Intensive Care Medicine Journal

#VisualAbstract In a multicentre study of 1,094 ICU patients, VAEs were linked to higher 30-day mortality, longer ICU and hospital stays, and delayed recovery, supporting their role as indicators of poor prognosis in critical care. zurl.co/0iYC6

PEEP improves oxygenation yet may disturb intracranial dynamics in acute brain injury, outlining brain–heart–lung interplay, key determinants of tolerance, and an individualised strategy to balance lung protection with cerebral perfusion. zurl.co/34zbw

Two weeks after pacemaker implantation, dyspnoea led to detection of a 7.6×5.5 cm right-heart mass around the leads. Multimodal imaging and pathology identified diffuse large B-cell lymphoma, not a device-associated thrombus. zurl.co/gTmJu

Targeting driving pressure to individualise PEEP lowered intraoperative DP but did not reduce postoperative pulmonary complications in at-risk patients, with signals of harm and plausible physiological explanations. zurl.co/Uck9k

#1minutevideo A 7-day course of hydrocortisone in severe community-acquired pneumonia was unlikely to reduce 90-day mortality and may pose potential harm, despite a possible reduction in shock duration. zurl.co/95rMB

Serum sickness may appear 7–14 days after antivenoms, vaccines or monoclonal antibodies, with rash, fever, joint pain and shock. Management is resuscitation, drug withdrawal and corticosteroids if needed. zurl.co/fD3Tw

Acute brain injury care prioritises limiting secondary damage through tiered intracranial pressure strategies and seizure detection with continuous EEG, supported by multimodal monitoring, biomarkers, and imaging. zurl.co/xtUKi

Post hoc analysis of SEPSIS-PAM found no baseline heterogeneity between low (65–70 mmHg) and high (80–85 mmHg) MAP targets in septic shock; higher targets may be harmful when high norepinephrine is needed or mottling persists. zurl.co/5MwT4

#VisualAbstract A personalised PEEP strategy targeting driving pressure below 13 cmH₂O did not reduce respiratory failure or death and was linked to more reintubation or need for non-invasive ventilation after emergency abdominal surgery. zurl.co/2JI5m

ICU professionals generally support donation after circulatory death, but ethical tensions and organisational barriers persist. Clear protocols, targeted training and emotional support are needed to safeguard compassionate, ethical care. zurl.co/XYMq2

Echocardiography supports ICU atrial fibrillation care, from onset to rhythm or rate control. It assesses ventricular and valvular function, stratifies cardioversion chances, guides drug choice, monitors recovery, and informs anticoagulation decisions. zurl.co/wkd1A

#ICM-Quizz #MedEd Purpura in meningococcal disease may be absent or appear late. It progresses rapidly and can be hard to detect on dark skin. PCR from biopsy aids diagnosis even after antibiotics. Careful skin checks are essential. zurl.co/TXSUk

#ICM-Quizz #MedEd Which of these panels is consistent with the cutaneous manifestations of invasive meningococcal disease?

Very low tidal volume ventilation with PEEP during bypass did not change postoperative immune or pulmonary outcomes. Recruitment manoeuvres may explain the lack of effect. Studies in patients with lung disease are needed. zurl.co/zqMdT

Proning brain-injured patients with ARDS is feasible but demands close ICP monitoring, tailored haemodynamic targets, and positioning that preserves jugular drainage, guided by invasive or non-invasive neuromonitoring. zurl.co/RVCgd

ICU melatonin trial limitations: only 0.3 and 3 mg tested, half on 0.3 mg underexposed; 14-day course may be short; >80% restraints could confound sleep and delirium. Future research: lower or individualised dosing and restraint-minimised protocols. zurl.co/3powT

#VisualAbstract Optimising antibiotic therapy in severe infections means balancing early treatment with avoiding overuse. Rapid diagnostics, de-escalation, and tailored dosing improve outcomes, reduce harm, and fight the rise of resistant pathogens. zurl.co/oxehV

A simple colouring poster in a MICU waiting room invites families to add colour and messages, easing anxiety and building shared support. When full, it is preserved in ICU corridors, and a new blank canvas keeps the quiet transformation going. zurl.co/s3VoC

A 17-year-old with persistent hiccups and syncope suffered cardiac arrest from bradycardia. MRI revealed area postrema involvement in neuromyelitis optica spectrum disorder, and treatment led to full recovery. zurl.co/SOlYq

The IMPROVE-2 trial highlights challenges in personalising ventilation for surgical patients. Commentary raises concerns over driving pressure thresholds, protocol adherence, and the need for more nuanced approaches. zurl.co/Nh1vn

#VisualAbstract VV ECMO supports selected adults with very severe ARDS, potentially improving survival. ECCO2R enables ultra-protective ventilation but lacks proven mortality benefit and is not advised outside research settings. zurl.co/nJxIv

The TIMING trial on early versus delayed drainage in severe acute pancreatitis faces limitations from low statistical power and inconsistent definitions of organ failure, leaving its conclusions uncertain for ICU practice. zurl.co/Wd787

In a multicentre study of 1,094 ICU patients, ventilator-associated events were linked to higher 30-day mortality, longer ICU and hospital stays, and delayed recovery, supporting their role as indicators of poor prognosis in critical care. zurl.co/jVRIW

Blood purification in liver failure can alter bilirubin, creatinine, and INR levels. These shifts complicate prognosis and transplant evaluation, making careful interpretation of liver tests essential for critically ill patients. zurl.co/cxehb

#VisualAbstract Four ICU survivor clusters showed distinct long-term outcomes based on pre-ICU health, demographics, and clinical data, highlighting the value of multidimensional over diagnosis-based classification. zurl.co/wM2y2

Optimising ventilation in surgical ICU patients requires careful intraoperative strategies, timely extubation, appropriate non-invasive support after surgery, and early mobilisation to reduce complications and improve recovery. zurl.co/BT79Q

An end-tidal CO₂ of 17 mmHg and pulmonary artery pulse pressure indicate that atrial activity can sustain transpulmonary flow and venous return during ventricular fibrillation, reflecting effective pulmonary perfusion. zurl.co/9fCse

A 17-year-old with chikungunya developed life-threatening toxic epidermal necrolysis with nearly complete skin detachment, septic shock, and mucosal necrosis, but recovered after intensive supportive care. zurl.co/aNjeQ

#VisualAbstract In critically ill obese patients, kidney replacement therapy was linked to higher 90-day and 1-year mortality, with persistent kidney dysfunction and dialysis dependence more frequent among KRT recipients. zurl.co/8jF8f

Invasive meningococcal disease shows varied purpura, from petechiae to necrosis. Some patients may present with purpura-free septic shock despite severe infection. zurl.co/E3Xsm