Once again, the emperor of inductive physiological reasoning is revealed to have no clothes...

💧Early diuretics after cardiac surgery? No gain, potential pain In this post-hoc analysis of the #BROTHERstudy early IV diuresis didn’t prevent #AKI and prolonged hospitalization 🔗 www.signavitae.com/articles/10.22514/sv.2023.112 #Anesthesia #CardiacSurgery #ICU #MedEd @yukikotani.bsky.social

🧠 Sedation in the ICU: are volatile anesthetics better than IV anesthetics? Our meta-analysis of 21 RCTs (n=2,367): volatile sedation ↑ mortality (RR 1.17 [1.02–1.35]) vs. IV Sedation ⚠️ Routine use is not supported. Consider only in selected patients. 🔗 ccforum.biomedcentral.com/articles/10....

🩸 Our new meta-analysis on arterial line blood cultures Contamination rate with arterial catheter–drawn cultures was comparable to venipuncture & lower vs venous catheter–drawn cultures 📌 In critically ill adults, arterial line sampling may be a reasonable alternative. doi.org/10.1093/cid/...

🆕 New RCT in JAMA: Sedation in mechanically ventilated ICU patients—Dexmedetomidine vs Clonidine vs Propofol 📕 Main takeaway: In critically ill patients, neither dexmedetomidine nor clonidine shortened time to successful extubation compared to propofol.

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📢 Your 𝗹𝗮𝘁𝗲𝘀𝘁 𝗶𝘀𝘀𝘂𝗲 of the @intenscaremed.bsky.social with the latest articles is here! 📖 𝗙𝗼𝗹𝗹𝗼𝘄 𝘂𝘀 & stay updated with the latest research, delivered straight to you. 📍 Read all the latest articles here 👉 www.esicm.org/icm-latest-i... #ICM #ESICM #Research #MedicalJournals #IntensiveCare

Guidelines for CPB in adult cardiac surgery The CPB can only be performed through collaboration between cardiac surgeons, anesthesiologists, and perfusionists. This European guideline covers hot topics, such as intravenous amino acid therapy for AKI prevention. www.bjanaesthesia.org/article/S000...

Both frequentist and Bayesian approaches are important to interpret the findings of critical care research. ccforum.biomedcentral.com/articles/10....

This secondary analysis of an RCT examined whether the risk of death changes between balanced crystalloids and saline depending on the Cl concentration. The higher the Cl concentration, the more the point estimates of mortality risk favor balanced crystalloids. link.springer.com/article/10.1...

Pathological physiology, clinical significance, and differential diagnosis of euglycemic DKA by SGLT2 inhibitors idp.springer.com/authorize?re...

Recently, it has been mostly accepted that ketamine does not increase intracranial pressure. Rather, thanks to its hemodynamic tolerance, ketamine can avoid hypotension and maintain cerebral perfusion pressure when used as an induction agent for intubation. www.bjanaesthesia.org/article/S000...

Heterogeneity in the therapeutic effects of oxygen therapy in critically ill patients Different baseline conditions, acute diseases, and concurrent interventions likely modify the optimal goals for oxygen therapy. Two large RCTs may guide future practice. ccforum.biomedcentral.com/articles/10....

Induction Agents for Tracheal Intubation in Critically Ill Patients CCR Journal Watch criticalcarereviews.com/latest-evide... Get the latest critical care literature every weekend via the CCR Newsletter - subscribe at criticalcarereviews.com/newsletters/...

What happens to hemodynamics in ARDS patients after VV ECMO initiation? Improvements occurred in 61% at 2 h & 83% at 24 h. The main causes seem to be improved respiratory parameters & acid-base balance and a reduction in ventilator support. www.jcvaonline.com/article/S105...

Review article on AKI: Lancet This is a must-read paper that covers not only the epidemiology, pathophysiology, and management of AKI, but also crosstalk with other organs during the acute phase and long-term adverse effects on other organs. www.thelancet.com/journals/lan...

Narrative review on vasoplegic shock Regarding the dosage of norepinephrine used as a guideline for starting vasopressin therapy, there are an increasing number of publications stating "0.2 µg/kg/min" rather than "0.25 µg/kg/min." www.bjaed.org/article/S205...

US assessment of LV function in septic shock EF does not represent LV contractility but the relationship between LV contractility and afterload. For example, if there is too much vasopressor, the afterload will increase and EF may appear relatively low. link.springer.com/article/10.1...

#sepsis #levophed #angiotensin ii, methylene blue, septic shock, fluid management, #vasopressin #epinephrine #neosynephrine #emimcc #cardiosky #critcaresky

A review article on hemodynamic management in septic shock has been published in Burns & Trauma! It covers a wide range of topics, including fluids, vasopressors, steroids, and resuscitation goals! Open access👇 academic.oup.com/burnstrauma/...

Our SR of angiotensin II published in JCVA is now available to read with free access until March 2! authors.elsevier.com/c/1kQEu3lSIP...

CCR Journal Watch #NAVIGATEtrial from #CCR24 is now published in @bjajournals.bsky.social NIV for early resp failure on general wards @yukikotani.bsky.social et al criticalcarereviews.com/latest-evide... CCR Newsletter - subscribe at criticalcarereviews.com/newsletters/...

🆕Publication: RCT to assess NIV for acute respiratory failure in general wards @bjajournals.bsky.social Most NIV trials were conducted in ICUs. Only two small, single-center RCTs evaluated NIV in general wards. Here are the results of the first multicenter RCT👇 authors.elsevier.com/c/1kNDs1dCDu...

Last publication in 2024🍾 We assessed the effects of non-adrenergic vasopressors in three populations (sepsis, cardiac surgery, and non-cardiac surgery). Our findings justify future RCTs comparing these agents with usual care based on noradrenaline alone. ccforum.biomedcentral.com/articles/10....

Intravenous amino acid infusion in cardiac surgery patients with CKD: secondary analysis of PROTECTION trial AKI prevention was confirmed in CKD, and the treatment effect was similar regardless of baseline eGFR, although renal functional reserve declines in CKD. journals.lww.com/anesthesiolo...

Higher vs. lower protein delivery in critically ill patients: a Bayesian meta-analysis of RCTs Inconclusive posterior probabilities may suggest heterogeneity of treatment effects among the enrolled patients. journals.lww.com/ccmjournal/a...

Scoping review of persistent/chronic critical illness - varied terminology & definitions - prevalent, especially in sepsis, COVID-19, & trauma - poor long-term mortality and functional outcomes - need for the development of a consensus definition ccforum.biomedcentral.com/articles/10....

🆕 Publication: Narrative review on intravenous amino acid therapy for renal protection in Clinical Kidney Journal 🔸Mechanisms of how AA may protect the kidney 🔸Evidence overview of all previous RCTs 🔸Clinical implications and future research directions Open access👇 academic.oup.com/ckj/advance-...

New SR on angiotensin II in critically ill patients We summarized 59 papers, including 5 RCTs, with 2918 patients. Potential benefits for the kidneys, lungs & heart were reported, while no associations with thrombotic or adverse events were observed. www.jcvaonline.com/article/S105...

Treating patients, not P values. Recently, NEJM published 2 RCTs of LVFX to prevent MDR-TB, and a meta-analysis pooling them was published in NEJM Evidence. This editorial explains how to interpret the MA, which integrated "negative" RCTs to become "positive." evidence.nejm.org/doi/full/10....

From Critical Care, a tribute to Prof. Luciano Gattinoni. "Luciano Gattinoni was a giant in Intensive care Medicine, a brilliant thinker, and a beloved companion in work and life. He was, above all, a true leader." ccforum.biomedcentral.com/articles/10....

Precision in critical care nutrition tailors interventions to metabolic needs, using markers like glucose and nitrogen balance. Despite progress, tools linking metabolic responses to outcomes are lacking. Advances aim to optimize care through personalized approaches. journals.lww.com/ccmjournal/f...

Fluid responsiveness prediction using a ventilator - Increase TV at 6→8 mL/kg for 1 min and PPV increase by 3.5% - End-expiratory occlusion test for 15 sec and CO increase by 5% - PEEP≥10→5 for 1 min and CO increase by 9% link.springer.com/article/10.1...

Top 10 Important ICU Papers: Second Half of 2024 From the ICU papers published between July and December 2024, I have selected top 10 key ones, including RCTs, guidelines, and reviews. Hope this will be useful as a topic for journal clubs, to check what you have missed, and to update your knowledge.

All trials can be practice-changing. Amazing achievements.

This systematic review examines how clinical trials in top journals have varied in their use of the SOFA score as an outcome measure. With the anticipated release of SOFA 2.0, this paper provides a valuable foundation for future discussions. journals.lww.com/ccmjournal/a...

Narrative review on sepsis & septic shock in NEJM The treatment section focuses on infection control and hemodynamic management. Table 2, which summarizes landmark clinical trials from the past decade, was particularly helpful in organizing and consolidating knowledge. www.nejm.org/doi/full/10....

A multicenter RCT published in BMJ reported that fluid & inotropic management guided by cardiac output in abdominal surgeries (ASA II or higher) did not reduce postoperative infections but led to an increase in cardiac events within 24 h, particularly tachyarrhythmias. www.bmj.com/content/387/...

Core Outcome Set for Physical Rehabilitation in Critically Ill Patients 🔸Physical function 🔸Exercise capacity 🔸ADL 🔸Cognitive function 🔸Survival 🔸Emotional and mental well-being 🔸Frailty 🔸Health-related quality of life 🔓 www.atsjournals.org/doi/10.1513/...

IABP for LV unloading in patients with cardiogenic shock treated with VA-ECMO The use of IABP after VA-ECMO was associated with a lower risk of in-hospital mortality but a higher risk of mechanical, bleeding, renal, and pulmonary complications. ccforum.biomedcentral.com/articles/10....

Meta-analysis of transfusion strategies in patients with traumatic brain injury Despite recent trials (HEMOTION & TRAIN) suggesting benefits of liberal strategies, the pooled results found no difference in mortality or neurological outcomes. annalsofintensivecare.springeropen.com/articles/10....

Continuous/extended infusion of β-lactams outside the ICU Some ICUs may have recently adopted continuous/extended infusion, but what about non-ICU settings? This paper by leading researchers explores its efficacy, safety, and feasibility outside the ICU. onlinelibrary.wiley.com/doi/10.1111/...

Almost there 8 major trial results Full, free livestream criticalcarereviews.com

β-blockers in sepsis A single-center RCT in 2013 demonstrated reduced mortality. Recently, however, multicenter RCTs have shown no mortality difference or raised concerns about increased mortality. This new meta-analysis found no mortality difference. ccforum.biomedcentral.com/articles/10....

New publication: Role of RAAS and Exogenous Angiotensin II Therapy in Sepsis We review RAAS alterations in sepsis, summarize the evidence for IV angiotensin II administration, and propose a practical algorithm for its use. Honor to collaborate with global experts in this field! x.gd/Yio8K

Energy and Protein Intake for Critically Ill Patients High energy: Worsening organ dysfunction High protein: Increased mortality in AKI Prolonged undernutrition: Poor functional recovery A proposed algorithm to determine energy and protein intake based on the severity and ICU days. bit.ly/4eMfOj6

This trial is a potentially practice-changing study, together with the HEMOTION trial published in NEJM earlier this year.

Guidelines on invasive pulmonary aspergillosis and invasive candidiasis from @atscommunity.bsky.social As we see immunocompromised patients more frequently, fungal infections are always on the differential diagnosis list. Please see the optimal management here. www.atsjournals.org/doi/10.1164/...

Honor to write a review on induction agents for intubation in critically ill patients! We discussed drug selection and dose titration, as well as concomitant hemodynamic management (e.g., preemptive vasopressor therapy) to reduce peri-intubation adverse events. journals.lww.com/ccmjournal/a...