Use of levosimendan in the ICU Levosimendan is an inodilator that promotes cardiac contractility primarily through calcium sensitisation of cardiac troponin C and vasodilatation via opening of adenosine triphosphate-sensitive potassium (KATP) channels in vascular smooth muscle cells. The drug also exerts organ-protective effects through a similar effect on mitochondrial KATP channels. Levosimendan has been demonstrated to have potential utility in a wide range o...

Original Investigation February 12, 2019 Association of Left Ventricular Ejection Fraction and Symptoms With Mortality After Elective Noncardiac Surgery Among Patients With Heart Failure Benjamin J. Lerman, Rita A. Popat, Themistocles L. Assimes, et al JAMA. 2019;321(6):572-579. doi:10.1001/jama.2019.0156 Abstract Importance   Heart failure is an established risk factor for postoperative mortality, but how left ventricular ejection fractio...

Artificial Intelligence in the ICU The paucity of positive multicentre prospective randomised control trials in ICU settings serves to highlight the challenge of running studies in such environments, where multiple treatments are given simultaneously to individuals who respond in variable ways based on their individual physiology. Consequently, without established guidelines, ICU clinician decision-making is driven largely by experience and instinct, resulting in s...

ARTICLES Paediatric acute respiratory distress syndrome incidence and epidemiology (PARDIE): an international, observational study Robinder G Khemani, Lincoln Smith, Yolanda M Lopez-Fernandez, et al Lancet Respir Med 2019; 7: 115-128 Background 背景 Paediatric acute respiratory distress syndrome (PARDS) is associated with high mortality in children, but until recently no paediatric-specific diagnostic criteria existed. The Pediatric Acute Lung Injury C...

New algorithm reduces testing for ICU patients Enrolling seriously ill patients in intensive care units for clinical trials is often a big challenge for investigators. This is one reason why there is a dearth of evidence-based guidelines in critical medicine. For instance, ICU doctors often face a dilemma when it comes to ordering lab tests for specific patients.  While ICU doctors are aware that every blood test they order could yield critical informatio...

Prehospital transdermal glyceryl trinitrate in patients with ultra-acute presumed stroke (RIGHT-2): an ambulance-based, randomised, sham-controlled, blinded, phase 3 trial The RIGHT-2 Investigators Lancet Published:February 06, 2019 DOI:https://doi.org/10.1016/S0140-6736(19)30194-1 Summary Background 背景 High blood pressure is common in acute stroke and is a predictor of poor outcome; however, large trials of lowering blood pressure have given variable res...

AKI: long-term impact on mortality and renal function Acute kidney injury (AKI) is defined as an abrupt loss in renal function and may be caused by a wide variety of clinical conditions. AKI is a frequent complication of hospitalisation and is associated with an increased risk of chronic kidney disease (CKD), end-stage renal disease (ESRD), and mortality.Based on more recent studies, AKI is also known to be a risk factor for other adverse outcomes, including stroke...

Editorial|February 17, 2019 How Best to Resuscitate Patients With Septic Shock? Derek C. Angus JAMA. 2019;321(7):647-648. doi:10.1001/jama.2019.0070 What is the best approach for resuscitation of a patient with septic shock? Despite considerable investigation over several decades, this important question still has no clear answer. There is agreement that resuscitation should proceed quickly, for the longer the delay, the greater the physiologic ...

PulmCrit: The surviving sepsis campaign 1-hour bundle is… back? February 12, 2019 by Josh Farkas The surviving sepsis campaign (SSC) has had substantial problems dating back to its inception.  The original backbone of the guidelines was a single-center trial by Rivers, which has largely been debunked.1–4  Initially the SSC was slow to let go of invasive early goal-directed therapy.  The SSC has finally started eliminating older dogma (e.g., ...

脓毒症质控项目：国际调查 感谢您参与脓毒症质量改进评估的国际调查 目的: 了解目前全球范围内脓毒症的疾病监测、治疗、质量改进以及登记上报情况 关于本次调查: WHO近期就全球脓毒症问题通过一项决议，目前，我们已逐渐认识到脓毒症是威胁人类健康的重大问题。尽管如此，我们对于全球范围内脓毒症的疾病监测、治疗、质量改进以及登记上报情况仍知之甚少。GSA由政府决策者以及医疗工作者等利益相关方组成，我们想要了解上述方案的推行和实践情况，在不同的地区、病人人群、医疗环境之间存在的...