Study: Nitric oxide decreases renal failure after cardiac surgery Results of a phase IIb prospective randomised controlled trial Prevention of Renal Failure by Nitric Oxide in Prolonged Cardiopulmonary Bypass showed that nitric oxide (NO) administered during surgery and for 24 hours afterwards was safe, and postoperatively reduced the incidence of acute kidney injury (AKI), transition to stage 3 chronic kidney disease, and major adverse kidney events at 30 days, 90 days, a...

ICU Management & Practice, Volume 18 - Issue 3, 2018 What should we stop doing in the ICU? Dr. Fernando Zampieri, MD, PhD Research Institute - HCor-Hospital do Coração São Paulo, Brazil In this article, I highlight that the most important thing intensive care physicians should stop doing is ignoring that they are prone to several cognitive biases. I will first support my statement by looking for conceptual caveats and cognitive bias in routine intensive care unit...

Clinical significance of viral detection in critically ill patients Noninvasive diagnostic tests can ensure the early identification and treatment of viral infections in patients with haematological malignancies. New research from France assessed the clinical relevance of a positive virus polymerase chain reaction (PCR) test on nasal swabs in haematology patients at ICU admission. "Respiratory virus detection in the upper airway by multiplex PCR assay is common in critica...

CORRESPONDENCE Procalcitonin-Guided Antibiotic Use N Engl J Med 2018; 379:1971-1973 DOI: 10.1056/NEJMc1811150 The authors reply: Pulia et al. correctly note that implementation of a procalcitonin guideline in our trial had minimal effect on antibiotic prescription in cases of community-acquired pneumonia, but in patients with acute bronchitis, antibiotic prescription in the ED dropped by 50%. However, the finding for acute bronchitis, while robust to correction for multipl...

CORRESPONDENCE Procalcitonin-Guided Antibiotic Use N Engl J Med 2018; 379:1971-1973 DOI: 10.1056/NEJMc1811150 TO THE EDITOR The null result for the use of procalcitonin level to guide the prescription of antibiotics, reported by Huang et al. (July 19 issue),1 is incongruent with our experience as an early emergency department (ED) adopter. Rapid procalcitonin assays have been ordered for more than 4000 patients since 2014. The ability of procalcitonin to differentiate vira...

Managing patients with refractory septic shock The Surviving Sepsis Guidelines provide a specific framework to treat patients with septic shock. These guidelines include the use of antimicrobial therapy, source control, fluid therapy and targeted vasoporessors. However, there is still a small proportion of patients that does not respond to these measures and consequently deteriorates into refractory shock and progressive multi-organ failure. Specific guidelines to manage...

High-risk ECMO - heroic rescue or futile care? Over the past decade, extracorporeal membrane oxygenation (ECMO) has become mainstream therapy in adult intensive care. Although the list of contraindications to ECMO has shrunk considerably, a few of these remain absolute, notes Dr. Graeme MacLaren in an editorial article published in the journal Critical Care. "There are a number of circumstances outside of this list of contraindications to which ECMO could be applied ...

Medical News & Perspectives September 19, 2018 Unproven but Profitable: The Boom in US Stem Cell Clinics Rita Rubin JAMA. Published online September 19, 2018. doi:10.1001/jama.2018.13861 Stanford orthopedic surgeon Jason Dragoo, MD, is conducting 4 randomized clinical trials of the use of autologous stem cells to treat knee osteoarthritis. Interest in the trials seems high—nearly 100 people inquire about them daily, Dragoo says—but he recognizes that some patient...

Editorial September 25, 2018 Treatment Algorithms for Staphylococcal Bacteremia: Improving Clinical Care and Enhancing Antimicrobial Stewardship Eli N. Perencevich, Preeti N. Malani JAMA. 2018;320(12):1243-1244. doi:10.1001/jama.2018.13315 Antimicrobial resistance is among the most important threats to human health. Lost in the episodic outbreaks of emerging pathogens such as 2009 H1N1 influenza, Ebola, and Zika virus has been the steady increase in resistance to...

Viewpoint September 14, 2018 Antibiotics for Sepsis—Finding the Equilibrium Michael Klompas, MD, Thierry Calandra, Mervyn Singer, et al JAMA. Published online September 14, 2018. doi:10.1001/jama.2018.12179 Sepsis is medicine’s last remaining preserve for unrestrained antibiotic prescribing. The Surviving Sepsis Campaign guidelines recommend empirical broad-spectrum therapy within one hour of triage for both sepsis and septic shock.1 This recommendation, and mandates t...