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Personalized medicine in the ICU

Thematic Series

New Content Item

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.


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  1. Dyspnea is a key symptom of de novo acute hypoxemic respiratory failure. This study explores dyspnea and its association with intubation and mortality in this population.

    Authors: Alexandre Demoule, Amandine Baptiste, Arnaud W. Thille, Thomas Similowski, Stephanie Ragot, Gwénael Prat, Alain Mercat, Christophe Girault, Guillaume Carteaux, Thierry Boulain, Sébastien Perbet, Maxens Decavèle, Lisa Belin and Jean-Pierre Frat
    Citation: Critical Care 2024 28:174
  2. Rapidly improving acute respiratory distress syndrome (RIARDS) is an increasingly appreciated subgroup of ARDS in which hypoxemia improves within 24 h after initiation of mechanical ventilation. Detailed clini...

    Authors: Patricia L. Valda Toro, Andrew Willmore, Nelson E. Wu, Kevin L. Delucchi, Alejandra Jauregui, Pratik Sinha, Kathleen D. Liu, Carolyn M. Hendrickson, Aartik Sarma, Lucile P. A. Neyton, Aleksandra Leligdowicz, Charles R. Langelier, Hanjing Zhuo, Chayse Jones, Kirsten N. Kangelaris, Antonio D. Gomez…
    Citation: Critical Care 2024 28:132
  3. Extracorporeal Carbon Dioxide Removal (ECCO2R) is used in acute respiratory distress syndrome (ARDS) patients to facilitate lung-protective ventilatory strategies. Electrical Impedance Tomography (EIT) allows ind...

    Authors: Benjamin Pequignot, Alain Combes, Mickael Lescroart, Bruno Levy and Matthieu Koszutski
    Citation: Critical Care 2024 28:124
  4. Perhaps nowhere else in the healthcare system than in the intensive care unit environment are the challenges to create useful models with direct time-critical clinical applications more relevant and the obstac...

    Authors: Michael R. Pinsky, Armando Bedoya, Azra Bihorac, Leo Celi, Matthew Churpek, Nicoleta J. Economou-Zavlanos, Paul Elbers, Suchi Saria, Vincent Liu, Patrick G. Lyons, Benjamin Shickel, Patrick Toral, David Tscholl and Gilles Clermont
    Citation: Critical Care 2024 28:113
  5. 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.

    Authors: Paul Gabarre, Cyrielle Desnos, Alexandra Morin, Louai Missri, Tomas Urbina, Vincent Bonny, Matthieu Turpin, Jean-Luc Baudel, Laurence Berard, Melissa Montil, Bertrand Guidet, Guillaume Voiriot, Jérémie Joffre, Eric Maury and Hafid Ait-Oufella
    Citation: Critical Care 2024 28:43

    The Matters Arising to this article has been published in Critical Care 2024 28:79

  6. 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 ...

    Authors: Renée Blaauw, Philip C. Calder, Robert G. Martindale and Mette M. Berger
    Citation: Critical Care 2024 28:38
  7. 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...

    Authors: Ryan W. Haines, John R. Prowle, Andrew Day, Danielle E. Bear, Daren K. Heyland and Zudin Puthucheary
    Citation: Critical Care 2024 28:24
  8. 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...

    Authors: Vivienne Theobald, Felix Carl Fabian Schmitt, Chiara Simone Middel, Lena Gaissmaier, Thorsten Brenner and Markus Alexander Weigand
    Citation: Critical Care 2024 28:17
  9. 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 ...

    Authors: Jamie O. Yang, Matt S. Zinter, Matteo Pellegrini, Man Yee Wong, Kinisha Gala, Daniela Markovic, Brian Nadel, Kerui Peng, Nguyen Do, Serghei Mangul, Vinay M. Nadkarni, Aaron Karlsberg, Dhrithi Deshpande, Manish J. Butte, Lisa Asaro, Michael Agus…
    Citation: Critical Care 2023 27:486
  10. 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...

    Authors: Natalja L. Stanski, Rajit K. Basu, Natalie Z. Cvijanovich, Julie C. Fitzgerald, Michael T. Bigham, Parag N. Jain, Adam J. Schwarz, Riad Lutfi, Neal J. Thomas, Torrey Baines, Bereketeab Haileselassie, Scott L. Weiss, Mihir R. Atreya, Andrew J. Lautz, Basilia Zingarelli, Stephen W. Standage…
    Citation: Critical Care 2023 27:463
  11. 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...

    Authors: Roberto Brito, Caio C. A. Morais, Marioli T. Lazo, Dannette V. Guiñez, Abraham I. J. Gajardo, Daniel H. Arellano, Marcelo B. P. Amato and Rodrigo A. Cornejo
    Citation: Critical Care 2023 27:457
  12. 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...

    Authors: Vincent Bonny, Jeremie Joffre, Paul Gabarre, Tomas Urbina, Louai Missri, Mathilde Ladoire, Maxime Gasperment, Jean-Luc Baudel, Bertrand Guidet, Guillaume Dumas, Eric Maury, Laurent Brochard and Hafid Ait-Oufella
    Citation: Critical Care 2023 27:368
  13. 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...

    Authors: Zhenziang Fan, Kate F. Kernan, Yidi Qin, Scott Canna, Robert A. Berg, David Wessel, Murray M. Pollack, Kathleen Meert, Mark Hall, Christopher Newth, John C. Lin, Allan Doctor, Tom Shanley, Tim Cornell, Rick E. Harrison, Athena F. Zuppa…
    Citation: Critical Care 2023 27:347
  14. 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 ...

    Authors: Congli Zeng, Min Zhu, Gabriel Motta-Ribeiro, David Lagier, Takuga Hinoshita, Mingyang Zang, Kira Grogg, Tilo Winkler and Marcos F. Vidal Melo
    Citation: Critical Care 2023 27:307
  15. 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...

    Authors: Jeremy A. Balch, Uan-I Chen, Oliver Liesenfeld, Petr Starostik, Tyler J. Loftus, Philip A. Efron, Scott C. Brakenridge, Timothy E. Sweeney and Lyle L. Moldawer
    Citation: Critical Care 2023 27:292
  16. 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...

    Authors: Thilo von Groote, Felix Albert, Melanie Meersch, Raphael Koch, Joachim Gerss, Birte Arlt, Mahan Sadjadi, Christian Porschen, Peter Pickkers and Alexander Zarbock
    Citation: Critical Care 2023 27:276
  17. 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...

    Authors: Paul E. Wischmeyer, Danielle E. Bear, Mette M. Berger, Elisabeth De Waele, Jan Gunst, Stephen A. McClave, Carla M. Prado, Zudin Puthucheary, Emma J. Ridley, Greet Van den Berghe and Arthur R. H. van Zanten
    Citation: Critical Care 2023 27:261
  18. 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...

    Authors: Itsuki Osawa, Tadahiro Goto, Daisuke Kudo, Mineji Hayakawa, Kazuma Yamakawa, Shigeki Kushimoto, Debra M. Foster, John A. Kellum and Kent Doi
    Citation: Critical Care 2023 27:245

    The Correspondence to this article has been published in Critical Care 2023 27:327

    The Correspondence to this article has been published in Critical Care 2023 27:284

  19. 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...

    Authors: Nick Kastenholz, Murad Megjhani, Catharina Conzen-Dilger, Walid Albanna, Michael Veldeman, Daniel Nametz, Soon Bin Kwon, Henna Schulze-Steinen, Hani Ridwan, Hans Clusmann, Gerrit Alexander Schubert, Soojin Park and Miriam Weiss
    Citation: Critical Care 2023 27:235
  20. 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...

    Authors: Thibaut Genty, Stanislas Burguburu, Audrey Imbert, Calypso Roman, Wirth Camille, Jacques Thès and François Stéphan
    Citation: Critical Care 2023 27:219
  21. 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.

    Authors: Lu Wang, Yu Wang, Hua-Xin Li, Rui-peng Zhang, Li Chang, Jun Zeng and Hua Jiang
    Citation: Critical Care 2023 27:173
  22. 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...

    Authors: Tiantian Tang, Ying Li, Ping Xu, Yanjun Zhong, Min Yang, Wanjun Ma, Daxiong Xiang, Bikui Zhang and Yangang Zhou
    Citation: Critical Care 2023 27:164
  23. 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 ...

    Authors: Maxime Bodinier, Guillaume Monneret, Marie Casimir, Aurore Fleurie, Filippo Conti, Fabienne Venet, Marie-Angélique Cazalis, Elisabeth Cerrato, Estelle Peronnet, Thomas Rimmelé, Anne-Claire Lukaszewicz, Karen Brengel-Pesce and Jean-François Llitjos
    Citation: Critical Care 2023 27:158
  24. 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...

    Authors: Douglas Slobod, Elena Spinelli, Stefania Crotti, Alfredo Lissoni, Alessandro Galazzi, Giacomo Grasselli and Tommaso Mauri
    Citation: Critical Care 2023 27:145
  25. 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...

    Authors: Elena Spinelli, Antonio Pesenti, Douglas Slobod, Carla Fornari, Roberto Fumagalli, Giacomo Grasselli, Carlo Alberto Volta, Giuseppe Foti, Paolo Navalesi, Rihard Knafelj, Paolo Pelosi, Jordi Mancebo, Laurent Brochard and Tommaso Mauri
    Citation: Critical Care 2023 27:138
  26. 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...

    Authors: Daniel Agustín Godoy, Sérgio Brasil, Corrado Iaccarino, Wellingson Paiva and Andres M. Rubiano
    Citation: Critical Care 2023 27:137
  27. 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...

    Authors: Xavier Monnet, Christopher Lai and Jean-Louis Teboul
    Citation: Critical Care 2023 27:123

    The Comment to this article has been published in Critical Care 2023 27:154

  28. 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 ...

    Authors: K. Hoppe, E. Khan, P. Meybohm and T. Riese
    Citation: Critical Care 2023 27:111
  29. 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...

    Authors: Sjoerd D. Meenks, Nieko Punt, Jos L. M. L. le Noble, Norbert A. Foudraine, Kees Neef and Paddy K. C. Janssen
    Citation: Critical Care 2023 27:82
  30. 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...

    Authors: Lucy A. Coupland, David J. Rabbolini, Jonathan G. Schoenecker, Philip J. Crispin, Jennene J. Miller, Tony Ghent, Robert L. Medcalf and Anders E. Aneman
    Citation: Critical Care 2023 27:55
  31. 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...

    Authors: Tuo Pan, Chen-Yu Jiang, He Zhang, Xi-Kun Han, Hai-Tao Zhang, Xin-Yi Jiang, Wei Chen, Kuo Wang, Fu-Dong Fan, Jun Pan, Qing Zhou, Chuang-Shi Wang, Li Zhang and Dong-Jin Wang
    Citation: Critical Care 2023 27:49
  32. 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...

    Authors: Mingjia Zheng
    Citation: Critical Care 2023 27:46
  33. 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...

    Authors: Xiaoying Wang, Shuai Liu, Ju Gao, Yang Zhang and Tianfeng Huang
    Citation: Critical Care 2023 27:45
  34. 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...

    Authors: Semagn Mekonnen Abate, Bivash Basu, Bedru Jemal, Siraj Ahmed, Bahru Mantefardo and Tagesse Taye
    Citation: Critical Care 2023 27:37
  35. 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...

    Authors: Jeremy Penn, Will Douglas, Jeffrey Curran, Dipayan Chaudhuri, Joanna C. Dionne, Shannon M. Fernando, David Granton, Rebecca Mathew and Bram Rochwerg
    Citation: Critical Care 2023 27:12
  36. 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.

    Authors: Zhongheng Zhang, Lin Chen, Huiheng Liu, Yujing Sun, Pengfei Shui, Jian Gao, Decong Wang, Huilin Jiang, Yanling Li, Kun Chen and Yucai Hong
    Citation: Critical Care 2022 26:398
  37. 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...

    Authors: Daniel De Backer, Maurizio Cecconi, Michelle S. Chew, Ludhmila Hajjar, Xavier Monnet, Gustavo A. Ospina-Tascón, Marlies Ostermann, Michael R. Pinsky and Jean-Louis Vincent
    Citation: Critical Care 2022 26:372
  38. 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...

    Authors: Paweł Morzywołek, Johan Steen, Stijn Vansteelandt, Johan Decruyenaere, Sigrid Sterckx and Wim Van Biesen
    Citation: Critical Care 2022 26:365