Editorial July 16, 2019 Psychological Consequences of Admission to the ICU： Helping Patients and Families Louise Rose, Fiona Muttalib, Neill K. J. Adhikari JAMA. 2019;322(3):213-215. doi:10.1001/jama.2019.9059 For most patients and their families, admission to the intensive care unit (ICU) is an unanticipated event that causes substantial psychological distress. For patients, short- and long-term consequences include delirium, anxiety, depressi...

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...

COMMENT|ONLINE FIRST Testing the waters: a new test for hypotonic polyuria Ewout J Hoorn Lancet Published: July 11, 2019 DOI:https://doi.org/10.1016/S0140-6736(19)31414-X Three disorders can cause water diuresis (hypotonic polyuria): primary polydipsia, central diabetes insipidus, and nephrogenic diabetes insipidus. These causes of hypotonic polyuria are difficult to differentiate, especially the partial forms of central diabetes insipidus from primary polydip...

C. auris in the ICU - a global challenge Candida auris (C. auris) is a type of fungus first isolated in 2009; since then there have numerous infection episodes and outbreaks in different regions of the world. In the U.S. alone, 560 cases of C. auris infections have been reported as at 31 January 2019. Overall, most of those affected were critically ill adults, with risk factors for invasive fungal infections, such as immunosuppression, surgery, or in...

Treatment implications of novel clinical phenotypes for sepsis Sepsis affects millions of individuals every year. It carries a high risk of death, even if prompt care is provided. It has been decades, and no new therapies for sepsis have been discovered. A major barrier to progress in this area has been the overly broad definition for this syndrome. Sepsis has a vast array of clinical and biological features, and these features can be clustered in different combina...

Immunotherapy effects on sepsis A randomised controlled multicentre trial assessed for the first time the safety and pharmacokinetics of an antiprogrammed cell death-ligand 1 (anti–PD-L1) immune checkpoint inhibitor (BMS-936559; Bristol-Myers Squibb, Princeton, NJ) and its effect on immune biomarkers in participants with sepsis-associated immunosuppression. Results show that BMS-936559 was well tolerated, with no evidence of drug-induced hypercytokinaemia or cyt...

Effect of adhesive tape versus endotracheal tube fastener in critically ill adults The securement method of endotracheal tubes should ideally prevent dislodgement and minimise complications. Endotracheal tube fastener can reduce complications among critically ill patients who are undergoing endotracheal intubation.  You might also like:UK study: extubating ventilated patients on vasoactive infusions 'safe' A study was conducted with critically ill adults who ...

Resuscitation in septic shock: is less better? On Day 2 of the Euroanaesthesia Congress 2019 (#EA19), there was a session on Resuscitation in septic shock: is less better? Three key speakers Gernot Marx (Aachen, Germany), Claude Martin (Marseille, France) and Jean-Louis Vincent (Brussels, Belgium), spoke about less fluid, less vasopressors and less inotropes in septic shock. The central message of this session was simple: less is more in sepsis.  The session was...

Acute pain in the ICU: management beyond the usual therapeutic strategies At this year’s Euroanaesthesia 2019 in Vienna, Austria, Prof. Caterina Aurilio (Naples, Italy), talked about acute pain management in the ICU. She started her presentation with the definition of pain as outlined by the International Association for the Study of Pain (IASP). Pain is an "unnecessary sensory and emotional experience associated with actual or potential tissue damage, or desc...

Highlights from the pro-con debate on guidelines At this year’s Euroanaesthesia Congress #EA19, there was a short debate on the topic of guidelines. Talking about the pros was Edoardo De Robertis, Past-Chair, ESA Guidelines Committee, University of Perugia, Italy, and talking about the cons was Arash Afshari, Chair, ESA Guidelines Committee, Rigshospitalet, Copenhagen, Denmark  Here are some highlights from both sides of the debate! Dr. Arash Afshari“I think tha...