Optimal Respiratory Support for COVID-19 Patients Non-invasive respiratory support is an essential part of critical care. Non-invasive ventilation and high-flow nasal oxygen (HFNO) are commonly used in patients with acute hypoxaemic respiratory failure. Non-invasive respiratory support can alleviate respiratory distress, improve oxygenation and reduce the need for invasive mechanical ventilation. It can also help reduce mortality by reducing the need for trachea...

Diagnosing Non-Convulsive Seizures in the ICU: Tackling the Top Challenges One clinical factor complicating the work of ICU physicians and nurses is the difficulty of diagnosing nonconvulsive status epilepticus (NCSE)—an invisible condition that must be managed aggressively to prevent lasting damage to the brain. Because the prevalence of NCSE among neurological patients can reach up to 60%, and because it becomes increasingly hard to manage the longer it goes untreate...

Prone Positioning in Patients Receiving vvECMO for ARDS Several studies have supported the efficacy of venovenous extracorporeal membrane oxygenation (vvECMO) to improve survival in severe acute respiratory distress syndrome (ARDS). ARDS is one of the primary causes of admission to the ICU. The use of an effective approach to support respiratory function in patients with severe respiratory failure is thus an important goal when managing these patients. This has bec...

ARDS Subphenotypes Using Machine Learning An observational, multicohort, retrospective study was conducted to validate two machine-learning clinical classifier models for assigning acute respiratory distress syndrome (ARDS) subphenotypes. Two ARDS subphenotypes with distinct biological and clinical features and differential treatment responses have been identified in seven individual cohorts. In addition, clinical classifier models to facilitate bedside identi...

Post-hoc Analysis of the NONSEDA Trial In recent years, there has been an increase in awareness of minimising sedation in the ICU. Several benefits of avoiding heavy sedation have been reported in clinical studies, and clinical guidelines also encourage less sedation. Findings from the NONSEDA trial were published in 2020. In this trial, 700 critically ill patients were randomised to receive light sedation or non-sedation during mechanical ventilation. Findings ...

Editorials Awake prone positioning for patients with covid-19 Joseph Barker, David Koeckerling, Nadeesha Lakmal Mudalige, et al BMJ 2022; 376 doi: https://doi.org/10.1136/bmj.o632 (Published 23 March 2022)Cite this as: BMJ 2022;376:o632 It’s a matter of time Awake prone positioning is thought to improve clinical outcomes in patients with covid-19 by modulating lung mechanics during progressive hypoxaemic respiratory failure.12 The intervention is attra...

ICU Management & Practice, Volume 21 - Issue 3, 2021 Diaphragm Ultrasonography in ICU: Why, How, and When To Use It? An overview of the principles and current applications of diaphragm ultrasound and innovative ultrasound-based techniques. Introduction  In the intensive care unit (ICU), ultrasound imaging has become increasingly popular for the diagnosis and to guide treatment in critically ill patients (Volpicelli et al. 2020). The use of ultras...

Outcome After Intubation for Septic Shock Acute respiratory failure in septic patients is associated with higher in-hospital mortality. Early management and treatment with antibiotics, fluids, vasopressors, and source control, can reduce morbidity and mortality. Sepsis-related acute respiratory failure is also frequent and may require non-invasive or invasive ventilator support. While intubation can improve outcomes, there are no specific criteria defined and no...

COV-AID Trial: Effect of Anti-Interleukin Drugs in COVID-19 The coronavirus infection continues to cause significant morbidity and mortality. COVID-19 is a new illness, and clinicians are still trying to find the most effective treatment strategies. Interleukin (IL)-1 and IL-6 blockade have been proposed as one possible option. However, study results so far are conflicting. COV-AID, a prospective, multicentre, open-label, randomised controlled trial, was co...

Editorial January 24, 2022 Defining Optimal Respiratory Support for Patients With COVID-19 Fernando G. Zampieri, Juliana C. Ferreira JAMA. Published online January 24, 2022. doi:10.1001/jama.2022.0067 Noninvasive respiratory support is an essential component of critical care. Both noninvasive ventilation, with its different interface types and modes (including helmet and face masks), and high-flow nasal oxygen (HFNO) are successfully used to man...