Latest Critical Care and Intensive Care Medicine research

Top 10 this week

Week of 1 November 2026

1. 1

   Permissive Blood Pressure Targets in Pediatric Critical Care: The PRESSURE Randomized Clinical Trial

   JAMA · Q1 journal · RCT · Evidence level 1 (High) · 28 September 2026

   In a trial of 1,900 critically ill children receiving ventilation and blood pressure drugs, a lower target reduced median drug dose by 37.5% but did not significantly change the combined outcome of death and ventilation duration at 30 days. Most other outcomes were also similar; whether the modestly shorter PICU stay among survivors matters clinically remains unclear.

2. 2

   Prone positioning and high-frequency oscillatory ventilation in early paediatric acute respiratory distress syndrome (PROSpect): an international, two-by-two factorial, response-adaptive, phase 3, randomised controlled trial

   Lancet (London, England) · Q1 journal · RCT · Evidence level 1 (High) · 31 October 2026

   In an international trial of 424 children with moderate-to-severe acute respiratory distress syndrome, prone positioning and high-frequency oscillatory ventilation did not improve ventilator-free days compared with standard approaches; deaths also did not differ between groups. The trial stopped early, and some complications were more frequent with prone positioning or oscillatory ventilation, offering no support for their routine first-line use.

3. 3

   European Society of Intensive Care Medicine consensus statement on human-centred partnership in the intensive care unit

   Intensive care medicine · Q1 journal · Guideline · Evidence level 1 (High) · 26 October 2026

   An international panel endorsed 43 consensus statements to make intensive care more person-centered, drawing on evidence reviews and input from clinicians, patients, families, and other stakeholders. Recommendations include flexible family visits, clearer team communication, psychological support, culturally responsive care, and changes to improve sleep and reduce delirium; whether the framework improves patient or staff outcomes remains untested.

4. 4

   Intraosseous versus intravenous access in adult out-of-hospital cardiac arrest: a Bayesian secondary analysis of the Paramedic-3 randomised controlled trial

   Resuscitation · Q1 journal · RCT · Evidence level 1 (High) · 25 September 2026

   In a Bayesian secondary analysis of a randomized trial, an intraosseous-first strategy had an 18.4% probability of improving 30-day survival compared with intravenous-first access. Researchers estimated an 81.6% probability it was worse for survival and a 98% probability it reduced return of spontaneous circulation, though any overall disadvantage was likely modest.

5. 5

   Airway Pressure Release Ventilation Versus Conventional Ventilation in Adults With or at Risk for Acute Respiratory Distress Syndrome: A Systematic Review and Meta-Analysis of Randomized Trials

   Lung · Q1 journal · SR/MA of RCTs · Evidence level 1 (High) · 31 October 2026

   Across nine randomized trials involving 585 adults, airway pressure release ventilation did not demonstrate lower mortality or clear gains in ventilator-free days or ventilation duration compared with conventional ventilation. Oxygen levels improved and ICU stays were shorter, but varied protocols, study limitations, and low to very low certainty leave those findings uncertain; the evidence does not establish equivalence or superiority to modern lung-protective ventilation.

6. 6

   Chlorhexidine within a standardized oral-care bundle for the prevention of ventilator-associated pneumonia: a pragmatic cluster-randomized crossover trial in six medical intensive care units

   Critical care (London, England) · Q1 journal · RCT · Evidence level 1 (High) · 29 October 2026

   In six medical ICUs, a trial of 1,035 ventilated adults found no reduction in pneumonia when 0.12% chlorhexidine was added to standard oral care: rates were 18.8 versus 16.9 cases per 1,000 ventilator-days. Mortality was also similar, while ICU stays averaged 0.89 days longer with chlorhexidine; the single-hospital findings offer no clear case for routine use.

7. 7

   Low-Use vs. High-Use Physical Restraint in Older Adults With Sepsis Receiving Mechanical Ventilation: A Multicenter Randomized Clinical Trial

   Journal of the American Geriatrics Society · Q1 journal · RCT · Evidence level 1 (High) · 27 October 2026

   In a randomized trial of 485 older adults with sepsis on mechanical ventilation, using restraints only for severe agitation did not increase days alive without delirium or coma. The low-use strategy was linked to 0.69 more ventilator-free days and 0.46 more coma-free days, with no detected difference in safety events; whether restraint reduction is safe more broadly remains uncertain.

8. 8

   Music Therapy During Weaning From Invasive Mechanical Ventilation in the ICU: A Randomized Controlled Trial

   Critical care medicine · Q1 journal · RCT · Evidence level 1 (High) · 21 October 2026

   In this 100-patient randomized trial, daily individualized music therapy did not shorten weaning from invasive ventilation. Patients receiving therapy had less agitation and sedation, fewer needed propofol, and tracheostomy was less common, with a 14% rate in the music group. The findings support a possible role as an adjunct, but larger studies are needed to confirm these benefits.

9. 9

   Effect of blood transfusion on respiratory failure in severe trauma patients: A post hoc analysis of a randomized multicenter trial in Japan

   Injury · Q1 journal · RCT · Evidence level 1 (High) · 19 October 2026

   In a post hoc analysis of 417 severely injured patients, 40 developed respiratory failure within seven days. Greater platelet transfusion volume in the first 24 hours was associated with respiratory failure after adjustment, while red blood cell and plasma transfusions were not. The analysis cannot show that platelets caused the complication, so the finding needs confirmation.

10. 10

    The clinical benefit of prostacyclin treatment in mechanically ventilated patients with SARS-CoV-2 infection is not attributed to anti-inflammatory effects

    Cytokine · Q1 journal · RCT · Evidence level 1 (High) · 3 September 2026

    In a post-hoc analysis of 80 mechanically ventilated COVID-19 patients with endotheliopathy, a 72-hour iloprost infusion did not alter any of the 54 measured inflammatory or T-cell cytokines compared with placebo. The result suggests the drug's clinical benefit is unrelated to anti-inflammatory effects, highlighting the need to target patient selection and combine therapies.

Paper of the day, last two weeks

• Efficacy and Safety of Ulinastatin in the Treatment of Patients with Sepsis: The ADJUST Trial

  Chest · Q1 journal · RCT · Evidence level 1 (High) · 6 November 2026

  In this randomized trial, 23.6% of patients given ulinastatin died within 28 days, compared with 22.9% given placebo, with similar results for other mortality and length-of-stay outcomes. Adverse events were more common with ulinastatin, occurring in 56.8% versus 42.7%; the findings do not support routine use for sepsis.

• Meta-analysis of the effect of nafamostat mesilate versus no-anticoagulation regimens in adult patients undergoing continuous renal replacement therapy

  Frontiers in medicine · Q1 journal · SR/MA of RCTs · Evidence level 1 (High) · 21 October 2026

  In eight studies involving 969 adults on continuous renal replacement therapy, nafamostat was linked to longer-lasting filters and fewer filter changes, with bleeding risks similar to regimens without anticoagulation. The analysis also found lower in-hospital mortality, but the mix of randomized and observational studies cannot establish that nafamostat caused better survival; evidence beyond East Asia remains uncertain.

• Effect of Diaphragmatic Neuromuscular Electrical Stimulation on Diaphragm Function and Clinical Outcomes in ICU Mechanically Ventilated Patients: A Meta-analysis and Systematic Review

  American journal of physical medicine & rehabilitation · Q1 journal · SR/MA of RCTs · Evidence level 1 (High) · 3 November 2026

  Across 19 randomized trials involving 1,437 ICU patients, stimulation improved measures of diaphragm function and was linked to about 2 fewer days on a ventilator and a 29% higher weaning success rate. ICU stays were also shorter, but confidence in many outcomes is low or very low because of study limitations and variation; larger, better-reported trials are needed.

• Individualized treatment effects of high flow nasal oxygen in immunocompromised patients

  Intensive care medicine · Q1 journal · RCT · Evidence level 2 (Moderate) · 2 November 2026

  In 704 immunocompromised patients with acute respiratory failure, high-flow nasal oxygen had no significant overall effect on intubation by day 28. A machine-learning model identified a subgroup with a predicted 20.2-percentage-point lower risk; the ranking of likely benefit held in a separate observational cohort, but estimates were less precise. Prospective studies must confirm who benefits.

• Sodium bicarbonate therapy for metabolic acidosis in critically ill patients: a Bayesian systematic review and meta-analysis of randomised controlled trials

  Intensive care medicine · Q1 journal · SR/MA of RCTs · Evidence level 1 (High) · 2 November 2026

  Across four randomized trials involving 1,544 critically ill adults with metabolic acidosis, sodium bicarbonate was associated with about 26% fewer starts of kidney replacement therapy. It showed no clear short-term survival benefit, and effects on other outcomes were uncertain; further trials must identify which patients, if any, benefit most.

• Adjunctive therapeutic plasma exchange as rescue therapy in septic shock due to streptococcal infection: a multicentric retrospective cohort study

  Intensive care medicine experimental · Q1 journal · Prospective cohort · Evidence level 2 (Moderate) · 28 October 2026

  In this retrospective study of 149 adults, 31 received plasma exchange and were more severely ill at baseline. Overall 90-day hospital mortality was similar, at 29% with exchange versus 27% with standard care, but adjusted analyses linked exchange to lower mortality and faster improvement in blood pressure support and lactate. A prospective study is needed to determine whether exchange improves survival.

• Biomarker tests for invasive Candida infection in critically ill patients in the UK (A-Stop): a multicentre diagnostic test accuracy study

  The Lancet. Microbe · Q1 journal · Unclassified · Evidence level 5 (Expert Opinion) · 23 October 2026

  ICU diagnostic accuracy study informs empirical antifungal discontinuation

• Comparative Analysis of Tracheal Intubation-Associated Cardiac Arrest in 2015-2023: A Report From the National Emergency Airway Registry for Children Multicenter Registry

  Critical care medicine · Q1 journal · Prospective cohort · Evidence level 2 (Moderate) · 23 October 2026

  In 27,773 intubations across 68 pediatric intensive care units, cardiac arrest or chest compressions occurred in 1.2%; each additional intubation attempt was associated with 70% higher odds. Video laryngoscopy and several medications were associated with lower odds, but this retrospective registry cannot establish that they prevent arrest, and the findings need to be interpreted in light of patients' illness severity.

• Precision fluid therapy in sepsis: fluid responsiveness vs. fluid tolerance

  Frontiers in medicine · Q1 journal · Review / opinion · Evidence level 5 (Expert Opinion) · 5 October 2026

  Sepsis fluid responsiveness and tolerance guide ICU resuscitation

Evidence summaries in Critical Care and Intensive Care Medicine

• Septic Shock
• Sepsis