EDITORIAL Traumatic Acute Subdural Hematoma — Should the Bone Flap Be Removed or Replaced? Shankar Gopinath N Engl J Med April 23, 2023DOI: 10.1056/NEJMe2302936 Traumatic acute subdural hematomas often warrant emergency evacuation of the blood clot to avoid further cerebral compression and its sequelae. Once the subdural clot is removed, the million-dollar question in the mind of the neurosurgeon is to whether to replace the bone flap (craniotomy) or not (deco...

Safety Outcomes of Direct Discharge From ICU Patients discharged from ICUs are traditionally transferred to a hospital ward to facilitate recovery and rehabilitation and to organise discharge planning. However,  direct discharge home (DDH) from ICUs is becoming more common due to high hospital ward censuses and transfer delays. This increase is mainly due to strained ward capacity and high costs. Prior research shows an inverse correlation between DDH and ICU ...

ORIGINAL ARTICLE Decompressive Craniectomy versus Craniotomy for Acute Subdural Hematoma Peter J. Hutchinson, Hadie Adams, Midhun Mohan, et al N Engl J Med April 23, 2023DOI: 10.1056/NEJMoa2214172 Abstract BACKGROUND Traumatic acute subdural hematomas frequently warrant surgical evacuation by means of a craniotomy (bone flap replaced) or decompressive craniectomy (bone flap not replaced). Craniectomy may prevent intracranial hypertension, but whether it ...

COMMENT|ONLINE FIRST Guidelines adherence as a major protective aspect to increase survival rate in patients with candidaemia in Europe Mohammad Sadegh Rezai, Fatemeh Ahangarkani Lancet Infect Dis Published:February 15, 2023 DOI:https://doi.org/10.1016/S1473-3099(23)00046-4 Despite improvements in medical interventions and new antifungal drugs, candidaemiais widely recognised as a major cause of morbidity and mortality worldwide.1, 2 Not...

ORIGINAL ARTICLE Randomized Trial of BCG Vaccine to Protect against Covid-19 in Health Care Workers Laure F. Pittet, Nicole L. Messina, Francesca Orsini, et al N Engl J Med 2023; 388:1582-1596DOI: 10.1056/NEJMoa2212616 Abstract BACKGROUND The bacille Calmette–Guérin (BCG) vaccine has immunomodulatory “off-target” effects that have been hypothesized to protect against coronavirus disease 2019 (Covid-19). METHODS In this international, double-blind, ...

ICU Diaries and Post-ICU Distress Symptoms In recent years, health diaries have become an important tool for patients and providers to manage personal health. A health diary is a record of a patient's overall health and wellness, which the patient writes to keep track of different aspects of their health. Studies show that greater self-care behaviours, such as the use of symptom diaries, improve survival for patients with heart failure. Health diaries, either in wr...

Original Investigation  April 20, 2023 Piperacillin-Tazobactam Compared With Cefoxitin as Antimicrobial Prophylaxis for Pancreatoduodenectomy: A Randomized Clinical Trial Michael I. D’Angelica, Ryan J. Ellis, Jason B. Liu, et al JAMA. Published online April 20, 2023. doi:10.1001/jama.2023.5728 Key Points Question  Does use of perioperative broad-spectrum antibiotics reduce postoperative surgical site infection after open pancreat...

ARTICLES|ONLINE FIRST Intravenous ravulizumab in mechanically ventilated patients hospitalised with severe COVID-19: a phase 3, multicentre, open-label, randomised controlled trial Djillali Annane, Sean J Pittock, Hrishikesh S Kulkarni, et al Lancet Respir Med Published:March 20, 2023 DOI:https://doi.org/10.1016/S2213-2600(23)00082-6 Summary Background The complement pathway is a potential target for the treatment of severe COVID-19. We evaluated the ...

Socioeconomic Status and Outcomes in Critical Care Socioeconomic status is a known determinant of health inequalities. However, previous studies on the impact of socioeconomic status on outcomes in critical care have produced inconsistent findings.  A new review analyses available evidence on the relationship between socioeconomic status and outcomes in critical care. The analysis included observational cohort studies of adults that examined the association...

ARTICLES|ONLINE FIRST Low versus standard calorie and protein feeding in ventilated adults with shock: a randomised, controlled, multicentre, open-label, parallel-group trial (NUTRIREA-3) Jean Reignier, Gaetan Plantefeve, Jean-Paul Mira, et al Lancet Respir Med Published:March 20, 2023 DOI:https://doi.org/10.1016/S2213-2600(23)00092-9 Summary Background The optimal calorie and protein intakes at the acute phase of severe critical illness remain unknow...