Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health Challenging the One-Hour Sepsis Bundle Annahieta Kalantari, DO; Salim R. Rezaie, MD Western J Emerg Med. 2019;20(2):185-190.  In April 2018, the Surviving Sepsis Campaign (SSC) released an updated sepsis bundle, which combines directives previously listed in the three-hour and six-hour bundles. The authors discussed the reasoning and evidence supporting these changes. Howe...

Optimising beta-lactam treatment in the ICU - expert consensus The French Society of Pharmacology and Therapeutics (SFPT) and the French Society of Anaesthesia and Intensive Care Medicine (SFAR) have released guidelines on the optimisation of beta-lactam treatment in intensive care unit (ICU) patients. The two groups strongly recommend the use of personalised dosing, continuous or prolonged infusion and therapeutic drug monitoring when administering beta-lactam ant...

PROTINVENT study: protein intake timing and dose for the critically ill Optimal protein intake during critical illness is unknown. In order to achieve a personalised nutritional approach, Dutch researchers conducted the PROTein INtake and clinical outcomes of adult critically ill patients on prolonged mechanical VENTilation (PROTINVENT) study. The study’s primary aim was to determine the best timing and dose of protein intake to support the lowest 6-month mortality...

European guideline on managing post-traumatic bleeding: 5th edition An updated guideline on the management of significant bleeding and coagulopathy following major trauma has been released by the pan-European, multidisciplinary Task Force for Advanced Bleeding Care in Trauma. The document, published in the journal Critical Care, includes recommendations intended to guide the management of patients during the early phase of hospital care following traumatic injury. ...

The role of post-ICU recovery clinics With multiple advances in critical care, more patients are given the chance to survive life-threatening illnesses such as sepsis. This growing cohort of patients, however, grapples with a new challenge – post-intensive care syndrome (PICS). A raft of symptoms, including muscle weakness, depression, anxiety, and posttraumatic stress disorder (PTSD), makes it difficult for patients with PICS to resume their prehospitalisation liv...

News Oxygen after surgery: review questions WHO advice that high levels reduce infection BMJ 2019; 364 doi: https://doi.org/10.1136/bmj.l777 (Published 18 February 2019)Cite this as: BMJ 2019;364:l777 World Health Organization guidelines on using high levels of oxygen during and after surgery have been questioned after claims that research by an Italian surgeon lacks credibility. Mario Schietroma of the University of L’Aquila in central Italy is the author of ...

Value-based incentive programmes and CAUTI rates Value-based incentive programmes (VBIPs) aim to drive improvements in quality and reduce costs by linking financial incentives or penalties to hospital performance. A new study evaluated the association of two U.S. federal VBIPs – the Hospital Value-Based Purchasing (VBP) Program and the Hospital-Acquired Condition Reduction Program (HACRP) – and catheter-associated urinary tract infections (CAUTIs) in the critical c...

Declining rate of ARDS-related mortality There have been multiple advances in the management of acute respiratory distress syndrome (ARDS), but the temporal trends in ARDS-related mortality are not well known. Conservative fluid management strategy for ARDS, in particular, has been extensively studied and is increasingly being used in clinical practice. However, it is largely unknown whether this changing practice parallels with the improvement in survival outcome....

Harvard study: machine learning improves ED triage The increasing number of emergency department (ED) visits often correlates with ED crowding and delays in care. This problem highlights the need for ED triage systems that accurately differentiate and prioritise critically ill from stable patients, enabling efficient allocation of finite ED resources.   Currently, the Emergent Severity Index (ESI) is the most commonly used triage algorithm in U.S. EDs....

Advances in monitoring expired CO2 in critically ill patients Reviews the potential uses and pitfalls of capnography in critically ill patients, especially for haemodynamic and respiratory monitoring. Expired CO2 can be easily monitored in the intensive care unit (ICU), especially in patients under invasive mechanical ventilation, using infrared measurement by sampling mainstream expiratory flow using an in-line chamber, or sidestream expiratory flow (by contin...