COMMENT|ONLINE FIRST Carbapenem-resistant Enterobacteriaceae: global action required Federico Perez, Robert A Bonomo Lancet Infect Dis Published: April 29, 2019 DOI: https://doi.org/10.1016/S1473-3099(19)30210-5 Enterobacteriaceae are common pathogens in hospitals and in the community. When resistant to powerful and versatile antibiotics such as carbapenems, they can have devastating consequences, particularly in the most vulnerable individuals.1 Much infor...

Early Paralytic Agents for ARDS? Yes, No, and Sometimes Arthur S. Slutsky, Jesús Villar N Engl J Med May 19, 2019DOI: 10.1056/NEJMe1905627 Lung-protective ventilation, which includes low tidal volumes and limitation of plateau pressures, is the standard approach in patients with acute respiratory distress syndrome (ARDS).1 Almost a decade ago, the ARDS et Curarisation Systematique (ACURASYS) trial2 showed that in patients with moderate-to-severe ARDS, a strategy ...

Comment & Response May 14, 2019 Acute Kidney Injury Related to Sepsis—Reply Matthieu Legrand, John A. Kellum JAMA. 2019;321(18):1828-1829. doi:10.1001/jama.2019.2072 In Reply 回答 Dr Seres comments on the effect of low muscle mass on serum creatinine level. We agree that muscle mass and cachexia can decrease sensitivity of serum creatinine to detect a drop in GFR and AKI. Recently, Yoo and colleagues1 reporte...

Comment & Response May 14, 2019 Acute Kidney Injury Related to Sepsis David S. Seres JAMA. 2019;321(18):1827-1828. doi:10.1001/jama.2019.2040 To the Editor 致编辑 Drs Legrand and Kellum reviewed the interpretation of serum creatinine in a critically ill patient.1 However, they only included a glancing reference to muscle mass and did not discuss protein intake. Both factors affect the evaluation of renal function and m...

Acute-on-chronic liver failure: criteria for ICU admission Cirrhosis is a leading cause of morbidity and mortality throughout the world. Patients with cirrhosis may develop decompensated disease with portal hypertension and functional impairment of the liver, resulting in numerous complications including infection, variceal bleeding, hepatic encephalopathy (HE), and hepatorenal syndrome (HRS). Along with decompensation of cirrhosis, the concept of acute-on-chron...

PERFECT protocol: volume-based feeding in ventilated adults Underfeeding in critical illness is common and associated with poor outcomes. Researchers in the UK designed a before-and-after study to evaluate the safety, efficacy and clinical outcomes associated with volume-based feeding (VBF) compared to rate-based feeding (RBF) in a single intensive care unit (ICU).The prospective before-and-after study suggests that VBF safely and effectively increased the delivery...

ICU Management & Practice, Volume 19 - Issue 1, 2019 Protecting ward patients Finding patients before they crash might be the next major opportunity to improve patient safety. This article describes recent advances and perspectives for ward monitoring with wearable sensors and smart algorithms. Hospital wards are dangerous. Indeed, they are where most unexpected deaths occur within institutions. In a UK national audit study, among 23,554 adult in-hospita...

Innovations in ICU ventilation The future delivered In this article, we aim to summarise the developments in mechanical ventilation that we believe are shaping the present and will shape the future ahead. Introduction Many centuries ago, Socrates stated that “the secret of change is to focus all of your energy, not on fighting the old, but on building the new.” Nowadays, we may relate his quote with the concept of innovation, which is considered the process of...

Is Sepsis-Associated Mortality Often Preventable? Authors: News Author: Veronica Hackethal, MD CME Author: Charles P. Vega, MD Clinical Context Approximately 1.7 million US adults are diagnosed annually with sepsis, and sepsis can contribute to more than a quarter of a million deaths among US residents per year. The authors of the current study acknowledged multiple programs to improve the care and outcomes of patients with sepsis; one of the best known of the...

Management of obese patients with ARDS At least one fifth of all patients admitted to the ICU are obese, and these patients are at risk of developing lung de-recruitment and then atelectasis. Moreover, the incidence of acute respiratory distress syndrome (ARDS) is increased in obese patients. A major challenge of the critical care management of obese patients is successful respiratory system management. However, while obesity contributes to many diseases and is ...