Imaging and intensive care medicine An evolving partnership A major evolution is underway involving critical care and imaging.  The intensive care patient population is changing. Increasingly intensive care units (ICUs) are treating older patients, with more comorbidities, and variable prognosis, at a time when family expectations are different and often with higher expectations of recovery. Life support technology is increasingly sophisticated, surgery is minima...

Intensive blood pressure reduction with intravenous thrombolysis therapy for acute ischaemic stroke (ENCHANTED): an international, randomised, open-label, blinded-endpoint, phase 3 trial Craig S Anderson, Yining Huang, Richard I Lindley, et al Lancet Published:February 07, 2019 DOI:https://doi.org/10.1016/S0140-6736(19)30038-8 Summary Background 背景 Systolic blood pressure of more than 185 mm Hg is a contraindication to thrombolytic treatment with intraven...

Antifungal treatment in the ICU Best practice in managing fungal infections Invasive candidiasis: Every milligram of antifungal counts! Think Aspergillus! Invasive fungal infections (IFIs) are a major cause of morbidity and mortality in critically ill patients. Almost 80% of IFIs are due to Candida spp., which are the third most common isolated microorganisms in the intensive care unit (ICU) (Kett et al. 2011; Bassetti et al. 2017). Although the incidence of inva...

Efficacy and safety of minimally invasive surgery with thrombolysis in intracerebral haemorrhage evacuation (MISTIE III): a randomised, controlled, open-label, blinded endpoint phase 3 trial Daniel F Hanley, Richard E Thompson, Michael Rosenblum, et al Lancet Published:February 07, 2019 DOI:https://doi.org/10.1016/S0140-6736(19)30195-3 Summary Background 背景 Acute stroke due to supratentorial intracerebral haemorrhage is associated with high morbidity and ...

Venovenous extracorporeal membrane oxygenation for acute respiratory distress syndrome: a systematic review and meta-analysis Laveena Munshi, Allan Walkey, Ewan Goligher, et al Lancet Respir Med 2019; 7: 163-172 Background 背景 Use of extracorporeal membrane oxygenation (ECMO) in adults with severe acute respiratory distress syndrome has increased in the past 10 years. However, the efficacy of venovenous ECMO in people with acute respiratory distress synd...

Risk of sepsis: does DNA matter? A new analysis has identified several genetic variants that could influence one's susceptibility to sepsis, a life-threatening condition. This study provides a novel insight that may affect personalised targeted treatment in the future clinical management of sepsis. Variants are alterations in nucleotide base pairs located within a gene or noncoding portion of the genome. In sepsis, the focus has been on understanding the impac...

Research Impact of scribes on emergency medicine doctors’ productivity and patient throughput: multicentre randomised trial Katherine Walker, Michael Ben-Meir, William Dunlop, et al https://doi.org/10.1136/bmj.l121  BMJ 2019;364:l121 Abstract Objectives 目的 To evaluate the changes in productivity when scribes were used by emergency physicians in emergency departments in Australia and assess the effect of scribes on throughput. 评估澳大利亚急诊科医...

REMEMBER score predicts mortality in patients receiving VA-ECMO after CABG Prediction scoring systems for coronary artery bypass grafting (CABG) patients on veno-arterial extracorporeal membrane oxygenation (VA-ECMO) have not yet been reported. To help clinicians select patients that would benefit from VA-ECMO after CABG, a team of international researchers devised a mortality risk score – REMEMBER score – comprising six pre-ECMO variables. The REMEMBER (pRedi...

Omadacycline for Community-Acquired Bacterial Pneumonia Roman Stets, Monica Popescu, Joven R. Gonong, et al N Engl J Med 2019; 380:517-527DOI: 10.1056/NEJMoa1800201 Abstract BACKGROUND 背景 Omadacycline, a new once-daily aminomethylcycline antibiotic agent that can be administered intravenously or orally, reaches high concentrations in pulmonary tissues and is active against common pathogens that cause community-acquired bacterial pneumonia. Omadacy...

Use of levosimendan in the ICU Levosimendan is an inodilator that promotes cardiac contractility primarily through calcium sensitisation of cardiac troponin C and vasodilatation via opening of adenosine triphosphate-sensitive potassium (KATP) channels in vascular smooth muscle cells. The drug also exerts organ-protective effects through a similar effect on mitochondrial KATP channels. Levosimendan has been demonstrated to have potential utility in a wide range o...