Critical Care Time 64. JC4: End of 2025 Journal Club
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Dec 15, 2025 This week features a fascinating journal club exploring whether A-lines should be discarded and the efficacy of bicarbonate for treating metabolic acidosis in AKI. The discussion dives into the selective decontamination trial, revealing no mortality benefit but interesting microbiology insights. We also learn about the EVERDAC trial, which challenges the need for early arterial lines. Lastly, a new approach to shock management using capillary refill guidance shows promise in personalized care, promoting tailored interventions while reducing unnecessary treatments.
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SDD Targets Gut Pathogens And Unit Ecology
- Selective decontamination of the digestive tract (SDD) aims to suppress pathogenic gut and oropharyngeal organisms using topical non-absorbable antibiotics plus a short IV course.
- The Sud-ICU trial was designed to test both clinical benefit and ecological resistance effects at the ICU level rather than just individual patients.
Cluster Crossover Captures Unit Effects
- Cluster crossover randomization randomizes ICUs not patients to capture unit-level ecological effects of interventions like SDD.
- That design reduces patient-level power and risks non-stationarity affecting results across time and sites.
SDD Reduced Bacteremia But Not Mortality
- The Sud‑ICU trial showed no significant 90‑day mortality benefit for SDD versus standard care.
- However, SDD reduced ICU-acquired bloodstream infections and patient-level acquisition of resistant organisms in the Australian cohort.