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...

SPOTLIGHT|ONLINE FIRST Organising international research in critical care medicine: current challenges and potential solutions Jan J De Waele, Dylan W de Lange Lancet Respir Med Published: December 17, 2019 DOI:https://doi.org/10.1016/S2213-2600(19)30475-8 During the first years of intensive care medicine, many of its treatments were introduced because they were thought to be beneficial to patients, despite there being a lack of evidence from high-quality rese...

ICU Management & Practice, Volume 19 - Issue 3, 2019 The Metabolic Phenotype of Skeletal Muscle During Early Critical Illness The Muscle UK Critical Care program was set up 10 years ago and focused on the association between muscle and skeletal muscle wasting to weakness to clinical outcome. There are a total of five pivotal trials, including Bernhard Jonghe et al.1 and Herridge M.2 that looked at skeletal muscle weakness and its impact on patients. In the ...