Trends in Antimicrobial Prescribing During Hospitalisation for Sepsis There have been concerns that the emphasis on rapid administration of antimicrobials for sepsis may result in an increase in the overall use of antimicrobials, even in patients without sepsis. In a study of 1,559,523 patients hospitalised at 152 hospitals in two health care delivery systems, researchers aimed to determine whether shortening the time to treatment for sepsis was associated ...

ARTICLES| VOLUME 10, ISSUE 10, P972-984, OCTOBER 01, 2022 Tixagevimab–cilgavimab for treatment of patients hospitalised with COVID-19: a randomised, double-blind, phase 3 trial ACTIV-3–Therapeutics for Inpatients with COVID-19 (TICO) Study Group Lancet Respir Med 2022; 10: 972-984 Summary Background Tixagevimab–cilgavimab is a neutralising monoclonal antibody combination hypothesised to improve outcomes for patients hospitalised with COVID...

ARTICLES| VOLUME 10, ISSUE 10, P985-996, OCTOBER 01, 2022 Efficacy and safety of intramuscular administration of tixagevimab–cilgavimab for early outpatient treatment of COVID-19 (TACKLE): a phase 3, randomised, double-blind, placebo-controlled trial Hugh Montgomery, F D Richard Hobbs, Francisco Padilla, et al Lancet Respir Med 2022; 10: 985-996 Summary Background Early intramuscular administration of SARS-CoV-2-neutralising monoclonal ant...

ORIGINAL ARTICLE Haloperidol for the Treatment of Delirium in ICU Patients Nina C. Andersen-Ranberg, Lone M. Poulsen, Anders Perner, et al N Engl J Med October 26, 2022DOI: 10.1056/NEJMoa2211868 Abstract BACKGROUND Haloperidol is frequently used to treat delirium in patients in the intensive care unit (ICU), but evidence of its effect is limited. METHODS In this multicenter, blinded, placebo-controlled trial, we randomly assigned adult patients wit...

Serial Measurement of Pancreatic Stone Protein for Detection of Sepsis Sepsis continues to be a challenging health problem associated with high morbidity and mortality. Approximately 48.9 million cases of sepsis were recorded worldwide in 2017, with 11 million related deaths. Sepsis guidelines emphasise the early recognition and aggressive management of this condition with early antibiotic treatment and support. If not treated early, sepsis can evolve into life-thr...

EDITORIAL Early Mobilization of Critical Care Patients — Still More to Learn Marc Moss N Engl J Med October 26, 2022DOI: 10.1056/NEJMe2212360 Each year, intensive care unit (ICU)–acquired weakness occurs in approximately 1 million critically ill patients who are undergoing mechanical ventilation worldwide.1 ICU-acquired weakness begins early in the course of critical illness and is related to multiple mechanisms, including deconditioning, myopathy, and ne...

COVID-19 Vaccines Prevented 20 Million Deaths Worldwide Findings from the first modelling study to quantify the impact of COVID-19 vaccines show that nearly 19.9 million out of a potential 31.4 million deaths were prevented in the first year (December 2020-December 2021) after the introduction of the vaccine. The findings are based on data from 185 countries using COVID-19 death records and total excess deaths from each country.  It is not possible to measu...

Early Deep Sedation in Mechanically Ventilated COVID-19 Patients Sedation management is a critical component when managing mechanically ventilated patients. It is important to use a protocol-driven approach, which favours paired spontaneous awakening (SAT) and breathing (SBT) trials, along with light levels of sedation. The initial period of respiratory failure in the emergency department and the first 48 hours in the ICU are critical to ensure reduced overall time...

ORIGINAL ARTICLE Oxygen-Saturation Targets for Critically Ill Adults Receiving Mechanical Ventilation Matthew W. Semler, Jonathan D. Casey, Bradley D. Lloyd, et al N Engl J Med October 24, 2022DOI: 10.1056/NEJMoa2208415 Abstract BACKGROUND Invasive mechanical ventilation in critically ill adults involves adjusting the fraction of inspired oxygen to maintain arterial oxygen saturation. The oxygen-saturation target that will optimize clinical outcomes in t...

ORIGINAL ARTICLE Early Active Mobilization during Mechanical Ventilation in the ICU The TEAM Study Investigators and the ANZICS Clinical Trials Group N Engl J Med October 26, 2022DOI: 10.1056/NEJMoa2209083 Abstract BACKGROUND Intensive care unit (ICU)–acquired weakness often develops in patients who are undergoing invasive mechanical ventilation. Early active mobilization may mitigate ICU-acquired weakness, increase survival, and reduce disability. ME...