📢【Top 10 ICU RCTs from the First Half of 2025】

This has become a bit of a tradition every six months 😊
Here are 10 important RCTs from NEJM, JAMA, and The Lancet that are highly relevant to intensive care medicine.
We’re covering a wide range of topics—from fluids, ventilation, sedation, hemostasis, nutrition to oxygen therapy.
One post per study, starting now 👇 ① FLUID trial｜NEJM
Lactated Ringer’s vs Normal Saline
90-day mortality or readmission: 20.3% vs 21.4%
📌 The treatment effect is small, but consistent with past studies favoring Ringer’s.
Given how ubiquitous IV fluids are, even a 1% difference can’t be ignored.
I'll continue to choose Ringer’s.
nejm.org/doi/full/10.10…

Top 10 Important ICU Papers: Second Half of 2024
From the ICU papers published between July and December 2024, I have selected the top 10 key ones, including RCTs, guidelines, and narrative reviews.
I hope you like this list. 1️⃣RCT of antibiotic therapy duration for bacteremia: 7 vs. 14 days: NEJM
- 90-d death: 14.5% vs. 16.1%, showing the non-inferiority of 7-day therapy
- Important to interpret the results considering the exclusion criteria, extended administration, etc.
nejm.org/doi/full/10.10…

🚨10 must-read papers for ICU staff: Jan to Jun 2024

Check out these 10 essential papers on intensive care medicine from Jan to Jun 2024.
Stay updated with the latest research🧵 1⃣RCT on continuous infusion vs. intermittent administration of beta-lactams in sepsis
- Largest trial on this topic (N = 7031)
- 90-day mortality: 24.9％vs. 26.8％, i.e., 2% absolute risk reduction with continuous infusion
jamanetwork.com/journals/jama/…

✅Summary of Key ICU RCTs in the 2nd half of 2023!

Specifically, this list covers 14 trials published in NEJM, JAMA, and Lancet between July and December of this year!

I hope this 🧵 will help you review the best RCTs of the year😉

#FOAMcc @NEJM @JAMA_current @TheLancet 1. Extracorporeal Life Support in Infarct-Related Cardiogenic Shock (ECLS-SHOCK): NEJM

In patients with AMI & cardiogenic shock, ECLS did not reduce 30-day mortality compared to medical therapy.

☝️ECLS increased bleeding & ischemic complications.
🔗 nejm.org/doi/full/10.10…

Report of @ESICM consensus on shock & hemodynamic monitoring @DrMCecconi

1️⃣methodology @MGrecoMD

What role does the methodological team play?
Which approach was applied?
What aspect should be considered?

#LIVES2023





Shock definition Prof. Jan Bakker

- Shock is an acute circulatory failure with reduced hypoperfusion
- Lactate is often elevated
- Hypotension is NOT a requisite

#LIVES2023 #FOAMcc

✅Summary of Important RCTs in ICU for the First Half of 2023!

Quickly summarize the intensive care RCTs published from January to June this year!

Specifically, 13 trials in NEJM, JAMA, and Lancet!

I hope this 🧵 is a useful review of important literature👇👇
#FOAMcc 1. ECPR for Refractory Out-of-Hospital Cardiac Arrest: NEJM

ECPR did not increase neurologically favorable survival at 30 days when compared to conventional CPR after OHCA caused by an initial VT/VF.

☝️1st multicenter RCT on ECPR
🔗 https://t.co/8VVqpxnymcnejm.org/doi/full/10.10…

Day 3 of #ISICEM23 begins with
Sepsis: the first steps

There are many things to do in the first few hours of sepsis care, e.g.,
🦠Sampling for pathogens
💉Antibiotics
📝Severity assessment
🫀Resuscitation

This session will address a whole picture of the initial TO DOs!
@ISICEM Sepsis prediction is challenging

🔸Heterogeneity
🔸High AUROC ≠ High utility in clinical context
🔸Poor generalizability to different settings (units, department)
🔸Necessity of prediction??

@ISICEM #ISICEM23

The #vasopressor session has started with 1️⃣“When is radial artery pressure unreliable?”

Detection
🔸Invasive vs Non-invasive
🔸Brain monitoring
🔸Mitral valve gradient
🔸Artery stenosis
🔸Waveform

👇Possible mechanisms of radial vs femoral differences
@ISICEM #isicem23

https://twitter.com/YukiKotani5/status/1638256892450336772

2️⃣Peripheral vasopressor use @HalliePrescott

🔸Low rates of complications reported up to 48 h with monitoring protocol

🔸Peripheral administration may avoid central line insertion (& its complications)

🔸Peripheral administration is becoming more common.

@ISICEM #isicem23

Future sepsis therapies session💉🦠

Disease tolerance by Christopher Seymour @seymoc

🔸Difficulties in measurement
🔸May become a new focus in future clinical trials

@ISICEM #isicem23 Immune stimulation by Anthony Gordon @agordonICU

🔸Sepsis occurs as a result of dysregulated immune reactions.

🤔What happens when stimulating the immune system in patients with immune suppression?

A large RCT on GM-CSF is ongoing.

europepmc.org/grantfinder/gr…
@ISICEM #isicem23

✅Updated norepinephrine equivalent score

How can you compare the potency of the following vasopressors?

1️⃣Norepinephrine: 0.2 μg/kg/min
2️⃣Vasopressin: 0.04 U/min
3️⃣Angiotensin II: 20 ng/kg/min

Our new publication gives you the answer👇

🔓link.springer.com/content/pdf/10…
#FOAMcc The norepinephrine equivalent (NEE) score tells you the dose of each vasopressor necessary to reach the target MAP with reference to norepinephrine.

You can find one example of NEE in the table below.
🔗journal.chestnet.org/article/S0012-…