ICU Management & Practice, Volume 23 - Issue 3, 2023 Intravenous Fluids in Critically Ill Patients: When Less is Better While intravenous fluids have traditionally been a routine treatment for most critically ill patients, many severe pathologies now suggest a preference for conservative fluid therapy over liberal fluid administration. Introduction Intravenous fluid resuscitation began in 1832 during the cholera pandemic, improving intravascular volum...

Original Investigation  July 10, 2023 Temporal Clustering of Critical Illness Events on Medical Wards Samik Doshi, Saeha Shin, Lauren Lapointe-Shaw, et al JAMA Intern Med. Published online July 10, 2023. doi:10.1001/jamainternmed.2023.2629 Key Points Question  Is a critical illness event (death or intensive care unit transfer) associated with an increase in the near-term risk of critical illness in other patients on the same medi...

Original Investigation  June 26, 2023 Evidence for Anchoring Bias During Physician Decision-Making Dan P. Ly, Paul G. Shekelle, Zirui Song JAMA Intern Med. Published online June 26, 2023. doi:10.1001/jamainternmed.2023.2366 Key Points Question  Do emergency department physicians anchor on information found in the patient visit reason section documented before a physician sees the patient? Findings  In this cross-sect...

JAMA Insights  June 26, 2023 Prophylaxis Against Pneumocystis jirovecii Pneumonia in Adults Shiwei Zhou, Samuel L. Aitken JAMA. Published online June 26, 2023. doi:10.1001/jama.2023.9844 Pneumocystis jirovecii is an opportunistic fungal pathogen that causes life-threatening pneumonia in immunocompromised patients. Patients with Pneumocystis pneumonia (PCP) typically present with fever, nonproductive cough, dyspnea, an...

Original Investigation  June 26, 2023 Use of Mechanical Ventilation Across 3 Countries Naheed K. Jivraj, Andrea D. Hill, Meng-Shiou Shieh, et al JAMA Intern Med. Published online June 26, 2023. doi:10.1001/jamainternmed.2023.2371 Key Points Question  Do population-level rates of invasive mechanical ventilation differ among countries? Findings  In this cohort study of 59 873 hospital admissions in England, 70 250 in C...

ICU Without Borders Critical illness is characterised by various phases and outcomes, including deterioration, organ dysfunction, and recovery or death. Patient care is often fragmented, with different groups of healthcare providers managing different aspects of the patient's journey. Communication and collaboration gaps between these groups can lead to breakdowns in care and potentially impact patient outcomes. A study reported that delays in transferring patients...

Editorials Surgeon volume and patient outcomes in shoulder replacement surgery Marta Karbowiak, Nashat Siddiqui BMJ 2023; 381 doi: https://doi.org/10.1136/bmj.p1334 (Published 21 June 2023)Cite this as: BMJ 2023;381:p1334 Higher volumes are associated with lower risks for patients The association between the volume of procedures performed by surgeons and patient outcomes has been well documented, notably in the context of hip and knee joint replacement surg...

Original Investigation  January 18, 2023 Association of Whole Blood With Survival Among Patients Presenting With Severe Hemorrhage in US and Canadian Adult Civilian Trauma Centers Crisanto M. Torres, Alistair Kent, Dane Scantling, et al JAMA Surg. 2023;158(5):532-540. doi:10.1001/jamasurg.2022.6978 Key Points Question  Is whole blood as an adjunct to component therapy–based massive transfusion protocol (MTP) compared with MTP alone associa...

ICU Management & Practice, Volume 23 - Issue 2, 2023 Detecting Euglycaemic Diabetic Ketoacidosis Associated With SGLT2 Inhibitors SGLT2 inhibitor associated EDKA is becoming more prevalent due to the increasing use of SGLT2 inhibitors in cardiovascular medicine and type 2 diabetes. Physician awareness and knowledge about the disease and diagnostic tools need to improve for better management. Point of care blood testing for ketones can allow for rapid and ac...

A New Global Definition of Acute Respiratory Distress Syndrome Michael A. Matthay, Yaseen Arabi, Alejandro C. Arroliga, et al Am J Respir Crit Care Med Published July 24, 2023 10.1164/rccm.202303-0558WS Abstract Background Since the 2012 Berlin Definition of the Acute Respiratory Distress Syndrome (ARDS), several developments have supported the need for an expansion of the definition, including the use of high flow nasal oxygen (HFNO), expanding use of p...