Original Investigation  Caring for the Critically Ill Patient Development and Validation of the Sequential Organ Failure Assessment (SOFA)-2 Score Otavio T. Ranzani, Mervyn Singer, Jorge I. F. Salluh, et al JAMA Published Online: October 29, 2025 doi: 10.1001/jama.2025.20516 Key Points Question  Does an updated Sequential Organ Failure Assessment (SOFA)-2 score describe organ dysfunction in critically ill patients and its association wi...

Editorial  Capillary Refill Time in Sepsis—Searching for the Holy Grail Flavia R. Machado, Matthew W. Semler JAMA Published Online: October 29, 2025 doi: 10.1001/jama.2025.20518 Almost 25 years ago, a landmark trial of early goal-directed therapy (EGDT) by Rivers and colleagues reshaped the care of septic shock by introducing the concept that “early” management was crucial.1 Although implementation has varied across high- and low-resource settings, the...

Original Investigation  Caring for the Critically Ill Patient Sodium Bicarbonate for Severe Metabolic Acidemia and Acute Kidney Injury: The BICARICU-2 Randomized Clinical Trial Boris Jung, Mathieu Jabaudon, Audrey De Jong, et al JAMA Published Online: October 29, 2025 doi: 10.1001/jama.2025.20231 Key Points Question  For patients with severe metabolic acidosis and moderate to severe acute kidney injury, does sodium bicarbonate infusion ...

Original Investigation  Caring for the Critically Ill Patient Personalized Hemodynamic Resuscitation Targeting Capillary Refill Time in Early Septic Shock: The ANDROMEDA-SHOCK-2 Randomized Clinical Trial The ANDROMEDA-SHOCK-2 Investigators for the ANDROMEDA Research Network, Spanish Society of Anesthesiology, Reanimation and Pain Therapy (SEDAR), and Latin American Intensive Care Network (LIVEN) JAMA Published Online: October 29, 2025 doi: 10.1001/jama...

EDITORIAL A Less Invasive Approach to Intensive Care Hayley B. Gershengorn N Engl J Med Published October 29, 2025 DOI: 10.1056/NEJMe2512006 The intensive care unit (ICU) conjures images of unconscious patients surrounded by machines and penetrated by devices — endotracheal tubes, surgical drains, and urinary, venous, and arterial catheters. Although this scenario may be necessary for some patients, for many, high-quality studies have shown benefits of a di...

EDITORIAL Glucocorticoids for Pneumonia in Africa — Old Therapy, New Context Arthur Kwizera, Martin W. Dünser Published October 29, 2025 DOI: 10.1056/NEJMe2514533 The African continent is home to 1.55 billion people, one fifth of the world’s population, spread over an area larger than the United States, China, and India combined. The disease burden is enormous,1 and health care resources are severely constrained. In one multinational survey, one i...

ORIGINAL ARTICLE Deferring Arterial Catheterization in Critically Ill Patients with Shock Grégoire Muller, Damien Contou, Stephan Ehrmann, et al N Engl J Med Published October 29, 2025 DOI: 10.1056/NEJMoa2502136 Abstract BACKGROUND In patients with shock, whether noninvasive blood-pressure monitoring is an effective alternative to the recommended use of an arterial catheter is uncertain. METHODS In this multicenter, open-label, noninferiority tr...

ORIGINAL ARTICLE A Pragmatic Trial of Glucocorticoids for Community-Acquired Pneumonia Ruth K. Lucinde, Henry Gathuri, B.Sc., Paul Mwaniki, et al N Engl J Med Published October 29, 2025 DOI: 10.1056/NEJMoa2507100 Abstract BACKGROUND Adjunctive glucocorticoids may reduce mortality among patients with severe community-acquired pneumonia (CAP) in well-resourced settings. Whether these drugs are beneficial in low-resource settings with limited diagnostic ...

Machine Learning vs Humans: Identifying Trauma Patients in Need of Haemorrhage Control Resuscitation In ICU Mon, 16 Jun 2025 Timely identification of haemorrhage control resuscitation (HCR) needs in trauma patients is challenging due to inconsistent recognition and decision-making, which delay treatment and harm outcomes. Traditional clinical tools like scores and flowcharts are easy to use but often lack predictive accuracy and are poorly integrated i...

ORIGINAL ARTICLE Selective Decontamination of the Digestive Tract during Ventilation in the ICU The SuDDICU Investigators for the Australia and New Zealand Intensive Care Society Clinical Trials Group and the Canadian Critical Care Trials Group N Engl J Med Published October 29, 2025 DOI: 10.1056/NEJMoa2506398 Abstract BACKGROUND Whether selective decontamination of the digestive tract (SDD) reduces mortality among patients undergoing mechanical venti...