ICU Management & Practice, Volume 18 - Issue 4, 2018 What a difference a drug makes? Asking why the patient needs to be sedated is as important as the choice of drug for sedation.  Why use sedation?  Intensivists should ask why they use sedation every time they order it. Sedation is used to reduce the burden and stress of critical illness. Sedative agents mixed with analgesic agents reduce pain and keep the patient calm, especially at night....

Editorial May 19, 2019 Recombinant Human Soluble Thrombomodulin in Patients With Sepsis-Associated Coagulopathy: Another Negative Sepsis Trial? Tom van der Poll JAMA. Published online May 19, 2019. doi:10.1001/jama.2019.5792 Sepsis is a heterogeneous syndrome caused by an unbalanced host response to an infection resulting in organ dysfunction.1 Sepsis is associated with activation of the coagulation system, and 30% to 60% of patients have d...

ARTICLES OF THE MONTH - MAY 2019 SEVEN-DAY PROFILE PUBLICATION ~Feasibility and safety of extracorporeal CO2 removal to enhance protective ventilation in acute respiratory distress syndrome: the SUPERNOVA study Combes A. et al:Feasibility and safety of extracorporeal CO2 removal to enhance protective ventilation in acute respiratory distress syndrome: the SUPERNOVA study The SUPERNOVA study assessed feasibility and safety of extracorporeal carbon dioxide remo...

Editorial May 19, 2019 New Phenotypes for Sepsis: The Promise and Problem of Applying Machine Learning and Artificial Intelligence in Clinical Research William A. Knaus, Richard D. Marks JAMA. Published online May 19, 2019. doi:10.1001/jama.2019.5794 In this issue of JAMA, Seymour and his multidisciplinary team of coauthors1 aim to improve the current understanding of sepsis by identifying new clinical phenotypes using machine learning...

ICU Management & Practice, Volume 19 - Issue 1, 2019 Trends in epidemiology and antimicrobial resistance in intensive care units The intensive care unit has a unique environment, mainly because it treats severe and critically ill patients who require special care. Critical care patients often require high-risk surgeries, and there is also a frequent need for invasive devices such as central or peripheral venous catheters, urinary catheters or tracheal tubes...

COMMENT|ONLINE FIRST Carbapenem-resistant Enterobacteriaceae: global action required Federico Perez, Robert A Bonomo Lancet Infect Dis Published: April 29, 2019 DOI: https://doi.org/10.1016/S1473-3099(19)30210-5 Enterobacteriaceae are common pathogens in hospitals and in the community. When resistant to powerful and versatile antibiotics such as carbapenems, they can have devastating consequences, particularly in the most vulnerable individuals.1 Much infor...

ARTICLES|ONLINE FIRST Effect of carbapenem resistance on outcomes of bloodstream infection caused by Enterobacteriaceae in low-income and middle-income countries (PANORAMA): a multinational prospective cohort study Andrew J Stewardson, Kalisvar Marimuthu, Sharmila Sengupta, et al Lancet Infect Dis Published: April 29, 2019 DOI:https://doi.org/10.1016/S1473-3099(18)30792-8 Summary Background 背景 Low-income and middle-income countries (LMICs) are under...

Early Paralytic Agents for ARDS? Yes, No, and Sometimes Arthur S. Slutsky, Jesús Villar N Engl J Med May 19, 2019DOI: 10.1056/NEJMe1905627 Lung-protective ventilation, which includes low tidal volumes and limitation of plateau pressures, is the standard approach in patients with acute respiratory distress syndrome (ARDS).1 Almost a decade ago, the ARDS et Curarisation Systematique (ACURASYS) trial2 showed that in patients with moderate-to-severe ARDS, a strategy ...

ORIGINAL ARTICLE Early Sedation with Dexmedetomidine in Critically Ill Patients Yahya Shehabi, Belinda D. Howe, Rinaldo Bellomo, et al Abstract BACKGROUND 背景 Dexmedetomidine produces sedation while maintaining a degree of arousability and may reduce the duration of mechanical ventilation and delirium among patients in the intensive care unit (ICU). The use of dexmedetomidine as the sole or primary sedative agent in patients undergoing mechanical ventilati...

ORIGINAL ARTICLE Nasal High-Flow Therapy for Newborn Infants in Special Care Nurseries Brett J. Manley, Gaston R.B. Arnolda, Ian M.R. Wright, et al N Engl J Med 2019; 380:2031-2040DOI: 10.1056/NEJMoa1812077 Abstract BACKGROUND 背景 Nasal high-flow therapy is an alternative to nasal continuous positive airway pressure (CPAP) as a means of respiratory support for newborn infants. The efficacy of high-flow therapy in nontertiary special care nurseries is un...