COMMENT|ONLINE FIRST Simplified control measures for ESBL-producing Enterobacteriacae? Jean-Christophe Lucet, Jean-Ralph Zahar Lancet Infect Dis Published:August 23, 2019 DOI:https://doi.org/10.1016/S1473-3099(19)30412-8 Extended-spectrum β-lactamase (ESBL)-producing Enterobacteriacae have disseminated worldwide, with very high prevalence in countries of low and middle income1 and a roughly 10% prevalence in the community and at hospital admission in high-inco...

Outcomes of ABCDE Bundle in Mechanically Ventilated Patients Increasing focus on ICU utilisation and survivorship has also resulted in a greater focus on the long-term consequences of critical illness. Post Intensive Care Syndrome (PICS) is characterised by physical, cognitive, and emotional manifestations and can have a long-lasting impact on survivors of ICU as well as their families and caregivers.  The ABCDEF bundle is an organisational approach that is used...

Untangling the Infusion Confusion Many patients in the ICU receive multiple IV infusions. This can lead to significant confusion because infusions look quite similar, and a patient with multiple infusions tends to be surrounded by associated components such as bags, tubing, pumps, etc. There is often a lack of information along the infusion pathway, which can lead to confusion. For example, if an infusion change is required, the healthcare provider must reconcile t...

ICU Management & Practice, Volume 19 - Issue 2, 2019 Use of sedation and controlled paralysis in ICU patients with ARDS According to a National Institutes of Health sponsored clinical trial that was conducted at several North American hospitals and was led by clinician-scientists at the University of Pittsburgh and University of Colorado schools of medicine, reversibly paralysing and sedating hospitalised patients with severe breathing problems does not pro...

Original Investigation August 27, 2019 Association Between Educational Attainment and Causes of Death Among White and Black US Adults, 2010-2017 Isaac Sasson, Mark D. Hayward JAMA. 2019;322(8):756-763. doi:10.1001/jama.2019.11330 Abstract Importance 背景 There are substantial and increasing educational differences in US adult life expectancy. To reduce social inequalities in mortality, it is important to understand...

ICU Management & Practice, Volume 18 - Issue 3, 2018 Fluids in shock Fluid management during shock from physiology to bedside. Shock is a common life-threatening, generalised form of acute circulatory failure in critically ill patients, which is usually managed by infusing fluids to increase cardiac output and supply the systemic oxygen request. International guidelines recommend use of an aggressive fluid resuscitation in the early phases of shock. In t...

Liberation from Mechanical Ventilation Over 1 million people patients throughout the world receive mechanical ventilation for acute respiratory failure. The management of these critically ill patients and liberating them from invasive ventilation is one of the most important decisions clinicians have to make. Liberation from ventilation is also a major dilemma for clinicians because any error could result in significant harm to the patient. Premature or failed atte...

ICU Management & Practice, Volume 18 - Issue 4, 2018 Abdominal point-of-care ultrasound in critical care The secrets of the abdomen Overview of abdominal point-of-care ultrasound use in the ICU, potential diagnoses and findings common to the critical care patient population. The use of point-of-care ultrasound (POCUS) in critical care as a diagnostic and monitoring tool is rapidly expanding. While its role in cardiovascular and respiratory assessment ...

Assessing delirium in the ICU Dr. Ulf Guenther from Germany made an excellent presentation today at Euroanaesthesia 2019 #EA19 on assessing delirium in the ICU. Dr. Guenther has spent a large part of his research career dealing with delirium, and he shared his insight with respect to the clinical impact, diagnosis, risk factors, and management of delirium in the ICU. According to Dr. Guenther, acute inattention is the core feature of delirium that clinicians mus...

COMMENT|ONLINE FIRST Uncovering covert stroke in surgical patients Phillip E Vlisides, Michael S Avidan, George A Mashour Lancet epub August 15, 2019 DOI:https://doi.org/10.1016/S0140-6736(19)31770-2 Stroke can be a devastating complication of surgery, with few effective strategies for detection or prevention. Overt stroke (ie, stroke with clinically apparent manifestations) occurs in approximately 0·1–1·0% of patients undergoing non-cardiac surgery and is ass...