Intensive Renal Replacement Therapy and Mechanical Ventilation Duration Acute kidney injury (AKI) is a global health issue, accounting for approximately two million deaths per year as well as presenting a heavy economic burden on healthcare systems. Hospital-acquired AKI is associated with increased risk of death and prolonged length of hospital stay. There are no effective treatments beyond supportive care for patients with AK from sepsis or hypotension. Sever...

Original Investigation October 23, 2020 Effect of Regional Citrate Anticoagulation vs Systemic Heparin Anticoagulation During Continuous Kidney Replacement Therapy on Dialysis Filter Life Span and Mortality Among Critically Ill Patients With Acute Kidney Injury: A Randomized Clinical Trial Alexander Zarbock, Mira Küllmar, Detlef Kindgen-Milles, et al JAMA. 2020;324(16):1629-1639. doi:10.1001/jama.2020.18618 Abstract I...

Better Planning of COVID-19 Vaccine Trials The world is desperate for a reliable vaccine against COVID-19. However, the pressure for such rapid introduction could lead to deployment of a vaccine that may be weakly effective. In order to avoid this from happening, three issues must be considered when planning COVID-19 vaccine trials. These include proof of vaccine efficacy and worthwhile efficacy, whether these trials should prioritise single-vaccine or multivaccine ...

Editorials Convalescent plasma is ineffective for covid-19 Elizabeth B Pathak BMJ 2020; 371:m4072 doi: https://doi.org/10.1136/bmj.m4072  Lessons from the Placid Trial Convalescent plasma generated great enthusiasm in the earliest days of the coronavirus disease 2019 (covid-19) pandemic because of a plausible mechanism of action,1 its 100 year history of use in the treatment of other infectious diseases,2 and rapid availability from voluntary dono...

ICU Management & Practice, Volume 20 - Issue 3, 2020 Unmasking the Triumphs, Tragedies, and Opportunities of the COVID-19 Pandemic The COVID-19 pandemic has resulted in many changes to society and the practice of critical care medicine. Perhaps now is the time to address deficiencies in communication and decision-making that impact quality of care provided to older patients with serious illness. The COVID-19 pandemic has created a juxtaposition of triump...

Research Convalescent plasma in the management of moderate covid-19 in adults in India: open label phase II multicentre randomised controlled trial (PLACID Trial) Anup Agarwal, Aparna Mukherjee, Gunjan Kumar, et al BMJ 2020; 371:m3939 doi: https://doi.org/10.1136/bmj.m3939 Abstract Objective To investigate the effectiveness of using convalescent plasma to treat moderate coronavirus disease 2019 (covid-19) in adults in India. Design Open label, para...

ICU Management & Practice, Volume 20 - Issue 3, 2020 Nutritional Management of the Critically Ill Older Adult A review of available evidence and an overview of recommendations for the nutritional management of the critically ill older adult. Introduction Worldwide, there is a shift in the distribution of the population towards older ages. This shift is similarly being experienced in the Intensive Care Unit (ICU), with the median age of the entire ICU ...

COVID-19: Still Poorly Understood During the first few months of the coronavirus disease, it was being suggested that severe COVID-19 may represent a hyperimmune disorder, similar to secondary haemophagocytic lymphohistiocytosis (sHLH) and macrophage activation syndrome (MAS). Cytokine storm, elevated plasma levels, ferritin and inflammatory biomarkers are all typical signs of sHLH/MAS. But in many severe cases, T cells were found to be decreased, indicating T cell lym...

ORIGINAL ARTICLE Efficacy of Tocilizumab in Patients Hospitalized with Covid-19 John H. Stone, Matthew J. Frigault, Naomi J. Serling-Boyd, et al N Engl J Med October 21, 2020DOI: 10.1056/NEJMoa2028836 BACKGROUND The efficacy of interleukin-6 receptor blockade in hospitalized patients with coronavirus disease 2019 (Covid-19) who are not receiving mechanical ventilation is unclear. METHODS We performed a randomized, double-blind, placebo-controlled tria...

Corticosteroids and Mortality in COVID-19 Patients The use of corticosteroids to treat severe infections has been a controversy for quite a long time. Now, as we face the COVID-19 pandemic, clinical research on corticosteroids has received a significant push. During the first six months of 2020, 55 studies of corticosteroids for the treatment of COVID-19 have been registered. The RECOVERY trial has reported its findings demonstrating that 6mg/d of dexamethasone resu...