After so many negative randomized, controlled trials, that have evaluated a number of simplified therapeutic interventions that could be applied to large patient populations, people are turning their interest back to personalized medicine.
This new Thematic Series will share thoughts based on scientific data and help the clinician to individualize the different aspects of the patient management.
Personalized medicine in the ICU
Thematic Series
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Citation: Critical Care 2024 28:60
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Albumin versus saline infusion for sepsis-related peripheral tissue hypoperfusion: a proof-of-concept prospective study
Albumin has potential endothelial protective effects through antioxidant and anti-inflammatory properties. However, the effect of albumin on peripheral tissue perfusion in human sepsis remains poorly known.
Citation: Critical Care 2024 28:43 -
Combining proteins with n-3 PUFAs (EPA + DHA) and their inflammation pro-resolution mediators for preservation of skeletal muscle mass
The optimal feeding strategy for critically ill patients is still debated, but feeding must be adapted to individual patient needs. Critically ill patients are at risk of muscle catabolism, leading to loss of ...
Citation: Critical Care 2024 28:38 -
Association between urea trajectory and protein dose in critically ill adults: a secondary exploratory analysis of the effort protein trial (RE-EFFORT)
Delivering higher doses of protein to mechanically ventilated critically ill patients did not improve patient outcomes and may have caused harm. Longitudinal urea measurements could provide additional informat...
Citation: Critical Care 2024 28:24 -
Triggering receptor expressed on myeloid cells-1 in sepsis, and current insights into clinical studies
Triggering receptor expressed on myeloid cells-1 (TREM-1) is a pattern recognition receptor and plays a critical role in the immune response. TREM-1 activation leads to the production and release of proinflamm...
Citation: Critical Care 2024 28:17 -
Lost in a number: concealed heterogeneity within the sequential organ failure assessment (SOFA) score
Citation: Critical Care 2024 28:6 -
Whole blood transcriptomics identifies subclasses of pediatric septic shock
Sepsis is a highly heterogeneous syndrome, which has hindered the development of effective therapies. This has prompted investigators to develop a precision medicine approach aimed at identifying biologically ...
Citation: Critical Care 2023 27:486 -
External validation of the modified sepsis renal angina index for prediction of severe acute kidney injury in children with septic shock
Acute kidney injury (AKI) occurs commonly in pediatric septic shock and increases morbidity and mortality. Early identification of high-risk patients can facilitate targeted intervention to improve outcomes. W...
Citation: Critical Care 2023 27:463 -
Dynamic relative regional lung strain estimated by computed tomography and electrical impedance tomography in ARDS patients
In the acute distress respiratory syndrome (ARDS), specific lung regions can be exposed to excessive strain due to heterogeneous disease, gravity-dependent lung collapse and injurious mechanical ventilation. C...
Citation: Critical Care 2023 27:457 -
Sonometric assessment of cough predicts extubation failure: SonoWean—a proof-of-concept study
Extubation failure is associated with increased mortality. Cough ineffectiveness may be associated with extubation failure, but its quantification for patients undergoing weaning from invasive mechanical venti...
Citation: Critical Care 2023 27:368 -
Hyperferritinemic sepsis, macrophage activation syndrome, and mortality in a pediatric research network: a causal inference analysis
One of five global deaths are attributable to sepsis. Hyperferritinemic sepsis (> 500 ng/mL) is associated with increased mortality in single-center studies. Our pediatric research network’s objective was to o...
Citation: Critical Care 2023 27:347 -
Authors’ reply to the comment from Uchida et al.
Citation: Critical Care 2023 27:327 -
Evidence for a personalized early start of norepinephrine in septic shock
During septic shock, vasopressor infusion is usually started only after having corrected the hypovolaemic component of circulatory failure, even in the most severe patients. However, earlier administration of ...
Citation: Critical Care 2023 27:322 -
Dynamic lung aeration and strain with positive end-expiratory pressure individualized to maximal compliance versus ARDSNet low-stretch strategy: a study in a surfactant depletion model of lung injury
Positive end-expiratory pressure (PEEP) individualized to a maximal respiratory system compliance directly implies minimal driving pressures with potential outcome benefits, yet, raises concerns on static and ...
Citation: Critical Care 2023 27:307 -
Defining critical illness using immunological endotypes in patients with and without sepsis: a cohort study
Sepsis is a heterogenous syndrome with limited therapeutic options. Identifying immunological endotypes through gene expression patterns in septic patients may lead to targeted interventions. We investigated w...
Citation: Critical Care 2023 27:292 -
Evaluation of Proenkephalin A 119–159 for liberation from renal replacement therapy: an external, multicenter pilot study in critically ill patients with acute kidney injury
Recent evidence suggests an association of plasma Proenkephalin A 119–159 (penKid) with early and successful liberation from continuous renal replacement therapy (CRRT) in critically ill patients with acute ki...
Citation: Critical Care 2023 27:276 -
Artificial intelligence is the new chief editor of Critical Care (maybe?)
Citation: Critical Care 2023 27:270 -
Personalized nutrition therapy in critical care: 10 expert recommendations
Personalization of ICU nutrition is essential to future of critical care. Recommendations from American/European guidelines and practice suggestions incorporating recent literature are presented. Low-dose ente...
Citation: Critical Care 2023 27:261 -
The absolute value of recruitment-to-inflation ratio does not correlate with the recruited volume
Citation: Critical Care 2023 27:246 -
Targeted therapy using polymyxin B hemadsorption in patients with sepsis: a post-hoc analysis of the JSEPTIC-DIC study and the EUPHRATES trial
Polymyxin B hemadsorption (PMX-HA) reduces blood endotoxin levels, but characteristics of patients with sepsis likely to benefit from PMX-HA are not well known. We sought to identify patient subgroups likely t...
Citation: Critical Care 2023 27:245 -
The oxygen reactivity index indicates disturbed local perfusion regulation after aneurysmal subarachnoid hemorrhage: an observational cohort study
Cerebral autoregulation (CA) can be impaired in patients with delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH). The Pressure Reactivity Index (PRx, correlation of blood pressure and...
Citation: Critical Care 2023 27:235 -
Circuit change during extracorporeal membrane oxygenation: single-center retrospective study of 48 changes
Bleeding and thrombosis induce major morbidity and mortality in patients under extracorporeal membrane oxygenator (ECMO). Circuit changes can be performed for oxygenation membrane thrombosis but are not recomm...
Citation: Critical Care 2023 27:219 -
Optimizing enteral nutrition delivery by implementing volume-based feeding protocol for critically ill patients: an updated meta-analysis and systematic review
This study aims to provide an updated assessment of the efficacy of optimized enteral nutrition (EN) delivery by implementing the volume-based feeding (VBF) protocol in critically ill patients.
Citation: Critical Care 2023 27:173 -
Optimization of polymyxin B regimens for the treatment of carbapenem-resistant organism nosocomial pneumonia: a real-world prospective study
Polymyxin B is the first-line therapy for Carbapenem-resistant organism (CRO) nosocomial pneumonia. However, clinical data for its pharmacokinetic/pharmacodynamic (PK/PD) relationship are limited. This study a...
Citation: Critical Care 2023 27:164 -
Identification of a sub-group of critically ill patients with high risk of intensive care unit-acquired infections and poor clinical course using a transcriptomic score
The development of stratification tools based on the assessment of circulating mRNA of genes involved in the immune response is constrained by the heterogeneity of septic patients. The aim of this study is to ...
Citation: Critical Care 2023 27:158 -
Effects of an asymmetrical high flow nasal cannula interface in hypoxemic patients
Optimal noninvasive respiratory support for patients with hypoxemic respiratory failure should minimize work of breathing without increasing the transpulmonary pressure. Recently, an asymmetrical high flow nas...
Citation: Critical Care 2023 27:145 -
Clinical risk factors for increased respiratory drive in intubated hypoxemic patients
There is very limited evidence identifying factors that increase respiratory drive in hypoxemic intubated patients. Most physiological determinants of respiratory drive cannot be directly assessed at the bedsi...
Citation: Critical Care 2023 27:138 -
The intracranial compartmental syndrome: a proposed model for acute brain injury monitoring and management
For decades, one of the main targets in the management of severe acute brain injury (ABI) has been intracranial hypertension (IH) control. However, the determination of IH has suffered variations in its thresh...
Citation: Critical Care 2023 27:137 -
The comforting companion: using AI to bring loved one's voices to newborns, infants, and unconscious patients in ICU
Citation: Critical Care 2023 27:135 -
How I personalize fluid therapy in septic shock?
During septic shock, fluid therapy is aimed at increasing cardiac output and improving tissue oxygenation, but it poses two problems: it has inconsistent and transient efficacy, and it has many well-documented...
Citation: Critical Care 2023 27:123 -
Mechanical power of ventilation and driving pressure: two undervalued parameters for pre extracorporeal membrane oxygenation ventilation and during daily management?
The current ARDS guidelines highly recommend lung protective ventilation which include plateau pressure (Pplat < 30 cm H2O), positive end expiratory pressure (PEEP > 5 cm H2O) and tidal volume (Vt of 6 ml/kg) of ...
Citation: Critical Care 2023 27:111 -
Target attainment and population pharmacokinetics of flucloxacillin in critically ill patients: a multicenter study
Insufficient antimicrobial exposure has been associated with worse clinical outcomes. Reportedly, flucloxacillin target attainment in critically ill patients was heterogeneous considering the study population sel...
Citation: Critical Care 2023 27:82 -
Point-of-care diagnosis and monitoring of fibrinolysis resistance in the critically ill: results from a feasibility study
Fibrinolysisis is essential for vascular blood flow maintenance and is triggered by endothelial and platelet release of tissue plasminogen activator (t-PA). In certain critical conditions, e.g. sepsis, acute r...
Citation: Critical Care 2023 27:55 -
The low-dose colchicine in patients after non-CABG cardiac surgery: a randomized controlled trial
Recent high-quality trials have shown that the anti-inflammatory effects of colchicine reduce the risk of cardiovascular events in patients suffering post-myocardial infarction and chronic coronary disease. Th...
Citation: Critical Care 2023 27:49 -
Dead space ventilation-related indices: bedside tools to evaluate the ventilation and perfusion relationship in patients with acute respiratory distress syndrome
Cumulative evidence has demonstrated that the ventilatory ratio closely correlates with mortality in acute respiratory distress syndrome (ARDS), and a primary feature in coronavirus disease 2019 (COVID-19)-ARD...
Citation: Critical Care 2023 27:46 -
Does tidal volume challenge improve the feasibility of pulse pressure variation in patients mechanically ventilated at low tidal volumes? A systematic review and meta-analysis
Pulse pressure variation (PPV) has been widely used in hemodynamic assessment. Nevertheless, PPV is limited in low tidal volume ventilation. We conducted this systematic review and meta-analysis to evaluate wh...
Citation: Critical Care 2023 27:45 -
Pattern of disease and determinants of mortality among ICU patients on mechanical ventilator in Sub-Saharan Africa: a multilevel analysis
The global mortality rate of patients with MV is very high, despite a significant variation worldwide. Previous studies conducted in Sub-Saharan Africa among ICU patients focused on the pattern of admission an...
Citation: Critical Care 2023 27:37 -
Chest physiotherapy guided by electrical impedance tomography in high-dependency unit patients with pulmonary diseases: an introduction of methodology and feasibility
Citation: Critical Care 2023 27:24 -
Efficacy and safety of corticosteroids in cardiac arrest: a systematic review, meta-analysis and trial sequential analysis of randomized control trials
Post-cardiac arrest, outcomes for most patients are poor, regardless of setting. Many patients who do achieve spontaneous return of circulation require vasopressor therapy to maintain organ perfusion. There is...
Citation: Critical Care 2023 27:12 -
Gene signature for the prediction of the trajectories of sepsis-induced acute kidney injury
Acute kidney injury (AKI) is a common complication in sepsis. However, the trajectories of sepsis-induced AKI and their transcriptional profiles are not well characterized.
Citation: Critical Care 2022 26:398 -
Reply to: Higher PEEP in intubated COVID-19-associated ARDS patients? We are not sure
Citation: Critical Care 2022 26:388 -
Commentary: ‘Critical illness subclasses: all roads lead to Rome’
Citation: Critical Care 2022 26:387 -
A plea for personalization of the hemodynamic management of septic shock
Although guidelines provide excellent expert guidance for managing patients with septic shock, they leave room for personalization according to patients’ condition. Hemodynamic monitoring depends on the evolut...
Citation: Critical Care 2022 26:372 -
Timing of dialysis in acute kidney injury using routinely collected data and dynamic treatment regimes
Defining the optimal moment to start renal replacement therapy (RRT) in acute kidney injury (AKI) remains challenging. Multiple randomized controlled trials (RCTs) addressed this question whilst using absolute...
Citation: Critical Care 2022 26:365 -
The ICU Bridge Program: volunteers bridging medicine and people together
The intensive care unit (ICU) is an emotionally taxing environment. Patients and family members are at an increased risk of long-term physical and psychological consequences of critical illness, known collecti...
Citation: Critical Care 2022 26:346 -
Corticotropin-stimulated steroid profiles to predict shock development and mortality in sepsis: From the HYPRESS study
Steroid profiles in combination with a corticotropin stimulation test provide information about steroidogenesis and its functional reserves in critically ill patients.
Citation: Critical Care 2022 26:343 -
A genome-wide association study of survival in patients with sepsis
Sepsis is a severe systemic inflammatory response to infections that is accompanied by organ dysfunction and has a high mortality rate in adult intensive care units. Most genetic studies have identified gene v...
Citation: Critical Care 2022 26:341 -
Proenkephalin A 119–159 predicts early and successful liberation from renal replacement therapy in critically ill patients with acute kidney injury: a post hoc analysis of the ELAIN trial
Renal replacement therapy (RRT) remains the key rescue therapy for critically ill patients with severe acute kidney injury (AKI). However, there are currently no tools available to predict successful liberatio...
Citation: Critical Care 2022 26:333 -
An area under the concentration–time curve threshold as a predictor of efficacy and nephrotoxicity for individualizing polymyxin B dosing in patients with carbapenem-resistant gram-negative bacteria
Evidence supports therapeutic drug monitoring of polymyxin B, but clinical data for establishing an area under the concentration–time curve across 24 h at steady state (AUCss,24 h) threshold are still limited. Th...
Citation: Critical Care 2022 26:320 -
Individualizing mechanical ventilation: titration of driving pressure to pulmonary elastance through Young’s modulus in an acute respiratory distress syndrome animal model
Mechanical ventilation increases the risk of lung injury (VILI). Some authors propose that the way to reduce VILI is to find the threshold of driving pressure below which VILI is minimized. In this study, we p...
Citation: Critical Care 2022 26:316