Targeted next-generation sequencing (tNGS) has emerged as an advanced diagnostic technique. While tNGS is increasingly recognized as a valuable tool for detecting infections, its most relevant clinical indications remain underdefined. This study aimed to evaluate the clinical utility of tNGS for lower respiratory tract infections (LRTIs). We conducted a prospective, observational study to evaluate

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock (J-SSCG) 2020 aimed to standardize sepsis care in Japan. However, the extent of their impact on clinical practice remains uncertain. We conducted a nationwide retrospective cohort study using the Japanese Diagnosis Procedure Combination database between April 2018 and December 2021. Of the 118 clinical questions (CQs)

Non-invasive ventilation (NIV) is widely used in emergency settings for acute respiratory failure, with NIV failure, usually defined by the need for tracheal intubation, as its primary complication. In emergency settings where patients may not be intubated or or where NIV represents the ceiling of care, a pragmatic understanding of NIV failure requires a broader definition that incorporates early clinical

Low skeletal mass, often present at hospital admission, has been associated with poor prognoses. To explore the association between computed tomography (CT)-derived skeletal muscle mass at the lumbar level and short- and long-term mortality in critically ill patients. Following PRISMA 2020 guidelines, we included studies on critically ill adults (≥ 18 years) hospitalized in intensive care units (ICU)

The perspective by Ji et al. [1] provides a timely synthesis of evidence for traditional Chinese medicine (TCM) in sepsis management and underscores critical challenges in clinical translation. While the authors comprehensively outline the methodological limitations of existing TCM trials and emphasize the need for high-quality evidence, three interrelated issues warrant further discussion to guide

In Critical Care, Mellado-Artigas and colleagues [1] aimed to evaluate the effect of initiating invasive mechanical ventilation (IMV) immediately versus waiting in patients with hypoxemic respiratory failure on one-year mortality. They used the target trial emulation framework, which is an increasingly recognized approach for designing observational studies that aim to compare treatment strategies

The recruitment-to-inflation (R/I) ratio is a new bedside tool with potential to evaluate lung recruitability by positive end-expiratory pressure (PEEP) but was only validated using pressure–volume curves and the optimal threshold separating low and high recruiters by PEEP is not precisely known. The aim of the study is to evaluate the diagnostic performance of the R/I ratio using computed tomography

Cerebral compliance describes the pressure–volume relationship within the intracranial space, quantifying the brain’s capacity to accommodate changes in volume before significant increases in intracranial pressure (ICP) occur. The pulse shape index – PSI—classifies the ICP pulse-wave-configuration into 4 categories representing the incremental state of compliance. In this analysis we explore the metric

This study assessed the accuracy of three International Classification of Diseases (ICD) codes methods derived from Global Burden of Disease (GBD) sepsis study (modified GBD method) in identifying sepsis, compared to the Angus method. Sources of errors in these methods were also reported. Prospective multicentre, observational, study. Emergency Department patients aged ≥ 16 years with high sepsis risk

It was a pleasure to read the recent publication in Critical Care on the cardiovascular effects of lactate [1]. The authors conducted a randomized comparison between the infusion of hypertonic lactated solution and hypertonic saline solution and their effects on echocardiography measurements. The authors equalized the osmolarity of the solutions to ensure that there were no differences in volume expansion

Fluid management is an essential component of renal replacement therapy (RRT) in critically ill patients. Both a positive cumulative fluid balance (CFB) and a high net ultrafiltration (NUF) rate have been reported to be associated with adverse outcomes in epidemiological studies, although the overall trajectory of fluid balance after RRT initiation is not well-described. We aimed to characterize trajectories

Astrocytes assist in modulating the breathing cycle. Mechanically ventilated sedated patients have their respiratory drive suppressed, which may affect astrocytes’ function. This pilot study showed that phrenic nerve stimulation may protect astrocyte function and activity, maintaining the integrity of the blood–brain barrier in these patients. Neural control of respiratory rhythm is a complicated process

The optimal time for initiating kidney replacement therapy (KRT) in acute kidney injury (AKI) has been extensively studied in recent years. In contrast, there are currently insufficient data on the best time to discontinue KRT. One diagnostic option to unmask tubular reserve and indirectly estimate the glomerular filtration rate is the furosemide stress test (FST). We conducted a prospective, observational

Renal replacement therapy (RRT) is commonly used in critically ill patients with acute kidney injury (AKI). However, optimal timing of RRT liberation remains controversy. This meta-analysis evaluates novel biomarkers to predict successful RRT liberation in critically ill AKI patients. The systematic review reported following PRISMA guidelines, PubMed, Embase, and Scopus were searched up to May 2, 2025

Major Adverse Kidney Events within 30 days (MAKE30) is an important patient-centered outcome for assessing the impact of acute kidney injury (AKI). Existing prediction models for MAKE30 are static and overlook dynamic changes in clinical status. We introduce ORAKLE, a novel deep-learning model that utilizes evolving time-series data to predict MAKE30, enabling personalized, patient-centered approaches

Computed tomography perfusion (CTP) of the brain, are increasingly being employed for the assessment of critically ill patients admitted to intensive care units (ICU), including comatose cardiac arrest patients (CCAP). The purpose of our study was to validate the use of CTP in predicting in-hospital mortality in CCAPs. This prospective cohort study enrolled newly admitted adult CCAP, with an out of

One-way speaking valves (OWV) can be used in tracheostomy patients. Their design enables inhalation via the tracheostomy tube due to an open diaphragm, that closes immediately before or during exhalation, thus restoring normal physiological exhalation pathways. This mechanism provides multiple physiological and psychological benefits, including enabling voice, re-establishes subglottic pressure, enhances

We were highly interested in reading the clinical research conducted by Kim et al. [1]. This study is a single-center, retrospective clinical cohort investigation with a large sample size, focusing primarily on the significance of lower respiratory tract (LRT) cytomegalovirus (CMV) positivity in the prognosis of critically ill patients. The research departs from the traditional focus on CMV reactivation

Standard dosing regimens of meropenem and piperacillin-tazobactam frequently fail to achieve targeted plasma concentrations in critically ill patients. Extended or continuous regimens are often used to improve target attainment. Although prompt antibiotic initiation is a major determinant of survival, few studies have reported systemic concentrations early after treatment initiation. No prior study

Cerebral perfusion pressure (CPP) management is central to neurocritical care management after traumatic brain injury (TBI). While the Brain Trauma Foundation recommends a target of 60–70 mmHg, it is unclear whether this range reflects the lower limit or the optimal level, when viewed through the prism of cerebrovascular autoregulation. Autoregulation aims at stabilizing cerebral blood flow and can

Endotoxin septic shock is marked by severe organ failure and mortality rate that exceeds fifty percent, underscoring the critical need to tailor management strategies. Monitoring -endotoxin activity can guide the initiation and direction of adjunctive treatment for refractory septic shock through hemoadsorption. Thus, intervening based on the pathophysiological foundation may potentially improve outcomes

Intensive care units (ICUs) contribute significantly to healthcare's environmental footprint, with medications playing a major role. This study performed a comprehensive Material Flow Analysis (MFA) of medications in a large academic ICU to quantify material flows and identify opportunities for sustainability. A single-center MFA was conducted at a 50-bed ICU, analyzing all medications delivered in

Predicting the need for renal replacement therapy (RRT) in acute kidney injury (AKI) remains challenging. The utility of biomarkers was explored during previous studies which were biased as RRT indications relied on clinician opinion rather than evidence. Those studies preceded trials that clarified RRT initiation criteria. We aimed to assess biomarkers in predicting criteria for RRT initiation in

Recent studies have reported paradoxical associations between alcohol use and trauma outcomes, sparking debate in public health, trauma surgery, and emergency medicine [1,2,3]. In a recent paper published in Critical Care, Kazuma Sasaki et al. [4] explored the relationship between pre-injury alcohol consumption and traumatic brain injury (TBI) outcomes of hospitalized patients in Japan, reporting a

Sepsis survivors often experience cognitive, physiological, and functional impairments that may limit return to work (RTW). We aimed to describe changes in workforce attachment among working-age patients with sepsis, both overall and stratified by treatment in general wards versus the intensive care unit (ICU). Additionally, we aimed to evaluate the impact of educational level and to identify factors

Listeriosis is a rare but severe foodborne infection, particularly affecting immunocompromised individuals and older adults. Severe cases may lead to neurolisteriosis and sepsis, necessitating intensive care unit (ICU) admission. This study aims to analyze the demographic characteristics, clinical presentation, microbiological findings, treatments, and outcomes of critically ill patients with Listeria

Pre-admission status obtained through patient-reported outcome measures is an essential metric in both clinical and research settings for prognostication and treatment decisions. It is frequently collected by proxies, although its reliability has yet to be thoroughly investigated. The objective was to determine the reliability of proxy assessments regarding pre-ICU admission status via patient-reported

The pre-existing diagnosis of cirrhosis is a complicating factor in the progression and prognosis of sepsis; however, the unique epidemiology, sepsis characteristics, and underlying mechanisms of immune dysregulation in sepsis among patients with cirrhosis remain incompletely understood. Our primary objective was to identify clinical outcomes and biological characteristics that differ between patients

Neutrophil extracellular traps (NETs) are a vital part of the innate immune response, while excessive NET formation can cause tissue damage. H3.1 nucleosomes, a component of NETs, have emerged as a potential biomarker. This study aimed to evaluate H3.1 nucleosomes in critical illness, assessing their relationship with sepsis, organ failure, inflammatory subphenotypes and outcomes. The MARS cohort was

We have taken great interest in reading two recent studies published in Critical Care regarding the safety and efficacy of rezafungin in the treatment of candidemia and/or invasive candidiasis (IC) [1, 2]. Both studies conducted a pooled analysis of the randomized controlled trials (RCTs) ReSTORE and STRIVE, which demonstrated that rezafungin is comparable to caspofungin in terms of safety and efficacy

Current guidelines recommend a uniform mean arterial pressure (MAP) target for resuscitating critically ill patients; for example, 65 mmHg for patients with sepsis and post-cardiac arrest. However, since cerebral autoregulation capacity likely varies widely in patients, uniform target may be insufficient in maintaining cerebral perfusion. Personalized MAP targets, based on a non-invasive determination

The significance of the Recruitment to Inflation (R/I) ratio in identifying PEEP recruiters in patients undergoing ultra-protective lung ventilation during venovenous ECMO is not well established. To compare the concordance of the R/I ratio and Electrical Impedance Tomography (EIT) in determining optimum PEEP settings in severe ARDS patients on ECMO and ventilated with very low tidal volumes. Initially

Recent studies report that chest wall loading may reduce airway pressures and increase respiratory system compliance, contrary to the anticipated effect of this maneuver (“mechanical paradox”). Aim of this physiological study is to clarify the mechanism underlying this phenomenon. Twenty patients receiving invasive mechanical ventilation for acute hypoxemic respiratory failure were studied during a

The global health burden of sepsis is immense, characterized by significant loss of life and high healthcare costs. Traditional Chinese medicine (TCM), with its over two millennia of clinical practice in China, has gained attention as a potential adjunctive approach for sepsis. Here, we evaluated TCM applications in sepsis management, highlighting both potential benefits and methodological limitations

Airway management in critically ill obese patients is potentially associated with a higher risk of adverse events due to a constellation of physiological and anatomical challenges. Data from international prospective studies on peri-intubation adverse events in obese critically ill patients are lacking. INTUBE (International Observational Study to Understand the Impact and Best Practices of Airway

Dear Editor, We read with great interest the recent article by Shankar et al. on the use of admission CT perfusion (CTP) to diagnose in-hospital mortality in patients with severe traumatic brain injury (TBI) [1]. The study presents a compelling case for CTP as an early prognostic tool. However, we have a few questions and concerns that we believe warrant further discussion [2,3,4]. 1. The study defines

Failure to wean from invasive mechanical ventilation is multifactorial, with diaphragmatic dysfunction a significant contributing factor. Diaphragmatic function can be easily and non-invasively assessed by ultrasound. However, it remains unknown how ultrasound measurements of diaphragm function are affected by changes in apparent work of breathing. In patients undergoing weaning from mechanical ventilation

Acute kidney injury (AKI) is a critical yet frequently under diagnosed condition in hospitalized patients, impacting morbidity and mortality. Electronic alerts for AKI aimed to assist physicians in early diagnosis and intervention, though evidence for their effectiveness is inconsistent. A systematic search was conducted in PubMed, the Cochrane Central Register of Controlled Trials, Cochrane Library

In septic shock, the optimal timing of adjunctive vasopressin initiation shock is unknown. We aimed to assess the effect of its early initiation for patients with septic shock. We conducted a multicenter target trial emulation to estimate the intensive care unit (ICU) mortality effect of early (≤ 6 h) adjunctive vasopressin compared with usual care. Eligible patients had septic shock diagnosed within

Delayed administration of polymyxin B hemoperfusion (PMX-HP) for septic shock could diminish its efficacy in real-world clinical settings. BEAT-SHOCK (BEst Available Treatment for septic SHOCK) registry is a prospective registry consisting of 309 adult patients with septic shock requiring high-dose norepinephrine (≥ 0.2 μg/kg/min). This predetermined analysis included 82 patients treated with PMX-HP

Patients who undergo extracorporeal cardiopulmonary resuscitation (ECPR) are at risk of left ventricular distention and complications. There is emerging evidence that concurrent mechanical left ventricular (LV) unloading (e.g. an intra-aortic balloon pump, or microaxial left ventricular assist device) may improve survival. Despite this, there are no large, well-conducted studies investigating the impact

Extubation failure leading to reintubation is associated with high mortality. In patients at high-risk of extubation failure, clinical practice guidelines recommend prophylactic non-invasive ventilation (NIV) over high-flow nasal oxygen (HFNO) immediately after extubation. However, the physiological effects supporting the beneficial effect of NIV have been poorly explored. We hypothesized that NIV

The limited availability of novel antimicrobials against multidrug-resistant Gram-negative bacteria (MDR-GNB) has necessitated the reevaluation of older antibiotics [1, 2]. Polymyxins, including colistin (polymyxin E) and polymyxin B, were first discovered in 1949 and subsequently reclassified by the World Health Organization (WHO) in 2012 as critically important agents for the treatment of MDR-GNB

The pathophysiology of COVID-19 sepsis is linked to activation of the renin–angiotensin–aldosterone system (RAAS) pathway, a heightened inflammatory cascade, and thrombosis. Catecholamines are likely central to all three [1]. COVID-19 sepsis is often characterized by hypoxemia, hypotension, and shock, which are treated with exogenous catecholamines. However, some data suggest detrimental effects of

The optimal timing for initiating norepinephrine in septic shock is debated. This updated systematic review and meta-analysis aimed to evaluate the impact of early versus delayed norepinephrine initiation on mortality and clinical outcomes in adults with septic shock. A systematic search in Pubmed, EMbase and the Cochrane Library to identify eligible randomized controlled trials, propensity score matching

To advocate for a Liberal Transfusion Strategy (LTS) in neurocritical care patients with Acute Brain Injury (ABI) and provide updated evidence for optimizing transfusion thresholds in clinical guidelines. Anemia frequently complicates ABI management, often necessitating red blood cell transfusions. However, the optimal hemoglobin (Hb) threshold for transfusion remains controversial. While earlier meta-analyses

Correspondence Sepsis is characterized by life-threatening organ dysfunction due to a dysregulated systemic response to infection [1]. Previous studies have documented volumetric changes in single organs during sepsis [2, 3]. However, to our knowledge, no studies have simultaneously measured the volumes of multiple intra-abdominal organs and examined how these volumes change over time. Accordingly

Many patients who survive intensive care unit (ICU) stays experience persistent mental impairments. It is estimated that one-third of ICU survivors suffer from psychiatric disorders. However, research into how these disorders affect long-term outcomes in this population is scarce. Therefore, the aim of this study is to investigate the association between depression or anxiety and long-term mortality

Airway closure results in a lack of communication between proximal and distal airways unless the airway pressure (Paw) overcomes the airway opening pressure (AOP). This has been described in patients undergoing mechanical ventilation with acute respiratory distress syndrome, obesity, hydrostatic pulmonary edema and during cardiopulmonary resuscitation. In these categories of patients, esophageal pressure

The clinical significance of cytomegalovirus reactivation in the lower respiratory tract (LRT) of critically ill patients remains unclear. We aimed to investigate the association between cytomegalovirus reactivation detected in LRT and intensive care unit (ICU) prognosis. This study included critically ill patients admitted to a medical ICU at a tertiary referral center in South Korea between January

Assessing fluid responsiveness is problematic for critically ill patients with spontaneous breathing activity, such as during Pressure Support Ventilation (PSV), since spontaneous breathing activity physiologically affects heart–lung interplay. We compared the reliability of two hemodynamic tests in predicting fluid responsiveness in this clinical setting: SIGH35, based on a ventilator-generated sigh

Severe protein catabolism is a major aspect of critical illness and leads to pronounced muscle wasting and, consequently, extended intensive care unit (ICU) stay and increased mortality. The urea-to-creatinine ratio (UCR) has emerged as a promising biomarker for assessing protein catabolism in critical illness, which is currently lacking. This review aims to elucidate the role of UCR in the context

Severe traumatic brain injury (TBI) stands as the leading cause of post-injury hospitalization, disability, and mortality globally. Imaging serves as a cornerstone in the assessment of patients with severe TBI and CT Perfusion (CTP) has emerged as an early prognostic tool. Our study aims to validate CTP features of non-survivable brain injury, upon hospital admission to characterize in-hospital mortality

COVID-19 has been associated with an increased risk of thromboembolic complications, particularly in hospitalized patients. While early research focused on pre-Omicron variants, the thrombotic risk associated with SARS-CoV-2 Omicron infections remains unclear. Given the evolving nature of the pandemic, it is critical to assess whether current anticoagulation recommendations remain appropriate. We conducted

Trial registration: NCT03763773 . Registered 3 December 2018.

Procalcitonin is a 14.5 kDa protein used clinically as a marker of sepsis and therapeutic response to antibiotic therapy. However, its utility in critically ill patients with either acute kidney injury (AKI) or end-stage kidney disease (ESKD) who require continuous kidney replacement therapy (CKRT) is unknown. The aim of this study was to determine if plasma levels of procalcitonin could reliably distinguish

Studies suggest that the colonization of multidrug-resistant organism in the gut of healthcare workers is similar to that of healthy individuals. However, due to exposure to medical environments, is the abundance of antibiotic resistance genes (ARG) in the gut of ICU healthcare workers higher than that of healthy individuals? Prospective, multicentre, cross-sectional study. Eight medical centers in

Point-of-Care Ultrasonography (POCUS) has become part of the daily clinical practice of physicians dealing with emergencies in almost all European countries. This involves intensivists, emergency physicians, anesthesiologists, and generally physicians treating patients who require immediate clinical decision making, emergency care and proper monitoring improving safety of critically ill patients. In

Sepsis-associated acute kidney injury (S-AKI) is a severe complication characterized by high morbidity and mortality, driven by multi-organ dysfunction. Recent evidence suggests that pyroptosis, a form of programmed cell death distinct from apoptosis and necrosis, plays a critical role in the pathophysiology of S-AKI. This review examines the mechanisms of pyroptosis, focusing on inflammasome activation

The aim of this study was to evaluate the association of arterial hyperoxemia with neurological outcomes and mortality in adults with acute brain injury (ABI). Six electronic databases, including MEDLINE, Embase and online registers of clinical trials, were systematically searched from inception to June 1 st, 2024. Studies comparing the effects of hyperoxemia versus no hyperoxemia on outcomes of hospitalized