Viewpoint July 30, 2021 The Increasing Role of Physician Practices as Bill Collectors: Destined for Failure A. Jay Holmgren, David Cutler, Ateev Mehrotra JAMA. Published online July 30, 2021. doi:10.1001/jama.2021.12191 Through increasing deductibles, coinsurance, and co-payments, the privately insured population in the US is responsible for a larger share of health care out-of-pocket costs. Although many studies have examined the effects on pat...

ICU Management & Practice, Volume 20 - Issue 3, 2020 Vitamin D in Critical Illness – Fifty Shades of VIOLET Did the VITDALIZE study and the VIOLET study manage to answer some of the questions regarding vitamin D deficiency and its impact on critically ill patients? Experts compare the findings and present an overview. Introduction Vitamin D deficiency is very common in the ICU (usually >60%) because many critically ill patients were already chronic...

JAMA Insights August 2, 2021 Cognitive Decline Associated With Anesthesia and Surgery in Older Patients Susana Vacas, Daniel J. Cole, Maxime Cannesson JAMA. Published online August 2, 2021. doi:10.1001/jama.2021.4773 In the last decade, the population aged 65 years and older increased by 34.2% in the US and now accounts for a disproportionate number of surgical procedures requiring anesthesia. Among these patients, aging causes a number of chang...

Renal Replacement Therapy in Critically Ill Patients with AKI Many critical care patients with severe acute kidney injury (AKI), especially those who develop refractory complications, receive renal replacement therapy (RRT). However, when RRT should be initiated for these patients remains unclear. There is a consensus that in patients with urgent or refractory complications, RRT should be started. However, the question is: should it be started earlier in the course...

Culture-Negative and Culture-Positive Sepsis or Septic Shock Incidence of sepsis and septic shock has been increasing consistently, and the morbidity and mortality associated with this is an area of concern. Mortality from sepsis and septic shock is quite high, ranging between 20 to 40%. Guidelines for sepsis and septic shock recommend the application of broad-spectrum antibiotics. There is clinical evidence that time to effective antibiotic therapy could reduce pa...

Precision Medicine and COVID-19 Precision medicine has been an important goal in healthcare. Researchers have been focused on generating new disease subclassifications to maximise individualised treatment options. There have been many phenotypes, endotypes, and subtypes so that patients who demonstrate specific symptoms and fall into a specific subtype or phenotype can be treated with precision. The same is true for SARS-CoV-2. To date, more than 60 subtypes hav...

Cardiopulmonary Resuscitation in COVID-19 Patients Experiencing In-Hospital Cardiac Arrest COVID-19 continues to infect people across the globe, and the United States continues to be one of the most affected regions in the world. Coronavirus primarily affects the respiratory system through angiotensin-converting enzyme (ACE) 2 receptor on host cells. It also affects other systems because ACE2 is present in the heart, GI tract and kidneys. Infection with COVID-19 leads ...

Effect of Vitamin D in Patients with Moderate to Severe COVID-19 A clinical trial was conducted to evaluate the effect of a single high dose of vitamin D3 on hospital length of stay among hospitalised patients with moderate to severe COVID-19.  Vitamin D is believed to enhance innate and adaptive immunity. A deficiency of vitamin D is known to be a potential risk for non-communicable and acute respiratory tract diseases, including viral infections. During ...

Editorial August 10, 2021 Does Crystalloid Composition or Rate of Fluid Administration Make a Difference When Resuscitating Patients in the ICU? Michael J. Connor Jr, Craig M. Coopersmith JAMA. Published online August 10, 2021. doi:10.1001/jama.2021.11119 Administration of intravenous fluids is among the most common interventions performed in intensive care units (ICUs). The first description of fluids for resuscitation of a critically ill patie...

EDITORIAL Surviving Covid-19 with Heparin? Hugo ten Cate N Engl J Med August 4, 2021DOI: 10.1056/NEJMe2111151 Patients who are admitted to the hospital with coronavirus disease 2019 (Covid-19) are at high risk for thrombosis, particularly venous thromboembolism (VTE). In a meta-analysis of 66 studies, the overall prevalence of VTE among patients with Covid-19 was 14.1%, with the highest incidence (22.7%) among those admitted to intensive care units (ICUs).1&nb...