Category: Intensive Care Medicine

A collection of TBL summaries relevant to Intensive Care Medicine

OVISS: Optimal Vasopressin Initiation in Septic Shock with Reinforcement Learning

13 June 2025 Hrishee Vaidya Intensive Care Medicine Leave a comment

OVISS: Optimal Vasopressin Initiation in Septic Shock Kalimouttou et al. for the OVISS Study group, JAMA 2025. doi:10.1001/jama.2025.3046 Clinical Question In patients with septic shock, does a reinforcement learning model identify a strategy for vasopressin initiation that improves mortality? Background Vasopressin is a non-catecholamine vasoconstrictor that is currently recommended as a secondary agent to be considered alongside noradrenaline if mean […]

TGC-Fast: Tight Blood-Glucose Control without Early Parenteral Nutrition in the ICU

11 June 2025 Daniel Chung Intensive Care Medicine Leave a comment

Tight Blood-Glucose Control without Early Parenteral Nutrition in the ICU Gunst et al. N Engl J Med 2023;389:1180-1190 DOI: 10.1056/NEJMoa2304855 Clinical Question In ICU patients not receiving early parenteral nutrition, does liberal glucose control (initiating insulin when blood glucose level [BGL] >11.9 mmol per liter [>215 mg per deciliter]) or tight glucose control (commencing insulin at BGL 4.4 to 6.1 […]

MINT – Restrictive or Liberal Transfusion Strategy in Myocardial Infarction

23 May 2025 Daniel Chung Intensive Care Medicine Leave a comment

Restrictive or Liberal Transfusion Strategy in Myocardial Infarction and Anemia Carson et al. NEJM 2023 DOI: 10.1056/NEJMoa2307983 Clinical Question In patients with myocardial infarction and anaemia, does a restrictive or liberal transfusion strategy decrease myocardial ischaemia or death at 30 days? Myocardial Ischemia and Transfusion (MINT) Trial Background Anaemia is common in patients with acute myocardial infarction and may exacerbate […]

FARES II: PCC vs FFP in Cardiac Surgery

23 May 2025 Aniket Nadkarni Intensive Care Medicine, Summaries Leave a comment

Prothrombin Complex Concentrate vs Frozen Plasma for Coagulopathic Bleeding in Cardiac Surgery The FARES-II Multicenter Randomized Clinical Trial Karkouthi. JAMA 2025; doi:10.1001/jama.2025.3501 Clinical Question In adults undergoing cardiac surgery with cardiopulmonary bypass, is the use of a 4-factor prothrombin complex concentrate (PCC), compared to fresh frozen plasma (FFP), safe and efficacious in treating active or anticipated bleeding? Background Bleeding post […]

NIV vs HFNC to prevent re-intubation in patients with obesity

26 March 2025 George Walker Intensive Care Medicine Leave a comment

Humidified Non-Invasive Ventilation versus High-Flow Therapy to Prevent Reintubation in Patients with Obesity Hernández et al. AJRCCM 2025. DOI: 10.1164/rccm.202403-0523OC Clinical Question In obese adult patients at intermediate risk for hypoxaemic extubation failure, does non-invasive ventilation (NIV) therapy with active humidification compared to use of high-flow nasal oxygen (HFNO or HFNC) reduce all-cause reintubation within 7 days after extubation? Background […]

NAVIGATE: Early noninvasive ventilation in general wards for acute respiratory failure

28 February 2025 Hrishee Vaidya Emergency Medicine, Intensive Care Medicine, Summaries Leave a comment

NAVIGATE: Early noninvasive ventilation in general wards for acute respiratory failure Monti et al. for the NAVIGATE Study Group, BJA Feb 2025. doi:10.1016/j.bja.2024.11.023 Clinical Question In adult patients with mild acute respiratory failure (ARF), does a regime of 2-hour cycles of noninvasive ventilation (NIV), delivered on general wards every 8 hours, reduce the progression to severe acute respiratory failure (defined […]

BALANCE – 7 vs 14 days of antibiotics

30 January 2025 Generic Contributor Intensive Care Medicine Leave a comment

Antibiotic Treatment for 7 versus 14 Days in Patients with Bloodstream Infections BALANCE Investigators. NEJM 2024; DOI: 10.1056/NEJMoa2404991 Clinical Question In hospitalised patients with bloodstream infections (BSI), is antibiotic treatment for 7 days, compared to treatment for 14 days, non-inferior with respect to mortality at 90 days? Background BSI are common and a leading cause of mortality and morbidity, accounting […]

ADAPT-Sepsis: PCT or CRP Guided Antibiotic Duration

24 January 2025 Hrishee Vaidya Intensive Care Medicine, Summaries Leave a comment

ADAPT-Sepsis: PCT or CRP-guided Antibiotic Duration for Patients with suspected Sepsis Dark et al. JAMA Dec 9 2024. doi:10.1001/jama.2024.26458 Clinical Question For critically ill adults with suspected sepsis, does a procalcitonin (PCT) guided or C-reactive protein (CRP) guided antibiotic discontinuation prompt, compared with usual care, reduce the total duration of antibiotics without increasing all-cause 28-day mortality? Background Shorter antibiotic durations […]

Continued enteral nutrition until extubation compared with fasting before extubation

17 January 2025 Jody Ede Intensive Care Medicine, Summaries Leave a comment

Continued enteral nutrition until extubation compared with fasting before extubation in patients in the intensive care unit: an open-label, cluster-randomised, parallel-group, non-inferiority trial Landais et al. The Lancet Respiratory Medicine 2023. 11:319-28. doi://10.1016/ S2213-2600(22)00413-1 Clinical Question In patients ventilated for more than 48h in the Intensive Care Unit, is continued enteral nutrition compared with fasting prior to extubation, non-inferior with […]

ASTER – Acetaminophen in Sepsis

9 January 2025 Generic Contributor Intensive Care Medicine Leave a comment

Acetaminophen for Prevention and Treatment of Organ Dysfunction in Critically Ill Patients With Sepsis Ware. JAMA 2024. doi:10.1001/jama.2024.8772 Clinical Question In critically ill adult patients with sepsis does the administration of acetaminophen compared to placebo increase the number of days alive and free of organ support to day 28? Background Acetaminophen is a potent and specific haemoprotein reductant that can […]

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