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Critical care

7 items in the last 7 days · 7 in the last 60.

Critical careChronic painPerioperative medicinePatient safety & quality
Prospective cohortNewJ Clin Anesth· Oct 27

Emergency surgery, intraoperative complications and ASA >2 predicted unplanned ICU admission across 75 ICUs

In this prospective study of 55,963 surgical patients across 75 ICUs, 2764 (4.9%) were planned for ICU admission, but 804 could not be admitted because of bed limits. Emergency surgery (OR 12.4), intraoperative complications (OR 3.1) and ASA >2 (OR 2.7) independently raised the risk of unplanned admission; 90-day mortality was 7.5% overall and 18.9% after emergent admission.

Why it matters. Raises the question of whether combining risk scores with intraoperative events could better target scarce postoperative ICU beds.

Limitation. Observational design in one national network; the benefit of ICU care was judged by modified Wang criteria, not tested directly.

Critical carePerioperative medicinePubMedDOIReport a correction
ReviewNewJ Clin Anesth· Oct 26

Review: avoid severe hypotension, but trials do not show higher blood pressure targets protect the kidneys

This narrative review finds a consistent, roughly dose-response association between intraoperative hypotension (especially MAP below 60-65 mmHg) and postoperative AKI in observational studies. Randomized trials of individualized or higher blood pressure targets have generally not confirmed kidney protection, and IOH definitions vary widely.

Why it matters. Explains why current evidence supports avoiding severe, sustained hypotension without endorsing higher targets for renal protection.

Limitation. Narrative review; the authors describe their conclusion as provisional.

General anesthesiologyCritical carePubMedDOIReport a correction
RetrospectiveNewCrit Care Med· Oct 23

Cardiac arrest followed 1.2% of PICU intubations, and each extra attempt raised the odds

Among 27,773 intubations in international PICUs and pediatric cardiac ICUs (2015-2023), intubation-associated cardiac arrest occurred in 1.2%. Each additional attempt raised the odds (aOR 1.70), shock (aOR 4.67) and oxygenation failure (aOR 2.29) were strong risk factors, and video laryngoscopy was associated with lower odds (aOR 0.76).

Why it matters. Adds registry evidence for prioritizing first-attempt success, including video laryngoscopy, in critically ill children.

Limitation. Retrospective registry analysis; associations may reflect confounding.

PediatricCritical careAirwayPubMedDOIReport a correction
Prospective cohortNewCrit Care Med· Oct 23

Nearly 1 in 5 ICU patients on vasoactive drugs had a significant brachial-to-radial pressure gradient

In a prospective study of 303 patients across 13 Polish ICUs, 56 (18.4%) had a gradient between noninvasive brachial and invasive radial MAP above 11 mm Hg. Only vasoactive dose was independently associated with it (OR 1.68; 95% CI 1.12-2.52), and ICU mortality was higher in these patients (48.0% vs 30.1%).

Why it matters. Raises the question of how far radial arterial readings can be relied on in patients on high vasoactive doses.

Limitation. Observational study; a noninvasive brachial cuff was the comparator, not a central arterial line.

Critical carePubMedDOIReport a correction
RetrospectiveNewCrit Care Med· Oct 23

Deep-learning chest X-ray ARDS score predicted ventilated patients’ mortality beyond the P/F ratio

In 6591 mechanically ventilated patients at one center, a deep-learning ARDS-CXR score predicted 28-day mortality with AUROC 0.68 vs 0.64 for Pao2/Fio2. Mortality was 35.1% with a positive score vs 13.5% with a negative score, and the association held after adjusting for Pao2/Fio2 or APACHE-IV.

Why it matters. Raises the question of using imaging-derived lung injury scores for risk stratification or trial enrichment.

Limitation. Single-center retrospective cohort; discrimination was modest.

Critical carePubMedDOIReport a correction
Meta-analysisNewCrit Care Med· Oct 21

Furosemide stress test predicted AKI progression (AUC 0.89), but evidence certainty is low

Across 20 studies (n = 1979), the furosemide stress test predicted progression to stage 3 AKI with sensitivity 0.69 and specificity 0.88 (AUC 0.89), and successful KRT liberation with AUC 0.89. FST-guided early KRT did not change short-term mortality (RR 1.00; 2 RCTs).

Why it matters. Supports the FST as a low-cost bedside risk-stratification tool, not as a trigger for early dialysis.

Limitation. Low to very low certainty of evidence.

Critical carePediatricPubMedDOIReport a correction
Research methodsNewCrit Care Med· Oct 21

Cluster trials reported smaller effects than individually randomized trials on length-of-stay outcomes

A meta-epidemiological study of 65 meta-analyses (212 trials, 315,276 patients) in prehospital, emergency and critical care found no difference in mortality effect sizes between cluster and individually randomized trials, but smaller effects in cluster trials for length-of-stay or days-alive outcomes.

Why it matters. A methods caution for readers pooling ICU trials of different designs.

Limitation. Under half of the eligible meta-analyses reported randomization type.

Critical carePubMedDOIReport a correction