REMEMBER score predicts mortality in patients receiving VA-ECMO after CABG Prediction scoring systems for coronary artery bypass grafting (CABG) patients on veno-arterial extracorporeal membrane oxygenation (VA-ECMO) have not yet been reported. To help clinicians select patients that would benefit from VA-ECMO after CABG, a team of international researchers devised a mortality risk score – REMEMBER score – comprising six pre-ECMO variables. The REMEMBER (pRedi...

Omadacycline for Community-Acquired Bacterial Pneumonia Roman Stets, Monica Popescu, Joven R. Gonong, et al N Engl J Med 2019; 380:517-527DOI: 10.1056/NEJMoa1800201 Abstract BACKGROUND 背景 Omadacycline, a new once-daily aminomethylcycline antibiotic agent that can be administered intravenously or orally, reaches high concentrations in pulmonary tissues and is active against common pathogens that cause community-acquired bacterial pneumonia. Omadacy...

Use of levosimendan in the ICU Levosimendan is an inodilator that promotes cardiac contractility primarily through calcium sensitisation of cardiac troponin C and vasodilatation via opening of adenosine triphosphate-sensitive potassium (KATP) channels in vascular smooth muscle cells. The drug also exerts organ-protective effects through a similar effect on mitochondrial KATP channels. Levosimendan has been demonstrated to have potential utility in a wide range o...

Original Investigation February 12, 2019 Association of Left Ventricular Ejection Fraction and Symptoms With Mortality After Elective Noncardiac Surgery Among Patients With Heart Failure Benjamin J. Lerman, Rita A. Popat, Themistocles L. Assimes, et al JAMA. 2019;321(6):572-579. doi:10.1001/jama.2019.0156 Abstract Importance   Heart failure is an established risk factor for postoperative mortality, but how left ventricular ejection fractio...

Artificial Intelligence in the ICU The paucity of positive multicentre prospective randomised control trials in ICU settings serves to highlight the challenge of running studies in such environments, where multiple treatments are given simultaneously to individuals who respond in variable ways based on their individual physiology. Consequently, without established guidelines, ICU clinician decision-making is driven largely by experience and instinct, resulting in s...

ARTICLES Paediatric acute respiratory distress syndrome incidence and epidemiology (PARDIE): an international, observational study Robinder G Khemani, Lincoln Smith, Yolanda M Lopez-Fernandez, et al Lancet Respir Med 2019; 7: 115-128 Background 背景 Paediatric acute respiratory distress syndrome (PARDS) is associated with high mortality in children, but until recently no paediatric-specific diagnostic criteria existed. The Pediatric Acute Lung Injury C...

New algorithm reduces testing for ICU patients Enrolling seriously ill patients in intensive care units for clinical trials is often a big challenge for investigators. This is one reason why there is a dearth of evidence-based guidelines in critical medicine. For instance, ICU doctors often face a dilemma when it comes to ordering lab tests for specific patients.  While ICU doctors are aware that every blood test they order could yield critical informatio...

Prehospital transdermal glyceryl trinitrate in patients with ultra-acute presumed stroke (RIGHT-2): an ambulance-based, randomised, sham-controlled, blinded, phase 3 trial The RIGHT-2 Investigators Lancet Published:February 06, 2019 DOI:https://doi.org/10.1016/S0140-6736(19)30194-1 Summary Background 背景 High blood pressure is common in acute stroke and is a predictor of poor outcome; however, large trials of lowering blood pressure have given variable res...

AKI: long-term impact on mortality and renal function Acute kidney injury (AKI) is defined as an abrupt loss in renal function and may be caused by a wide variety of clinical conditions. AKI is a frequent complication of hospitalisation and is associated with an increased risk of chronic kidney disease (CKD), end-stage renal disease (ESRD), and mortality.Based on more recent studies, AKI is also known to be a risk factor for other adverse outcomes, including stroke...

Editorial|February 17, 2019 How Best to Resuscitate Patients With Septic Shock? Derek C. Angus JAMA. 2019;321(7):647-648. doi:10.1001/jama.2019.0070 What is the best approach for resuscitation of a patient with septic shock? Despite considerable investigation over several decades, this important question still has no clear answer. There is agreement that resuscitation should proceed quickly, for the longer the delay, the greater the physiologic ...