小剂量阿奇霉素可能减少COPD急性加重住院患者的治疗失败。这是American Journal of Respiratory and Critical Care Medicine杂志在线发表的一项多中心随机对照试验的结果。 既往研究表明，阿奇霉素能够预防COPD的急性加重。然而，尚不清楚这种抗生素如何能够COPD急性加重的住院患者强化治疗的需求，或者在上述患者出院后为何能够减少急性加重的风险。 在新的研究中，即比利时阿奇霉素治疗COPD加重住院患者研究(BACE)，除住院期间的其他用药外，患者使用小剂量阿奇霉素，并在出院后继续使用小剂量阿奇霉...

Azithromycin may reduce treatment failure in acute COPD exacerbations Low‐dose azithromycin may reduce treatment failure in patients hospitalised for acute exacerbations of chronic obstructive pulmonary disease (COPD). This finding is from a multicentre, randomised controlled trial published online in the American Journal of Respiratory and Critical Care Medicine. The antibiotic azithromycin prevents acute exacerbations in COPD as shown in previous studies. It w...

Editorial June 3, 2019 Setting Positive End-Expiratory Pressure in Mechanically Ventilated Patients Undergoing Surgery Thomas Godet, Emmanuel Futier JAMA. 2019;321(23):2285-2287. doi:10.1001/jama.2019.7540 What is the optimal level of positive end-expiratory pressure (PEEP) for patients receiving mechanical ventilation? Despite decades of investigations, this question continues to be discussed among researchers and clinicians with no clear answer, leaving...

Reasonable Doubt Don't Be Fooled by New Study Tamiflu Still Pretty Worthless for H1N1 Runde, Dan, MD Emergency Medicine News: April 2019 - Volume 41 - Issue 4 - p 6 doi: 10.1097/01.EEM.0000554842.09002.7c It's possible that the Tamiflu pandemonium may be peaking for most emergency and primary care physicians because the dubious benefits of oseltamivir have now been well documented, discussed, and disseminated. (See box.) But there's also a new kid on the...

Editorial June 11, 2019 Revisiting, Reframing, and Casting a New Light on Liberation From Mechanical Ventilation Timothy D. Girard, Karen E. A. Burns JAMA. 2019;321(22):2167-2169. doi:10.1001/jama.2019.7364 Every year, more than 1 million patients throughout the world receive mechanical ventilation for acute respiratory failure. One of the most important decisions clinicians make in managing these critically ill patients is how to liberate them ...

Fluid responsiveness in sepsis: the fluid challenge revisiting (FCREV) study Fluid challenge is a common practice in the ICU. It is one of the most important resuscitation manoeuvres of acute circulatory failure management in critically ill patients. Adequate fluid resuscitation is very important because both hypovolaemia and fluid overload can result in poor outcomes in the ICU. The criteria for fluid administration still remains controversial. A study was cond...

ICU Management & Practice, Volume 18 - Issue 4, 2018 What a difference a drug makes? Asking why the patient needs to be sedated is as important as the choice of drug for sedation.  Why use sedation?  Intensivists should ask why they use sedation every time they order it. Sedation is used to reduce the burden and stress of critical illness. Sedative agents mixed with analgesic agents reduce pain and keep the patient calm, especially at night....

Editorial May 19, 2019 Recombinant Human Soluble Thrombomodulin in Patients With Sepsis-Associated Coagulopathy: Another Negative Sepsis Trial? Tom van der Poll JAMA. Published online May 19, 2019. doi:10.1001/jama.2019.5792 Sepsis is a heterogeneous syndrome caused by an unbalanced host response to an infection resulting in organ dysfunction.1 Sepsis is associated with activation of the coagulation system, and 30% to 60% of patients have d...

Editorial May 19, 2019 New Phenotypes for Sepsis: The Promise and Problem of Applying Machine Learning and Artificial Intelligence in Clinical Research William A. Knaus, Richard D. Marks JAMA. Published online May 19, 2019. doi:10.1001/jama.2019.5794 In this issue of JAMA, Seymour and his multidisciplinary team of coauthors1 aim to improve the current understanding of sepsis by identifying new clinical phenotypes using machine learning...

ICU Management & Practice, Volume 19 - Issue 1, 2019 Trends in epidemiology and antimicrobial resistance in intensive care units The intensive care unit has a unique environment, mainly because it treats severe and critically ill patients who require special care. Critical care patients often require high-risk surgeries, and there is also a frequent need for invasive devices such as central or peripheral venous catheters, urinary catheters or tracheal tubes...