Critical Care Evidence Updates – May 2025

Randomised Controlled Trials

A Multinational Randomized Trial of Mega-Dose Esomeprazole As Anti-Inflammatory Agent in Sepsis  Critical Care Medicine

A pilot multicenter randomized controlled trial on individualized blood pressure targets versus standard care among critically ill patients with shock  Journal of Intensive Care

A randomised, controlled, feasibility trial comparing vasopressors infused via peripheral cannula versus central venous access for critically ill adults: The VIPCA trial  Critical Care and Resuscitation

Ascorbate for Organ Dysfunction in Critically Ill Patients with Sepsis – The Phase 2b ASTER Trial  CHEST Critical Care

Dexmedetomidine- or Clonidine-Based Sedation Compared With Propofol in Critically Ill Patients – The A2B Randomized Clinical Trial  JAMA Network Open

Does inspiratory muscle training affect expiratory muscle thickness in respiratory intensive care patients? A pilot randomized controlled study  Journal of Critical Care

Effect of Ketamine Analgosedation on Neurological Outcome in patients with Severe Traumatic Brain Injury: A Randomized Controlled Pilot Study  Neurocritical Care

Effects of a general practitioner-led brief narrative exposure intervention on symptoms of post-traumatic stress disorder after intensive care (PICTURE): multicentre, observer blind, randomised controlled trial  BMJ

Efficacy of targeting high mean arterial pressure for older patients with septic shock (OPTPRESS): a multicentre, pragmatic, open-label, randomised controlled trial  Intensive Care Medicine

Iloprost for the Treatment of Severe Septic Shock with Persistent Hypoperfusion: A Double-Blind, Randomized Controlled Trial  American Journal of Respiratory and Critical Care Medicine

Improving physical function with physiotherapy assistants following intensive care unit admission (EMPRESS): A randomised controlled feasibility study  Journal of the Intensive Care Society

Improving Recovery and Outcomes Every Day After the ICU (IMPROVE): A Randomized Controlled Trial  Critical Care Medicine

Low versus high positive end expiratory pressure in noninvasive ventilation for hypoxemic respiratory failure: a multicenter randomized controlled trial  Intensive Care Medicine

Maintaining ventilation with very low tidal volume and positive-end expiratory pressure versus no ventilation during cardiopulmonary bypass for cardiac surgery in adults: a randomized clinical trial  Intensive Care Medicine

Negative extra-abdominal pressure (NEXAP)-based lung recruitment maneuver versus standard lung recruitment maneuver in the treatment of postoperative atelectasis after cardiac surgery: A single-center randomized controlled trial  Journal of Critical Care

Negative pressure wound therapy versus usual care in patients with surgical wound healing by secondary intention in the UK (SWHSI-2): an open-label, multicentre, parallel-group, randomised controlled trial  The Lancet

Physiological comparison of noninvasive ventilation and high-flow nasal oxygen on inspiratory efforts and tidal volumes after extubation: a randomized crossover trial  Critical Care

Preoxygenation With and Without Positive End-Expiratory Pressure in Lung-Healthy Volunteers – A Randomized Clinical Trial  JAMA Network Open

ROBotic-assisted Early Mobilization in Ventilated Surgical Critically ill Patients (ROBEM-I) – a randomized, controlled, outcome-assessor-blinded pilot study  Anaesthesia Critical Care & Pain Medicine

Role of Preoperative Antibiotic Treatment While Awaiting Appendectomy – The PERFECT-Antibiotics Randomized Clinical Trial  JAMA Surgery

Safety and efficacy of low-intensity versus standard monitoring following intravenous thrombolytic treatment in patients with acute ischaemic stroke (OPTIMISTmain): an international, pragmatic, stepped-wedge, cluster-randomised, controlled non-inferiority trial  The Lancet

Suzetrigine, a Nonopioid NaV1.8 Inhibitor for Treatment of Moderate-to-severe Acute Pain: Two Phase 3 Randomized Clinical Trials  Anesthesiology

Tocilizumab, sarilumab and anakinra in critically ill patients with COVID-19: a randomised, controlled, open-label, adaptive platform trial  Thorax

 

NICE

Nirmatrelvir plus ritonavir, sotrovimab and tocilizumab for treating COVID-19 TA878

 

Other Guidance/Reports

2025 Clinical Practice Guideline Update by the Infectious Diseases Society of America on the Treatment and Management of COVID-19: Vilobelimab  Clinical Infectious Diseases

ACR Appropriateness Criteria® Acute Respiratory Illness in Immunocompetent Patients: 2024 Update  JACR

American Society of Hematology/International Society on Thrombosis and Haemostasis 2024 updated guidelines for treatment of venous thromboembolism in pediatric patients  Blood Advances

Antithrombotic drugs for acute coronary syndromes in women: sex-adjusted treatment and female representation in randomised clinical trials. A clinical consensus statement of the European Association of Percutaneous Cardiovascular Interventions (EAPCI) and the ESC Working Group on Thrombosis  European Heart Journal

Blood-Based Biomarkers for Improved Characterization of Traumatic Brain Injury: Recommendations from the 2024 National Institute for Neurological Disorders and Stroke Traumatic Brain Injury Classification and Nomenclature Initiative Blood-Based Biomarkers Working Group  Journal of Neurotrauma

Clinical Assessment on Days 1–14 for the Characterization of Traumatic Brain Injury: Recommendations from the 2024 NINDS Traumatic Brain Injury Classification and Nomenclature Initiative Clinical/Symptoms Working Group  Journal of Neurotrauma

Enhancing Safety in Regional Anesthesia: Guidelines from the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI)  Journal of Anesthesia, Analgesia and Critical Care

ESICM—ESPNIC international expert consensus on quantitative lung ultrasound in intensive care  Intensive Care Medicine

Establishing Core Competencies for Antimicrobial Stewardship Teams: A Consensus Development Using the Modified Delphi Technique; an ESGAP position paper  Clinical Microbiology and Infection

European Stroke Organisation (ESO) and European Association of Neurosurgical Societies (EANS) guideline on stroke due to spontaneous intracerebral haemorrhage  European Stroke Journal

Golden hour management in the patient with intraparenchymal cerebral hemorrhage: an Italian intersociety document  Journal of Anesthesia, Analgesia and Critical Care

Guidelines for the management of emergencies and critical illness in pediatric and adult patients with sickle cell disease  Annals of Intensive Care

Management and Prevention of Hypersensitivity Reactions to Radiocontrast Media: A Consensus Statement from the American College of Radiology and the American Academy of Allergy, Asthma & Immunology  Radiology

Marking a New Age in Characterization of Acute Traumatic Brain Injury: The National Institute of Neurological Disorders and Stroke Traumatic Brain Injury Classification and Nomenclature Initiative  Journal of Neurotrauma

Neuroimaging Characterization of Acute Traumatic Brain Injury with Focus on Frontline Clinicians: Recommendations from the 2024 National Institute of Neurological Disorders and Stroke Traumatic Brain Injury Classification and Nomenclature Initiative Imaging Working Group  Journal of Neurotrauma

Platelet Transfusion – 2025 AABB and ICTMG International Clinical Practice Guidelines  JAMA

Retrospective Identification and Characterization of Traumatic Brain Injury—Recommendations from the 2024 National Institute of Neurological Disorders and Stroke Traumatic Brain Injury Classification and Nomenclature Initiative Retrospective Classification Working Group  Journal of Neurotrauma

Optimising trial design for cardiogenic shock: insights from the sixth Critical Care Clinical Trialists Workshop  The Lancet Respiratory Medicine

Palliative and End-of-Life Care During Critical Cardiovascular Illness: A Scientific Statement From the American Heart Association  Circulation

Pathophysiology and clinical use of agents with vasodilator properties in acute heart failure. A scientific statement of the Heart Failure Association (HFA) of the European society of Cardiology (ESC)  European Journal of Heart Failure

SCAI/EAPCI/ACVC Expert Consensus Statement on Cardiogenic Shock in Women  JSCAI

Starting with the End in Mind: Recommendations to Optimize Implementation of a Novel TBI Classification from the 2024 NINDS TBI Classification and Nomenclature Workshop’s Knowledge to Practice Working Group  Journal of Neutrotrauma

Update to the Local Safety Standards for Invasive Procedures (LocSSIPs) – Central venous catheter insertion, intercostal drain insertion, tracheostomy, bronchoscopy, intubation  Journal of the Intensive Care Society

 

Cochrane

Ultrasound guidance versus anatomical landmarks for neuraxial anaesthesia in adults

 

Primary Research

A bi-institutional observational study comparing short-term and long-term outcome of operative and non-operative management of clinical and radiological flail chest injuries  Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

A nurse-driven protocol for early weaning from mechanical ventilation in patients with acute respiratory failure: A pilot study  Intensive and Critical Care Nursing

A Retrospective Review of Tracheal Intubation of Obstetrical Patients, Incidence and Associated Factors  Journal of Intensive Care Medicine

Absolute blood levels and kinetics of neurofilament light (NFL) chains for neurological prognosis in comatose patients after cardiac arrest  Annals of Intensive Care

Anaesthesia mumps – the unseen puffy problem: A case report  Journal of Perioperative Practice

Association of low-dose ketamine with hallucinations in critically ill patients: a target trial emulation  Intensive Care Medicine

Association of metformin administration after septic shock with short-term and long-term survival in septic shock patients with diabetes  Annals of Intensive Care

Biomarkers in acute kidney injury settings to predict interventions and outcomes: the MARKISIO study  Critical Care

Circular material flow of medication in the intensive care unit  Critical Care

Clinical Description and Acute Outcomes of Cryptogenic Encephalitis in the Intensive Care Unit  Neurocritical Care

Clinical Significance of Aspergillus sp Found in Respiratory Fungal Cultures of ICU Patients  Journal of Intensive Care Medicine

Cost-Effectiveness of α2 Agonists for Intravenous Sedation in Patients With Critical Illness  JAMA Network Open

Cystatin C-derived measures of renal function as risk factors for mortality and renal replacement therapy in the critically ill – An analysis of the SWECRIT cohort  Journal of Critical Care

Cytomegalovirus reactivation in the lower respiratory tract as an independent risk factor for mortality in critically Ill patients  Critical Care

Depression or anxiety and long-term mortality among adult survivors of intensive care unit: a population-based cohort study  Critical Care

Development and validation of a nomogram for predicting acute kidney injury in elderly patients in intensive care unit  Renal Failure

Determination of Glomerular Filtration Rate After Contrast-Enhanced CT Among Critically Ill Patients: Support for a New Procedure  Critical Care Explorations

Diagnosis of in-hospital mortality using admission CT perfusion in severe traumatic brain injury patients (ACT-TBI study)  Critical Care

Effect of early adjunctive vasopressin initiation for septic shock patients: a target trial emulation  Critical Care

Effect of extended intravenous diclofenac infusions on brain tissue oxygenation in patients with acute brain injury  Intensive Care Medicine Experimental

Evaluating extreme temperature values and patient outcomes in aneurysmal subarachnoid hemorrhage: Post-hoc insights from the Earlydrain trial  Journal of Critical Care

Evaluating the SWIFT algorithm’s efficacy in predicting hypoxemia across multiple critical care datasets  Journal of Critical Care

Exploring the influence of communication and team dynamics relating to infection care on intensive care unit patient discussions: Insights from sociograms and team reflexivity  Journal of Critical Care

Exposure keratopathy in prone ventilated patients: A cross-sectional study  Intensive and Critical Care Nursing

Extracorporeal multi-organ support: ECMO, CRRT, and hemoperfusion for acute alcohol intoxication with renal and respiratory failure  Renal Failure

Factors influencing the transition phase in acute respiratory distress syndrome: an observational cohort study  Annals of Intensive Care

First dose target attainment with extended infusion regimens of piperacillin and meropenem  Critical Care

Identifying a unique signature of sepsis in patients with pre-existing cirrhosis  Critical Care

Immediate or delayed initiation of renal replacement therapy in patients with leptospirosis and acute kidney injury: a target trial emulation  Annals of Intensive Care

Impact of Glucagon-Like Peptide-1 Receptor Agonist Exposure on Gastrointestinal Outcomes Among ICU Patients: A Multicenter Matched Cohort Study  Critical Care Explorations

Impact of substance use disorders on critical care management and health outcomes in septic adolescents  Annals of Intensive Care

Intensive care nurses’ attitudes about the importance of family involvement in adult intensive care: A multicentre cross-sectional study  Intensive and Critical Care Nursing

Laxative use and 28-day mortality in critically ill sepsis patients: a retrospective cohort study using MIMIC-IV (v3.1)  Journal of Intensive Care

Left ventricular unloading during extracorporeal cardiopulmonary resuscitation: a target trial emulation of the ELSO registry  Critical Care

Long-term mortality after stage 1 acute kidney injury in critically ill patients – an observational cohort study  Journal of Critical Care

Long-term mortality in ICU patients with hematological malignancies: Impact of organ support duration and ICU length of stay  Journal of Critical Care

Machine Learning Accurately Predicts Need for Critical Care Support in Patients Admitted to Hospital for Community-Acquired Pneumonia  Critical Care Explorations

Nosocomial lower respiratory tract infections in patients with immunosuppression: a cohort study  Annals of Intensive Care

Optimum electrical impedance tomography-based PEEP and recruitment-to-inflation ratio in patients with severe ARDS on venovenous ECMO  Critical Care

ORAKLE: Optimal Risk prediction for mAke30 in patients with sepsis associated AKI using deep LEarning  Critical Care

Peri-intubation complications in critically ill obese patients: a secondary analysis of the international INTUBE cohort  Critical Care

Potassium Levels and In-Hospital Cardiac Arrest: A Matched Case-Control Study  Critical Care Medicine

Prediction of peripheral blood lymphocyte subpopulations after renal transplantation  Renal Failure

Reduction of iatrogenic withdrawal syndrome in high-risk critically ill patients with acute respiratory distress syndrome  Anaesthesia and Intensive Care

Reversal of antithrombotics in the critically ill: An international online survey  Journal of Critical Care

Severe listeriosis in intensive care units: insights from a retrospective multicentric study  Critical Care

SIGH₃₅ and end-expiratory occlusion test for assessing fluid responsiveness in critically ill patients undergoing pressure support ventilation  Critical Care

Stress hyperglycemia ratio as a predictor of acute kidney injury and its outcomes in critically ill patients  Renal Failure

Stress ulcer prophylaxis practice in UK critical care units: A comparison of cross-sectional surveys between 2020 and 2024  Journal of the Intensive Care Society

The association between socioeconomic status and outcomes in critical illness: A national cohort study of emergency admissions to critical care units in Scotland 2010–2021  Journal of the Intensive Care Society

The Cost-Effectiveness of Early Active Mobilization During Mechanical Ventilation in the ICU: An Economic Evaluation Alongside the Treatment of Mechanically Ventilated Adults With Early Activity and Mobilization (TEAM) Trial  Critical Care Medicine

The effects of prolonged prone positioning on response and prognosis in patients with acute respiratory distress syndrome: a retrospective cohort study  Journal of Intensive Care

Trajectories of fluid management after the initiation of renal replacement therapy in critically ill patients: a secondary analysis of the STARRT-AKI trial  Critical Care

Venoarterial extracorporeal membrane oxygenation is a feasible option for patients with pregnancy-associated diagnoses who require mechanical circulatory support  Resuscitation Plus

Metadata

Summary author: Rebecca Howes @ClinicalLibsPHU
Summary date:
Picture by: Ehimetalor Akhere Unuabona on Unsplash