Antibiotic decisions in the ICU: a dragon’s tale Pieter Depuydt, MD, PhD Head of Clinic - Department of Intensive Care Ghent University Hospital Ghent, Belgium Associate Professor - Department of Internal Medicine Faculty of Medicine Ghent University consider the clinical problem of suspected infection in your ICU patient as a ‘monster’ … with a ‘head’, a ‘body’ and a ‘tail’ Medical decision-making about antibiotic use in critically ill patients is challenging and comple...

Algorithm for early diagnosis and treatment of thrombocytopaenia in ICU Patients in the intensive care unit (ICU) have a range of clinical problems, including multi-organ failure, sepsis, and shock, and early diagnosis and management are crucial to optimise outcomes. A report in the journal Critical Care proposes a new algorithm to help intensivists make a rapid diagnosis so that they can initiate early appropriate management for ICU patients with thrombocytopaenia. The...

Perspective > Medscape Critical Care > Critical Issues COMMENTARY A Negative APRV Trial in ARDS Aaron B. Holley, MD June 29, 2018 Recently, I reviewed a randomized, controlled trial (RCT)[1] comparing acute respiratory distress syndrome (ARDS) management with protocolized airway pressure release ventilation (APRV) with low-tidal-volume (LTV) ventilation. APRV showed superiority for the primary outcome, ventilator-free days, and a number of secondary outcomes. Mo...

News > Medscape Medical News > Conference News > ESOC 2018 TICH-2: Tranexamic Acid for ICH Yields Mixed Results Damian McNamara June 19, 2018 GOTHENBURG, Sweden — Tranexamic acid for intracranial hemorrhage failed to significantly improve functional status compared with placebo at 90 days in a randomized controlled study. However, the antifibrinolytic agent was associated with a decrease in deaths in the first week and attenuation of hematoma expansion. The pri...

News > Medscape Medical News Oxytocin Not Best for Postpartum Hemorrhage Prevention, Study Finds Norra MacReady May 29, 2018 Postpartum hemorrhage (PPH), defined as maternal blood loss of 500 mL or more within 24 hours after delivery, is the leading cause of maternal mortality worldwide. The World Health Organization (WHO) currently recommends treatment with oxytocin to reduce the risk for excessive postpartum bleeding, but a new meta-analysis suggests that other dru...

Perspective SHATTUCK LECTURE Innovation for Pandemics Bill Gates N Engl J Med 2018; 378:2057-2060 DOI: 10.1056/NEJMp1806283 Over recent decades, the world has seen incredible progress in reducing child mortality and tackling infectious diseases. Thanks to better vaccines and other interventions, child mortality has decreased by more than 50% since 1990. We are on the verge of eradicating polio. HIV is no longer a certain death sentence. And half the world is now malaria-fr...

Correspondence The Magic Bullet in Sepsis or the Inflation of Chance Findings? Morten H. Møller, Jon H. Laake, John A. Myburgh, et al. Chest 2017; 152: 222-223 To the Editor: In the June 2017 issue of CHEST, Marik et al1 presented a single-center retrospective before and after study assessing the effects of treating patients with severe sepsis/septic shock with IV vitamin C, hydrocortisone, and thiamine. Forty-seven patients were treated with IV vitamin C, hydroc...

EDITORIAL Finding the Right Balance Birgitte Brandstrup N Engl J Med 2018; 378:2335-2336 DOI: 10.1056/NEJMe1805615 When I was a young resident in the 1990s, surgical patients received so much intravenous saline on the day of surgery that they often gained 4 to 6 kg, and by postoperative day 2 or 3, pulmonary congestion and cardiac arrhythmias were commonplace. That was the basis for a 2003 trial of restrictive versus standard fluid therapy,1 which aimed to answer a simple ...

News > WebMD Health News Vitamin Cocktail for Sepsis Getting Wider Test Matt Smith May 29, 2018 A simple vitamin cocktail to treat sepsis has shaken up the medical world, raising hopes of a more effective treatment for one of history's great killers. But will it stand up to tougher tests? 一种简单的维生素鸡尾酒疗法治疗全身性感染对医学界产生了震动，为治疗这种一个世纪以来危及生命的临床疾病带来了有效治疗的曙光。但是，这种疗法能否经受更加严苛的验证呢？ Researchers at sev...

Editorial May 20, 2018 qSOFA Score for Patients With Sepsis in Low- and Middle-Income Countries Neill K. J. Adhikari, Gordon D. Rubenfeld JAMA. Published online May 20, 2018. doi:10.1001/jama.2018.6413 In the past 2 years, sepsis has received considerable attention from the global community. In 2017, the World Health Assembly passed a resolution urging all 194 UN Member States to implement actions to reduce the burden of sepsis, and for the World Health Organization to...