Vasopressin and its analogues in patients with septic shock: holy Grail or unfulfilled promise?

The Surviving Sepsis Campaign (SSC) recommends norepinephrine as first-line vasopressor in patients with septic shock. For many years, there has been growing evidence that high doses of norepinephrine might have cardiac and immunological adverse effects and be associated with poorer outcomes. Current SSC guidelines therefore suggest adding vasopressin, a non-catecholaminergic vasopressor, as a second-line vasopressor rather than increasing the norepinephrine dose in patients requiring doses of norepinephrine base > 0.

Evaluation of the mitral velocity-time integral changes induced by a passive leg raising test as a marker of fluid responsiveness in critically ill patients.

Background: Assessing fluid responsiveness is crucial in managing critically ill patients. Echocardiography, particularly passive leg raising (PLR)-induced changes in the velocity-time integral of the left ventricular outflow tract (VTI), is widely used for this purpose. We hypothesized that PLR-induced changes in the mitral valve velocity-time integral (VTI) could serve as a reliable alternative.

Vasopressin use across shock states: international insights from an international ESICM-endorsed survey: the PRESS Survey.

Background: Vasopressin is currently suggested as a second-line vasopressor in patients with septic shock and persistent arterial hypotension. This survey aimed to assess the current use of vasopressin and terlipressin in patients with septic shock.

Methods: An international survey endorsed by the European Society of the Intensive Care Medicine.

Correction: Impact of non-invasive oxygen reserve index versus standard SpO2 monitoring on peripheral oxygen saturation during endotracheal intubation in the intensive care unit: Protocol for the randomized controlled trial NESOI2.

[This corrects the article DOI: 10.1371/journal.pone.

Real-time changes in pulse pressure during a 10-second end-expiratory occlusion test reliably detect preload responsiveness.

Background: The end-expiratory occlusion (EEO) test detects preload responsiveness through changes in cardiac index (ΔCI) during a 15-second respiratory hold at end-expiration. We investigated the diagnostic accuracy of EEO-induced changes in arterial pulse pressure (∆PP), especially when the duration of EEO is reduced to 10'' and 5'', and whether adding an end-inspiratory occlusion (EIO) improves this diagnostic accuracy.

Methods: In 143 mechanically ventilated patients with sinus rhythm, EEO and EIO were performed while recording ΔCI and ∆PP values.

Study protocol and statistical plan for the ICRAKI trial: Intermittent haemodialysis versus continuous renal replacement therapy for severe acute kidney injury in critically ill patients.

Background: The effect of intermittent haemodialysis (IHD) continuous renal replacement therapy (CRRT) on mortality and/or renal function recovery in adults with acute kidney injury (AKI) and a recognised indication for renal replacement therapy (RRT) remains controversial.

Objective: To summarise the protocol and statistical analysis plan for the ICRAKI trial.

Design Settings And Participants: ICRAKI is a non-inferiority multicentre randomised controlled trial comparing IHD and CRRT.

Severe listeriosis in intensive care units: insights from a retrospective multicentric study.

Background: 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 infections in the ICU.

Mean arterial pressure after out-of-hospital cardiac arrest (METAPHORE): study protocol for a multicentre controlled trial with blinded primary outcome assessor.

Introduction: Out-of-hospital cardiac arrest is a public health concern with a high mortality rate. Hypoxic ischaemic brain injury is the primary cause of death in patients admitted to the intensive care unit (ICU) after return of spontaneous circulation (ROSC). Several systemic factors, such as hypotension, can exacerbate brain injuries.

Amikacin use in critically ill patients requiring renal replacement therapy: the AMIDIAL-ICU study.

Background: Acute kidney injury (AKI) requiring renal replacement therapy (RRT) is common in intensive care units (ICUs), yet optimal amikacin dosing in this context remains poorly understood.

Methods: We conducted a prospective observational study across 18 French hospitals from April 2020 to January 2022. Adult ICU patients (aged > 18 years) receiving their first amikacin dose while on RRT were included.

Using weak signals to predict spontaneous breathing trial success: a machine learning approach.

Background: Weaning from mechanical ventilation (MV) is a key phase in the management of intensive care unit (ICU) patient. According to the WEAN SAFE study, weaning from MV initiation is defined as the first attempt to separate a patient from the ventilator and the success is the absence of reintubation (or death) within 7 days of extubation. Mortality rates increase with the difficulty of weaning, reaching 38% for the most challenging cases.

Influence of Age and Central Hypertension on the Form Factor Needed to Estimate Mean Aortic Pressure, and Its Implications for Pulse Pressure Amplification: A Secondary Data Analysis.

Background: Mean aortic pressure (MAP) plays a pivotal role in both cardiovascular dynamics and the noninvasive estimation of systolic aortic pressure. MAP can be estimated by adding a fraction of the pulse pressure (PP) to the diastolic aortic pressure, known as the form factor (FF=100×[MAP-diastolic aortic pressure]/PP). A 41.

Management of diabetic keto-acidosis in adult patients admitted to intensive care unit: an ESICM-endorsed international survey.

Background: 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.

Methods: 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 Intensive Care Medicine.

Biomarkers in cardiogenic shock: old pals, new friends.

In cardiogenic shock, biomarkers should ideally help make the diagnosis, choose the right therapeutic options and monitor the patient in addition to clinical and echocardiographic indices. Among "old" biomarkers that have been used for decades, lactate detects, quantifies, and follows anaerobic metabolism, despite its lack of specificity. Renal and liver biomarkers are indispensable for detecting the effect of shock on organ function and are highly predictive of poor outcomes.

Oxygen therapy in acute hypoxemic respiratory failure: guidelines from the SRLF-SFMU consensus conference.

Introduction: Although largely used, the place of oxygen therapy and its devices in patients with acute hypoxemic respiratory failure (ARF) deserves to be clarified. The French Intensive Care Society (Société de Réanimation de Langue Française, SRLF) and the French Emergency Medicine Society (Société Française de Médecine d'Urgence, SFMU) organized a consensus conference on oxygen therapy in ARF (excluding acute cardiogenic pulmonary oedema and hypercapnic exacerbation of chronic obstructive diseases) in December 2023.

Methods: A committee without any conflict of interest (CoI) with the subject defined 7 generic questions and drew up a list of sub questions according to the population, intervention, comparison and outcomes (PICO) model.

Heart-Lungs interactions: the basics and clinical implications.

Heart-lungs interactions are related to the interplay between the cardiovascular and the respiratory system. They result from the respiratory-induced changes in intrathoracic pressure, which are transmitted to the cardiac cavities and to the changes in alveolar pressure, which may impact the lung microvessels. In spontaneously breathing patients, consequences of heart-lungs interactions are during inspiration an increase in right ventricular preload and afterload, a decrease in left ventricular preload and an increase in left ventricular afterload.

Effect of noninvasive ventilation on mortality and clinical outcomes among patients with severe hypoxemic COVID-19 pneumonia after high-flow nasal oxygen failure: a multicenter retrospective French cohort with propensity score analysis.

Background: We assessed the effect of noninvasive ventilation (NIV) on mortality and length of stay after high flow nasal oxygenation (HFNO) failure among patients with severe hypoxemic COVID-19 pneumonia.

Methods: In this multicenter, retrospective study, we enrolled COVID-19 patients admitted in intensive care unit (ICU) for severe COVID-19 pneumonia with a HFNO failure from December 2020 to January 2022. The primary outcome was to compare the 90-day mortality between patients who required a straight intubation after HFNO failure and patients who received NIV after HFNO failure.

Assessing the Accuracy of Systolic Aortic Pressure Estimation From a Brachial Cuff Alone: A Comparison With Radial Tonometry.

Background: A novel method for estimating central systolic aortic pressure (cSAP) has emerged, relying solely on the peripheral mean (MBP) and diastolic (DBP) blood pressures. We aimed to assess the accuracy of this Direct Central Blood Pressure estimation using cuff alone (DCBPcuff = MBP2/DBP) in comparison to the use of a generalized transfer function to derive cSAP from radial tonometry (cSAPtono).

Methods: This retrospective analysis involved the International Database of Central Arterial Properties for Risk Stratification (IDCARS) data (Aparicio et al.

Right ventricular injury in critically ill patients with COVID-19: a descriptive study with standardized echocardiographic follow-up.

Purpose: Patients with COVID-19 admitted to intensive care unit (ICU) may have right ventricular (RV) injury. The main goal of this study was to investigate the incidence of RV injury and to describe the patient trajectories in terms of RV injury during ICU stay.

Methods: Prospective and bicentric study with standardized transthoracic echocardiographic (TTE) follow-up during ICU stay with a maximum follow-up of 28 days.

Value and Variability of Pulse Shape Indicator for Estimating Mean Arterial Pressure in the Radial and Femoral Arteries.

Background: The form factor (FF) is a pulse shape indicator that corresponds to the fraction of pulse pressure added to diastolic blood pressure to estimate the time-averaged mean arterial pressure (MAP). Our invasive study assessed the FF value and variability at the radial and femoral artery levels and evaluated the recommended fixed FF value of 0.33.