The Year in Critical Care: Sepsis and ID
Part 6 of the 2025 year-end roundup
Happy New Year! Again, there were too many articles on sepsis and ID to fit into one email.
Click the title link or visit pulmccm.org to see the whole sepsis roundup from 2025.
Severe Community-Acquired Pneumonia: A 2025 Not-IDSA Guideline
Since 2005, the major professional society for infectious diseases (IDSA) periodically issued joint guidance documents with a major US critical care society on the prevention, diagnosis, and treatment of community-acquired and hospital-acquired pneumonia.
Sepsis alerts work! Just not in the patients who fire the alerts
In the past decade, so-called “sepsis alerts” came out of nowhere to become a ubiquitous and resource-intensive component of inpatient medical care.
Is procalcitonin "safe" to guide antibiotic use in patients with sepsis?
Many randomized trials have tested the biomarker procalcitonin as a guide to de-escalate or stop antibiotic therapy in patients with known or suspected infection. A large proportion have concluded PCT is a safe and effective method to shorten antibiotic courses, including in patients with sepsis.
The Real-World Boards: Question #5
These are the Real-World Boards. As in the real world, there is often no “right” answer, and you are only competing against yourself. Upgrade to the Lifelong Learner level for full access to all the questions and unlimited CME credits with an included Learner+ account.
Arterial lines for shock: harms exceed benefits (EVERDAC trial)
Continuous measurement of blood pressure by arterial catheters has been a cornerstone of shock management since the birth of critical care. Directed by clinical guidelines and generations of tradition, clinicians insert arterial lines into millions of patients each year in ICUs around the world.
Peripheral IVs are preferable to central lines for most patients with septic shock (Review)
Over the past decade or so, peripheral IVs have become accepted as a reasonably safe, temporary alternative to central venous access for vasopressor administration. But there’s a lingering cultural belief that peripheral IVs are second-best to central venous catheters.
"Sepsis bundles": No good evidence of benefit
SEP-1, the Centers for Medicare & Medicaid Services (CMS)’s much-maligned sepsis “quality” measure, was the brainchild of a small group of insiders conceived in the early- to mid-2000s.
Beta-blockers for septic shock (Review)
Patients in septic shock are under extreme stress and have high levels of circulating catecholamines. Catecholamine toxicity has been postulated to worsen the organ failure associated with severe sepsis.
The new goal in goal-directed sepsis therapy: Pink pinkies
There’s a new goal in goal-directed therapy for sepsis, and it’s right at your fingertips. It works as well as any other, which is to say, not very well.
Give vasopressin earlier and oftener in septic shock to save humans, says Computer
For patients in septic shock, norepinephrine has been recommended as the first vasopressor to be infused.
The Real-World Boards: Question #6
These are the Real-World Boards. As in the real world, there is often no “right” answer, and you are only competing against yourself. Upgrade to the Lifelong Learner level for full access to all the questions and unlimited CME credits with an included Learner+ account.
Targeted precision therapy for sepsis! Is it here?
“Sepsis” is a circularly defined syndromic concept that clinicians have historically used to express their belief that the cause of a person’s severe illness is an infection.
The new goal in goal-directed sepsis therapy: Pink pinkies
There’s a new goal in goal-directed therapy for sepsis, and it’s right at your fingertips. It works as well as any other, which is to say, not very well.
What prevents antibiotic resistance? Antibiotics
Patients receiving mechanical ventilation are particularly vulnerable to hospital-acquired infections, especially by aerobic gram-negative bacteria and yeasts. These pathogens incubate in the stomach and gain resistance after exposure to intermittent antibiotics.
FDA set to approve "blood purification" for sepsis?
Sepsis is sometimes called “blood poisoning” by laypeople, and they’re not wrong. Can the blood of patients with sepsis be removed from their bodies, detoxified, and returned, saving lives in the process?
