Going Green in the ICU In ICU Fri, 22 Mar 2024 The environmental impact of ICUs was in focus at ISICEM 2024. Nicole Hunfeld, a hospital pharmacist at Erasmus Medical Center in the Netherlands, emphasised the need for a sustainable medication process, particularly noting the heightened waste production during the COVID-19 pandemic.  There is an overwhelming level of plastic waste in the ICU, and its environmental implications need to be addresse...

Editorial  April 19, 2024 Harnessing the Electronic Health Record to Improve Empiric Antibiotic Prescribing Anurag N. Malani, Preeti N. Malani JAMA. Published online April 19, 2024. doi:10.1001/jama.2024.6554 Approximately half of hospitalized adults in the US receive antibiotics, with pneumonia and urinary tract infection (UTI) being the 2 most frequent indications.1 Estimates suggest about 30% of all antibiotics prescribed in US hospit...

Vascular Leak in Sepsis In Sepsis Tue, 26 Mar 2024 Sepsis remains a major cause of mortality, accounting for nearly 20% of global deaths. Microcirculatory dysfunction, marked by irregular blood flow and increased permeability of blood vessels, is a characteristic feature of sepsis. This dysfunction can lead to tissue swelling and impaired organ function. Endothelial dysfunction, which is also seen in other acute inflammatory disorders like burns, traum...

Tranexamic Acid for Acute UGIB in Patients With Cirrhosis In ICU Tue, 12 Mar 2024 A recent study aimed to assess the effectiveness and safety of tranexamic acid in treating acute upper gastrointestinal bleeding (UGIB) in patients with cirrhosis, particularly those classified as Child-Turcotte-Pugh (CTP) class B and C. These patients experience systemic and localised fibrinolysis in the mucosa of the oesophagus and stomach. The study included 600 pat...

Multidisciplinary Management of Gram-Negative Bloodstream Infections In ICU Tue, 12 Mar 2024 Bloodstream infections (BSIs) caused by Gram-negative pathogens pose significant challenges in ICU patients due to their high prevalence and severity, with mortality rates reported as high as 40%. The widespread prevalence of multidrug-resistant organisms (MDRO) further complicates antibiotic treatment choices, with mortality rates reaching 43% when MDROs are i...

Respiratory Muscle Assessments to Predict Weaning Outcomes In ICU Tue, 12 Mar 2024 Various factors influence failure to wean from mechanical ventilation, including respiratory muscle dysfunction, which is strongly associated with weaning failure and mortality. However, respiratory muscle function assessment is not routinely performed in most ICUs.  Various bedside tools are available for assessing respiratory muscle function, including non-voli...

Ventilator Parameters During OR–to–ICU Transition In ICU Tue, 5 Mar 2024 Lung-protective mechanical ventilation strategies are beneficial both in the operating room (OR) and the ICU. However, there are variations in ventilator management practices between these settings, leading to adjustments in ventilator parameters when patients transition from the OR to the ICU. The impact of changes in ventilator settings during transitions between these settings ...

Violence Against Healthcare Professionals in ICUs In ICU Tue, 5 Mar 2024 A new study reviewed existing literature on workplace violence (WPV) against healthcare workers (HCWs) in ICUs, focusing on prevalence, risk factors, interventions, and preventive measures. WPV, defined as violent acts or threats directed towards individuals at work, is a significant issue globally, with HCWs experiencing a 20% higher rate compared to other employees. However, WPV...

Sex Differences in Vital Organ Support in ICU There is increasing evidence that factors such as sex, race, and socioeconomic status may influence the treatment received in ICUs. Data suggests that women are less likely to receive invasive ventilation, vasoactive medication, renal replacement therapy (RRT), extracorporeal membrane oxygenation (ECMO), and tracheostomy than men, but previous studies have shown heterogeneity and risk of bias. Factors like illness sever...

Editorial  April 1, 2024 Controlling Multidrug-Resistant Organisms Across Patient-Sharing Networks Christopher J. Crnich JAMA. Published online April 1, 2024. doi:10.1001/jama.2024.0267 Antimicrobial resistance is a major public health problem that threatens to reverse many of the medical therapy advances achieved over the past 4 decades.1 Infections caused by multidrug-resistant organisms (MDROs) are estimated to cause 35000 deaths in t...