Multisociety sepsis position paper, trauma nutrition protocol, and two definitions of heart failure that disagree

Nothing new from the French societies since yesterday’s check (SFAR, SRLF, SPILF). ESC Congress continues through 31 August; yesterday’s ESC heart failure guidelines and Fifth Universal Definition of MI are in the 28 August entry.

1. Multisociety position paper — hospital strategies to improve sepsis outcomes

Society · Published: IDSA, convening ACEP, ASM, PIDS, SCCM, SHEA, SHM and SIDP. Clinical Infectious Diseases, 25 August 2026 — genuinely new, 4 days old Rhee, Masur, Klompas et al.

The stated gap: CMS and CDC are advancing new sepsis quality measures focused on outcomes and hospital programmatic capacity, and the Surviving Sepsis Campaign covers bedside management — but nothing addresses hospital-based strategy across the continuum of care. This fills that, focused on the infection-related aspects, across six domains: diagnostic testing and pathogen detection, antimicrobial management and delivery, surveillance and performance metrics, adjunctive therapy, program infrastructure and organisational support, and infection prevention.

Concrete examples the panel gives:

• Multiplex nucleic acid amplification testing on positive blood cultures, paired with active stewardship support
• Optimising workflows for timely antibiotic delivery in septic shock
• Clinical decision support to prioritise β-lactam administration before vancomycin when both are ordered
• Defaulting antipseudomonal β-lactams to prolonged infusion in critically ill patients
• EHR-based sepsis surveillance
• Tracking rates of inadequate empiric therapy, unnecessarily broad empiric therapy, antibiotic de-escalation, and timeliness of source control

Interpretation. The β-lactam-before-vancomycin recommendation is the one to act on tomorrow: it costs nothing, it is a pure ordering problem, and it addresses a real delay that nobody designed and everybody tolerates. Prolonged-infusion β-lactams as the default rather than an option is the other substantive shift, and it aligns with the Hong et al. prolonged-infusion paper noted on 25 August.

Read the framing as a deliberate move away from SEP-1. That measure drove broad-spectrum antibiotics and fluid bundles regardless of phenotype, and the criticism — much of it from Rhee and Klompas themselves — was that it optimised documentation rather than care. This paper’s metrics are notably about appropriateness (inadequate empiric therapy, unnecessarily broad therapy, de-escalation) rather than speed alone. That is the argument being won in public.

Read the position paper · PMID 42640090

2. AAST/ACS clinical protocol — nutrition support in adult trauma

Society · Published: American Association for the Surgery of Trauma with the ACS Committee on Trauma. Journal of Trauma and Acute Care Surgery, 26 August 2026 — genuinely new, 3 days old Valenzuela, Haines, Sachdev, Napolitano et al.

• Assess every patient for malnutrition — the hypermetabolic state of acute trauma can worsen malnutrition risk during the acute phase
• ICU patients: determine nutrition risk (high vs low) with modified NUTRIC or NRS, and evaluate for malnutrition
• Indirect calorimetry is most accurate for calorie and protein requirements in the critically ill
• Early enteral nutrition once resuscitation is complete; continuous gastric feeds, with postpyloric jejunal feeding where aspiration risk is high
• Feeding intolerance and ileus: prokinetics first, then a postpyloric tube if intolerance persists
• Parenteral nutrition if enteral is contraindicated (obstruction, severe ileus, high-output fistula, ischaemia) or goal enteral cannot be reached
• Shock on vasopressors: individualised, weighing early enteral nutrition against the risk of non-occlusive mesenteric ischaemia
• Geriatric, obese and cirrhotic trauma patients warrant specialised care
• Immunonutrition, glutamine and probiotics/prebiotics are not recommended for trauma or burn patients

Graded Level V, therapeutic/care management.

Interpretation. The negative recommendations carry the most weight. Glutamine has been formally dead since REDOXS (NEJM 2013) showed increased mortality, yet it persists in protocols; immunonutrition has been fading since the sepsis signal in the 2000s. Seeing all three named and excluded in one line is useful for anyone still maintaining a local formulary.

The vasopressor paragraph is the honest one — it declines to give a rule, which is right, because the evidence for early enteral nutrition in shock (NUTRIREA-2 and NUTRIREA-3) points at harm in the sickest without defining a threshold. Note this is Level V evidence throughout: a protocol built on expert consensus, not trials.

Read the protocol · PMID 42647750

3. Empyema and chylothorax — management algorithm

Society · Published: Journal of Trauma and Acute Care Surgery Emergency General Surgery Algorithms work group, 24 August 2026 — genuinely new, 5 days old Winchell, Biffl, Costantini, Diaz, Inaba, Livingston, Martin, Napolitano, Salim et al.

Access note: no abstract is deposited for this one, and the full text was not reachable. Recorded here as a pointer, not summarised — I have not seen the algorithm’s content and will not guess at it.

Directly relevant to thoracic surgical practice, and worth retrieving if empyema management is a live question in your unit. The Emergency General Surgery Algorithms series is deliberately practical and cost-conscious in framing.

Article page · PMID 42635972

4. Second Universal Definition of Heart Failure (2026)

Society · Published: AHA, ACC, ESC and WHF, with HFSA, HFA and JHFS. Circulation and JACC, ~June 2026 — ~3 months old, appearing now in the European Heart Journal print issue, which is why the aggregator surfaced it today.

• Moves away from rigid LVEF cutoffs, grouping heart failure into reduced, preserved and improved ejection fraction
• Reaffirms the four stages — A at risk, B pre-heart failure, C heart failure, D advanced — and centres Stage B as the critical window for early detection, monitoring and proactive individualised intervention
• Adds a universal classification by cause, to standardise how aetiology is reported in practice and research
• Addresses dynamic trajectories — improvement, remission, recovery — and the effect of social determinants and geographic variation

Interpretation, and a genuine tension worth noticing. Yesterday’s 2026 ESC heart failure guidelines collapsed the phenotypes to two, defined by a hard cutoff: HFrEF below 50%, HFpEF at or above 50%. This document, which ESC co-authored, explicitly moves away from rigid cutoffs and keeps a three-way grouping that includes improved EF — a category the ESC scheme has no place for.

Both are current, both carry ESC’s name, and they classify the same patients differently. The improved-EF group is the substantive disagreement: a patient whose EF recovers from 30% to 55% is HFpEF under the ESC guideline and HFimpEF under the universal definition, and those labels imply different things about whether to continue therapy. Worth watching how this gets reconciled — and worth being precise about which document you are citing when it matters.

Circulation · JACC · PMID 42366993

5. Cardiac ultrasound in cardiovascular emergency and critical care

Society · Published: European Association of Cardiovascular Imaging, the Acute CardioVascular Care Association, and the European Association of Cardiothoracic Anaesthesia and Intensive Care (EACTAIC). EHJ Cardiovascular Imaging, 1 October 2025 — ~11 months old, not new. The aggregator listed it today; the listing date is not the publication date. Soliman Aboumarie, Tavazzi, Via, Guarracino, Stankovic, Hagendorff, Gargani et al.

No abstract is deposited, so this is recorded as a pointer rather than summarised.

Included despite its age because it has never been surfaced here and EACTAIC is a directly relevant co-author — this is the cardiothoracic anaesthesia and intensive care community’s own consensus on echo in the emergency and critical care setting, with Guarracino and Tavazzi among the authors.

Article page · PMID 40838793