ECMO for COVID-19 ARDS There is increasing evidence supporting the use of extracorporeal membrane oxygenation (ECMO) for severe acute respiratory distress syndrome (ARDS) in patients that do not respond to maximal medical therapy. ARDS can occur in some COVID-19 patients who are hospitalised, and ECMO can be utilised as a treatment option in some cases. Using ECMO can help avoid ventilator-induced lung injury and give the lungs time to rest while waiting for recove...

Prone Positioning for Acute Hypoxaemic Respiratory Failure Prone positioning is a medical intervention that was initially proposed over 50 years ago as a way to improve gas exchange. Multiple clinical trials have been conducted on its effectiveness, with the Proning Severe ARDS Patients landmark trial demonstrating a mortality benefit in patients with severe ARDS. As a result, expert consensus and societal guidelines now recommend using prone positioning for severe...

Invited Commentary  May 1, 2023 Xuebijing Injection for the Treatment of Sepsis: What Would a Path to FDA Approval Look Like? Ellis F. Unger, David B. Clissold JAMA Intern Med. Published online May 1, 2023. doi:10.1001/jamainternmed.2023.0788 Sepsis is a serious condition with high morbidity and mortality for which treatment advancements are desperately needed. In this issue of JAMA Internal Medicine, Liu et al1 describe the results...

Sequential Extracorporeal Therapy in Sepsis Sepsis and septic shock are significant causes of morbidity and mortality in critical care, with a complex and rapidly evolving clinical presentation. This involves microbial invasion, infection focus, immune response, circulating pathogen and pathogen products, immunodysregulation, organ damage, and multiple organ dysfunction. Extracorporeal therapies may be used to target specific molecules at different stages, includin...

Invited Commentary  March 27, 2023 Should We Add Fludrocortisone to Hydrocortisone for Treatment of Septic Shock? Michael A. Matthay, Issa J. Dahabreh, B. Taylor Thompson JAMA Intern Med. 2023;183(5):460-461. doi:10.1001/jamainternmed.2023.0257 Mortality for patients with septic shock is greater than 30% in most studies. The mechanisms that contribute to poor survival are primarily explained by the development of multiorgan failure from activ...

ICU Management & Practice, Volume 22 - Issue 5, 2022 Rapid Assessment of Fluid Responsiveness and Tolerance With Ultrasound of the Neck Vessels Ultrasonographic assessment of the neck vessels in critically ill patients contributes to rapid and non-invasive management of fluids to evaluate responsiveness and tolerance and blood volume status. Introduction There are multiple ways to evaluate the responsiveness and tolerance to IV fluids, as well as veno...

Editorial  March 21, 2023 Toward Personalizing Care: Assessing Heterogeneity of Treatment Effects in Randomized Trials Issa J. Dahabreh, Dhruv S. Kazi JAMA. 2023;329(13):1063-1065. doi:10.1001/jama.2023.3576 Clinicians know that individual patients may respond differently to a given treatment and that the overall treatment effect reported in a randomized trial of the treatment may not be directly applicable to all patients in clinical practice.1 D...

Strategies to Optimise Extubation Extubation failure refers to the inability to sustain spontaneous breathing after the removal of an artificial airway. The need for reintubation with 24 to 72 hours or up to seven days can lead to high morbidity, mortality and disability. The incidence of extubation failure in ICUs remains high (10-15%) and has two main causes: weaning failure and airway failure.  In this paper, the authors aim to update strategies for opti...

Viewpoint  March 23, 2023 Medical School Rankings—Bad for the Health of the Profession and the Public Holly J. Humphrey, Dana Levinson, Keme Carter JAMA. Published online March 23, 2023. doi:10.1001/jama.2023.2815 All of higher education sat up and took notice when Heather Gerken, dean of Yale Law School, announced in November 2022 that Yale would no longer contribute data to US News & World Report (USNWR) for the ranking of law...

Predicting Readmission, Death After Discharge From ICU Many machine learning (ML) models have been developed for use in the ICU, but their effectiveness in new settings is uncertain due to a lack of external validation. A study showed that less than one-third of Food and Drug Administration (FDA) approved ML models have undergone multisite assessment. In addition, only 11% of  ICU prediction models have been externally validated.  The ICU is a popular ...