Deferring Arterial Catheterization in Critically Ill Patients with Shock

Deferring Arterial Catheterization in Critically Ill Patients with Shock

Muller G, et al. Deferring Arterial Catheterization in Critically Ill Patients with Shock. N Engl J Med. 2025 Nov 13;393(19):1875-1888

Editorial: A Less Invasive Approach to Intensive Care.

Gershengorn HB. A Less Invasive Approach to Intensive Care. N Engl J Med. 2025 Nov 13;393(19):1953-1954.

Methodology: 4/5
Usefulness: 4/5

Question and Methods: The authors evaluated whether a non-invasive blood pressure monitoring strategy was noninferior to routine arterial catheterization in critically ill patients with shock, using a multicenter, open-label, randomized noninferiority trial involving 1010 ICU patients.

Findings: Twenty-eight day mortality occurred in 173 patients in the non-invasive monitoring group and 185 patients in the invasive monitoring group (adjusted risk difference, −3.2 percentage points; 96% CI, −8.9 to 2.5; P=0.006 for noninferiority), demonstrating noninferiority of the non-invasive strategy.

Limitations: The trial was open-label, pain assessments were limited in patients with impaired consciousness, staff satisfaction and workflow impacts were not evaluated, trauma and postoperative patients were underrepresented, and patients with BMI greater than 40 were excluded.

Interpretation: Non-invasive blood pressure monitoring in critically ill patients with shock appears noninferior to routine arterial catheterization, suggesting arterial lines may not need to be the default management strategy in many ICU patients.