Editorial  April 11, 2023 Lack of Benefit of Renin-Angiotensin System Inhibitors in COVID-19 Matthew M. Y. Lee, John J. V. McMurray JAMA. 2023;329(14):1155-1156. doi:10.1001/jama.2023.4405 There has been considerable interest in the potential role of renin-angiotensin system (RAS) inhibitors in patients with COVID-19 given that angiotensin-converting enzyme 2 (ACE2) is the functional receptor for SARS-CoV-2.1 Because ACE inhibitors and angiot...

Original Investigation  Caring for the Critically Ill Patient April 11, 2023 Effect of Angiotensin-Converting Enzyme Inhibitor and Angiotensin Receptor Blocker Initiation on Organ Support–Free Days in Patients Hospitalized With COVID-19: A Randomized Clinical Trial Writing Committee for the REMAP-CAP Investigators JAMA. 2023;329(14):1183-1196. doi:10.1001/jama.2023.4480 Key Points Question  Does initiating an angiotensin-conve...

Original Investigation  April 11, 2023 Renin-Angiotensin System Modulation With Synthetic Angiotensin (1-7) and Angiotensin II Type 1 Receptor–Biased Ligand in Adults With COVID-19: Two Randomized Clinical Trials Wesley H. Self, Matthew S. Shotwell, Kevin W. Gibbs, et al JAMA. 2023;329(14):1170-1182. doi:10.1001/jama.2023.3546 Key Points Question  Among adults hospitalized with severe COVID-19, does treatment with synthetic angio...

ECMO for COVID-19 ARDS There is increasing evidence supporting the use of extracorporeal membrane oxygenation (ECMO) for severe acute respiratory distress syndrome (ARDS) in patients that do not respond to maximal medical therapy. ARDS can occur in some COVID-19 patients who are hospitalised, and ECMO can be utilised as a treatment option in some cases. Using ECMO can help avoid ventilator-induced lung injury and give the lungs time to rest while waiting for recove...

Original Investigation  April 11, 2023 Heterogeneity in Blood Pressure Response to 4 Antihypertensive Drugs: A Randomized Clinical Trial Johan Sundström, Lars Lind, Shamim Nowrouzi, et al JAMA. 2023;329(14):1160-1169. doi:10.1001/jama.2023.3322 Key Points Question  Is there a potential for personalized drug therapy in hypertension, and, if so, what is the magnitude of the benefit of personalization? Findings  In this...

ORIGINAL ARTICLE Tranexamic Acid to Prevent Obstetrical Hemorrhage after Cesarean Delivery Luis D. Pacheco, Rebecca G. Clifton, George R. Saade, et al N Engl J Med 2023; 388:1365-1375DOI: 10.1056/NEJMoa2207419 Abstract BACKGROUND Prophylactic use of tranexamic acid at the time of cesarean delivery has been shown to decrease the calculated blood loss, but the effect on the need for blood transfusions is unclear. METHODS We randomly assigned patients...

ARTICLES| VOLUME 4, ISSUE 5, E330-E339, MAY 2023 Infection and co-infection patterns of community-acquired pneumonia in patients of different ages in China from 2009 to 2020: a national surveillance study Yan-Ning Liu, Yun-Fa Zhang, Qiang Xu, et al Lancet Microbe 2023; 4: E330-E339 Published:March 28, 2023 DOI:https://doi.org/10.1016/S2666-5247(23)00031-9 Summary Background Severe community-acquired pneumonia (SCAP) is associated with ...

Prone Positioning for Acute Hypoxaemic Respiratory Failure Prone positioning is a medical intervention that was initially proposed over 50 years ago as a way to improve gas exchange. Multiple clinical trials have been conducted on its effectiveness, with the Proning Severe ARDS Patients landmark trial demonstrating a mortality benefit in patients with severe ARDS. As a result, expert consensus and societal guidelines now recommend using prone positioning for severe...

Invited Commentary  May 1, 2023 Xuebijing Injection for the Treatment of Sepsis: What Would a Path to FDA Approval Look Like? Ellis F. Unger, David B. Clissold JAMA Intern Med. Published online May 1, 2023. doi:10.1001/jamainternmed.2023.0788 Sepsis is a serious condition with high morbidity and mortality for which treatment advancements are desperately needed. In this issue of JAMA Internal Medicine, Liu et al1 describe the results...

Original Investigation  May 1, 2023 Effect of an Herbal-Based Injection on 28-Day Mortality in Patients With Sepsis: The EXIT-SEP Randomized Clinical Trial Songqiao Liu, Chen Yao, Jianfeng Xie, et al JAMA Intern Med. Published online May 1, 2023. doi:10.1001/jamainternmed.2023.0780 Key Points Question  Is Xuebijing injection (XBJ) effective in reducing mortality in patients with sepsis? Findings  In this randomized c...