ICU Management & Practice, Volume 19 - Issue 2, 2019 Big Data and hidden subtypes of sepsis Results of a study conducted by the University of Pittsburgh School of Medicine suggests that sepsis is not one condition, but many conditions that could benefit from different treatments. The findings are published in JAMA and were presented at the American Thoracic Society's Annual Meeting. Sepsis is the number one killer of hospitalised patients and is a life-t...

COMMENT|ONLINE FIRST Testing the waters: a new test for hypotonic polyuria Ewout J Hoorn Lancet Published: July 11, 2019 DOI:https://doi.org/10.1016/S0140-6736(19)31414-X Three disorders can cause water diuresis (hypotonic polyuria): primary polydipsia, central diabetes insipidus, and nephrogenic diabetes insipidus. These causes of hypotonic polyuria are difficult to differentiate, especially the partial forms of central diabetes insipidus from primary polydip...

C. auris in the ICU - a global challenge Candida auris (C. auris) is a type of fungus first isolated in 2009; since then there have numerous infection episodes and outbreaks in different regions of the world. In the U.S. alone, 560 cases of C. auris infections have been reported as at 31 January 2019. Overall, most of those affected were critically ill adults, with risk factors for invasive fungal infections, such as immunosuppression, surgery, or in...

ARTICLES|ONLINE FIRST Arginine-stimulated copeptin measurements in the differential diagnosis of diabetes insipidus: a prospective diagnostic study Bettina Winzeler, Nicole Cesana-Nigro, Julie Refardt, et al Lancet Published: July 11, 2019 DOI:https://doi.org/10.1016/S0140-6736(19)31255-3 Summary Background 背景 Differential diagnosis of diabetes insipidus is challenging. The most reliable approach is hypertonic saline-stimulated copeptin measurements. H...

Treatment implications of novel clinical phenotypes for sepsis Sepsis affects millions of individuals every year. It carries a high risk of death, even if prompt care is provided. It has been decades, and no new therapies for sepsis have been discovered. A major barrier to progress in this area has been the overly broad definition for this syndrome. Sepsis has a vast array of clinical and biological features, and these features can be clustered in different combina...

Research Association of changes in red meat consumption with total and cause specific mortality among US women and men: two prospective cohort studies Yan Zheng, Yanping Li, Ambika Satija, et al BMJ 2019; 365: l2110 doi:https://doi.org/10.1136/bmj.l2110 Abstract Objective 目的 To evaluate the association of changes in red meat consumption with total and cause specific mortality in women and men. 评价红肉摄入的改变对女性和男性全因死亡率与疾病特异性死亡...

Immunotherapy effects on sepsis A randomised controlled multicentre trial assessed for the first time the safety and pharmacokinetics of an antiprogrammed cell death-ligand 1 (anti–PD-L1) immune checkpoint inhibitor (BMS-936559; Bristol-Myers Squibb, Princeton, NJ) and its effect on immune biomarkers in participants with sepsis-associated immunosuppression. Results show that BMS-936559 was well tolerated, with no evidence of drug-induced hypercytokinaemia or cyt...

Pessimism in providing critical care for elderly patients A recent study conducted in France investigated the association of age with long-term mortality after discharge from the ICU. Another subset of this discussion relates to the critically ill elderly patients who have higher mortality compared to younger patients as well as longer lengths of stay in the ICU prior to death.  There has been a great deal of discussion on how a disproportionate amount of health...

ORIGINAL ARTICLE C-Reactive Protein Testing to Guide Antibiotic Prescribing for COPD Exacerbations Christopher C. Butler, David Gillespie, Patrick White, et al N Engl J Med 2019; 381:111-120DOI: 10.1056/NEJMoa1803185 Abstract BACKGROUND 背景 Point-of-care testing of C-reactive protein (CRP) may be a way to reduce unnecessary use of antibiotics without harming patients who have acute exacerbations of chronic obstructive pulmonary disease (COPD). ...

Effect of adhesive tape versus endotracheal tube fastener in critically ill adults The securement method of endotracheal tubes should ideally prevent dislodgement and minimise complications. Endotracheal tube fastener can reduce complications among critically ill patients who are undergoing endotracheal intubation.  You might also like:UK study: extubating ventilated patients on vasoactive infusions 'safe' A study was conducted with critically ill adults who ...