Trauma Surgery

Ketamine vs propofol for RSI in the critically ill: MAP differences are small and transient

In 175 critically ill adults needing RSI, ketamine yielded a slightly higher lowest MAP than propofol over 10 minutes (66 vs 60 mmHg). The adjusted mean MAP difference was 6.0 mmHg (95% CI 0.0–11.9), not sustained over the first hour (average difference 1.67 mmHg). Cardiovascular collapse occurred in 22% with ketamine and 33% with propofol, mainly via early vasopressor escalation. Short-term and hospital mortality were numerically higher with ketamine but with wide confidence intervals overlapping no effect. These data suggest ketamine’s hemodynamic advantage over propofol during RSI is modest and clinically marginal in unstable ICU patients. 1

Consensus criteria define refractory septic shock for bedside use and research

An SCCM/ESICM Delphi panel reached consensus on 13 criteria to define refractory septic shock. Key elements include persistent tissue hypoperfusion, elevated lactate, or prolonged capillary refill despite initial resuscitation. Patients must be fluid unresponsive after initial resuscitation and require norepinephrine-equivalent doses >0.5 μg/kg/min. Critical care ultrasound was the only diagnostic modality with consensus support, particularly when mixed shock is suspected. These criteria provide a standardized framework for diagnosis, escalation decisions, prognostication, and trial enrollment in severe septic shock. 2

New Surviving Sepsis guidelines refine adult sepsis management in the ICU

This JAMA synopsis summarizes updated Surviving Sepsis Campaign guidelines for adults with sepsis. The guidelines focus on antimicrobial therapy, including agent selection and timing, and on fluid management strategies. They provide granular recommendations intended to standardize early resuscitation and ongoing hemodynamic support. These updates will influence protocolized sepsis care in trauma and emergency surgical ICUs. 3