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...

Blood biomarker can identify infection-related disease progression In settings such as the emergency department (ED), early assessment of the potential for further disease progression is vital. An early identification of infection severity is helpful in initiating appropriate treatment strategies. However, currently there is a lack of validated tools to assess risk of further disease progression in patients presenting to the ED with a suspected infection. A new ...

Imaging and intensive care medicine An evolving partnership A major evolution is underway involving critical care and imaging.  The intensive care patient population is changing. Increasingly intensive care units (ICUs) are treating older patients, with more comorbidities, and variable prognosis, at a time when family expectations are different and often with higher expectations of recovery. Life support technology is increasingly sophisticated, surgery is minima...

Antifungal treatment in the ICU Best practice in managing fungal infections Invasive candidiasis: Every milligram of antifungal counts! Think Aspergillus! Invasive fungal infections (IFIs) are a major cause of morbidity and mortality in critically ill patients. Almost 80% of IFIs are due to Candida spp., which are the third most common isolated microorganisms in the intensive care unit (ICU) (Kett et al. 2011; Bassetti et al. 2017). Although the incidence of inva...

Risk of sepsis: does DNA matter? A new analysis has identified several genetic variants that could influence one's susceptibility to sepsis, a life-threatening condition. This study provides a novel insight that may affect personalised targeted treatment in the future clinical management of sepsis. Variants are alterations in nucleotide base pairs located within a gene or noncoding portion of the genome. In sepsis, the focus has been on understanding the impac...

REMEMBER score predicts mortality in patients receiving VA-ECMO after CABG Prediction scoring systems for coronary artery bypass grafting (CABG) patients on veno-arterial extracorporeal membrane oxygenation (VA-ECMO) have not yet been reported. To help clinicians select patients that would benefit from VA-ECMO after CABG, a team of international researchers devised a mortality risk score – REMEMBER score – comprising six pre-ECMO variables. The REMEMBER (pRedi...

Use of levosimendan in the ICU Levosimendan is an inodilator that promotes cardiac contractility primarily through calcium sensitisation of cardiac troponin C and vasodilatation via opening of adenosine triphosphate-sensitive potassium (KATP) channels in vascular smooth muscle cells. The drug also exerts organ-protective effects through a similar effect on mitochondrial KATP channels. Levosimendan has been demonstrated to have potential utility in a wide range o...

Artificial Intelligence in the ICU The paucity of positive multicentre prospective randomised control trials in ICU settings serves to highlight the challenge of running studies in such environments, where multiple treatments are given simultaneously to individuals who respond in variable ways based on their individual physiology. Consequently, without established guidelines, ICU clinician decision-making is driven largely by experience and instinct, resulting in s...

New algorithm reduces testing for ICU patients Enrolling seriously ill patients in intensive care units for clinical trials is often a big challenge for investigators. This is one reason why there is a dearth of evidence-based guidelines in critical medicine. For instance, ICU doctors often face a dilemma when it comes to ordering lab tests for specific patients.  While ICU doctors are aware that every blood test they order could yield critical informatio...