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Edition 11September 1, 2026

High-yield critical care science, written every week

Andes Virus Outbreak,ECMO Weaning Protocols,and Geriatric Delirium Bundles

This week, we dissect the clinical manifestations of the 2026 Andes virus outbreak, evaluate a standardized sweep gas challenge for VV-ECMO weaning, and analyze non-pharmacological interventions to prevent delirium in older ICU patients.

Articles
01
Briefs
02
Pearls
02
min read
2
This edition covers
Andes Virus PathogenesisVV-ECMO Sweep Gas ChallengeGeriatric Delirium Prevention

Featured articles

01

01
Epidemiological CohortVirology JournalCEBM 2b
Neutral

Incidence, pathogenesis, clinical manifestations, and pharmacological management of the 2026 Andes virus outbreak

Virology Journal · 2026 · DOI: 10.1186/s12985-026-03298-9

The 2026 Andes virus outbreak highlights a severe clinical phenotype characterized by rapid-onset capillary leak, thrombocytopenia, and refractory cardiogenic shock. This observational cohort delineates the pathophysiological cascade where viral hantavirus cardiopulmonary syndrome (HCPS) triggers intense endothelial activation and myocardial depression.

Pharmacological interventions, including ribavirin, showed no mortality benefit when initiated late in the course of the disease. Early supportive care remains the cornerstone of therapy, with a high proportion of patients requiring advanced respiratory and circulatory support.

Also in this edition

02

02Positive
RCTIntensive Care MedCEBM 1b

Standardized Sweep Gas Challenge Protocol for Venovenous Extracorporeal Membrane Oxygenation Weaning: A Randomized Controlled Trial

Intensive Care Med · 2025 · n = 180

This multicenter randomized trial evaluated a standardized sweep gas challenge protocol for weaning patients from venovenous extracorporeal membrane oxygenation (VV-ECMO). Patients randomized to the protocol underwent a structured reduction of sweep gas to 0 L/min over 4 hours while maintaining baseline ventilator settings. The protocol significantly reduced the time to decannulation and lowered the rate of post-decannulation respiratory failure compared to unstructured clinical weaning.

View original article
03Positive
RCTJAMACEBM 1b

Multicomponent Non-Pharmacological Delirium Prevention Bundle in Critically Ill Older Adults: The SAFE-BRAIN Randomized Trial

JAMA · 2026 · n = 450

The SAFE-BRAIN trial investigated the efficacy of a multicomponent, non-pharmacological delirium prevention bundle in critically ill patients aged 65 and older. The intervention integrated early mobilization, cognitive stimulation, sleep hygiene protocols, and sensory support (hearing aids/glasses). The bundle demonstrated a significant increase in delirium-free and ventilator-free days, alongside a reduction in overall ICU length of stay.

View original article

Quick hits · clinical pearls

02

Mechanical Ventilation01

Driving Pressure Optimization

Keep driving pressure below 15 cmH2O by adjusting tidal volume and PEEP. This directly correlates with survival in severe ARDS.

Geriatric ICU02

Dexmedetomidine vs. Propofol

In elderly patients requiring light sedation, dexmedetomidine may reduce the incidence of transition to active delirium compared to propofol.

Resources

Podcasts

Further reading

Courses & updates

Closing note

The clinical researcher must always be guided by the spirit of systematic doubt.
Claude Bernard · Lectures on Experimental Medicine · 1865

Clinical humility requires us to constantly question our weaning protocols and supportive strategies. Let the physiology guide your bedside decisions.

— Caroline

Next edition — Issue #12

Coming up next week

  • 01Right ventricular failure in ARDS
  • 02Inhaled vasodilators in severe hypoxemia
  • 03Early tracheostomy timing