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...

PUBLIC RELEASE: 14-FEB-2019 Antidepressant could stop deadly sepsis, study suggests Previous FDA approval could fast-track new treatment UNIVERSITY OF VIRGINIA HEALTH SYSTEM An antidepressant drug used to treat obsessive-compulsive disorder could save people from deadly sepsis, new research from the University of Virginia School of Medicine suggests. Sepsis is a significant cause of death around the world. The federal Centers for Disease Control an...

Blood biomarker can identify infection-related disease progression In settings such as the emergency department (ED), early assessment of the potential for further disease progression is vital. An early identification of infection severity is helpful in initiating appropriate treatment strategies. However, currently there is a lack of validated tools to assess risk of further disease progression in patients presenting to the ED with a suspected infection. A new ...

Mortality, morbidity, and hospitalisations due to influenza lower respiratory tract infections, 2017: an analysis for the Global Burden of Disease Study 2017 GBD 2017 Influenza Collaborators Lancet Respir Med 2019; 7: 69-89 Background 背景 Although the burden of influenza is often discussed in the context of historical pandemics and the threat of future pandemics, every year a substantial burden of lower respiratory tract infections (LRTIs) and other respirato...

Intensive Care Medicine ONLINE FIRST THIS WEEK(FREE ACCESS) Seven-Day Profile Publication ~ Alain Combes - Feasibility and safety of extracorporeal CO2 removal to enhance protective ventilation in Acute Respiratory Distress Syndrome: the SUPERNOVA study  Review ~ G. A. Schmidt - Ultrasound-guided vascular access in critical illness  Original ~ Gerald Chi - Extended-duration Betrixaban versus shorter-duration Enoxaparin for Venous Thromboembolism Prophylaxis in criti...

Original Investigation Effect of Electroencephalography-Guided Anesthetic Administration on Postoperative Delirium Among Older Adults Undergoing Major Surgery: The ENGAGES Randomized Clinical Trial Troy S. Wildes, Angela M. Mickle, Arbi Ben Abdallah, et al JAMA. 2019;321(5):473-483. doi:10.1001/jama.2018.22005Key Points Abstract Importance 背景 Intraoperative electroencephalogram (EEG) waveform suppression, often suggesting excessive general anesthesia, ...