30-Second Takeaway
- Polytrauma status alone does not justify higher transfusion thresholds after moderate–severe TBI.
- In ICU patients with suspected mesenteric ischemia, clustered clinical features strongly predict necrotic bowel.
- Initial intraosseous access in adult cardiac arrest offers no survival benefit and may slightly reduce sustained ROSC.
- High-dose intermittent meropenem (6 g/day) was associated with lower 90-day mortality without excess AKI.
- Point-of-care pancreatic stone protein plus CRP markedly improves early sepsis specificity in heterogeneous ICU patients.
Week ending March 7, 2026
Trauma ICU Pearls: Transfusion in Polytrauma TBI, Mesenteric Ischemia, and Critical Care Decisions
Polytrauma Does Not Clearly Change Liberal vs Restrictive Transfusion Effects After Moderate–Severe TBI
This HEMOTION sub-study tested whether multiple trauma modifies the effect of liberal (Hb > 10 g/dL) versus restrictive (> 7 g/dL) transfusion after moderate–severe TBI. Among 742 patients, three definitions of multiple trauma showed no interaction between trauma status and transfusion strategy on 6-month GOS-E. Adjusted risks for unfavorable outcome with liberal strategy were numerically lower across extracranial injury definitions, but confidence intervals crossed 1. Liberal transfusion was associated with better functional independence and quality-of-life scores in some polytrauma definitions, without mortality or depression differences.
Predicting Necrotic Bowel in ICU Patients With Suspected Mesenteric Ischemia
This prospective three-ICU cohort enrolled 202 patients with suspected acute mesenteric ischemia, 74 (37%) of whom had necrotic bowel at surgery. Necrotic bowel was mainly non-occlusive mesenteric ischemia, reflecting typical ICU pathophysiology. Independent predictors of necrotic bowel were older age, active fluid removal, signs of gastrointestinal injury, renal replacement therapy, and higher LDH. LDH had the best biomarker discrimination, but the authors emphasize combining clinical context with laboratory data for operative decision-making.
Initial Intraosseous vs Intravenous Access in Adult OHCA: No Survival Benefit, Less Sustained ROSC
This systematic review and meta-analysis included two randomized trials with 7,561 adults experiencing out-of-hospital cardiac arrest. Initial intraosseous access did not improve 30-day survival versus intravenous access (OR 0.97; 95% CI 0.80–1.18). Favorable neurological outcome at 30 days or discharge was similar between routes (OR 1.03; 95% CI 0.81–1.31). Sustained ROSC was slightly less likely with intraosseous access (OR 0.89; 95% CI 0.80–0.99), suggesting a small physiologic disadvantage despite similar survival.
Pediatric OHCA: Survival Probability Falls Below 1% After About 15 Minutes of EMS CPR
This retrospective cohort analyzed 1,313 EMS-treated, non-traumatic pediatric out-of-hospital arrests in a North American registry. Overall, 10.4% survived to hospital discharge; median age was 1 year, underscoring the predominance of infants and toddlers. Time-dependent modeling showed survival probability for children still receiving CPR declined from 7.9% at 1 minute to under 1% at 14.8 minutes. The upper 95% confidence bound for survival dropped below 1% by 22 minutes, informing field and ED termination-of-resuscitation discussions.
References
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Additional Reads
Optional additional studies from this edition.