CCN Weekly · 28 Sep–4 Oct 2026
A short trawl of the last seven days. Papers, POCUS, FOAMed, and the meeting that is actually next week.
Editor’s opener
Sunday 4 October. Lisbon is a week away, and the literature has been practical rather than flashy. Weaning boards that nearly, then maybe, move the needle. A huge videolaryngoscopy series that says a pretty glottic view is not an easy tube. And a commentary telling us the arterial line is a tool, not a reflex.
Pick of the papers
PRiVENT: specialist weaning boards for the patient who will not separate
Trudzinski and the PRiVENT group screened ventilated patients at high risk of weaning failure and put them through a specialist-led interprofessional programme: weaning boards, bedside consults, knowledge transfer. Compared with claims-data controls, successful weaning was 58.3% versus 51.7%. The primary adjusted analysis just missed the line (OR 1.46, 95% CI 0.99 to 2.17). A prespecified propensity-matched look was much louder (OR 2.90). Useful signal for the stuck wean. Not a clean RCT, so do not rewrite the unit protocol off the matched analysis alone.
Source: Critical Care, 30 Sep 2026. DOI 10.1186/s13054-026-06357-3
Ferritin does not pick anakinra winners. Low suPAR might.
Exploratory look at the immune-modulation domain of REMAP-CAP in critically ill COVID-19. Higher ferritin tracked with worse outcomes, but it did not mark who benefited from anakinra. In the smaller suPAR subset, baseline suPAR under 6 ng/ml carried a higher posterior probability of benefit. High suPAR did not. This is a treatable-trait hypothesis from a COVID domain, not a new sepsis mandate. If you are still reaching for biomarkers to justify IL-1 blockade, this paper is a brake, not an accelerator.
Source: Critical Care, 1 Oct 2026. DOI 10.1186/s13054-026-06311-3
Intra-op hypotension and pneumonia: relative drop beat the magic number
Wang and colleagues, retrospective cohort of 151,036 adults having non-cardiac surgery under general anaesthesia. Postoperative pneumonia in 2.3%. Relative reductions from baseline mean arterial pressure associated more consistently with pneumonia than absolute thresholds. At a 20% drop from baseline, both the presence of hypotension and the number of episodes tracked with pneumonia. Bedside translation: chasing a fixed 65 mmHg and ignoring the patient’s own baseline is a blunt way to think about pulmonary risk. Association, not proof that holding baseline MAP prevents pneumonia.
Source: Anaesthesia, 2 Oct 2026. DOI 10.1111/anae.70426
Videolaryngoscopy: a good view is not an easy tube
Fernández-Vaquero and the VCISpain investigators, prospective observational series across 44 hospitals, 5,302 paired assessments. They split the procedure into blade geometry, POGO score, and tube delivery. Agreement was high. The dissociation is the point. About a quarter of poor views (POGO under 25%) were still classed easy. Even with POGO over 75%, 6.3% of initial strategies were difficult or failed. If the notes only say “grade 1”, you have not described the intubation. Write what you used, what you saw, and what you did.
Source: Anaesthesia, 2 Oct 2026. PMID 42823939
Andes virus in this week’s NEJM: person-to-person hantavirus, ICU problem
Harris and colleagues review Andes virus, the orthohantavirus with documented human-to-human spread. It causes hantavirus pulmonary syndrome, case fatality roughly 25 to 40%, and can move from fever to respiratory failure and shock in hours. Clues are travel or exposure, leukocytosis, thrombocytopenia, immunoblasts. Care is aggressive support and strict infection control. Online from July, sitting in the 1 October issue. Worth five minutes if your retrieval desk ever sees a febrile traveller who is about to drown.
Source: NEJM 2026;395:1310-1317. Issue of 1 Oct 2026
Best #POCUS
Thin week for original case threads. These four are the ones with a named clinician and a decision, not a hashtag pile-on.
Trauma bay, hypotensive and hypoxic: the probe finds a pericardial effusion
Haney Mallemat posts a ResusX clip from Joshua Rempell. Team is set to act on the hypoxic, hypotensive, tachypnoeic trauma patient, then POCUS shows pericardial fluid. The question is the whole case: do you pivot the resuscitation, or keep marching down the chest-injury pathway? Short, and exactly the fork we hit at 03:00.
Source: Haney Mallemat, 1 Oct 2026
“Pneumonia” with a systolic murmur was severe aortic stenosis
EM:RAP clip. Persistent dyspnoea, a murmur, antibiotics already running, and the probe shows severe aortic stenosis. Reminder that the breathless patient on the ward round is allowed a quick parasternal look before the third day of co-amoxiclav. Not a new trial. A pattern you will see this month.
Source: EM:RAP, 2 Oct 2026
TEE of a failing biological mitral, with clot in the appendage
Sergio Moreno, cardiologist in Lima, posts this morning’s TEE: biological prosthetic mitral malfunction, a large left atrium, and clot in the left atrial appendage. Useful if your post-op or endocarditis patient is in atrial fibrillation and you have a probe in the room. Look at the prosthesis and the appendage, not just the leaflets.
Source: Sergio Moreno, 4 Oct 2026
POCUS for the airway: difficult anatomy and tube confirmation
Hayley Gershengorn pointed this week at Michael Gottlieb’s how-I-do-it in CHEST Critical Care. Two jobs: flag a difficult airway before you induce, and confirm the tube after you pass it. Not a replacement for waveform capnography. A sensible adjunct when the neck is a mess, the saturations are already falling, or you do not trust the auscultation.
Source: Hayley Gershengorn, 29 Sep 2026 · CHEST Critical Care article
Best #FOAMed
EMCrit 435: procedural sedation, definitions and boundaries
Scott Weingart, 3 October. Part VI of the sedation series, and the one to send the governance committee. He separates scheduled from unscheduled sedation, argues fasting rules are not backed by evidence that they cut aspiration, and wants the lightest depth that still gets the procedure done. Capnography for moderate, deep, and dissociative sedation. Mallampati does not earn its keep here. Ketamine still preserves reflexes. Practical, and pointed.
Source: EMCrit, 3 Oct 2026
CCR: The Trouble with Getting Better
Rob Mac Sweeney, 2 October. A boy who has never walked starts to run, and everyone congratulates the explanation. The essay walks from an old coeliac “cure” to prone positioning and early goal-directed therapy: treatments that worked, mechanisms we over-trusted. Short, and a useful corrective before the next protocol launch in Lisbon.
Source: Critical Care Reviews, 2 Oct 2026
REBEL EM: HINTS versus the Sudbury Vertigo Risk Score
Eric Steinberg, 28 September. HINTS is a bedside eye exam for the right patient: ongoing acute vestibular syndrome, nystagmus, and an examiner who has actually practised it. Sudbury estimates the chance of a serious central cause across a wider dizzy population. Know which patient is in front of you before you pick the tool. The dizzy patient in resus is still where we miss posterior circulation strokes.
Source: REBEL EM, 28 Sep 2026
DFTB Bubble Wrap PLUS, October 2026
Anke Raaijmakers and Jaan Toelen, 1 October. Monthly paediatric journal-club list from 34 journals. One highlight for the adult ICU that still takes teenagers: acute emotional symptoms after concussion, not just headache, tracked with worse emotional function out to six months, with higher risk in younger children and in girls. A 30-second check in the emergency department may be doing more work than we think.
Source: Don’t Forget the Bubbles, 1 Oct 2026
Lidocaine versus amiodarone in refractory in-hospital VF/VT
Pharmacy Joe, episode 1170, 1 October, walking through a Chest retrospective analysis of more than 600 adults with refractory VF or pulseless VT across 40 Chinese hospitals. Unadjusted survival, sustained ROSC, and favourable neurology were similar. After adjustment, still no clear winner. Real-world support for the guideline line that either antiarrhythmic is acceptable. Your arrest trolley preference is habit, not a hidden mortality benefit.
Source: The Elective Rotation, 1 Oct 2026
Fluids / haemodynamics watch
Interpreting EVERDAC: you do not have to arterially cannulate on autopilot
Adrienne Ho, Cleveland Clinic Journal of Medicine, epub 1 October. Commentary on EVERDAC: in shock, deferring the arterial catheter unless it was truly needed met the trial’s non-inferiority bar for death, and most patients in the deferred arm never got a line. Ho argues this should change the reflex, with the obvious caveats. Swinging pressures, repeated blood gas sampling, and a deteriorating trajectory are still reasons to put one in. When you do, use ultrasound. Pain from cycling a cuff all night is not a free intervention either.
Source: Cleve Clin J Med 2026;93:597-602. PMID 42823123
Impella “suction” is a clue, not a fluid challenge
IMCrit, 3 October, posts a one-page visual for the Impella suction alarm. The reflex is a fluid bolus. Suction can be position, afterload, right-ventricular failure, or a true preload problem. Give volume only if the rest of the exam agrees. Handy for the unit that has a pump and a junior who has just been told to “fill them”.
Source: IMCrit, 3 Oct 2026
Podcasts
ICSCast, Critical Care Commute, and Block It Like It’s Hot did not drop a new episode in this window. Three that did:
EMCrit 435, procedural sedation part VI
3 October. Definitions, unscheduled sedation, fasting, monitoring, and who is actually in charge. Show notes are enough if the commute is short. Linked again because the audio is the episode.
Source: EMCrit, 3 Oct 2026
The Resus Room: October papers of the month
1 October, about 39 minutes. Three papers. Abdominal pain in older adults, and whether history and examination reassure us more than the CT yield deserves. A large UK trial of immediate 14-day ambulatory ECG in unexplained syncope: more arrhythmias found, earlier, more treatment, no reduction in recurrent syncope at one year. Then paediatric emergency intubation on video, and which technical errors cluster around failure. Diagnosing more is not the same as helping more.
Source: The Resus Room, 1 Oct 2026
Elective Rotation 1170: lidocaine or amiodarone
1 October. The in-hospital refractory VF/VT comparison above, in podcast form. Useful pre-brief before the next arrest drill.
Source: Pharmacy Joe, 1 Oct 2026
Meetings / dates
LIVES 2026, Lisbon, 10–14 October
ESICM’s 39th annual congress at the CCL, Lisboa Congress Centre. Pre-congress courses 10–11 October. Welcoming ceremony 12 October, 17:00–18:15. Scientific sessions and workshops 12–14 October. Late registration is open. The congress app went up this week: programme, personal schedule, venue map, posters, and live Q&A. Official domains are @esicm.org, @esicm-congress.org, and @cyim.com. ESICM has a fraud alert up for emails pretending to be the congress.
Source: ESICM LIVES 2026 · Congress app, posted 1 Oct 2026
From Waveform
Standouts from icuwaveform.grok.me this week. Paper of the Day on 1 October was a publisher correction on a narrative review of non-invasive intracranial pressure estimation, so we have not dressed that up as a new trial.
Two Anaesthesia papers on the same day
Waveform flagged both on 2 October: the hypotension-threshold pneumonia cohort, and the videolaryngoscopy view-versus-delivery study. They are in the picks above. If you only open one tab from the aggregator this week, make it those two.
Source: Waveform, This Week, 2 Oct 2026
ESICM flags the latest ICM issue
Waveform picked up the 2 October ESICM note: latest ICM issue, with results from weaning, transfusion, and antibiotic studies. We have not re-listed papers we could not open individually. The society post is the pointer, and Lisbon is the room where they will be argued.
Source: ESICM, 2 Oct 2026 · via Waveform
Resus Room papers of the month, on the aggregator
Waveform surfaced the 1 October episode: geriatric abdominal pain, ambulatory ECG in syncope, and paediatric airway video review. Same episode as the podcast shelf. Worth the commute if you cover the emergency department as well as the unit.
Source: The Resus Room, 1 Oct 2026 · via Waveform
Bubble Wrap PLUS landed on Waveform the same day
Paediatric journal club, 1 October. Useful if your unit still owns the teenage trauma and the retrieval phone. Full list is on DFTB, not recycled here.
Source: DFTB · via Waveform
Close
That is the week. Shorter than some, because the last seven days were shorter. If you are flying to Lisbon, read the Mac Sweeney essay on the way and do not trust a grade 1 view.
CCN crew.
Companion sites: criticalcarenorthampton.com · Waveform
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