ICU Management & Practice, Volume 19 - Issue 3, 2019 DIVINE Nutritional Management in ICU The following is an overview of the DIVINE trial (Dietary Management of Glucose Variabilty in the ICU) as well as a quick summary of the role of glucose control and outcomes in critically ill patients. The DIVINE study was funded by Nestlé. Clinical studies show that goal nutrition may not result in the best outcomes. Available data suggest that protein may be more ...

Passive immunity for the treatment of influenza: quality not quantity Sanjat Kanjilal, Michael J Mina Lancet 2019; 7: 922-923 The use of convalescent plasma to treat influenza infection was first described during the 1918 influenza pandemic.1 The concept is based on the assumption that patients who have recovered from an infection did so partly because they had effective antibody responses against the virus. However, studies into the clinical benefit of ...

CorrespondenceSepsis hysteria: excess hype and unrealistic expectations MervynSinger, Matt Inada-Kim, ManuShankar-Hari Lancet 2019; 394: 1513-1514 “Sepsis kills over 52 000 every year—each death a preventable tragedy”, tweeted Matt Hancock, UK Secretary of State for Health and Social Care, in March, 2019.1 Many other non-contextualised or fictitious claims regularly fill media pages and airwaves, creating a distorted picture of sepsis epidemiology and unreal...

ICU Management & Practice, Volume 19 - Issue 3, 2019 Virtual Reality in the Intensive Care Unit: State of Play and Future Prospects An overview of the practical uses of virtual reality in the ICU and the benefits it can provide. One way of defining virtual reality (VR) is as the set of techniques and systems required for human beings to enter computer-generated synthetic worlds. VR techniques are based on real-time interaction with an artificial immersiv...

Comment & Response November 5, 2019 Spontaneous Breathing Trials and Successful Extubation—Reply Carles Subirà, Rafael Fernández JAMA. 2019;322(17):1717. doi:10.1001/jama.2019.14244 In Reply We agree with Drs Friedrich and Burns that prophylaxis against postextubation respiratory failure with NIV or HFNC was more common in the PSV group than in the T-piece group (24.7% vs 18.7%).1 However, the decision to apply prophyl...

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...

Lung Recruitment in Patients with Severe ARDS Acute Respiratory Distress Syndrome (ARDS) affects up to 10% of patients in the ICU. Typical symptoms of ARDS include an increase in lung weight and a reduction of aerated lung tissue. For the treatment of ARDS alveolar recruitment is key, however, this has not yet been shown to benefit severe ARDS cases. It has been suggested that lung recruitment manoeuvres (LRM) and increased positive end-expiratory pressure (PEEP) w...

Comment & Response November 5, 2019 Spontaneous Breathing Trials and Successful Extubation Jan O. Friedrich, Karen E. A. Burns JAMA. 2019;322(17):1716. doi:10.1001/jama.2019.14217 To the Editor  The results of the randomized clinical trial reported by Dr Subirà and colleagues compared a less demanding spontaneous breathing trial (SBT) of 30 minutes of pressure support ventilation (PSV) with a more demanding 2-hour T-pi...

End-Tidal CO2 Levels vs. Arterial CO2 Levels in Children with TBI For patients with Traumatic Brain Injury (TBI), the partial pressure of CO2, arterial (PaCO2) can be adjusted to help with the regulation of cerebral perfusion. However, this can prove difficult to carry out in children. The non-invasive method of capnography measures end-tidal CO2 (EtCO2) and is often used for paediatric patients as an alternative to arterial cannulation. EtCO2 measurements have ...

Machine-Learning-Based Prediction Models for AKI Acute Kidney Injury (AKI) is a common occurrence for critically ill patients in the ICU, and its early diagnosis has proven to be challenging. The accuracy of the online, machine-learning-based prediction model, AKIpredictor, was analysed for its use in a clinical setting. The study, which took place over five ICUs in Belgium, compared the predictions of AKIpredictor with physician predictions. The patient informa...