PCT-guided antibiotic treatment improves outcomes in sepsis patients Procalcitonin (PCT)-guided antibiotic treatment in ICU patients with infection and sepsis patients results in improved survival and reduced antibiotic treatment duration, according to results of a new meta-analysis published in the journal Critical Care. Early identification of sepsis and appropriate initial management including the start of antibiotic treatment and fluid resuscitation improves outcomes....

ICU Management & Practice, Volume 17 - Issue 3, 2017 Innovations in monitoring: from smartphones to wearables There are over 320 million inpatient surgical procedures worldwide (Weiser et al. 2015). We learnt from the recent International Surgical Outcomes (ISOS) Study (ISOS Group 2016) that around 17% of these patients develop one or more complications, and among them, that 2.8% die from their complications. One can therefore estimate that around 1.5 million patients...

Perspective > Medscape Oncology > Prasad on Medicine COMMENTARY When Do We Need Randomized Controlled Trials, and When Can We Manage Without Them? Vinay Prasad, MD, MPH August 07, 2018 Recently I watched a debate unfold on Twitter over whether we should run a randomized controlled trial (RCT) of the inferior vena cava (IVC) filter for patients with a venous thromboembolism (VTE) and a contraindication to anticoagulation.[1] Like witnessing a car accident, I was ho...

ICU Management & Practice, Volume 17 - Issue 1, 2017 ARDS and Precision Medicine What is the path forward for treatment of acute respiratory distress syndrome (ARDS)? Is it big trials (favoured by clinical scientists) or further insight into disease physiopathology (favoured by basic scientists)? Or both? Funding resources are limited and the debate is wide open. In the post-genomic era, a new direction is needed. On 20 January 2015, then U.S. President Barack Obama ...

ICU Management & Practice, Volume 17 - Issue 2, 2017 How to Run Successful Rounds in the Intensive Care Unit Dr. Katherine Nugent, MD Critical Care Fellow Departments of Emergency Medicine and Anesthesiology and Emory Critical Care Center Emory University School of Medicine and Emory Healthcare Atlanta, GA, USA Rounds in the intensive care unit (ICU) allow for scheduled discussions in which healthcare providers review clinical information and develop care plans for c...

Viewpoint August 28, 2018 Gaps in the Clinical Management of Influenza: A Century Since the 1918 Pandemic Timothy M. Uyeki, Robert A. Fowler, William A. Fischer II JAMA. 2018;320(8):755-756. doi:10.1001/jama.2018.8113 This year marks the centennial of the devastating 1918 influenza A(H1N1) pandemic, which killed an estimated 50 million people worldwide. Prevention and control activities were limited in 1918 because global surveillance did not exist, influenza viruses w...

Perspective > Medscape General Surgery > Viewpoints COMMENTARY Not Too Low, Not Too High: Optimal Fluid Volume During Surgery Albert B. Lowenfels, MD August 08, 2018 What is the optimum amount of intravenous fluid that should be administered during surgery to obtain the best outcome? The authors of a study, published in Annals of Surgery,[1] investigated this topic in 92,094 patients undergoing noncardiac surgery with endotracheal intubation between 2007 and 2014...

The 10 false beliefs in adult critical care nephrology Zaccaria Ricci, Stefano Romagnoli, Claudio Ronco Intensive Care Med 2018; 44: 1302-1305 1. Acute tubular necrosis is the main histopathologic finding in AKI 急性肾小管坏死是AKI的主要组织病理学表现 Acute tubular necrosis (ATN), a histological pattern observed after ischemic insult, is considered the most frequent cause of any form of acute kidney injury (AKI) despite the absence of extensive histological data. This bel...

Perspective > Society for Healthcare Epidemiology of America (SHEA) > Expert Commentaries COMMENTARY Multidrug-Resistant Infections: What's on the Horizon? Jasmine R. Marcelin, MD July 18, 2018 Ceftazidime-Avibactam Resistance 头孢他啶-阿维巴坦耐药 Ceftazidime-avibactam is approved by the US Food and Drug Administration (FDA) for the treatment of complicated intra-abdominal and urinary tract infections, and has activity against carbapenem-resistant Enterobacteri...

Antibiotic decisions in the ICU: a dragon’s tale Pieter Depuydt, MD, PhD Head of Clinic - Department of Intensive Care Ghent University Hospital Ghent, Belgium Associate Professor - Department of Internal Medicine Faculty of Medicine Ghent University consider the clinical problem of suspected infection in your ICU patient as a ‘monster’ … with a ‘head’, a ‘body’ and a ‘tail’ Medical decision-making about antibiotic use in critically ill patients is challenging and comple...