Meropenem and piperacillin/tazobactam optimised dosing regimens for critically ill patients receiving renal replacement therapy.

Purpose: Optimal dosing of meropenem and piperacillin/tazobactam in critically ill patients receiving renal replacement therapy (RRT) is uncertain due to variable pharmacokinetics. We aimed to develop generalisable optimised dosing recommendations for these antibiotics.

Methods: Prospective, multinational pharmacokinetic study including patients requiring various forms of RRT.

Albumin Enhances Microvascular Reactivity in Sepsis: Insights from Near-Infrared Spectroscopy and Vascular Occlusion Testing.

: In septic shock, microcirculatory dysfunction contributes to organ failure and mortality. While sidestream dark-field (SDF) imaging is the reference method for assessing microvascular perfusion, its complexity limits routine use. This study evaluates near-infrared spectroscopy (NIRS) with vascular occlusion testing (VOT) as a potential bedside tool for monitoring microcirculatory changes following fluid resuscitation.

Advocating for the recognition of underlying immunosuppression in critical illness.

Unlabelled: Immunosuppression, characterised by impaired immune function, significantly influences infection risk and ICU admissions in critically ill patients. This manuscript highlights the need for grading criteria to assess pre-existing immunosuppression, considering factors like underlying diseases, immunosuppressive therapies, and clinical outcomes variability. We propose a grading system categorising immunosuppression as mild, moderate, or severe.

Current sepsis management practices in European emergency departments: the ISG-emergency department European Survey.

Background: Emergency departments (EDs) are often the first point of contact for patients with sepsis, and therefore play a critical role in early recognition and treatment. However, the extent to which sepsis guidelines are implemented across EDs in Europe remains unclear, and variability in adherence may impact patient outcomes.

Objective: This study aimed to assess current sepsis management practices in European EDs, evaluate adherence to international guidelines, and identify key challenges limiting effective implementation.

Platelet transfusion practice in the intensive care unit: the Nine-I international platelet transfusion survey.

Background: Platelet transfusions are frequent in the Intensive Care Unit (ICU), either as prophylaxis against bleeding complications or as treatment for bleeding. The European Society of Intensive Care Medicine guidelines for ICU patients generally recommend not using prophylactic platelet transfusions unless the platelet count falls below 10 × 10 cells/L in non-bleeding patients and make no recommendation for platelet transfusion threshold in non-massively bleeding patients with thrombocytopenia. Therefore, the decision to transfuse platelets is often left to clinical assessment by the treating physician.

Longitudinal analysis of lung microbiome, immune response, and metabolism in ventilator-associated pneumonia: a cohort study.

Rationale:  Ventilator-associated pneumonia (VAP) is a common complication in patients under invasive mechanical ventilation (IMV), yet its underlying mechanisms remain poorly understood. This study investigated the lung microbiome, inflammatory response, and metabolism in patients undergoing IMV to identify factors that may predispose them to developing VAP.

Objectives: To investigate how changes in lung microbiome composition, inflammatory response, and metabolic profiles may predispose patients undergoing IMV to develop VAP.

Advances in the critical care management for patients with hematological malignancies.

Hematological malignancies (HMs) are increasingly associated with life-threatening complications requiring intensive care unit (ICU) management. Recent advancements in therapies, diagnostics, and critical care protocols have improved outcomes for these patients, yet significant challenges persist. This manuscript explores the evolving landscape of critical care in hematology, emphasizing the unique complications, management strategies, and future directions in the field.

Sex-based differences in ICU management and outcomes of immunocompromised patients: A post hoc analysis of the prospective multicenter multinational Efraim cohort.

Purpose: There may be sex-based disparities in intensive care unit (ICU) management and outcomes. We compared baseline variables, interventions, and outcomes of immunocompromised critically ill men and women.

Methods: We performed a post hoc analysis of the Efraim study, a prospective multinational cohort study of immunocompromised adults with acute hypoxemic respiratory failure admitted to one of 68 ICU in 16 countries between November 2015 and July 2016.

Does Empirical Antibiotic Use Improve Outcomes in Ventilated Patients with Pandemic Viral Infection? A Multicentre Retrospective Study.

During the influenza A(H1N1) and COVID-19 pandemics, empirical antibiotic treatment (EAT) was widely administered to critically ill patients despite low rates of confirmed bacterial co-infection (COI). The clinical benefit of this practice remains uncertain and may contradict antimicrobial stewardship principles. To evaluate whether EAT at ICU admission reduces ventilator-associated pneumonia (VAP) incidence or ICU mortality in critically ill patients with pandemic viral pneumonia, stratified by presence of COI.

Mortality of pneumonia in intensive care units: a post-hoc analysis of an international multicenter study by ESGCIP and EFISG.

Background: pneumonia (PJP) is a life-threatening disease. In the intensive care unit (ICU), PJP is most frequently observed among patients with several conditions not related to the human immunodeficiency virus (HIV) infection.

Methods: The primary objective of the present post-hoc analysis of a multicenter, multinational, retrospective study was to assess factors impacting prognosis in ICU patients with PJP through univariable and multivariable analyses.

Management of Intra-Abdominal Candidiasis in Intensive Care Setting: A Narrative Review.

Intra-abdominal candidiasis (IAC), with or without candidemia, is a common condition in patients in intensive care units (ICUs). Early diagnosis of IAC remains a challenge for clinicians despite new biomarkers. Early and appropriate antifungal treatment, which is associated with better clinical outcomes, is negatively affected by the increased isolation of non-albicans strains that are resistant to the commonly used azoles and echinocandins.

How to approach a patient hospitalized for pneumonia who is not responding to treatment?

Pneumonia is a frequent cause of intensive care unit (ICU) admission and is the most common infection in ICU patients across all geographic regions. It takes 48-72h for most patients to respond to appropriate antibiotic therapy. Non-response is typically defined as the persistence/worsening of clinical signs-such as fever, respiratory distress, impaired oxygenation and/or radiographic abnormalities-with rates ranging 20-30%.

Severe community-acquired pneumonia (sCAP): advances in management and future directions.

Severe community-acquired pneumonia (sCAP) is a major global health challenge, with high morbidity and mortality, especially among patients requiring intensive care. Despite advancements in antimicrobial therapies and supportive care, sCAP remains a significant threat, particularly for those needing invasive mechanical ventilation or vasopressor support. Recent progress in diagnostics, therapeutics and management strategies offers hope for improved outcomes.

Nosocomial lower respiratory tract infections in patients with immunosuppression: a cohort study.

Background: This post-hoc analysis of a multinational, multicenter study aimed to describe and compare clinical characteristics, microbiology, and outcomes between immunosuppressed and non-immunosuppressed patients with nosocomial lower respiratory tract infections (nLRTI). The study utilized data from the European Network for ICU-related Respiratory Infections, including 1,060 adult ICU patients diagnosed with nLRTI. Descriptive statistics were used to compare baseline characteristics and pathogen distribution between groups.

Identification and validation of robust hospital-acquired pneumonia subphenotypes associated with all-cause mortality: a multi-cohort derivation and validation.

Purpose: Despite optimal antimicrobial therapy, the treatment failure rate of hospital-acquired pneumonia (HAP) routinely reaches 40% in critically ill patients. Subphenotypes have been identified within sepsis and acute respiratory distress syndrome with important predictive and possibly therapeutic implications. We derived prognosis subphenotypes for HAP and explored whether they were associated with biological markers and response to treatment.

Outcomes in immunocompromised patients with acute hypoxemic respiratory failure treated by high-flow nasal oxygen.

Purpose: Acute hypoxemic respiratory failure (ARF) is a major challenge in immunocompromised patients, often complicated by severe respiratory distress and organ dysfunction. High-flow nasal oxygen (HFNO) therapy is the standard of care, but data on its effectiveness and outcomes are limited. This study evaluated the outcomes of HFNO in this population, predictors of invasive mechanical ventilation (IMV), and factors associated with 28-day mortality.

How to manage antivirals in critically ill patients with influenza?

Background: Influenza is a significant cause of morbidity and mortality, particularly in critically ill patients. The availability of effective antiviral therapies is pivotal in mitigating the severity and complications associated with influenza.

Objectives: This review evaluates the antivirals available for the treatment of severe influenza in critically ill patients, focusing on the strength of recommendations and levels of evidence derived from clinical trials, observational studies, and guidelines.

A consensus of European experts on the definition of ventilator-associated pneumonia recurrences obtained by the Delphi method: the RECUVAP study.

Background: There are recognized diagnostic criteria for a first ventilator-associated pneumonia (VAP) episode, but not for recurrences. Many randomized clinical trials (RCTs) have used the recurrence of VAP as a criterion for efficacy evaluation. Still, the different definitions used in RCTs make it difficult to compare studies.

End-of-life decision disparities according to the gross national income in critically ill patients: a secondary analysis of the ETHICUS-2 study.

Aim: This study aimed to evaluate the association of end-of-life decisions and time to death in a global cohort of critically ill patients who participated in the international study on end-of-life practices in intensive care units (ICU) (Ethicus-2 study).

Methods: A post hoc analysis was conducted on data from a worldwide observational study that prospectively recruited adult ICU patients who died between September 1, 2015, and September 30, 2016, from 199 ICUs in 36 countries.

Results: The end-of-life pathways of 10,547 ICU non-survivors were s analysed.