Lactate Predicts Citrate Accumulation During Continuous Kidney Replacement Therapy: incidence, severity, and clinical implications
Posted inCritical Care Nephrology news

Lactate Predicts Citrate Accumulation During Continuous Kidney Replacement Therapy: incidence, severity, and clinical implications

In 911 critically ill patients on RCA-CKRT, citrate accumulation occurred in 17%. Pre-CKRT lactate strongly predicted accumulation (OR 2.34 per 1-unit increase on log scale); VIS was less discriminatory. Accumulation linked to liver dysfunction but not to shock and—after adjustment—did not increase mortality.
Higher Standardized ICU Admission Ratio After Rapid Response Calls Is Linked to Better Neurologic and Survival Outcomes: Insights from a Multicenter Japanese Registry
Posted inCritical Care news

Higher Standardized ICU Admission Ratio After Rapid Response Calls Is Linked to Better Neurologic and Survival Outcomes: Insights from a Multicenter Japanese Registry

A multicenter retrospective Japanese study found that hospitals admitting more patients to ICU than predicted after rapid response activations had fewer poor neurologic outcomes or deaths within 30 days, suggesting ICU utilization after RRS events may influence recovery.
Continuous Intravenous Sedation Produces Novel EEG ‘Ups’ in Early Acute Hypoxemic Respiratory Failure — Implications for Monitoring and Outcomes
Posted inAnesthesiology Critical Care news

Continuous Intravenous Sedation Produces Novel EEG ‘Ups’ in Early Acute Hypoxemic Respiratory Failure — Implications for Monitoring and Outcomes

In mechanically ventilated patients with early acute hypoxemic respiratory failure, continuous IV sedation produces EEG patterns (EEG Ups) not seen in natural sleep; these patterns correlate with sedation dose, drug combinations, clinical sedation depth, and ICU mortality.
Physiologic PK-PD Modeling Reveals Greater Fentanyl Potency for Ventilatory Depression Than Simpler Approaches
Posted inAnesthesiology Critical Care news

Physiologic PK-PD Modeling Reveals Greater Fentanyl Potency for Ventilatory Depression Than Simpler Approaches

A population PK–PD study in healthy volunteers found that a physiologic model incorporating CO2 kinetics and a ventilatory controller estimates fentanyl potency for ventilatory depression at ~2.3 ng/mL—substantially lower than estimates from simpler models, with implications for perioperative opioid safety and modeling methodology.
Restrictive Red Blood Cell Transfusion Is Safe for Most Patients — Except in Neurocritical Care (and Some Bleeding Syndromes)
Posted inAnesthesiology Critical Care Hematology-Oncology news

Restrictive Red Blood Cell Transfusion Is Safe for Most Patients — Except in Neurocritical Care (and Some Bleeding Syndromes)

A Cochrane update (2025) of 69 randomized trials found restrictive RBC transfusion thresholds (typically Hb 7–8 g/dL) cut transfusion exposure ~42% without increasing 30‑day mortality overall, but liberal strategies improved long‑term neurological outcomes after brain injury and restrictive thresholds reduced mortality in GI bleeding.
Lower-Intensity Anticoagulation During Venovenous ECMO: A Pilot RCT Shows Feasibility and a Signal Toward Less Bleeding
Posted inCardiology Critical Care news

Lower-Intensity Anticoagulation During Venovenous ECMO: A Pilot RCT Shows Feasibility and a Signal Toward Less Bleeding

A 3-center randomized pilot trial found that randomized allocation to low- versus moderate-intensity anticoagulation during venovenous ECMO is feasible, with lower major bleeding rates in the low-intensity arm and no clear excess of thromboembolic events—but the study was underpowered for definitive safety or efficacy conclusions.
Higher Early IV Fluid Rates Tied to More SIRS but Lower BUN Rise in Acute Pancreatitis: Findings From an International Cohort Presented at ACG 2025
Posted inCritical Care Gastroenterology news

Higher Early IV Fluid Rates Tied to More SIRS but Lower BUN Rise in Acute Pancreatitis: Findings From an International Cohort Presented at ACG 2025

An international prospective cohort found that higher early IV fluid rates were associated with lower odds of BUN rise but higher odds of new or persistent SIRS at 6 and 24 hours after presentation, highlighting confounding issues and the need to individualize resuscitation.
Innovative Extracorporeal Therapy Combining HLA-Depleted Liver Organoids and Granulocyte-Monocyte Apheresis for Reversal of Acute Liver Failure
Posted inCritical Care Gastroenterology news

Innovative Extracorporeal Therapy Combining HLA-Depleted Liver Organoids and Granulocyte-Monocyte Apheresis for Reversal of Acute Liver Failure

The UTOpiA system, integrating HLA-depleted iPSC-derived liver organoids with granulocyte-monocyte apheresis, significantly improves survival and liver regeneration in acute-on-chronic and acute liver failure rat models, representing a promising off-the-shelf extracorporeal liver support therapy.
Evaluating the Cost-Effectiveness of Early In-Bed Cycling Plus Routine Physiotherapy in Mechanically Ventilated ICU Patients: Insights from the CYCLE Trial
Posted inCritical Care news Rehabilitation Medicine Respiratory

Evaluating the Cost-Effectiveness of Early In-Bed Cycling Plus Routine Physiotherapy in Mechanically Ventilated ICU Patients: Insights from the CYCLE Trial

This economic evaluation from the CYCLE randomized trial found no significant cost or quality-adjusted life-year benefit by adding early in-bed cycling to usual physiotherapy for ICU patients on mechanical ventilation, underscoring a need for further research to clarify its value.