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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. 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
    Content type: Review Published on:

  2. 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
    Content type: Research Published on:

  3. 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
    Content type: Research Published on:

  4. 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
    Content type: Research Published on:

  5. 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
    Content type: Research Published on:

  6. 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
    Content type: Perspective Published on:

  8. 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
    Content type: Review Published on:

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

  9. 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
    Content type: Perspective Published on:

  10. 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
    Content type: Research Published on:

  11. 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
    Content type: Research Published on:

  12. 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
    Content type: Research Published on:

  13. 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
    Content type: Review Published on:

  14. 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
    Content type: Research Published on:

  15. 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
    Content type: Research Published on:

  17. 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
    Content type: Research Published on:

  18. 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
    Content type: Research Published on:

  21. 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
    Content type: Review Published on:

  22. 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
    Content type: Research Published on:

  23. 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...

    Authors: Sarah Petrecca, Adrian Goin, David Hornstein, Milanka Stevanovic and Adamo Anthony Donovan
    Citation: Critical Care 2022 26:346
    Content type: Perspective Published on:

  24. Steroid profiles in combination with a corticotropin stimulation test provide information about steroidogenesis and its functional reserves in critically ill patients.

    Authors: Josef Briegel, Patrick Möhnle, Didier Keh, Johanna M. Lindner, Anna C. Vetter, Holger Bogatsch, Dorothea Lange, Sandra Frank, Ludwig C. Hinske, Djillali Annane and Michael Vogeser
    Citation: Critical Care 2022 26:343
    Content type: Research Published on:

  25. 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...

    Authors: Tamara Hernandez-Beeftink, Beatriz Guillen-Guio, Jose M. Lorenzo-Salazar, Almudena Corrales, Eva Suarez-Pajes, Rui Feng, Luis A. Rubio-Rodríguez, Megan L. Paynton, Raquel Cruz, M. Isabel García-Laorden, Miryam Prieto-González, Aurelio Rodríguez-Pérez, Demetrio Carriedo, Jesús Blanco, Alfonso Ambrós, Elena González-Higueras…
    Citation: Critical Care 2022 26:341
    Content type: Research Published on:

  26. 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...

    Authors: Thilo von Groote, Felix Albert, Melanie Meersch, Raphael Koch, Christian Porschen, Oliver Hartmann, Deborah Bergmann, Peter Pickkers and Alexander Zarbock
    Citation: Critical Care 2022 26:333
    Content type: Research Published on:

  27. 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...

    Authors: Jing Yang, Shaohua Liu, Jingli Lu, Tongwen Sun, Peile Wang and Xiaojian Zhang
    Citation: Critical Care 2022 26:320
    Content type: Research Published on:

    The Correspondence to this article has been published in Critical Care 2023 27:41

  28. 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...

    Authors: Álvaro Mingote, Ramsés Marrero García, Martín Santos González, Raquel Castejón, Clara Salas Antón, Juan Antonio Vargas Nuñez and Javier García-Fernández
    Citation: Critical Care 2022 26:316
    Content type: Research Published on:

  29. The 40-year-old experience with glucocorticosteroids (GCs) in the context of severe infections is complex and troublesome. Recently, however, a clear indication for GCs in severe COVID-19 has been established....

    Authors: Martin S. Winkler, Marcin F. Osuchowski, Didier Payen, Antoni Torres, Steffen Dickel and Tomasz Skirecki
    Citation: Critical Care 2022 26:308
    Content type: Perspective Published on:

  30. Fluid overload and venous congestion are associated with morbi-mortality in the ICU (intensive care unit). Administration of diuretics to correct the fluid balance is common, although there is no strong relati...

    Authors: Pierre-Grégoire Guinot, Pierre-Alain Bahr, Stefan Andrei, Bogdan A. Popescu, Vincenza Caruso, Paul-Michel Mertes, Vivien Berthoud, Maxime Nguyen and Belaid Bouhemad
    Citation: Critical Care 2022 26:305
    Content type: Research Published on:

  31. Right ventricular (RV) and pulmonary vascular dysfunction appear to be common in sepsis. RV performance is frequently assessed in isolation, yet its close relationship to afterload means combined analysis with...

    Authors: Emma Maria Bowcock, Benjamin Gerhardy, Stephen Huang and Sam Orde
    Citation: Critical Care 2022 26:303
    Content type: Research Published on:

  32. It is unknown how to titrate positive end-expiratory pressure (PEEP) in patients with COVID-19-related acute respiratory distress syndrome (ARDS). Guidelines recommend the one-size-fits-all PEEP-FiO2 table. In th...

    Authors: Peter Somhorst, Philip van der Zee, Henrik Endeman and Diederik Gommers
    Citation: Critical Care 2022 26:272
    Content type: Research Published on:

    The Correspondence to this article has been published in Critical Care 2022 26:388

    The Comment to this article has been published in Critical Care 2022 26:327

  33. Adequate antibiotic dosing may improve outcomes in critically ill patients but is challenging due to altered and variable pharmacokinetics. To address this challenge, AutoKinetics was developed, a decision sup...

    Authors: Luca F. Roggeveen, Tingjie Guo, Lucas M. Fleuren, Ronald Driessen, Patrick Thoral, Reinier M. van Hest, Ron A. A. Mathot, Eleonora L. Swart, Harm-Jan de Grooth, Bas van den Bogaard, Armand R. J. Girbes, Rob J. Bosman and Paul W. G. Elbers
    Citation: Critical Care 2022 26:265
    Content type: Research Published on:

  34. To assess the impact of different electronic relaxation devices on common stressful patient symptoms experienced in intensive care unit (ICU).

    Authors: Lili Merliot-Gailhoustet, Chloé Raimbert, Océane Garnier, Julie Carr, Audrey De Jong, Nicolas Molinari, Samir Jaber and Gerald Chanques
    Citation: Critical Care 2022 26:263
    Content type: Research Published on:

    The Publisher Correction to this article has been published in Critical Care 2022 26:291

  35. Acute kidney injury (AKI) is a frequently encountered syndrome especially among the critically ill. Current diagnosis of AKI is based on acute deterioration of kidney function, indicated by an increase in crea...

    Authors: Suvi T. Vaara, Pavan K. Bhatraju, Natalja L. Stanski, Blaithin A. McMahon, Kathleen Liu, Michael Joannidis and Sean M. Bagshaw
    Citation: Critical Care 2022 26:251
    Content type: Review Published on:

  37. Trauma is a heterogeneous condition, and specific clinical phenotypes may identify target populations that could benefit from certain treatment strategies. In this retrospective study, we determined clinical p...

    Authors: Jotaro Tachino, Hisatake Matsumoto, Fuminori Sugihara, Shigeto Seno, Daisuke Okuzaki, Tetsuhisa Kitamura, Sho Komukai, Yoshiyuki Kido, Takashi Kojima, Yuki Togami, Yusuke Katayama, Yuko Nakagawa and Hiroshi Ogura
    Citation: Critical Care 2022 26:241
    Content type: Research Published on:

  38. While the Glasgow coma scale (GCS) is one of the strongest outcome predictors, the current classification of traumatic brain injury (TBI) as ‘mild’, ‘moderate’ or ‘severe’ based on this fails to capture enormo...

    Authors: Cecilia A. I. Åkerlund, Anders Holst, Nino Stocchetti, Ewout W. Steyerberg, David K. Menon, Ari Ercole and David W. Nelson
    Citation: Critical Care 2022 26:228
    Content type: Research Published on:

  40. Sepsis is a heterogeneous syndrome, and the identification of clinical subphenotypes is essential. Although organ dysfunction is a defining element of sepsis, subphenotypes of differential trajectory are not w...

    Authors: Zhenxing Xu, Chengsheng Mao, Chang Su, Hao Zhang, Ilias Siempos, Lisa K. Torres, Di Pan, Yuan Luo, Edward J. Schenck and Fei Wang
    Citation: Critical Care 2022 26:197
    Content type: Research Published on:

  41. Interleukin (IL)-18 is a marker of inflammasome activation, and high baseline plasma IL-18 is associated with increased mortality in patients with sepsis-induced ARDS. The aim of this analysis was to determine...

    Authors: Andrew James Boyle, Peter Ferris, Ian Bradbury, John Conlon, Manu Shankar-Hari, Angela J. Rogers, Cecilia M. O’Kane and Daniel F. McAuley
    Citation: Critical Care 2022 26:164
    Content type: Research Published on:

  42. Thrombotic microangiopathy-induced thrombocytopenia-associated multiple organ failure and hyperinflammatory macrophage activation syndrome are important causes of late pediatric sepsis mortality that are often mi...

    Authors: Yidi Qin, Kate F. Kernan, Zhenjiang Fan, Hyun-Jung Park, Soyeon Kim, Scott W. Canna, John A. Kellum, Robert A. Berg, David Wessel, Murray M. Pollack, Kathleen Meert, Mark Hall, Christopher Newth, John C. Lin, Allan Doctor, Tom Shanley…
    Citation: Critical Care 2022 26:128
    Content type: Research Published on:

    The Comment to this article has been published in Critical Care 2022 26:387

  45. Late mortality risk in sepsis-survivors persists for years with high readmission rates and low quality of life. The present study seeks to link the clinical sepsis-survivors heterogeneity with distinct biologi...

    Authors: Sabri Soussi, Divya Sharma, Peter Jüni, Gerald Lebovic, Laurent Brochard, John C. Marshall, Patrick R. Lawler, Margaret Herridge, Niall Ferguson, Lorenzo Del Sorbo, Elodie Feliot, Alexandre Mebazaa, Erica Acton, Jason N. Kennedy, Wei Xu, Etienne Gayat…
    Citation: Critical Care 2022 26:114
    Content type: Research Published on:

  46. Trials comparing early and delayed strategies of renal replacement therapy in patients with severe acute kidney injury may have missed differences in survival as a result of mixing together patients at heterog...

    Authors: François Grolleau, Raphaël Porcher, Saber Barbar, David Hajage, Abderrahmane Bourredjem, Jean-Pierre Quenot, Didier Dreyfuss and Stéphane Gaudry
    Citation: Critical Care 2022 26:64
    Content type: Research Published on:

  47. The use of ultrasonography in the intensive care unit (ICU) is steadily increasing but is usually restricted to examinations of single organs or organ systems. In this study, we combine the ultrasound approach...

    Authors: Stefan Schmidt, Jana-Katharina Dieks, Michael Quintel and Onnen Moerer
    Citation: Critical Care 2021 25:405
    Content type: Research Published on:

  48. Identifying new effective treatments for the acute respiratory distress syndrome (ARDS), including COVID-19 ARDS, remains a challenge. The field of ARDS investigation is moving increasingly toward innovative a...

    Authors: Katherine D. Wick, Daniel F. McAuley, Joseph E. Levitt, Jeremy R. Beitler, Djillali Annane, Elisabeth D. Riviello, Carolyn S. Calfee and Michael A. Matthay
    Citation: Critical Care 2021 25:404
    Content type: Review Published on:

  49. Authors: Jean-Louis Vincent, Mervyn Singer, Sharon Einav, Rui Moreno, Julia Wendon, Jean-Louis Teboul, Jan Bakker, Glenn Hernandez, Djillali Annane, Angélique M. E. de Man, Xavier Monnet, V. Marco Ranieri, Olfa Hamzaoui, Jukka Takala, Nicole Juffermans, Jean-Daniel Chiche…
    Citation: Critical Care 2021 25:397
    Content type: Editorial Published on:

  50. Timely recognition of hemodynamic instability in critically ill patients enables increased vigilance and early treatment opportunities. We develop the Hemodynamic Stability Index (HSI), which highlights situat...

    Authors: Asif Rahman, Yale Chang, Junzi Dong, Bryan Conroy, Annamalai Natarajan, Takahiro Kinoshita, Francesco Vicario, Joseph Frassica and Minnan Xu-Wilson
    Citation: Critical Care 2021 25:388
    Content type: Research Published on: