Leone M, Myatra SN, Dugar S
… +62 more, Wieruszewski PM, Russell L, Evans L, Delamarre L, Sharif S, Chew MS, Gong MN, Hernández G, Schorr C, Lakbar I, Smith SE, Martin-Loeches I, Annane D, Balik M, Cecconi M, De Backer D, Donadello K, Dünser MW, Einav S, Ferrer R, Juffermans N, Hamzaoui O, Landoni G, Levy B, McKenzie C, Monnet X, Ostermann M, Spies C, Singer M, Theodorakopulou M, Topeli A, Barreto E, Bauer SR, Busse LW, Coopersmith CM, Deutschman C, Holder AL, Kamaleswaran R, Legrand M, Martin GS, Maves RC, Nazer L, Nunnally ME, Prescott HC, Rincon T, Sacha GL, Seymour CW, Arabi YM, Besen BA, Cavalcanti AB, Deane AM, Finfer S, Hammond N, Ibarra-Estrada M, Kattan E, Kotani Y, Machado FR, Ospina-Tascón GA, Mer M, Young PJ, Rochwerg B, Khanna AK
Crit Care Med
· 2026 May · PMID 41873857
·
Publisher ↗
OBJECTIVE: A definition of refractory septic shock is necessary to guide diagnosis, management, prognostication, research, and future guidelines for this most severe form of the disease. We sought to achieve consensus on...OBJECTIVE: A definition of refractory septic shock is necessary to guide diagnosis, management, prognostication, research, and future guidelines for this most severe form of the disease. We sought to achieve consensus on clinical criteria that would be used to define refractory septic shock. DESIGN: Review of literature, expert panel position statements, and Delphi rounds with an international expert group. SETTING: Consensus was defined as having at least 75% of panellists in agreement or disagreement on the three highest or lowest levels of a 7-point Likert scale or based on responses to single- or multiple-choice questions, respectively. SUBJECTS: A panel of multinational, multiprofessional and multidisciplinary critical care experts assembled by the Society of Critical Care Medicine and the European Society of Intensive Care Medicine (57 invitations and 56 participants). MEASUREMENTS AND MAIN RESULTS: A five-round Delphi process was conducted for consensus and stability. The steering committee proposed 34 statements, and five of them were rejected by panel experts after round 2. Among 29 statements selected from eight domains, consensus was reached for 13. The panel agreed on the need for a comprehensive consensus set of clinical criteria for refractory septic shock. Markers of organ dysfunction (75%, 2 rounds), tissue perfusion (91.1%, 2 rounds) including lactate (94.6%, 2 rounds) and capillary refill time (76.8%, 2 rounds), assessment of fluid-responsiveness after initial resuscitation (92.9%, 5 rounds), and use of vasoactive drugs at norepinephrine equivalents greater than 0.5 µg/kg/min (75.0%, 3 rounds), were selected as clinical criteria of refractory septic shock. The use of critical care ultrasound (CCUS) (92.9%, 3 rounds) was the single diagnostic modality that reached a consensus-based agreement. CONCLUSIONS: A consensus for 13 criteria to frame the definition of refractory septic shock was reached. Refractory septic shock is characterised by persistently elevated lactate concentrations and or prolonged capillary refill time in patients with septic shock who are fluid unresponsive, require a norepinephrine base equivalent dose greater than 0.5 micrograms per kilogram per minute, and undergo CCUS assessment when mixed shock is suspected.
Renet A, Ledorze M, Souppart V
… +3 more, Chubbère JJ, Denise T, Kentish-Barnes N
Crit Care Med
· 2026 Jun · PMID 41870237
·
Publisher ↗
OBJECTIVES: Research on relatives' experiences with controlled donation after circulatory determination of death (cDCDD) is limited. This study aims to explore the challenges and experiences of relatives whose loved ones...OBJECTIVES: Research on relatives' experiences with controlled donation after circulatory determination of death (cDCDD) is limited. This study aims to explore the challenges and experiences of relatives whose loved ones die under cDCDD, focusing on how they navigate the process. DESIGN: A qualitative study using semi-structured, in-depth interviews conducted 6 months post-death. This research is part of a larger quantitative multicenter study on the psychologic burden in relatives of cDCDD patients. Relatives of patients in the cDCDD process were purposively sampled and invited to participate in qualitative interviews. Thematic analysis was used to explore the phenomenon from the participants' perspectives. SETTING: This study was conducted in France between November 2022 and November 2023. PATIENTS: Family members of ICU patients identified as potential cDCDD donors. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of 23 family members approached, 19 (mean age 53 yr; 11 women) agreed to participate. The mean interview duration was 43 minutes. In three cases, organ retrieval was not possible. Thematic analysis revealed three key themes: 1) "Two decisions, two worlds"-discussing the decision to withdraw life-sustaining therapies and the organ donation request; 2) "Waiting for death"-the period between the decision and its implementation; and 3) "A controlled death"-dying and death in a monitored and technical environment. CONCLUSIONS: Relatives can be deeply engaged in cDCDD when well-prepared. However, additional support is needed during the waiting period, as families witness their loved one's decline. Proper preparation for dying is crucial to prevent perceptions of suffering, thereby reducing distress. Healthcare professionals must balance emotional, ethical, and medical considerations to facilitate informed choices in a highly regulated system.
Christiaanse PMR, van Zutphen T, Bolding HA
… +6 more, van der Werf RAM, Stellingwerf F, de Jager CM, Buter H, Boerma EC, Beumeler LFE
Crit Care Med
· 2026 Jun · PMID 41870216
·
Publisher ↗
OBJECTIVES: Evidence supporting the benefits of combined nutrition and exercise programs in ICU survivors is limited. We assessed the impact of a combined lifestyle intervention on perceived physical functioning (PF) and...OBJECTIVES: Evidence supporting the benefits of combined nutrition and exercise programs in ICU survivors is limited. We assessed the impact of a combined lifestyle intervention on perceived physical functioning (PF) and health-related quality of life (HRQoL) post-ICU. DESIGN: Single-center randomized control trial. SETTING: Teaching hospital in the Netherlands (Frisius Medical Centre Leeuwarden). PATIENTS: Adult long stay ICU survivors (≥ 48 hr) with a PF score of less than 67% on the Dutch translation of the RAND-36 item Health Survey. INTERVENTIONS: The 12-week intervention included twice-weekly group exercise, dietary advice, and protein supplementation as needed. The control group received standard aftercare according to local protocol. MEASUREMENTS AND MAIN RESULTS: Primary outcome (PF score at 12 wk) and secondary outcomes were assessed during a clinic visit at baseline and after a 12-week period. 39 patients completed the study (control, n = 20; intervention, n = 19): 26% female, median age 61 years (46-72), median ICU stay 7 days (4-14), and patients were severely ill (Acute Physiology and Chronic Health Evaluation III: 67 [50-89]). Although there were imbalances in ICU characteristics, baseline characteristics and PF scores were similar. At 12 weeks, the intervention group showed a significant improvement ( p = 0.024) in PF-domain score. Daily protein intake in the intervention group increased from 82.3 (67.5-97.9) to 116.7 (107.3-138.7) g/kg ( p = 0.003), with 68% meeting the minimal intake target of 1.2 g/kg/d. CONCLUSIONS: The data of this small-sample size randomized controlled trial suggest that a combined lifestyle intervention program can significantly improve PF and protein intake in ICU survivors with a prolonged PF scores below reference.
Wetterberg H, Nilsson A, Linder A
… +4 more, Lengquist M, Frigyesi A, Sundén-Cullberg J, Inghammar M
Crit Care Med
· 2026 Jul · PMID 41870200
·
Full text
OBJECTIVES: To quantify the risk of incident psychiatric morbidity after community-acquired sepsis and assess whether new chronic diseases mediate the association. DESIGN: Nationwide, population-based matched register co...OBJECTIVES: To quantify the risk of incident psychiatric morbidity after community-acquired sepsis and assess whether new chronic diseases mediate the association. DESIGN: Nationwide, population-based matched register cohort; hazards estimated with weighted Cox regression. SETTING: Sweden, linking the National Quality Sepsis Registry, National Patient Register, Prescribed Drug Register, and population registers. PATIENTS: Ten thousand three hundred eight adults (≥ 18 yr) treated in an ICU for sepsis (2008-2019), matched to 155,705 population controls by sex, age, region, and year. Individuals with a psychiatric diagnosis within 5 years or psychotropic medication within 1 year before index were excluded. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The primary outcome, psychiatric event, was first occurrence after index date of either initiation of a psychotropic medication (anatomic therapeutic chemical classification system code N05A, N05BA, N05C, N06A) in the Prescribed Drug Register (capturing prescriptions from primary and specialist care) or a new International Classification of Diseases , 10th Edition mood (F3) or anxiety (F4) diagnosis in specialist care. Weighted Cox models balanced baseline covariates. We used a Landmark approach with risk sets at 0-30, 31-90, 91-365 days; 1-3, 3-5, and greater than or equal to 5 years after the index date. Sepsis was associated with increased hazards of psychiatric events vs. matched controls, with the strongest associations in the first year (0-30 d: adjusted hazard ratio [aHR], 6.2 [5.0-7.7]; 31-90 d: aHR, 7.4 [6.5-8.6]; and 91-365 d: aHR, 2.3 [2.1-2.5]) attenuating over time but remaining elevated through 5 years (1-3 yr: aHR, 1.2 [1.1-1.5]; 3-5 yr: aHR, 1.3 [1.1-1.5]; and ≥ 5 yr: aHR, 1.1 [0.9-1.3]). In mediation analyses considering incident chronic diseases, estimates changed little, suggesting that these conditions did not mediate the association. CONCLUSIONS: Patients with sepsis had a higher subsequent incidence of psychiatric events compared with matched population controls, with a persistently elevated risk for at least 5 years. This increased risk suggests that sepsis may have a long-term impact on psychiatric health, warranting consideration of preventive strategies.
Prescott HC, Antonelli M, Alhazzani W
… +66 more, Møller MH, Alshamsi F, Azevedo LCP, Belley-Cote E, De Waele J, Derde L, Dionne JC, Evans L, Gershengorn HB, Hodgson CL, Honarmand K, Kesecioglu J, McIntyre L, Mer M, Nunnally ME, Oczkowski SJW, Rochwerg B, Akinola OO, Akuamoah-Boateng KA, Alberto L, Angus DC, Arabi YM, Azoulay E, Cecconi M, Convocar PF, De Pascale G, Doi K, Du B, Egi M, Elie-Turenne MC, Ferrer R, Fox-Robichaud A, French C, Freund Y, Gong MN, Hale CP, Hammond NE, Hashmi M, Heunks L, Iwashyna TJ, Jacob ST, Klompas M, Kwizera A, Leeies M, Lejnieks JD, Levy MM, Machado FR, Maia MO, Masur H, Maves RC, McGloughlin S, McPeake J, Mohr NM, Myatra SN, Ostermann M, Peake SL, Pletz MW, Roberts JA, Rosa RG, Sawyer RG, Schorr CA, Simpson SQ, Weng L, Wiersinga WJ, Rhodes A, Coopersmith CM
Crit Care Med
· 2026 Apr · PMID 41869847
·
Publisher ↗
Prescott HC, Antonelli M, Alhazzani W
… +66 more, Møller MH, Alshamsi F, Azevedo LCP, Belley-Cote E, De Waele J, Derde L, Dionne JC, Evans L, Gershengorn HB, Hodgson CL, Honarmand K, Kesecioglu J, McIntyre L, Mer M, Nunnally ME, Oczkowski SJW, Rochwerg B, Akinola OO, Akuamoah-Boateng KA, Alberto L, Angus DC, Arabi YM, Azoulay E, Cecconi M, Convocar PF, De Pascale G, Doi K, Du B, Egi M, Elie-Turenne MC, Ferrer R, Fox-Robichaud A, French C, Freund Y, Gong MN, Hale CP, Hammond NE, Hashmi M, Heunks L, Iwashyna TJ, Jacob ST, Klompas M, Kwizera A, Leeies M, Lejnieks JD, Levy MM, Machado FR, Maia MO, Masur H, Maves RC, McGloughlin S, McPeake J, Mohr NM, Myatra SN, Ostermann M, Peake SL, Pletz MW, Roberts JA, Rosa RG, Sawyer RG, Schorr CA, Simpson SQ, Weng L, Wiersinga WJ, Rhodes A, Coopersmith CM
Crit Care Med
· 2026 Apr · PMID 41869831
·
Publisher ↗
Hidalgo JL, Akech SO, Acharya SP
… +18 more, Coopersmith CM, Jacob ST, Johnston C, Kissoon N, Machado FR, Maves RC, Molyneux E, Morrow BM, Myatra SN, Pérez Cornejo MS, Perez-Fernandez J, Permpikul C, Piyavechviratana K, Rhodes A, Kortz TB, Kumar VK, Ulisubisya MM, Nadkarni V
Crit Care Med
· 2026 May · PMID 41860329
·
Publisher ↗
OBJECTIVES: Sepsis is a time-sensitive cause of preventable death worldwide, with disproportionate mortality in low-resource settings (LRS). Many recommendations in international sepsis guidance presume resources unavail...OBJECTIVES: Sepsis is a time-sensitive cause of preventable death worldwide, with disproportionate mortality in low-resource settings (LRS). Many recommendations in international sepsis guidance presume resources unavailable in many facilities and communities. We sought to develop a practical framework that helps health systems embed feasible sepsis actions within broader emergency and essential critical care systems, while highlighting where evidence is limited and where local learning systems are needed. DATA SOURCES: A targeted scoping review of peer-reviewed and grey literature on sepsis epidemiology, emergency care systems, essential emergency and critical care, implementation strategies, and quality improvement (QI) in LRS; and key guideline and policy documents relevant to sepsis and emergency care. STUDY SELECTION: We prioritized publications and guidance relevant to LRS, including observational studies, pragmatic implementation reports, consensus statements, and policies addressing emergency care organization, workforce, supply chains, diagnostics, and QI. DATA EXTRACTION: Task force members abstracted actionable strategies, implementation barriers/enablers, and feasibility considerations across the care continuum (community, transport/prehospital, facility-based acute care, and referral). We also identified domains where guideline certainty is low or indirect for LRS. DATA SYNTHESIS: A Society of Critical Care Medicine-convened multidisciplinary task force iteratively developed the "Sepsis Frame of Survival" using a structured process that included 1) scoping evidence review, 2) a Delphi-style prioritization of candidate framework elements by importance and feasibility, and 3) a structured consensus meeting ("Utstein-style" conference format) to finalize the model and its priority actions. We produced a concise implementation roadmap and a feasible measurement set aligned with resource constraints. CONCLUSIONS: The Sepsis Frame of Survival is a pragmatic model to organize sepsis improvement as part of emergency and essential critical care strengthening. It emphasizes high-impact actions that can be implemented with limited resources (triage and early recognition, timely antimicrobials, oxygen and basic supportive care, cautious fluid resuscitation with reassessment, source control and referral, diagnostics/microbiology where feasible, and QI). The framework explicitly distinguishes near-term, feasible changes from longer-term system investments and highlights the need for locally generated evidence to guide quality indicators and resuscitation strategies in LRS.
Myatra SN, Boyer KM, Hidalgo JL
… +21 more, Maves RC, Acharya SP, Jacob ST, Kortz TB, Nadkarni VM, Pérez Cornejo MS, Perez-Fernandez J, Johnston C, Machado FR, Morrow BM, Coopersmith CM, Kissoon N, Molyneux E, Permpikul C, Piyavechviratana K, Rhodes A, Ulisubisya MM, Kumar VK, Patel H, Woznica D, Akech SO
Crit Care Med
· 2026 May · PMID 41860328
·
Publisher ↗
OBJECTIVES: Almost 80% of sepsis cases occur in low-resource settings (LRS), where limited resources impede the effective implementation of international guidelines for sepsis management. In addition, existing sepsis gui...OBJECTIVES: Almost 80% of sepsis cases occur in low-resource settings (LRS), where limited resources impede the effective implementation of international guidelines for sepsis management. In addition, existing sepsis guidelines have not fully addressed specific issues relevant to LRS. Therefore, an international panel of 20 multiprofessional sepsis experts was convened to generate consensus on the gaps in and strategies for sepsis care in LRS. The recently developed "sepsis chain of survival" was used as a framework. DATA SOURCES: MEDLINE, Embase. STUDY SELECTION: Studies selected included human studies (clinical trials, cohort, case-control, and case series) reporting clinical outcomes in patients with sepsis from LRS between January 1, 2000, and July 4, 2024. Search terms included "developing countries," "LMIC," "resource-poor settings," and regional terms such as Africa, Southeast Asia, and Latin America. The Delphi process involved iterative, anonymous voting by the expert panel to achieve consensus to draft clinical practice statements. DATA EXTRACTION: A detailed literature review was conducted using the "sepsis chain of survival" as a basis, with an emphasis on sepsis prevention, detection, therapy, post-sepsis care, education, and future research priorities. A total of 8865 studies were identified and screened, with 155 included in the review. DATA SYNTHESIS: Based on literature review, the Delphi process achieved a stable consensus for 58 of 62 (94%) of the proposed clinical practice statements after eight survey rounds. These statements offer guidance on measures to improve the prevention, early recognition and time-sensitive, comprehensive management of sepsis in LRS through the continuum of care from first response to post-sepsis care and follow-up. CONCLUSIONS: There remains a significant lack of high-quality evidence to support improvements in sepsis care for patients in LRS. Pending new data, the clinical practice statements identified here complement the existing international guidelines for sepsis management by serving as a basis for immediate care and future research in LRS.
Andrea L, Berg KM, Johnson NJ
… +73 more, Mitchell OJL, Pearce AK, Green A, Elmer J, Huespe IA, Lanspa MJ, Davis GR, Peltan ID, Herman NS, Malhotra R, Bangar MD, Peterson LN, Wadud N, Mayfield H, Vaena M, Valdez P, Howard TE, Loewe MR, Faiver L, Tam J, Halablab SM, Kaviyarasu A, Baram M, Chan V, Crisci T, Rosal N, Ghamande SA, White HD, Anderson B, Dugar S, Mehkri O, Saleem T, Vine J, Lee JH, Norton DL, Gaillard JP, Wachs T, Herbert JT, Krishnamoorthy V, Wardi G, Long MT, Craigova L, DeMasi SC, Shipley K, Khan A, Schnittke N, Hubel K, Crowley CP, Hansen CK, Dodd KW, Choudhury S, March C, Martinez A, Reyes A, Joffe AM, Bui A, Denchev K, Bissell Turpin BD, Fowajuh R, Ward J, Khan A, Chang C, Richieri E, Mirofsky M, Sagardia J, Piezny D, Gira AR, Cunto E, Khan R, Al-Hakim T, Gong MN, Moskowitz A, Discovery, the Critical Care Research Network of the Society of Critical Care Medicine
Crit Care Med
· 2026 Jun · PMID 41860326
·
Full text
OBJECTIVES: A temperature control strategy is strongly recommended for comatose in-hospital cardiac arrest (IHCA) survivors. We aimed to investigate variation in adherence to this recommendation and associations with out...OBJECTIVES: A temperature control strategy is strongly recommended for comatose in-hospital cardiac arrest (IHCA) survivors. We aimed to investigate variation in adherence to this recommendation and associations with outcomes, which have not been comprehensively assessed for IHCA. DESIGN: Prospective observational cohort study with data collected from October 2023 to June 2024. SETTING: Multicenter, international (24 hospital systems, 46 enrolling hospitals). PATIENTS: Adults who suffered IHCA, survived initial resuscitation, and remained comatose and eligible for temperature control. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The main exposure was documentation of a temperature control strategy in the first 24 hours after arrest. Outcomes were survival to hospital discharge (primary), use of temperature control therapy, fever (temperature ≥ 38°C), favorable functional outcome (modified Rankin Scale ≤ 3), and favorable neurologic outcome (Cerebral Performance Category score ≤ 2). Among 1006 enrolled patients, 615 (61.1%) remained comatose and were eligible for temperature control; of those, 273 (44.4%) had a documented temperature control strategy. A documented strategy was associated with higher adjusted odds of receiving a temperature control therapy (adjusted odds ratio [aOR], 21.3; 95% CI, 12.3-36.7; p < 0.01), and lower adjusted odds of fever in the first 24 hours after resuscitation (aOR, 0.63; 95% CI, 0.43-0.92; p = 0.02). Having a strategy, compared with not, had no statistically significant association with survival (32.6% vs. 28.1%; aOR, 1.19; 95% CI, 0.79-1.80; p = 0.42), favorable functional outcome (9.9% vs. 10.5%; aOR, 1.14; 95% CI, 0.53-2.42; p = 0.74), or favorable neurologic outcome (12.8% vs. 12.3%; aOR, 1.15; 95% CI, 0.63-2.12; p = 0.65). Hospital system specific proportions of temperature control strategy ranged from 0% to 100%. CONCLUSIONS: Among comatose IHCA survivors, more than half received no documented temperature control strategy. Those with a strategy were less likely to have a fever and more likely to receive temperature control directed therapy, but showed no difference in survival, functional, or neurologic outcomes.
Ferrante LE, Chaudhuri D, Laiya Carayannopoulos K
… +19 more, Jain S, Tate JA, Álvarez-Espinoza E, Austin CA, Burry L, Devinney MJ, Ehlenbach WJ, Happ MB, Hope AA, Hua M, Kho ME, Palakshappa JA, Scheunemann LP, Sinvani L, Stahl B, Wang S, Wunsch H, Rochwerg B, Brummel NE
Crit Care Med
· 2026 May · PMID 41860322
·
Publisher ↗
RATIONALE: Older adults (those 65 years old or greater) compose a substantial proportion of the ICU population. As older adults with critical illness possess unique factors and considerations relevant to their care and o...RATIONALE: Older adults (those 65 years old or greater) compose a substantial proportion of the ICU population. As older adults with critical illness possess unique factors and considerations relevant to their care and outcomes, there is a need for evidence-based recommendations to guide critical care clinicians in the care of older ICU patients. OBJECTIVE: The objective of this guideline is to develop evidence-based recommendations addressing the care of older adults during and after critical illness. DESIGN: The American College of Critical Care Medicine Board convened a 22-member interprofessional panel, comprising physicians, advanced practice providers, nurses, a pharmacist, physical therapist, occupational therapist, and a patient representative. The panel included two expert methodologists specialized in developing evidence-based recommendations in alignment with the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. Conflict-of-interest policies were strictly followed during all phases of guideline development including task force selection and voting. METHODS: The panel members prioritized five Population, Intervention, Comparator, and Outcomes questions. A systematic review was conducted for each question to identify the best available evidence, synthesize the evidence and assess the certainty of evidence using GRADE. The evidence-to-decision framework was used to formulate recommendations. RESULTS: The panel generated two conditional recommendations and three "no recommendation" statements. The conditional recommendations are: 1) We suggest a geriatric model of care for all older adults admitted to the ICU and 2) We suggest not using antipsychotic medications for the prevention of delirium in older adults with critical illness. The three "no recommendation" statements are: 1) We make no recommendation regarding specialized post-ICU follow-up for older survivors of critical illness, 2) For older adults (age 65 and over) admitted to the ICU with vasodilatory shock, we make no recommendation with regard to targeting a mean arterial pressure (MAP) of 60-65 mm Hg as compared with usual care (MAP target > 65 mm Hg), and 3) We make no recommendation regarding the use of antipsychotic medication in the treatment of delirium in older adults with critical illness. CONCLUSIONS: The guideline panel developed recommendations on caring for older adults during and after critical illness. Areas for future research were also identified during the guideline process.
Kortz TB, Hidalgo JL, Akech SO
… +20 more, Myatra SN, Maves RC, Perez-Fernandez J, Acharya SP, Coopersmith CM, Jacob ST, Johnston C, Kissoon N, Machado FR, Molyneux E, Morrow BM, Pérez Cornejo MS, Permpikul C, Piyavechviratana K, Rhodes A, Ulisubisya MM, Kumar VK, Patel H, Woznica D, Nadkarni VM
Crit Care Med
· 2026 Apr · PMID 41860319
·
Publisher ↗
OBJECTIVES: To develop a practical consensus-based framework for 10 steps to improve sepsis care in low-resource settings (LRSs), aligned with the sepsis chain of survival and informed by global expertise. DATA SOURCES:...OBJECTIVES: To develop a practical consensus-based framework for 10 steps to improve sepsis care in low-resource settings (LRSs), aligned with the sepsis chain of survival and informed by global expertise. DATA SOURCES: We reviewed peer-reviewed literature on sepsis epidemiology, prevention, recognition, and management in LRS; international guidelines, including the Surviving Sepsis Campaign; and prior "10-step" consensus frameworks for resuscitation and emergency care. STUDY SELECTION: A Task Force representing adult and pediatric sepsis care, emergency care, critical care, infectious diseases, public health, and implementation science identified key domains from the above data sources. DATA EXTRACTION: With guidance from methodologists and implementation science experts, we utilized an iterative, consensus-based process-literature review, Delphi survey, Utstein-style conference, stakeholder input, and public comment-to first define and then refine steps and implementation strategies. DATA SYNTHESIS: The process resulted in 10 nonsequential, actionable steps covering governance and commodities, provider and caregiver education, community and facility prevention, early recognition and rapid response, timely guideline-based interventions, structured post-sepsis care, data systems, quality improvement, a culture of excellence and respect, and holistic well-being of patients, caregivers, and providers. Each step includes a rationale and potential implementation strategies adaptable to local resources and needs. Collectively, the ten steps emphasize integration across the continuum of care, equitable access to essential interventions, and the role of emerging technologies to prevent, recognize, monitor, and follow-up sepsis. CONCLUSIONS: The 10 steps provide a consensus-driven roadmap for health leaders, clinicians, and policymakers to improve sepsis care, strengthen the sepsis chain of survival, reduce preventable morbidity and mortality, and address global inequities in sepsis outcomes.
Almoosawy SA, Fernando SM, Rochwerg B
… +5 more, Durr K, McIntyre L, Seely AJE, Patel R, Tran A
Crit Care Med
· 2026 Apr · PMID 41860316
·
Publisher ↗
OBJECTIVES: To evaluate the association between socioeconomic position (SEP) and mortality in patients with sepsis or septic shock. DATA SOURCES: We searched MEDLINE, Embase, and Cochrane CENTRAL from inception to August...OBJECTIVES: To evaluate the association between socioeconomic position (SEP) and mortality in patients with sepsis or septic shock. DATA SOURCES: We searched MEDLINE, Embase, and Cochrane CENTRAL from inception to August 11, 2025. STUDY SELECTION: We included English-language observational studies that evaluated the association between SEP indicators and mortality in adults with sepsis and/or septic shock. DATA EXTRACTION: Two reviewers independently and in duplicate performed data extraction and risk-of-bias assessment using the Quality in Prognosis Studies tool. We pooled adjusted odds ratios (aORs) or adjusted hazard ratios (aHRs) using random-effects models and assessed certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach. DATA SYNTHESIS: We included 13 observational studies involving 3,951,677 patients. Lack of private insurance (aOR, 1.34; 95% CI, 1.19-1.51; high certainty) was associated with increased mortality while lower neighborhood socioeconomic status (aOR, 1.35; 95% CI, 1.29-1.41; moderate certainty) and lower income (aOR, 1.06; 95% CI, 1.01-1.11; aHR, 1.51; 95% CI, 1.01-2.25; moderate certainty) were probably associated with increased mortality. Less education (aOR, 1.33; 95% CI, 1.14-1.55; low certainty) and unemployment (aOR, 1.91; 95% CI, 1.00-3.63; low certainty) may be associated with increased mortality. CONCLUSIONS: We found that several indicators of SEP were associated with increased short-term mortality in patients with sepsis and septic shock. These findings underscore the need for routine collection of equity-relevant variables in sepsis research to inform health policy and support equitable care delivery. Given that some of these variables are potentially modifiable, targeted interventions may help improve outcomes and reduce disparities in disadvantaged populations.
Nagata I, Sprung CL, Lautrette A
… +21 more, Jaschinski U, Mullick S, Aggarwal A, Pantazopoulos I, Anstey MH, Jensen HI, Karlis G, Marliere MH, Tsagkaris I, Montiel BE, Barrachina LG, Weiss M, Romain M, Nunnally ME, Cerny V, Piras C, Miskolci O, Barth E, Ricou B, Avidan A, ETHICUS-2 Study Group
Crit Care Med
· 2026 Apr · PMID 41860289
·
Full text
OBJECTIVES: The practice of limiting life-sustaining therapy (LST) at end-of-life is widespread globally. The goal of this study was to evaluate whether patient's age influences end-of-life limitations overall and of var...OBJECTIVES: The practice of limiting life-sustaining therapy (LST) at end-of-life is widespread globally. The goal of this study was to evaluate whether patient's age influences end-of-life limitations overall and of various LST in ICUs worldwide. DESIGN: Multinational, multicenter, prospective observational study. SETTING: One hundred ninety-nine ICUs in 36 countries worldwide. PATIENTS: Consecutive adult patients admitted to ICUs who died and/or had LST limitations (withholding, withdrawing, or active shortening of the dying process) were included during a 6-month period between September 2015 and September 2016. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Patients were grouped: younger than 65 years, 65-79 years old, and 80 years old or older. A total of 12,200 patients were included. In multivariate logistic regression analysis, odds ratio (OR) for any LST limitation in the 80 years old or older group was higher than in younger than the 65 years old group (OR 1.47 [95% CI, 1.22-1.76], p < 0.001). When stratified by region, this association was significant in Central and Southern Europe (OR 1.56 [95% CI, 1.11-2.20], p = 0.037 and OR 2.23 [95% CI, 1.58-3.17], p < 0.001, respectively), but not in the other regions. The proportion of withholding therapy of each LST was highest in the group of individuals 80 years or older, whereas the proportion of withdrawing therapy was highest in the group younger than 65 years. The 80-year-old or older group also had a shorter time from ICU admission to first limitation. The predominant reason for any LST limitation in all age groups was unresponsiveness to maximal therapy, followed by neurologic and chronic diseases. Patient age was rarely the primary reason for limitations for all groups. CONCLUSIONS: End-of-life limitations were higher in patients 80 years or older compared to those 65 years old or younger, with regional variations. The main reasons for limitations were comparable across age groups, with age not being the primary reason.
Shiozumi T, Matsuyama T, Imamura T
… +4 more, Nishioka N, Kiguchi T, Kitamura T, Iwami T
Crit Care Med
· 2026 Jun · PMID 41848362
·
Publisher ↗
OBJECTIVES: To evaluate temporal trends in clinical outcomes among nontraumatic out-of-hospital cardiac arrest (OHCA) patients transported to critical care medical centers (CCMCs) in Japan. DESIGN: Retrospective cohort s...OBJECTIVES: To evaluate temporal trends in clinical outcomes among nontraumatic out-of-hospital cardiac arrest (OHCA) patients transported to critical care medical centers (CCMCs) in Japan. DESIGN: Retrospective cohort study. SETTING: Nationwide multicenter registry involving CCMCs in Japan, which are government-designated advanced emergency care institutions specializing in intensive resuscitation and post-cardiac arrest management. Data were obtained from the Japanese Association for Acute Medicine OHCA (JAAM-OHCA) registry from June 1, 2014, to December 31, 2022. PATIENTS: Adult patients (≥ 18 yr old) with nontraumatic OHCA who were transported to CCMCs and had Utstein-style prehospital data available. Patients were categorized into three calendar periods (2014-2016, 2017-2019, and 2020-2022) for temporal comparison. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Among 61,725 eligible patients, the proportion with favorable neurologic outcomes decreased from 3.6% (2014-2016) to 3.3% (2017-2019) and further to 2.5% (2020-2022). Using multivariable logistic regression, the adjusted odds ratios (aORs) for favorable neurologic outcome were 1.01 (95% CI, 0.89-1.15) in 2017-2019 and 0.83 (95% CI, 0.72-0.94) in 2020-2022, compared with 2014-2016. Similarly, 30-day survival declined during the same period, from 6.9% to 6.8% and 5.4%. In most predefined subgroups, similar trends were observed. In contrast, neurologic outcomes improved among candidates for extracorporeal cardiopulmonary resuscitation (ECPR), with an aOR of 1.43 (95% CI, 1.06-1.93) in 2020-2022 compared with 2014-2016. CONCLUSIONS: Outcomes among OHCA patients transported to CCMCs remained stable until 2019 but declined during the COVID-19 pandemic period. However, improved outcomes among patients eligible for ECPR suggest that timely and targeted post-arrest interventions may improve outcomes in selected populations.
Crit Care Med
· 2026 Jun · PMID 41841954
·
Publisher ↗
Central to managing critically ill patients is the identification of the etiology of cardiorespiratory insufficiency (i.e., shock), early appropriate targeted therapies to support the cardiorespiratory system to sustain...Central to managing critically ill patients is the identification of the etiology of cardiorespiratory insufficiency (i.e., shock), early appropriate targeted therapies to support the cardiorespiratory system to sustain adequate blood flow and oxygen to the tissues, plus specific treatments to reverse the cause of shock. Over the past 40 years, numerous advances in our understanding of shock, its severity, and its response to therapies, along with more specific and insightful monitoring approaches, have been developed. This perspective summarizes some aspects of that progress. We have come a long way, but we need to understand three things. First, that once organ injury has occurred all that our treatments can do is mitigate further injury, not reverse it. If initial aggressive resurrection efforts cannot restore organ function, then their actions often cause only iatrogenic injury. Second, existing advanced monitoring devices, no matter how insightful their data, will not improve patient outcomes unless coupled to a treatment that itself improves outcomes. Finally, all our advances over these years have underscored the fundamental need for having a thoughtful and observant bedside clinician cognizant of the pathophysiologic underpinnings of disease and its care who titrates care based on the patient's individual response.
Lyu S, Luo J, Liu P
… +5 more, Qin X, He W, Jing G, Ehrmann S, Li J
Crit Care Med
· 2026 Jun · PMID 41837717
·
Publisher ↗
OBJECTIVES: To assess the effects of adjunctive inhaled antibiotics in treating ventilator-associated pneumonia (VAP). DATA SOURCES: We searched PubMed, Web of Science, Embase, Cochrane Library, and ClinicalTrials.gov th...OBJECTIVES: To assess the effects of adjunctive inhaled antibiotics in treating ventilator-associated pneumonia (VAP). DATA SOURCES: We searched PubMed, Web of Science, Embase, Cochrane Library, and ClinicalTrials.gov through May 31, 2025. STUDY SELECTION: We included randomized controlled trials (RCTs) and nonrandomized studies comparing adjunctive inhaled antibiotics with placebo/blank or IV antibiotics for VAP treatment. DATA EXTRACTION: Two groups independently screened studies, extracted data, and assessed risk of bias. Analyses used random effects models. Subgroup analyses, meta-regression, trial sequential analysis, and the Grading of Recommendations Assessment, Development, and Evaluation were performed. DATA SYNTHESIS: We included 32 RCTs in the primary analysis and 41 non-RCTs in sensitivity analysis. Compared with placebo/blank, inhaled antibiotics significantly improved clinical cure (16 RCTs; n = 1425; risk ratio [RR], 1.24; 95% CI, 1.07-1.43) and reduced all-cause mortality (21 RCTs; n = 1855; RR, 0.84; 95% CI, 0.71-0.98), with consistent findings in sensitivity analyses including non-RCTs. These benefits were significant in VAP-only patients (clinical cure: 11 RCTs; n = 775; RR, 1.29; 95% CI, 1.10-1.52 and all-cause mortality: 15 RCTs; n = 1152; RR, 0.77; 95% CI, 0.65-0.90), but not in studies including mixed pneumonia populations. Meta-regression confirmed VAP-only population as a significant effect modifier. Inhaled antibiotics also improved microbiological eradication (20 RCTs; n = 1805; RR, 1.42; 95% CI, 1.27-1.58) and reduced emergence of new drug resistance (four RCTs; n = 182; RR, 0.20; 95% CI, 0.06-0.64). No differences were found in ICU length of stay, ventilator duration, or other adverse events. Compared with IV antibiotics, inhaled antibiotics shortened ventilator duration (three RCTs; n = 322; mean difference, -2.11 d; 95% CI, -3.73 to -0.49 d), and reduced nephrotoxicity (three RCTs; n = 292; RR, 0.42; 95% CI, 0.26-0.68). CONCLUSIONS: Compared with placebo/blank, adjunctive inhaled antibiotics improve clinical cure and microbiological eradication, and may reduce mortality, particularly in VAP-only patients. Exploratory analyses based on limited data suggest potential advantages over IV therapy, including shorter ventilator duration and lower nephrotoxicity, warranting further high-quality trials.