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Clinical significance of viral detection in critically ill patients Noninvasive diagnostic tests can ensure the early identification and treatment of viral infections in patients with haematological malignancies. New research from France assessed the clinical relevance of a positive virus polymerase chain reaction (PCR) test on nasal swabs in haematology patients at ICU admission. "Respiratory virus detection in the upper airway by multiplex PCR assay is common in critica...
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CORRESPONDENCE Procalcitonin-Guided Antibiotic Use N Engl J Med 2018; 379:1971-1973 DOI: 10.1056/NEJMc1811150 The authors reply: Pulia et al. correctly note that implementation of a procalcitonin guideline in our trial had minimal effect on antibiotic prescription in cases of community-acquired pneumonia, but in patients with acute bronchitis, antibiotic prescription in the ED dropped by 50%. However, the finding for acute bronchitis, while robust to correction for multipl...
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Prothrombin complex concentrates for rapid anticoagulation reversal before surgery Current guidelines for rapid anticoagulation reversal for emergency surgery recommend four-factor prothrombin complex concentrate (PCC) and vitamin K co-administration. A team of experts from the U.S., Canada and Germany reviewed the current evidence on PPC treatment for vitamin K antagonist reversal in the perioperative setting. Overall, the studies identified in this review support curren...
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ORIGINAL ARTICLE Intravenous Iron in Patients Undergoing Maintenance Hemodialysis Iain C. Macdougall, Claire White, Stefan D. Anker, et al N Engl J Med October 26, 2018 DOI: 10.1056/NEJMoa1810742 Abstract BACKGROUND Intravenous iron is a standard treatment for patients undergoing hemodialysis, but comparative data regarding clinically effective regimens are limited. METHODS In a multicenter, open-label trial with blinded end-point evaluation, we randomly assigned adults un...
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Use sepsis bundles, or you’re breaking the (New York) law Sep 28, 2017 In 2013, New York's state government began regulating the care of sepsis. The state has since required its hospitals (and thus its doctors) to adhere to some version of a sepsis protocol that included a "bundle" to be delivered within 3 hours after sepsis recognition: blood cultures before antibiotics; lactate measurement; broad-spectrum antibiotics The Empire State legislature and health departmen...
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ORIGINAL ARTICLE Randomized Trial of Platelet-Transfusion Thresholds in Neonates Anna Curley, Simon J. Stanworth, Karen Willoughby, et al N Engl J Med November 2, 2018 DOI: 10.1056/NEJMoa1807320 Abstract BACKGROUND Platelet transfusions are commonly used to prevent bleeding in preterm infants with thrombocytopenia. Data are lacking to provide guidance regarding thresholds for prophylactic platelet transfusions in preterm neonates with severe thrombocytopenia. METHODS In th...
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Intensive Care Medicine本周免费阅读 ONLINE FIRST THIS WEEK (FREE ACCESS) Original ~ Emily A. Vail. Relationship between height and outcomes among critically ill adults: a cohort study. Original ~ Sean M. Bagshaw. Timing of onset of persistent critical illness: a multi-centre retrospective cohort study. Review ~ Djillali Annane. Academic conflict of interest. Imaging in Intensive Care Medicine ~ Gustavo Nobre de Jesus. Post-intubation tracheal laceration. Imaging in Intensi...
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ORIGINAL ARTICLE Effect of Genetic Diagnosis on Patients with Previously Undiagnosed Disease Kimberly Splinter, David R. Adams, Carlos A. Bacino, et al N Engl J Med October 10, 2018 DOI: 10.1056/NEJMoa1714458 Abstract BACKGROUND 背景 Many patients remain without a diagnosis despite extensive medical evaluation. The Undiagnosed Diseases Network (UDN) was established to apply a multidisciplinary model in the evaluation of the most challenging cases and to identify the biolog...
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CORRESPONDENCE Procalcitonin-Guided Antibiotic Use N Engl J Med 2018; 379:1971-1973 DOI: 10.1056/NEJMc1811150 TO THE EDITOR The null result for the use of procalcitonin level to guide the prescription of antibiotics, reported by Huang et al. (July 19 issue),1 is incongruent with our experience as an early emergency department (ED) adopter. Rapid procalcitonin assays have been ordered for more than 4000 patients since 2014. The ability of procalcitonin to differentiate vira...
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July 13, 2018 SEP-1 Guidelines May Be Too Restrictive Daniel M. Lindberg, MD reviewing Rhee C et al. Crit Care Med 2018 Jun 28 Most bundle failures had no effect on mortality. Hospitals are required to report compliance with the SEP-1 quality bundle as a core sepsis measure. Components of SEP-1 include blood cultures (within 3 hours), initial (3 hours) and repeat (6 hours) lactate measurement, early antibiotics and fluid resuscitation (3 hours), and vasopressors for p...
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