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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. Current guidelines recommend a uniform mean arterial pressure (MAP) target for resuscitating critically ill patients; for example, 65 mmHg for patients with sepsis and post-cardiac arrest. However, since cereb...

    Authors: Jiale Xie, Adam Renato Carbonara, Al-Waleed Al-Battashi, Amanda Ross-White and J. Gordon Boyd
    Citation: Critical Care 2025 29:196
    Content type: Research Published on:

  2. Sepsis-associated acute kidney injury (S-AKI) is a severe complication characterized by high morbidity and mortality, driven by multi-organ dysfunction. Recent evidence suggests that pyroptosis, a form of prog...

    Authors: Wenyu Wu, Wanning Lan, Xin Jiao, Kai Wang, Yawen Deng, Rui Chen, Ruifeng Zeng and Jun Li
    Citation: Critical Care 2025 29:168
    Content type: Review Published on:

  3. Acute Respiratory Distress Syndrome (ARDS) is a leading cause of morbidity and mortality among critically ill patients, and mechanical ventilation (MV) plays a critical role in its management. One of the key p...

    Authors: Martín H. Benites, Fernando Suarez-Sipmann, Eduardo Kattan, Pablo Cruces and Jaime Retamal
    Citation: Critical Care 2025 29:130
    Content type: Review Published on:

  4. Acute respiratory distress syndrome (ARDS) is a heterogeneous condition with varying response to prone positioning. We aimed to identify subphenotypes of ARDS patients undergoing prone positioning using machin...

    Authors: Maxime Fosset, Dario von Wedel, Simone Redaelli, Daniel Talmor, Nicolas Molinari, Julie Josse, Elias N. Baedorf-Kassis, Maximilian S. Schaefer and Boris Jung
    Citation: Critical Care 2025 29:116
    Content type: Research Published on:

  5. Diagnosing septic shock promptly is essential but challenging, especially due to its clinical similarity to non-septic shock. Extracellular vesicle-derived miRNAs may serve as biomarkers to distinguish septic ...

    Authors: Adrián García-Concejo, Belén Sánchez-Quirós, Esther Gómez-Sánchez, Laura Sánchez-de Prada, Álvaro Tamayo-Velasco, María Sherezade Tovar-Doncel, Mario Lorenzo, Estefanía Gómez-Pesquera, Rodrigo Poves-Álvarez, David Bernardo, Marta Martín-Fernández, Hugo Gonzalo-Benito, Paula Moreno-Portales, Rosa Prieto-Utrera, Miguel Bardají-Carrillo, Rocío López-Herrero…
    Citation: Critical Care 2025 29:96
    Content type: Research Published on:

  7. Infections are a leading cause of early mortality after liver transplantation (LT). Prior to transplantation, cirrhosis-associated immune dysfunction significantly increases the risk of infection. This study i...

    Authors: M. C. Delignette, A. Riff, T. Antonini, T. Soustre, M. Bodinier, E. Peronnet, F. Venet, M. Gossez, S. Pantel, J. Y. Mabrut, X. Muller, K. Mohkam, F. Villeret, D. Erard, J. Dumortier, F. Zoulim…
    Citation: Critical Care 2025 29:79
    Content type: Research Published on:

  8. Serum cardiac troponin (cTn) elevation is a well-established phenomenon in sepsis. However, the clinical significance of this phenomenon with high-sensitivity (hs) assays and the current sepsis definition need...

    Authors: Abraham I. J. Gajardo, Santiago Ferrière-Steinert, Joaquín Valenzuela Jiménez, Sebastián Heskia Araya, Thomas Kouyoumdjian Carvajal, José Ramos-Rojas and Juan Nicolás Medel
    Citation: Critical Care 2025 29:76
    Content type: Research Published on:

    The Matters Arising to this article has been published in Critical Care 2025 29:118

  9. The application of sepsis subtypes to enhance personalized medicine in critically ill patients is hindered by the lack of validation across diverse cohorts and the absence of a simple classification model. We ...

    Authors: Rombout B. E. van Amstel, Emma Rademaker, Jason N. Kennedy, Lieuwe D. J. Bos, Hessel Peters-Sengers, Joe M. Butler, Niklas Bruse, Dave A. Dongelmans, Matthijs Kox, Alexander P. J. Vlaar, Tom van der Poll, Olaf L. Cremer, Christopher W. Seymour and Lonneke A. van Vught
    Citation: Critical Care 2025 29:58
    Content type: Research Published on:

  10. Capillary refill time (CRT) and skin blood flow (SBF) have been reported to be strong predictors of mortality in critically ill patients. However, the relationship between both parameters remains unclear.

    Authors: Alexandra Morin, Louai Missri, Tomas Urbina, Vincent Bonny, Maxime Gasperment, Juliette Bernier, Jean-Luc Baudel, Eduardo Kattan, Eric Maury, Jérémie Joffre and Hafid Ait-Oufella
    Citation: Critical Care 2025 29:57
    Content type: Research Published on:

  12. Aneurysmatic subarachnoid hemorrhage (aSAH) is a critical condition associated with significant mortality rates and complex rehabilitation challenges. Early prediction of functional outcomes is essential for o...

    Authors: Masamichi Moriya, Kenji Karako, Shogo Miyazaki, Shin Minakata, Shuhei Satoh, Yoko Abe, Shota Suzuki, Shohei Miyazato and Hikaru Takara
    Citation: Critical Care 2025 29:36
    Content type: Research Published on:

  13. The oxygen reactivity index (ORx) reflects the correlation between focal brain tissue oxygen (pbtO2) and the cerebral perfusion pressure (CPP). Previous, small cohort studies were conflicting on whether ORx conve...

    Authors: Teodor Svedung Wettervik, Erta Beqiri, Anders Hånell, Stefan Yu Bögli, Ihsane Olakorede, Xuhang Chen, Adel Helmy, Andrea Lavinio, Peter J. Hutchinson and Peter Smielewski
    Citation: Critical Care 2025 29:20
    Content type: Research Published on:

  14. Pulse pressure variation (PPV) is limited in low tidal volume mechanical ventilation. We conducted this systematic review and meta-analysis to evaluate whether passive leg raising (PLR)-induced changes in PPV ...

    Authors: Jihad Mallat, Matthew T. Siuba, Osama Abou-Arab, Pedja Kovacevic, Khaled Ismail, Abhijit Duggal and Pierre-Grégoire Guinot
    Citation: Critical Care 2025 29:18
    Content type: Review Published on:

  15. Continuous electroencephalography (cEEG) has been recommended in critically ill patients although its efficacy for improving patients’ functional status remains unclear. This study aimed to compare the efficac...

    Authors: Chusak Limotai, Suda Jirasakuldej, Sattawut Wongwiangiunt, Tipakorn Tumnark, Piradee Suwanpakdee, Kwuanrat Wangponpattanasiri, Piyanuch Rakchue, Chaiwiwat Tungkasereerak, Polchai Pleumpanupatand, Phopsuk Tansuhaj, Phattarawin Ekkachon, Songchai Kittipanprayoon, Apiwoot Kerddonfag, Thippamas Pobsuk, Anuchate Pattanateepapon, Kammant Phanthumchinda…
    Citation: Critical Care 2025 29:15
    Content type: Research Published on:

  16. Patients with sepsis-induced AKI can be classified into two distinct sub-phenotypes (AKI-SP1, AKI-SP2) that differ in clinical outcomes and response to treatment. The biologic mechanisms underlying these sub-p...

    Authors: Ian B. Stanaway, Eric D. Morrell, F. Linzee Mabrey, Neha A. Sathe, Zoie Bailey, Sarah Speckmaier, Jordan Lo, Leila R. Zelnick, Jonathan Himmelfarb, Carmen Mikacenic, Laura Evans, Mark M. Wurfel and Pavan K. Bhatraju
    Citation: Critical Care 2024 28:419
    Content type: Research Published on:

    The Matters Arising to this article has been published in Critical Care 2025 29:77

  17. Dysregulation of the renin–angiotensin–aldosterone-system (RAAS) in sepsis is a complex and early phenomenon with a likely significant contribution to organ failure and patient outcomes. A better understanding...

    Authors: Matthieu Legrand, Ashish K. Khanna, Marlies Ostermann, Yuki Kotani, Ricard Ferrer, Massimo Girardis, Marc Leone, Gennaro DePascale, Peter Pickkers, Pierre Tissieres, Filippo Annoni, Katarzyna Kotfis, Giovanni Landoni, Alexander Zarbock, Patrick M. Wieruszewski, Daniel De Backer…
    Citation: Critical Care 2024 28:389
    Content type: Research Published on:

  18. The level of inflammation alters drug pharmacokinetics (PK) in critically ill patients. This might compromise treatment efficacy. Understanding the specific effects of inflammation, measured by biomarkers, on ...

    Authors: Letao Li, Julia Zinger, Sebastiaan D. T. Sassen, Nicole P. Juffermans, Birgit C. P. Koch and Henrik Endeman
    Citation: Critical Care 2024 28:376
    Content type: Review Published on:

  20. Sub-phenotyping of acute respiratory distress syndrome (ARDS) could be useful for evaluating the severity of ARDS or predicting its responsiveness to given therapeutic strategies, but no studies have yet inves...

    Authors: Mitsuaki Nishikimi, Shinichiro Ohshimo, Giacomo Bellani, Wataru Fukumoto, Tatsuhiko Anzai, Keibun Liu, Junki Ishii, Michihito Kyo, Kazuo Awai, Kunihiko Takahashi and Nobuaki Shime
    Citation: Critical Care 2024 28:343
    Content type: Research Published on:

  21. Sepsis and septic shock remain global healthcare problems associated with high mortality rates despite best therapy efforts. Circulating biomarkers may identify those patients at risk for poor outcomes, howeve...

    Authors: Mark C. Chappell, Christopher L. Schaich, Laurence W. Busse, Greg S. Martin, Jonathan E. Sevransky, Jeremiah K. Hinson and Ashish K. Khanna
    Citation: Critical Care 2024 28:333
    Content type: Brief Report Published on:

    The Matters Arising to this article has been published in Critical Care 2024 28:407

    The Matters Arising to this article has been published in Critical Care 2024 28:398

  22. Veno-venous extracorporeal membrane oxygenation (VV ECMO) has become standard of care in patients with the most severe forms of acute respiratory distress syndrome. However, hemolysis and bleeding are one of t...

    Authors: Christopher Blum, Micha Landoll, Stephan E. Strassmann, Ulrich Steinseifer, Michael Neidlin and Christian Karagiannidis
    Citation: Critical Care 2024 28:330
    Content type: Research Published on:

  23. The superimposed pressure is the primary determinant of the pleural pressure gradient. Obesity is associated with elevated end-expiratory esophageal pressure, regardless of lung disease severity, and the super...

    Authors: Stefano Spina, Lea Mantz, Yi Xin, David C. Moscho, Roberta Ribeiro De Santis Santiago, Luigi Grassi, Alice Nova, Sarah E. Gerard, Edward A. Bittner, Florian J. Fintelmann, Lorenzo Berra and Maurizio Cereda
    Citation: Critical Care 2024 28:306
    Content type: Research Published on:

  24. Exploring clinical trial data using alternative methods may enhance original study’s findings and provide new insights. The SOAP II trial has been published more than 10 years ago; but there is still some spec...

    Authors: Fernando G. Zampieri, Sean M. Bagshaw, Hassane Njimi, Jean-Louis Vincent and Daniel DeBacker
    Citation: Critical Care 2024 28:299
    Content type: Research Published on:

  25. This review explores the complex interactions between sedation and invasive ventilation and examines the potential of volatile anesthetics for lung- and diaphragm-protective sedation. In the early stages of in...

    Authors: Lukas M. Müller-Wirtz, Brian O’Gara, Marcelo Gama de Abreu, Marcus J. Schultz, Jeremy R. Beitler, Angela Jerath and Andreas Meiser
    Citation: Critical Care 2024 28:269
    Content type: Review Published on:

    The Matters Arising to this article has been published in Critical Care 2024 28:393

    The Matters Arising to this article has been published in Critical Care 2024 28:369

  26. The optimal strategy for positive end-expiratory pressure (PEEP) titration in the management of severe acute respiratory distress syndrome (ARDS) patients remains unclear. Current guidelines emphasize the impo...

    Authors: Christoph Boesing, Patricia R. M. Rocco, Thomas Luecke and Joerg Krebs
    Citation: Critical Care 2024 28:277
    Content type: Review Published on:

  27. Sepsis presents a challenge due to its complex immune responses, where balance between inflammation and anti-inflammation is critical for survival. Glucocorticoid-induced leucine zipper (GILZ) is key protein i...

    Authors: Stefan Rusev, Patrick Thon, Birte Dyck, Dominik Ziehe, Tim Rahmel, Britta Marko, Lars Palmowski, Hartmuth Nowak, Björn Ellger, Ulrich Limper, Elke Schwier, Dietrich Henzler, Stefan Felix Ehrentraut, Lars Bergmann, Matthias Unterberg, Michael Adamzik…
    Citation: Critical Care 2024 28:270
    Content type: Research Published on:

  29. Although cumulative studies have demonstrated a beneficial effect of high-flow nasal cannula oxygen (HFNC) in acute hypercapnic respiratory failure, randomized trials to compare HFNC with non-invasive ventilat...

    Authors: Dingyu Tan, Bingxia Wang, Peng Cao, Yunyun Wang, Jiayan Sun, Ping Geng, Joseph Harold Walline, Yachao Wang and Chenlong Wang
    Citation: Critical Care 2024 28:250
    Content type: Research Published on:

    The Matters Arising to this article has been published in Critical Care 2024 28:313

    The Matters Arising to this article has been published in Critical Care 2024 28:264

  30. To examine the relationship between physical rehabilitation parameters including an approach to quantifying dosage with hospital outcomes for patients with critical COVID-19.

    Authors: Kirby P. Mayer, Evan Haezebrouck, Lori M. Ginoza, Clarisa Martinez, Minnie Jan, Lori A. Michener, Lindsey E. Fresenko, Ashley A. Montgomery-Yates, Anna G. Kalema, Amy M. Pastva, Michelle Biehl, Matthew F. Mart and Joshua K. Johnson
    Citation: Critical Care 2024 28:248
    Content type: Brief Report Published on:

  31. Sepsis poses a grave threat, especially among children, but treatments are limited owing to heterogeneity among patients. We sought to test the clinical and biological relevance of pediatric septic shock subcl...

    Authors: Mihir R. Atreya, Min Huang, Andrew R. Moore, Hong Zheng, Yehudit Hasin-Brumshtein, Julie C. Fitzgerald, Scott L. Weiss, Natalie Z. Cvijanovich, Michael T. Bigham, Parag N. Jain, Adam J. Schwarz, Riad Lutfi, Jeffrey Nowak, Neal J. Thomas, Michael Quasney, Mary K. Dahmer…
    Citation: Critical Care 2024 28:246
    Content type: Research Published on:

  32. The immune response of critically ill patients, such as those with sepsis, severe trauma, or major surgery, is heterogeneous and dynamic, but its characterization and impact on outcomes are poorly understood. ...

    Authors: Maxime Bodinier, Estelle Peronnet, Jean-François Llitjos, Louis Kreitmann, Karen Brengel-Pesce, Thomas Rimmelé, Aurore Fleurie, Julien Textoris, Fabienne Venet, Delphine Maucort-Boulch and Guillaume Monneret
    Citation: Critical Care 2024 28:240
    Content type: Research Published on:

  33. The objective of this study was to analyze the effects of sedation administration on clinical parameters, comfort status, intubation requirements, and the pediatric intensive care unit (PICU) length of stay (L...

    Authors: Lorena Bermúdez-Barrezueta, Juan Mayordomo-Colunga, María Miñambres-Rodríguez, Susana Reyes, Juan Valencia-Ramos, Yolanda Margarita Lopez-Fernandez, Mikel Mendizábal-Diez, Ana Vivanco-Allende, Alba Palacios-Cuesta, Lidia Oviedo-Melgares, José Luis Unzueta-Roch, Jorge López-González, María Teresa Jiménez-Villalta, Maite Cuervas-Mons Tejedor, Lourdes Artacho González, Ainhoa Jiménez Olmos…
    Citation: Critical Care 2024 28:235
    Content type: Research Published on:

  34. Early fluid management in patients with advanced chronic kidney disease (CKD) and sepsis-induced hypotension is challenging with limited evidence to support treatment recommendations. We aimed to compare an ea...

    Authors: Anselm Jorda, Ivor S. Douglas, Thomas Staudinger, Gottfried Heinz, Felix Bergmann, Rainer Oberbauer, Gürkan Sengölge, Markus Zeitlinger, Bernd Jilma, Nathan I. Shapiro and Georg Gelbenegger
    Citation: Critical Care 2024 28:231
    Content type: Research Published on:

  35. Adjusting trunk inclination from a semi-recumbent position to a supine-flat position or vice versa in patients with respiratory failure significantly affects numerous aspects of respiratory physiology includin...

    Authors: Martín H. Benites, Marcelo Zapata-Canivilo, Fabian Poblete, Francisco Labbe, Romina Battiato, Andrés Ferre, Jorge Dreyse, Guillermo Bugedo, Alejandro Bruhn, Eduardo L. V. Costa and Jaime Retamal
    Citation: Critical Care 2024 28:228
    Content type: Research Published on:

  36. In a phase 3 trial (PANAMO, NCT04333420), vilobelimab, a complement 5a (C5a) inhibitor, reduced 28-day mortality in mechanically ventilated COVID-19 patients. This post hoc analysis of 368 patients aimed to ex...

    Authors: Rombout B. E. van Amstel, Marleen A. Slim, Endry H. T. Lim, Simon Rückinger, Christopher W. Seymour, Bruce P. Burnett, Lieuwe D. J. Bos, Lonneke A. van Vught, Niels C. Riedemann, Diederik van de Beek and Alexander P. J. Vlaar
    Citation: Critical Care 2024 28:210
    Content type: Brief Report Published on:

  37. Critical illness syndromes including sepsis, acute respiratory distress syndrome, and acute kidney injury (AKI) are associated with high in-hospital mortality and long-term adverse health outcomes among surviv...

    Authors: Joseph Stevens, Oğuzhan Tezel, Valentina Bonnefil, Matthew Hapstack and Mihir R. Atreya
    Citation: Critical Care 2024 28:186
    Content type: Review Published on:

  38. The use of transpulmonary pressure monitoring based on measurement of esophageal pressure has contributed importantly to the personalization of mechanical ventilation based on respiratory pathophysiology in cr...

    Authors: Lorenzo Ball, Daniel Talmor and Paolo Pelosi
    Citation: Critical Care 2024 28:177
    Content type: Review Published on:

    The Matters Arising to this article has been published in Critical Care 2024 28:355

  39. 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
    Content type: Research Published on:

    The Correction to this article has been published in Critical Care 2025 29:89

    The Matters Arising to this article has been published in Critical Care 2025 29:90

    The Matters Arising to this article has been published in Critical Care 2024 28:417

  40. 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
    Content type: Research Published on:

  42. 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
    Content type: Brief Report Published on:

  43. 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
    Content type: Perspective Published on:

  45. 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
    Content type: Research Published on:

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

  46. 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
    Content type: Review Published on:

  47. 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
    Content type: Research Published on:

  48. 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
    Content type: Review Published on:

  50. 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
    Content type: Research Published on: