Emergency & Critical Care
Over half of children admitted with sepsis had been seen by a clinician in the week before
A 6,928-admission claims study makes the case for explicit safety-netting of febrile children; AI assistance raised fracture detection sensitivity from 73% to 87%; and erector spinae blocks gave lower pain scores than intercostal blocks.
Endoscopy within 6 hours for non-variceal upper GI bleeding did not beat endoscopy within 24
A meta-analysis of 10,785 patients finds no mortality or rebleeding benefit from ultra-early endoscopy; one in five septic shock patients meets new refractory criteria, with 64% mortality; and AI sepsis models look better on paper than they have yet proved at the bedside.
Saline or balanced fluid for children in septic shock: no difference in kidney outcomes or death
PRoMPT BOLUS, in over 8,000 children, found balanced crystalloid no better than 0.9% saline; bedside ultrasound signs of plasma leakage flag severe dengue; and AI read large-vessel occlusion on plain CT more sensitively than clinicians in retrospective studies.
Sodium bicarbonate did not protect the kidneys in metabolic acidosis with shock
SODa-BIC found no reduction in death, dialysis or persistent kidney dysfunction with bicarbonate in 500 vasopressor-dependent ICU patients. Also: who attempts suicide after a positive ED screen, low-dose ketamine to spare opioids on the ventilator, and a generic adrenaline supplement.
Fourteen days of ECG monitoring after unexplained syncope in the ED did not reduce further faints
ASPIRED, a 2,234-patient UK trial, questions routine extended monitoring from the emergency department. Also: one-year survival after ECMO by type, where beta-blockers help and harm in critical illness, what the evidence says about 'medical clearance' for psychiatric patients, and where children with mental health crises present.
Routine CT coronary angiography after MI rule-out did not prevent MI or cardiac death
TARGET-CTCA randomised 3170 ED patients with MI excluded but troponin above 5 ng/L to outpatient CT coronary angiography or standard care, with no difference at three years. Also: protocolised early mobilisation in ventilated patients, online ECG teaching for occlusion MI patterns, and a Baxter vasopressin recall.
Cardiac arrest arrivals: analysing the rhythm on the paramedics' pads saved over two minutes
A video-review study questions the reflex to switch defibrillators at the door. Also: a recall of premixed vasopressin bags, what VExUS can and cannot tell you, diabetes-specific tube feeds, and driving after critical illness.
Head-up positioning prevents ventilator pneumonia — and the steeper angles cause pressure ulcers
An updated Cochrane review of 48 trials separates what head-of-bed angle actually buys from what it costs, a dual-framework meta-analysis leaves capillary refill–guided resuscitation on the edge of significance, and WEAN SAFE shows a 78% ICU mortality in patients who never wean.
Nothing supports holding the home beta-blocker in suspected infection
A target trial emulation in 4,635 admissions found continuation associated with lower 90-day mortality; a pupillometer adds little to a torch after arrest; AI raises fracture sensitivity most for the juniors reading the film; and more bupivacaine does not make a better nerve block.
Mucolytics did nothing for ventilated patients, and both caused harm
MARCH randomised 1,956 ventilated patients to carbocisteine, hypertonic saline, both or neither: no effect on ventilation duration, a sixfold rise in upper gastrointestinal bleeding with carbocisteine and a thirteenfold rise in desaturation during nebulisation with saline.
Premixed amiodarone under recall, and half of paediatric sepsis was seen the week before
A Class II recall covers Nexterone premixed amiodarone bags for manufacturing deviations; 53.5% of children admitted with sepsis had been seen somewhere in the preceding seven days; and adding lung views to resuscitative transoesophageal echo raised the rate at which operators named a cause of shock.
Correcting the acidosis did not protect the kidneys, and balanced fluid did not beat saline in 8,482 children with septic shock
SODa-BIC finds sodium bicarbonate makes no difference to major adverse kidney events in vasopressor-dependent metabolic acidosis; PRoMPT BOLUS settles the crystalloid question in paediatric septic shock; low-dose ketamine trims opioid requirement in ventilated adults; atropine vials are recalled for particulate contamination.
Unexplained syncope: 14-day ambulatory ECG monitoring did not reduce repeat faints at one year
ASPIRED tests immediate ambulatory monitoring after an ED syncope work-up, a fall brings four in ten older adults back to the ED within a year, and long-term ECMO mortality ranges from 37% to 74% by modality.
Routine CT coronary angiography after MI is ruled out did not prevent later heart attacks
TARGET-CTCA followed 3170 intermediate-risk chest pain patients for three years. Also: a transfusion trial in cancer septic shock stopped early, early mobilisation and multiplex PCR in ventilated patients, and a Baxter vasopressin recall.
Premixed vasopressin and amiodarone both under recall, and the resuscitation trolley is the place to check
Ongoing Class II recalls cover two vasopressin concentrations and a ready-to-use amiodarone presentation. Plus what happened when 167 emergency departments switched to RVU-based pay, and the state of cluster trials in critical care.
Capillary refill as a resuscitation target: seven trials, and a result that depends on which statistics you read
Pooled across 2,408 patients in septic shock, peripheral perfusion-guided resuscitation gave a mortality risk ratio of 0.87 (95% CI 0.76-1.01) - not significant frequentist, 97.2% posterior probability of benefit Bayesian. Same data, two honest answers.
Most ICU survivors could drive months before anyone told them so
Four in five were assessed as fit to drive at three months and fewer than half had resumed; a three-marker rapid immunoassay reproduces paediatric critical care subphenotypes at the bedside; and a thousand studies of kidney injury biomarkers have produced twelve on management.
Half of hantavirus patients needing support went to ECMO, and the ICU's real work starts after discharge
A national cohort of Andes virus cardiopulmonary syndrome, diabetes-specific tube feeds tested on glucose rather than outcomes, which emergency physician tasks AI can actually take, and what post-intensive care syndrome demands of a unit.
Sudden painless vision loss, one in five septic shocks refractory, and where the transfusion threshold sits in infarction
A joint position paper separates the two forms of ischaemic optic neuropathy; consensus criteria put a number on refractory septic shock; and MINT's ICU subgroup declines to carve out an exception.
Low-dose ketamine trims opioid requirement in ventilated adults
A 120-patient double-blind trial reports a 13 microgram per hour fall in fentanyl-equivalent dosing, with a 95% probability of benefit and no signal of harm. Plus atropine vials recalled for particulate contamination, what VExUS actually predicts, transfer time from department to intensive care, and the week before a child is admitted with sepsis.
Stop measuring gastric residual volumes in ventilated children
A 4,700-child noninferiority trial across 24 paediatric intensive care units found dropping routine six-hourly checks did no harm and improved feeding. Plus a negative trial of MRSA nares swabs for vancomycin de-escalation, a buprenorphine-naloxone licence supplement, lung ultrasound through the oesophagus, and what happens when home beta-blockers are held on admission.
One year after ECMO, the modality is the prognosis
Pooled outcomes from 78,000 adults put one-year mortality at 37% for venovenous support and 74% after extracorporeal CPR. Also: a bigger sphenopalatine block is not a better one, dexmedetomidine as a bridge for the agitated adolescent, and the case against routine bloods before psychiatric admission.
Two large analgesia trials cleared statistical significance and missed clinical importance
Intravenous magnesium added to paracetamol raised headache treatment success from 65.1% to 78.9% while every pain-score difference stayed below the 1.3-point threshold that matters, and 1,194 patients showed subcutaneous and intranasal ketamine equivalent for acute trauma pain.
CT coronary angiography after a ruled-out infarct changed nothing over three years
TARGET-CTCA randomised 3,170 chest pain patients with a mildly raised troponin but no infarct to outpatient CT angiography or standard care. After three years, myocardial infarction or cardiac death occurred in 7.1% versus 7.3%. Plus: 14-day monitoring after syncope also fails, and saline holds its ground in paediatric septic shock.
Intranasal ketamine matches the needle for acute trauma pain
A 1,194-patient trial finds no clinically important difference between intranasal and subcutaneous ketamine, magnesium added to paracetamol helps headache statistically but marginally, and a protocolised early mobilisation programme did not improve function at ICU discharge or a year later.