In-line Filtration Reduces Organ Dysfunction, Inflammation Patients admitted to the intensive care unit are administered drugs, fluid, and blood products intravenously. In the vast majority of these patients, there are no untoward effects of the intravenous infusion. However, young children and neonates who are ill are usually administered intravenous infusions with the use of in-line filters. The philosophy behind this approach is that the filters may not only block/f...

Using Biomarkers for Mortality Prediction in Patients With Sepsis Sepsis has always carried high mortality. Even today, with all the latest technology and newer antibiotics, sepsis continues to be a major risk factor for death. It is important to understand that the earlier sepsis is diagnosed and treated, the better the prognosis. Each year, nearly 6 million people die of sepsis in the US.  Because of its aggressive course, sepsis  necessitates early diagnosis and imm...

ICU Management & Practice, Volume 19 - Issue 3, 2019 New Trends in ICU Nutrition The new trends in nutrition management included in the last guidelines are discussed, in particular the route and the dose of calories and proteins recommended. During the last decade, numerous paradigms and dogmas based on observational cohort studies were challenged by the publication of large multicentre prospective randomised controlled trials (RCT). Actually, until rece...

Machine Learning to Predict Severe Sepsis and Septic Shock Sepsis is a major cause of death among hospitalised patients. It affects nearly 6% of all admissions and results in in-hospital mortality of greater than 15%. Early detection could reduce mortality, as it would result in the timely implementation of evidence-based interventions.  Clinical researchers have developed and implemented a machine-learning algorithm to predict severe sepsis and septic shock. The go...

Nutritional Support in Malnourished Medical Inpatients Patients who are malnourished or at nutritional risk do tend to have poorer outcomes compared to patients who are relatively healthier when they undergo surgery or are sick. Poorly nourished patients do not have the reserves to fight off illness, and in many cases, are also immunosuppressed with delayed wound healing. Malnutrition is a major public health problem. Approximately 30% of patients who are admitted t...

New Mode of Adaptive Ventilation For most patients who are admitted to the ICU and require mechanical ventilation, conventional modes of ventilation usually suffice. However, there are some patients who may require fine adjustments in ventilation so that the work of breathing is minimised, and the patient is still adequately ventilated and oxygenated. Over the years, many types of ventilatory approaches to protect the lung have been developed, but none has proven to...

ICU Management & Practice, Volume 19 - Issue 3, 2019 Knowledge Transfer to Improve Outcomes in Critically Ill Immunocompromised Patients An overview on sharing information, improving clinician skills, and transferring knowledge to ICU specialists about the care of immunocompromised patients. Background Studies have reported a volume-outcome relationship for cancer patients admitted to the ICU. In acute respiratory failure, mortality in ICUs managing m...

Risk Factors for ARDS in Mechanically Ventilated Adults Acute respiratory distress syndrome (ARDS) is an inflammatory process that could lead to diffuse oedema and hypoxaemic respiratory failure. It is also characterised by increased pulmonary vascular permeability, increased lung weight, and loss of aerated lung. In low and middle-income countries, ARDS mortality ranges from 26 to 58%.  A large majority of patients require mechanical ventilation with positive press...

Editorial | December 30, 2019 Decreasing Staphylococcus aureus in the Neonatal Intensive Care Unit by Decolonizing Parents Philip Zachariah, Lisa Saiman JAMA. Published online December 30, 2019. doi:https://doi.org/10.1001/jama.2019.20784 Infants hospitalized in the neonatal intensive care unit (NICU) continue to pose challenges for infection prevention and control.1 Immunologic immaturity in addition to iatrogenic risk factors, such as high rates of...

Hydrocortisone Versus Placebo in Patients with Septic Shock Septic shock is a serious illness that is associated with high morbidity and mortality. A significant number of patients who develop septic shock also have a number of comorbidities that further worsens the prognosis. Over the years, many studies have been published on the benefits of corticosteroids in patients with septic shock. Most of these studies have not shown any significant benefit. The few studies th...