SPECIAL ARTICLE FREE PREVIEW Discrimination, Abuse, Harassment, and Burnout in Surgical Residency Training Yue-Yung Hu, Ryan J. Ellis, D. Brock Hewitt, et al. N Engl J Med 2019; 381:1741-1752DOI: 10.1056/NEJMsa1903759 BACKGROUND Physicians, particularly trainees and those in surgical subspecialties, are at risk for burnout. Mistreatment (i.e., discrimination, verbal or physical abuse, and sexual harassment) may contribute to burnout and suicidal thoughts. ...

ICU Management & Practice, Volume 19 - Issue 3, 2019 Pre-packed Critical Care Drug Pouch for Acute Patient Care Human factors are significant contributors to drug error. To overcome some of these human factors, we propose standardisation and consolidation of agreed drugs and equipment into a compact pre-packed critical care drug pouch (CCP) for use in non-theatre environments. Introduction  Emergency and sedation drugs availability and preparation rep...

ORIGINAL ARTICLE FREE PREVIEW Early Surgery or Conservative Care for Asymptomatic Aortic Stenosis Duk-Hyun Kang, Sung-Ji Park, Seung-Ah Lee, et al N Engl J Med November 16, 2019DOI: 10.1056/NEJMoa1912846 BACKGROUND 背景 The timing and indications for surgical intervention in asymptomatic patients with severe aortic stenosis remain controversial. 无症状的严重主动脉瓣狭窄患者手术干预的时机及适应症存在争议。 METHODS 方法 In a multicenter trial, we ran...

Myocardial Ischaemia During Ventilator Weaning Weaning is a critical process for patients in intensive care. Weaning failure can result in poor outcomes and prolonged weaning which in turn can increase the risk of death. One of the main mechanisms of weaning failure is weaning-induced cardiac pulmonary oedema (WiPO). While advances in diagnosis have been made using tools such as bedside echocardiography or biomarkers, the underlying mechanisms of WiPO still remain uncl...

ORIGINAL ARTICLE Prevention of Early Ventilator-Associated Pneumonia after Cardiac Arrest Bruno François, Alain Cariou, Raphaël Clere-Jehl, et al N Engl J Med 2019; 381:1831-1842DOI: 10.1056/NEJMoa1812379 BACKGROUND 背景 Patients who are treated with targeted temperature management after out-of-hospital cardiac arrest with shockable rhythm are at increased risk for ventilator-associated pneumonia. The benefit of preventive short-term antibiotic therapy...

ICU Management & Practice, Volume 19 - Issue 3, 2019 New ESPEN Guidelines for Nutrition in the Critically Ill: Help, What Happened!? ESPEN guidelines for nutrition in critical illness have shifted from optimistic anticipative nutritional pharmacotherapy towards cautious and balanced metabolic support. This important new orientation in ICU nutrition management is a consequence of recent strong RCT-based evidence. Introduction Recently, the new ESPEN gu...

Comment & Response November 5, 2019 Spontaneous Breathing Trials and Successful Extubation—Reply Carles Subirà, Rafael Fernández JAMA. 2019;322(17):1717. doi:10.1001/jama.2019.14244 In Reply We agree with Drs Friedrich and Burns that prophylaxis against postextubation respiratory failure with NIV or HFNC was more common in the PSV group than in the T-piece group (24.7% vs 18.7%).1 However, the decision to apply prophyl...

Liberation from Mechanical Ventilation Over 1 million people patients throughout the world receive mechanical ventilation for acute respiratory failure. The management of these critically ill patients and liberating them from invasive ventilation is one of the most important decisions clinicians have to make. Liberation from ventilation is also a major dilemma for clinicians because any error could result in significant harm to the patient. Premature or failed atte...

ORIGINAL ARTICLE FREE PREVIEW Diagnosis of Pulmonary Embolism with d-Dimer Adjusted to Clinical Probability Clive Kearon, Kerstin de Wit, Sameer Parpia, et al N Engl J Med 2019; 381:2125-2134DOI: 10.1056/NEJMoa1909159 BACKGROUND 背景 Retrospective analyses suggest that pulmonary embolism is ruled out by a d-dimer level of less than 1000 ng per milliliter in patients with a low clinical pretest probability (C-PTP) and by a d-dimer level o...

Lung Recruitment in Patients with Severe ARDS Acute Respiratory Distress Syndrome (ARDS) affects up to 10% of patients in the ICU. Typical symptoms of ARDS include an increase in lung weight and a reduction of aerated lung tissue. For the treatment of ARDS alveolar recruitment is key, however, this has not yet been shown to benefit severe ARDS cases. It has been suggested that lung recruitment manoeuvres (LRM) and increased positive end-expiratory pressure (PEEP) w...