Nebulised Heparin for Patients with ARDS Mechanical ventilation in the ICU for 48 hours or longer is known to be associated with ARDS, which could be present either when ventilatory support is initiated or develop afterwards, typically during the first five days. ARDS affects approximately 23% of mechanically ventilated, critically ill patients and has a mortality of nearly 46%. Patients on prolonged mechanical ventilation and ARDS are at risk of impaired physical func...

ICU Management & Practice, Volume 20 - Issue 4, 2020 The Seraph® 100: Evidence and Perspectives An overview of the clinical application and future perspective of the Seraph® 100 haemoperfusion in critically ill patients with sepsis. Background Over the last few decades, sepsis has been spreading worldwide to such an extent that it has been declared global health priority by the World Health Organization (Reinhart et al. 2017). Sepsis is an old disease...

ICU Management & Practice, Volume 20 - Issue 4, 2020 Biomarkers and Their Impact in ICU Patient Outcomes The laboratory plays a critical role in ensuring optimal outcomes for ICU patients. Several biomarkers are valuable in this context and can help clinicians achieve improved patient outcomes and decreased expenses for healthcare. Improving both in-ICU and post-ICU clinical outcomes often depends on actions taken much sooner in a patient’s pathway durin...

CORRESPONDENCE Renal replacement therapy in acute kidney injury – Authors' reply Stéphane Gaudry, David Hajage, Agnès Dechartres, et al Lancet 2020; 396: 1975-1976 DOI:https://doi.org/10.1016/S0140-6736(20)32673-8 We disagree with Vincenzo Sepe and colleagues' comment about the timing and prescription of renal replacement therapy (RRT). In the randomised controlled trials included in our systematic review and individual patient data meta-analysis,1 the protoco...

ICU Management & Practice, Volume 20 - Issue 4, 2020 Nutrition in the Post ICU Period: Where is the Evidence? This article summarises the current nutrition evidence in the phase of recovery that occurs following critical illness. Introduction It is plausible that the importance of nutrition may differ across different phases of illness. Reflecting this, the most recently updated clinical nutrition practice guidelines for critical care from the Europea...

CORRESPONDENCE|DECEMBER 19, 2020 Renal replacement therapy in acute kidney injury Vincenzo Sepe, Teresa Rampino, Carmelo Libetta Lancet 2020; 396: 1974 DOI:https://doi.org/10.1016/S0140-6736(20)32399-0 Stéphane Gaudry and colleagues1 found that early renal replacement therapy (RRT) in critically ill patients with acute kidney injury does not affect survival compared with a delayed RRT strategy. A major limitation of their meta-analysis is the clinical discreti...

Editorial December 9, 2020 Searching for the Optimal PEEP in Patients Without ARDS: High, Low, or in Between? Sarina K. Sahetya, Ewan C. Goligher, Arthur S. Slutsky JAMA. Published online December 9, 2020. doi:10.1001/jama.2020.23067 Positive pressure ventilation is lifesaving for patients with acute respiratory failure and has been the cornerstone of care for critically ill patients since the polio epidemic in the 1950s. Increasing end-expirato...

JAMA Insights November 23, 2020 Diagnosis, Management, and Pathophysiology of Arterial and Venous Thrombosis in COVID-19 Gregory Piazza, David A. Morrow JAMA. 2020;324(24):2548-2549. doi:10.1001/jama.2020.23422 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated with arterial and venous thrombotic complications. In a US registry of patients with coronavirus disease 2019 (COVID-19), thrombotic complications occurred in 2.6%...

FeatureHPE6-A44 HPE6-A43 Covid-19: What now for remdesivir? Jeremy Hsu BMJ 2020; 371: m4457 doi: https://doi.org/10.1136/bmj.m4457 (Published 20 November 2020) The spectre of past pandemics looms large over remdesivir, one of the first drug treatments for covid-19. With a WHO trial finding little benefit, Jeremy Hsu asks if the expensive drug is just Tamiflu redux? It’s a cautionary tale worth remembering amid the coronavi...

ICU Management & Practice, Volume 20 - Issue 4, 2020 COVID-19, Corticosteroids and the Road to Enlightenment The use of corticosteroids for respiratory diseases has been a matter of discussion. Here, we present recent evidence of corticosteroids benefits for COVID-19, including improvements in mortality and ventilator-free days. More than six months riding treacherous waves in the COVID-19 storm had passed until a glimpse of a rudimentary old harbour app...