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...

Comment & Response November 5, 2019 Spontaneous Breathing Trials and Successful Extubation Jan O. Friedrich, Karen E. A. Burns JAMA. 2019;322(17):1716. doi:10.1001/jama.2019.14217 To the Editor  The results of the randomized clinical trial reported by Dr Subirà and colleagues compared a less demanding spontaneous breathing trial (SBT) of 30 minutes of pressure support ventilation (PSV) with a more demanding 2-hour T-pi...

ICU Management & Practice, Volume 18 - Issue 3, 2018 Advances in source control in patients with sepsis and septic shock In the past decades there have been significant advances in the diagnosis and management of patients with sepsis and septic shock, and overall awareness has increased significantly (Angus and van der Poll 2013). Emphasis is currently on the early detection of sepsis and rapid initiation of fluid administration and antibiotic therapy, all ...

Research Weight change across adulthood in relation to all cause and cause specific mortality: prospective cohort study Chen Chen,  Yi Ye, Yanbo Zhang, et al BMJ 2019;367:l5584 doi: https://doi.org/10.1136/bmj.l5584 Objective 目的 To investigate the association between weight changes across adulthood and mortality. 研究成年期间体重改变与死亡率的相关性 Design 实验设计 Prospective cohort study. 前瞻队列研究 Setting 场景 U...

End-Tidal CO2 Levels vs. Arterial CO2 Levels in Children with TBI For patients with Traumatic Brain Injury (TBI), the partial pressure of CO2, arterial (PaCO2) can be adjusted to help with the regulation of cerebral perfusion. However, this can prove difficult to carry out in children. The non-invasive method of capnography measures end-tidal CO2 (EtCO2) and is often used for paediatric patients as an alternative to arterial cannulation. EtCO2 measurements have ...

Effect of a fluid bolus on cardiovascular collapse among critically ill adults undergoing tracheal intubation (PrePARE): a randomised controlled trial David R Janz, Jonathan D Casey, Matthew W Semler, et al Lancet Respir Med. 2019 Oct 1. doi: 10.1016/S2213-2600(19)30246-2 Background 背景 Tracheal intubation is common in the care of critically ill adults and is frequently complicated by hypotension, cardiac arrest, or death. We aimed to evaluate ...

Machine-Learning-Based Prediction Models for AKI Acute Kidney Injury (AKI) is a common occurrence for critically ill patients in the ICU, and its early diagnosis has proven to be challenging. The accuracy of the online, machine-learning-based prediction model, AKIpredictor, was analysed for its use in a clinical setting. The study, which took place over five ICUs in Belgium, compared the predictions of AKIpredictor with physician predictions. The patient informa...