Martin M. Cearras, MD

09/23/2026

Could esmolol be lifesaving in septic shock? New short-read blog: Esmolol for Heart Rate Control in Septic Shock — rapid overview, clinical takeaways, and what the latest evidence suggests. Read now: https://wix.to/iR7SEHs

Beta-blockers reduce mortality in septic shock

09/18/2026

Trying to understand how to use likelihood ratios for diagnostic test? See our post at https://www.criticalthinkinginmedicine.com/items/likelihood-ratios and please leave me a comment if you find the page helpful!

The information provided by Critical Thinking in Medicine (“we,” “us,” or “our”) on this website is for general informational purposes only. All content, including text, graphics, images, and information, is presented as an educational resource and is not intended as a substitute for pro...

09/18/2026

If you want to understand EBM a little more, visit www.criticalthinkinginmedicine.com and use our new, interactive EBM tools. Enter the data from any study and see how their likelihood ratios perform or see all therapy results calculated by using some data from their tables. No statistics or statistician friends required!

The information provided by Critical Thinking in Medicine (“we,” “us,” or “our”) on this website is for general informational purposes only. All content, including text, graphics, images, and information, is presented as an educational resource and is not intended as a substitute for pro...

09/07/2026

New blog: VASST Trial — why subgroup analysis results shouldn’t change clinical practice. New concept page on subgroup analysis added. Read the full breakdown and practical takeaways: https://wix.to/Q3fMgaD

https://www.criticalthinkinginmedicine.com/post/vasst-trial-vasopressin-septic-shock

VASST trial, showing vasopressin added to levophed does not improve outcomes or have more harm.

09/03/2026

New blog: PROSEVA trial — to prone or not to prone. Discover how prone positioning in the ICU improves survival for severe ARDS and what this means for practice. Read the full breakdown and clinical takeaways: https://wix.to/LCUByCx

Prone positioning in the ICU improves survival in severe ARDS

02/03/2026

We reviewed the Leuven II trial — a single-center RCT in medical ICU patients comparing intensive insulin (target 80–110 mg/dL) with a conventional approach (180–200 mg/dL). Key takeaways: intensive therapy did not reduce overall in-hospital mortality in the intention-to-treat group, but it was associated with potentially reduced renal injury, shorter ventilator time, and shorter ICU/hospital stays (hypothesis-generating). Notably, patients who stayed >3 days showed a mortality benefit with intensive control (NNT ≈ 11) — a subgroup signal that needs cautious interpretation (subgroup analyses can mislead).

Why this matters: these results highlight how important trial design, blinding, and co-interventions are when we apply evidence to bedside decisions. For clinicians and trainees, the paper is a useful lesson in weighing primary vs secondary outcomes and avoiding overinterpretation of subgroup findings. Read the full appraisal and the original NEJM link in the post to decide how (or whether) this informs your practice. What questions does this raise for your ICU practice? Let’s discuss. 🩺📊💬

Critical Thinking In Medicine - Enhance patient care with evidence-based practices. Free resources for medical professionals.

02/25/2025

After over a decade, reunion with a former co-resident at UM! Great to see you, Marcela Ferrada. Excellent lecture.

02/23/2025

At SCCM Florida Congress! Reach out if you are also here!

12/27/2024

Thank you, Tooba, for your contribution to Critical Thinking in Medicine!

Critical Appraisal by Tooba Shaukat Butt, MD. Edited by Martin M. Cearras, MD, FACP.Find the original article here! https://www.nejm.org/doi/full/10.1056/NEJMoa2409501Summary:The VANISH2 trial was an international, randomized study comparing catheter ablation to antiarrhythmic drug therapy alone, in...

12/02/2024

Please join our website to see the new concepts and critical appraisals

Author: Peter Ryu Tofts MDEditor: Martin M. Cearras, MDFind the original article here! Timing of Initiation of Renal-Replacement Therapy in Acute Kidney Injury | New England Journal of MedicineSummary:STARRT AKI is a large multicenter, international RCT, conducted in 168 hospitals in 15 countries, c...