Fluid responsiveness in sepsis: the fluid challenge revisiting (FCREV) study Fluid challenge is a common practice in the ICU. It is one of the most important resuscitation manoeuvres of acute circulatory failure management in critically ill patients. Adequate fluid resuscitation is very important because both hypovolaemia and fluid overload can result in poor outcomes in the ICU. The criteria for fluid administration still remains controversial. A study was cond...

ORIGINAL ARTICLE Clinical Metagenomic Sequencing for Diagnosis of Meningitis and Encephalitis Michael R. Wilson, Hannah A. Sample, Kelsey C. Zorn, et al N Engl J Med 2019; 380:2327-2340DOI: 10.1056/NEJMoa1803396  Abstract BACKGROUND 背景 Metagenomic next-generation sequencing (NGS) of cerebrospinal fluid (CSF) has the potential to identify a broad range of pathogens in a single test. 脑脊液(CSF)的宏基因二代测序(NGS)能够通过一次检测鉴别多种致病微...

Original Investigation June 11, 2019 Association of Blood Donor Sex and Prior Pregnancy With Mortality Among Red Blood Cell Transfusion Recipients Gustaf Edgren Edward L. Murphy, Don J. Brambilla, et al JAMA. 2019;321(22):2183-2192. doi:10.1001/jama.2019.7084 Abstract 摘要 Importance 背景 Evidence regarding associations of blood donor sex with mortality among red blood cell transfusion recipients is conflicting. 有关献血者性别与接受输血...

Effect of ultra-short-term treatment of patients with iron deficiency or anaemia undergoing cardiac surgery: a prospective randomised trial Donat R Spahn, Felix Schoenrath, Gabriela H Spahn, et al Lancet 2019; 393: 2201-2212 DOI:https://doi.org/10.1016/S0140-6736(18)32555-8 Summary Background 背景 Anaemia and iron deficiency are frequent in patients scheduled for cardiac surgery. This study assessed whether immediate preoperative treatment could result...

Original Investigation June 11, 2019 Effect of Pressure Support vs T-Piece Ventilation Strategies During Spontaneous Breathing Trials on Successful Extubation Among Patients Receiving Mechanical Ventilation: A Randomized Clinical Trial Carles Subirà, Gonzalo Hernández, Antònia Vázquez, et al JAMA. 2019;321(22):2175-2182. doi:10.1001/jama.2019.7234Key Points Objective 目的 To evaluate the effect of an SBT consisting of 30 minutes of pressure support ventilat...

Individualised nutritional support in medical inpatients at nutritional risk: a randomised clinical trial Philipp Schuetz, Rebecca Fehr, Valerie Baechli, et al Lancet 2019 Published:April 25, 2019 DOI:https://doi.org/10.1016/S0140-6736(18)32776-4 Summary Background 背景 Guidelines recommend the use of nutritional support during hospital stays for medical patients (patients not critically ill and not undergoing surgical procedures) at risk of malnutrition...

ICU Management & Practice, Volume 18 - Issue 4, 2018 What a difference a drug makes? Asking why the patient needs to be sedated is as important as the choice of drug for sedation.  Why use sedation?  Intensivists should ask why they use sedation every time they order it. Sedation is used to reduce the burden and stress of critical illness. Sedative agents mixed with analgesic agents reduce pain and keep the patient calm, especially at night....

Editorial May 19, 2019 Recombinant Human Soluble Thrombomodulin in Patients With Sepsis-Associated Coagulopathy: Another Negative Sepsis Trial? Tom van der Poll JAMA. Published online May 19, 2019. doi:10.1001/jama.2019.5792 Sepsis is a heterogeneous syndrome caused by an unbalanced host response to an infection resulting in organ dysfunction.1 Sepsis is associated with activation of the coagulation system, and 30% to 60% of patients have d...

ARTICLES OF THE MONTH - MAY 2019 SEVEN-DAY PROFILE PUBLICATION ~Feasibility and safety of extracorporeal CO2 removal to enhance protective ventilation in acute respiratory distress syndrome: the SUPERNOVA study Combes A. et al:Feasibility and safety of extracorporeal CO2 removal to enhance protective ventilation in acute respiratory distress syndrome: the SUPERNOVA study The SUPERNOVA study assessed feasibility and safety of extracorporeal carbon dioxide remo...

Editorial May 19, 2019 New Phenotypes for Sepsis: The Promise and Problem of Applying Machine Learning and Artificial Intelligence in Clinical Research William A. Knaus, Richard D. Marks JAMA. Published online May 19, 2019. doi:10.1001/jama.2019.5794 In this issue of JAMA, Seymour and his multidisciplinary team of coauthors1 aim to improve the current understanding of sepsis by identifying new clinical phenotypes using machine learning...