EDITORIAL Uncertain Answers — Proton-Pump Inhibition in the ICU Samuel M. Brown N Engl J Med Published June 14, 2024 DOI: 10.1056/NEJMe2405782 A critical care clinician’s job includes administering timely and tailored antibiotics, expediting appropriate surgery, supporting a patient’s beleaguered body and mind until they are ready to recover, and preventing complications in this vulnerable state. This is surprisingly strenuous work, even if it is often, app...

Editorial  June 14, 2024 Sodium-Glucose Cotransporter 2 Therapy for Acute Organ Dysfunction in Critically Ill Patients Hernando Gómez, Lennie P. G. Derde JAMA. Published online June 14, 2024. doi:10.1001/jama.2024.10171 Multisystem organ dysfunction can follow several acute injury mechanisms, including trauma, sepsis, and shock and is the leading cause of death in critically ill patients.1 Even after the initial cause of organ injury has...

Unravelling the Role of HIF-1α in Sepsis In Sepsis Tue, 2 Apr 2024 A recent review explores the crucial role of hypoxia-inducible factor-1α (HIF-1α) in the development and progression of sepsis.  Hypoxia-inducible factor (HIF) is a protein complex consisting of a constitutively expressed subunit β and an oxygen-dependent subunit α. HIF-1α is associated with acute hypoxia and regulates glycolytic genes, oxygen consumption, and reactive oxygen sp...

Ventilator-Associated Brain Injury - A Priority for Research in Mechanical Ventilation In ICU Tue, 2 Apr 2024 Mechanical ventilation can lead to complications like ventilator-induced lung injury and ventilator-induced diaphragm dysfunction. However, there may be other forms of ventilator-associated issues that require understanding to improve outcomes for patients on mechanical ventilation. In particular, ventilator-associated brain injury (VABI) shoul...

Fluid and Vasopressor Decisions in Early Sepsis Management In Sepsis Tue, 30 Apr 2024 A recent study investigates the clinical factors influencing clinician decisions regarding fluid administration, vasopressor initiation, and vasopressor route in early sepsis. Previous concerns about fluid overload in sepsis have prompted interest in early vasopressor initiation, especially through peripheral IVs, as an alternative to central lines. While cl...

Going Green in the ICU In ICU Fri, 22 Mar 2024 The environmental impact of ICUs was in focus at ISICEM 2024. Nicole Hunfeld, a hospital pharmacist at Erasmus Medical Center in the Netherlands, emphasised the need for a sustainable medication process, particularly noting the heightened waste production during the COVID-19 pandemic.  There is an overwhelming level of plastic waste in the ICU, and its environmental implications need to be addresse...

Editorial  April 19, 2024 Harnessing the Electronic Health Record to Improve Empiric Antibiotic Prescribing Anurag N. Malani, Preeti N. Malani JAMA. Published online April 19, 2024. doi:10.1001/jama.2024.6554 Approximately half of hospitalized adults in the US receive antibiotics, with pneumonia and urinary tract infection (UTI) being the 2 most frequent indications.1 Estimates suggest about 30% of all antibiotics prescribed in US hospit...

Vascular Leak in Sepsis In Sepsis Tue, 26 Mar 2024 Sepsis remains a major cause of mortality, accounting for nearly 20% of global deaths. Microcirculatory dysfunction, marked by irregular blood flow and increased permeability of blood vessels, is a characteristic feature of sepsis. This dysfunction can lead to tissue swelling and impaired organ function. Endothelial dysfunction, which is also seen in other acute inflammatory disorders like burns, traum...

Tranexamic Acid for Acute UGIB in Patients With Cirrhosis In ICU Tue, 12 Mar 2024 A recent study aimed to assess the effectiveness and safety of tranexamic acid in treating acute upper gastrointestinal bleeding (UGIB) in patients with cirrhosis, particularly those classified as Child-Turcotte-Pugh (CTP) class B and C. These patients experience systemic and localised fibrinolysis in the mucosa of the oesophagus and stomach. The study included 600 pat...

Multidisciplinary Management of Gram-Negative Bloodstream Infections In ICU Tue, 12 Mar 2024 Bloodstream infections (BSIs) caused by Gram-negative pathogens pose significant challenges in ICU patients due to their high prevalence and severity, with mortality rates reported as high as 40%. The widespread prevalence of multidrug-resistant organisms (MDRO) further complicates antibiotic treatment choices, with mortality rates reaching 43% when MDROs are i...