Pub Date : 2025-07-01DOI: 10.1016/j.jointm.2025.03.001
Jiajia Ren , Xiaoming Gao , Jueheng Liu , Mingzhu Liu , Aihui Dai , Chuchu Zhang , Guorong Deng , Xi Xu , Ruohan Li , Jiamei Li , Gang Wang
{"title":"The association of blood eosinophil levels with sepsis and mortality risk: An observational and Mendelian Randomization Study","authors":"Jiajia Ren , Xiaoming Gao , Jueheng Liu , Mingzhu Liu , Aihui Dai , Chuchu Zhang , Guorong Deng , Xi Xu , Ruohan Li , Jiamei Li , Gang Wang","doi":"10.1016/j.jointm.2025.03.001","DOIUrl":"10.1016/j.jointm.2025.03.001","url":null,"abstract":"","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"5 3","pages":"Pages 292-294"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144522365","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 : 2025-07-01DOI: 10.1016/j.jointm.2024.12.009
Yanxia Huang , Mei Meng , Xiaojun Pan , Sheng Zhang, Lidi Zhang, Jiao Liu, Dechang Chen
Background
Family presence is essential in reducing delirium and promoting early recovery of patients in the intensive care unit (ICU). This study was conducted through a questionnaire survey to examine the current visitation policies of ICUs in China and explore flexible visitation options.
Methods
Two versions of independently developed questionnaire, informed by relevant literature, was distributed in two versions: a medical staff questionnaire and a family questionnaire. The survey was administered online and conducted anonymously, with participants completing it after scanning a two-dimensional bar code. Data were collected from January 2020 to June 2020. We accessed the difference between the two groups were compared and the association between factors associated with family satisfaction were assessed.
Results
A total of 1200 hospitals across 30 provinces participated, yielding 16,359 valid responses (13,483 from medical staff and 2876 from family members). Currently, 90.5 % of the ICUs allow once-daily visitation, whereas only 1.2 % permit unrestricted visitation. Family care was allowed in 15.0 % of the ICUs at the end of the patient's life, and 30.3 % allowed flexible visitation for rehabilitation exercises. Among medical staff, 73.9 % of doctors and 58.7 % of nurses supported flexible visitation when rehabilitation exercises are needed. In addition, 73.3 % of family members were willing to help with rehabilitation exercises, and 77.3 % were satisfied with the existing visitation policies.
Conclusions
Most ICUs in mainland of China enforce restrictive visitation policies, most medical staff and family members accept. Moreover, flexible visitation policies for rehabilitation purposes may be increasingly acceptable in the future.
{"title":"Nationwide survey on ICU visiting policies in Mainland of China: Current practices and perspectives","authors":"Yanxia Huang , Mei Meng , Xiaojun Pan , Sheng Zhang, Lidi Zhang, Jiao Liu, Dechang Chen","doi":"10.1016/j.jointm.2024.12.009","DOIUrl":"10.1016/j.jointm.2024.12.009","url":null,"abstract":"<div><h3>Background</h3><div>Family presence is essential in reducing delirium and promoting early recovery of patients in the intensive care unit (ICU). This study was conducted through a questionnaire survey to examine the current visitation policies of ICUs in China and explore flexible visitation options.</div></div><div><h3>Methods</h3><div>Two versions of independently developed questionnaire, informed by relevant literature, was distributed in two versions: a medical staff questionnaire and a family questionnaire. The survey was administered online and conducted anonymously, with participants completing it after scanning a two-dimensional bar code. Data were collected from January 2020 to June 2020. We accessed the difference between the two groups were compared and the association between factors associated with family satisfaction were assessed.</div></div><div><h3>Results</h3><div>A total of 1200 hospitals across 30 provinces participated, yielding 16,359 valid responses (13,483 from medical staff and 2876 from family members). Currently, 90.5 % of the ICUs allow once-daily visitation, whereas only 1.2 % permit unrestricted visitation. Family care was allowed in 15.0 % of the ICUs at the end of the patient's life, and 30.3 % allowed flexible visitation for rehabilitation exercises. Among medical staff, 73.9 % of doctors and 58.7 % of nurses supported flexible visitation when rehabilitation exercises are needed. In addition, 73.3 % of family members were willing to help with rehabilitation exercises, and 77.3 % were satisfied with the existing visitation policies.</div></div><div><h3>Conclusions</h3><div>Most ICUs in mainland of China enforce restrictive visitation policies, most medical staff and family members accept. Moreover, flexible visitation policies for rehabilitation purposes may be increasingly acceptable in the future.</div></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"5 3","pages":"Pages 269-275"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144522362","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 : 2025-07-01DOI: 10.1016/j.jointm.2025.03.004
Craig M. Coopersmith
{"title":"Future directions in sepsis research","authors":"Craig M. Coopersmith","doi":"10.1016/j.jointm.2025.03.004","DOIUrl":"10.1016/j.jointm.2025.03.004","url":null,"abstract":"","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"5 3","pages":"Pages 211-213"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144522456","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 : 2025-07-01DOI: 10.1016/j.jointm.2025.01.001
Guillaume Carteaux , Anne-Fleur Haudebourg
De novo acute hypoxemic respiratory failure (AHRF) remains one of the leading causes of intensive care unit (ICU) admission and is still associated with high rates of intubation and mortality. Developing effective strategies to prevent intubation and its associated complications remains a critical objective in this population. Noninvasive ventilation (NIV) has been proposed as a potential alternative to invasive ventilation in AHRF. However, no clear clinical benefit has been consistently demonstrated to date. The lack of definitive evidence has left experts unable to provide recommendations for the use of NIV in AHRF. Several factors may account for the inconsistencies in the literature and merit further investigation. Identifying early predictive criteria for NIV failure could be essential in determining which patients are most likely to benefit from this intervention. In addition, the approach to NIV settings may require reconsideration, particularly regarding the level of assistance. Efforts to reduce tidal volume, while aiming to minimize ventilator-induced lung injury, may have inadvertently resulted in insufficient support, amplifying the harmful effects of excessive inspiratory effort. The choice of interface may also significantly influence the physiological effects and outcomes and warrants further exploration. Finally, the frugal nature of noninvasive techniques makes them well-suited for the universal management of AHRF, regardless of constraints. This highlights the need for future developments aimed at optimizing oxygen and energy efficiency, enhancing the ease of use and robustness of NIV devices, and evaluating the effectiveness of NIV under high-constraint conditions, such as in low- and middle-income countries. This review addresses these critical questions.
{"title":"Noninvasive ventilation in acute hypoxemic respiratory failure: What is the future?","authors":"Guillaume Carteaux , Anne-Fleur Haudebourg","doi":"10.1016/j.jointm.2025.01.001","DOIUrl":"10.1016/j.jointm.2025.01.001","url":null,"abstract":"<div><div><em>De novo</em> acute hypoxemic respiratory failure (AHRF) remains one of the leading causes of intensive care unit (ICU) admission and is still associated with high rates of intubation and mortality. Developing effective strategies to prevent intubation and its associated complications remains a critical objective in this population. Noninvasive ventilation (NIV) has been proposed as a potential alternative to invasive ventilation in AHRF. However, no clear clinical benefit has been consistently demonstrated to date. The lack of definitive evidence has left experts unable to provide recommendations for the use of NIV in AHRF. Several factors may account for the inconsistencies in the literature and merit further investigation. Identifying early predictive criteria for NIV failure could be essential in determining which patients are most likely to benefit from this intervention. In addition, the approach to NIV settings may require reconsideration, particularly regarding the level of assistance. Efforts to reduce tidal volume, while aiming to minimize ventilator-induced lung injury, may have inadvertently resulted in insufficient support, amplifying the harmful effects of excessive inspiratory effort. The choice of interface may also significantly influence the physiological effects and outcomes and warrants further exploration. Finally, the frugal nature of noninvasive techniques makes them well-suited for the universal management of AHRF, regardless of constraints. This highlights the need for future developments aimed at optimizing oxygen and energy efficiency, enhancing the ease of use and robustness of NIV devices, and evaluating the effectiveness of NIV under high-constraint conditions, such as in low- and middle-income countries. This review addresses these critical questions.</div></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"5 3","pages":"Pages 237-245"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144522357","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 : 2025-07-01DOI: 10.1016/j.jointm.2025.01.002
Antonis Kalakoutas , Ashley Thomas , Thomas Fisher , Bethany Lane
Background
Fluid balance management is critical in moderate and severe traumatic brain injury (TBI) due to impaired cerebrovascular autoregulation. This study systematically reviews the association of fluid volume management with outcomes in moderate to severe TBI.
Methods
We conducted a systematic literature search on MEDLINE, EMBASE, CINAHL, The Cochrane Database, and bibliographies of included articles. Studies assessing fluid volume management and outcomes in moderate/severe TBI patients were included. Risk of bias, publication bias, and heterogeneity were comprehensively assessed. Primary outcomes were short/long-term mortality and neurological outcomes. Secondary outcomes included the effect on intracranial pressure, development of acute kidney injury (AKI), refractory intracranial hypertension (RIH), pulmonary edema/acute respiratory distress syndrome, length of stay, and length of mechanical ventilation. Fluid balance groups were categorized into restrictive, euvolemic, and liberal.
Results
Out of 2668 studies identified, 12 studies (seven observational and five randomized controlled trials [RCTs]) involving 9184 TBI patients were included. Euvolemic fluid balance was associated with lower odds of mortality compared to restrictive (odds ratio [OR] = 0.39, 95% confidence interval [CI]: 0.27 to 0.57, P <0.00001) and liberal groups (OR=0.47, 95% CI: 0.31 to 0.70, P=0.0003), and improved odds of favorable neurological outcomes compared to restrictive (OR=2.51, 95% CI: 1.72 to 3.66, P <0.00001) and liberal groups (OR=1.86, 95% CI: 1.18 to 2.92, P=0.007). Euvolemic balance also reduced the odds of AKI and RIH, and shortened the mean length of mechanical ventilation compared to liberal fluid balance groups but not the restrictive ones.
Conclusions
Euvolemic fluid balance may improve key outcomes in TBI patients, including reduced mortality and better neurological outcomes. These findings underscore the need for RCTs to further assess euvolemic fluid management protocols in neurocritical care and their potential to inform clinical guidelines.
{"title":"The association of fluid balance with traumatic brain injury outcomes: A systematic review","authors":"Antonis Kalakoutas , Ashley Thomas , Thomas Fisher , Bethany Lane","doi":"10.1016/j.jointm.2025.01.002","DOIUrl":"10.1016/j.jointm.2025.01.002","url":null,"abstract":"<div><h3>Background</h3><div>Fluid balance management is critical in moderate and severe traumatic brain injury (TBI) due to impaired cerebrovascular autoregulation. This study systematically reviews the association of fluid volume management with outcomes in moderate to severe TBI.</div></div><div><h3>Methods</h3><div>We conducted a systematic literature search on MEDLINE, EMBASE, CINAHL, The Cochrane Database, and bibliographies of included articles. Studies assessing fluid volume management and outcomes in moderate/severe TBI patients were included. Risk of bias, publication bias, and heterogeneity were comprehensively assessed. Primary outcomes were short/long-term mortality and neurological outcomes. Secondary outcomes included the effect on intracranial pressure, development of acute kidney injury (AKI), refractory intracranial hypertension (RIH), pulmonary edema/acute respiratory distress syndrome, length of stay, and length of mechanical ventilation. Fluid balance groups were categorized into restrictive, euvolemic, and liberal.</div></div><div><h3>Results</h3><div>Out of 2668 studies identified, 12 studies (seven observational and five randomized controlled trials [RCTs]) involving 9184 TBI patients were included. Euvolemic fluid balance was associated with lower odds of mortality compared to restrictive (odds ratio [OR] = 0.39, 95% confidence interval [CI]: 0.27 to 0.57, <em>P</em> <0.00001) and liberal groups (OR=0.47, 95% CI: 0.31 to 0.70, <em>P</em>=0.0003), and improved odds of favorable neurological outcomes compared to restrictive (OR=2.51, 95% CI: 1.72 to 3.66, <em>P</em> <0.00001) and liberal groups (OR=1.86, 95% CI: 1.18 to 2.92, <em>P</em>=0.007). Euvolemic balance also reduced the odds of AKI and RIH, and shortened the mean length of mechanical ventilation compared to liberal fluid balance groups but not the restrictive ones.</div></div><div><h3>Conclusions</h3><div>Euvolemic fluid balance may improve key outcomes in TBI patients, including reduced mortality and better neurological outcomes. These findings underscore the need for RCTs to further assess euvolemic fluid management protocols in neurocritical care and their potential to inform clinical guidelines.</div></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"5 3","pages":"Pages 276-287"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144522363","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 : 2025-07-01DOI: 10.1016/j.jointm.2024.11.001
Yucai Hong , Lin Chen , Yang Yu , Ziyue Zhao , Ronghua Wu , Rui Gong , Yandong Cheng , Lingmin Yuan , Shaojun Zheng , Cheng Zheng , Ronghai Lin , Jianping Chen , Kangwei Sun , Ping Xu , Li Ye , Chaoting Han , Xihao Zhou , Yaqing Liu , Jianhua Yu , Yaqin Zheng , Zhongheng Zhang
Background
Heterogeneity is a critical characteristic of severe coronavirus disease 2019 (COVID-19) pneumonia. Integrating chest computed tomography (CT) imaging and plasma proteomics holds the potential to elucidate Image-Expression Axes (IEAs) that can effectively address this disease heterogeneity.
Methods
A cohort of subjects diagnosed with severe COVID-19 pneumonia at 12 participating hospitals between December 2022 and March 2023 was prospectively screened for eligibility. Context-aware self-supervised representation learning (CSRL) was employed to extract intricate features from CT images. Quantification of plasma proteins was achieved using the Olink® inflammation panel. A deep learning model was meticulously trained, with CSRL features serving as input and the proteomic data as the target. This trained model facilitated the construction of IEAs, offering a representation of the underlying disease heterogeneity. The potential of these IEAs for prognostic and predictive enrichment was subsequently explored via conventional regression models.
Results
The study cohort comprised 1979 eligible patients, who were stratified into a training set of 630 individuals and a testing set of 1349 individuals. Three distinct IEAs were identified: IEA1 was correlated with shock conditions, IEA2 was associated with the systemic inflammatory response syndrome (SIRS), and IEA3 was reflective of the coagulation profile. Notably, IEA1 (odds ratio [OR]= 0.52, 95 % confidence interval [CI]: 0.40 to 0.67, P < 0.001) and IEA2 (OR=0.74, 95 % CI: 0.62 to 0.90, P=0.002) exhibited significant associations with the risk of mortality. Intriguingly, patients characterized by lower IEA1 values (<-2, indicative of more severe shock) demonstrated a reduced mortality risk when administered with steroids. Conversely, patients with higher IEA2 values seemed to benefit from a judicious approach to fluid infusion.
Conclusions
Our comprehensive approach, seamlessly integrating advanced deep learning techniques, proteomic profiling, and clinical data, has unraveled intricate interdependencies between IEAs, protein abundance patterns, therapeutic interventions, and ultimate patient outcomes in the context of severe COVID-19 pneumonia. These discoveries make a significant contribution to the rapidly advancing field of precision medicine, paving the way for tailored therapeutic strategies that can significantly impact patient care.
{"title":"Deep learning integration of chest computed tomography and plasma proteomics to identify novel aspects of severe COVID-19 pneumonia","authors":"Yucai Hong , Lin Chen , Yang Yu , Ziyue Zhao , Ronghua Wu , Rui Gong , Yandong Cheng , Lingmin Yuan , Shaojun Zheng , Cheng Zheng , Ronghai Lin , Jianping Chen , Kangwei Sun , Ping Xu , Li Ye , Chaoting Han , Xihao Zhou , Yaqing Liu , Jianhua Yu , Yaqin Zheng , Zhongheng Zhang","doi":"10.1016/j.jointm.2024.11.001","DOIUrl":"10.1016/j.jointm.2024.11.001","url":null,"abstract":"<div><h3>Background</h3><div>Heterogeneity is a critical characteristic of severe coronavirus disease 2019 (COVID-19) pneumonia. Integrating chest computed tomography (CT) imaging and plasma proteomics holds the potential to elucidate Image-Expression Axes (IEAs) that can effectively address this disease heterogeneity.</div></div><div><h3>Methods</h3><div>A cohort of subjects diagnosed with severe COVID-19 pneumonia at 12 participating hospitals between December 2022 and March 2023 was prospectively screened for eligibility. Context-aware self-supervised representation learning (CSRL) was employed to extract intricate features from CT images. Quantification of plasma proteins was achieved using the Olink® inflammation panel. A deep learning model was meticulously trained, with CSRL features serving as input and the proteomic data as the target. This trained model facilitated the construction of IEAs, offering a representation of the underlying disease heterogeneity. The potential of these IEAs for prognostic and predictive enrichment was subsequently explored via conventional regression models.</div></div><div><h3>Results</h3><div>The study cohort comprised 1979 eligible patients, who were stratified into a training set of 630 individuals and a testing set of 1349 individuals. Three distinct IEAs were identified: IEA1 was correlated with shock conditions, IEA2 was associated with the systemic inflammatory response syndrome (SIRS), and IEA3 was reflective of the coagulation profile. Notably, IEA1 (odds ratio [OR]= 0.52, 95 % confidence interval [CI]: 0.40 to 0.67, <em>P</em> < 0.001) and IEA2 (OR=0.74, 95 % CI: 0.62 to 0.90, <em>P</em>=0.002) exhibited significant associations with the risk of mortality. Intriguingly, patients characterized by lower IEA1 values (<-2, indicative of more severe shock) demonstrated a reduced mortality risk when administered with steroids. Conversely, patients with higher IEA2 values seemed to benefit from a judicious approach to fluid infusion.</div></div><div><h3>Conclusions</h3><div>Our comprehensive approach, seamlessly integrating advanced deep learning techniques, proteomic profiling, and clinical data, has unraveled intricate interdependencies between IEAs, protein abundance patterns, therapeutic interventions, and ultimate patient outcomes in the context of severe COVID-19 pneumonia. These discoveries make a significant contribution to the rapidly advancing field of precision medicine, paving the way for tailored therapeutic strategies that can significantly impact patient care.</div></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"5 3","pages":"Pages 252-261"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144522360","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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