Fresh trawl from Critical Care Reviews (Journal Watch / Hot Trials, updated through 6 September), NEJM, JAMA, Intensive Care Medicine, The Bottom Line, EMCrit/PulmCrit, LITFL and active #FOAMcc discussions. We’ve chosen 20 of the best!
This edition is dominated by PE catheter therapy, peri-operative AKI, oxygen targeting, transfusion logistics and post-arrest temperature management.
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1. ICECAP: Duration of Therapeutic Hypothermia After OHCA
Adaptive RCT: Extending cooling at 33°C beyond ~6 hours did not improve 90-day neurological outcome in shockable or non-shockable out-of-hospital cardiac arrest. Do not routinely prolong hypothermia.
2. MERCURI-2: Dapagliflozin to Prevent AKI After Elective Cardiac Surgery
Double-blind RCT (n=784): Four doses of dapagliflozin 10 mg from the day before surgery reduced 7-day KDIGO AKI (28% vs 52%; RR 0.54). No difference in stage 3 AKI, length of stay or 30-day MACE. Urine-output criterion drove much of the AKI signal.
3. PRAGUE-26: Catheter-Directed Thrombolysis in Intermediate-High-Risk PE
RCT (n=558): Catheter-directed alteplase plus anticoagulation vs anticoagulation alone. Primary composite (death, recurrent PE or cardiorespiratory collapse at 7 days) 0.7% vs 6.8% (RR 0.10), driven by less collapse. Major bleeding similar. Complements HI-PEITHO from Episode 8.
4. SAVE-O2 AI: Autonomous Closed-Loop Oxygen Titration
RCT (n=300): O2matic closed-loop titration vs manual titration in acutely ill adults. Time in SpO2 90–96% was 85% vs 63%; less hypoxia and less oxygen used. No proven effect yet on mortality or length of stay.
5. CHIPS: Cold-Stored vs Room-Temperature Platelets in Cardiac Surgery
Phase 3 noninferiority RCT (n=1000): Cold-stored platelets (up to 21 days) were noninferior to standard 5–7 day room-temperature platelets for haemostasis after cardiopulmonary bypass. Important inventory and wastage implications.
6. EVER: Protocolised Early Mobilisation in Ventilated Sepsis / ARF
Multicentre RCT (n=169): Earlier and more mobilisation vs usual physiotherapy did not improve FSS-ICU at ICU discharge or at 12 months. Sitting-to-stand remains the functional sweet spot.
7. X-COPD: ECCO2R in Invasively Ventilated Severe AECOPD
RCT: Extracorporeal CO2 removal vs standard ventilation in acute exacerbation of COPD requiring invasive mechanical ventilation. Directly relevant where NIV has already failed.
8. Sodium Bicarbonate for in-hospital cardiac arrest
The age-old adage of reducing acidosis after circulation compromise; did soda-bic have a role?
9. Response-Tailored vs Standard-Duration Antibiotics for Infective Endocarditis
RCT: Bundgaard et al. Tests stopping antibiotics by clinical/biomarker response rather than a fixed course. Stewardship-heavy.
10. TIVA vs Volatile Anaesthesia for Major Non-Cardiac Surgery
RCT: Jhanji et al. Head-to-head comparison of total intravenous vs volatile inhalational anaesthesia on postoperative outcomes after major non-cardiac surgery.
11. Nutrition Therapy in Critically Ill Adults
NEJM review: Patel & McClave. Restrictive energy in the acute phase; no benefit (possible harm) from high-dose protein, especially in AKI; skip routine gastric residual volume monitoring. The 2026 nutrition synthesis to quote.
12. Olanzapine vs Low-Dose Dexmedetomidine for ICU Delirium
RCT: Liu et al. Direct comparison of two commonly used delirium agents in critically ill patients.
13. MICROINHALO: Automated Cuff Pressure + Subglottic Drainage to Prevent VAP
Multicentre RCT: Personalised tracheal-cuff pressure management plus subglottic suction vs usual care for pneumonia prevention in intubated patients. Topical any the moment, not a paper from Aug/Sept this year, but more trials are underway into these systems. Of note PROTECT AIRWAYS click below:
14. Refractory septic shock: our updated pragmatic approach
Review / framework: Palmesino et al give us an updated, pragmatic, and largely inexpensive approach based on their current clinical practice, focussing on early multimodal therapy, aiming to reduce the detrimental effects associated with high-dose vasopressors and more…
15. Severe Metabolic Acidosis in the ICU
Narrative review: Jung. Practical diagnosis and management of severe metabolic acidosis. Pairs well with SODa-BIC from Episode 8.
16. 13-Valent Pneumococcal Conjugate Vaccine After Sepsis
RCT: Shankar-Hari et al. Placebo-controlled trial of PCV13 to accelerate immune recovery after sepsis.
17. Dual Antithrombotic Therapy in AF + ACS
RCT: Rizas et al. Dual antithrombotic therapy using potent P2Y12 inhibitors in atrial fibrillation with acute coronary syndrome.
18. State-of-the-art review: ß-blockade in critical illness
Review: We’ve heard a lot about this with Esmolol and Landiolol…but what’s the right course (excuse the pun), of action?
19. Vasopressor Weaning in Septic Shock — Asking the Wrong Question
Commentary / review: Akhter Zaidi. Argues the field has been asking the wrong weaning question. Strong teaching piece for the shop floor.
20. HFNC vs NIV After Extubation in High-Risk ICU Patients
Meta-analysis: 15 RCTs (n=2073). HFNC did not reduce reintubation compared with NIV after extubation in high-risk ICU patients, and may be associated with harm in selected subgroups.
Quick Hits from the Trenches
- PE is the story of the month: PRAGUE-26 (catheter-directed thrombolysis) plus last episode’s HI-PEITHO. Catheter therapy is moving fast.
- ICECAP: longer cooling is not better. Stop stretching 33°C “just in case.”
- MERCURI-2: peri-operative SGLT2 inhibition for cardiac-surgery AKI is suddenly a live question.
- SAVE-O2 AI and CHIPS are logistics papers with real ICU and blood-bank impact.
- EVER is another reminder that “more physio” ≠ better 12-month function unless patients actually stand..
