This Week in Critical Care — Jun 9, 2026

Welcome to This Week in Critical Care. This week we're covering 10 notable papers spanning advances in point-of-care ultrasound, a re-evaluation of common ICU therapies, and new perspectives on lung injury and population health. Let's dive in.

We begin this week with a focus on point-of-care ultrasound, a tool that continues to expand its role at the bedside. The journal *Intensive Care Medicine* has published the 2025 focused update to the international evidence-based recommendations for point-of-care lung ultrasound, or PoCLUS [2]. This is the first major update since 2012, and it's based on a comprehensive review of over 1,700 new publications. The consensus process involved 21 experts and resulted in 83 evidence-based statements covering ultrasound signs, technical aspects, and clinical applications. A key goal of this update is to define the strengths and limitations of lung ultrasound as a standalone tool, providing a foundation for its integration with other diagnostic modalities. This document will be an essential reference for any clinician performing or interpreting bedside lung ultrasound. Building on that theme, a systematic review and meta-analysis in *Critical Care Medicine* evaluates the diagnostic and prognostic value of the Venous Excess Ultrasound, or VExUS, grading system [7]. Across 32 studies including over 3,000 patients, the review found that VExUS has moderate to good accuracy for diagnosing increased central venous and right atrial pressures, with sensitivities and specificities generally in the 80 to 95 percent range. However, its prognostic value appears to depend heavily on the patient population. In cardiac patients, a high VExUS grade was strongly associated with acute kidney injury, with an odds ratio over four, and mortality. In contrast, for a general population of critically ill patients, the association between VExUS grades and these outcomes was much less clear and not statistically significant. This suggests that while VExUS is a useful tool for assessing venous congestion, its ability to predict outcomes in non-cardiac ICU patients needs further study.

Next, we turn to a series of papers that re-examine common ICU interventions and management strategies. First, an updated systematic review and meta-analysis in *Critical Care Medicine*, which informed the 2024 Society of Critical Care Medicine guidelines, compares intensive versus conventional glycemic control [8]. Analyzing 45 randomized trials with over 32,000 patients, the study confirmed that intensive glucose targets do not improve hospital or ICU mortality. While intensive control was associated with some benefits, like lower rates of infection and critical illness polyneuropathy, it came at a significant cost: a 3.6-fold higher risk of severe hypoglycemia. The guideline conclusion is that intensive targets should not be routinely used. However, a lower target, in the range of 110 to 140 milligrams per deciliter, may be considered in select centers with robust protocols that can demonstrate a negligible risk of hypoglycemia. Also in *Intensive Care Medicine*, a narrative review provides a comprehensive update on patient blood management in the ICU [3]. The review reinforces the importance of a multimodal approach to reduce blood loss and optimize red cell mass. Key recommendations include the use of intravenous iron to treat anemia, the routine adoption of small-volume blood collection tubes to limit iatrogenic anemia, and the continued application of restrictive transfusion strategies for both red blood cells and platelets. The authors also emphasize that there is no evidence to support prophylactic fresh frozen plasma transfusion in non-bleeding patients. This paper serves as an excellent summary of current best practices for a core aspect of critical care. Finally in this section, a study in *Critical Care Medicine* challenges the common practice of automatically holding home medications at admission. Using a target trial emulation framework on a cohort of over 4,600 patients, researchers investigated whether to continue or withhold home beta-blockers for patients admitted from the emergency department with a suspected infection [4]. Patients with shock or significant heart rate abnormalities were excluded. The results showed that continuing oral beta-blockers within 48 hours of admission was associated with a significantly reduced risk of 90-day all-cause mortality, with a hazard ratio of 0.77, as well as a shorter hospital stay. This suggests that for stable patients, the reflexive discontinuation of chronic beta-blockers may not be the safest approach and warrants further study in controlled trials.

Our third theme covers the spectrum of lung injury, from prevention to advanced support. A narrative review in *Intensive Care Medicine* asks a fundamental question: Is acute respiratory distress syndrome a preventable disease? [10]. The authors argue that, for iatrogenic causes, the answer is largely yes. Policies like using male-predominant plasma have dramatically reduced transfusion-related acute lung injury, and the widespread adoption of lung-protective ventilation has lowered ARDS incidence. The challenge now lies with the remaining, non-iatrogenic causes of ARDS, which represent a heterogeneous mix of conditions. The review concludes that future prevention efforts will require precision-based approaches, like phenotype-targeted therapies, to make further progress. For patients who progress to the most severe forms of cardiopulmonary failure, a systematic review in *Critical Care* examines the effects of mechanical ventilation during veno-arterial ECMO support [5]. The review highlights a stark lack of high-quality evidence in this area, identifying only 12 relevant studies. The limited available data, mostly from observational studies, suggest that lower driving pressures and respiratory rates may be associated with improved survival. One study found that moderate PEEP can be protective, but excessive PEEP impairs cardiac function. The overwhelming conclusion is that we do not yet know the optimal way to ventilate these complex patients, and well-designed mechanistic studies are urgently needed. Shifting to chronic lung disease, a study in the *American Journal of Respiratory and Critical Care Medicine* explores a novel genetic marker in idiopathic pulmonary fibrosis, or IPF [6]. Researchers developed a method to create an age-adjusted telomere length from whole genome sequencing data. They found that this age-adjusted score was better than raw telomere length at identifying IPF patients with genetic variants related to telomere biology. Furthermore, an age-adjusted telomere length below the 10th percentile was associated with shorter transplant-free survival. This work represents a step towards using genomic data to better stratify risk in patients with severe fibrotic lung disease.

Finally, we look at two papers with a focus on public health and long-term outcomes. A large cohort study from Korea published in *Nature Medicine* provides important data on the risks of electronic cigarettes after smoking cessation [1]. Following over 4.5 million adults with a history of conventional smoking, researchers found that former smokers who used e-cigarettes had a significantly higher risk of developing lung cancer and dying from it compared to those who quit completely. Specifically, e-cigarette use was associated with a 1.56-fold increased risk of lung cancer incidence and a two-fold increased risk of lung cancer-specific death. This finding challenges the perception of e-cigarettes as a safe alternative and suggests that for lung cancer prevention, complete cessation from all nicotine products is superior. And from *The Lancet Global Health*, a large quasi-experimental and modeling study examines the impact of education on health outcomes in low- and middle-income countries [9]. Using data from 20 countries, the study found that compulsory and free basic education policies were associated with significant reductions in neonatal, infant, and under-5 child mortality for children of both mothers and fathers who benefited from these policies. The study then modeled the potential long-term consequences of COVID-19-related educational disruptions. Under a worst-case scenario, the loss of parental education is projected to lead to an increase in child deaths, peaking around the year 2038, underscoring the profound and long-lasting impact of education on global public health.

If you only have time for one paper this week, make it the study on continuing versus withholding home beta-blockers from *Critical Care Medicine* [4]. This paper directly addresses a common clinical decision point and provides compelling observational evidence that challenges the widespread practice of reflexively holding these medications in patients admitted with suspected infection.

Here are the key takeaways from this week in Critical Care. First, in stable patients admitted with suspected infection, consider continuing their home beta-blocker. New data suggests this is associated with a lower risk of 90-day mortality. Second, counsel patients that e-cigarette use after smoking cessation is not a benign alternative. A large cohort study found it was associated with a significantly higher risk of lung cancer incidence and death compared to complete cessation. Third, the evidence continues to favor conventional over intensive glycemic control for most ICU patients. The lack of a mortality benefit does not justify the 3.6-fold increased risk of severe hypoglycemia seen with intensive targets. Fourth, point-of-care ultrasound continues to evolve. While the VExUS protocol is a good diagnostic tool for venous congestion, its prognostic value for predicting AKI and mortality is established in cardiac patients but remains uncertain in the general critically ill population. And finally, while we have been successful in preventing many iatrogenic causes of ARDS, the next frontier will require precision medicine and phenotype-targeted therapies to address the remaining, heterogeneous causes of the syndrome.

That's your roundup for This Week in Critical Care. The full transcript and references are available on the episode page in your AudioScholar library. This is an AI-curated summary — for clinical decisions, always consult primary sources and current guidelines. See you next week.

This is an automated summary generated by artificial intelligence, which can make mistakes. Always review the original source materials.