Venous Doppler to Predict Adverse Kidney Events In patients admitted to the ICU following surgery, trauma or septic shock, fluid boluses are often used to increase cardiac output and blood pressure. However, clinical evidence shows that excess fluid administration could be detrimental for patients and could lead to increased rates of acute kidney injury (AKI), prolonged days of mechanical ventilation and death. There are currently no established ultrasound measures of ...

Use of Non-Invasive Ventilation in Critically Ill Older Adults In seriously ill older adults or those near the end of life, acute respiratory failure is a common cause of hospitalisation. These hospitalisations are generally complicated by distressful respiratory symptoms and transitions that require the use of high-intensity, high-risk interventions, including invasive mechanical ventilation (IMV) and non-invasive ventilation (NIV).  Trends in both invasive an...

ICU Management & Practice, Volume 20 - Issue 2, 2020 Sleep Deprivation and Fatigue Management in the Intensive Care Unit The impact of sleep deprivation and fatigue on patients and staff in the intensive care unit and how improved sleep, reduced noise disturbances, and more organised shifts could be beneficial for both patients and clinicians. The World Health Organization (WHO) recommends that average daily sound levels in patient care areas should be a...

ICU Management & Practice, Volume 20 - Issue 3, 2020 Advances in Sepsis Research – New Tools Against One of the Oldest Diseases? Sepsis and septic shock are the leading causes of death in the ICU. With an estimated mortality rate of 40-60%, septic shock is in the focus of adult critical care medicine. It is broadly accepted that intervention in the very early phase of sepsis before the complex inflammatory host response is initiated should be one major area...

Awake Prone Positioning and Risk of Intubation in COVID-19 Many COVID-19 patients develop severe bilateral viral pneumonia, which evolves into acute respiratory distress syndrome (ARD). High-flow nasal oxygen therapy (HFNO) has been shown to be effective in decreasing the need for endotracheal intubation with patients with acute hypoxaemic respiratory failure (ARF). However, in patients with COVID-19, the recommendation is of early intubation and invasive mechanical ve...

Do We Need to Diagnose ARDS? Acute respiratory distress syndrome (ARDS) is the clinical expression of acute, non-haemodynamic lung oedema. It is typically diagnosed by hypoxaemia, and bilateral lung infiltrates in the absence of increased capillary hydrostatic pressure. ARDS represents nearly a quarter of the ICU patients who require mechanical ventilation. There is significant research and literature on ARDS, with over 13,000 articles published on this syndrome since ...

Increasing Efficiency Without Affecting Patient Outcomes The economic and clinical fragilities of healthcare systems around the globe have never been more visible than during the COVID-19 pandemic. In particular, the importance of resource allocation has been at the forefront. Weighing safety against costs when dealing with critically ill patients has been a source of dilemma for many healthcare professionals. When we evaluate the use of imaging in the ICU, we see that...

Editorial October 12, 2020 Excess Deaths and the Great Pandemic of 2020 Howard Bauchner, Phil B. Fontanarosa JAMA. Published online October 12, 2020. doi:10.1001/jama.2020.20016 Two new reports in JAMA provide updated estimates regarding the mortality associated with the coronavirus disease 2019 (COVID-19) pandemic in the US. In a research letter by Woolf and colleagues, the authors update their analysis of the number of “excess” deaths in the U...

Lung Histopathology: COVID-19 Compared to SARS, H1N1 The coronavirus disease has spread throughout the world and has resulted in many challenges for healthcare systems. It is a new disease with a significant burden of respiratory failure. This has led to questions about the pathogenesis and pulmonary pathology of COVID-19.  Patients with severe COVID-19 have respiratory failure with hypoxaemia, and acute bilateral pulmonary infiltrates. This is consistent with ...

ICU Management & Practice, Volume 20 - Issue 3, 2020 PCT-guided Antibiotic Stewardship in COVID-19 Patients Professor Michael Mansour is a physician-scientist with a research concentration in immune responses against invading pathogens. He attends on the Clinical Transplant Infectious Diseases and Immunocompromised Host Service at the Massachusetts General Hospital - Division of Infectious Diseases, where he cares for solid and stem cell transplant recipien...