THE EVIDENCE LIBRARY
Primary research and guidance, with the clinical context kept in.
PREOXI randomized 1,301 critically ill adults to NIV or an oxygen mask before intubation. Hypoxemia (SpO2 <85%) occurred in 9.1% versus 18.5% (absolute difference -9.4 percentage points; 95% CI -13.2 to -5.6).
The 2026 AAP guideline expands UTI guidance to medically noncomplex children from 8 days through 5 years and uses GRADE methodology. It suggests antibiotic courses of 7 days or less for most children, with age- and syndrome-specific durations, and recommends oral rather than hospitalization-requiring parenteral or sequential therapy for children older than 28 days and younger than 5 years who tolerate oral treatment and do not otherwise require admission. It also updates post-UTI imaging, including renal/bladder ultrasonography after a first febrile UTI and a suggestion against routine VCUG when ultrasonography is normal.
VASSPR was a pragmatic, open-label, cluster-randomized cluster-crossover strategy trial across 13 US hospitals involving 3,959 adults receiving vasopressors for septic shock. Hospitals alternated between recommending fixed-dose vasopressin 0.03 U/min when other vasopressors reached 0.1 versus 0.4 micrograms/kg/min norepinephrine-equivalent. Twenty-eight-day mortality was 31.8% versus 33.0% (adjusted marginal OR 0.98, 95% CI 0.87-1.06; adjusted risk difference -0.4 percentage points, 95% CI -2.7 to 1.3), with no difference in kidney replacement therapy-free days.
CLOVERS randomized 1,563 adults after initial fluid resuscitation to a restrictive strategy prioritizing vasopressors or a liberal fluid strategy. Death before discharge home by day 90 occurred in 14.0% versus 14.9% (difference -0.9 percentage points; 95% CI -4.4 to 2.6; P=0.61).
In 1,417 critically ill adults, video laryngoscopy achieved first-pass success in 85.1% versus 70.8% with direct laryngoscopy (difference 14.3 percentage points; 95% CI 9.9 to 18.7). Severe complications occurred in 21.4% versus 20.9% (difference 0.5 points; 95% CI -3.9 to 4.9).
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