Early IV fluid treatment and sepsis mortality Intravenous (IV) fluids provided by paramedics were associated with reduced in-hospital mortality for patients with sepsis and hypotension but not for those with a higher initial systolic blood pressure. This is the central finding of a large cohort study (n = 1,871 patients) conducted in Canada and published by JAMA Network.  Early IV fluid resuscitation is recommended for the management of sepsis; however, the opti...

Fluid resuscitation in ICU: crystalloids inferior to colloids? Researchers performed a systematic review and meta-analysis to evaluate data from randomised controlled trials (RCTs) of crystalloids and colloids for fluid resuscitation in critically ill adults. They found that crystalloids were less effective than colloids at stabilising haemodynamic resuscitation endpoints such as adequate central venous pressure (CVP) and cardiac index. Current international gui...

We jumped from planes without parachutes (and lived to tell the tale) December 13, 2018 “Would you be willing to jump out of this plane without a parachute?”   For the last year we’ve posed this question, mid-flight, to dozens of unsuspecting travellers seated on commercial aeroplanes.  Why would we set out to ask such a ridiculous question? Some background may be in order. In 2003, Smith and Pell published a tongue-in-cheek systematic revi...

Not All Organ Failures Are Created Equal: Study Identifies the Sepsis Symptoms That Lead to Death By: Lauren Ingeno November 26, 2018 Using patient records from 210,289 hospital visits between 2013 and 2016, Drexel University researchers have identified the specific symptoms that put patients at the greatest risk of dying from sepsis – and they’re not what many clinicians might think. Sepsis, a life-threatening condition caused by the body’s response to an infection, i...

Phenotyping: need to identify subgroups of ARDS patients The consensus definitions of acute respiratory distress syndrome (ARDS) mainly rely on feasible clinical criteria, which help to group patients together for inclusion in clinical trials and for clinical management. This generates clinical and biological differences in observable patient characteristics. These differences could be used to group ARDS patients, referred to as ARDS subphenotypes, according to an arti...

Patients with AKI and sepsis: when to initiate renal-replacement therapy Among patients with septic shock who had severe acute kidney injury (AKI), there was no significant difference in overall mortality at 90 days between patients who were assigned to an early strategy for the initiation of renal-replacement therapy and those who were assigned to a delayed strategy, according to a randomised controlled trial published in The New England Journal of Medicine. AKI is the m...

It is time for improved fluid stewardship Prof. Manu Malbrain, MD, PhD ICU Director - Intensive Care Unit, University Hospital Brussels (UZB), Jette, Belgium Professor - Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB) Brussels, Belgium A conceptual framework for developing institutional programmes and guidelines to enhance fluid stewardship (especially in the intensive care unit [ICU] environment), an activity that includes appropriate selection, dosin...

Blood glucose targets: time to think again? A rethink of blood glucose targets in critically ill patients is needed, according to James S. Krinsley, MD, FCCP, Department of Medicine, Stamford Hospital, writing in an editorial in Chest.Krinsley outlines the take-home points from the observational multicentre study by Hersh et al. that analysed outcomes for 1895 medical and surgical cardiac patients treated with a validated insulin administration algorithm, comparing two tar...

ICU Management & Practice, Volume 18 - Issue 1, 2018 Caring for critically ill immunocompromised patients: We can do better Professor Ellie Azoulay Professor of Medicine in Specialty Pulmonary Medicine and Critical Care, Saint Louis Teaching Hospital and Université Paris Diderot, France What are the major challenges in treating critically ill immunocompromised patients? Thank you for starting with the most important question. It is now demonstrated that critically i...

Study: sepsis-induced DIC associated with high mortality Researchers in Japan conducted a multicentre retrospective observational study to investigate the epidemiology of disseminated intravascular coagulation (DIC) in patients with sepsis. They found that patients with DIC diagnosed by two consensus criteria had higher severity and in-hospital mortality than patients without DIC. The study results confirm the previous findings that, using consensus criteria, DIC is a com...