Ultra-early endoscopy shows no advantage in non-variceal bleeding; higher inotrope exposure on VA-ECMO tracks with weaning failure

The edition in brief

A meta-analysis of nine studies (10,785 patients) found ultra-early endoscopy within 6 hours did not significantly reduce mortality (OR 0.88, 95% CI 0.58 to 1.34) or rebleeding (OR 1.23, 0.90 to 1.67) in non-variceal upper gastrointestinal bleeding compared with endoscopy after 6 hours, and was associated with more ICU admission (OR 1.41, 1.20 to 1.66); the pooled studies were comparative rather than described as randomised trials, and guidelines recommend endoscopy within 24 hours. In a six-hospital Dutch cohort of 440 adults on venoarterial ECMO for cardiogenic shock, 53.4% had weaning failure, and higher cumulative inotrope exposure was associated with weaning failure (HR 1.04 per unit, 95% CI 1.00 to 1.07) and 30-day mortality, but inotropes were not randomly allocated. A 60-patient single-centre trial in ARDS found closed suction preserved lung volume at 1 and 10 minutes better than open suction on electrical impedance tomography, with no difference in oxygenation index at 30 minutes, extubation or survival. A systematic evidence map of 1,116 studies of novel acute kidney injury biomarkers in critically ill patients found abundant accuracy data but few trials showing that biomarker-guided management helps.