Critical care medicine
Audio Summaries

Ethical Implications of the Slow Code: A Systematic Review of Ethics of Slow Codes in U.S. Hospitals

Jun 24, 2026

The authors investigate the ethical implications of "slow codes" in U.S. hospitals, where clinicians perform resuscitation efforts without full commitment, often in response to patient or family requests despite the futility of such interventions. Their systematic review of 34 studies reveals a significant divide among physicians regarding the permissibility of slow codes, with most ethics literature deeming them impermissible due to concerns about deception, patient autonomy, and moral distress. The findings underscore the need for improved communication and ethical guidance in navigating end-of-life care decisions.

Perceived Inappropriateness of Intensive Care Treatment Among Clinicians: A Cross-Sectional Nationwide Survey on the Prevalence, Associated Factors, and Outcomes

Jun 12, 2026

This study aimed to evaluate the prevalence and reasons for perceived inappropriateness of care (PIC) among ICU clinicians, identify associated factors, and assess its impact on patient outcomes within six months post-ICU. The findings revealed that 26% of clinicians reported PIC, primarily due to distributive injustice and disproportionality of care, with higher risks linked to being a nurse and working in a culture that avoids end-of-life decisions. Notably, PIC was associated with an increased risk of patient death and adverse outcomes, highlighting the need for reflection on ethical practices within ICU teams.

Positive Pleural Fluid Cultures in the ICU: A 10-Year Population-Based Cohort Study of Prevalence, Microbial Characteristics, and Clinical Associations

Jun 12, 2026

The study aimed to evaluate the prevalence and microbial characteristics of positive pleural fluid cultures in ICU patients, as well as their associations with clinical assessments and 90-day mortality. The findings revealed that while the overall rate of positive cultures was low (4.1%), suspected pleural infections significantly increased the likelihood of a positive culture, which in turn was associated with higher 90-day mortality. This suggests that pleural fluid culturing may be particularly beneficial in cases of suspected infection.

Clinical Prediction Models for Prognostication After Out-of-Hospital Cardiac Arrest: A Systematic Review and Meta-Analysis

Jun 11, 2026

The authors aimed to evaluate the prognostic performance of existing clinical prediction models (CPMs) for neuroprognostication following out-of-hospital cardiac arrest (OHCA). They found that while several CPMs, including the OHCA and Cardiac Arrest Hospital Prognosis (CAHP) scores, demonstrated moderate accuracy in predicting poor functional outcomes, there was substantial heterogeneity among validation cohorts, which limits their clinical applicability for critical decisions like withdrawing life-sustaining therapy.

Correlation Between Quantitative Pupillometry and Other Markers for Neuroprognostication of Comatose Patients After Cardiac Arrest: A Bicentric Study

Jun 11, 2026

The authors aimed to investigate the correlation between quantitative pupillometry (qPLR) and other neuroprognostic markers in comatose patients following cardiac arrest. They found that low qPLR values were strongly associated with poor outcomes and correlated with clinical features, EEG findings, and serum neuron-specific enolase levels, while high qPLR values had limited predictive power for good outcomes. Overall, the study suggests that while qPLR is a useful prognostic tool, its performance does not surpass that of qualitative pupillary light reflex assessments.

International Validation of Temperature-Trajectory Sepsis Subphenotypes With Longitudinal Immune and Coagulation Patterns and Its Implications for Immunoglobulin Therapy

Jun 10, 2026

This study aimed to validate a temperature-trajectory model of sepsis in a Chinese cohort and characterize the immune and coagulation profiles associated with distinct sepsis subphenotypes. The findings confirmed that the hypothermic (HT) subphenotype had the highest mortality and exhibited significant immune dysfunction and coagulopathy. Additionally, the study revealed that responses to immunoglobulin therapy varied across subphenotypes, highlighting the potential for precision medicine in treating sepsis.

Pulse Pressure Variation During Passive Leg Raising to Assess Preload Responsiveness: Influence of Inspiratory Effort During Pressure Support Ventilation

Jun 10, 2026

The authors aimed to determine whether changes in pulse pressure variation (PPV) and pulse pressure (PP) during passive leg raising (PLR) can effectively assess preload responsiveness in critically ill patients undergoing pressure support ventilation (PSV). Their findings indicate that PLR-induced changes in PPV are associated with preload responsiveness, particularly in patients with lower inspiratory effort, suggesting that this method can predict cardiac output response to fluid administration without the need for direct measurements.

Comparison of Intensive Versus Conventional Glycemic Control Targets: An Updated Systematic Review and Meta-Analysis of the 2024 Society of Critical Care Medicine Guidelines on Glycemic Control for Critically Ill Adults

Jun 9, 2026

The authors aimed to evaluate the efficacy and safety of intensive versus conventional blood glucose targets in critically ill adults receiving insulin infusions. Their systematic review and meta-analysis of 45 randomized controlled trials found no significant differences in hospital or ICU mortality between the two approaches, but intensive targets were linked to lower ICU length of stay and fewer infections, albeit with a significantly higher risk of severe hypoglycemia. The findings suggest that while intensive targets may improve certain morbidity outcomes, they should not be routinely adopted due to safety concerns regarding hypoglycemia.

Short-Term and Long-Term Mortality of Pulmonary Embolism Patients Admitted to the ICU in the Netherlands

Jun 9, 2026

The authors aimed to assess both short-term and long-term mortality rates among pulmonary embolism patients admitted to ICUs in the Netherlands. Their findings revealed that high-risk pulmonary embolism patients had significantly higher hospital mortality (25.4%) compared to non-high-risk patients (2.8%), and this elevated risk persisted with a higher 1-year mortality rate for high-risk patients post-discharge. These results underscore the importance of risk stratification in the management of pulmonary embolism patients in critical care settings.

Diagnostic and Prognostic Value of the Venous Excess Ultrasound Grading System: A Systematic Review and Meta-Analysis

Jun 9, 2026

The authors aimed to evaluate the diagnostic accuracy and prognostic value of the Venous Excess Ultrasound (VExUS) grading system in assessing venous congestion and its implications for fluid management in acute and critical care settings. Their systematic review and meta-analysis of 32 studies involving 3,142 patients indicated that VExUS demonstrates moderate to good accuracy for diagnosing increased central venous and right atrial pressures, with significant associations found between higher VExUS grades and acute kidney injury and mortality in cardiac patients, though these associations were less clear in critically ill patients.