Critical Care
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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
New Persistent Opioid Use Among ICU Survivors After Discharge: Incidence, Predictors, and Nationwide Cohort Insights
New persistent opioid use develops in 4.2% of opioid-naïve ICU survivors by six months post-discharge, with early opioid prescription as the strongest predictor. Risk varies by opioid potency and patient factors, highlighting tailored taper
Rescue Noninvasive Ventilation After Extubation: High Failure but No Clear Increase in Hospital Mortality — A Post‑hoc RINO Trial Analysis
A post‑hoc analysis of the RINO trial found rescue NIV for post‑extubation respiratory failure had a 58% failure rate but was associated with lower ICU mortality and no clear increase in hospital mortality when applied with prespecified re‑
Hemorrhage Dominates Obstetric ICU Admissions in Japan: Insights from a Nationwide Inpatient Database
A nationwide Japanese study of 8,184 peripartum ICU admissions (2010–2022) found hemorrhage accounted for 52.6% of cases; interventions commonly included transfusion (71.5%), mechanical ventilation (28.0%), and transcatheter arterial emboli
Preventing Post‑Induction Hypotension With Low‑Dose Norepinephrine Reduces Postoperative Complications After Major Abdominal Surgery
A single‑center RCT found that starting a titrated norepinephrine infusion at anesthesia induction reduced intraoperative hypotension and lowered 30‑day medico‑surgical complications compared with reactive ephedrine boluses in high‑risk abd
Higher Standardized ICU Admission Ratio After Rapid Response Calls Is Linked to Better Neurologic and Survival Outcomes: Insights from a Multicenter Japanese Registry
A multicenter retrospective Japanese study found that hospitals admitting more patients to ICU than predicted after rapid response activations had fewer poor neurologic outcomes or deaths within 30 days, suggesting ICU utilization after RRS
Continuous Intravenous Sedation Produces Novel EEG ‘Ups’ in Early Acute Hypoxemic Respiratory Failure — Implications for Monitoring and Outcomes
In mechanically ventilated patients with early acute hypoxemic respiratory failure, continuous IV sedation produces EEG patterns (EEG Ups) not seen in natural sleep; these patterns correlate with sedation dose, drug combinations, clinical s
Physiologic PK-PD Modeling Reveals Greater Fentanyl Potency for Ventilatory Depression Than Simpler Approaches
A population PK–PD study in healthy volunteers found that a physiologic model incorporating CO2 kinetics and a ventilatory controller estimates fentanyl potency for ventilatory depression at ~2.3 ng/mL—substantially lower than estimates fro
Restrictive Red Blood Cell Transfusion Is Safe for Most Patients — Except in Neurocritical Care (and Some Bleeding Syndromes)
A Cochrane update (2025) of 69 randomized trials found restrictive RBC transfusion thresholds (typically Hb 7–8 g/dL) cut transfusion exposure ~42% without increasing 30‑day mortality overall, but liberal strategies improved long‑term neuro
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