Editorial June 11, 2019 Revisiting, Reframing, and Casting a New Light on Liberation From Mechanical Ventilation Timothy D. Girard, Karen E. A. Burns JAMA. 2019;321(22):2167-2169. doi:10.1001/jama.2019.7364 Every year, more than 1 million patients throughout the world receive mechanical ventilation for acute respiratory failure. One of the most important decisions clinicians make in managing these critically ill patients is how to liberate them ...

Fluid responsiveness in sepsis: the fluid challenge revisiting (FCREV) study Fluid challenge is a common practice in the ICU. It is one of the most important resuscitation manoeuvres of acute circulatory failure management in critically ill patients. Adequate fluid resuscitation is very important because both hypovolaemia and fluid overload can result in poor outcomes in the ICU. The criteria for fluid administration still remains controversial. A study was cond...

ICU Management & Practice, Volume 18 - Issue 4, 2018 What a difference a drug makes? Asking why the patient needs to be sedated is as important as the choice of drug for sedation.  Why use sedation?  Intensivists should ask why they use sedation every time they order it. Sedation is used to reduce the burden and stress of critical illness. Sedative agents mixed with analgesic agents reduce pain and keep the patient calm, especially at night....

Editorial May 19, 2019 Recombinant Human Soluble Thrombomodulin in Patients With Sepsis-Associated Coagulopathy: Another Negative Sepsis Trial? Tom van der Poll JAMA. Published online May 19, 2019. doi:10.1001/jama.2019.5792 Sepsis is a heterogeneous syndrome caused by an unbalanced host response to an infection resulting in organ dysfunction.1 Sepsis is associated with activation of the coagulation system, and 30% to 60% of patients have d...

Editorial May 19, 2019 New Phenotypes for Sepsis: The Promise and Problem of Applying Machine Learning and Artificial Intelligence in Clinical Research William A. Knaus, Richard D. Marks JAMA. Published online May 19, 2019. doi:10.1001/jama.2019.5794 In this issue of JAMA, Seymour and his multidisciplinary team of coauthors1 aim to improve the current understanding of sepsis by identifying new clinical phenotypes using machine learning...

ICU Management & Practice, Volume 19 - Issue 1, 2019 Trends in epidemiology and antimicrobial resistance in intensive care units The intensive care unit has a unique environment, mainly because it treats severe and critically ill patients who require special care. Critical care patients often require high-risk surgeries, and there is also a frequent need for invasive devices such as central or peripheral venous catheters, urinary catheters or tracheal tubes...

COMMENT|ONLINE FIRST Carbapenem-resistant Enterobacteriaceae: global action required Federico Perez, Robert A Bonomo Lancet Infect Dis Published: April 29, 2019 DOI: https://doi.org/10.1016/S1473-3099(19)30210-5 Enterobacteriaceae are common pathogens in hospitals and in the community. When resistant to powerful and versatile antibiotics such as carbapenems, they can have devastating consequences, particularly in the most vulnerable individuals.1 Much infor...

Early Paralytic Agents for ARDS? Yes, No, and Sometimes Arthur S. Slutsky, Jesús Villar N Engl J Med May 19, 2019DOI: 10.1056/NEJMe1905627 Lung-protective ventilation, which includes low tidal volumes and limitation of plateau pressures, is the standard approach in patients with acute respiratory distress syndrome (ARDS).1 Almost a decade ago, the ARDS et Curarisation Systematique (ACURASYS) trial2 showed that in patients with moderate-to-severe ARDS, a strategy ...

Comment & Response May 14, 2019 Acute Kidney Injury Related to Sepsis—Reply Matthieu Legrand, John A. Kellum JAMA. 2019;321(18):1828-1829. doi:10.1001/jama.2019.2072 In Reply 回答 Dr Seres comments on the effect of low muscle mass on serum creatinine level. We agree that muscle mass and cachexia can decrease sensitivity of serum creatinine to detect a drop in GFR and AKI. Recently, Yoo and colleagues1 reporte...

Comment & Response May 14, 2019 Acute Kidney Injury Related to Sepsis David S. Seres JAMA. 2019;321(18):1827-1828. doi:10.1001/jama.2019.2040 To the Editor 致编辑 Drs Legrand and Kellum reviewed the interpretation of serum creatinine in a critically ill patient.1 However, they only included a glancing reference to muscle mass and did not discuss protein intake. Both factors affect the evaluation of renal function and m...