Corticosteroids in Severe CAP Corticosteroid use in the care of critically ill patients has been the subject of ongoing research with conflicting findings. There is a growing interest in understanding their role in treating a common source of sepsis: community-acquired pneumonia (CAP). Some studies have focused on determining whether corticosteroids provide clinical benefits to patients with the most severe clinical presentation and highest mortality rate of C...

Levels of Intensive Care and In-Hospital Mortality in Sepsis Sepsis is a life-threatening condition caused by a dysfunctional response to infection. It is a significant global health issue, with approximately 48.9 million cases and 11 million deaths annually. Sepsis accounts for nearly 30% of all ICU admissions worldwide. Previous studies have reported varying prevalence rates of ICU-treated sepsis, ranging from 58 to 80 cases per 100,000 person-years, highlighting...

Sex and Gender Differences in Intensive Care In recent years, there has been a growing focus on recognising sex and gender differences in diagnosis, clinical care, and outcomes. Several landmark publications have highlighted how women often receive unequal treatment compared to men, leading to worse outcomes. Historically, there has been a significant oversight in research when it comes to considering sex differences. Women have been underrepresented in clinical...

Triage Procedures for Critical Care Resources During the COVID-19 pandemic, several states in the U.S. used pandemic preparedness plans to guide the allocation of critical resources in times of crisis. These state-specific plans varied in the factors used to triage patients. Some encountered significant scrutiny from advocacy groups due to concerns about potential discrimination. A study assessed the role of comorbidities and long-term prognosis in state triage ...

Thiamine for Renal Protection in Septic Shock Kidney injury frequently occurs in patients with septic shock and is linked to worse clinical outcomes. Administering thiamine (vitamin B1) as part of a mitochondrial resuscitation strategy might help mitigate septic kidney injury. Thiamine is crucial for aerobic respiration, and thiamine can lead to organ dysfunction. Because the kidney contains a high concentration of mitochondria and relies on thiamine for mitocho...

Atrial Fibrillation in the ICU Atrial fibrillation (AF) is a common cardiac arrhythmia. Research has consistently shown that AF heightens the risk of adverse outcomes in hospitalised and outpatient populations. Data suggests that newly developed AF (NAF) is common among critically ill patients, negatively impacting both short- and long-term outcomes, including prolonged hospitalisation and a greater risk of stroke and death. Treatment options are available to ma...

ICU Management & Practice, Volume 22 - Issue 5, 2022 Imaging the Critically Ill Patient: Echocardiography Current applications and limitations of critical care echocardiography in the critical care context and its use in guiding the care of the critically ill patient. Echocardiography in the ICU Echocardiography is currently considered an essential diagnostic tool at the disposal of the intensivist – a significant change from less than two decades ago...

Editor's Note  October 9, 2023 FDA Regulations of AI-Driven Clinical Decision Support Devices Fall Short Anand R. Habib, Cary P. Gross JAMA Intern Med. Published online October 9, 2023. doi:10.1001/jamainternmed.2023.5006 We are entering a new era of computerized clinical decision support (CDS) tools. Companies are increasingly using artificial intelligence and/or machine learning (AI/ML) to develop new CDS devices, which ...

Oxygen Targets and the Future of Critical Care Clinical Research Stephanie C. DeMasi,  Wesley H. Self, Matthew W. Semler Am J Respir Crit Care Med 2023; 208: 746-748 In this issue of the Journal, van der Wal and colleagues (pp. 770–779) report the findings of the “ConservatIve versus CONventional oxygenation targets in Intensive Care patients” (ICONIC) trial, a randomized trial that compared the use of a lower oxygenation target (PaO2 = 5...

EDITORIAL Universal Decolonization in Nursing Homes — Apparent Benefits but Feasible? Morgan J. Katz, Sara E. Cosgrove N Engl J Med 2023; 389:1815-1816DOI: 10.1056/NEJMe2311215 Nursing homes house a population most at risk for prolonged colonization with multidrug resistant organisms (MDROs) owing to the residents’ older age, repeat health care and antibiotic exposures, and ongoing contact with other persons with colonization.1 Although nursing homes pose...