Intensive Care Medicine Journal

Frailty in cardiac arrest survivors is best used to inform function-oriented goals, not to drive prognosis-centred withdrawal of life-sustaining therapy. zurl.co/XtKAQ

Greater ABCDE bundle compliance was associated with less disability and better quality of life at 12 months after discharge. zurl.co/rhC2M

Microcirculatory alterations can persist after macro-hemodynamic stabilisation in shock. zurl.co/PxX6u

#ICM-Quizz #MedEd Hepatic portal venous gas has surgical and non-surgical causes. Causes include intestinal ischaemia (~40%, lower survival), infection, IBD, obstruction, procedures, trauma and bronchopneumonia. Ultrasound may exceed CT. zurl.co/zLacK

#ICM-Quizz #MedEd 39-year-old woman with uSAID and pulmonary disease was in ICU for respiratory failure from pneumonitis flare, intubated on steroids/antibiotics; day 10 lung ultrasound showed portal venous gas. What is the most likely cause?

Rapid 8-hour immune profile switching in ICU sepsis suggests classification instability. zurl.co/HImiL

Higher dynamic driving pressure during mechanical ventilation was linked to higher mortality in acute brain injury. zurl.co/mh51r

#VisualAbstract AKI severity at ICU admission in Ontario adults was linked to higher 90-day mortality and greater 90-day kidney replacement therapy dependence. zurl.co/vB6tB

In septic shock, norepinephrine remains first-line, with add-on agents used to reach MAP targets while limiting catecholamine exposure. zurl.co/fqDOP

Mean arterial pressure of 60–65 mmHg appears sufficient in most noncardiac surgery. zurl.co/CVjkp

Cerebral autoregulation can be disturbed in ICU brain injury, and PRx monitoring can support individualised cerebral perfusion pressure targets. zurl.co/wzrQM

#ICM-Quizz #MedEd Ghost cells on blood smear with non-centrifugable blood signalled Clostridium perfringens sepsis with fulminant intravascular haemolysis from a liver abscess. zurl.co/KAqYk

#ICM-Quizz #MedEd A 75 y. o. man arrives in shock with fever, jaundice and reddish-brown urine. LDH is high with rapid Hb drop, DAT is negative; CT shows gas in a liver lesion; smear shows ghost cells. What's the most appropriate transfusion management?

Corticosteroid use in severe influenza pneumonia remains controversial due to limited randomised evidence. zurl.co/8ig2y

Excess oxygen exposure may worsen outcomes in acute brain injury in intensive care. zurl.co/UV6aH

#VisualAbstract Higher time-varying dynamic driving pressure during the first 14 ICU days was associated with increased mortality in mechanically ventilated adults with acute brain injury. zurl.co/HPrpq

Creatinine rises during acute heart failure often reflect therapy or congestion, so context with venous Doppler, BNP and urine sodium supports safer decisions on decongestion and guideline-directed treatment. zurl.co/FbBha

Bi-level high-flow nasal cannula enables separate inspiratory and expiratory flow settings. zurl.co/f8yIo

Consensus ranked double and ineffective triggering as the most clinically relevant ICU ventilator asynchronies. zurl.co/cw0nR

#ICM-Quizz #MedEd Ureteroenteric fistula can follow pelvic radiation and surgery and is often suspected with recurrent UTIs. An unusual case involved persistent GI bleeding from JJ stent protrusion with polymicrobial pyelonephritis. zurl.co/pPDbH

#ICM-Quizz #MedEd A 67-year-old ICU patient had septic shock and gastrointestinal bleeding, with polymicrobial UTI and positive blood cultures. Endoscopy and colonoscopy were normal. CT and capsule endoscopy followed. What's your diagnosis?

Prone positioning during invasive ventilation improves lung homogeneity, reduces ventilator-induced injury and can unload the right ventricle in moderate-to-severe ARDS. zurl.co/Gm38c

In 839 patients with acute brain injury, extubation failure rates were similar after T-piece, pressure support ventilation or CPAP breathing trials. zurl.co/EdjOk

#VisualAbstract Canadian RECOVER participants showed higher ICU mortality in males, while female ICU survivors had lower functional independence and more frequent and severe depression over 1-year follow-up. zurl.co/7jmEW

E4 and CAUSE structure early ICU admission, diagnosis, treatment and expert advice in haematologic emergencies. zurl.co/qrRXN

Potential controlled DCD donors increasingly die outside the ICU, raising organisational complexity and moral tension for ICU admission aimed at organ donation. zurl.co/avQFG

Protein-based sepsis endotypes can change over time, complicating precision immunotherapy. zurl.co/Y9Moy

#ICM-Quizz #MedEd Serum–ascites albumin gradient (>11 g/L) is high in portal hypertension and cardiac failure. In bladder leak, ascites is protein-poor unless renal disease. The peritoneum dialyses creatinine, causing falsely raised serum levels. zurl.co/6ePk4

#ICM-Quizz #MedEd A 62-year-old woman with abdominal pain, renal failure, ascites resolving with bladder catheter but recurring after removal had CT evidence of bladder leak, confirmed and repaired surgically. What are the correct propositions?

Perioperative delirium, cognitive dysfunction and stroke remain under-recognised in non-neurosurgical patients and call for patient-specific monitoring of cerebral perfusion, oxygenation and anaesthetic depth. zurl.co/UfEzp