Critical Care
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Persistent Inspiratory Muscle Weakness After Prolonged Intubation: MIP at Day 12 Predicts Failure to Recover in the Acute-Care Stay
In patients extubated after ≥7 days of mechanical ventilation, 43% had persistent inspiratory muscle weakness at hospital discharge. Maximal inspiratory pressure (MIP) measured 12 days after diagnosis strongly predicted persistent weakness
Prolonged Prone Positioning in ARDS: Current Evidence Is Inconclusive — No Clear Mortality or Safety Benefit
A systematic review and meta-analysis found no clear mortality, oxygenation, or safety benefit for prolonged prone positioning (≥24 h) in ARDS; evidence is low to very low certainty and does not support routine use outside clinical trials.
Cefiderocol Non‑Inferior to Standard Therapy for Hospital‑Acquired Gram‑Negative Bacteraemia: Insights from the GAME CHANGER Trial
The GAME CHANGER randomized trial found cefiderocol non‑inferior to standard‑of‑care antibiotics for 14‑day mortality in hospital‑acquired and healthcare‑associated Gram‑negative bloodstream infection; no superiority was seen, including in
Conservative Dialysis Strategy Accelerates Kidney Recovery in Dialysis-Requiring AKI — Early Randomized Evidence from LIBERATE-D
The LIBERATE-D randomized trial found that a conservative, indication-triggered dialysis strategy increased unadjusted kidney-recovery rates at hospital discharge and shortened time to dialysis independence compared with routine thrice-week
SOFA-2 Recalibrated: Global Development and Validation of an Updated Organ Dysfunction Score in >3.3 Million ICU Admissions
SOFA-2 updates the 30-year-old SOFA score using data from >3.3 million ICU admissions across diverse settings. The revised tool modestly improves ICU mortality discrimination (AUROC 0.79 vs 0.77) and incorporates contemporary organ support,
Targeting Capillary Refill Time in Early Septic Shock Reduced Duration of Organ Support: Key Findings from ANDROMEDA‑SHOCK‑2
ANDROMEDA‑SHOCK‑2 randomized 1,501 patients with early septic shock to a personalized CRT‑guided hemodynamic protocol versus usual care. A hierarchical composite outcome favored the CRT strategy (win ratio 1.16; 95% CI 1.02–1.33; P = .04),
A 250‑ml Ultrafiltration Challenge Identifies Patients at Risk of Becoming Preload‑Dependent During CRRT
A randomized cross‑over trial found that a 250‑ml net ultrafiltration challenge reliably identified preload‑independent critically ill patients who became preload‑dependent during continuous renal replacement therapy; a ≥5% calibrated cardi
Circulating Endothelial Transcriptomic Signatures Predict Worse Outcomes in COVID-19, Respiratory Failure and ARDS
Transcriptomic deconvolution of blood identifies elevated circulating endothelial signatures (ECS%) that associate with higher 28‑day mortality and worse respiratory trajectories in pediatric respiratory failure and adults hospitalized with
Resistance Training in the ICU Improves Muscle, Function, and Survival — HMB Adds Only Modest Benefit
A multicenter 2×2 factorial RCT in 266 critically ill adults shows that in‑ICU resistance training improves discharge physical function, muscle mass, patient‑reported outcomes, and lowers 6‑ and 12‑month mortality; HMB supplementation produ
Sodium Bicarbonate in Severe Metabolic Acidemia with AKI: No Survival Benefit but Less Dialysis — Insights from BICARICU-2
The BICARICU-2 randomized trial found that intravenous sodium bicarbonate in patients with severe metabolic acidemia and moderate-to-severe acute kidney injury did not reduce 90‑day mortality, but was associated with a substantial reduction
Trunk Inclination Changes Worsen Compliance and Raise PaCO2 in Obese ARDS Patients: Clinical Implications from a Seven-Study Pooled Analysis
A secondary analysis of 159 mechanically ventilated ARDS patients shows that increasing trunk inclination reduces respiratory system, lung, and chest wall compliance—especially in patients with obesity—and is associated with increased PaCO2
Choice of Vasopressor in Septic Shock: Does It Change Kidney Outcomes? A Critical Appraisal of the Evidence
A systematic review of 17 randomized trials (n=4,259) found no consistent renoprotective effect from any vasopressor in septic shock. Heterogeneous definitions, underpowered studies, and reliance on RRT limit conclusions; standardized renal
Adjunctive Terlipressin in Refractory Septic Shock: Lowers High-Dose Catecholamine Need at 6 Hours but No Mortality Benefit
In a double-blind RCT of 130 patients with refractory septic shock, terlipressin increased the proportion achieving MAP ≥65 mmHg with low catecholamine exposure at 6 hours versus placebo but did not change 28-day mortality; digital ischemia
Inhaled PEG‑Adrenomedullin in ARDS: Safe but Ineffective — Phase 2 RCT Stopped for Futility
A multicentre randomized Phase 2a/b trial found inhaled pegylated adrenomedullin (PEG‑ADM) well tolerated in ventilated ARDS patients but without improvement in ventilator‑free survival or a composite clinical utility index; the study was s
Baseline SGLT2 Inhibitor Use Associated with Lower Risk of Sepsis-Induced Cardiomyopathy and Improved Outcomes in Type 2 Diabetes: Insights from a Large Propensity-Matched Cohort
A large propensity-matched cohort study found that baseline SGLT2 inhibitor use versus DPP4 inhibitor therapy in adults with type 2 diabetes and infection was associated with lower 30-day sepsis-induced cardiomyopathy and improved 1-year mo
Therapeutic Plasma Exchange May Improve Transplant-Free Survival in Severe Amatoxin-Associated Acute Liver Failure
A multinational retrospective cohort found adjunctive plasma exchange was associated with higher 28‑day transplant-free survival in amatoxin-related ALF patients with grade ≥2 hepatic encephalopathy.
Renal Contrast‑Enhanced Ultrasound Is Reproducible in Stable Critically Ill Patients — mTT Is the Most Robust Metric
In stable critically ill patients, contrast‑enhanced ultrasound (CEUS) renal perfusion metrics are reproducible; amplitude measures (RBV, PI) are more dose‑sensitive while mean transit time (mTT) shows greater robustness across infusion cha
Septal Curvature Ratio on CTPA Identifies Normotensive PE Patients at High Risk of Early Deterioration
A multicentre prospective study shows the ventricular septum curvature ratio on CTPA strongly predicts 30‑day clinical deterioration in normotensive acute pulmonary embolism, outperforming conventional single metrics and offering potential
Indirect Calorimetry Reveals Hypermetabolism That Predicts Accelerated Muscle Loss and Energy Deficit Risk in ICU Patients
Serial indirect calorimetry–measured hypermetabolism is independently associated with more rapid CT-quantified muscle wasting and higher risk of energy deficit in critically ill adults, suggesting personalized metabolic monitoring could gui
Lactate Predicts Citrate Accumulation During Continuous Kidney Replacement Therapy: incidence, severity, and clinical implications
In 911 critically ill patients on RCA-CKRT, citrate accumulation occurred in 17%. Pre-CKRT lactate strongly predicted accumulation (OR 2.34 per 1-unit increase on log scale); VIS was less discriminatory. Accumulation linked to liver dysfunc
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