SeptiCyte LAB: new test aims to make sepsis molecular Sepsis is a life-threatening condition and early detection is critical to ensure that the patient receives timely and appropriate treatment. For almost 25 years, clinicians have used the systemic inflammatory response syndrome (SIRS) criteria, a measure of the clinical expression of the host response to inflammation, as a marker of sepsis. A new approach to the diagnosis of sepsis has been proposed by Miller et al., ba...

News > Medscape Medical News > Neurology News Glasgow Coma Scale Gets an Eye-Opening Update Damian McNamara April 19, 2018 Working with a developer of the original Glasgow Coma Scale (GCS), researchers have found that adding pupil response to the GCS more accurately predicts prognosis after traumatic brain injury, including the likelihood of death, than either measure alone. Because previous research suggested that the GCS score and pupil reaction independently ...

Hyperchloraemia in sepsis: saline vs. balanced crystalloids Chloride, as the major anion of the extracellular fluid, constitutes an important element in the homeostasis of the human organism. Hyperchloraemia, whether a result of the sepsis process or a consequence of its treatment with supraphysiologic chloride fluids, appears to have a negative impact on the clinical outcome of septic patients, according to an article published in Annals of Intensive Care. Acidosis is a f...

Editorial Imaging for the Management of Community-Acquired Pneumonia: What to Do if the Chest Radiograph Is Clear Michael Niederman CHEST 2018; 153: 583-585 The diagnosis of community-acquired pneumonia (CAP) is made when a patient has symptoms of a respiratory infection, a compatible physical examination, and a new lung infiltrate on chest radiograph. We have known for some time that some patients with respiratory infection symptoms and a negative chest radiograph can hav...

[编者按]：近年来，ECMO已经成为重症医学界时尚的宠儿。诚然，对部分危重病患者而言，ECMO能够显著改善生理指标，甚至挽救患者生命。然而，我们是否也面临着滥用ECMO的问题？这里介绍的是Blue Journal一个很短篇幅的文章。作者发现，在ARDS患者接受ECMO治疗（价格昂贵且疗效并未证实）前，仅有31%使用过俯卧位通气（价格便宜且疗效确定）。但愿这样的文章不仅仅是为当前的ECMO热潮浇一点凉水，更能够促进我们的思考... Unproven and Expensive before Proven and Cheap – Extracorporeal Membrane Oxygenation vs....

Comment Antibiotic strategies in critical care: back to square one? Philipp Schuetz, Robert Eric Beardmore Lancet Infect Dis 2018: 8: 360-361 https://doi.org/10.1016/S1473-3099(18)30057-4 The worth of antibiotics to human health is without bound, but antimicrobial resistance poses a serious threat to this treasured resource.1 Reduction of the selection pressure on pathogens through the rational use of antimicrobials, and discernment of which antibiotic treatment strat...

Comment Evidence to improve the treatment of infections caused by carbapenem-resistant Gram-negative bacteria FedericoPerez, Robert ABonomo Lancet Infect Dis 2018; 8: 358-360 https://doi.org/10.1016/S1473-3099(18)30112-9 WHO recognises carbapenem-resistant Acinetobacter baumannii, Pseudomonas aeruginosa, and Entero-bacteriaceae as pathogens of crucial importance for the development of novel antibiotics.1 These bacteria manifest resistance to our most trusted therapeutic...

Comment & Response March 6, 2018 Lung Recruitment and Positive End-Expiratory Pressure Titration in Patients With Acute Respiratory Distress Syndrome—Reply Alexandre Biasi Cavalcanti, Marcelo Britto Passos Amato, Carlos Roberto Ribeiro de Carvalho JAMA. 2018;319(9):934-935. doi:10.1001/jama.2017.21864 In Reply Dr McKown and colleagues suggest that the method used to personalize PEEP might be one explanation for the higher mortality in the recruitment maneuver and P...

JAMA Clinical Evidence Synopsis March 6, 2018 Procalcitonin Testing to Guide Antibiotic Therapy in Acute Upper and Lower Respiratory Tract Infections Philipp Schuetz, Yannick Wirz, Beat Mueller JAMA. 2018;319(9):925-926. doi:10.1001/jama.2018.0852 Abstract Clinical Question 临床问题 Is the use of procalcitonin for guiding antibiotic decisions in patients with acute upper and lower respiratory tract infections associated with improved clinical outcomes compared with...

Comment & Response March 6, 2018 Lung Recruitment and Positive End-Expiratory Pressure Titration in Patients With Acute Respiratory Distress Syndrome Andrew C. McKown, Matthew W. Semler, Todd W. Rice JAMA. 2018;319(9):932-933. doi:10.1001/jama.2017.21856 To the Editor The trial by the Alveolar Recruitment for Acute Respiratory Distress Syndrome Trial (ART) Investigators1 compared a low positive end-expiratory pressure (PEEP) strategy2 with one combining a recr...