Editorial October 1, 2019 Is High-Dose Vitamin C Beneficial for Patients With Sepsis? Emily B. Brant, Derek C. Angus JAMA. 2019;322(13):1257-1258. doi:10.1001/jama.2019.11643 For centuries, scurvy was the scourge of naval exploration. Then, in 1747, in arguably the first clinical trial, James Lind assigned sailors sick with scurvy to alternative acid treatments, and noted that those who received citrus fruits, as sources of ascorbic acid (vitami...

Editorial October 2, 2019 Added Benefit of Noninvasive Ventilation to High-Flow Nasal Oxygen to Prevent Reintubation in Higher-Risk Patients Irene Telias, Niall D. Ferguson JAMA. Published online October 2, 2019. doi:10.1001/jama.2019.14609 Liberating patients from ongoing invasive mechanical ventilation is typically a 3-step process. First, clinicians must recognize that patients may no longer require mechanical ventilation—ie, when the reasons...

#LIVES2019: Should We Treat Fever in Critically Ill Patients Without Acute Brain Pathology? In one of the sessions at #LIVES2019 in Berlin, Prof. Frank Van Haren of Canberra Hospital, Australia, presented findings from the Randomised Evaluation of Active Control of Temperature versus Ordinary Temperature Management (REACTOR) trial. The question which this study aimed to answer was whether there is a reason why fever should be actively prevented and treated in all c...

Extracorporeal Life Support for Patients with Acute Respiratory Failure Millions of people with acute respiratory failure are hospitalised every year. Nearly half of these patients require invasive mechanical ventilation. In-hospital mortality in these patients is quite high. Despite the fact that mechanical ventilation is the primary management tool for such patients, it is associated with major complications that increase mortality. That is why there is a need fo...

Personalised Mechanical Ventilation - The LIVE Study The effectiveness of personalised mechanical ventilation in patients with acute respiratory distress syndrome (ARDS) is still unclear. A new study was conducted in France to test whether a mechanical ventilation strategy personalised to an individual patient's lung morphology could improve survival compared with the standard of care. For the purpose of this study, 400 patients with moderate-to-severe ARDS were...

PERSONAL VIEW|ONLINE FIRST Improving the estimation of the global burden of antimicrobial resistant infections Direk Limmathurotsakul, Susanna Dunachie, Keiji Fukuda, et al. Lancet Infect Dis Published:August 16, 2019 DOI:https://doi.org/10.1016/S1473-3099(19)30276-2 Summary Estimating the global burden of disease from infections caused by pathogens that have acquired antimicrobial resistance (AMR) is essential for resource allocation and to inform AMR acti...

Stable/Unstable? Cardiovascular Dynamics in Critically Ill Patients There is currently doubt over the terms stable and unstable regarding cardiovascular dynamics in critically ill patients. Labelling a patient as haemodynamically stable or unstable can have different connotations depending on the practising physician. The term stable is originally defined as the condition of the patient being unchanged for a substantial amount of time. However, if this is the ca...

ICU Management & Practice, Volume 19 - Issue 2, 2019 Big Data and hidden subtypes of sepsis Results of a study conducted by the University of Pittsburgh School of Medicine suggests that sepsis is not one condition, but many conditions that could benefit from different treatments. The findings are published in JAMA and were presented at the American Thoracic Society's Annual Meeting. Sepsis is the number one killer of hospitalised patients and is a life-t...

SPOTLIGHT|ONLINE FIRST When is the right time to discuss ECMO? William B Feldman, Steven P Keller Lancet Respir Med Published:August 12, 2019 DOI:https://doi.org/10.1016/S2213-2600(19)30278-4 The rise of extracorporeal membrane oxygenation (ECMO) over the past decade as a support modality provides clinicians with a powerful new therapy to care for patients with advanced cardiopulmonary disease. The growing use of this technology has required careful attention ...

Effects of Sedatives and Opioids on Patient Ventilator Asynchrony Patient-ventilator asynchrony is frequent during invasive mechanical ventilation. If patient-ventilator interaction is poor, it can prolong the duration of mechanical ventilation and can also result in longer ICU and hospital stay as well as increased mortality. It is thus important to optimise patient-ventilator interaction.  There are many factors that could affect patient-ventilator interaction...