Intensive Care Medicine Journal

Large language models can speed up screening and data extraction in critical care systematic reviews, reducing workload while keeping clinicians in charge of complex judgements and ethical oversight. zurl.co/dkIg7

Reduced monocyte HLA-DR in septic shock is linked to mortality and ICU-acquired infections, especially when it persists beyond the first days, supporting its use for severity stratification and guiding immunomodulatory strategies. zurl.co/N7Guo

#VisualAbstract ESICM’s 2025 guidance delivers 50 statements on shock diagnosis and monitoring, highlighting capillary refill, serial venous oxygenation, fluid responsiveness, arterial lines, cardiac output tracking and first-line echocardiography. zurl.co/invjr

A calcium-free dialysate technique provides regional anticoagulation for high bleeding risk ICU patients needing intermittent hemodialysis, with low circuit clotting rates and an alternative to heparin-coated membranes or systemic heparin. zurl.co/J7Tty

Low-dose norepinephrine at extubation appears safe in obese and non-obese ICU patients, challenging the practice of delaying weaning until all vasopressors are stopped. zurl.co/8nE3A

Metabolic acidosis occurs in 2–10% of ICU patients and can carry mortality rates up to 60%, altering organ function and oxygen delivery, and involving diagnostic work-up plus sodium bicarbonate and kidney replacement therapy. zurl.co/keZpO

#VisualAbstract Immune checkpoint therapy boosts survival yet can trigger acute immune toxicities needing ICU care. Fast recognition, structured diagnostics, timely immunosuppression, organ support and coordinated multidisciplinary care improve outcomes. zurl.co/7aegh

Machine-learning analysis of the TEAM trial identified varying individual responses to enhanced early mobilisation, showing potential benefit for some ICU patients and possible harm for others based on baseline characteristics. zurl.co/oeleH

An updated meta-analysis finds open lung ventilation in ARDS does not improve mortality or stay versus ARDSNet, increases short-term complications, and supports avoiding routine use in favour of recruitability-based individualised strategies. zurl.co/RRX6C

Coagulopathy in critical illness is portrayed as a dynamic hemostatic imbalance, where bleeding and thrombosis coexist, static thresholds fail, and the timing of anticoagulation, transfusion and endothelial protection shapes outcomes. zurl.co/YJ0qU

#VisualAbstract Across 219 ICUs in Australia and New Zealand, in-hospital mortality for ICU sepsis fell from 28% in 2000 to 13% in 2023, with a nadir of 11% in 2020; mortality remained higher with septic shock (25%) and with invasive ventilation (23%). zurl.co/va83d

Recent research on acute kidney injury highlights diverse mechanisms, variable risks across populations and mixed results from preventive strategies, underscoring persistent challenges in improving outcomes. zurl.co/yafva

Thoracic ultrasound improves diagnostic accuracy in shock and acute respiratory failure, helping identify hemodynamic profiles and respiratory conditions while supporting rapid bedside decisions. zurl.co/cepgm

Authors clarify that the Pcv–aCO2/Ca–cvO2 ratio is a complex, context-dependent marker that should not be used alone to diagnose anaerobic metabolism, but can complement lactate trends and perfusion indices. zurl.co/KeWC9

#VisualAbstract Across 426 ICU survivors, one in seven had amnesia and over a third reported delusional memories. Delusional memories, often without recognised delirium, were independently linked to higher PTSD at 3 and 12 months. zurl.co/T4o2B

A German population-wide cohort shows that older ICU survivors have higher five-year mortality and greater risk of functional decline than their peers, with the greatest impact seen in previously fit adults aged 60–79 years. zurl.co/wUEY7

After acute brain injury, transfusion decisions should consider haemoglobin’s proton-buffering role and the impact of 2,3-DPG-depleted stored blood, not just global oxygen delivery targets. zurl.co/tfoRo

#VisualAbstract Pharmaceutical poisonings make up to 10% of ICU admissions. The review outlines ABCDE-based stabilisation and when to escalate from supportive care to decontamination, extracorporeal removal, antidotes, lipid emulsion or VA-ECMO. zurl.co/hOjyW

Intracranial pressure dose, integrating magnitude and duration of ICP elevation, offers a more physiologically meaningful and prognostically robust metric than fixed thresholds in traumatic brain injury and subarachnoid haemorrhage. zurl.co/C6Ndt

#ICM-Quizz #MedEd Serum sickness is an immune complex–mediated type III reaction, often following snake antivenoms, vaccines, or monoclonal antibodies. It typically appears 7–14 days post exposure with rash, fever, malaise, and hypocomplementemia. zurl.co/r7O3H

#ICM-Quizz #MedEd An 84-year-old woman, 13 days post equine-derived habu antivenom, develops a purpuric lower-leg rash and vasoplegic shock. Labs show hypocomplementemia, high lactate, and acute kidney injury. What's your diagnosis?

TIMING trial authors acknowledge limited power, reaffirm support for delaying invasive intervention in necrotizing pancreatitis, and report that early catheter drainage was safe without increasing infected pancreatic necrosis. zurl.co/3eoVp

Randomised cross-over trial in 88 CVVH patients with regional citrate anticoagulation shows low bicarbonate replacement fluid causes fewer pH and bicarbonate excursions than high bicarbonate fluid, with similar pH normalisation in acidotic patients. zurl.co/5UxYl

ESICM issues 2025 guidelines on circulatory shock, defining shock as acute circulatory failure with tissue hypoperfusion and offering 50 recommendations on clinical assessment, hemodynamic monitoring, fluid responsiveness and use of echocardiography. zurl.co/invjr

#VisualAbstract Across 213 studies in adult ICUs, delirium affected about one-third of patients and pain about two-fifths; both have fallen since pain, agitation and delirium guidelines, yet remain common. zurl.co/Um39j

Authors critique the 4D trial of dexmedetomidine for hyperactive delirium, highlighting early stopping, a heterogeneous composite endpoint, haloperidol co-administration, and limited impact on patient-centered outcomes in non-intubated ICU patients. zurl.co/SbOfn

Delirium in ICU patients, particularly hyperactive delirium, remains challenging. While dexmedetomidine has shown potential for agitation control, the trial results indicate limited evidence for delirium resolution or prevention of intubation. zurl.co/0fvtR

Healthcare generates ~5% of global emissions; ICUs have nearly triple other wards’ footprint. The authors call to embed sustainability into undergraduate critical care teaching to equip future doctors for climate-conscious practice. zurl.co/eJ7Qx

#VisualAbstract An ICU follow-up model for family caregivers reduced PTSD symptoms at 6 months in a randomised trial of 196 participants, with strongest effects when the patient survived and benefits persisting at 12 months. zurl.co/WtFbf

Burn shock resuscitation is shifting from fixed formulas to goal-directed titration focused on organ perfusion and avoiding fluid overload. Balanced crystalloids, selective albumin, early debridement and cautious vasopressors are emphasised. zurl.co/aZUUA