ICU Management & Practice, Volume 18 - Issue 4, 2018 How to manage severe dengue infection A review of diagnosis and treatment of dengue, a mosquito-borne febrile illness caused by flavivirus with a clinical spectrum ranging from self-limited fever to dengue haemorrhagic fever with shock.  Dengue is a febrile illness, caused by one of the serotypes of Flavivirus (DENV1-4), transmitted by Aedes aegypti and Aedes albopictus mosquitoes during a blood m...

Monocyte Distribution Width as Biomarker for Early Sepsis Detection Existing biomarkers provide limited use for rapid detection of sepsis since they cannot accurately distinguish sepsis from other common conditions encountered in the emergency department (ED). Now a U.S. clinical trial suggests that the monocyte distribution width (MDW) can be a useful indicator of Sepsis-2 and Sepsis-3 in high-risk ED patients. "Changes in the volume of peripheral blood monocyt...

ICU Diaries Not Useful in Preventing PTSD Symptoms Results of a randomised clinical trial in France indicate that the use of ICU diaries was not helpful in preventing post-traumatic stress disorder symptoms (PTSD) after ICU hospitalisation. In this multicentre study, investigators compared the use of patients' ICU diaries – filled out by clinicians and family members during the ICU stay – with usual care.Previous studies exploring the usefulness of ICU diaries in p...

Vitamin C Drug Cocktail for Sepsis The combination of intravenous vitamin C, corticosteroids and thiamine has been made famous by Dr. Paul Marik, M.D. for the treatment of sepsis in critically ill patients. The ‘Marik protocol’, also termed HAT (Hydrocortisone, Ascorbic acid, Thiamine), has however come under criticism regarding the lack of evidence. Dr. Marik of Sentara Norfolk General Hospital, Virginia, has been using the Marik protocol to treat sepsis in his...

Viewpoint | July 19, 2019 Evidence vs Consensus in Clinical Practice Guidelines Benjamin Djulbegovic, Gordon Guyatt, JAMA. Published online July 19, 2019. doi:10.1001/jama.2019.9751 Clinical practice guidelines have become increasingly prominent in clinical medicine over the last 4 decades, and represent one of the most important tools for potentially improving clinical decision-making and, in turn, potentially improving patients’ outcomes.1 Historically, m...

IROI Study: Intra-abdominal hypertension afflicts 50% of ICU patients The Incidence, Risk Factors, and Outcomes of Intra-Abdominal Hypertension in Critically Ill Patients (IROI) Study is the first prospective multicentre observation on prevalence, risk factors, and outcome of intra-abdominal hypertension (IAH) among the consecutive patients admitted to the ICU. Results show that nearly half of all patients admitted to the ICUs worldwide developed IAH and that two t...

Editor's Note July 16, 2019 Government Regulation of Sepsis Care Demetrios N. Kyriacou JAMA. 2019;322(3):250-251. doi:10.1001/jama.2019.9230 每年全球约有3000万脓毒症患者，且导致约600万患者死亡。尽管不断提出新的治疗手段，但是，过去数十年间脓毒症相关病死率的下降主要源于早期识别以及包括静脉抗生素和晶体液复苏在内的及时治疗。拯救脓毒症行动指南将重要治疗措施与其他重症治疗及实验室检查整合成集束化治疗进行推荐。然而，在医院环境下，根据这些指南推荐的...

ICU Management & Practice, Volume 18 - Issue 1, 2018 CO2 in the critically ill CO2 exerts potent effects on lung biology that could be clinically relevant in critically ill patients, in particular those with acute respiratory distress syndrome (ARDS). The impact of hypercapnia on outcome in these patients is yet to be determined. The physiological effects of hypercapnia are increasingly well understood, but the literature remains confusing. Importan...

Editor's Note July 16, 2019 Government Regulation of Sepsis Care Demetrios N. Kyriacou JAMA. 2019;322(3):250-251. doi:10.1001/jama.2019.9230 Sepsis is estimated to affect more than 30 million people and cause an estimated 6 million deaths worldwide every year. Although new medical treatments are continually being proposed and tested, the greatest reduction in sepsis-related deaths over the past few decades has come from the early recog...

Editorial July 16, 2019 Psychological Consequences of Admission to the ICU： Helping Patients and Families Louise Rose, Fiona Muttalib, Neill K. J. Adhikari JAMA. 2019;322(3):213-215. doi:10.1001/jama.2019.9059 For most patients and their families, admission to the intensive care unit (ICU) is an unanticipated event that causes substantial psychological distress. For patients, short- and long-term consequences include delirium, anxiety, depressi...