used in 60.7% of the aerosol sessions used a single drug, and 39.3% were prescribed combination drugs. Shorter-acting bronchodilators were the predominant drugs, with jet nebulizers (55.4%) being the most commonly used aerosol generators. These were followed by ultrasonic (23.1%) and vibrating-mesh nebulizers (21.5 %). During IMV, only in 50.1% of aerosol sessions (460 out of 918) was an aerosol generator placed at the optimum position (15–30 cm away from the Y-junction).</div></div><div><h3>Conclusions</h3><div>Aerosol therapy is frequently used in ARDS, with bronchodilators being the most common drug. The jet nebulizer is the most familiar aerosol-generating device, but only half of the aerosol sessions are at the optimum position during invasive mechanical ventilation.</div></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"5 4","pages":"Pages 385-391"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145335067","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}
Pub Date : 2025-10-01Epub Date: 2025-06-14DOI: 10.1016/j.jointm.2025.03.007
Tariq A. Dam , Daan de Bruin , Giovanni Cinà , Patrick J. Thoral , Paul W.G. Elbers , Corstiaan A. den Uil , Reinier F. Crane
Background
Inadvertent intensive care unit (ICU) readmission is associated with longer length of stay and increased mortality. Conversely, delayed ICU discharge may represent inefficient use of resources. To better inform discharge timing, several hospitals have implemented machine learning models to predict readmission risk following discharge. However, these models are typically created locally and may not generalize well to other hospitals or patient populations. A single multi-hospital-based model might provide more accurate predictions and insight into features that are applicable across diverse clinical settings.
Methods
This study involved a retrospective multi-center cohort from one academic hospital (Amsterdam University Medical Center [AUMC]) and two large teaching hospitals (Maasstad Ziekenhuis [MSZ] and OLVG). Data from the latter two hospitals were combined to create a pooled model, which was tested on the academic hospital dataset. Data relating to all adult ICU patients were included, starting from the implementation of the electronic health record system until the commencement of model development for each hospital. An XGBoost model was trained to predict a composite outcome of readmission or mortality within 7 days and an autoencoder was used as an out-of-distribution (OOD) detector to capture dataset heterogeneity.
Results
In total, 44,837 patients were available for analysis across the three hospitals. The average readmission rates were 7.1 %, 6.9 %, and 5.9 % for MSZ, OLVG, and AUMC, respectively. Performance evaluation of the local models on AUMC data demonstrated weighted area under the receiver operating characteristic curves of 69.7 %±0.8 %, 70.5 %±0.5 %, and 76.5 %±1.9 %, respectively, whereas the pooled model achieved a weighted area under the receiver operating characteristic curves of 71.1 %±0.7 %. The difference between internal and external performance was reduced when cardiac surgery patients were excluded. The key features across models were albumin levels and the use of oxygen therapy.
Discussion
A single, multi-hospital-based model performed comparably on external datasets, especially when cardiac surgery patients were excluded. However, when applied externally, model predictions risk being uncalibrated for specific patient subgroups and require careful calibration before implementation. While external models were more stable than local ones over OOD scores, their performance was comparable after excluding cardiac surgery patients. Although pooling data marginally improved performance on external datasets, the incorporation of data from diverse hospitals is likely to provide greater benefits.
{"title":"ICU readmission and mortality risk prediction: Generalizability of a multi-hospital model","authors":"Tariq A. Dam , Daan de Bruin , Giovanni Cinà , Patrick J. Thoral , Paul W.G. Elbers , Corstiaan A. den Uil , Reinier F. Crane","doi":"10.1016/j.jointm.2025.03.007","DOIUrl":"10.1016/j.jointm.2025.03.007","url":null,"abstract":"<div><h3>Background</h3><div>Inadvertent intensive care unit (ICU) readmission is associated with longer length of stay and increased mortality. Conversely, delayed ICU discharge may represent inefficient use of resources. To better inform discharge timing, several hospitals have implemented machine learning models to predict readmission risk following discharge. However, these models are typically created locally and may not generalize well to other hospitals or patient populations. A single multi-hospital-based model might provide more accurate predictions and insight into features that are applicable across diverse clinical settings.</div></div><div><h3>Methods</h3><div>This study involved a retrospective multi-center cohort from one academic hospital (Amsterdam University Medical Center [AUMC]) and two large teaching hospitals (Maasstad Ziekenhuis [MSZ] and OLVG). Data from the latter two hospitals were combined to create a pooled model, which was tested on the academic hospital dataset. Data relating to all adult ICU patients were included, starting from the implementation of the electronic health record system until the commencement of model development for each hospital. An XGBoost model was trained to predict a composite outcome of readmission or mortality within 7 days and an autoencoder was used as an out-of-distribution (OOD) detector to capture dataset heterogeneity.</div></div><div><h3>Results</h3><div>In total, 44,837 patients were available for analysis across the three hospitals. The average readmission rates were 7.1 %, 6.9 %, and 5.9 % for MSZ, OLVG, and AUMC, respectively. Performance evaluation of the local models on AUMC data demonstrated weighted area under the receiver operating characteristic curves of 69.7 %±0.8 %, 70.5 %±0.5 %, and 76.5 %±1.9 %, respectively, whereas the pooled model achieved a weighted area under the receiver operating characteristic curves of 71.1 %±0.7 %. The difference between internal and external performance was reduced when cardiac surgery patients were excluded. The key features across models were albumin levels and the use of oxygen therapy.</div></div><div><h3>Discussion</h3><div>A single, multi-hospital-based model performed comparably on external datasets, especially when cardiac surgery patients were excluded. However, when applied externally, model predictions risk being uncalibrated for specific patient subgroups and require careful calibration before implementation. While external models were more stable than local ones over OOD scores, their performance was comparable after excluding cardiac surgery patients. Although pooling data marginally improved performance on external datasets, the incorporation of data from diverse hospitals is likely to provide greater benefits.</div></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"5 4","pages":"Pages 377-384"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145335068","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}
Pub Date : 2025-10-01Epub Date: 2025-05-14DOI: 10.1016/j.jointm.2025.03.006
Shanshan Jin , Shiyu Meng , Qiuping Huang , Hui Xie , Jingjing Zheng , Ruilan Wang
Background
Critically ill patients in ICUs are highly vulnerable to infectious diseases. Early and accurate identification of pathogens is vital for initiating appropriate antimicrobial therapy. To evaluate the diagnostic effectiveness in patients with suspected infectious diseases; three different molecular technologies and conventional microbiological tests were used.
Methods
A total of 97 individuals suspected of having infectious diseases were retrospectively enrolled from July 2023 to January 2024 at Shanghai General Hospital. Samples were collected for metagenomic next-generation sequencing (mNGS), droplet digital polymerase chain reaction (ddPCR), multiplex drop-off digital polymerase chain reaction (MDO-dPCR), and conventional microbiological tests (CMTs) for suspected pathogen detection. The diagnostic efficacies of the three molecular technologies and CMTs were compared, and the effects of their joint application on clinical outcomes were evaluated. Intergroup comparisons were performed using the Kruskal–Wallis test, with a P-value <0.05 considered statistically significant.
Results
Joint detection exhibited a high negative predictive value. The sensitivity of MDO-dPCR, ddPCR, and mNGS was 52.6%, 48.5%, and 96.6%, respectively; and the corresponding specificity was 72.5%, 73.3%, and 50.0%. A positive correlation was observed between pathogen copies detected using MDO-dPCR and procalcitonin (Pearson’s ρ=0.21, P=0.039), acute physiology and chronic health evaluation II (Pearson’s ρ=0.24, P =0.018), and sequential organ failure assessment (Pearson’s ρ=0.25, P=0.012). Therapeutic regimens were adjusted in 51.5% of the patients (50/97) based on the results of the combination tests.
Conclusions
In the present study, we highlighted the significance of molecular technologies for the early diagnosis of patients with suspected infections. These technologies can serve as a complement to CMTs and should be implemented promptly to guide clinicians in providing timely and effective anti-infective treatments. Future studies should aim to confirm these findings in large-scale clinical trials to refine diagnostic protocols, while also incorporating cost-utility analyses.
{"title":"Joint application of multiplex drop-off digital PCR, droplet digital PCR, and metagenomic next-generation sequencing for the diagnosis of suspected infectious diseases: A retrospective cohort study","authors":"Shanshan Jin , Shiyu Meng , Qiuping Huang , Hui Xie , Jingjing Zheng , Ruilan Wang","doi":"10.1016/j.jointm.2025.03.006","DOIUrl":"10.1016/j.jointm.2025.03.006","url":null,"abstract":"<div><h3>Background</h3><div>Critically ill patients in ICUs are highly vulnerable to infectious diseases. Early and accurate identification of pathogens is vital for initiating appropriate antimicrobial therapy. To evaluate the diagnostic effectiveness in patients with suspected infectious diseases; three different molecular technologies and conventional microbiological tests were used.</div></div><div><h3>Methods</h3><div>A total of 97 individuals suspected of having infectious diseases were retrospectively enrolled from July 2023 to January 2024 at Shanghai General Hospital. Samples were collected for metagenomic next-generation sequencing (mNGS), droplet digital polymerase chain reaction (ddPCR), multiplex drop-off digital polymerase chain reaction (MDO-dPCR), and conventional microbiological tests (CMTs) for suspected pathogen detection. The diagnostic efficacies of the three molecular technologies and CMTs were compared, and the effects of their joint application on clinical outcomes were evaluated. Intergroup comparisons were performed using the Kruskal–Wallis test, with a <em>P</em>-value <0.05 considered statistically significant.</div></div><div><h3>Results</h3><div>Joint detection exhibited a high negative predictive value. The sensitivity of MDO-dPCR, ddPCR, and mNGS was 52.6%, 48.5%, and 96.6%, respectively; and the corresponding specificity was 72.5%, 73.3%, and 50.0%. A positive correlation was observed between pathogen copies detected using MDO-dPCR and procalcitonin (Pearson’s <em>ρ</em>=0.21, <em>P</em>=0.039), acute physiology and chronic health evaluation II (Pearson’s <em>ρ</em>=0.24, <em>P</em> =0.018), and sequential organ failure assessment (Pearson’s <em>ρ</em>=0.25, <em>P</em>=0.012). Therapeutic regimens were adjusted in 51.5% of the patients (50/97) based on the results of the combination tests.</div></div><div><h3>Conclusions</h3><div>In the present study, we highlighted the significance of molecular technologies for the early diagnosis of patients with suspected infections. These technologies can serve as a complement to CMTs and should be implemented promptly to guide clinicians in providing timely and effective anti-infective treatments. Future studies should aim to confirm these findings in large-scale clinical trials to refine diagnostic protocols, while also incorporating cost-utility analyses.</div></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"5 4","pages":"Pages 407-418"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145335103","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}
Pub Date : 2025-10-01Epub Date: 2025-09-04DOI: 10.1016/j.jointm.2025.06.001
Loreto Vidaur , Izaskun Azkarate , Estibaliz Salas , Iñigo Ansa , Diego Vicente , Jordi Rello , Milagrosa Montes
Background
Improving outcomes among patients with invasive group A Streptococcus pyogenes (iGAS) infections is an unmet clinical need. The main objective of this study was to analyze epidemiological and outcome differences in adults admitted to the intensive care unit (ICU) with iGAS infection over a 15-year period and to evaluate the impact of M1uk isolates and clindamycin optimization on patient outcomes.
Methods
This was a single-center observational study conducted at the ICU of Donostia University Hospital, located in Donostia, Spain. The recruitment of all consecutive adult patients admitted to the ICU by iGAS was carried out from January 2010 to May 2024 and divided into three periods: pre-pandemic (January 2010–2019), pandemic (2020–2021), and post-pandemic (May 2022–2024). The main outcome variables were ICU length of stay, hospital length of stay, and ICU mortality. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) software (version 25; SPSS Inc., Chicago, IL, USA). A significance level of P <0.05 was considered for all analyses.
Results
Sixty-eight adults were enrolled, with a crude mortality in pre- and post-pandemic periods being 25.5% and 10.0% (P=0.200), respectively. Twenty (29.4%) were respiratory and 29 (41.2%) were soft tissue infections. The incidence had valleys (<1/100,000) in 2020 and 2021 and peaks (>4/100,000 inhabitants) in 2014, 2019, and 2023. Pre-pandemic patients were significantly younger (median: 58.0 vs. 67.5 years, P <0.050), had lower Charlson scores (median: 0 vs. 2, P=0.009), and required more renal replacement therapy (48.9% vs. 15.0%, P=0.013). Emm1 type was the most frequent isolated strain, with the M1uk lineage being represented in 6 out of 7 Emm1 isolates in post-pandemic period. M1uk-infected patients were older (median: 67.0 vs. 50.0 years, P=0.073) but mortality was similar. Most patients (86.6%) received β-lactams plus clindamycin. Interestingly, time to clindamycin administration was earlier (median: 1 h vs. 24 h; P <0.050) in the post-pandemic period with a 5-fold increase in ICU mortality (5.6% to 26.5%, OR=6.14, 95% CI: 0.74 to 50.85; P=0.090) among those adults who did not receive clindamycin in the emergency department.
Conclusions
The incidence of iGAS infections requiring ICU admission showed no significant increase post-Coronavirus Disease-19 pandemic. The highly toxigenic M1uk strain became predominant, but it was not associated with worse mortality among adult ICU patients.
{"title":"Severe invasive Streptococcus pyogenes infections: A 15-year observational study with molecular characterization of isolates among intensive care adults","authors":"Loreto Vidaur , Izaskun Azkarate , Estibaliz Salas , Iñigo Ansa , Diego Vicente , Jordi Rello , Milagrosa Montes","doi":"10.1016/j.jointm.2025.06.001","DOIUrl":"10.1016/j.jointm.2025.06.001","url":null,"abstract":"<div><h3>Background</h3><div>Improving outcomes among patients with invasive group A <em>Streptococcus pyogenes</em> (iGAS) infections is an unmet clinical need. The main objective of this study was to analyze epidemiological and outcome differences in adults admitted to the intensive care unit (ICU) with iGAS infection over a 15-year period and to evaluate the impact of M1uk isolates and clindamycin optimization on patient outcomes.</div></div><div><h3>Methods</h3><div>This was a single-center observational study conducted at the ICU of Donostia University Hospital, located in Donostia, Spain. The recruitment of all consecutive adult patients admitted to the ICU by iGAS was carried out from January 2010 to May 2024 and divided into three periods: pre-pandemic (January 2010–2019), pandemic (2020–2021), and post-pandemic (May 2022–2024). The main outcome variables were ICU length of stay, hospital length of stay, and ICU mortality. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) software (version 25; SPSS Inc., Chicago, IL, USA). A significance level of <em>P</em> <0.05 was considered for all analyses.</div></div><div><h3>Results</h3><div>Sixty-eight adults were enrolled, with a crude mortality in pre- and post-pandemic periods being 25.5% and 10.0% (<em>P</em>=0.200), respectively. Twenty (29.4%) were respiratory and 29 (41.2%) were soft tissue infections. The incidence had valleys (<1/100,000) in 2020 and 2021 and peaks (>4/100,000 inhabitants) in 2014, 2019, and 2023. Pre-pandemic patients were significantly younger (median: 58.0 <em>vs.</em> 67.5 years, <em>P</em> <0.050), had lower Charlson scores (median: 0 <em>vs.</em> 2, <em>P</em>=0.009), and required more renal replacement therapy (48.9% <em>vs.</em> 15.0%, <em>P</em>=0.013). <em>Emm1</em> type was the most frequent isolated strain, with the M1uk lineage being represented in 6 out of 7 <em>Emm1</em> isolates in post-pandemic period. M1uk-infected patients were older (median: 67.0 <em>vs.</em> 50.0 years, <em>P</em>=0.073) but mortality was similar. Most patients (86.6%) received β-lactams plus clindamycin. Interestingly, time to clindamycin administration was earlier (median: 1 h <em>vs.</em> 24 h; <em>P</em> <0.050) in the post-pandemic period with a 5-fold increase in ICU mortality (5.6% to 26.5%, OR=6.14, 95% CI: 0.74 to 50.85; <em>P</em>=0.090) among those adults who did not receive clindamycin in the emergency department.</div></div><div><h3>Conclusions</h3><div>The incidence of iGAS infections requiring ICU admission showed no significant increase post-Coronavirus Disease-19 pandemic. The highly toxigenic M1uk strain became predominant, but it was not associated with worse mortality among adult ICU patients.</div></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"5 4","pages":"Pages 336-343"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145335149","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}
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