Round Table @ISICEM: Rethinking ICU Myths and Misconceptions
- In ICU
- Wed, 18 Mar 2026
An interesting Round Table session @ISICEM, Rethinking ICU myths and misconceptions, challenged clinicians to reconsider how much of intensive care practice is truly evidence-based versus driven by entrenched beliefs.
The expert meeting aimed not simply to criticise current practices, but to understand how and why certain clinical beliefs become embedded, even when evidence is weak, outdated, or evolving. These beliefs often persist because they are repeatedly taught, reinforced by senior clinicians, and supported by cognitive and cultural factors within medicine.
The Round Table highlighted several widely accepted practices that may lack strong evidence or be oversimplified, including:
- Fixed transfusion thresholds (e.g. haemoglobin of 7 g/dL)
- Giving fluids solely because a patient is fluid responsive
- Universal mean arterial pressure target of 65 mmHg
- Routine use of decompressive craniectomy
- Maintaining high sodium in neurological patients
- Treating oliguria with fluids
- Overestimating contrast-induced nephrotoxicity
- Measuring gastric residual volumes to prevent aspiration
Several mechanisms explain their persistence:
- Action bias: clinicians feel compelled to “do something,” even with uncertain evidence
- Preference for simple rules: thresholds and targets simplify decision-making but may ignore physiological complexity
- Misinterpretation of evidence: overinterpreting weak signals or assuming lack of contradiction equals proof
- Cultural reinforcement: repeated teaching, audits, and influence of senior role models
- Publication and conference bias: selective emphasis can amplify certain ideas
Myths and misconceptions have significant consequences:
- Patient harm: unnecessary interventions, complications, discomfort, and delayed recovery
- Opportunity cost: misallocation of staff time and resources
- Practice variation: inconsistent, non-reproducible care
- Erosion of trust and slowed learning: difficulty adopting new evidence and confusion when practices are reversed
A key contribution of the report was clarifying these terms:
- Myths: strongly held beliefs treated as fact despite weak or absent evidence → should be actively debunked
- Misconceptions: incorrect or oversimplified interpretations of real evidence → require clarification
- Controversies: areas with incomplete or conflicting evidence → require ongoing research and open debate
Historically, haemoglobin targets around 10 g/dL were standard until the TRICC trial showed that restrictive strategies could be as good or better. However, this led to a new misconception: that 7 g/dL is universally optimal. Subsequent trials (e.g. HEMOTION, TRAIN, SAHARA) suggest that thresholds should vary by patient group, particularly in neurological populations.
A central theme was that uncertainty is unavoidable in critical care, where definitive trials are often lacking. Evidence-based medicine requires integrating research evidence with clinical expertise and patient context, rather than relying on rigid rules.
Improving ICU practice requires both scientific and cultural change:
- Question entrenched assumptions
- Interpret evidence more carefully
- Accept and tolerate uncertainty
- Align actions with evolving data rather than tradition
Overall, this expert meeting clearly established that progress in intensive care depends not only on new discoveries, but on the willingness to critically reassess long-standing practices that may no longer be justified.
Source: ISICEM Congress
Image Credit: ISICEM
