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‌Review the Latest Research in Critical Care

SCCM knows how busy you are caring for critically ill patients. That’s why, as a Select or Professional member, you receive Critical Pulse—a concise, curated update with the latest information and insights to help you stay current and deliver the highest-quality care.

Elevated BUN-to-Creatinine Ratio Can Predict Short-Term Mortality in ICU Patients With Ischemic Stroke

A multicenter retrospective cohort study published in PLoS One investigated the association between BUN-to-creatinine ratio (BUCR) and 28-day in-hospital mortality in ICU ischemic stroke patients. A total of 2702 ICU patients with ischemic stroke were included. BUCR was calculated within the first 24 hours of ICU admission. BUCR was significantly associated with 28-day in-hospital mortality (HR = 1.616; 95% CI, 1.173-2.226). After full adjustment for potential confounders, a linear relationship was observed between BUCR and mortality risk. Each unit increase in BUCR was associated with a 1.4% increase in the hazard of death (HR = 1.014; 95% CI, 1.002-1.027; P = 0.021). These study results suggest that BUCR may serve as a simple and effective biomarker for identifying high-risk patients with severe ischemic stroke.

Machine Learning Models Demonstrate Promising Accuracy in Predicting Vasospasm After Aneurysmal Subarachnoid Hemorrhage

A systematic review and meta-analysis published in Acta Neurochirurgica investigated the use of machine learning (ML) to predict vasospasm following aneurysmal subarachnoid hemorrhage (aSAH). Twelve studies (2011-2025) encompassing 25 ML models were included. Deep learning achieved the highest sensitivity (mean 97.6%) and AUC-ROC (0.97), outperforming regression, ensemble, and SVM methods in sensitivity (P = 0.003) but not in specificity or AUC. Across cohort types, deep learning consistently delivered high accuracy and generalizability, although with greater positive predictive value variability. These tools may enable earlier, personalized interventions; however, due to risk of bias, heterogeneity, and limited external validation, prospective trials are needed to support clinical adoption.

Intravenous Lidocaine Decreases Pain Scores 24 Hours Post Cardiac Surgery

An RCT published in Pain Physician determined the effect of IV lidocaine on pain scores and opioid consumption in the first 48 hours post cardiac surgery. A total of 449 patients who met the inclusion criteria were enrolled and randomized to receive either IV lidocaine or normal saline. A statistically significant difference in Visual Analog Scale pain score at 24 hours post-surgery (adjusted mean difference -0.68; 95% CI, -1.23-0.13; P = 0.016) was observed between patients treated with lidocaine vs. placebo; however, no difference was observed at 48 hours post-surgery. The cumulative opioid use in morphine milligram equivalents was not significant.

Aromatherapy May Improve the Well-Being of Healthcare Professionals 

An RCT published in Nursing in Critical Care aimed to demonstrate whether inhaling essential oils using sticks improved the well-being of healthcare professionals working in the ED, ICU, and operating wards of a hospital. Healthcare professionals (n=51) were given a mixture of essential oils to inhale in stick form for 2 months, starting either immediately or after a 2-month control period without essential oils. The WHO-5 well-being score was significantly increased after the aromatherapy period compared to the control period (65.9 ± 1.8 vs. 60.4 ± 1.8; P = 0.0142). There was also a significant reduction in the general anxiety and perceived stress scores. The complementary use of aromatherapy is a promising and inexpensive method to reduce anxiety and stress in healthcare workers but needs to be confirmed by larger-scale, methodologically robust studies.

Systemic Corticosteroids May Reduce Short-Term Mortality in Adults With Pneumonia or ARDS

A systematic review and meta-analysis published in Annals of Internal Medicine assessed the effects of corticosteroids on mortality and infection-related complications in adults with severe pneumonia or ARDS. Low-dose, short-course corticosteroids probably reduced short-term mortality in severe pneumonia (15 studies, 2445 participants; RR = 0.73; 95% CI, 0.57-0.93) and ARDS (5 studies, 1014 participants; RR = 0.77; 95% CI, 0.61-0.99). Corticosteroids may reduce secondary shock in severe pneumonia (9 studies, 1690 participants; RR = 0.49; 95% CI, 0.26-0.92). In both conditions, corticosteroids may have little to no effect on hospital-acquired infections or secondary pneumonia. Evidence is uncertain for catheter-related and bloodstream infections. Long-term mortality evidence is uncertain for severe pneumonia. 

Dysregulated Serum Chloride Levels May Increase Risk of Mortality in Critically Ill Adults

A systematic review and meta-analysis published in PloS One quantified the prevalence of hypochloremia and hyperchloremia and their associations with mortality and AKI in critically ill populations. Thirty-four studies (n = 175,021 patients) were included. The aggregated prevalence of hyperchloremia was 34% (95% CI, 26-43) and hypochloremia was 14% (95% CI, 1-28). Meta-analysis demonstrated that both hyperchloremia and hypochloremia were significantly associated with increased risk of mortality (OR = 1.28; 95% CI, 1.08-1.52) and (OR = 1.55; 95% CI, 1.33-1.81), respectively. Furthermore, hyperchloremia was linked to an increased risk of AKI (OR = 1.40; 95% CI, 1.07-1.85). These findings suggest that serum chloride is a common and clinically significant biomarker, underscoring the need to monitor and manage both high and low chloride levels in critically ill patients. Future large-scale studies are needed to validate these results.

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