PERFECT protocol: volume-based feeding in ventilated adults Underfeeding in critical illness is common and associated with poor outcomes. Researchers in the UK designed a before-and-after study to evaluate the safety, efficacy and clinical outcomes associated with volume-based feeding (VBF) compared to rate-based feeding (RBF) in a single intensive care unit (ICU).The prospective before-and-after study suggests that VBF safely and effectively increased the delivery...

Original Investigation April 24, 2019 Association of Duration and Type of Surgical Prophylaxis With Antimicrobial-Associated Adverse Events Westyn Branch-Elliman, William O’Brien, Judith Strymish, et al JAMA Surg. Published online April 24, 2019. doi:10.1001/jamasurg.2019.0569 Importance 背景 The benefits of antimicrobial prophylaxis are limited to the first 24 hours postoperatively. Little is known abo...

ICU Management & Practice, Volume 19 - Issue 1, 2019 Protecting ward patients Finding patients before they crash might be the next major opportunity to improve patient safety. This article describes recent advances and perspectives for ward monitoring with wearable sensors and smart algorithms. Hospital wards are dangerous. Indeed, they are where most unexpected deaths occur within institutions. In a UK national audit study, among 23,554 adult in-hospita...

ESICM/ESCMID task force on practical management of invasive candidiasis in critically ill patients Question 1: Can we recommend the use of risk prediction models in daily clinical practice?我们能否推荐工作中采用风险预测模型？ Recommendations 推荐意见 Risk prediction models, because of their simplicity and high negative predictive values, should be used for identifying high-risk patients (Strong recommendation, low-quality evidence). 由于风险预测模型简单且阴性...

Innovations in ICU ventilation The future delivered In this article, we aim to summarise the developments in mechanical ventilation that we believe are shaping the present and will shape the future ahead. Introduction Many centuries ago, Socrates stated that “the secret of change is to focus all of your energy, not on fighting the old, but on building the new.” Nowadays, we may relate his quote with the concept of innovation, which is considered the process of...

Is Sepsis-Associated Mortality Often Preventable? Authors: News Author: Veronica Hackethal, MD CME Author: Charles P. Vega, MD Clinical Context Approximately 1.7 million US adults are diagnosed annually with sepsis, and sepsis can contribute to more than a quarter of a million deaths among US residents per year. The authors of the current study acknowledged multiple programs to improve the care and outcomes of patients with sepsis; one of the best known of the...

Original Investigation Pediatrics Evaluation of Oxygen Saturation Index Compared With Oxygenation Index in Neonates With Hypoxemic Respiratory Failure Hemananda K. Muniraman,  Ashley Y. Song, Rangasamy Ramanathan, et al JAMA Netw Open. 2019;2(3):e191179. doi:10.1001/jamanetworkopen.2019.1179 Abstract Importance 背景 Oxygenation index (OI), an invasive measurement, is routinely used as a marker of severity of h...

Original Investigation Critical Care Medicine Prevalence, Underlying Causes, and Preventability of Sepsis-Associated Mortality in US Acute Care Hospitals Chanu Rhee, Travis M. Jones, Yasir Hamad, et al JAMA Netw Open. 2019;2(2):e187571. doi:10.1001/jamanetworkopen.2018.7571 Abstract Importance 背景 Sepsis is present in many hospitalizations that culminate in death. The contribution of sepsis to these deaths, and the extent to which they are preventable, ...

Management of obese patients with ARDS At least one fifth of all patients admitted to the ICU are obese, and these patients are at risk of developing lung de-recruitment and then atelectasis. Moreover, the incidence of acute respiratory distress syndrome (ARDS) is increased in obese patients. A major challenge of the critical care management of obese patients is successful respiratory system management. However, while obesity contributes to many diseases and is ...

Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health Challenging the One-Hour Sepsis Bundle Annahieta Kalantari, DO; Salim R. Rezaie, MD Western J Emerg Med. 2019;20(2):185-190.  In April 2018, the Surviving Sepsis Campaign (SSC) released an updated sepsis bundle, which combines directives previously listed in the three-hour and six-hour bundles. The authors discussed the reasoning and evidence supporting these changes. Howe...