VITAMINS Trial: No Significant Benefit of Vitamin C Cocktail Sepsis is a life-threatening condition that causes nearly one-third to half of all hospital deaths. It is also responsible for more than 5 million deaths worldwide each year. Patients with septic shock are an important subgroup of sepsis. These patients have circulatory and metabolic abnormalities that further increase their mortality risk. New treatments could potentially improve outcomes for such p...

PEPTIC Trial: Preventing Stress Ulcers in ICU Patients Medicines in the ICU. Medicinal lines next to the bed of the patient Approximately 2.5% of adults acutely admitted to an ICU develop upper gastrointestinal bleeding. 70% of these patients are prescribed stress ulcer prophylaxis. Proton pump inhibitors are the most commonly prescribed drugs as they reduce bleeding risk. However, there are some clinicians who prescribe histamine-2 receptor blockers. But this pract...

Editorial February 16, 2020 Physician Orders for Life-Sustaining Treatment and Limiting Overtreatment at the End of Life Robert D. Truog, Terri R. Fried JAMA. Published online February 16, 2020. doi:10.1001/jama.2019.22522 In this issue of JAMA, Lee and colleagues1 examine the association between Physician Orders for Life-Sustaining Treatment (POLST), which involve portable medical orders that document treatment limitations for out-of-...

ICU Management & Practice, Volume 18 - Issue 2, 2018 Is pre-hospital coagulation management in trauma feasible? Coagulation management remains a formidable challenge in severely bleeding trauma patients. A strong rationale suggests starting treatment of trauma-induced coagulopathy in the pre-hospital phase. The burden of trauma is increasing worldwide, particularly in less well-resourced nations. There are an estimated 5 million deaths per year, more tha...

Top ICU Stories of 2019 3d text - "Top 10". High quality 3d render on white background. As we move into 2020, here's a quick recap of our most clicked stories in ICU in 2019:  Using Biomarkers for Mortality Prediction in Patients With SepsisA new study evaluated the prognostic value of six biomarkers at onset of sepsis in adult patients with sepsis or septic shock. Risk Factors for Frailty and Death in the ICUA study was conducted to determine the risk fa...

Editorial February 17, 2020 Randomized Clinical Trials of Artificial Intelligence Derek C. Angus JAMA. Published online February 17, 2020. doi:10.1001/jama.2020.1039 As patient data are increasingly captured digitally, the opportunities to deploy artificial intelligence (AI), especially machine learning, are increasing rapidly. Machine learning is automated learning by computers using tools such as artificial neural networks to search data itera...

Potentially Preventable ICU Admissions Interior of an empty intensive care unit. As our population continues to age, and as medical conditions become more complex, the need for intensive care unit beds continues to increase. One possible way to ensure adequate capacity is by reducing potentially preventable ICU stays.  Increased demand for critical care services could be managed through improved ICU triage and increased interprofessional ICU staffing. Also, recog...

Editorial February 17, 2020 Lack of Clinical Benefit of Interferon β-1a Among Patients With Severe Acute Respiratory Distress Syndrome: Time to Overhaul Drug Trials in ARDS? Manu Shankar-Hari, Carolyn S. Calfee JAMA. Published online February 17, 2020. doi:10.1001/jama.2019.2252 In acute respiratory distress syndrome (ARDS), the alveolar-capillary units are disrupted, with lung endothelial and epithelial injury resulting in exudative pulmonary e...

Targeted Temperature Management After Cardiac Arrest Medical nurse cares about patient in ICU. Post-anoxic brain damage after cardiac arrest is a complex condition that is managed through targeted temperature management (TTM) as it is currently the only neuroprotective intervention recommended after out-of-hospital cardiac arrest (OHCA). However, experts have raised concerns about the level of evidence supporting this intervention. Two early clinical trials have ...

Treatment of High Intracranial Pressure After Traumatic Brain Injury One of the most frequent causes of death and disability after severe traumatic brain injury (TBI) is high intracranial pressure (ICP). ICP is generally treated with usual techniques such as normothermia, sedation, etc. and first-line therapeutic strategies such as moderate hypocapnia, mannitol etc. However, in patients where these measures do not work, second-line therapies are usually initiated. ...