Multiplex PCR in VAP, and dapagliflozin for post-cardiac-surgery AKI

Fourth consecutive quiet run. criticalcarereviews.com journal-watch had posted nothing after Thursday Aug 20 (checked twice, explicitly asked for Aug 21–24 — absent); the hot-trials page was unchanged since Aug 17/CHIPS. EHJ advance articles for Aug 20–21 were all editorials and viewpoints. link.springer.com ICM online-first was the productive source this run.

1. Multiplex PCR and targeted antibiotic therapy in suspected VAP/HAP

Journal · Published: Intensive Care Medicine, online 20 August 2026 — genuinely new Millot, Rouzé, Nseir et al.

Multicentre single-blind RCT in immunocompetent adults with suspected VAP or ventilated HAP, enrolled Jun 2020–Sep 2023. 156 randomised, 146 analysed (74 FilmArray Pneumonia Panel plus conventional microbiology vs 72 conventional microbiology alone).

• Primary outcome — targeted antimicrobial therapy within 24 h: 35.1% vs 23.6%, absolute difference 11.5%, p=0.13 (not significant).
• Culture-documented pneumonia subgroup (45.9% of the cohort): 55.3% vs 31.0%, p=0.048.
• Conclusion: FAPP did not significantly increase targeted antimicrobial therapy at 24 h except in confirmed pneumonia.

Interpretation. More equivocal than MULTI-CAP (ICM 2025) and the 2023 SARS-CoV-2 pneumonia multiplex+PCT RCT (Clin Microbiol Infect), both of which reduced antibiotic exposure. Small n and COVID-era enrolment mean this is likely null-by-imprecision rather than a clean negative.

Note: this is the same Millot item flagged “could not confirm” on 2026-08-23 — resolved via link.springer.com ICM online-first.

Read the paper

2. MERCURI-2 — Dapagliflozin and AKI following cardiac surgery

Journal · Published: JAMA, 30 July 2026 — ~3.5 weeks old, sent as recent-but-not-new, widely picked up Oosterom-Eijmael et al.

Double-blind placebo-controlled RCT across 7 Dutch hospitals (2 academic, 5 non-academic), N=784 randomised / 778 completed; median age 68, 76% male, BMI 27. Dapagliflozin 10 mg daily vs placebo — four doses only, from the day before surgery through POD2.

• Primary outcome — AKI within 7 days (KDIGO): 28% vs 52%, RR 0.54, p<0.001.
• No secondary outcome improved: postoperative AF 45% in both arms, reoperation 11% vs 10%.

Interpretation. Cardiac-surgery-associated AKI prophylaxis has been a graveyard of negative trials — RIPC, statins, NAC, bicarbonate, with PrevAKI bundles the partial exception. SGLT2 inhibitors arrived here from DAPA-CKD/EMPA-KIDNEY/DAPA-HF plus a small 2025 J Clin Anesth open-label pilot. This is the first adequately powered RCT with an acute perioperative renal signal.

Caveats flagged to the user: the 52% placebo AKI rate is very high, and no downstream outcome moved (dialysis, LOS, mortality, CKD). A creatinine/urine-output endpoint shifting without clinical endpoints is exactly the debate this will generate.

Read the paper · PMID 42530910

3. EVERDAC — Deferring arterial catheterization in shock

Journal · Published: NEJM, 6 November 2025, presented at ESICM LIVES 2025 — ~9.5 months old, sent explicitly as older-but-still-hot

Multicentre randomised noninferiority trial, 9 French hospitals, Nov 2018–Nov 2022, CRICS-TRIGGERSEP. N=1,010 adult ICU patients with circulatory shock (median age 67, mostly medical/septic shock, 87–90% on vasopressors); excluded BMI>40, severe TBI, ECMO, vasopressors >2.5 µg/kg/min. Arterial line within 4 h vs noninvasive BP with protocolised rescue.

• 28-day all-cause mortality 34.3% vs 36.9%, adjusted risk difference −3.2 pp (95% CI −8.9 to 2.5), p=0.006 for noninferiority, margin 5 pp.
• Haematoma/haemorrhage 1.0% vs 8.2%; pain or discomfort ≥1 day 13.1% vs 9.0%.
• 14.7% of the noninvasive arm crossed over to a rescue arterial line.

Interpretation. The first RCT on a near-universal reflex previously supported only by observational data (Gershengorn propensity analyses, both null for mortality) and by the known unreliability of oscillometric BP at low flow. It doesn’t abolish arterial lines — 15% rescue rate, and high-dose vasopressor patients were excluded — but it shifts the default. The NEJM editorial: “A Less Invasive Approach to Intensive Care.”

Read the paper · PMID 41159885

Considered but not sent

• OFACAR — Opioid Free anesthesia in cardiac surgery: the OFACAR randomized clinical trial — Anesthesiology, DOI 10.1097/ALN.0000000000006164, PMID
  1. Directly on topic and appears recent, but journals.lww.com returned 402 and PubMed 429 on every attempt; the Ovid mirror is also LWW-gated. Could not confirm design, results, or exact publication date — flagged to the user as blocked with an offer to write it up from a supplied PDF. High priority.
• EHJ Aug 20–21 advance articles (Ji — statins and frailty; Pennells — transformer models for CV risk; McCarthy — periodontitis/CHD editorial; Marwick — MRA in cardio-kidney-metabolic disease of cancer survivors): all editorials or viewpoints, secondary scope, no primary data.
• CCR journal-watch Aug 20 list (Dauw cardiorenal device therapies; Ma vasopressin/steroids/epinephrine in IHCA; Assimakopoulos newer beta-lactams for CR-GN; Gonzalez-Barbuzano sepsis biomarkers; Albertse APRV pathway; Hewson BJA Educ stats series): all narrative or expert reviews. The Ma triple-therapy IHCA review and the Assimakopoulos beta-lactam review are the two worth reconsidering on a future quiet week.