Adrenoceptor physiology in shock, and the negative NEXIS trial

Confirmed via criticalcarereviews.com journal-watch (full listing through Aug 20 pulled — nothing dated Aug 21–23 yet), hot-trials (nothing past Aug 17/CHIPS), academic.oup.com advance articles for EHJ/EJCTS/AJRCCM/CID (all reachable, nothing new or major dated Aug 21–23 in core priority journals), and targeted WebSearch per journal and society. The genuinely quiet stretch continues — third run in a row.

1. Cardiovascular adrenoceptors physiology in patients with shock

Journal · Published: Intensive Care Medicine, Understanding the Disease review, epublished 19 August 2026 — genuinely new Jozwiak, Singer, Annane

Reviews alpha and beta adrenoceptor physiology in shock: prolonged catecholamine exposure causes receptor desensitisation; beta-3 receptors are relatively upregulated and resistant to downregulation; downstream signalling is impaired alongside mitochondrial dysfunction. The result is vasopressor resistance and escalating catecholamine doses with their attendant harms — arrhythmia, immunosuppression. Discusses catecholamine-sparing strategies (vasopressin, angiotensin II) and receptor-restoring therapies (corticosteroids, cholesterol repletion).

Interpretation. No new primary data — this ties the mechanistic rationale together for established trials (VASST, ATHOS-3 for angiotensin II, CORTICUS/ADRENAL for corticosteroids). The authors are prominent shock and sepsis physiologists: Singer at UCL, Annane behind the corticosteroids-in-septic-shock trials.

Read the paper

2. NEXIS — Nutrition and Exercise in Critical Illness

Journal · Published: AJRCCM, online 13 July 2026 — ~6 weeks old, sent as a still-fresh notable negative trial rather than “new this week” Needham, Files, Hough et al.

RCT across 9 US academic centres, N=115 patients with acute respiratory failure. Combined early in-bed cycling plus IV amino acid supplementation vs usual care. Outcomes: mobility, strength, physical function, quality of life and cognitive function, in hospital and at 6 months.

Result: the intervention was safely deliverable but produced no significant improvement in any recovery outcome versus usual care. A negative trial.

Interpretation. This addresses a decade-long research arc on combined exercise-plus-protein interventions for ICU-acquired weakness and PICS, and contrasts with positive results for similar combined interventions in frail or elderly non-ICU populations. The authors propose anabolic resistance during early critical illness as the likely explanation, redirecting the field toward right-patient/right-time personalisation rather than blanket early mobilisation plus nutrition.

Read the paper

Considered but not sent

• STS Adult Cardiac Surgery Database: 2026 Update on Outcomes and Research (Hui, Iribarne et al.) — Annals of Thoracic Surgery, 1 June 2026. Registry status and methods report covering 8.6M+ surgeries, not a discussion-generating trial — lower priority per the established pattern.
• A Randomized Trial of Acute Normovolemic Hemodilution in Cardiac Surgery — NEJM, PMID 40503713. Older than the ~5-year-but-still-hot bar was checked for, but from mid-2025 and still generating a JCVA commentary and a BJA comment thread into 2026. (Sent on 2026-08-25.)
• Ultrasound-guided thoracic paravertebral block vs erector spinae plane block for cardiac surgery with median sternotomy (noninferiority RCT) — Br J Anaesth 2025;135:764–71. Directly on topic (regional anaesthesia plus cardiothoracic) but BJA fulltext and abstract fully blocked this run — 403 on bjanaesthesia.org, 402 on Ovid, sciencedirect abstract page also inaccessible. Could not confirm even basic design or results without risking fabrication. Still outstanding.
• CHAMPION-AF vs CLOSURE-AF viewpoint (Omerovic & Redfors) — European Heart Journal, 20 Aug 2026. Commentary reconciling two LAA-closure-vs-anticoagulation trials (CHAMPION-AF presented at ACC 2026 in March); secondary-scope cardiology, viewpoint not primary data.
• Companion items on the same Aug 19 ICM list — Millot et al. multiplex PCR/antibiotic therapy; Elbers AI/RL editorial; Guan AKI-RRT guideline — either unconfirmable or lower priority. (Millot resolved and sent 2026-08-24.)