JAMA Clinical Guidelines Synopsis July 18, 2019 Management of Patients With Acute Ischemic Stroke James R. Brorson, Adam S. Cifu JAMA. Published online July 18, 2019. doi:10.1001/jama.2019.10436 Guideline title 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke Release date January 24, 2018 Prior version 2013 Developer American Heart Association (AHA)/American Stroke Association (ASA) Funding ...

Viewpoint | July 19, 2019 Evidence vs Consensus in Clinical Practice Guidelines Benjamin Djulbegovic, Gordon Guyatt, JAMA. Published online July 19, 2019. doi:10.1001/jama.2019.9751 Clinical practice guidelines have become increasingly prominent in clinical medicine over the last 4 decades, and represent one of the most important tools for potentially improving clinical decision-making and, in turn, potentially improving patients’ outcomes.1 Historically, m...

IROI Study: Intra-abdominal hypertension afflicts 50% of ICU patients The Incidence, Risk Factors, and Outcomes of Intra-Abdominal Hypertension in Critically Ill Patients (IROI) Study is the first prospective multicentre observation on prevalence, risk factors, and outcome of intra-abdominal hypertension (IAH) among the consecutive patients admitted to the ICU. Results show that nearly half of all patients admitted to the ICUs worldwide developed IAH and that two t...

ORIGINAL ARTICLE A Multicenter Trial of Vena Cava Filters in Severely Injured Patients Kwok M. Ho, Sudhakar Rao, Stephen Honeybul, et al N Engl J Med 2019; 381:328-337DOI: 10.1056/NEJMoa1806515 Abstract BACKGROUND 背景 Whether early placement of an inferior vena cava filter reduces the risk of pulmonary embolism or death in severely injured patients who have a contraindication to prophylactic anticoagulation is not known. 对于具有预防性抗凝禁忌的严重...

Original Investigation | July 23/30, 2019 Intensive vs Standard Treatment of Hyperglycemia and Functional Outcome in Patients With Acute Ischemic Stroke: The SHINE Randomized Clinical Trial Karen C. Johnston, Askiel Bruno, Qi Pauls, et al JAMA. 2019;322(4):326-335. doi:10.1001/jama.2019.9346 Abstract Importance 背景 Hyperglycemia during acute ischemic stroke is common and is associated with worse out...

Editor's Note July 16, 2019 Government Regulation of Sepsis Care Demetrios N. Kyriacou JAMA. 2019;322(3):250-251. doi:10.1001/jama.2019.9230 每年全球约有3000万脓毒症患者，且导致约600万患者死亡。尽管不断提出新的治疗手段，但是，过去数十年间脓毒症相关病死率的下降主要源于早期识别以及包括静脉抗生素和晶体液复苏在内的及时治疗。拯救脓毒症行动指南将重要治疗措施与其他重症治疗及实验室检查整合成集束化治疗进行推荐。然而，在医院环境下，根据这些指南推荐的...

ICU Management & Practice, Volume 18 - Issue 1, 2018 CO2 in the critically ill CO2 exerts potent effects on lung biology that could be clinically relevant in critically ill patients, in particular those with acute respiratory distress syndrome (ARDS). The impact of hypercapnia on outcome in these patients is yet to be determined. The physiological effects of hypercapnia are increasingly well understood, but the literature remains confusing. Importan...

Editor's Note July 16, 2019 Government Regulation of Sepsis Care Demetrios N. Kyriacou JAMA. 2019;322(3):250-251. doi:10.1001/jama.2019.9230 Sepsis is estimated to affect more than 30 million people and cause an estimated 6 million deaths worldwide every year. Although new medical treatments are continually being proposed and tested, the greatest reduction in sepsis-related deaths over the past few decades has come from the early recog...

Editorial July 16, 2019 Psychological Consequences of Admission to the ICU： Helping Patients and Families Louise Rose, Fiona Muttalib, Neill K. J. Adhikari JAMA. 2019;322(3):213-215. doi:10.1001/jama.2019.9059 For most patients and their families, admission to the intensive care unit (ICU) is an unanticipated event that causes substantial psychological distress. For patients, short- and long-term consequences include delirium, anxiety, depressi...

Original Investigation  Association Between State-Mandated Protocolized Sepsis Care and In-hospital Mortality Among Adults With Sepsis Jeremy M. Kahn, Billie S. Davis, Jonathan G. Yabes, et al JAMA. 2019;322(3):240-250. doi:10.1001/jama.2019.9021 Abstract Importance 背景 Beginning in 2013, New York State implemented regulations mandating that hospitals implement evidence-based protocols for sepsis management, ...