When Hospitals Shrink: Preventing Loss of Hospital Beds Through Effective Bed Management In ICU Fri, 19 Apr 2024 With an ageing population and more sophisticated treatments, hospitals must become more bed-efficient or risk contracting. Strategic management is needed since ineffective bed management can reduce bed availability. Introduction There are multiple challenges for healthcare institutions in the coming decades. Important demographic changes a...

Decision-Making in Uncertainty: Time-Limited Trials In ICU Fri, 19 Apr 2024 An overview of time-limited trials (TLT), collaborative agreements between the treating team and the patient to apply life-sustaining therapies to help reduce prognostic uncertainty and foster trust between teams and patients and/or patient surrogates. Introduction Medical indication and a patient's consent form the basis of every diagnostic or therapeutic medical measure (Mi...

The Least Bad Decision: Crisis Standards of Care After the Pandemic In ICU Fri, 19 Apr 2024 COVID-19 was an emergency that lasted for years and left few regions of the world untouched. The pandemic shone a spotlight on both the strengths and weaknesses of our disaster planning. What worked, what did not, and how can we better plan for future emergencies? The COVID-19 pandemic forced hospitals and health systems around the world to confront shortages on ...

Anti-Inflammatory Therapies for Severe Community-Acquired Pneumonia In ICU Fri, 19 Apr 2024 Emerging evidence highlights the potential advantages of employing anti-inflammatory therapies like macrolide antibiotics and corticosteroids in managing severe community-acquired pneumonia (CAP). Although their use remains a subject of debate, recent findings indicate improved clinical outcomes, and support the adoption of a tailored approach that emphasises person...

Dealing With Uncertainty in ICU Decision-Making: A Practical Guide In ICU Fri, 19 Apr 2024 When the stakes are high, and the path ahead is uncertain, the decisions made, especially if a patient continues to worsen, can be sources of self-torment and can haunt us for a long time. Our goal is to suggest ways to steer decision-making for intensivists in the face of uncertainty by proposing a clear, practical, stepwise approach through the creation of a new al...

INSPIRE Trial: Improving Antibiotic Selection for Pneumonia In ICU Thu, 25 Apr 2024 Over 1.5 million adults are hospitalised in the U.S. each year due to pneumonia, with about half of them receiving unnecessary extended-spectrum antibiotics. This overuse contributes to the risk of antibiotic resistance and other adverse effects. Current strategies to improve antibiotic prescribing mainly focus on shortening the duration or de-escalating antib...

Editor's Note  May 20, 2024 Tracking Physical Activity One Step at a Time Cary P. Gross, Raegan W. Durant JAMA Intern Med. Published online May 20, 2024. doi:10.1001/jamainternmed.2024.0898 Current physical activity guidelines recommend at least 150 minutes per week of moderate-intensity physical activity or 75 minutes per week of vigorous activity. These time thresholds were based on studies using self-reported activity, which is prone to bi...

Low vs High Blood Pressure Targets in Critically Ill and Surgical Patients In ICU Thu, 25 Apr 2024 The treatment of critically ill and perioperative patients often involves targeting blood pressure as a cornerstone of haemodynamic management. Current guidelines suggest maintaining high blood pressure targets for these patients based on observational studies linking hypotensive events to adverse outcomes. However, these recommendations are not...

Editorial  May 19, 2024 When the Third Time Is Not the Charm—Trial Outcomes in Idiopathic Pulmonary Fibrosis Ana C. Zamora, Victor E. Ortega, Eva M. Carmona JAMA. Published online May 19, 2024. doi:10.1001/jama.2024.8776 Idiopathic pulmonary fibrosis (IPF) is a progressive fibrotic lung disease that inevitably results in respiratory failure and death within 3 to 5 years of diagnosis.1 No effective treatment for IPF existed until the appr...

English Proficiency and Sepsis Mortality Sepsis is a leading cause of hospital deaths. Despite initiatives like the Surviving Sepsis Campaign and Centers for Medicare & Medicaid Services Severe Sepsis and Septic Shock Management Bundle (SEP-1), healthcare disparities persist. Previous studies revealed disparities in sepsis outcomes by age, sex, race, and ethnicity, but limited English proficiency (LEP) and its impact on sepsis outcomes have been understudied. ...