OptiTHO Trial - Early NIV and HFNC-O2 vs COT and Late NIV Non-invasive ventilation (NIV) in blunt chest trauma patients without immediate life-threatening injuries is commonly used to prevent the need for endotracheal intubation. However, the actual benefits of NIV in this context have not been extensively studied. Existing literature in this field has been limited by variations in study designs, patient severity and differences in comparators. Consequently, strong...

High vs Low Mean Arterial Pressure in Cirrhosis Patients A new study assessed the impact of high mean arterial pressure (MAP) on renal outcomes in critically ill cirrhosis patients with septic shock (CIC). The efficacy of a high MAP strategy (80-85 mm Hg; H-MAP) was compared to a low MAP strategy (60-65 mm Hg; L-MAP) in improving 28-day mortality in CIC. Additionally, the study examined the reversal of shock, the occurrence of acute kidney injury (AKI) by day 5, th...

Viewpoint  July 18, 2023 Physical Activity for Health—Every Minute Counts Peter T. Katzmarzyk, John M. Jakicic JAMA. 2023;330(3):213-214. doi:10.1001/jama.2023.11014 Public health guidelines for physical activity provide evidence-based recommendations for the amount, intensity, and types of physical activity that should be undertaken to obtain and maintain health benefits. The Physical Activity Guidelines for Americans, 2nd Edition, reco...

ICU Management & Practice, Volume 23 - Issue 2, 2023 Biomarkers as Prognostic Predictors and Guide in Critically Ill Patients An overview of promising biomarkers in critical care, characteristics a biomarker should have and how to ensure their usefulness in clinical practice. Introduction Precision medicine is a medical approach that tailors treatments based on individual patient characteristics and their unique response to therapies for a particular ...

ICU Management & Practice, Volume 23 - Issue 2, 2023 A Very Old Patient in the ICU: Much More Than an Acute Organ Dysfunction Treating an elderly patient in intensive therapy requires the integration of many components. The purpose of this paper is to promote a comprehensive assessment of the critically ill patient aged 80 or more years. Introduction Ageing of the population combined with a shortage of intensive care unit (ICU) beds results in a deman...

ICU Management & Practice, Volume 23 - Issue 2, 2023 Heparin-Induced Thrombocytopaenia Heparin-induced thrombocytopaenia (HIT) is an immune complication of heparin therapy. This review discusses the pathophysiology, incidence, clinical manifestations, diagnostic approach, and management of patients with HIT. Pathophysiology HIT is an immune complication of heparin therapy caused by IgG antibodies to complexes of platelet factor 4 (PF4) and heparin. Th...

ICU Management & Practice, Volume 23 - Issue 2, 2023 Which Vasopressors and Inotropes to Use in the Intensive Care Unit Vasopressors and inotropes are frequently used in intensive care units. With a special focus on recent studies, this article summarises the key messages in the management of patients requiring inotropes and vasopressors. Introduction Cardiac output (CO) is a key determinant of oxygen delivery. Low cardiac output syndrome (LCOS) cause...

ICU Management & Practice, Volume 23 - Issue 2, 2023 Combined Extracorporeal Lung and Kidney Support in Fluid Overload During artificial organ support, kidney injury is multifactorial and related to the high severity of patients treated with extracorporeal membrane oxygenation (ECMO). The successful delivery of continuous renal replacement therapy (CRRT) during ECMO requires a clear prescription of the target solute clearance and fluid removal rate based on...

Functional Outcomes After Invasive Mechanical Ventilation for Older Adults Invasive mechanical ventilation can be a life-saving treatment, but it has poor short- and long-term outcomes for patients. In older adults, especially those with pre-existing long-term care needs due to functional and cognitive impairment, it may not be beneficial and could cause more suffering. Therefore, it is important to discuss with patients and families whether or not invasive mechani...

Editorial  July 10, 2023 Translating Clinical Trial Results to Clinical Practice During a Pandemic Andre C. Kalil, Angela Huttner, Carlos A. Gomez JAMA. Published online July 10, 2023. doi:10.1001/jama.2023.11260 In February 2020, the National Institutes of Health (NIH) launched a public-private partnership, the Adaptive COVID-19 Treatment Trial (ACTT) network,1,2 followed in April 2020 by the Accelerating COVID-19 Therapeutic Interventi...