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.

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.

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.

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.

In patients with severe metabolic acidemia and moderate to severe acute kidney injury, intravenous sodium bicarbonate did not reduce mortality but was associated with a lower rate and delayed initiation of renal replacement therapy.

The ANDROMEDA-SHOCK-2 trial, published in JAMA (2025), represents a major evolution in early septic shock management. Across 86 intensive care units in 19 countries, researchers compared a personalized hemodynamic resuscitation strategy targeting capillary refill time (CRT-PHR) with usual care. Among 1467 analyzed patients, CRT-guided therapy demonstrated superiority on a hierarchical composite outcome of 28-day mortality, duration of vital support, and length of hospital sta

A landmark NEJM trial challenges ICU convention — showing that many patients in shock can be safely managed without early arterial catheterization. Could this signal the end of routine invasive monitoring? Read the editorial and share your view in the poll.

Restrictive vs. Liberal Transfusion in Myocardial Infarction: Implications for Clinical Practice