Hot Articles

The following articles have been chosen as the most noteworthy publications in critical care since December 2011.


Randomised Controlled Trials

Guidelines & Position Statements

Lancet Infect Dis - Antibiotic Cycling

Lancet Respir Med - Perioperative Ventilation

NEJM - Late Stroke Thrombectomy

Stroke - Ischaemic Stroke Guideline

New Engl J Med - Steroids in Septic Shock

Lancet Respiratory Medicine - Perioperative Ventilation

Lancet Respiratory Medicine - Induced Hypothermia in Septic Shock

Resuscitation - Antibiotics in Survivors of Out-of-Hospital Cardiac Arrest


Harvey. Management of perceived devastating brain injury after hospital admission: a consensus statement from stakeholder professional organizations. Br J Anaesth 2018;120(1):138–145

Antimicrobial resistance and antibiotic stewardship programs in the ICU: insistence and persistence in the fight against resistance. A position statement from ESICM/ESCMID/WAAAR round table on multi-drug resistance. Intensive Care Med 2017;epublished December 29th

Unanticipated difficult airway management in children - the consensus statement of the Paediatric Anaesthesiology and Intensive Care Section and the Airway Management Section of the Polish Society of Anaesthesiology and Intensive Therapy and the Polish Society of Neonatology. Anaesthesiol Intensive Ther 2017;49(5):336-349

van der Kooi. Prevention of hospital infections by intervention and training (PROHIBIT): results of a pan-European cluster-randomized multicentre study to reduce central venous catheter-related bloodstream infections. Intensive Care Med 2017;epublished December 16th

Gamble. Guidelines for the Content of Statistical Analysis Plans in Clinical Trials. JAMA 2017;318(23):2337-234

Intensive care in severe malaria: Report from the task force on tropical diseases by the World Federation of Societies of Intensive and Critical Care Medicine. J Crit Care 2018;43:356–360

Ebola virus disease: Report from the task force on tropical diseases by the World Federation of Societies of Intensive and Critical Care Medicine. J Crit Care 2018;43:352–355

Dengue fever: Report from the task force on tropical diseases by the World Federation of Societies of Intensive and Critical Care Medicine. J Crit Care 2018;43:346–351

Torres. Ceftazidime-avibactam versus meropenem in nosocomial pneumonia, including ventilator-associated pneumonia (REPROVE): a randomised, double-blind, phase 3 non-inferiority trial. Lancet Infectious Dis 2017;epublished December 15th

Thwaites. Adjunctive rifampicin for Staphylococcus aureus bacteraemia (ARREST): a multicentre, randomised, double-blind, placebo-controlled trial. Lancet 2017;epublished December 14th

van der Kooi. Prevention of hospital infections by intervention and training (PROHIBIT): results of a pan-European cluster-randomized multicentre study to reduce central venous catheter-related bloodstream infections. Intensive Care Med 2017;epublished December 16th

Chinese Collaboration Group for Emergency Airway Management. Clinical consensus of emergency airway management. J Thorac Dis 2017;9(11):4599-4606

2017 ACC Expert Consensus Decision Pathway on Management of Bleeding in Patients on Oral Anticoagulants. JACC 2017;epublished December 1st

Arola. Inhaled Xenon Attenuates Myocardial Damage in Comatose Survivors of Out-of-Hospital Cardiac Arrest: The Xe-Hypotheca Trial. J Am Coll Cardiol 2017;70(21):2652-2660

Intensive Care Medicine - Discomfort Reduction in ICU

Lancet Respiratory Medicine - Prehospital Antibiotics for Sepsis

Laptook. Effect of Therapeutic Hypothermia Initiated After 6 Hours of Age on Death or Disability Among Newborns With Hypoxic-Ischemic Encephalopathy. A Randomized Clinical Trial. JAMA 2017;318(16):1550-1560

Stöckl. Continuous versus intermittent neuromuscular blockade in patients during targeted temperature management after resuscitation from cardiac arrest—A randomized, double blinded, double dummy clinical trial. Resuscitation 2017;120:14-19

Koster. Safety of mechanical chest compression devices AutoPulse and LUCAS in cardiac arrest: a randomized clinical trial for non-inferiority. European Heart Journal 2017;38(40):3006–3013

The Implementation of Targeted Temperature Management: An Evidence-Based Guideline from the Neurocritical Care Society. Neurocrit Care 2017;epublished October 16th

Right heart dysfunction and failure in heart failure with preserved ejection fraction: mechanisms and management. Position statement on behalf of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2017;epublished October 16th

Koch. A Randomized Clinical Trial of Red Blood Cell Transfusion Triggers in Cardiac Surgery. Ann Thorac Surg 2017;104(4):1243-1250

Jaillette. Impact of tapered-cuff tracheal tube on microaspiration of gastric contents in intubated critically ill patients: a multicenter cluster-randomized cross-over controlled trial. Intensive Care Med 2017;43(11):1562–1571

Guidelines for the diagnosis and management of critical illness-related corticosteroid insufficiency (CIRCI) in critically ill patients (Part II): Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM) 2017. Intnsive Care Med 2017;epublished October 31st

Treatment and Outcome of Hemorrhagic Transformation After Intravenous Alteplase in Acute Ischemic Stroke: A Scientific Statement for Healthcare Professionals From the American Heart Association / American Stroke Association. Stroke 2017;epublished November 2nd

Thiele. PCI Strategies in Patients with Acute Myocardial Infarction and Cardiogenic Shock (CULPRIT-SHOCK). N Engl J Med 2017;epublished October 30th

van Brunschot. Endoscopic or surgical step-up approach for infected necrotising pancreatitis: a multicentre randomised trial. Lancet 2017;epublished November 3rd

European Stroke Organization guideline for the diagnosis and treatment of cerebral venous thrombosis – endorsed by the European Academy of Neurology. Eur J Neurol 2017;24:1203–1213

30th Annual ESICM Congress (LIVES2017, Vienna) 

New Engl J Med - Age of Transfused Red Cells

JAMA - Alveolar Recruitment in ARDS

JAMA - Intra-Operative Blood Pressure Management

JAMA - Systematic ICU Admission for Elderly Sick Patients

JAMA - Early Goal-Directed Sepsis Care in Zambia

Intensive Care Medicine - Early Goal-Directed Nutrition

Intensive Care Medicine - Airway Pressure Release Ventilation

Intensive Care Medicine - Spontaneous Breathing Trials

Intensive Care Medicine - Biomarker-Guided Strategy for Discontinuing Antifungal Therapy

Kneyber. Recommendations for mechanical ventilation of critically ill children from the Paediatric Mechanical Ventilation Consensus Conference (PEMVECC). Intensive Care Med 2017;epublished September 22nd

Intensive Care Medicine - Positioning for VAP

Intensive Care Medicine - Adrenal Insufficiency Guideline

Circulation - Cardiogenic Shock Guideline

Lancet Respiratory Medicine - Sedation Interruption

Chest - Checklists for ICU Intubation

Critical Care Medicine - Nebulized Versus IV Amikacin in VAP

European Respiratory Journal - HAP / VAP Guideline

Annals of Surgery - Transfusion Thresholds in Burns

Critical Care - Loxapine for Agitation

Critical Care - Recombinant ACE 2 in ARDS

J Crit Care - Enteral Nutrition as Stress Prophylaxis

Am J Respir Crit Care Med - Coping Skills in ICU Survivors

European Respiratory Journal - NIV Guideline

NEJM - Oxygen in Acute Myocardial Infarction

Crit Care Resusc - Earplugs for Sleep Quality

Resuscitation - Intermittent vs Continuous Neuromuscular Blockade during Temperature Management post Cardiac Arrest

JAMA - Ganciclovir in CMV-Positive Critically Ill Patients

Critical Care - Serlipressin in Septic Shock

Critical Care Medicine - Simulation for ECMO Emergencies

Critical Care Medicine - Exposure Keratopathy

Critical Care - Software-Guided Glycaemic Control

Thorax - Rehabilitation in the ICU

JAMA - 24 vs 48 Hours of Hypothermia post Cardiac Arrest

JPEN - Paediatric Nutritional Support Guideline

Journal of Intensive Care - Japanese ARDS Guideline

Chinese Medical Journal - EEG Monitoring Guideline

Lancet respiratory Medicine - Simvastatin for Prevention & Treatment of ICU Delirium

Journal of Critical Care - Furosemide in Early Acute Kidney Injury

Lancet - Procalcitonin-Guided Antibiotics in Early Sepsis

Minerva Pneumologica - NIV vs IMV in Hypoxaemic Respiratory Failure

JAMA Cardiology - Spironolactone in Acute Heart Failure

Anaesth Crit Care Pain - French TTM Guideline

World Jounal of Emergency Surgery - Intra-Abdominal Infections Guideline

Critical Care Medicine - Blood flow & CRRT Circuit Lifespan

European Heart Journal - Safety of Mechanical Chest Compression Devices

Journal of Korean medical Science - Mild Hypothermia for Poor Grade Subarachnoid Haemorrhage

Critical Care Medicine - Shenfu Injection post Cardiac Arrest

JAMA - Cooling post Neonatal Hypoxic-Ischaemic Encephalopathy

Circulation - N-Acetylcysteine & Nitrate Therapy in STEMI

Thorax - Post ICU Rehabilitation

McDowell. Effectiveness of an exercise programme on physical function in patients discharged from hospital following critical illness: a randomised controlled trial (the REVIVE trial) Thorax 2017;72:594-595

JAMA - FAST Scan in Paediatric Trauma

J Allergy Clin Immunol Pract - Icatibant for ACE Inhibitor-Induced Angioedema

Ann Emerg Med - High Flow Nasal Oxygen in Cardiogenic Pulmonary Oedema

Critical Care - Supplementary Parenteral Nutrition

JAMA Surgery - Intraoperative Dexmedetomidine & Post-Op Cognitive Dysfunction

Intensive Care Med - AKI Guideline

American Thoracic Society Conference

NEJM - Angiotensin II for Septic Shock

NEJM - Time to Treatment in Sepsis

JAMA - Outcome Prediction ICU

Thorax - BTS Oxygen Use Guideline

Crit Care Medicine - Paediatric & Neonatal Septic Shock Guideline

Neurology - Brain Injury after CPR Guideline

Chest - Positioning for Endotracheal Intubation

Resuscitation - Video versus Direct Laryngoscopy for Paramedic Endotracheal Intubation

European Journal of Anaesthesiology - Severe Perioperative Bleeding Guideline

Annals of Intensive Care - Post Extubation High Flow Nasal Oxygen

Crit Care Medicine - Stress Ulcer Prophylaxis

American Heart Journal - Nitric Oxide in Acute PE

N Eng J Med - Bystander Efforts in Out-of-Hospital Cardiac Arrest

Lancet - Tranexamic Acid for Post Partum Haemorrhage

Lancet Haematology - FFP vs Coagulation Factor Concentrates for Traumatic Coagulopathy

JAMA Internal Medicine - Antiviral Therapy for CMV Reactivation

Annals of Thoracic Surgery - Corticosteroids in Neonatal Cardiac Operations

JAMA - Postoperative Troponin Elevation in Noncardiac Surgery

Intensive Care Medicine - Immunoglobulin for Necrotising Soft Tissue Infection

New England Journal of Medicine - Ularitide in Acute Heart Failure

Intensive Care Medicine - NIV Post Extubation in Chronic Respiratory Disorders

Intensive Care Medicine - IV Chloride Restriction in Cardiac Surgery

Critical Care Medicine - Transfusion in Critically Ill Oncology Patients

J Trauma - Damage Control Resuscitation Guideline

J Crit Care - Tracheostomy Guideline

Intensive Care Med - Condolence Letter

JPEN J Parenter Enteral Nutr - Parenteral Nutrition Guideline

Intensive Care Medicine - Early Enteral Nutrition Guideline

Critical Care Medicine - Contrast-Induced Nephropathy

Critical Care - Pseudomonas Vaccine

Society of Critical Care Medicine Annual Congress

JAMA - Video vs Direct Laryngoscopy for Intubation in ICU

N Engl J Med - Therapeutic Hypothermia for Paediatric Cardiac Arrest

N Engl J Med - Paediatric Glycaemic Control

JAMA - Intubation during Cardiac Arrest

Crit Care Med - Surviving Sepsis Campaign Guidelines

Crit Care Med - Family-Centred Care Guidelines

Chest - Liberation from Mechanical Ventilation Guidelines


NEJM - Age of Transfused Blood

NEJM - Tranexamic Acid for Coronary Artery Surgery

Intensive Care Medicine - High Flow Nasal Oxygen post Abdominal Surgery

Intensive Care Medicine - Balanced versus Unbalanced Crystalloids

Intensive Care Medicine - HFNO vs NIV for Pre-Oxygenation in Hypoxic ICU patients

Critical Care - Steroids in Early Sepsis-Associated ARDS

Am J Respir Crit Care Med - Helium / Oxygen in Exacerbations of COPD

Intensive Care Medicine - Intravascular Catheter Dressings

J Crit Care - Intensity of Feeding

ESICM 2016

NEJM - Levosimendan in Sepsis




JAMA - Intubation during Paediatric Cardiac Arrest

Therapeutic Hypothermia & Cardiac Arrest

JAMA - Steroids in Sepsis

Intensive Care Medicine - Fluid Resuscitation in Sepsis

Intensive Care Medicine - Nitric Oxide during Cardiopulmonary Bypass

Intensive Care Medicine - NAVA

Intensive Care Medicine - IV Iron for Anaemia

Intensive Care Medicine - Recovery Programme

Lancet - Early, Goal-Directed Mobilisation

Critical Care Medicine - Dopamine vs Adrenaline in Septic Shock

 Neurosurgery - 4th Brain Trauma Foundation TBI Guideline

NEJM - High Flow Nasal Oxygen for Preterm Infants

Crit Care Med - Stress Ulcer Prophylaxis

Liver International - Vasopressor Support for Cirrhosis & Septic Shock

NEJM - Decompressive Craniotomy

Am J Respir Crit Care Med - Sevoflurane for Sedation ARDS

Chinese Medical Journal - Evaluation of Coma after Cardiac Arrest

N Engl J Med - Factor Xa Inhibitor Related Bleeding

Lancet Respiratory Medicine - Sedation & Analgesia

JAMA Cardiology - Nonshockable Out-of-Hospital Cardiac Arrest

Shock - Hydrocortisone in Septic Shock

JAMA Internal Medicine - Sodium Selenite & Procalcitonin in Sepsis

Journal of Critical Care - Heparin for Pneumonia in Ventilated Patients

European Heart Journal - Acute Heart Failure Guideline

Clinical Infectious Diseases - HAP & VAP Guideline

Am J Respir & Crit Care Med - Burnout Syndrome in Critical Care Professionals

JAMA - Palliative Care-Led Meetings

Lancet - Platelet Transfusion in Haemorrhagic Stroke

JAMA - Timing of Renal Replacement Therapy in AKI

American Thoracic Society Meeting

New England Journal of Medicine:     Timing of Renal Replacement Therapy in AKI

JAMA:     Aspirin for the Prevention of ARDS

JAMA:     Helmet NIV for ARDS

American Journal of Kidney Disease:     Renal Replacement Therapy Dose

Journal of the American College of Cardiology:     Early Aldosterone Blockade in Acute MI

Resuscitation:     Video Laryngoscopy during CPR

Critical Care:     European Guideline on Bleeding & Coagulopathy post Trauma

JAMA:     Checklists

Resuscitation:     Hypercapnoea post Cardiac Arrest

NEJM:     Antiarrhythmics in Out-of-Hospital Cardiac Arrest

Critical Care:     Steroids for Refractory Shock post Cardiac Arrest

Intensive Care Medicine:     Probiotics for the Prevention of VAP

Brussel's International Symposium on Intensive Care & Emergency Medicine

JAMA:  Dexmedetomidine Sedation in ICU

JAMA: High-Flow Nasal Oxygen post Extubation

JAMA: Non-Invasive Ventilation post Extubation after Abdominal Surgery

JAMA: Secondary Infections post Sepsis

NEJM: Early TPN in Childern

Critical Care Medicine:  Fragility Index in Critical Care

Journal of Infection - UK Meningitis Guidelines

JAMA - Sepsis Definition

JAMA - Statins for AKI

JAMA - ARDS Epidemiology

Lancet Respiratory Medicine - Effect of Light on Delirium

Intensive Care Medicine - Blood Pressure Targets in Shock

NICE Trauma Guideline

JAMA - Acetazolamide for COPD

Intensive Care Medicine - Percutaneous Dilational Tracheostomy

Pediatric Crit Care Med - Aminophylline for Prevention of AKI

Blue Journal - End-of-Life Communication

JPEN J Parenter Enteral Nutr - Nutritional Support in the Critically Ill

Intensive Care Medicine - Continuous vs Intermittent Beta Lactam Infusion

Chest - Antithrombotic Therapy for VTE

Resuscitation - TTM post Cardiac Arrest

German Medical Society - Delirium, Analgesia & Sedation Guideline

Annals of Intensive Care - Renal Replacement Therapy Guideline

ANZICS - Acute Pain Management Scientific Evidence


Journal of Thrombosis and Haemostasis - Guideline on Antidotes for Direct Oral Anticoagulants

American Journal of Respiratory & Critical Care Medicine:     Physical Therapy for Respiratory Failure

NICE Guideline on Acute Heart Failure

NICE Guideline on IV Fluid Therapy in Young People

Journal of Trauma:  Western Trauma Guidelines

Critical Care Medicine:     SCCM Guideline on Ultrasound in Critical Care

Critical Care Medicine: SCCM Guideline on Organ Procurement

Critical Care Medicine:    SCCM Guideline on ICU Process & Structures

Lancet Infectious Diseases:     Body Surface Decolonization & UTIs

JAMA:     Transfusion in Anaemic Children with Elevated Lactate

Intensive Care Medicine:  Post-Resuscitation Care Guideline

American Heart Association:  ST-Elevation MI Guideline Update

American Heart Association:  Infective Endocarditis Guideline

2015 Cardiac Arrest Guidelines

  1. Part 1: Executive Summary: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2015;132:S315-S367
  2. Part 2: Evidence Evaluation and Management of Conflicts of Interest: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2015;132:S368-S382
  3. Part 3: Ethical Issues: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2015;132:S383-S396
  4. Part 4: Systems of Care and Continuous Quality Improvement: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2015;132:S397-S413
  5. Part 5: Adult Basic Life Support and Cardiopulmonary Resuscitation Quality: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2015;132:S414-S435
  6. Part 6: Alternative Techniques and Ancillary Devices for Cardiopulmonary Resuscitation: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2015;132:S436-S443
  7. Part 7: Adult Advanced Cardiovascular Life Support: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2015;132:S444-S464
  8. Part 8: Post–Cardiac Arrest Care: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2015;132:S465-S482
  9. Part 9: Acute Coronary Syndromes: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2015;132:S483-S500
  10. Part 10: Special Circumstances of Resuscitation: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2015;132:S501-S518
  11. Part 11: Pediatric Basic Life Support and Cardiopulmonary Resuscitation Quality: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2015;132:S519-S525
  12. Part 12: Pediatric Advanced Life Support: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care
  13. Circulation 2015;132:S526-S542
  14. Part 13: Neonatal Resuscitation: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2015;132:S543-S560
  15. Part 14: Education: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2015;132:S561-S573

ESICM Hot Topics and New Trials

N Engl J Med:     Plasmalyte vs Saline

JAMA:     Paracetamol for Fever in Critically ill with Suspected Infection

Lancet:     Erythropoietin for Traumatic Brain Injury

N Engl J Med:     Hypothermia for Intracranial Hypertension in Traumatic Brain Injury

Am J Respir Crit Care Med:     Apnoeic Oxygenation

JAMA:     ICU Admission for Older Adults with Pneumonia

JAMA:     Do-Not-Resuscitate Status


NEJM:     CVC Insertion Site

Clinical Drug Investigation:  Esmolol for Sepsis

Lancet:     Methylprednisolone for Cardiopulmonary Bypass

Lancet:     Sigmoid Diverticulitis

Lancet:  CVC Line Infection Prevention

American Journal of Respiratory & Crit Care Med:     End-of-Life Care

Critical Care:     Laxative Therapy

Lancet:  Oxyenation Target in Bronchiolitis

Lancet:  Bubble CPAP for Paediatric Pneumonia

European Journal of Anesthesiology:     Pre-Oxygenation

Critical Care Medicine:     Vasopressors for Paediatric Septic Shock

Blue Journal:     Oxygenation Targets in Mechanically Ventilated Patients

Journal of Hepatology:     Plasma Exchange for Acute Liver Failure

Circulation:     ESC Guidelines on Pulmonary Hypertension | Pericardial Disease | Non-Persistent ST Elevation Coronary Syndromes | Infective Endocarditis

British Journal of Haematology:     Guideline on Admission for Haematology Cancer Patients

Journal of Trauma:  Early Surgery in Traumatic Brain Injury

Annals of Surgery:     Cryopreserved Packed Red Cells

NEJM / Lancet:     Idarucizumab for Dabigatran

Lancet:     Bioprosthetic Total Artificial Heart Heart

New England Journal of Medicine:     Hypothermia for Deceased Kidney Donor Graft

JAMA:     Bystander CPR

Blue Journal:     β-Lactam Infusion in Severe Sepsis

Perioperative Medicine:     Stroke Volume Variation

Critical Care Medicine:    Critical Care Interventions

Blue Journal:     Haemofiltration for Postcardiac Surgery Shock

Annals of Surgery:     Abdominal Vacuum Therapy post Laparotomy

Annals of Intensive Care:     Guideline on Cardiogenic Shock

Journal of Trauma:     Guideline on ED Thoracotomy

Critical Care Medicine:     Hypothermia for Paediatric Traumatic Brain Injury

Circulation:     Targeted Temperature Management

New England Journal of Medicine:     Out-of-Hospital CPR

New England Journal of Medicine:     Stroke Thrombolysis

New England Journal of Medicine:     Stroke Thrombectomy

Blue Journal:     Guideline on Requests for Inappropriate ICU Therapy

Blue Journal:     Guideline on Managing Conscientious Objections in ICM

Journal of Cardiac Failure:     Statement on Percutaneous Mechanical Circulatory Support

European Heart Journal:     Guideline on Acute Heart Failure

Stroke:     Guideline on Spontaneous Intracerebral Haemorrhage

Critical Care Medicine:     Talactoferrin for Sepsis

New England Journal of Medicine:     Intra-Abdominal Infection

American Thoracic Society Meeting 2015

New England Journal of Medicine:     Underfeeding

New England Journal of Medicine:     High Flow Nasal Oxygen

Journal of the American Medical Association:     High Flow Nasal Oxygen

Lancet:     Red Cell Transfusion in Upper GI Haemorrhage

 British Medical Journal:     MRSA Therapy

AJRCCM:     GUIDELINE - Conscientious Objections in ICU

Intensive Care Society:     Provision of Intensive Care Servces

Neurocritical Care:     Hemispheric Infarction

Neurocritical Care:     Devastating Brain Injury

Swiss Medical Weekly:     Ethics in ICU

New England Journal of Medicine:     Paediatric Therapeutic Hypothermia post Cardiac Arrest

New England Journal of Medicine:     Alcoholic Hepatitis

Intensive Care Medicine:     High Flow Nasal Cannulae Oxygen for Intubation

JAMA Internal Medicine:     Post ICU Rehabilitation

Intensive Care Medicine:     Polymyxin B Hemoperfusion

Chest:     Surfactant in ARDS

Intensive Care Medicine:    Early Rehabilitation

Critical Care Medicine:     Regional Citrate Anticoagulation for RRT

NEJM:     Age of Transfused Red Cells

NEJM:     ARDS Driving Pressure

JAMA:     Steroids for Community-Acquired Pneumonia

Acta Anaesthesiologica Scandinavica:     Fluid Resuscitation Guideline

NEJM:     Endovascular Stroke Therapy

Journal of Trauma:     EAST Guideline on Clearing the Cervical Spine in the Obtunded Patient

NEJM:     Stroke Neuroprotection

JAMA:     Trauma Transfusion Ratios


Lancet Respiratory Medicine:     Perioperative Goal-Directed Oxygen Delivery

JAMA:     Hypoxaemic Ischaemic Encephalopathy

New England Journal of Medicine:     Endovascular Stroke Therapy

New England Journal of Medicine:     Traumatic Brain Injury

Stroke:     Statins for Subarachnoid Haemorrhage

Lancet:     Red Cell Transfusion Triggers

 Lancet:     IV Fluid Therapy

Intensive Care Medicine:     Therapeutic Hypothermia for Cardiac Arrest

Intensive Care Medicine:    Balanced Crystalloid Solutions

Cell Transplantation:     Spinal Cord Regeneration

Resuscitation:     Refractory Cardiac Arrest

Journal of Clinical Epidemiology:     Fragility Index

ESICM Congress Studies

New England Journal of Medicine:     ARISE Study

The ARISE study Investigators completed a large, international, multi-centre, parallel group, randomized controlled trial, comparing early goal-directed therapy (n=796) with usual care (n=804) in 1600 patients presenting to the emergency department with early septic shock, and found:

  1. groups were similar at baseline
  2. no significant differences in
    • 90 day mortality
      • EGDT 18.6% vs UC 18.8%
      • absolute risk difference with EGDT vs UC, −0.3%; 95% CI -4.1 to 3.6; P = 0.90
    • survival time
    • mortality
      • ICU
        • 10.9 vs 12.9; RR 0.85, 95% CI 0.64 to 1.13; P=0.28
      • hospital
        • 14.5 vs 15.7; RR 0.92, 95% CI 0.73 to 1.17; 0.53
      • day 28 
        • 14.8 vs 15.9; RR 0.93 95% CI 0.73 to 1.17; P=0.53
    • duration of organ support
    • length of
      • ICU stay
        • 2.8 vs 2.8 days; p=0.81
      • hospital stay
        • 8.2 vs 8.5 days; p=0.89
  3. EGDT was associated with
    • greater fluid administration in the first 6 hours
      • 1964±1415 ml vs 1713±1401 ml
    • increased liklihood of receiving
      • vasopressors
        • 66.6% vs. 57.8%; P<0.001
      • red-cell transfusions
        • 13.6% vs. 7.0%; P<0.001
      • dobutamine
        • 15.4% vs. 2.6%; P<0.001

New England Journal of Medicine:     TRISS Study

Holst and colleagues completed a Scandanavian multicenter, randomized, parallel-group trial in 1,005 patients (998 analyzed) with shock and a haemoglobin concentration ≤ 9g/dL, comparing a red cell transfusion trigger of ≤ 7g/dL with ≤ 9g/dL and found

  1. both groups were similar at baseline (≤ 7 g/d vs <9 g/dL)
    • SOFA median 10 vs 10; SAPS II median 51 vs 52
  2. the more restrictive transfusion trigger was associated with
    • less units of transfused red cells (median/IQR)
      • 1 (0-3) vs 4 (2-4)
  3. there was no statistically significant difference in (≤ 7 g/d vs <9 g/dL)
    • 90 day mortality
      • 43% vs 45%; RR 0.94; 95% CI 0.78 to 1.09; P = 0.44
    • ischemic events 
      • 7.2% vs 8%, RR 0.90, 95% CI 0.58 to 1.39, P=0.64
    • severe adverse reactions
      • 0 vs 0.2%, P≈1.0
    • requiring life support
      • at day 5: 64.4% vs 62.2%, RR 1.04, 95% 0.93 to 1.14; P=0.47
      • at day 14: 36.8% vs 36.8%, RR 0.99, 95% 0.81 to 1.19; P=0.95
      • at day 28: 7.2% vs 8.0%, RR 0.90, 95% CI 0.58 to 1.39; P=0.64
    • alive without vasopressor or inotropic therapy (mean % of days)
      • 73% vs 75%; P=0.93
    • alive without mechanical ventilation (mean % of days)
      • 65% vs 67%; P=0.49
    • alive without renal-replacement therapy (mean % of days)
      • 85% vs 83%; P=0.54
    • alive and out of the hospital (mean % of days)
      • 30% vs 31%; P=0.89

Unpublished:     EPO ACR 02

Cariou and colleagues completed a French, multi-centre, parallel group, randomised controlled trial, comparing early, high-dose erythropoietin (40,000 IU immediately after ROSC and 12 hourly for 48 hours, n=234) with placebo (n=242) in 476 patients with return of spontaneous circulation after out-of-hospital cardiac arrest, and found:

  1. groups were similar at baseline
  2. there was no difference in
    • neurological recovery
    • cerebral performance category 1 (best outcome) - 32% each
    • mortality (missed the figure)
    • duration mechanical ventilation
      • Epo 5.6 days vs placebo 6.0 days; p=0.61
  3. erythropoietin was associated with increased rates of
    • thrombosis
      • 12.4% vs 5.8%; p=0.01
    • acute stent thrombosis
      • 8 (3.4%) vs 1 (0.4%); p=0.02

New England Journal of Medicine:     CALORIES

Journal of the American Medical Association:     SDD vs SOD

ESICM Congress Studies

Journal of the American Medical Association:     VITdAL-ICU Study

Amrein and colleagues performed a randomized double-blind, placebo-controlled, single-center study in 492 critically ill patients with vitamin D deficiency (≤20 ng/mL), comparing vitamin D3 administration (PO or NG, 540,000 IU followed by monthly maintenance doses of 90,000 IU for 5 months; n=249) with placebo (n=243), and found:

  1. 475 patients were included in the final analysis (vit D n=237; placebo n=238)
  2. there were no significant differences in (median / IQR)
    • length of hospital stay
      • vit D: 20.1 days [11.1-33.3] vs placebo 19.3 days [11.1-34.9]; P = 0.98
    • mortality
      • hospital
        • vit D 28.3% [95% CI 22.6%-34.5%] vs placebo 35.3% [95% CI 29.2%-41.7%]; HR 0.81 [95% CI 0.58-1.11]; P=0.18
      • 6-month
        • vit D 35.0% [95% CI 29.0%-41.5%] vs placebo 42.9% [95% CI 36.5%-49.4%]; HR 0.78 [95% CI 0.58-1.04]; P = 0.09
  3. in the most severe vitamin D deficiency subgroup (n = 200)
    • no significant differences in
      • length of hospital stay
        • vit D 20.1 days (12.9-39.1) vs placebo 19.0 days (11.6-33.8)
      • 6-month mortality
        • vit D 34.7% [95% CI 25.4%-45.0%] vs placebo 50.0% [95% CI 39.9%-60.1%]; HR 0.60 [95% CI 0.39-0.93], P for interaction = 0.12
    • vit D was associated with significantly lower
      • hospital mortality
        • 28.6% [95% CI 19.9%-38.6%] vs 46.1% [95% CI 36.2%-56.2%]; HR 0.56 [95% CI 0.35-0.90], P for interaction = 0.04

Unpublished:     FLORALI Study

In 310 patients with acute hypoxaemic respiratory failure (PaO2 /FiO2 < 300 mmHg), standard oxygen therapy (n=94) was compared with high flow nasal oxygen (n=106) and with a combination of noninvasive ventilation (minimum 8 hours per day) and HFNO (n=110). The authors found:

  1. most patients had either community-acquired pneumonia (≈60%) or hospital-acquired pneumonia (≈10%)
  2. 77% had a PaO2 /FiO2 < 200 mmHg
  3. no difference in the requirement for invasive mechanical ventilation (1° outcome)
    • SOT 46.8 % vs HFNO 37.7% vs NIV/HFNO 50%; p=0.17
      • reduced requirement for invasive mechanical ventilation in those with a PaO2 /FiO2 < 200 mmHg (n=238)
      • SOT 52.7 % vs HFNO 34.9% vs NIV/HFNO 58%; p=0.009
  4. reduced 
    • ICU mortality
      • SOT 19.1 % vs HFNO 11.3 % vs NIV/HFNO 24.5 %; p<0.05
    • 90 day mortality
      • SOT 23.4 % vs HFNO 12.3 % vs NIV/HFNO 28.2 %; p<0.05

New England Journal of Medicine:  Ebola Virus Disease

Critical Care Medicine:  Fatty Acid Supplementation

Anesthesiology:  Erythropoietin & Acute Kidney Injury

European Heart Journal:  STEMI

European Heart Journal:  Guidelines

European Journal of Anaesthesiology:  Cardiovascular Assessment & Management for Non-Cardiac Surgery

Canadian Medical Association Journal:  Melatonin for Delirium

ESC Congress Studies

ESC Congress Studies

European Heart Journal:     ESC Guidelines

Infection Control and Hospital Epidemiology:     Healthcare-Associated Infection Guidelines

Journal of the American Medical Association:     Immunonutrition

Abstract:  van Zanten. High-Protein Enteral Nutrition Enriched With Immune-Modulating Nutrients vs Standard High-Protein Enteral Nutrition and Nosocomial Infections in the ICU. A Randomized Clinical Trial (MetaPlus study). JAMA 2014;312(5):514-524

British Medical Journal:     Albumin in Sepsis

Full Text:  Patel. Randomised trials of human albumin for adults with sepsis: systematic review and meta-analysis with trial sequential analysis of all-cause mortality. BMJ 2014;349:g4561

Annals of Internal Medicine:     Fluid Resuscitation in Sepsis

Abstract:  Rochwerg. Fluid Resuscitation in Sepsis: A Systematic Review and Network Meta-analysis. Ann Intern Med 2014;epublished July 22nd

Anesthesia & Analgesia:     Perioperative Goal-Directed Therapy

Pestaña and colleagues completed a pragmatic, multi-centre study in 142 patients undergoing general surgery, comparing a noninvasive cardiac output monitor guided hemodynamic protocol, including fluid administration and vasoactive drugs, with standard practice, and found:

  • the interventional protocol was associated with
    • an increase in the number of
      • colloid boluses (2.4 ± 1.8 vs 1.3 ± 1.4; P < 0.001)
      • packed red blood cell units (0.6 ± 1.3 vs 0.2 ± 0.6; P = 0.019)
      • dobutamine use (p < 0.001)
        • intraoperatively: 25% vs 1.4%
        • postoperatively: 19.4% vs 0%
    • reduced
      • reoperations (5.6% vs 15.7%; P = 0.049)
    • no statistically significant differences in
      • overall fluid administration
      • overall complications (40% vs 41%)
        • relative risk 0.99; 95% CI 0.67 to 1.44; P = 0.397
      • length of stay (11.5 [8-15] vs 10.5 [8-16]; P = 0.874)
      • time to first flatus (62 hours [40-76] vs 72 hours [48-96]; P = 0.180)
      • wound infection (7 vs 14; P = 0.085)
      • anastomotic leaks (2 vs 5; P = 0.23)
      • mortality (4.2% vs 5.7%; P = 0.67)

Conclusion: The use of a perioperative goal-directed haemodynamic protocol in major abdominal surgery was not associated with reductions in overall complications, length of hospital stay, or mortality.

Abstract:  Pestaña. Perioperative Goal-Directed Hemodynamic Optimization Using Noninvasive Cardiac Output Monitoring in Major Abdominal Surgery: A Prospective, Randomized, Multicenter, Pragmatic Trial: POEMAS Study (PeriOperative goal-directed thErapy in Major Abdominal Surgery). Anesth Analg 2014;epublished July 9th

JAMA: Red Cell Management in Traumatic Brain Injury

Robertson and colleagues, using a factorial design, compared intravenous erythropoietin (500 IU/kg per dose, n=102) with saline (n=98), plus red cell transfusion at a threshold of either 7 g/dL (n=99) or 10 g/dL (n=101), on Glasgow Outcome Scale score at 6 months postinjury, in 200 patients within 6 hours of closed head injury and unable to follow commands. Erythropoietin or placebo was initially dosed daily for 3 days and then weekly for 2  weeks (group 1, n = 74). The protocol was subsequently amended to (I think, it's remarkably poorly described) a single erythropoietin dose, possibly followed by further doses at 1 and 2 weeks if the patient was still in ICU (n=126). The authors found:

  1. no interaction between erythropoietin and hemoglobin transfusion threshold
  2. no statistical improvement on favorable outcome rate (dichotomized as favorable (good recovery and moderate disability) or unfavorable (severe disability, vegetative, or dead))
    • between placebo and erythropoietin
      • placebo: 38.2%; 95% CI 28.1% to 49.1%
      • erythropoietin
        • first dosing regimen:  48.6%; 95% CI 31.4% to 66.0%, P =0.13
        • second dosing regimen: 29.8%; 95% CI 18.4% to 43.4%; P  < 0.001
    • between haemoglobin transfusion thresholds
      • 7 g/dL:  42.5%
      • 10 g/dL: 33.0%
        • 95% CI for the difference −0.06 to 0.25, P = 0.28
  3. the 10 g/dL transfusion threshold was associated with a
    • higher incidence of thromboembolic events (21.8% vs 8.1%; odds ratio 0.32, 95% CI 0.12 to 0.79; P = 0.009)

Conclusion: In a two centre, factorial, randomized controlled trial, in patients with closed head injury, neither erythropoietin administration nor red blood cell transfusion maintaining a haemoglobin level of ≥10 g/dL versus ≥ 7 g/dL, were statistically associated with improved outcomes, with the higher haemoglobin level associated with more thrombotic events.

Abstract:  Robertson. Effect of Erythropoietin and Transfusion Threshold on Neurological Recovery After Traumatic Brain Injury:  A Randomized Clinical Trial. JAMA 2014;312(1):36 

New Engl J Med:  PEEP in General Anaesthesia

The PROVE Network Investigators compared high PEEP (median 12 cmH20) plus recruitment maneuvres (n=447) with low PEEP (median 2 cmH20) without recruitment manuevres (n=453) in 900 patients undergoing open abdominal surgery, ventilated with 8 ml/kg and at high risk for postoperative pulmonary complications, and found no difference in post-operative complications (high PEEP 40% vs low PEEP 39%, RR1·01; 95% CI 0·86 to1·20; p=0·86), but increased hypotension with higher PEEP, requiring more vasopressor therapy.

Abstract:  The PROVE Network Investigators. High versus low positive end-expiratory pressure during general anaesthesia for open abdominal surgery (PROVHILO trial): a multicentre randomised controlled trial. Lancet 2014;epubished May 30th

New Engl J Med:  Long-Acting Gram Positive Antibacterial Therapy

Boucher et al pooled two identically designed, industry funded, noninferiority trials, and found once-weekly IV dalbavancin (a long-acting lipoglycopeptide antibiotic active against gram positive bacteria, n=659) was non-inferior to twice-daily IV vancomycin followed by oral linezolid (n=653) for the treatment of acute bacterial skin and skin-structure infection, with no difference in early clinical response indicating treatment success (79.7% vs 79.8%, respectively; weighted difference, −0.1%; 95% CI−4.5 to 4.2%), or side effects. Individual study analyses yielded similar results, as did pooled analysis of clinical status at end of therapy.

Abstract:  Boucher. Once-Weekly Dalbavancin versus Daily Conventional Therapy for Skin Infection (DISCOVER 1 & 2 studies).  N Engl J Med 2014;370:2169-2179

New Engl J Med:  Long-Acting Gram Positive Antibacterial Therapy

Corey and colleagues found a single dose of IV oritavancin (a long-acting lipoglycopeptide with bactericidal activity against gram-positive bacteria, n=475) was non-inferior to a regimen of twice daily IV vancomycin for 7 to 10 days (n=479) in 954 adults with acute bacterial skin and skin-structure infections, for three main outcomes:

  • spreading or reduction in lesion size, absence of fever, and no need for administration of a rescue antibiotic after 48 to 72 hours (82.3% vs 78.9%, respectively;  95% CI for difference −1.6 to 8.4%)
  • clinical cure 7 to 14 days after the end of treatment, as determined by a study investigator (79.6% vs 80.0%, 95% CI for difference −5.5 to 4.7%)
  • reduction in lesion size of 20% or more after 48 to 72 hours (86.9% vs 82.9%, 95% CI for difference −0.5 to 8.6%)

Abstract:  Corey. Single-Dose Oritavancin in the Treatment of Acute Bacterial Skin Infections (SOLO I study). N Engl J Med 2014;370:2180-2190 

Brar and colleagues completed a randomised, parallel-group, comparator-controlled, single-blind phase 3 trial, comparing a left ventricular end-diastolic pressure-guided fluid administration protocol with a standard fluid administration protocol in 396 adults undergoing cardiac catheterisation with an estimated glomerular filtration rate of 60 mL/min/1·73 m2 or less, and one or more of several risk factors, and found:

  1. the new fluid protocol was associated with
    • a reduced incidence of contrast-induced acute kidney injury 
    • 6·7% vs. 16·3%; RR 0·41, 95% CI 0·22 to 0·79; p=0·005
  2. hydration treatment was terminated prematurely because of shortness of breath in three patients in each group

Abstract:  Brar. Haemodynamic-guided fluid administration for the prevention of contrast-induced acute kidney injury: the POSEIDON randomised controlled trial. Lancet 2014;383(9931):1814-1823

Kirkpatrick and colleagues completed an international, multicentre, randomised, double-blind trial, comparing simvastatin 40 mg (n=391) with placebo (n=412) once a day for up to 21 days, in 803 adults within 96 hours of  subarachnoid haemorrhage, and found:

  1. no between-group difference in
    • incidence of favourable modified Rankin Scale (mRS) score, obtained by questionnaire at 6 months (1° outcome)
      • simvastatin 271 vs placebo 289
      • OR 0·97, 95% CI 0·75 to 1·25; p=0·803
    • mortality at 6 months
      • simvastatin 10% (n=37) vs placebo 9% (n=35); log-rank p=0·592
    • serious adverse events
      • 18% vs 18%

Abstract:  Kirkpatrick. Simvastatin in aneurysmal subarachnoid haemorrhage (STASH): a multicentre randomised phase 3 trial. Lancet Neurology 2014;epublished May 16th

Pearse and colleagues completed a pragmatic, multicenter, randomized, observer-blinded trial of 734 high-risk UK patients aged 50 years or older, undergoing major gastrointestinal surgery, comparing the effectiveness of a perioperative, cardiac output–guided hemodynamic therapy algorithm consisting of IV fluid and dopexamine infusion during and 6 hours following surgery (n=368) with standard care (n=366), as well as a systematic review and meta analysis evaluating perioperative goal directed care, and found:

  1. in the randomized controlled trial
    • groups were similar at baseline
    • nonadherence was < 10% in each group
    • the hemodynamic therapy algorithm was associated with
      • a trend towards a reduction in composite outcome of 30-day complications and mortality (1° outcome)
        • 36.6% vs 43.4% (RR 0.84, 95% CI 0.71 to 1.01; absolute risk reduction 6.8%, 95% CI −0.3% to 13.9%; P = 0.07)
      • no significant difference between groups for any secondary outcomes.
        • morbidity on day 7
          • 66.2% vs 67.9%; RR 0.97, 95% CI 0.87 to 1.09; P=0.72
        • infectious complications at day 30
          • 23.8% vs 29.7%; RR 0.80, 95% CI 0.63 to 1.02; P=0.08
        • critical care–free days at day 30
          • 27 vs 28; P=0.98
        • all-cause mortality at 30 days following surgery
          • 3.3% vs 3.0%; RR 1.08, 95% CI 0.48 to 2.43; P>0.99
        • all-cause mortality at 180 days following surgery
          • 7.7% vs 11.6%; RR 0.66, 95% CI 0.42 to 1.05; P=0.08
        • duration of acute hospital length of stay
          • 10 vs 11; P=0.05
        • a trend for increased cardiovascular serious adverse events within 24 hours (1.4% (n=5) vs 0) (P = 0.06)
  2. in the meta analysis (38 studies, n=6,595)
    • perioperative goal-directed therapy was associated with
      • fewer complications
        • 31.5% vs 41.6%; RR 0.77, 95% CI 0.71 to 0.83
      • nonsignificant reductions in mortality
        • hospital / 28-day / 30-day 
          • 4.9% vs 6.5%; RR 0.82, 95% CI 0.67 to 1.01
        • at longest follow-up
          • 8.3% vs 10.3%; RR 0.86, 95% CI 0.74 to 1.00

Full Text:  Pearse. Effect of a Perioperative, Cardiac Output–Guided Hemodynamic Therapy Algorithm on Outcomes Following Major Gastrointestinal SurgeryA Randomized Clinical Trial and Systematic Review (OPTIMISE). JAMA 2014;epublished May 19th

Liu and colleagues quantified the contribution of sepsis to mortality in 2 complementary inpatient cohorts from Kaiser Permanente Northern California (n=482,828) and the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (n=6,500,000), and found:

  1. the number of sepsis hospitalizations were
    • KPNC cohort
      • 55,008 explicit (11.4% of total; 95% CI 11.3% to 11.5%) 
      • 80,678 implicit (16.7%; 95% CI 16.6% to 16.8%)
    • NIS cohort
      • 280 663 explicit  (4.3%; 95% CI  4.3% to 4.3%)
      • 717,718 implicit (10.9%; 95% CI 10.9% to 11.0%)
  2. the numbers of inpatients dying with a diagnosis of sepsis were
    • KPNC cohort
      • of 14, 206 inpatient deaths