Intensive Care Medicine

Intensive Care Medicine The official page for ICM, Intensive Care Medicine.
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ICM is an international peer-reviewed medical journal intended for all those who are involved in intensive care medicine. ''Intensive Care Medicine'' is the publication platform for the communication and exchange of current work and ideas in intensive care medicine. The journal publishes original research papers, reviews, as well as discussions on technology, methods, new apparatus and modifications of standard techniques and correspondence concerning matters of topical interest or relating to published material. Official journal of The European Society of Intensive Care Medicine and The European Society of Paediatric and Neonatal Intensive Care.
12 issues per year.

https://zurl.co/6qxod Personalised PEEP should reflect the heterogeneity of acute brain injury. Subtypes such as TBI, in...
24/11/2025

https://zurl.co/6qxod Personalised PEEP should reflect the heterogeneity of acute brain injury. Subtypes such as TBI, intracerebral haemorrhage, subarachnoid haemorrhage and ischaemic stroke differ. SAH is vulnerable to reduced cardiac output and cerebral perfusion, whereas severe TBI with stable intracranial pressure may be buffered by intact compensatory reserve. Protocols should stratify by injury type, phase, recruitability and haemodynamics.

https://zurl.co/WqDG9 Norepinephrine, a first-line vasopressor in perioperative settings, is effective in stabilising bl...
24/11/2025

https://zurl.co/WqDG9 Norepinephrine, a first-line vasopressor in perioperative settings, is effective in stabilising blood pressure and improving cardiac output. It is preferred over other agents like phenylephrine and ephedrine. Safe administration practices include continuous infusion and the use of highly diluted solutions through peripheral lines.

23/11/2025

https://zurl.co/bQNgX In a multicentre cohort of 49,685 critically ill adults with AKI treated across 426 U.S. hospitals, higher hospital-level use of continuous kidney replacement therapy (CKRT) was associated with significantly lower risk-adjusted hospital mortality. The association remained consistent across multiple sensitivity analyses, suggesting that greater CKRT utilisation may reflect more effective processes of care.

https://zurl.co/uwYhh Delirium affects about one third of ICU patients and is linked to poorer outcomes. Reviewing the 4...
23/11/2025

https://zurl.co/uwYhh Delirium affects about one third of ICU patients and is linked to poorer outcomes. Reviewing the 4D randomised trial in non-intubated hyperactive delirium, the authors report a global benefit with dexmedetomidine and fewer rescue drugs, without serious safety signals. They scrutinise the O’Brien procedure that fused durations and intubation into a Z-score endpoint, and question early DSMB stopping that may overestimate effect.

https://zurl.co/GAihh Neisseria meningitidis can escalate from mild fever to fulminant sepsis or meningitis. A nine-year...
22/11/2025

https://zurl.co/GAihh Neisseria meningitidis can escalate from mild fever to fulminant sepsis or meningitis. A nine-year study across 102 French ICUs (654 adults) found two presentations: neurological compromise and hemodynamic failure; the latter needed more organ support and had 60-day mortality of 22.7% vs 4.7%. Early antibiotics cut risk. Survivors often face sequelae, including limb amputation, and families may endure long-term distress.

https://zurl.co/NQz35 Pragmatic guidance details vasopressin’s bedside use in septic shock: earlier initiation (within s...
22/11/2025

https://zurl.co/NQz35 Pragmatic guidance details vasopressin’s bedside use in septic shock: earlier initiation (within six hours, at lower norepinephrine doses) is associated with better outcomes, fixed dosing up to 0.04 IU/min is safe, 0.06 IU/min is feasible with vigilance for digital ischaemia, central-line infusion is advised, and large trials showed no overall survival advantage, with possible renal benefit in select contexts.

https://zurl.co/XQRxM The review outlines shifting species patterns and resistance in ICU candidiasis, the limits of ...
21/11/2025

https://zurl.co/XQRxM The review outlines shifting species patterns and resistance in ICU candidiasis, the limits of blood cultures (~40% sensitivity), and how BDG, PCR and targeted sampling support early stop–start decisions. Echinocandins lead initial care, with liposomal amphotericin B for difficult cases and newer options—rezafungin, fosmanogepix and ibrexafungerp—emerging. Emphasis falls on source control, therapeutic drug monitoring and multidisciplinary, stewardship-aligned pathways.

https://zurl.co/LEePl The authors thank Kotfis et al. and clarify that advice to mobilise within 72 hours of ICU admissi...
21/11/2025

https://zurl.co/LEePl The authors thank Kotfis et al. and clarify that advice to mobilise within 72 hours of ICU admission after surgery should be read as an upper boundary. Inactivity harms begin on day one, and less acute patients can be mobilised earlier. PRIME-AIR, combining incentive spirometry and mobilisation, did not prevent pulmonary complications and lacked prehabilitation. Evidence shows no overall benefit for 24 versus 72 hours; robust RCTs are still needed.

https://zurl.co/Kjfjc A single-centre observational analysis of 77 ICU patients on intravenous ceftriaxone modelled unbo...
20/11/2025

https://zurl.co/Kjfjc A single-centre observational analysis of 77 ICU patients on intravenous ceftriaxone modelled unbound AUC in the first 24 hours and tracked 523 CRP values for up to 10 days. CRP fell faster in the highest AUC tertile than in the middle or lowest (p-interaction 0.040 and 0.020). Results held after adjustment and in ICU survivors. Thirty-day mortality differed by tertile. Findings support future precision dosing research.

https://zurl.co/Mzx4s -Quizz Pulmonary artery pulse pressure via Swan-Ganz and a regular EtCO₂ waveform at 17 mmHg su...
20/11/2025

https://zurl.co/Mzx4s -Quizz Pulmonary artery pulse pressure via Swan-Ganz and a regular EtCO₂ waveform at 17 mmHg support that atrial electrical and mechanical activity can maintain transpulmonary flow with pulmonary venous return. With stable ventilation and metabolism, EtCO₂ is proportional to pulmonary blood flow and reflects native cardiac output; in VA-ECMO without native ejection it usually falls below 10 mmHg, so 17 mmHg indicates meaningful pulmonary perfusion.

-Quizz A 60-year-old man received VA-ECMO and Impella CP support for refractory ventricular fibrillation with flows o...
19/11/2025

-Quizz A 60-year-old man received VA-ECMO and Impella CP support for refractory ventricular fibrillation with flows of 5.2 L/min and 1.9 L/min. While sedated, paralysed, mildly hypothermic, and on mechanical ventilation, his monitoring revealed unexpected hemodynamic data including VFIB rhythm, low pressures, and measurable end-tidal CO₂. What's your diagnosis?

https://zurl.co/83kdx Mortality can drown the chronic kidney disease signal when MAKE combines death with renal outcomes...
19/11/2025

https://zurl.co/83kdx Mortality can drown the chronic kidney disease signal when MAKE combines death with renal outcomes after KDIGO stage-3 AKI. Reported results show 51% MAKE, with death 32%, long-term dialysis 12% and persistent dysfunction 7%; malignancy was the strongest risk factor for MAKE (adjusted HR 2.28). Kidney-centred, time-aware analyses that treat death as a competing risk and report component-specific incidence are urged.

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