Early mobilization's third null, plus β-blockade in critical illness
Two same-day ICM items, the MARCH deimplementation trial, and the 5th PONV consensus guidelines.
A good day: two genuinely same-day items plus two older-but-relevant ones.
1. EVER trial — early mobilization for mechanical ventilation in sepsis/ARF
Journal · Published: Intensive Care Medicine, 26 August 2026 — genuinely new, same-day Chung, Hong, Suh et al.
Multicentre, open-label RCT across 5 Korean tertiary hospitals (2020–2024). Adults with sepsis or respiratory failure expected to need ≥48 h of ventilation, randomised to a structured six-step early mobilization programme vs usual care (N=169: 93 intervention / 76 usual care).
- Primary outcome — functional status at ICU discharge (FSS-ICU) — was null: 23.6 vs 22.2, P=0.44.
- And that is despite the intervention working as intended: mobilization started earlier (30.0 vs 45.9 h) and happened far more (11 vs 4 sessions, 330 vs 120 total minutes).
- A subgroup reaching a higher mobilization “step” did better — but that is confounding by indication, since sicker patients can’t reach that step. It is not a dose-response signal. Worth being cautious about that distinction if you see it cited.
Interpretation. The third consecutive null trial in this arc, after TEAM (NEJM 2022) and NEXIS (AJRCCM, sent here in July/August). The field seems to be shifting from “does more mobilization help” toward “who and when” — see the AJRCCM “mobilizing smarter, not harder” editorial.
2. State-of-the-art review: β-blockade in critical illness
Journal · Published: Intensive Care Medicine, 26 August 2026 — genuinely new, same-day (review, not new trial data) Ostermann, De Backer, Belley-Côté, Cecconi, Citerio et al.
A heavyweight ESICM-affiliated author panel concludes that β-blockade “remains highly context-dependent and controversial.” Solid evidence in acute MI, tachyarrhythmias, hypertensive emergencies, thyroid storm and variceal bleed prevention; “limited or conflicting” in septic shock, TBI, acute heart failure and burns. They call for a phenotype-driven, physiology-guided approach rather than routine use.
Interpretation. This is essentially the field’s institutional voice declining to endorse routine β-blockade in septic shock, following Morelli’s 2013 JAMA esmolol trial (never replicated) and STRESS-L (JAMA 2023, stopped early). It also reads directly against the Jozwiak/Singer/Annane adrenoceptor-physiology review sent here on 23 August — same physiological premise, more cautious practical conclusion.
3. MARCH trial — carbocisteine or hypertonic saline for acute respiratory failure
Journal · Published: NEJM, online 10 June 2026 — ~2.5 months old, sent as recent-but-not-new Connolly & McAuley et al.
Large pragmatic 2×2 factorial RCT, 71 UK ICUs, N=1,956.
- Neither carbocisteine nor nebulised hypertonic saline shortened ventilation duration (HR 0.96 and 1.00) — both null with tight confidence intervals, a real negative rather than underpowered noise.
- The notable part is harm. Carbocisteine caused clinically important upper GI bleeding in 1.4% vs 0.2% — a 6.5× risk. Hypertonic saline caused hypoxaemia during nebulisation in 4.1% vs 0.3%.
Interpretation. A clean deimplementation trial. These mucoactive agents were adopted in ICU on physiological plausibility carried over from cystic fibrosis and bronchiectasis care, and were never properly tested. The harm signal is the practice-changing part.
4. Fifth Consensus Guidelines for PONV Management: Executive Summary
Journal · Published: Anesthesia & Analgesia, online November 2025 / print September 2026 — ~9 months old, sent as older-but-still-landing, since it is only now filtering into department protocols Gan, Jin, Ayad, Habib, Kranke, Chung et al.
The first full rewrite since the 4th consensus (2020). Pushes toward near-universal multimodal PONV prophylaxis rather than rationing by Apfel risk score, with the best-supported two-drug pairings — 5-HT3 + dexamethasone, 5-HT3 + aprepitant, aprepitant + dexamethasone, ondansetron + haloperidol — and explicitly caps at two drugs, not three.
Access note: the full abstract was paywalled everywhere tried, so this summary comes from a secondary source (UIC Drug Information Group) and is flagged as such.
Interpretation. Effectively concedes that risk-scoring discriminates too poorly to justify rationing cheap, safe antiemetics — a real practice shift if it takes hold.