The Latest in Critical Care: October 22, 2025
Relieving ICU patients’ distress with oversedation can steal their independence, study suggests
Authors retrospectively examined charts of 10,000 ventilated patients in ICUs at multiple hospitals in the Montefiore-Einstein system (NYC) who were living independently before their critical illness.
Those whose pain, anxiety, or agitation (by scoring with RAAS, CPOT, etc) was treated with deep sedation had about a 15% relative increase in the likelihood of losing their independent living status.
Almost three-quarters of patients were deeply sedated (RASS score of -3 to -5) during their first week in the ICU, often for long periods, despite having orders for the standard lighter sedation of RASS -2 to -1.
And yes, the night shift was more often to blame.
On the other hand, patients who had longer periods of unrelieved emotional distress (pain, anxiety, or agitation) were more likely to maintain their independent living status (relative risk for dependence 0.88).
Neither oversedation nor emotional distress was associated with new mental health diagnoses in the health system’s EMR over the following year.
As a retrospective study, its findings may be influenced by unmeasured confounders, but the results were robust to the numerous sensitivity analyses the authors performed.
Private equity hospital acquisitions led to lower pay, more deaths
Hospitals acquired by private equity slashed pay in ICUs (by 16%) and EDs (by 18%) compared to un-acquired hospitals, and cut staffing hospital-wide by 11.6% on average, a study concluded.
The authors compared outcomes at 49 private equity hospitals with 6 million ED visits and 760,000 ICU hospitalizations across 293 matched control hospitals.
After acquisitions, Medicare patients had 7 additional deaths per 10,000 ED visits compared to control hospitals—a 13% increase over the baseline of 52 deaths per 10,000 ED visits.
The acquired hospitals also transferred patients out to other hospitals more often after being purchased. Since those transferred out are usually the sickest, the increase in mortality among the remaining lower-risk patients was even more striking.
Kannan et al. Hospital Staffing and Patient Outcomes After Private Equity Acquisition | Annals of Internal Medicine 2025
Ivabradine to reduce perioperative MIs, didn’t
Beta-blockers were once initiated routinely for millions of patients before surgery, on the belief that this reduced the risk for perioperative myocardial infarction or other cardiovascular events. Then the POISE trial suggested that beta-blockade could be harmful, causing hypotension and stroke and increasing all-cause mortality. The indications for new preoperative beta-blockers narrowed to only a small subset of high-risk patients undergoing certain operations (e.g., vascular surgery).
Ivabradine is a selective heart rate-lowering compound that may cause less hypotension than beta-blockers. Among 2,100 patients with coronary disease or significant risk factors who underwent noncardiac surgery, those randomized to receive ivabradine had a successful reduction in their heart rates without an increase in hypotension, but no reduction in perioperative myocardial injury.
Sczcklik et al. Ivabradine in Patients Undergoing Noncardiac Surgery: a Randomized Controlled Trial | Circulation 2025
Perioperative beta-blockers in noncardiac surgery: Evolution of the evidence
Dex as adjunctive analgesia for rib fractures? Nope
Dexmedetomidine is primarily a sedative, but it has analgesic effects as well. Among 41 patients in the ICU for rib fractures, those randomized to dex required numerically more opioids (not less) than those receiving placebo. In almost half the patients, dex was stopped either because of adverse events or at the patients’ request.
Starting SGLTi (dapagliflozin) in the hospital for CHF led to better outcomes (DAPA ACT HF-TIMI 68 trial)
Among 2,400 patients hospitalized with heart failure, those randomized to start a SGLTi (dapagliflozin) as an inpatient had lower all-cause mortality and a trend toward reduction in heart failure readmissions.
A meta-analysis of all available randomized trials also suggested that starting SGLTis in the hospital reduced all-cause mortality, the risk of short-term cardiovascular death, or worsening heart failure.