Stable/Unstable? Cardiovascular Dynamics in Critically Ill Patients There is currently doubt over the terms stable and unstable regarding cardiovascular dynamics in critically ill patients. Labelling a patient as haemodynamically stable or unstable can have different connotations depending on the practising physician. The term stable is originally defined as the condition of the patient being unchanged for a substantial amount of time. However, if this is the ca...

ICU Management & Practice, Volume 19 - Issue 2, 2019 Big Data and hidden subtypes of sepsis Results of a study conducted by the University of Pittsburgh School of Medicine suggests that sepsis is not one condition, but many conditions that could benefit from different treatments. The findings are published in JAMA and were presented at the American Thoracic Society's Annual Meeting. Sepsis is the number one killer of hospitalised patients and is a life-t...

SPOTLIGHT|ONLINE FIRST When is the right time to discuss ECMO? William B Feldman, Steven P Keller Lancet Respir Med Published:August 12, 2019 DOI:https://doi.org/10.1016/S2213-2600(19)30278-4 The rise of extracorporeal membrane oxygenation (ECMO) over the past decade as a support modality provides clinicians with a powerful new therapy to care for patients with advanced cardiopulmonary disease. The growing use of this technology has required careful attention ...

Effects of Sedatives and Opioids on Patient Ventilator Asynchrony Patient-ventilator asynchrony is frequent during invasive mechanical ventilation. If patient-ventilator interaction is poor, it can prolong the duration of mechanical ventilation and can also result in longer ICU and hospital stay as well as increased mortality. It is thus important to optimise patient-ventilator interaction.  There are many factors that could affect patient-ventilator interaction...

COMMENT|ONLINE FIRST Simplified control measures for ESBL-producing Enterobacteriacae? Jean-Christophe Lucet, Jean-Ralph Zahar Lancet Infect Dis Published:August 23, 2019 DOI:https://doi.org/10.1016/S1473-3099(19)30412-8 Extended-spectrum β-lactamase (ESBL)-producing Enterobacteriacae have disseminated worldwide, with very high prevalence in countries of low and middle income1 and a roughly 10% prevalence in the community and at hospital admission in high-inco...

Outcomes of ABCDE Bundle in Mechanically Ventilated Patients Increasing focus on ICU utilisation and survivorship has also resulted in a greater focus on the long-term consequences of critical illness. Post Intensive Care Syndrome (PICS) is characterised by physical, cognitive, and emotional manifestations and can have a long-lasting impact on survivors of ICU as well as their families and caregivers.  The ABCDEF bundle is an organisational approach that is used...

Untangling the Infusion Confusion Many patients in the ICU receive multiple IV infusions. This can lead to significant confusion because infusions look quite similar, and a patient with multiple infusions tends to be surrounded by associated components such as bags, tubing, pumps, etc. There is often a lack of information along the infusion pathway, which can lead to confusion. For example, if an infusion change is required, the healthcare provider must reconcile t...

ICU Management & Practice, Volume 19 - Issue 2, 2019 Use of sedation and controlled paralysis in ICU patients with ARDS According to a National Institutes of Health sponsored clinical trial that was conducted at several North American hospitals and was led by clinician-scientists at the University of Pittsburgh and University of Colorado schools of medicine, reversibly paralysing and sedating hospitalised patients with severe breathing problems does not pro...

Original Investigation August 27, 2019 Association Between Educational Attainment and Causes of Death Among White and Black US Adults, 2010-2017 Isaac Sasson, Mark D. Hayward JAMA. 2019;322(8):756-763. doi:10.1001/jama.2019.11330 Abstract Importance 背景 There are substantial and increasing educational differences in US adult life expectancy. To reduce social inequalities in mortality, it is important to understand...

ICU Management & Practice, Volume 18 - Issue 3, 2018 Fluids in shock Fluid management during shock from physiology to bedside. Shock is a common life-threatening, generalised form of acute circulatory failure in critically ill patients, which is usually managed by infusing fluids to increase cardiac output and supply the systemic oxygen request. International guidelines recommend use of an aggressive fluid resuscitation in the early phases of shock. In t...