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Stable/Unstable? Cardiovascular Dynamics in Critically Ill Patients There is currently doubt over the terms stable and unstable regarding cardiovascular dynamics in critically ill patients. Labelling a patient as haemodynamically stable or unstable can have different connotations depending on the practising physician. The term stable is originally defined as the condition of the patient being unchanged for a substantial amount of time. However, if this is the ca...
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ARTICLES|ONLINE FIRST Personalised mechanical ventilation tailored to lung morphology versus low positive end-expiratory pressure for patients with acute respiratory distress syndrome in France (the LIVE study): a multicentre, single-blind, randomised controlled trial Jean-Michel Constantin, Matthieu Jabaudon, Jean-Yves Lefrant, et al Lancet Respir Med Published:August 06, 2019 DOI:https://doi.org/10.1016/S2213-2600(19)30138-9 Summary Background The effe...
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ICU Management & Practice, Volume 19 - Issue 2, 2019 Big Data and hidden subtypes of sepsis Results of a study conducted by the University of Pittsburgh School of Medicine suggests that sepsis is not one condition, but many conditions that could benefit from different treatments. The findings are published in JAMA and were presented at the American Thoracic Society's Annual Meeting. Sepsis is the number one killer of hospitalised patients and is a life-t...
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SPOTLIGHT|ONLINE FIRST When is the right time to discuss ECMO? William B Feldman, Steven P Keller Lancet Respir Med Published:August 12, 2019 DOI:https://doi.org/10.1016/S2213-2600(19)30278-4 The rise of extracorporeal membrane oxygenation (ECMO) over the past decade as a support modality provides clinicians with a powerful new therapy to care for patients with advanced cardiopulmonary disease. The growing use of this technology has required careful attention ...
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Effects of Sedatives and Opioids on Patient Ventilator Asynchrony Patient-ventilator asynchrony is frequent during invasive mechanical ventilation. If patient-ventilator interaction is poor, it can prolong the duration of mechanical ventilation and can also result in longer ICU and hospital stay as well as increased mortality. It is thus important to optimise patient-ventilator interaction.  There are many factors that could affect patient-ventilator interaction...
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COMMENT|ONLINE FIRST Simplified control measures for ESBL-producing Enterobacteriacae? Jean-Christophe Lucet, Jean-Ralph Zahar Lancet Infect Dis Published:August 23, 2019 DOI:https://doi.org/10.1016/S1473-3099(19)30412-8 Extended-spectrum β-lactamase (ESBL)-producing Enterobacteriacae have disseminated worldwide, with very high prevalence in countries of low and middle income1 and a roughly 10% prevalence in the community and at hospital admission in high-inco...
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Outcomes of ABCDE Bundle in Mechanically Ventilated Patients Increasing focus on ICU utilisation and survivorship has also resulted in a greater focus on the long-term consequences of critical illness. Post Intensive Care Syndrome (PICS) is characterised by physical, cognitive, and emotional manifestations and can have a long-lasting impact on survivors of ICU as well as their families and caregivers.  The ABCDEF bundle is an organisational approach that is used...
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ARTICLES|ONLINE FIRST Contact precautions in single-bed or multiple-bed rooms for patients with extended-spectrum β-lactamase-producing Enterobacteriaceae in Dutch hospitals: a cluster-randomised, crossover, non-inferiority study Marjolein F Q Kluytmans-van den Bergh, Patricia C J Bruijning-Verhagen, Prof Christina M J E Vandenbroucke-Grauls, et al. Lancet Infect Dis Published:August 23, 2019 DOI:https://doi.org/10.1016/S1473-3099(19)30262-2 Summary Backgro...
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Untangling the Infusion Confusion Many patients in the ICU receive multiple IV infusions. This can lead to significant confusion because infusions look quite similar, and a patient with multiple infusions tends to be surrounded by associated components such as bags, tubing, pumps, etc. There is often a lack of information along the infusion pathway, which can lead to confusion. For example, if an infusion change is required, the healthcare provider must reconcile t...
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Original Investigation September 3, 2019 N95 Respirators vs Medical Masks for Preventing Influenza Among Health Care Personnel: A Randomized Clinical Trial Lewis J. Radonovich Jr, Michael S. Simberkoff, Mary T. Bessesen, et al JAMA. 2019;322(9):824-833. doi:10.1001/jama.2019.11645 Abstract Importance 背景 Clinical studies have been inconclusive about the effectiveness of N95 respirators and medical m...
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