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INSIGHTS
The critical care medicine blog serves as a specialized platform committed to delivering profound insights and current knowledge on the cutting-edge advancements within critical care. With its broad coverage of meticulously examined critical care topics, the blog furnishes evidence-based responses to critical care questions, offering a comprehensive understanding of the subject matter. Stay informed with in-depth analysis and up-to-date information through our blog!
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Rethinking the Role of Inhaled Antibiotics in Ventilator-Associated Pneumonia: New Evidence From a Landmark Meta-Analysis
Three key lessons from this meta-analysis: (1) Delivery matters—vibrating mesh nebulizers and optimized ventilator settings are essential for effective lung deposition. (2) Patient selection matters—the greatest benefit was seen in confirmed VAP due to MDR gram-negative pathogens. (3) Mortality benefits are promising (RR 0.84) but require confirmation in large, standardized RCTs before routine use can be recommended.
Mazen Kherallah
Jun 235 min read
The 2026 Sepsis Update: 5 Surprising Shifts in How We Save Lives
A clinician's guide to the five most practice-changing shifts in the 2026 Surviving Sepsis Campaign guidelines—from replacing qSOFA with NEWS/NEWS2 screening to updated resuscitation, antibiotic, and vasopressor strategies for critically ill patients.
Mazen Kherallah
Apr 114 min read
Ketamine vs Etomidate for Emergency Intubation (The RSI Trial): No Mortality Difference, But Important Hemodynamic Considerations
In 2,365 critically ill adults undergoing emergency intubation, the pragmatic RSI trial found no difference in 28-day mortality between ketamine and etomidate (28.1% vs 29.1%). However, cardiovascular collapse was more common with ketamine (22.1% vs 17.0%), especially in sepsis—supporting an individualized, hemodynamics-guided choice of induction agent.
Mazen Kherallah
Dec 30, 20253 min read
STORM‑PE: First Randomized Trial of Mechanical Thrombectomy + Anticoagulation vs Anticoagulation Alone
STORM-PE, the first randomized trial comparing mechanical (vacuum) thrombectomy plus anticoagulation versus anticoagulation alone in intermediate-high-risk PE, found thrombectomy significantly reduced the RV/LV ratio at 48 hours and improved early functional recovery, without excess major bleeding. It was not powered for mortality.
Mazen Kherallah
Dec 21, 20253 min read
Methylene blue in septic shock!
Methylene blue is a non-adrenergic vasopressor option for catecholamine-resistant vasoplegia in the ICU, with evidence supporting its efficacy in improving hemodynamics and reducing vasopressor dependence.
Mazen Kherallah
Nov 29, 20253 min read
Transfusion Strategies in High Cardiac Risk Postoperative Patients: Insights from the TOP Trial
The TOP trial found no mortality difference between liberal and restrictive transfusion in high-risk cardiac patients post-surgery, but liberal transfusion significantly reduced cardiac complications, supporting a more individualized approach.
Mazen Kherallah
Nov 18, 20252 min read
Augmented Enteral Protein in Critical Illness: Evidence Update and Clinical Implications
Augmenting enteral protein during the acute phase of critical illness does not improve outcomes and may be harmful in specific populations, notably those with AKI. The findings from recent high-quality trials and a robust meta-analysis challenges current guideline recommendations and support a more cautious, individualized approach to protein provision in the ICU.
Mazen Kherallah
Nov 16, 20253 min read
Systemic Corticosteroids in Severe Community-Acquired Pneumonia: Navigating Conflicting Signals in the ICU with REMAP-CAP Trial!
Systemic corticosteroids are recommended for severe CAP based on trials like CAPE-COD and supporting meta-analyses. However, the REMAP-CAP trial found no mortality benefit—and possible harm—from hydrocortisone, raising concerns. Despite this, a Bayesian meta-analysis still supports corticosteroid use in high-risk ICU patients. Clinical decisions should consider disease severity, etiology, and individual patient factors.
Mazen Kherallah
Nov 15, 20253 min read
The BALANCE Trial: Is Seven Days Enough for Bloodstream Infections?
The BALANCE trial (NEJM 2025) compared 7 versus 14 days of antibiotics in over 3,600 hospitalized adults with bloodstream infections, including ICU patients. Mortality and relapse rates were similar, proving that shorter therapy was noninferior. For most stabilized patients with controlled infection, seven days of antibiotics is safe, effective, and supports antimicrobial stewardship.
Mazen Kherallah
Nov 12, 20253 min read
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