Comment & Response May 14, 2019 Acute Kidney Injury Related to Sepsis David S. Seres JAMA. 2019;321(18):1827-1828. doi:10.1001/jama.2019.2040 To the Editor 致编辑 Drs Legrand and Kellum reviewed the interpretation of serum creatinine in a critically ill patient.1 However, they only included a glancing reference to muscle mass and did not discuss protein intake. Both factors affect the evaluation of renal function and m...

Acute-on-chronic liver failure: criteria for ICU admission Cirrhosis is a leading cause of morbidity and mortality throughout the world. Patients with cirrhosis may develop decompensated disease with portal hypertension and functional impairment of the liver, resulting in numerous complications including infection, variceal bleeding, hepatic encephalopathy (HE), and hepatorenal syndrome (HRS). Along with decompensation of cirrhosis, the concept of acute-on-chron...

PERFECT protocol: volume-based feeding in ventilated adults Underfeeding in critical illness is common and associated with poor outcomes. Researchers in the UK designed a before-and-after study to evaluate the safety, efficacy and clinical outcomes associated with volume-based feeding (VBF) compared to rate-based feeding (RBF) in a single intensive care unit (ICU).The prospective before-and-after study suggests that VBF safely and effectively increased the delivery...

ICU Management & Practice, Volume 19 - Issue 1, 2019 Protecting ward patients Finding patients before they crash might be the next major opportunity to improve patient safety. This article describes recent advances and perspectives for ward monitoring with wearable sensors and smart algorithms. Hospital wards are dangerous. Indeed, they are where most unexpected deaths occur within institutions. In a UK national audit study, among 23,554 adult in-hospita...

Innovations in ICU ventilation The future delivered In this article, we aim to summarise the developments in mechanical ventilation that we believe are shaping the present and will shape the future ahead. Introduction Many centuries ago, Socrates stated that “the secret of change is to focus all of your energy, not on fighting the old, but on building the new.” Nowadays, we may relate his quote with the concept of innovation, which is considered the process of...

Is Sepsis-Associated Mortality Often Preventable? Authors: News Author: Veronica Hackethal, MD CME Author: Charles P. Vega, MD Clinical Context Approximately 1.7 million US adults are diagnosed annually with sepsis, and sepsis can contribute to more than a quarter of a million deaths among US residents per year. The authors of the current study acknowledged multiple programs to improve the care and outcomes of patients with sepsis; one of the best known of the...

Management of obese patients with ARDS At least one fifth of all patients admitted to the ICU are obese, and these patients are at risk of developing lung de-recruitment and then atelectasis. Moreover, the incidence of acute respiratory distress syndrome (ARDS) is increased in obese patients. A major challenge of the critical care management of obese patients is successful respiratory system management. However, while obesity contributes to many diseases and is ...

Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health Challenging the One-Hour Sepsis Bundle Annahieta Kalantari, DO; Salim R. Rezaie, MD Western J Emerg Med. 2019;20(2):185-190.  In April 2018, the Surviving Sepsis Campaign (SSC) released an updated sepsis bundle, which combines directives previously listed in the three-hour and six-hour bundles. The authors discussed the reasoning and evidence supporting these changes. Howe...

Optimising beta-lactam treatment in the ICU - expert consensus The French Society of Pharmacology and Therapeutics (SFPT) and the French Society of Anaesthesia and Intensive Care Medicine (SFAR) have released guidelines on the optimisation of beta-lactam treatment in intensive care unit (ICU) patients. The two groups strongly recommend the use of personalised dosing, continuous or prolonged infusion and therapeutic drug monitoring when administering beta-lactam ant...

PROTINVENT study: protein intake timing and dose for the critically ill Optimal protein intake during critical illness is unknown. In order to achieve a personalised nutritional approach, Dutch researchers conducted the PROTein INtake and clinical outcomes of adult critically ill patients on prolonged mechanical VENTilation (PROTINVENT) study. The study’s primary aim was to determine the best timing and dose of protein intake to support the lowest 6-month mortality...