Original Investigation Effect of a Resuscitation Strategy Targeting Peripheral Perfusion Status vs Serum Lactate Levels on 28-Day Mortality Among Patients With Septic Shock： The ANDROMEDA-SHOCK Randomized Clinical Trial Glenn Hernández, Gustavo A. Ospina-Tascón, Lucas Petri Damiani, et al JAMA. Published online February 17, 2019. doi:10.1001/jama.2019.0071 Abstract Importance  背景 Abnormal peripheral perfusion after septic shock resuscitation has been ...

Long-term developmental effects of withholding parenteral nutrition for 1 week in the paediatric intensive care unit: a 2-year follow-up of the PEPaNIC international, randomised, controlled trial Sören Verstraete, Sascha C Verbruggen, José A Hordijk, et al Lancet Respir Med 2019; 7: 141-153 Background 背景 The paediatric early versus late parenteral nutrition in critical illness (PEPaNIC) multicentre, randomised, controlled trial showed that, compared wit...

Hour-1 Bundle Updated The Surviving Sepsis Campaign has updated the Hour-1 bundle emphasizing time of recognition and element completion guidance. The Hour-1 bundle* should be viewed as a quality improvement opportunity moving toward an ideal state. For critically ill patients with sepsis or septic shock, time is of the essence. Although the starting time for the Hour-1 bundle is recognition of sepsis, both sepsis and septic shock should be viewed asmedical ...

A new ICU equipment diagram…but is it Art? Design for Southmead ICU  It is well established that the Arts have a clear contribution to make in the delivery of an improved healthcare experience for patients, service users and staff. ‘Arts and health are, and should be firmly recognised as being, integral to health, healthcare provision and healthcare environments, including supporting staff.' (Department of Health Working Group on Arts and Health 2006) Southm...

ORIGINAL ARTICLE Angiotensin–Neprilysin Inhibition in Acute Decompensated Heart Failure Eric J. Velazquez, David A. Morrow, Adam D. DeVore, et al N Engl J Med 2019; 380:539-548DOI: 10.1056/NEJMoa1812851 Abstract BACKGROUND 背景 Acute decompensated heart failure accounts for more than 1 million hospitalizations in the United States annually. Whether the initiation of sacubitril–valsartan therapy is safe and effective among patients who are hospitalized fo...

Intensive Care Medicine ONLINE FIRST (FREE ACCESS)  Review~ Jean-François Timsit - Rationalizing antimicrobial therapy in the ICU: a narrative review Original~ Christophe Guitton - Nasal high-flow preoxygenation for endotracheal intubation in the critically ill patient: a randomized clinical trial Original~ Stefan J. Schaller - Influence of the initial level of consciousness on early, goal-directed mobilization: a post hoc analysis Imaging in Intensive Care Me...

Treatment with allogeneic mesenchymal stromal cells for moderate to severe acute respiratory distress syndrome (START study): a randomised phase 2a safety trial Michael A Matthay, Carolyn S Calfee, Hanjing Zhuo, et al Lancet Respir Med 2019; 7: 154-162 Background 背景 Treatment with bone-marrow-derived mesenchymal stromal cells (MSCs) has shown benefits in preclinical models of acute respiratory distress syndrome (ARDS). Safety has not been established fo...

Enteral lactoferrin supplementation for very preterm infants: a randomised placebo-controlled trial The ELFIN trial investigators group Lancet Published: January 08, 2019 Summary Background 背景 Infections acquired in hospital are an important cause of morbidity and mortality in very preterm infants. Several small trials have suggested that supplementing the enteral diet of very preterm infants with lactoferrin, an antimicrobial protein processed from cow's...

ORIGINAL ARTICLE Randomized Trial of Platelet-Transfusion Thresholds in Neonates Anna Curley, Simon J. Stanworth, Karen Willoughby, et al N Engl J Med 2019; 380:242-251DOI: 10.1056/NEJMoa1807320 Abstract BACKGROUND 背景 Platelet transfusions are commonly used to prevent bleeding in preterm infants with thrombocytopenia. Data are lacking to provide guidance regarding thresholds for prophylactic platelet transfusions in preterm neonates with severe thrombo...

Original Investigation January 29, 2019 Effect of Hydrocortisone Therapy Initiated 7 to 14 Days After Birth on Mortality or Bronchopulmonary Dysplasia Among Very Preterm Infants Receiving Mechanical Ventilation: A Randomized Clinical Trial Wes Onland, Filip Cools, Andre Kroon, et al JAMA. 2019;321(4):354-363. doi:10.1001/jama.2018.21443 Abstract Importance 背景 Dexamethasone initiated after the first week of life reduces the rate of death ...