Category: Intensive Care Medicine

A collection of TBL summaries relevant to Intensive Care Medicine

Shared Decision Making in Resuscitation Decisions

A Randomized Trial of Shared Decision-Making in Code Status Discussions Becker. NEJM Evidence 2025; doi:10.1056/EVIDoa2400422 Clinical Question In hospitalized adults requiring code status discussions, does a shared decision-making approach (including a checklist and decision aid) compared to usual care increase the proportion of patients choosing a DNR status? Background In-hospital cardiac arrest outcomes are poor (<20% survival; ~40% with neurologic […]

UK-ROX Trial

27 June 2025 Celia Bradford Intensive Care Medicine Leave a comment

Conservative Oxygen Therapy in Mechanically Ventilated Critically Ill Adult Patients Martin. JAMA June 12 2025; doi:10.1001/jama.2025.9663 Clinical Question In mechanically ventilated adult patients in the ICU, does a strategy of conservative oxygen therapy, targeting a SpO2 of 90% (Range 88-92%) compared with usual care, reduce mortality at 90 days? Background In the United Kingdom, around 184,000 adults are admitted to […]

Fluid – Hospital Wide Lactated Ringer’s versus Normal Saline

19 June 2025 George Walker Emergency Medicine, Intensive Care Medicine, Peri-operative Medicine Leave a comment

A Crossover Trial of Hospital-Wide Lactated Ringer’s Solution versus Normal Saline L McIntyre. NEJM 2025; DOI: 10.1056/NEJMoa2416761 Clinical Question In hospitalised patients, does the use of Lactated Ringers (LR) vs Normal Saline (NS) lower the incidence of death or readmission to the hospital within 90 days after the index admission? Background Fluid choice (balanced solutions vs NS) has been widely […]

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 […]

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