ISSUE 3 · 15 MARCH 2026
Anaesthetics & ICU Evidence Rundown
Anaesthesia, Critical Care & Perioperative Medicine · Weekly Evidence Update
Jake Turner
Curated with the assistance of AI (Perplexity). All content editorially reviewed.
This week: GPICS V3 redefines the minimum standards for every UK intensive care unit, the AAGBI/BIHS perioperative blood pressure guidelines raise the threshold for surgical delay — potentially ending thousands of unnecessary cancellations. Plus a practice-changing NEJM trial asks whether we really need arterial lines in all shocked patients, the FIBERTRACH RCT challenges routine bronchoscopy during tracheostomy, S-ketamine shows a compelling NNT of 8 for delirium prevention, and a BJA meta-analysis quantifies why femoral nerve blocks are falling out of favour.
EVIDENCE QUALITY LEGEND
| CHANGE PRACTICE | RCT | GUIDELINE | SAFETY ALERT | META-ANALYSIS | CONSENSUS |
|---|---|---|---|---|---|
IN THIS ISSUE
- UK Guidelines & Safety — GPICS V3 CHANGE PRACTICE, AAGBI/BIHS BP Guidelines CHANGE PRACTICE, Safe Drug Management 2026, NICE NG24 TXA expansion, CPOC Paediatric Perioperative Guidance
- Critical Care & Key Trials — EVERDAC (arterial lines in shock), ACTiVE (automated ventilation), FIBERTRACH (bronchoscopy in PDT), S-Ketamine POD, PEFB vs PVB Rib Fractures, Femoral Nerve Block & Falls SR/MA
- International Guidelines — ASA Fascial Plane Blocks, SCCM Crisis Resource Allocation
- FOAMed & Critical Appraisal — The Bottom Line February Roundup, PulmCrit PE Guidelines Critique
- Quick Hits — 14 further items across regional, cardiac, vascular access, ventilation, sedation, and critical appraisal
01 · UK GUIDELINES & SAFETY
GPICS Version 3 — Guidelines for the Provision of Intensive Care Services
FICM / ICS · Published 28 January 2026 · FICM announcement
The third edition of GPICS is the definitive reference for planning, commissioning and delivering adult intensive care in the UK — published a decade after GPICS V1 (2015). Key updates include: enhanced care (Level 1) integration with 30 new enhanced care interfaces; new terminology distinguishing "minimum standards" from "recommendations to provide a quality service"; new chapters on burn care, neurocritical care, and remote/rural ICUs; and updated workforce standards for ACCPs, nurses, and AHPs.
GPICS V3 covers airway management, respiratory, cardiovascular, renal, GI/nutrition, neurological, and infection control standards. It is the document by which ICUs are peer-reviewed by the CQC and other regulators — and underpins business cases for service development.
- Why it matters: GPICS V3 sets the UK standards for every ICU. The enhanced care chapter is particularly relevant to perioperative pathways. You need this for governance meetings, business cases, and your ARCP.
⚠ Tell your department: Download the full GPICS V3 PDF and review it against your unit's current configuration. The new minimum standards for enhanced care, workforce ratios, and remote/rural provision may require immediate service changes.
Source: FICM — GPICS V3 announcement | Full PDF
AAGBI/BIHS — Perioperative Blood Pressure Management Guidelines 2026
Anaesthesia · Published 14 January 2026 · DOI: 10.1111/anae.70082 · PubMed
The Association of Anaesthetists and British & Irish Hypertension Society have updated the 2016 joint guidelines on perioperative blood pressure management. Key changes:
- Scope expanded from pre-operative to the full perioperative period (decision to operate → 30 days postop)
- Accept referral if clinic BP <160/100 mmHg or home BP <155/95 mmHg within 12 months
- Surgery may proceed without documented pre-op normotension if clinic BP <180/120 or home BP <175/115 mmHg
- Clearer communication pathways between primary care, hospital teams and patients
- Excludes cardiothoracic, obstetric, and endocrine surgery
- Why it matters: Directly affects pre-operative assessment decisions — raises thresholds for postponement, reducing unnecessary surgical delays for hypertensive patients. Major practical impact on every pre-op clinic.
⚠ Tell your department: Update your pre-assessment clinic BP thresholds for surgical cancellation. The new guidelines raise the "proceed" threshold — ensure all pre-assessment nurses and anaesthetists are briefed on the updated values to avoid inappropriate on-the-day cancellations.
Source: Anaesthesia — AAGBI/BIHS Perioperative BP Guidelines 2026 | PubMed
Safe Drug Management in Anaesthetic Practice — 2026 Update
RCoA / Association of Anaesthetists / SALG · Published February 2026
The Royal College of Anaesthetists and the Association of Anaesthetists have jointly published the updated Safe Drug Management in Anaesthetic Practice guidance — the first revision since the 2020 publication. The guidance governs drug storage, access, and reconciliation across all anaesthetic environments (theatres, labour ward, ED, critical care, radiology).
Key principles: (1) Patient safety is the paramount priority above regulatory compliance; (2) Immediately Available Drugs (IADs) — including a neuromuscular blocking drug and vasoconstrictor — must be accessible without key/code/RFID lock; (3) Prefilled syringes are strongly recommended as tamper-evident, ready-to-use formats; (4) Departments must cultivate an open, vigilant culture addressing drugs of diversion risk for healthcare professionals.
⚠ Tell your department: Review local SOPs for drug storage against the 2026 guidance, particularly around IAD access procedures and drugs of diversion policy. Inspect whether emergency drugs are accessible without key actuation during a crisis.
Source: SALG — Safe Drug Management in Anaesthetic Practice 2026 | RCoA Full Guidance PDF
NICE NG24 Blood Transfusion — TXA Expanded to All Surgical Bleeding
NICE · Updated 26 February 2026
NICE NG24 (Blood Transfusion) has been updated with new recommendations on tranexamic acid use in surgery. The previous threshold — TXA only for adults expected to lose >500ml — has been removed. TXA should now be offered if: surgery is performed in an operating theatre, there is a risk of bleeding, and the procedure will breach the skin or mucous membrane. The guidance is also extended to children using the same criteria.
The change is supported by new evidence demonstrating clinical safety and cost-effectiveness even for minor blood loss procedures. A 2024 national audit found that one in four eligible patients were not receiving TXA under the old guidance — this update simplifies decision-making and should increase appropriate use.
⚠ Tell your department: TXA is now indicated for virtually all operating theatre procedures with bleeding risk — no more estimating blood loss. Ensure pre-assessment and surgical team briefings reflect the new threshold. Relevant across ENT, orthopaedic, laparoscopic, and paediatric surgery.
Source: NICE NG24 — Blood Transfusion (February 2026 update) | CPOC summary
CPOC — Best Practice Guidance: Perioperative Care Services for Children & Young People
Centre for Perioperative Care (CPOC) / RCoA · February 2026 Consultation
CPOC has published — for the first time — a best practice guidance document for perioperative care services for children and young people (aged 0–18 years), endorsed by the Royal College of Anaesthetists. The guidance describes how a CYP perioperative service should be established, delivered and governed in any hospital treating children, covering the full perioperative pathway from pre-assessment through to discharge.
The document is currently in consultation phase. Key themes include age-appropriate shared decision-making, anaesthetic lead for paediatric services, and minimum standards for safe paediatric anaesthetic environments.
Source: CPOC CYP Perioperative Services Guidance 2026 (PDF)
02 · CRITICAL CARE & KEY TRIALS
EVERDAC — Do All Shocked Patients Need an Arterial Line? (NEJM)
N Engl J Med · November 2025 (featured in NEJM 12/19 March 2026 issue) · ICU Reach Summary
EVERDAC randomised 1,010 adults with shock (admitted to ICU within 24 hours; ~90% on vasopressors, ~54% septic shock) across 9 French ICUs to either: (a) noninvasive BP monitoring with automated brachial cuff — no arterial catheter in first 4 hours, or (b) early arterial catheter insertion within 4 hours (standard care). Arterial catheterisation was permitted later in the noninvasive group if prespecified safety criteria were met.
Outcome
NIBP (noninvasive)
Invasive (A-line)
28-day mortality
34.3%
36.9%
Risk difference (adjusted)
−3.2 pp (95% CI −8.9 to 2.5) — Noninferior P=0.006
Hematoma/haemorrhage
1.0%
8.2% ↑
Catheter-related bloodstream infection
1
3
Verdict: Noninvasive BP monitoring is noninferior to early arterial catheter insertion for 28-day mortality in ICU shock patients. Arterial lines carried a significantly higher risk of haemorrhage. This does not mean "never insert arterial lines" — but it challenges the reflex of early insertion in all shocked patients.
⚡ CONTROVERSY
The EVERDAC trial kept arterial lines out of the noninvasive arm even in patients on >100 μg/min norepinephrine — an extreme protocol unlikely to reflect most UK ICU practice. Critics note the trial was conducted in predominantly medical ICUs, limiting applicability to surgical or post-operative patients. The consensus interpretation is: in haemodynamically stable shock with adequate noninvasive monitoring, defer arterial line insertion — but retain clinical discretion in the surgical/post-op context.
- Tell your department: Early arterial catheterisation is not mandatory for all shocked patients. Adopt an individualised approach — insert when there are specific clinical indications (need for frequent ABGs, haemodynamic instability on high vasopressors, post-op cardiac patients) rather than as a reflex in all cases.
Source: ICU Reach — EVERDAC Trial Summary | PulmCCM critique
ACTiVE Trial — Automated Ventilation vs Conventional: No Benefit in Ventilator-Free Days (JAMA)
JAMA · Published December 8, 2025; editorial March 12, 2026 · DOI: 10.1001/jama.2025.24384
1,514 critically ill adults requiring invasive mechanical ventilation at 7 ICUs (Netherlands and Switzerland) were randomised to INTELLiVENT-ASV (fully automated closed-loop ventilation) vs. protocolised conventional mechanical ventilation within 1 hour of ICU intubation.
Outcome
ACTiVE (ASV)
Conventional
| VFD-28 (median) | 16.7 | 16.3 |
| 28-day mortality | ~27% | ~27% |
| Extubation failure (reintubation <24h) | 7.7% | 7.3% |
The automated system showed numerically improved "ventilation quality" in the first 6 hours (more time in optimal respiratory physiology zones), but this was statistically non-significant after adjustment for multiple comparisons. The editorial (JAMA, March 2026) noted that highly optimised conventional ventilation protocols in academic ICUs is a significant barrier to demonstrating superiority of automation — this "ceiling effect" problem may limit generalisability to less-resourced settings.
- Tell your department: Automated closed-loop ventilation does not improve VFD-28 compared with optimised conventional care. Do not invest in or adopt automated ventilation systems on the premise of shorter ventilation times. Larger trials in respiratory failure subgroups are needed.
Source: JAMA — ACTiVE trial (December 2025)
FIBERTRACH — No Benefit to Routine Bronchoscopy During Percutaneous Tracheostomy
Crit Care Med · Published 2 March 2026 · DOI: 10.1097/CCM.0000000000007100 · PubMed
Multicenter RCT across 4 Spanish ICUs (n=442; 221 per arm) comparing routine fiberoptic bronchoscopy (FB) guidance vs. non-endoscopic percutaneous dilatational tracheostomy (PDT) by experienced intensivists. Primary outcome: perioperative complications.
Results: Complication rates were similar — FB group 11.3% vs. non-FB group 13.1% (95%CI −6.8 to 10.4; p=0.663). Critically, FB guidance was associated with higher peak inspiratory pressures (47.4 vs. 37.1 cmH₂O; p<0.001) and higher end-procedure PaCO₂ (44.3 vs. 41.5 mmHg; p=0.001), indicating FB adds physiological burden without reducing complications.
- Why it matters: Definitively challenges routine use of bronchoscopic guidance for PDT. When performed by experienced clinicians in patients without difficult airway features, routine FB does not reduce complications and worsens ventilatory parameters. Direct implications for ICU tracheostomy protocols and cost.
Source: PubMed — FIBERTRACH RCT
S-Ketamine Reduces Postoperative Delirium in Elderly Arthroplasty — NNT = 8
Anesthesiology · January 2026; 144(1):63–76 · DOI: 10.1097/ALN.0000000000005800 · PubMed
Double-blind RCT of 372 elderly patients (≥65 years) undergoing total hip or knee arthroplasty under neuraxial anaesthesia (not general). Patients randomised to S-ketamine (n=186) or normal saline placebo (n=186). Primary outcome: POD within 3 days.
Results: POD rate 8.06% (S-ketamine) vs. 20.43% (placebo); adjusted OR 0.29 (95%CI 0.14–0.63; p=0.002). NNT ≈ 8. S-ketamine also reduced pain during exercise and rescue analgesia. Side effects (hallucinations, dizziness, nightmares) were more common in the S-ketamine group but manageable.
- Why it matters: First RCT testing S-ketamine in a non-general anaesthesia setting — prior trials were confounded by GA. Under neuraxial anaesthesia, S-ketamine showed a compelling anti-delirium effect (NNT≈8) in a high-risk elderly orthopaedic population. A strong candidate for perioperative brain protection protocols.
Source: PubMed — S-Ketamine POD RCT
PEFB vs PVB for Rib Fracture Analgesia — Noninferiority RCT
BJA · 2026; 136:677–686 · DOI: 10.1016/j.bja.2025.09.058 · PubMed
Level I trauma ICU RCT (France, n=90) comparing continuous posterior extrathoracic fascial plane block (PEFB), paravertebral block (PVB), and systemic analgesia in multiple rib fracture patients. Primary outcome: morphine consumption at 24h.
Results: PEFB was noninferior to PVB at 24h (17 vs. 22 mg morphine; p<0.001 for noninferiority). However, PEFB required rescue thoracic epidural in 30% vs. 6.7% for PVB (p=0.043), and PVB provided superior pain during coughing and better respiratory parameters.
- Why it matters: Head-to-head data for two fascial plane approaches in rib fractures. PEFB offers easier, safer access (no pneumothorax risk) but may not sustain analgesia as well as PVB. Useful for frontline decision-making in trauma rib fracture management.
Source: PubMed — PEFB vs PVB RCT | NYSORA commentary
Single-Shot Femoral Nerve Block and Falls Risk — RR 3.62 (BJA SR/MA)
BJA · Online January 2026 · DOI: 10.1016/j.bja.2025.11.018 · PubMed
MECIR/PRISMA-compliant systematic review and meta-analysis of 31 trials assessing fall, buckling, and near-fall risk following single-shot femoral nerve block (sFNB) after lower limb orthopaedic surgery.
Results: sFNB increased fall risk vs. non-motor-blocking techniques (RR 2.75; p=0.02), vs. neuraxial blockade (RR 6.35; p=0.03), and vs. systemic analgesia (RR 6.43; p=0.03). Overall RR for falls vs. no-block: 3.62 (95%CI 1.83–7.19; absolute risk increase 0.9%). Also increased buckling (RR 5.95) and near-falls (RR 4.56). Moderate certainty evidence.
- Why it matters: Provides quantitative evidence that sFNB meaningfully increases fall risk. Supports the trend toward motor-sparing alternatives (adductor canal block, iPACK) for arthroplasty analgesia, especially in elderly patients. Important for consent and postoperative rehabilitation planning.
Source: PubMed — FNB Falls SR/MA
03 · INTERNATIONAL GUIDELINES
ASA 2026 Practice Guideline — Perioperative Pain: Fascial Plane Blocks Strongly Endorsed
Anesthesiology · January 2026; 144(1):19–43 · PubMed
The ASA Task Force on Perioperative Pain Management has released its 2026 practice guideline on local and regional analgesia for major surgical procedures. The guideline provides procedure-specific recommendations across cardiothoracic, abdominal, mastectomy, and paediatric settings. Key recommendations (adults):
- STRONG: Fascial plane blocks for open cardiothoracic surgery (pain reduction ~1.3 pts on 10-pt scale; opioid reduction ~60mg OME)
- STRONG: Fascial plane blocks for open abdominal, retroperitoneal, and pelvic surgery; and mastectomy
- STRONG: Fascial plane blocks for minimally invasive abdominal procedures (cholecystectomy, appendicectomy, bariatric, liver)
- CONDITIONAL: Fascial plane blocks for minimally invasive cardiothoracic surgery and open hernia repair
- Children (open cardiac/thoracic): STRONG recommendation; children (open hernia): CONDITIONAL
Evidence quality is predominantly moderate to low — the guideline acknowledges limitations from small single-centre studies and heterogeneous outcome measures. The emphasis on opioid sparing is a central thread throughout.
- Tell your department: Fascial plane blocks are now strongly recommended for most major open surgical procedures by the ASA — supports building regional anaesthesia programmes for thoracic, abdominal, and breast surgery.
Source: PubMed — ASA 2026 Perioperative Pain Guideline | NYSORA summary
SCCM — Guidelines for Allocation of Critical Care Resources During Crisis-Level Shortages
Crit Care Med · March 2026; 54(3):619–629 · PubMed
The Society of Critical Care Medicine's first fully evidence-based (GRADE methodology) guidelines for ICU triage during crisis-level shortages. A 21-member multidisciplinary panel (including clinicians, nurses, ethicists, and patient representatives) addressed five PICO questions. Key outputs:
- ONE conditional recommendation: Early involvement of palliative care in ICU patients at high risk of dying (reduces length of stay; very low certainty)
- FIVE "no recommendation" statements — insufficient evidence for formal triage tools, clinician judgement vs. time-based triage, patient transfers, non-ICU boarding, and ICU practitioner assignments during surge
This guideline is noteworthy for what it cannot recommend — the lack of evidence for formal triage tools and crisis protocols is striking, given the clinical urgency of the topic. It highlights a fundamental evidence gap in crisis standards of care.
Source: PubMed — SCCM Crisis Resource Allocation Guidelines 2026
04 · FOAMED & CRITICAL APPRAISAL
The Bottom Line — Critical Care Evidence Updates: February 2026
The Bottom Line · Rebecca Howes · Published 13 March 2026 · Full post
The Bottom Line's monthly critical care evidence roundup for February 2026 is now live. Key RCTs highlighted across anaesthesia and critical care include:
- DREAM trial (pilot RCT): Temazepam for sleep in critically ill patients — Critical Care and Resuscitation
- Albumin replacement in septic shock RCT — JAMA Network Open
- Cerebral oximetry-guided anaesthesia and postoperative delirium in off-pump CABG — BMC Geriatrics
- FIBERTRACH: Fiberoptic bronchoscopy monitoring during PDT — Critical Care Medicine
- Increasing protein dose in critical illness: no additional augmentation of muscle protein synthesis — AJRCCM
- E-CRRT Trial: ECMO circuit lifespan with CRRT integration — Intensive Care Medicine
- PRINCESS2 pilot: on-scene selective brain cooling in VF cardiac arrest — Critical Care
Guidelines covered include the NICE NG24 TXA update, the 2026 AHA/ACC PE guideline, the SYNAPsE ventilator asynchrony consensus (ICM), and updated stress ulcer prophylaxis recommendations from the Saudi/Scandinavian societies (Acta Anaesthesiologica Scandinavica).
Source: The Bottom Line — February 2026 Evidence Updates
PulmCrit: "Four Fatal Flaws in the New AHA/ACC PE Risk-Stratification System"
EMCrit / PulmCrit (Josh Farkas) · 7 March 2026 · Full post
Josh Farkas' detailed critique of the newly published 2026 AHA/ACC PE Guidelines identifies four fundamental problems with the new risk-stratification framework — of particular relevance to intensivists and anaesthetists managing perioperative PE:
- Flaw 1: Three competing scores (PESI, sPESI, Bova) recommended simultaneously — causes clinical confusion
- Flaw 2: Low-risk PE not clearly delineated; fails to patch the sPESI vulnerability (doesn't account for RV dilation)
- Flaw 3: Risk categorisation does not account for medical interventions (a resuscitated arrested patient scores as a survivor)
- Flaw 4: Intermediate-risk group is so heterogeneous as to be clinically unusable
⚡ CONTROVERSY
Farkas concludes: "Hospitals and clinicians should continue using their current PE algorithms rather than updating them based on the new guidelines." The ESC 2019 risk-stratification system remains the preferred framework in the UK. This post is essential reading before updating any departmental PE protocol.
Source: PulmCrit — Four Fatal Flaws in AHA/ACC PE Guidelines (7 March 2026)
05 · QUICK HITS
- OBSERVATIONAL Propofol vs Sevoflurane & Postoperative Delirium (Critical Care, Feb 2026) —
Global comparative-effectiveness study: propofol-based TIVA associated with lower POD (8.4% vs 12.4%) in elderly major cancer surgery. Observational — RCT data needed, but supports propofol maintenance in high-risk elderly patients. [APSF]
- FOAMed CRITIQUE PulmCrit: STRATIFY Trial — CDT vs Systemic Thrombolysis for PE (EMCrit, 6
Mar 2026) — Farkas argues catheter-directed thrombolysis offers no advantage over systemic low-dose alteplase for PE; all cardiac output transits pulmonary vasculature, negating any "local" effect. Supports systemic over invasive approach. [PulmCrit]
- RCT ESPB vs TPVB for Cardiac Surgery (BJA 2026;136:687–694) — ESPB failed to demonstrate noninferiority to TPVB for analgesia after median sternotomy at 6h (NRS 3.5 vs 3.0; upper 95%CI 1.34
exceeded margin). TPVB remains preferred for early postop pain. [PubMed]
- META-ANALYSIS Remimazolam in Regional Anaesthesia (BMC Anesthesiol, Feb 2026) — SR of 6 RCTs (n=677): remimazolam provides faster recovery (7–11 min), less hypotension than propofol, and
less bradycardia than dexmedetomidine for sedation during regional blocks. [PubMed]
- OBSERVATIONAL Methadone QTc in Oncology (RAPM, Feb 2026) — Retrospective cohort (n=492):
methadone for cancer pain increased QTc by only 4.36 ms at ≥12 months. Reassuring for perioperative single-dose methadone use; ECG monitoring recommended with cardiac comorbidities (+9.40 ms). [PubMed]
- META-ANALYSIS Hyperoxia vs Normoxia in Cardiac Surgery (JCVA, highlighted Feb 2026) — SR/
MA of 19 RCTs (n=2,001): no mortality difference, but hyperoxia increased CK-MB and oxidative stress markers. Supports normoxia as the intraoperative target during cardiac surgery. [PubMed]
- OBSERVATIONAL Ecarin Monitoring for Argatroban in HIT (BJA, Nov 2025/2026) — Ecarin clotting
time (ECA-CT, ClotPro) showed strong correlation with argatroban levels (r=0.881) while aPTT was near-random above 55s (r=0.12). ECA-CT superior as a bedside monitor for perioperative HIT management. [PubMed]
- META-ANALYSIS ARDS Interventions + Lung-Protective Ventilation NMA (Can J Anaesth, Mar 2026) — Network meta-analysis updating the evidence on adjunctive therapies (prone positioning,
NMBA, ECMO, iNO) combined with lung-protective ventilation. Focuses on long-term (not just 28-day) mortality. [Springer]
- META-ANALYSIS MIDLINE vs PICC VTE Risk (Thromb Haemost, Feb 2026) — SR/MA of 19 studies
(n=29,680 catheters): pooled VTE rates 3.5% midline vs. 3.8% PICC (OR 0.92; NS). VTE risk alone should not drive catheter choice. [PubMed]
- RCT Perineural Dexamethasone with iPACK/ACB for TKA (Clin J Pain, Feb 2026) — Double-blind RCT (n=60, ≥65 yrs): dexamethasone 4 mg nearly doubled analgesic duration (15.9 vs. 8.8 h), halved opioid consumption, with no motor compromise. Supports routine adjuvant use in elderly knee
arthroplasty. [PubMed]
- META-ANALYSIS Long-Acting vs Mixed Local Anaesthetics for Nerve Blocks (RAPM, Feb
2026;51(2):132) — SR/MA of 10 RCTs (n=516): mixing lidocaine with bupivacaine/ropivacaine does not improve onset but shortens block duration (MD −2.16 h). Stop mixing LAs for ultrasound-guided
blocks. [PubMed]
- COMMENTARY Lung-Protective Ventilation is Not Sex-Neutral (BJA, 5 Mar 2026) — Females with
ARDS have higher mortality and are less likely to receive lung-protective ventilation due to PBW formula errors. Calls for auditing ventilation practice by sex and refining tidal volume calculations.
- RCT Individualised vs Fixed PEEP in Lung Cancer Surgery (Anaesthesia, 12 Mar 2026) — RCT
(n=400, ≥60 yrs): EIT-guided individualised PEEP improved intraoperative oxygenation but did not reduce postoperative pulmonary complications (28% vs 25%; p=0.60). Important null result for EIT-guided PEEP titration. [PubMed]
- FOAMed CRITIQUE Sepsis Phenotypes — Deep Review (PulmCCM, 13 Mar 2026) —
Comprehensive review of SENECA phenotypes, immunologic endotypes, and the ImmunoSep trial. Despite reducing SOFA scores, 90-day mortality ~68% in both arms. "Precision medicine" in sepsis remains theoretical. [PulmCCM]
THIS WEEK'S ACTION POINTS
- Download and read GPICS V3 — know the new minimum standards for your ICU. You'll need this for governance meetings, business cases, and your ARCP.
- Update your pre-assessment clinic BP thresholds — the new AAGBI/BIHS guidelines raise the "proceed" threshold, potentially reducing unnecessary on-the-day cancellations.
- Review your department's drug storage SOPs against the new RCoA/AAGBI Safe Drug Management 2026 guidance — particularly IAD access and drugs of diversion policy.
- Update your TXA prescribing practice: NICE NG24 now recommends TXA for all operating theatre procedures with any bleeding risk — no more estimated blood loss threshold.
- Revisit your ICU protocol for arterial line insertion in shock following EVERDAC — individualise rather than insert reflexively in all cases.
- Review your unit's PDT protocol following FIBERTRACH — routine bronchoscopy adds physiological burden without reducing complications when performed by experienced operators.
- Consider S-ketamine as a delirium-prevention adjunct in elderly patients undergoing arthroplasty under neuraxial anaesthesia (NNT≈8).
- Favour motor-sparing alternatives (adductor canal block, iPACK) over single-shot femoral nerve blocks for arthroplasty — the BJA SR/MA confirms RR 3.62 for falls.
- Before updating any departmental PE protocol, read the PulmCrit STRATIFY/PE guidelines critique — continue using ESC 2019 risk stratification, not AHA 2026.
ITEMS PENDING FOR FUTURE ISSUES
- ERC/ESICM Post-Resuscitation Care Guidelines 2025 — pending full review
- ESAIC Failing Epidural Guidelines 2025 — pending full coverage
- ELSO Nutrition Consensus for ECMO Patients (Feb 2026)
- ERAS/IATSIC Trauma Guidelines (2025)
- FLOWVENTIN HEARTSURG — Anesthesiology (FCV vs PCV in cardiac surgery) — exploratory only, pending larger RCT
- CPOC 10-Year Health Plan Recommendations (2026)
- OAA Obstetric Anaesthetic Standard Development (2026)
- REPACC Enhanced Care Services UK (Anaesthesia, April 2026 — not yet published)
SOURCES CHECKED THIS WEEK
UK Guidelines: RCoA · AAGBI/Association of Anaesthetists · DAS · OAA · FICM · ICS · NICE · MHRA · CPOC · SALG · BIHS
International: ESAIC · ASA · SCCM/SSC · ERAS Society · ELSO
Journals: BJA · Anaesthesia · Anesthesiology · NEJM · Lancet · JAMA · ICM · RAPM · Crit Care Med · JCVA · Can J Anaesth · Thromb Haemost · BMC Anesthesiol · Clin J Pain · Critical Care (BMC)
FOAMed: The Bottom Line · EMCrit/PulmCrit · PulmCCM · St Emlyn's · LITFL · DFTB · BJA Education · DAS Blog · RA-UK · NYSORA
Next briefing: Tuesday 17 March 2026
Disclaimer: This newsletter is an educational summary for postgraduate anaesthetic trainees and does not constitute clinical advice. All content should be interpreted in the context of your institution's policies and individual patient circumstances. Always refer to primary sources, full guideline documents, and current UK prescribing information. URLs were verified at time of publication; links may change. This is a test-run issue — not for distribution.
Anaesthetics & ICU Evidence Rundown · Issue 3 · 15 March 2026