Research True 99th centile of high sensitivity cardiac troponin for hospital patients: prospective, observational cohort study Mark Mariathas, Rick Allan, Sanjay Ramamoorthy, et al BMJ 2019;364:l729 Abstract Objective 目的 To determine the distribution, and specifically the true 99th centile, of high sensitivity cardiac troponin I (hs-cTnI) for a whole hospital population by applying the hs-cTnI assay currently used routinely at a large teaching hos...

Original Investigation |March 19, 2019 Levels of Evidence Supporting American College of Cardiology/American Heart Association and European Society of Cardiology Guidelines, 2008-2018 Alexander C. Fanaroff, Robert M. Califf, Stephan Windecker, et al JAMA. 2019;321(11):1069-1080. doi:10.1001/jama.2019.1122 Importance  背景 Clinical decisions are ideally based on evidence generated from multiple randomized control...

Declining rate of ARDS-related mortality There have been multiple advances in the management of acute respiratory distress syndrome (ARDS), but the temporal trends in ARDS-related mortality are not well known. Conservative fluid management strategy for ARDS, in particular, has been extensively studied and is increasingly being used in clinical practice. However, it is largely unknown whether this changing practice parallels with the improvement in survival outcome....

Post-anaesthesia pulmonary complications after use of muscle relaxants (POPULAR): a multicentre, prospective observational study Eva Kirmeier, Lars I Eriksson, Heidrun Lewald, et al Lancet Respir Med 2019; 7: 129-140 Background 背景 Results from retrospective studies suggest that use of neuromuscular blocking agents during general anaesthesia might be linked to postoperative pulmonary complications. We therefore aimed to assess whether the use of neuromus...

Intensive Care Medicine移植专刊 Organ Donation and Transplant in the ICU Editorial ~ Tobias Welte 10 tips for the Intensive care management of transplanted lung patients Editorial ~ Hasse Møller-Sørensen 10 tips for intensive care management of transplanted heart patients Editorial ~ Samir Jaber 10 tips for intensive care management of transplanted liver patients Editorial ~ Michael Darmon Ten tips to manage renal transplant rec...

Preliminary Communication | February 19, 2019 Effect of Intravenous Acetaminophen vs Placebo Combined With Propofol or Dexmedetomidine on Postoperative Delirium Among Older Patients Following Cardiac Surgery: The DEXACET Randomized Clinical Trial Balachundhar Subramaniam, Puja Shankar, Shahzad Shaefi, et al JAMA. 2019;321(7):686-696. doi:10.1001/jama.2019.0234 Abstract Importance 背景 Postoperative d...

Harvard study: machine learning improves ED triage The increasing number of emergency department (ED) visits often correlates with ED crowding and delays in care. This problem highlights the need for ED triage systems that accurately differentiate and prioritise critically ill from stable patients, enabling efficient allocation of finite ED resources.   Currently, the Emergent Severity Index (ESI) is the most commonly used triage algorithm in U.S. EDs....

Diagnostic approaches for hospital-acquired pneumonia A new study suggests that a comprehensive approach might be undertaken for microbiological diagnosis in critically ill non-ventilated hospital-acquired pneumonia (HAP). Sputum sampling determined one third of microbiological diagnosis in HAP patients who were not subsequently intubated. In contrast, invasive methods were associated with higher rates of microbiological diagnosis.  Hospital-acquired pneumo...

ORIGINAL ARTICLE Decolonization to Reduce Postdischarge Infection Risk among MRSA Carriers Susan S. Huang, Raveena Singh, James A. McKinnell, et al N Engl J Med 2019; 380:638-650DOI: 10.1056/NEJMoa1716771 BACKGROUND Hospitalized patients who are colonized with methicillin-resistant Staphylococcus aureus(MRSA) are at high risk for infection after discharge. METHODS We conducted a multicenter, randomized, controlled trial of postdischarge hygiene e...

Advances in monitoring expired CO2 in critically ill patients Reviews the potential uses and pitfalls of capnography in critically ill patients, especially for haemodynamic and respiratory monitoring. Expired CO2 can be easily monitored in the intensive care unit (ICU), especially in patients under invasive mechanical ventilation, using infrared measurement by sampling mainstream expiratory flow using an in-line chamber, or sidestream expiratory flow (by contin...