Intracranial multimodal monitoring (iMMM) is increasingly used in neurocritical care, but a lack of standardization hinders its evidence-based development. Here, we devised core outcome sets (COS) and reporting guidelines to harmonize iMMM practices and research. An open, decentralized, three-round Delphi consensus study involved experts between December 2023 and June 2024. Items—spanning three domains:

Perioperative airway management and oxygenation maintenance during central airway obstruction (CAO) treatment pose great challenges. While veno-venous extracorporeal membrane oxygenation (V-V ECMO) shows promise as a bridge therapy, optimal implementation and management strategies remain lacking. We present our experience with V-V ECMO in CAO management from a high-volume center. We retrospectively

Oliguria diagnosis includes the normalization of urine output (UO) by body weight. However, the rational and the method to apply to normalize UO to body weight are unclear. We aimed to explore the impact of the method applied to normalize UO on oliguria incidence and association with outcomes. We included all adult patients admitted to a Swiss (derivation cohort) and a US (MIMIC-IV database, validation

To the Editor Tracheostomy is a surgical procedure commonly performed in the intensive care unit (ICU) [1]. It creates an artificial opening in the trachea for prolonged ventilation or airway obstruction. It offers benefits like improved airway protection and decreased respiratory effort but also brings physiological and psychological challenges, including speech loss and anxiety [2]. A speaking valve

Luciano Gattinoni was a truly exceptional scientist and a unique personality. He was one of the rare individuals destined to be cited in medical textbooks for generations to come. He passed away at the end of an extraordinary, active, and impactful life, just shy of his 80th birthday. Gattinoni studied in Milan, where he completed high school with a focus on classical humanities. This background profoundly

Dear editor, We would like to thank Pereira et al. for their letter regarding our recently published article [1] in which we performed a post hoc analysis of our two recent Phase II clinical trials on thiamine administration in septic shock, Thiamine in Septic Shock Trial (TSS) (NCT01070810) [2] and The Thiamine for Renal Protection in Septic Shock Trial (TRPSS) (NCT03550794) [3]. The authors now share

The present study was designed to investigate the evolution and the impact of respiratory muscles function and limb muscles strength on weaning success in prolonged weaning of tracheotomized patients. The primary objective was to determine whether the change in respiratory muscles function and limb muscles strength over the time is or is not associated with weaning success. Tracheotomized patients

Gastrointestinal (GI) dysfunction is common in critically ill patients and associated with poor outcomes. There is a lack of standardised methods for daily monitoring of GI function. COSMOGI aimed to develop a Core Outcome Set (COS) for daily monitoring of GI function to improve consistency and comparability in future studies in critically ill patients. A modified Delphi consensus process engaging

Patients with sepsis-induced AKI can be classified into two distinct sub-phenotypes (AKI-SP1, AKI-SP2) that differ in clinical outcomes and response to treatment. The biologic mechanisms underlying these sub-phenotypes remains unknown. Our objective was to understand the underlying biology that differentiates AKI sub-phenotypes and associations with kidney outcomes. We prospectively enrolled 173 ICU

The venous excess ultrasound (VExUS) score, introduced in 2020, has emerged as a valuable tool for assessing venous congestion in clinical practice [1]. With great interest, we read the brief report by Longino, A.A., et al. on the reliability of VExUS, inter-observer variability and reproducibility [2]. Their work represents an important step toward the broader adoption of this tool across diverse

Dear Editor, We read with great interest the recent study [1], which explored the associations between dyspnea and intubation/mortality in patients with hypoxemic respiratory failure. In this study, dyspnea was measured using a visual analog scale (dyspnea-VAS) with a range from 0 to 100 mm. A total of 300 patients were included. Among ICU patients admitted with acute hypoxemic respiratory failure

Crystalloid-based fluid resuscitation has long been a cornerstone in the initial management of trauma-induced hemorrhagic shock. However, its benefit is increasingly questioned as it is suspected to increase bleeding and worsen coagulopathy. The emergence of alternative strategies like permissive hypotension and vasopressor use lead to a shift in early trauma care practices. Critical appraisal of current

Dear Editor, Early initiation of invasive mechanical ventilation (IMV) may represent a potentially beneficial approach for sepsis patients [1]. A recent study by Kim et al. [2], published in Critical Care, provides evidence supporting this approach, reporting that earlier IMV initiation (on the first day of ICU admission) may be associated with lower mortality. However, in their study, 2,363 patients

To the editor, Intracranial hypertension (HICP) is a frequent cerebral insult after aneurysmal subarachnoid hemorrhage (SAH) and it is related to unfavorable outcome [1]. Its treatment is based on escalating-intensity approaches, translated from traumatic brain injury, including aggressive therapies such as barbiturate infusion, secondary surgical decompression and/or intracerebral hemorrhage (ICH)

Delirium is a frequent complication in critically ill patients and is associated with adverse outcomes such as long-term cognitive impairment and increased mortality. It is unknown whether there are sex-related differences in intensive care unit (ICU) delirium and associated outcomes. We aimed to assess sex-specific differences in short-term mortality following ICU-delirium. We conducted a retrospective

Shorter courses of antimicrobial therapy have been shown to be non-inferior to longer durations for the management of several infections. However, data on critically ill patients with severe infections by multidrug-resistant Gram-negative bacteria (MDR-GNB) are scarce. In the duratiOn of theraPy in severe infecTIons by MultIdrug-reSistant gram-nEgative bacteria (OPTIMISE) trial, we assessed the non-inferiority

We read with great interest the recent study [1] which investigated whether a relatively high arterial oxygen tension (PaO2) is associated with improved survival rate in sepsis compared to conservative oxygenation targets. After propensity score matching (PSM), 2422 patients evenly distributed between the liberal and conservative oxygen groups. The findings indicated that a higher PaO2 (≥ 80 mmHg)

To the editor: We read with interest the comments by Zhu and Li [1] regarding our article on evaluating various urine output (UO) thresholds and timeframes for defining acute kidney injury (AKI) [2]. The authors rightly emphasize that the core principle of AKI diagnosis is to reflect impaired excretion of metabolic waste. However, the concept of AKI must evolve in parallel with advancements in our

Dear Editor, We would like to thank Wei et al. [1] for their interest in our recently published correspondence in Critical Care [2]. The authors share our enthusiasm for the comparison of baricitinib and tocilizumab therapies in patients with coronavirus disease 2019 (COVID-19) receiving mechanical ventilation (MV) and agree that the study findings are important. However, they raised several issues

Guidelines for diabetic ketoacidosis (DKA) management are limited, resulting in varied practices. This study assessed Intensive Care Unit (ICU) admission criteria, fluid resuscitation, insulin therapy, and metabolic management in adult patients with DKA. An international survey of ICU clinicians consisted of 39 items that focused on management of DKA and was endorsed by the European Society of the

Dear Editor, We appreciate the comments from Drs. Shen and Ding [1] regarding our brief research report, “Stronger association of intact angiotensinogen with mortality than lactate or renin in critical illness: post-hoc analysis from the VICTAS trial [2]. Their letter addresses several excellent points about the extent and severity of septic shock in the VICTAS cohort in relation to serum lactate.

Cardiopulmonary bypass (CPB) triggers marked cytokine release often followed by a systemic inflammatory response syndrome, associated with adverse postoperative outcomes. This trial investigates the intraoperative use of haemoadsorption (HA) during cardiac surgery with CPB to assess its impact on postoperative systemic inflammatory response. In this prospective randomised controlled trial (ethics approval

Low endogenous immunoglobulin(Ig)-levels are common in critically ill patients with sepsis, but it is unknown whether low Ig-levels are associated with poor outcome, and in which patients Ig-replacement therapy (IgRT) improves outcome. Given the crucial role of immunoglobulins in eliminating certain encapsulated pathogens, we examined the relationship between serial Ig-levels and disease course in

Continuous waveform monitoring is standard-of-care for patients at risk for or with critically illness. Derived from waveforms, heart rate, respiratory rate and blood pressure variability contain useful diagnostic and prognostic information; and when combined with machine learning, can provide predictive indices relating to severity of illness and/or reduced physiologic reserve. Integration of predictive

Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is a supportive therapy for acute respiratory failure with increased risk of packed red blood cells (PRBC) transfusion. Blood cell salvage (BCS) aims to reduce blood transfusion, but its efficacy is unclear. This study aimed to estimate the effect of BCS at the time of removal of the ECMO circuit (ECMO decannulation) on PRBC transfused. To compare

To the editor, We read with great interest the recent study [1] published in Critical Care examining sepsis mortality among patients with hematological malignancies admitted to intensive care units between 2000 and 2022. The study’s findings highlighted a notable decline in in-hospital mortality rates for patients with hematological malignancies (from 55.6% in 2000 to 23.1% in 2021) and those without

Paediatric septic shock is a formidable challenge worldwide that significantly impacts health care systems. This nationwide retrospective study analyses the prevalence and mortality rates of paediatric septic shock across Thailand from 2015 to 2022, focusing on hospital burdens, including mechanical ventilation and renal replacement therapy. The study included paediatric patients ranging from infants

Loss of hemodynamic coherence is a phenomenon in critically ill patients. Due to inflammatory events and endothelial remodeling, macro- and microhemodynamics are decoupled from each other, resulting in microcirculatory disturbances and end organ ischemia despite adequate vital parameters. So far, quantification of perfusion of vessels with < 100 μm diameter on the intensive care unit (ICU) was regularly

Sepsis causes multiorgan dysfunction from immune dysregulation, resulting in high ICU admissions and mortality [1]. Lymphocytes are essential in the immune response during sepsis, with lymphopenia linked to increased vulnerability to secondary infections, higher sepsis severity, and mortality [2]. However, prior studies primarily analyzed lymphocyte counts at fixed time points, overlooking their dynamic

Dear editor In a recent brief report [1], Dr.Chappell and colleagues compared the predictive value of angiotensinogen, renin, and lactate for 30-day mortality in patients with sepsis or septic shock. The study included a total of 103 sepsis patients. The results showed that serum angiotensinogen concentration had a stronger association with mortality than either serum renin or lactate, suggesting that

To the editor, A recent study [1] by Dr. Kim and colleagues examined the association between the timing of mechanical ventilation (MV) and clinical outcomes in ICU patients with sepsis. The study included 2440 adult sepsis patients from 20 hospitals in Korea. Results showed that the early MV group had lower in-hospital mortality, shorter ICU stays, and less tracheostomy rate compared to the delayed

Thiamine and ascorbic acid have been proposed to mitigate the devastating consequences of sepsis and septic shock. To date, randomized controlled trials have failed to demonstrate a benefit of these therapies and heterogeneity of treatment effect is suspected. In this study, we aimed at assessing the heterogeneity of treatment effect of thiamine (B1) and the combination of B1 plus ascorbic acid (AA + B1)

In a recent study [1], Dr. Aoki and his colleagues investigated the association between whole blood ratio (WBR: whole blood volume/total blood volume) and the risk of mortality in trauma patients requiring massive blood transfusion. To adjust for potential confounders, multivariable logistic regression analysis with generalized estimating equations was adopted. The results showed that a higher proportion

The role of intra-aortic balloon pump (IABP) combined with venoarterial extracorporeal membrane oxygenation (VA-ECMO) in patients with cardiogenic shock (CS) remains unclear. This study investigated the effect of applying IABP for left ventricle (LV) unloading after VA-ECMO on reducing mortality in patients with CS. Data from 5,492 consecutive patients with CS treated with VA-ECMO between January 2017

We appreciate the comment by Añón and colleagues on our review article, which contributes to the discussion of potential benefits of inhaled sedation beyond hypnosis [1]. One key purpose of review articles is to explore developing areas of research. As Añón and colleagues illustrate well in their comment, our article synthesizes established pharmacological properties of volatile anesthetics with early

Treatment with short-acting betablockers in septic patients remains controversial. Two recent large multicenter trials have provided additional evidence on this therapeutic approach. We thus performed a meta-analysis, including the most recent data, to evaluate the potential impacts of treatment with short-acting betablockers on mortality in adult septic patients. The data search included PubMed, Web

Postextubation respiratory failure (PRF) frequently complicates weaning from mechanical ventilation and may increase morbidity/mortality. Noninvasive ventilation (NIV) alternating with high-flow nasal oxygen (HFNO) may prevent PRF. Ventilated patients without chronic obstructive pulmonary disease (COPD) and at high-risk of PRF defined as a lung ultrasound score (LUS) ≥ 14 assessed during the spontaneous

We read with great interest the database study by Aoki et al. [1], published in Critical Care. As highlighted in this article, whole blood (WB) transfusion for patients with trauma or severe hemorrhage has recently attracted worldwide attention for its promising potential in reducing mortality [2,3,4]. This study examines the association between the whole blood rate (WBR), defined as the number of

Dysregulation of the renin–angiotensin–aldosterone-system (RAAS) in sepsis is a complex and early phenomenon with a likely significant contribution to organ failure and patient outcomes. A better understanding of the pathophysiology and intricacies of the RAAS in septic shock has led to the use of exogenous angiotensin II as a new therapeutic agent. In this review, we report a multinational and multi-disciplinary

Morosanu and colleagues have recently published a fascinating pilot study in Critical Care [1]. Following elective coronary artery bypass grafting (CABG), patients were enrolled who were mechanically-ventilated within 6 h of admission to the intensive care unit (ICU) and who had acute circulatory failure. In these patients, the authors measured the change in portal vein pulsatility index (PVPI, i.e

The use of inhaled antibiotics for treating pneumonia in invasively ventilated patients offers a direct approach, allowing for high local concentrations of the drug in the lower respiratory tract while simultaneously reducing systemic toxicity. However, the real efficacy and safety of nebulized antibiotics remain unclear. The aim of the present is to assess among critically adult patients with pneumonia

High flow nasal cannula therapy (HFNC) and continuous positive airway pressure (CPAP) are two widely used modes of non-invasive respiratory support in paediatric critical care units. The FIRST-ABC randomised controlled trials (RCTs) evaluated the clinical and cost-effectiveness of HFNC compared with CPAP in two distinct critical care populations: acutely ill children (‘step-up’ RCT) and extubated children

The distinction between culture-positive sepsis and culture-negative sepsis regarding clinical characteristics and outcomes remains contentious. We aimed to elucidate these differences using large-scale nationwide data. This prospective cohort study analyzed data from the Korean Sepsis Alliance registry, comprising 21 intensive care units (ICUs) across 20 hospitals from September 2019 to December 2021

To the Editor, Inhaled nitric oxide (iNO) is widely used to treat hypoxic patients, especially those with acute respiratory distress syndrome (ARDS) [1]. We read with great interest the study by Isha et al. investigating the therapeutic efficacy of low-dose iNO in patients with COVID-19 [2]. Although this study provides valuable insights into this therapeutic approach, several considerations merit

Despite the clinical importance of sepsis-associated acute kidney injury (SA-AKI), little is known about its epidemiology. We aimed to investigate the incidence and outcomes of SA-AKI, as well as the risk factors for mortality among patients with severe SA-AKI in critically ill patients. This secondary multicenter, observational, prospective cohort analysis of sepsis in South Korea evaluated patients

Traumatic rhabdomyolysis (RM) is common and associated with the development of acute kidney injury and potentially with other organ dysfunctions. Thus, RM may increase the risk of death. The primary objective was to assess the effect of severe RM (Creatine Kinase [CK] > 5000 U/L) on 30-day mortality in trauma patients using a causal inference approach. In this multicenter cohort study conducted in

Pneumonia remains a significant global health concern, particularly among those requiring admission to the intensive care unit (ICU). Despite the availability of international guidelines, there remains heterogeneity in clinical management. The D-PRISM study aimed to develop a global overview of how pneumonias (i.e., community-acquired (CAP), hospital-acquired (HAP), and Ventilator-associated pneumonia

Sepsis remains an important global health problem and a leading cause of death in critically ill patients worldwide [1]. The β-lactam antibiotics are widely used as an important component of antibiotic therapy for patients with sepsis. The bactericidal activity of β-lactam antibiotics is typically time-dependent, and their clinical effectiveness is affected by the duration of the free drug concentration

To the editor, We read with great interest the recent study [1] by Dr. Machado et al., which proposed a new definition for acute kidney injury (AKI) in critically Ill patients, based on varied urine output thresholds and time frames. This study uses in-hospital mortality as an outcome-oriented approach to compose the proposed UO-AKI classification, applying different time frames (3 h, 6 h, 12 h, and

During central venous catheterization (CVC), ultrasound (US) guidance has been shown to reduce mechanical complications and increase success rates compared to the anatomical landmark (AL) technique. However, the impact of US guidance on catheter-related infections remains controversial. This systematic review and meta-analysis aimed to compare the risk of catheter-related infection with US-guided CVC

Electrical impedance tomography (EIT) is an emerging technology for the non-invasive monitoring of regional distribution of ventilation and perfusion, offering real-time and continuous data that can greatly enhance our understanding and management of various respiratory conditions and lung perfusion. Its application may be especially beneficial for critically ill mechanically ventilated patients. Despite

The level of inflammation alters drug pharmacokinetics (PK) in critically ill patients. This might compromise treatment efficacy. Understanding the specific effects of inflammation, measured by biomarkers, on drug absorption, distribution, metabolism, and excretion is might help in optimizing dosing strategies. This review investigates the relationship between inflammatory biomarkers and PK parameters

Sepsis is a global health problem with high morbidity and mortality. Low- and middle-income countries have a higher incidence and poorer outcome with sepsis. Large epidemiological studies in sepsis using Sepsis-3 criteria, addressing the process of care and deriving predictors of mortality are scarce in India. A multicentre, prospective sepsis registry was conducted using Sepsis 3 criteria of suspected

Sepsis is a frequent reason for ICU admission and a leading cause of death. Its incidence has been increasing over the past decades. While hospital mortality is decreasing, it is recognized that the sequelae of sepsis extend well beyond hospitalization and are associated with a high mortality rate that persists years after hospitalization. The aim of this study was to disentangle the relative contribution

To the Editor, The publication by Daniele Orsc et al. [1] in Critical Care, titled "Andexanet alpha versus four-factor prothrombin complex concentrate in DOACs anticoagulation reversal: an updated systematic review and meta-analysis," has significant clinical implications. This present study obtained two key findings that may complement their conclusions. The primary outcome of this meta-analysis revealed

In the context of an international, multicentre observational study—the GUTPHOS study [1]—the investigators documented the use of parenteral nutrition (PN), including daily energy intake via this route. A secondary outcome, “days free of PN," was planned to validate a gastrointestinal dysfunction score. During data quality check, we observed that the definition of PN varied among the participating

We read with interest the article by Michael Beshara et al. [1] entitled “Nuts and bolts of lung ultrasound: utility, scanning techniques, protocols, and findings in common pathologies”. In this review, the author provides a complete and accurate description of the latest applications of pulmonary ultrasound. For the part of pneumothorax, only the diagnostic methods and ultrasound signs were described

Dear Editor, We read the article by Isha et al. published in Critical Care with great interest [1]. The authors conducted a retrospective cohort study to explore the correlation between inhaled nitric oxide (iNO) and mortality in COVID-19 patients. This study had an important cohort, and one of the key conclusions drawn from their research is that COVID-19 patients supported by HFNC/NIV may benefit

We read the review by Müller-Wirtz [1] et al., recently published in this journal with interest. It addresses the advantages of using volatile anaesthetics for lung and diaphragm-protective sedation. As the authors point out in their methodology, it is a narrative review based on expert opinion to which we wanted to contribute with some comments we believe are important. The authors affirm that volatile

Understanding how preexisting comorbidities may interact with a critical illness is important for the assessment of long-term survival probability of older patients admitted to the ICU. The mortality after a first ICU admission in patients ≥ 55 years old registered in the Swedish Intensive Care Registry was compared to age- and sex-matched individuals from the general population with a landmark after