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Physician gestalt significantly outperformed existing sepsis screening tools (SIRS, qSOFA, SOFA, and MEWS) in identifying sepsis early in critically ill, undifferentiated patients’ ED courses.

Source
Early Physician Gestalt Versus Usual Screening Tools for the Prediction of Sepsis in Critically Ill Emergency Patients. Ann Emerg Med. 2024 Mar 25:S0196-0644(24)00099-4. doi: 10.1016/j.annemergmed.2024.02.009. Epub ahead of print. PMID: 38530675.

So sorry for the late email today. We had a technical issue...think it's fixed! ~Clay

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This secondary analysis derives and validates a machine learning model that supports the use of personalized oxygen saturation targets (SpO2) in mechanically ventilated critically ill adults based on individual patient characteristics.

Source
Individualized Treatment Effects of Oxygen Targets in Mechanically Ventilated Critically Ill Adults. JAMA. 2024 Apr 9;331(14):1195-1204. doi: 10.1001/jama.2024.2933. PMID: 38501205; PMCID: PMC10951851

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Data supporting pediatric cardiac arrest guidelines are limited. This study found increases in the longest pause in chest compressions (CC) during pediatric in-hospital cardiac arrest (pIHCA) were inversely associated with survival and ROSC.

Source
Association Between Chest Compression Pause Duration and Survival After Pediatric In-Hospital Cardiac Arrest. Circulation. 2024 May 7;149(19):1493-1500. doi: 10.1161/CIRCULATIONAHA.123.066882. Epub 2024 Apr 2. PMID: 38563137; PMCID: PMC11073898.

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In this RCT, successful intubation on the first attempt in critically ill neonates was much higher in patients when video laryngoscopy (VL) was used compared to direct laryngoscopy (DL).

Source
Video versus Direct Laryngoscopy for Urgent Intubation of Newborn Infants. NEJM. 2024 May 5. Online ahead of print. DOI: 10.1056/NEJMoa2402785

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This was a network meta-analysis of 13 randomized controlled trials comparing 5 different central venous catheterization (CVC) approaches. The supraclavicular subclavian (SupraSCV) demonstrated superior first-attempt success, while artery puncture was similar for all five locations.  

Source
Ultrasound-guided central venous catheterization around the neck: Systematic review and network meta-analysis. Am J Emerg Med. 2024;78:206-214.

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In a large multicenter observational cohort of patients with sepsis, the strongest mortality benefit was seen for early antibiotic administration (within 3 hours of arrival to the emergency department) in patients with metastatic cancer and with shock.

Source
Heterogeneity of Benefit from Earlier Time-to-Antibiotics for Sepsis. Am J Respir Crit Care Med. 2024 Apr 1;209(7):852-860. doi: 10.1164/rccm.202310-1800OC. PMID: 38261986; PMCID: PMC10995570.

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Sodium-glucose cotransporter 2 inhibitor (SGLT2i)-associated ketoacidosis (DKA) had delayed resolution compared to type 1 diabetes (T1D)-associated DKA despite often being “milder”. This could be due to significantly lower insulin doses given in the setting of the lower plasma glucose levels often seen in this population.

Source
SGLT2 Inhibitor-Associated Ketoacidosis vs Type 1 Diabetes-Associated Ketoacidosis. JAMA Netw Open. 2024 Mar 18;7(3):e242744. doi: 10.1001/jamanetworkopen.2024.2744. PMID: 38497966

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REBOA has emerged as a critical intervention for managing hemorrhagic shock, but current guidelines are non-specific. Employing REBOA in unstable trauma patients with SBPs 60-80 mmHg is ideal, before further decompensation and increased mortality.

Source
Critical systolic blood pressure threshold for endovascular aortic occlusion-A multinational analysis to determine when to place a REBOA. J Trauma Acute Care Surg. 2024 Feb 1;96(2):247-255. doi: 10.1097/TA.0000000000004160. Epub 2023 Oct 19. PMID: 37853558

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In a very specific subgroup of weights, using an ETT that is 0.5 mm smaller than the NRP recommended size was associated with reduced adverse events during tracheal intubation of neonates. 

Source
Endotracheal tube size adjustments within 7 day of neonatal intubation. Pediatrics. 2024 Mar 12:e2023062925. Online Ahead of Print.

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The HOT-COVID RCT found that hypoxemic COVID-19 patients in the ICU benefitted from a lower oxygenation target (PaO₂ 60 mm Hg) by having more days without life support than those who had a higher oxygenation target (PaO₂ goal 90 mm Hg).

Source
Lower vs Higher Oxygenation Target and Days Alive Without Life Support in COVID-19: The HOT-COVID Randomized Clinical Trial. JAMA. Published online March 19, 2024. doi:10.1001/jama.2024.2934