Critical Care
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Epinephrine Timing and Dosing in Pediatric In‑Hospital Cardiac Arrest: Mixed Signals — improved ROSC but unclear survival benefit
Recent multicenter studies show earlier and more frequent epinephrine in pediatric in‑hospital cardiac arrest increases ROSC and shortens CPR, but does not consistently improve survival to discharge or favorable neurologic outcome. Evidence
Pediatric In‑Hospital Cardiac Arrest: Why Adult Resuscitation Lessons Don’t Fully Translate — Airway, Epinephrine, and the Limits of Training
Recent multicenter studies show declining intra‑arrest intubation, no clear harm from intubation after time‑dependent matching, unclear benefit of epinephrine before defibrillation, and no survival gain from intensive point‑of‑care CPR trai
Prehospital Postintubation Hypotension Strongly Linked to 30‑Day Mortality After Severe Traumatic Brain Injury — Especially in Isolated TBI
A multicenter cohort study of 555 patients with severe TBI who underwent prehospital rapid sequence induction found postintubation hypotension (SBP
Early Neuromuscular Electrical Stimulation Plus Mobilization Improves 6‑Month Function and Quality of Life After Critical Illness
In a randomized, blinded trial of 74 mechanically ventilated ICU patients, adding early NMES to an early mobilization program started within 48 hours improved functional status, independence, mobility, and quality of life up to 6 months aft
Bridging the Gap: Improving Agreement Between Nurse-Documented ICDSC and Researcher CAM-ICU Delirium Assessments in the ICU
A predictive model combining bedside nurse ICDSC items and clinical variables (ventilation, SOFA) substantially improves agreement with researcher CAM-ICU assessments, enabling more accurate, scalable delirium ascertainment in ICU research
ICU Structure and Care Processes Drive VAP and CLABSI Burden in Brazilian ICUs: Insights from the IMPACTO‑MR Nested Cohort
A large multicenter Brazilian cohort found that ICU-level structure and process measures — staffing, prevention protocols, hand hygiene training, visitation policies, and specific clinical roles — explain substantial between-hospital variab
Early Enteral Nutrition in Critically Ill Children: Promising Associations but Very Low Certainty — What Clinicians Should Know
A systematic review and meta-analysis found early enteral nutrition (EEN) in critically ill children associated with lower mortality (adjusted OR 0.36) and improvements in several clinical outcomes, but evidence certainty is very low due to
Effectiveness of Automated Closed-Loop Ventilation versus Protocolized Conventional Ventilation in Critically Ill Adults: A Comprehensive Evidence Review
Automated closed-loop ventilation improves ventilation quality but does not increase ventilator-free days at day 28 compared to protocolized conventional ventilation in critically ill adults, with benefits in safety profiles and caregiver w
Conservative vs Liberal Post‑Oxygenator Targets on VA‑ECMO: Feasibility Concerns and No Early Biomarker Benefit in a Pilot RCT
A pilot multicenter RCT comparing conservative vs liberal post-oxygenator oxygen targets during VA-ECMO for cardiogenic shock found the conservative approach difficult to maintain (target achieved 33% of time) and no difference in biomarker
ICU Structure and Care Processes Explain Much of VAP and CLABSI Variation in Brazilian ICUs: Findings from a 50‑Unit IMPACTO‑MR Nested Cohort
A 50‑ICU nested cohort from the IMPACTO‑MR platform links ICU-level structure and care processes to substantially different ventilator‑associated pneumonia and central line‑associated bloodstream infection rates, highlighting modifiable ins
Digital twins suggest APRV can lower mechanical power and tidal recruitment versus PCV in ARDS — modeling evidence and clinical implications
High-fidelity digital twins of 98 ARDS patients indicate APRV (Phigh 25/Plow 0, long Tinsp, short Tlow to 75% peak expiratory flow) reduced mechanical power by ~32% and tidal recruitment by ~34% versus recorded PCV, at the cost of controlle
Midline Paracentesis May Lower Bleeding Risk: Evidence From a 4,500‑Procedure Retrospective Review
A large single‑center retrospective review found zero hemorrhagic complications after midline ultrasound‑guided paracentesis versus 60 events after lateral approaches (0/230 vs 60/4,283; p=0.03), suggesting the midline (linea alba) approach
Platelet Transfusion in the ICU: Rare But Variable — A 30-Country Prospective Cohort Reveals Wide Practice Differences
An international prospective cohort found platelet transfusions were used in 6% of ICU patients, mostly for bleeding or prophylaxis, with wide variation in thresholds and adherence across geo-economic regions, highlighting need for stewards
Hemoglobin Rules in European PICUs: 12.8% of Children Received RBCs in 2023 — Many Transfused Above the 7 g/dL Threshold
A 28‑day point‑prevalence study across 44 European PICUs found 12.8% of children received red‑cell transfusions; hemoglobin was the dominant trigger, often above the recommended 7.0 g/dL threshold, and transfusion exposure correlated with 2
RBC Transfusions in Early Sepsis Resuscitation: Common, Complex, and Potentially Harmful Above a 10 g/dL Threshold
In a multicenter Korean sepsis cohort, early RBC transfusions were frequent and driven by illness severity. No overall 60‑day mortality difference was seen after propensity matching, but transfusion was associated with harm at hemoglobin ≥1
Five-Year Survival and Quality of Life After ECMO: Good Long-Term Outcomes but Persistent Functional Burden
A large prospective Dutch cohort reports 36% five-year survival after ECMO with generally satisfactory health-related quality of life (median EQ-5D 0.82) but ongoing problems with pain, mobility, activities, and work capacity.
Higher Mortality When Children on Mechanical Ventilation Are Cared for Outside ICUs: National Japanese Cohort Signals Need for Pediatric ICU Centralization
A national retrospective cohort of 129,375 mechanically ventilated children in Japan found most received care on general wards and that ward care was associated with higher in-hospital mortality than ICU care after propensity matching (6.4%
Targeting Tissue Perfusion and Lower MAP in Septic Shock Did Not Improve 30‑Day Perfusion-Free Survival: Results from the TARTARE-2S Randomized Trial
In the TARTARE-2S trial, a tissue-perfusion–guided resuscitation strategy that permitted lower MAP (50–65 mm Hg) did not increase days alive with normalized lactate and without vasopressors at 30 days versus standard-of-care MAP-guided trea
Phenylephrine Versus Norepinephrine in Acute Abdomen Surgery: Similar Clinical Outcomes but Different Early Renin Responses — Implications for Perioperative Hemodynamic Care
A randomized trial in 156 emergency acute-abdomen patients found phenylephrine and norepinephrine produced similar postoperative RAAS changes and complication rates; norepinephrine produced an early renin rise, while high preoperative renin
Frailty Amplifies Mortality Risk Across the PaO2/FiO2 Spectrum: Insights from a 497,185‑Patient ANZICS Cohort
In a 497,185‑patient registry study, frailty (CFS ≥5) was common and associated with substantially higher in‑hospital mortality across all severities of acute hypoxemic respiratory failure (AHRF). The relationship between PaO2/FiO2 and deat
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