Imaging and intensive care medicine An evolving partnership A major evolution is underway involving critical care and imaging.  The intensive care patient population is changing. Increasingly intensive care units (ICUs) are treating older patients, with more comorbidities, and variable prognosis, at a time when family expectations are different and often with higher expectations of recovery. Life support technology is increasingly sophisticated, surgery is minima...

Antifungal treatment in the ICU Best practice in managing fungal infections Invasive candidiasis: Every milligram of antifungal counts! Think Aspergillus! Invasive fungal infections (IFIs) are a major cause of morbidity and mortality in critically ill patients. Almost 80% of IFIs are due to Candida spp., which are the third most common isolated microorganisms in the intensive care unit (ICU) (Kett et al. 2011; Bassetti et al. 2017). Although the incidence of inva...

Risk of sepsis: does DNA matter? A new analysis has identified several genetic variants that could influence one's susceptibility to sepsis, a life-threatening condition. This study provides a novel insight that may affect personalised targeted treatment in the future clinical management of sepsis. Variants are alterations in nucleotide base pairs located within a gene or noncoding portion of the genome. In sepsis, the focus has been on understanding the impac...

REMEMBER score predicts mortality in patients receiving VA-ECMO after CABG Prediction scoring systems for coronary artery bypass grafting (CABG) patients on veno-arterial extracorporeal membrane oxygenation (VA-ECMO) have not yet been reported. To help clinicians select patients that would benefit from VA-ECMO after CABG, a team of international researchers devised a mortality risk score – REMEMBER score – comprising six pre-ECMO variables. The REMEMBER (pRedi...

Use of levosimendan in the ICU Levosimendan is an inodilator that promotes cardiac contractility primarily through calcium sensitisation of cardiac troponin C and vasodilatation via opening of adenosine triphosphate-sensitive potassium (KATP) channels in vascular smooth muscle cells. The drug also exerts organ-protective effects through a similar effect on mitochondrial KATP channels. Levosimendan has been demonstrated to have potential utility in a wide range o...

Artificial Intelligence in the ICU The paucity of positive multicentre prospective randomised control trials in ICU settings serves to highlight the challenge of running studies in such environments, where multiple treatments are given simultaneously to individuals who respond in variable ways based on their individual physiology. Consequently, without established guidelines, ICU clinician decision-making is driven largely by experience and instinct, resulting in s...

New algorithm reduces testing for ICU patients Enrolling seriously ill patients in intensive care units for clinical trials is often a big challenge for investigators. This is one reason why there is a dearth of evidence-based guidelines in critical medicine. For instance, ICU doctors often face a dilemma when it comes to ordering lab tests for specific patients.  While ICU doctors are aware that every blood test they order could yield critical informatio...

AKI: long-term impact on mortality and renal function Acute kidney injury (AKI) is defined as an abrupt loss in renal function and may be caused by a wide variety of clinical conditions. AKI is a frequent complication of hospitalisation and is associated with an increased risk of chronic kidney disease (CKD), end-stage renal disease (ESRD), and mortality.Based on more recent studies, AKI is also known to be a risk factor for other adverse outcomes, including stroke...

Editorial|February 17, 2019 How Best to Resuscitate Patients With Septic Shock? Derek C. Angus JAMA. 2019;321(7):647-648. doi:10.1001/jama.2019.0070 What is the best approach for resuscitation of a patient with septic shock? Despite considerable investigation over several decades, this important question still has no clear answer. There is agreement that resuscitation should proceed quickly, for the longer the delay, the greater the physiologic ...

Early extubation plus NIV better than standard extubation in hypoxaemic patients In patients recovering from hypoxaemic acute respiratory failure, early extubation followed by immediate noninvasive ventilation (NIV) reduced the days spent on invasive ventilation without affecting intensive care unit (ICU) length of stay. These findings are from a new multicentre randomised controlled trial conducted by Italian and Chinese researchers. Although a post hoc analysis s...