The Latest in Critical Care: July 28, 2025
MAP targets for sepsis, albumin before cardiac surgery, corticosteroids for sepsis, SEPSIS-PPI, fraud alert
RCT suggests targeting higher MAPs is harmful in older adults with sepsis
Among 518 adults ≥65 years old with sepsis at 29 hospitals in Japan, those randomized to a higher MAP target ( 80–85 mmHg) had significantly higher 90-day mortality (39.3% vs. 28.6%) compared to those randomized to a lower MAP (target 65–70 mmHg).
The pragmatic and open-label trial was stopped early for concern for harm in the high-MAP group. The findings comport with two meta-analyses suggesting that higher MAP targets may be harmful in patients with severe sepsis:
—Endo et al, Intensive Care Medicine 2025
Albumin to prevent AKI after cardiac surgery, didn’t
Hypoalbuminemia after cardiac surgery is associated with the development of AKI, and retrospective studies suggested albumin improved outcomes and protected the endothelial glycocalyx.
Among 611 patients at high-risk for acute kidney injury after cardiac surgery at 7 centers in Australia and Italy, those randomized to receive a postoperative dose of 300 mL of 20% albumin had an absolute 6% higher rate of AKI than those receiving usual care only (49% vs 43%), statistically significant. The authors concluded that albumin should not be given routinely after cardiac surgery.
—Shehabi et al, JAMA Surgery, June 2025
Corticosteroids for sepsis: Cochrane meta-analysis
A meta-analysis combining 79 randomized trials enrolling ~20,000 adults concluded that corticosteroids likely reduced 28-day mortality (risk ratio 0.89) and hospital mortality (RR 0.90), along with ICU length of stay (-0.86 day), without reducing long-term mortality (RR 0.97) or increasing the likelihood of superinfection (RR 0.96), compared to patients receiving placebo or usual care.
—Annane et al, Cochrane Database of Systematic Reviews 2025
Fraudulent papers making their way into systematic reviews
A crosscheck of 200,000 systematic reviews published between 2013 and 2024 showed 0.15% of reviews included at least one fraudulent paper, most commonly from China (37%). The number of retracted papers was low but increased over time. Only a small percentage of fraudulent papers are identified and retracted, suggesting the problem is larger than this estimate.
—Tang et al, JAMA Network Open, June 2025
Megadose proton pump inhibitors for sepsis (PPI-SEPSIS)
Proton pump inhibitors reduce the production of proinflammatory cytokines, and their immunomodulatory effects may increase at higher doses. Many patients with sepsis are already receiving 40 mg daily of pantoprazole or another PPI. So why not try giving them 25 times that dose?
At 17 ICUs or EDs in 3 countries, 307 patients meeting case identification criteria for sepsis, who were randomized to 1024 mg esomeprazole or placebo for three days, had no differences in organ failure scores or secondary outcomes.
—Monti et al, Critical Care Medicine 2025
Why would you EVER target a MAP of 80-85 for septic shock??? Kind of a dumb trial, and the result was like...DUH.