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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. 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:

  2. 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
    Content type: Research Published on:

  3. 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
    Content type: Brief Report Published on:

  4. 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
    Content type: Brief Report Published on:

  5. 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
    Content type: Research Published on:

  8. 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
    Content type: Research Published on:

  9. 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
    Content type: Research Published on:

  10. 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
    Content type: Brief Report Published on:

  12. 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
    Content type: Review Published on:

  14. 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
    Content type: Research Published on:

    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

  15. 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
    Content type: Research Published on:

  16. 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
    Content type: Brief Report Published on:

  17. 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:

  18. 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:

  19. 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:

  20. 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:

  21. 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:

  22. 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:

  24. 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

  25. 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:

  26. 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:

  27. 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:

  28. 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:

  29. 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:

  30. 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:

  31. 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:

  33. 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:

  34. 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:

  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
    Content type: Review Published on:

  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
    Content type: Research Published on:

  39. 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:

  40. 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:

  41. 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:

  42. 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:

  43. 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

  44. 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:

  45. 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:

  46. 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:

  47. 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:

  48. 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

  49. 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:

  50. 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