Andes virus causes hantavirus cardiopulmonary syndrome (HCPS), a severe disease found in central and southern parts of Chile and Argentina. Recently a case-outbreak of HCPS was reported on a cruise ship, therefore contemporary data on organ support and outcomes is required. The objective of this study was to assess organ support use and patient outcomes in patients admitted with HCPS. We used the Diagnosis-Related Groups (DGR) database to analyse patients admitted in 31 Chilean hospitals between January 1, 2019, and December 31, 2024. They were stratified by the maximal respiratory support received: no respiratory support, non-invasive ventilation (NIV), invasive mechanical ventilation (MV) or extracorporeal membrane oxygenation (ECMO). Hospital length of stay (LOS) and in-hospital mortality were the main outcomes assessed. In-hospital mortality was further analysed by pre-COVID-19 pandemic, pandemic, and post-pandemic periods. A total of 215 patients with HCPS were identified, of whom 69.3
Ventilator-associated pneumonia (VAP) and hospital-acquired pneumonia requiring mechanical ventilation (vHAP) are frequent in intensive care units and require prompt diagnosis. The FilmArray Pneumonia Panel (FAPP) enables fast pathogen identification, but its clinical impact remains uncertain. To assess whether adding FAPP to conventional microbiology increases the rate of targeted antimicrobial therapy (AMT) in patients with suspected VAP or vHAP. Open-label, multicenter randomized-controlled trial in immunocompetent adults with suspected VAP or vHAP. Patients were randomized to management with FAPP plus conventional microbiology or conventional microbiology alone. The primary outcome was the proportion of patients receiving targeted AMT 24 h after inclusion. From June 2020 to September 2023, 156 patients were randomized; 146 were analyzed (74 intervention, 72 control), as 10 did not provide consent for continued participation. Median age was 58 years (interquartile range, 43–70), 67.8
To investigate whether respiratory system elastance (ERS) modifies the associations of tidal volume (VT) and respiratory rate with clinical outcomes in mechanically ventilated patients with acute brain injury. In this post hoc analysis of the VENTIBRAIN study, ERS was computed as the ratio of driving pressure (ΔP) to VT/PBW. Effect modification by ERS on outcome associations was assessed. In 1158 patients, VT was similar across ERS tertiles (median 7.9, 7.6 and 7.1 mL/kg), resulting in a marked ΔP gradient across tertiles (median 5, 9, and 12 cmH2O). Higher VT was associated with lower ICU mortality in patients with low ERS (OR 0.52, 95
Septic shock in cancer patients remains associated with a grim prognosis. With regard to the high prevalence of anemia, the optimal hemoglobin target to restore tissue oxygenation remains uncertain. This was a multicenter superiority randomized controlled trial carried out in 18 centers in France. Adult patients with hematological or solid malignancies presenting with septic shock with lactate level > 2.0 mmol/L and hemoglobin level < 9.0 g/dL were randomly assigned to liberal or restrictive red blood cell (RBC) transfusion directed by hemoglobin thresholds of 9.0 g/dL or 7.0 g/dL during the first 48 h of resuscitation. The primary endpoint was 12-h lactate reduction, defined as normalization ≤ 2.0 mmol/L or relative decrease by 30
Corticosteroids modulate key inflammatory and fibroproliferative pathways involved in ARDS through genomic and non-genomic glucocorticoid receptor signaling. Advances in ARDS pathophysiology have highlighted the importance of timing, inflammatory burden, and host response in determining treatment efficacy. Clinical evidence supports corticosteroid use in moderate-to-severe ARDS, particularly in COVID-19 ARDS and severe community-acquired pneumonia, with reductions in mortality and duration of mechanical ventilation. However, treatment effects remain heterogeneous across etiologies and biological subphenotypes. Recent identification of hyperinflammatory and hypoinflammatory ARDS phenotypes suggests that corticosteroid responsiveness is not uniform. Hyperinflammatory phenotypes and septic ARDS appear more likely to benefit, whereas evidence remains limited or conflicting in influenza-associated and non-septic ARDS. Long-term effects and adverse outcomes, including metabolic complications and ICU-acquired weakness, remain insufficiently characterized. Future research is increasingly focused on precision medicine approaches integrating biomarkers, adaptive platform trials, and phenotype-guided strategies. Emerging developments include lung-targeted corticosteroid delivery systems and selective glucocorticoid receptor modulators designed to improve efficacy while reducing systemic toxicity. Corticosteroids should therefore be considered a context-dependent therapy whose benefit is influenced by etiology, disease stage, inflammatory phenotype, and timing of administration.
Randomised controlled trials (RCTs) have reshaped intensive care medicine (ICM), a discipline defined by acute, interacting organ failures, time-sensitive decisions, biological uncertainty, and heterogeneous recovery trajectories. Many interventions supported by strong physiological rationale failed to improve patient-centred outcomes, whereas durable advances often emerged from optimisation of supportive care, avoidance of iatrogenic harm, and reassessment of established practices. We conducted an interpretive historical review of landmark multicentre RCTs in adult ICM from the early 1990s onwards. PubMed searches, reference lists from major trials and reviews, and international guidelines were used to identify trials with conceptual influence on practice, guidelines, physiological reasoning, therapeutic strategy, research priorities, de-implementation, or outcome framing. Evidence was organised into overlapping paradigms rather than rigid chronological periods. Across haemodynamic support, mechanical ventilation, renal replacement therapy, antimicrobial treatment, nutrition, glucose control, transfusion, and sedation, landmark RCTs describe more than therapeutic expansion. Early biological and haemodynamic trials exposed the limits of reductionist strategies in syndromic critical illness. Protocol-driven approaches improved timeliness and consistency, but later pragmatic trials showed that rigid targets and invasive algorithms often added little once high-quality usual care was established. More recent trials challenge the assumption that greater intervention intensity improves outcomes, emphasising timing, disease phase, baseline risk, heterogeneity, patient selection, and treatment-related harm. Modern ICM RCTs have clarified not only what works, but what can be reduced, delayed, avoided, or applied selectively. Future progress requires biologically informed, context-sensitive trials focussed on meaningful survival, recovery, and long-term function.
