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Editorial Imaging for the Management of Community-Acquired Pneumonia: What to Do if the Chest Radiograph Is Clear Michael Niederman CHEST 2018; 153: 583-585 The diagnosis of community-acquired pneumonia (CAP) is made when a patient has symptoms of a respiratory infection, a compatible physical examination, and a new lung infiltrate on chest radiograph. We have known for some time that some patients with respiratory infection symptoms and a negative chest radiograph can hav...
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[编者按]:近年来,ECMO已经成为重症医学界时尚的宠儿。诚然,对部分危重病患者而言,ECMO能够显著改善生理指标,甚至挽救患者生命。然而,我们是否也面临着滥用ECMO的问题?这里介绍的是Blue Journal一个很短篇幅的文章。作者发现,在ARDS患者接受ECMO治疗(价格昂贵且疗效并未证实)前,仅有31%使用过俯卧位通气(价格便宜且疗效确定)。但愿这样的文章不仅仅是为当前的ECMO热潮浇一点凉水,更能够促进我们的思考... Unproven and Expensive before Proven and Cheap – Extracorporeal Membrane Oxygenation vs....
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Comment Antibiotic strategies in critical care: back to square one? Philipp Schuetz, Robert Eric Beardmore Lancet Infect Dis 2018: 8: 360-361 https://doi.org/10.1016/S1473-3099(18)30057-4 The worth of antibiotics to human health is without bound, but antimicrobial resistance poses a serious threat to this treasured resource.1 Reduction of the selection pressure on pathogens through the rational use of antimicrobials, and discernment of which antibiotic treatment strat...
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Comment Evidence to improve the treatment of infections caused by carbapenem-resistant Gram-negative bacteria FedericoPerez, Robert ABonomo Lancet Infect Dis 2018; 8: 358-360 https://doi.org/10.1016/S1473-3099(18)30112-9 WHO recognises carbapenem-resistant Acinetobacter baumannii, Pseudomonas aeruginosa, and Entero-bacteriaceae as pathogens of crucial importance for the development of novel antibiotics.1 These bacteria manifest resistance to our most trusted therapeutic...
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Comment & Response March 6, 2018 Lung Recruitment and Positive End-Expiratory Pressure Titration in Patients With Acute Respiratory Distress Syndrome—Reply Alexandre Biasi Cavalcanti, Marcelo Britto Passos Amato, Carlos Roberto Ribeiro de Carvalho JAMA. 2018;319(9):934-935. doi:10.1001/jama.2017.21864 In Reply Dr McKown and colleagues suggest that the method used to personalize PEEP might be one explanation for the higher mortality in the recruitment maneuver and P...
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JAMA Clinical Evidence Synopsis March 6, 2018 Procalcitonin Testing to Guide Antibiotic Therapy in Acute Upper and Lower Respiratory Tract Infections Philipp Schuetz, Yannick Wirz, Beat Mueller JAMA. 2018;319(9):925-926. doi:10.1001/jama.2018.0852 Abstract Clinical Question 临床问题 Is the use of procalcitonin for guiding antibiotic decisions in patients with acute upper and lower respiratory tract infections associated with improved clinical outcomes compared with...
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Comment & Response March 6, 2018 Lung Recruitment and Positive End-Expiratory Pressure Titration in Patients With Acute Respiratory Distress Syndrome Andrew C. McKown, Matthew W. Semler, Todd W. Rice JAMA. 2018;319(9):932-933. doi:10.1001/jama.2017.21856 To the Editor The trial by the Alveolar Recruitment for Acute Respiratory Distress Syndrome Trial (ART) Investigators1 compared a low positive end-expiratory pressure (PEEP) strategy2 with one combining a recr...
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Comment & Response February 13, 2018 Early Resuscitation for Adults With Sepsis in a Low-Income Country Wagner Luis Nedel, Caroline Deutschendorf JAMA. 2018;319(6):614. doi:10.1001/jama.2017.20406 To the Editor 致编辑 Dr Andrews and colleagues1 performed a randomized clinical trial of a sepsis protocol for early resuscitation involving intravenous fluids, vasopressors, and blood transfusion compared with usual care among adults with sepsis and hypotension in Zambi...
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Comment & Response February 13, 2018 Early Resuscitation for Adults With Sepsis in a Low-income Country—Reply Matthew W. Semler, Ben Andrews, Gordon R. Bernard JAMA. 2018;319(6):614-615. doi:10.1001/jama.2017.20410 In Reply 回复 Drs Nedel and Deutschendorf highlight 2 key considerations for the interpretation of our trial and the management of patients with sepsis across settings: (1) timing of antibiotic administration and (2) volume of intravenous fluid. Nedel和D...
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CC Nerd - The Case of the Relative Insufficiency January 20, 2018 by Rory Spiegel from https://emcrit.org/emnerd/cc-nerd-case-relative-insufficiency/ When it comes to the efficacy of glucocorticoid therapy for the treatment of septic shock, we have existed in a state of ambiguity, torn between the results of two contradictory RCTs. The first, the Annane et al trial published in JAMA in 2002, suggested a mortality benefit in favor of the corticosteroid group in the subset o...
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