Original Investigation Caring for the Critically Ill Patient Effect of Low-Normal vs High-Normal Oxygenation Targets on Organ Dysfunction in Critically Ill Patients: A Randomized Clinical Trial Harry Gelissen, Harm-Jan de Grooth, Yvo Smulders, et al JAMA. Published online August 31, 2021. doi:10.1001/jama.2021.13011 Abstract Importance  Hyperoxemia may increase organ dysfunction in critically ill patients, but optimal oxygenation targets are unkno...

ICU Management & Practice, Volume 20 - Issue 3, 2020 Vitamin D in Critical Illness – Fifty Shades of VIOLET Did the VITDALIZE study and the VIOLET study manage to answer some of the questions regarding vitamin D deficiency and its impact on critically ill patients? Experts compare the findings and present an overview. Introduction Vitamin D deficiency is very common in the ICU (usually >60%) because many critically ill patients were already chronic...

JAMA Insights August 2, 2021 Cognitive Decline Associated With Anesthesia and Surgery in Older Patients Susana Vacas, Daniel J. Cole, Maxime Cannesson JAMA. Published online August 2, 2021. doi:10.1001/jama.2021.4773 In the last decade, the population aged 65 years and older increased by 34.2% in the US and now accounts for a disproportionate number of surgical procedures requiring anesthesia. Among these patients, aging causes a number of chang...

Renal Replacement Therapy in Critically Ill Patients with AKI Many critical care patients with severe acute kidney injury (AKI), especially those who develop refractory complications, receive renal replacement therapy (RRT). However, when RRT should be initiated for these patients remains unclear. There is a consensus that in patients with urgent or refractory complications, RRT should be started. However, the question is: should it be started earlier in the course...

Original Investigation August 3, 2021 Effect of a Sedation and Ventilator Liberation Protocol vs Usual Care on Duration of Invasive Mechanical Ventilation in Pediatric Intensive Care Units: A Randomized Clinical Trial Bronagh Blackwood, Lyvonne N. Tume, Kevin P. Morris, et al JAMA. 2021;326(5):401-410. doi:10.1001/jama.2021.10296 Abstract Importance  There is limited evidence on the optimal strategy for liberating infants and childr...

Culture-Negative and Culture-Positive Sepsis or Septic Shock Incidence of sepsis and septic shock has been increasing consistently, and the morbidity and mortality associated with this is an area of concern. Mortality from sepsis and septic shock is quite high, ranging between 20 to 40%. Guidelines for sepsis and septic shock recommend the application of broad-spectrum antibiotics. There is clinical evidence that time to effective antibiotic therapy could reduce pa...

ORIGINAL ARTICLE Covid-19 Breakthrough Infections in Vaccinated Health Care Workers Moriah Bergwerk, Tal Gonen, Yaniv Lustig, et al N Engl J Med July 28, 2021DOI: 10.1056/NEJMoa2109072 Abstract BACKGROUND Despite the high efficacy of the BNT162b2 messenger RNA vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), rare breakthrough infections have been reported, including infections among health care workers. Data are needed t...

Precision Medicine and COVID-19 Precision medicine has been an important goal in healthcare. Researchers have been focused on generating new disease subclassifications to maximise individualised treatment options. There have been many phenotypes, endotypes, and subtypes so that patients who demonstrate specific symptoms and fall into a specific subtype or phenotype can be treated with precision. The same is true for SARS-CoV-2. To date, more than 60 subtypes hav...

Research Real time remote symptom monitoring during chemotherapy for cancer: European multicentre randomised controlled trial (eSMART) Roma Maguire, Lisa McCann, Grigorios Kotronoulas, et al BMJ 2021; 374 doi: https://doi.org/10.1136/bmj.n1647 (Published 22 July 2021) Cite this as: BMJ 2021;374:n1647 Abstract Objective To evaluate effects of remote monitoring of adjuvant chemotherapy related side effects via the Advanced Symptom Management System (A...

Cardiopulmonary Resuscitation in COVID-19 Patients Experiencing In-Hospital Cardiac Arrest COVID-19 continues to infect people across the globe, and the United States continues to be one of the most affected regions in the world. Coronavirus primarily affects the respiratory system through angiotensin-converting enzyme (ACE) 2 receptor on host cells. It also affects other systems because ACE2 is present in the heart, GI tract and kidneys. Infection with COVID-19 leads ...