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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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Managing patients with refractory septic shock The Surviving Sepsis Guidelines provide a specific framework to treat patients with septic shock. These guidelines include the use of antimicrobial therapy, source control, fluid therapy and targeted vasoporessors. However, there is still a small proportion of patients that does not respond to these measures and consequently deteriorates into refractory shock and progressive multi-organ failure. Specific guidelines to manage...
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High-risk ECMO - heroic rescue or futile care? Over the past decade, extracorporeal membrane oxygenation (ECMO) has become mainstream therapy in adult intensive care. Although the list of contraindications to ECMO has shrunk considerably, a few of these remain absolute, notes Dr. Graeme MacLaren in an editorial article published in the journal Critical Care. "There are a number of circumstances outside of this list of contraindications to which ECMO could be applied ...
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Medical News & Perspectives September 19, 2018 Unproven but Profitable: The Boom in US Stem Cell Clinics Rita Rubin JAMA. Published online September 19, 2018. doi:10.1001/jama.2018.13861 Stanford orthopedic surgeon Jason Dragoo, MD, is conducting 4 randomized clinical trials of the use of autologous stem cells to treat knee osteoarthritis. Interest in the trials seems high—nearly 100 people inquire about them daily, Dragoo says—but he recognizes that some patient...
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Editorial September 25, 2018 Treatment Algorithms for Staphylococcal Bacteremia: Improving Clinical Care and Enhancing Antimicrobial Stewardship Eli N. Perencevich, Preeti N. Malani JAMA. 2018;320(12):1243-1244. doi:10.1001/jama.2018.13315 Antimicrobial resistance is among the most important threats to human health. Lost in the episodic outbreaks of emerging pathogens such as 2009 H1N1 influenza, Ebola, and Zika virus has been the steady increase in resistance to...
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Viewpoint September 14, 2018 Antibiotics for Sepsis—Finding the Equilibrium Michael Klompas, MD, Thierry Calandra, Mervyn Singer, et al JAMA. Published online September 14, 2018. doi:10.1001/jama.2018.12179 Sepsis is medicine’s last remaining preserve for unrestrained antibiotic prescribing. The Surviving Sepsis Campaign guidelines recommend empirical broad-spectrum therapy within one hour of triage for both sepsis and septic shock.1 This recommendation, and mandates t...
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Late parenteral nutrition beneficial to undernourished critically ill children In undernourished critically ill children, withholding parenteral nutrition (PN) for one week was clinically superior to early PN, according to a subanalysis of the Pediatric Early vs. Late Parenteral Nutrition in Intensive Care Unit (PEPaNIC) randomised clinical trial. "In this subanalysis of 289 undernourished critically ill children with insufficient enteral nutritional intake, withholding...
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"Fluid overload" - a poorly-defined term that should be avoided Clinicians examining an oedematous patient are wont to say that the patient has “fluid overload” or “hypervolemia” or both and propose fluid restriction and/or diuretics as the logical strategy, when often during the acute phases of resuscitation from circulatory shock this approach may be inappropriate, says an editorial published in the journal Critical Care. A fundamental determinant of cardiac output an...
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News > Medscape Medical News > Neurology News New AI Platform Diagnoses Brain Disease in Seconds George W. Citroner August 15, 2018 An artificial intelligence (AI) platform accurately identifies acute neurologic events, such as stroke, from CT scans in as little as 1.2 seconds, new research suggests. If the findings are confirmed, this technology would radically speed the triage process by immediately alerting physicians to critical findings that may otherwise hav...
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PCT-guided antibiotic treatment improves outcomes in sepsis patients Procalcitonin (PCT)-guided antibiotic treatment in ICU patients with infection and sepsis patients results in improved survival and reduced antibiotic treatment duration, according to results of a new meta-analysis published in the journal Critical Care. Early identification of sepsis and appropriate initial management including the start of antibiotic treatment and fluid resuscitation improves outcomes....
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