Intensive Care Medicine

Intensive Care Medicine The official page for ICM, Intensive Care Medicine.

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.

-Quizz An 81-year-old woman was admitted to the ICU with sudden involuntary movements of the right limbs and altered ...
31/12/2025

-Quizz An 81-year-old woman was admitted to the ICU with sudden involuntary movements of the right limbs and altered consciousness. Serum glucose was markedly elevated at 21.97 mmol/L, with no ketones detected. Brain CT revealed hyperdensity in the left lentiform nucleus, while MRI showed corresponding T1-weighted hyperintensity in the same region. The combined findings point toward a specific metabolic cause. What's your diagnosis?

https://zurl.co/AR5DU Burst suppression reflects deep pharmacologically induced cortical inactivation beyond typical ana...
30/12/2025

https://zurl.co/AR5DU Burst suppression reflects deep pharmacologically induced cortical inactivation beyond typical anaesthesia and ICU sedation goals. ICU guidance favours light sedation such as RASS 0 to −1, but deeper levels remain common and burst suppression marks oversedation. Processed EEG and delirium screening with CAM-ICU or ICDSC support titration that limits burst suppression and may reduce postoperative delirium.

https://zurl.co/6ngrA Low PEEP is preferred in patients without ARDS. High PEEP is reserved for selected patients after ...
30/12/2025

https://zurl.co/6ngrA Low PEEP is preferred in patients without ARDS. High PEEP is reserved for selected patients after assessment of lung recruitment potential and with strict haemodynamic and cerebral perfusion monitoring. In the absence of robust evidence, a physiologically oriented algorithm for PEEP titration in brain-injured patients has been proposed, while balancing personalised management with pragmatic, generalisable algorithms.

https://zurl.co/807gX In 1,861 adults from the international TTM2 trial, greater pre-arrest frailty (Clinical Frailty ...
29/12/2025

https://zurl.co/807gX In 1,861 adults from the international TTM2 trial, greater pre-arrest frailty (Clinical Frailty Scale) was linked to progressively higher odds of death and poor functional outcome at 6 and 24 months after out-of-hospital cardiac arrest. Severely frail patients had neuroprognostication less often; withdrawal of life-sustaining therapies was more frequent; frail survivors more often reported functional decline and lower overall health status.

https://zurl.co/Sjt5x In sepsis, the ESICM 2025 guideline suggests up to 30 mL/kg crystalloids, adapted to context with ...
29/12/2025

https://zurl.co/Sjt5x In sepsis, the ESICM 2025 guideline suggests up to 30 mL/kg crystalloids, adapted to context with frequent reassessment. Optimisation uses passive leg raising or pulse pressure variation and ultrasound, and a fluid challenge can give 3–5 mL/kg over 10–15 min with stroke volume or cardiac output monitoring. After perfusion is restored, fluid input is minimised, including hidden fluids, and protocolised diuretics can support fluid removal.

https://zurl.co/LTsaM Renal replacement therapy timing in acute kidney injury has shifted toward delayed initiation to a...
28/12/2025

https://zurl.co/LTsaM Renal replacement therapy timing in acute kidney injury has shifted toward delayed initiation to avoid unnecessary treatment and vascular access complications. Renal replacement therapy use in French ICUs decreased from 39.7% in 2008–2011 to 35.9% in 2016–2019, with annual crude rates falling from 441 to 339 treatments per 1,000 ICU stays. The decline began before AKIKI and accelerated after 2016 without an abrupt inflection.

https://zurl.co/tYAOt Septic shock is defined by life-threatening organ dysfunction with persistent hypotension, eleva...
28/12/2025

https://zurl.co/tYAOt Septic shock is defined by life-threatening organ dysfunction with persistent hypotension, elevated lactate and a need for vasopressors, and affects millions worldwide with high mortality and long-term disability. Optimal care emphasises early recognition, individualised fluid and vasopressor therapy, appropriate antimicrobials, source control, haemodynamic monitoring and follow-up to address post-sepsis syndrome.

https://zurl.co/GUZbM Older adults have higher delirium risk due to cognitive impairment, functional disability, hearing...
27/12/2025

https://zurl.co/GUZbM Older adults have higher delirium risk due to cognitive impairment, functional disability, hearing loss and vision impairment. Delirium in older adults is linked to increased mortality, prolonged hospitalisations, long-term cognitive impairment, loss of independence and institutionalisation. Delirium screening uses CAM-ICU or ICDSC, and the ABCDEF bundle is associated with reduced delirium duration and improved survival.

https://zurl.co/D4QhE Early AKI biomarkers may add little to clinical assessment when shock, infection or nephrotoxins a...
27/12/2025

https://zurl.co/D4QhE Early AKI biomarkers may add little to clinical assessment when shock, infection or nephrotoxins are evident. Biomarker-gated bundles reduced AKI in cardiac surgery, but the incremental contribution of biomarkers remains uncertain and predictions can drive inappropriate action. Under standardised RRT criteria, individual and combined biomarkers showed only modest prediction, supporting a stronger research role than bedside triggering.

https://zurl.co/wmXhJ Mortality from ARDS remains high, and the Global ARDS definition enables earlier identification. G...
26/12/2025

https://zurl.co/wmXhJ Mortality from ARDS remains high, and the Global ARDS definition enables earlier identification. Global hospital mortality is estimated at 35% in mild, 40% in moderate and 46% in severe ARDS. Management uses low tidal volume ventilation at 6 (4–8) ml/kg PBW with plateau pressure below 30 cmH2O, oxygen targets of SpO2 90–95% or PaO2 60–80 mmHg and early prone positioning when PaO2/FiO2 is below 150 mmHg.

https://zurl.co/RmJbx Disorders of consciousness after acute brain injury can be masked in the ICU by sedation, seizur...
26/12/2025

https://zurl.co/RmJbx Disorders of consciousness after acute brain injury can be masked in the ICU by sedation, seizures and metabolic derangements, complicating diagnosis and prognosis. Standardised serial behavioural tools plus management of confounders and prevention of secondary injury underpin care. Neuroimaging, electrophysiology and blood biomarkers may refine prognostication, but routine ICU use remains limited.

https://zurl.co/R8H5U Weaning was markedly more prolonged in Guillain–Barré syndrome than in myasthenia gravis. Most Gui...
25/12/2025

https://zurl.co/R8H5U Weaning was markedly more prolonged in Guillain–Barré syndrome than in myasthenia gravis. Most Guillain–Barré syndrome patients were weaned via tracheostomy, while most myasthenia gravis patients had extubation attempts and 29% required reintubation. Early spontaneous-breathing trials, pressure-support trials and prophylactic non-invasive ventilation after extubation can shorten mechanical ventilation and reduce reintubation rates to below 15%.

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