Trauma Surgery

Higher BInI volume centers operate earlier and see less sepsis

This TQIP analysis included 3,954 adults with full-thickness blunt ileal, jejunal, or colonic perforations at hospitals stratified by annual BInI volume. High-volume centers had shorter mean time to surgery than low-volume centers (15 vs 18 hours; P < .001). High BInI volume independently reduced delayed surgery >24 hours (aOR 0.68, 95% CI 0.53–0.88) and post-injury sepsis (aOR 0.58, 95% CI 0.37–0.91). Similar associations with earlier surgery were seen when volume was defined by blunt or total trauma admissions. 1

Ferritin-guided precision immunotherapy improves SOFA but not mortality in sepsis

This double-blind trial randomized 281 adults with Sepsis-3 pneumonia or bacteremia and either macrophage activation-like syndrome or immunoparalysis across six countries. Precision therapy used IV anakinra for macrophage activation-like syndrome or subcutaneous interferon-γ for immunoparalysis versus double-dummy placebo plus standard care. More patients on precision immunotherapy achieved the prespecified SOFA improvement by day 9 (35.1% vs 17.9%; difference 17.2%, 95% CI 6.8–27.2; P = .002). Twenty-eight–day mortality was not significantly different despite better organ dysfunction trajectories. 2

Closed-loop ventilation improves safety and quality without more ventilator-free days

In this multicenter RCT, 1,201 adults started on invasive ventilation were randomized to INTELLiVENT adaptive support ventilation or protocolized conventional ventilation within 1 hour. Ventilator-free days at day 28 were similar (16.7 vs 16.3 days; OR 0.91, 95% CI 0.77–1.06; P = .23). There were no significant differences in 28-day mortality, ventilation duration among survivors, or ICU and hospital length of stay. Closed-loop ventilation yielded higher ventilation quality and fewer episodes of severe hypercapnia and hypoxemia, and fewer patients required rescue therapies such as prone positioning. 3

Esmolol probably improves sepsis outcomes; landiolol needs caution

This network meta-analysis synthesized 10 ICU RCTs including 1,035 adults with sepsis or septic shock treated with esmolol, landiolol, or standard care. Esmolol reduced 28-day mortality versus standard care (RR 0.69, 95% CI 0.56–0.85) and lowered 24-hour heart rate (MD −16.9 beats/min, 95% CI −23.5 to −10.4). Compared with esmolol, landiolol was linked to higher 28-day mortality (RR 1.57, 95% CI 1.08–2.30; low certainty) and greater norepinephrine requirements. Landiolol also increased norepinephrine use compared with standard care (MD 0.09 μg/kg/min, 95% CI 0.01–0.18). 4