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ICU Management & Practice, Volume 21 - Issue 1, 2021 Prone Position in Awake, Non-Intubated Patients with ARDS: From Physiology to the Bedside Prone position (PP) in awake, non-intubated patients with respiratory failure is a physiology-based ventilatory strategy that improves oxygenation and may decrease the need for intubation and invasive mechanical ventilation (IMV). Introduction During the pandemic caused by the SARS-CoV-2 virus, which produces c...
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ICU Management & Practice, Volume 21 - Issue 1, 2021 Twenty Lessons from 2020: With a Focus on the ICU Perspective 2020 has been an unusual year. As we begin 2021, it is important for intensivists to look back over what has happened and see whether lessons can be learned from our combined experiences.The year 2020 has been unusual in so many ways and as we start a new year, it is interesting and important as intensivists to look back and reflect on what has...
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Solidarity Trial Interim Results: Antiviral Drugs in Hospitalised COVID-19 Patients Mortality trials of four antiviral drugs - remdesivir, hydroxychloroquine, lopinavir and interferon beta-1a were recommended by the World Health Organization (WHO) to evaluate their effect in patients hospitalised with COVID-19. In March 2020, the WHO began a large international trial that included hospital inpatients to evaluate the effects of these four drugs on in-hospital mortali...
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High-flow Nasal Oxygen vs. Invasive Mechanical Ventilation in COVID-19 COVID-19 has caused thousands of cases of acute respiratory failure with a high mortality rate. However, so far, the use of high-flow nasal oxygen (HFNO) has been limited even though it may be an appropriate initial therapy in COVID-19 patients with acute respiratory failure. The use of invasive mechanical ventilation remains the primary treatment strategy in this patient population.  C...
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RECOVERY Trial: Tocilizumab in Hospitalised COVID-19 Patients A large majority of COVID-19 infections are mild or asymptomatic. However, there is a significant portion of individuals who develop severe respiratory illness that requires hospital care, and that could progress to critical illness with hypoxic respiratory failure requiring prolonged ventilatory support.  This hypoxic respiratory failure is associated with systemic inflammation. Beneficial effects o...
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Early and Late Intervention for Intubation-Related Laryngeal Injury A study was conducted to determine if there were differences in functional outcomes between early and late intervention for intubation-related laryngeal injury.  Approximately 13 million to 20 million patients are intubated in the ICU every year. Clinical evidence shows that 57% of patients who are intubated for more than 12 hours develop acute laryngeal injury after extubation. Acute laryngeal...
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Ventilator-Associated Events in Mechanically Ventilated Patients Critically ill patients in the ICU often require life-saving mechanical ventilation. For many, this is an unavoidable intervention, despite the multiple complications associated with it. Ventilator-associated event (VAE) surveillance was proposed in 2013 by a working group of the Centers for Disease Control and Prevention (CDC). Three tiers of VAEs were defined by this group: Ventilator-associated cond...
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News News Analysis Covid-19: Are cloth masks still effective? And other questions answered Elisabeth Mahase BMJ 2021; 372: n432 doi: https://doi.org/10.1136/bmj.n432 In light of new, more transmissible variants of SARS-CoV-2, Elisabeth Mahase examines what kinds of mask the public should be wearing, and where they should be worn Are cloth masks still recommended? Early in the pandemic, major problems in the global supply of medical grade m...
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ECMO, Mortality and ARDS An in-depth analysis was conducted in Germany to evaluate whether mortailty in Germany in Extracorporeal life support (ECLS) therapy differed from previously reported literature.  Extracorporeal life support (ECLS) is a critical component of intensive care therapy. There are various conditions that require the use of ECLS. The term ECLS encompasses different terms depending on the system and the type of cannulation that is used. Th...
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Editorial February 17, 2021 Vitamin D3 to Treat COVID-19: Different Disease, Same Answer David E. Leaf, Adit A. Ginde JAMA. Published online February 17, 2021. doi:10.1001/jama.2020.26850 Biological activity of vitamin D and its metabolites include, among other properties, potent antimicrobial and anti-inflammatory effects in vitro.1 In animal models, administration of vitamin D metabolites attenuates a variety of acute organ dysfunction, i...
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