Editorials Cancer trends in the UK Freddie Bray BMJ 2024; 384 doi: https://doi.org/10.1136/bmj.q504 (Published 13 March 2024)Cite this as: BMJ 2024;384:q504 Grounds for optimism but warning signs must not be ignored Cancer is a major public health problem in the UK, and in most high income countries. The disease is the leading cause of death in both men and women, and one in four people die prematurely from it at ages 30-69 years.1 A comprehensive asse...

Invited Commentary  March 13, 2024 Standardizing Resident Assessment and Competency—Milestones Matter Amanda C. Filiberto, Amalia Cochran JAMA Surg. Published online March 13, 2024. doi:10.1001/jamasurg.2024.0045 Smith et al1 present findings from an observational cohort study of early-career vascular surgeons and patient outcomes following endovascular aneurysm repair (EVAR), where lower mean Accreditation Council for Graduate Medical E...

ICU Management & Practice, Volume 24 - Issue 1, 2024 Defining Medicines Optimisation in the Intensive Care Unit Complex polypharmacy and pathophysiology are common in the intensive care unit (ICU). Medicines optimisation is essential to deliver safe, effective, and individualised pharmacotherapy. This is ideally performed by a specialised ICU pharmacist. Introduction Medicines are the most common intervention in healthcare and are a central compo...

ICU Management & Practice, Volume 24 - Issue 1, 2024 Haemoadsorption in Critically Ill Patients: The New Frontier Haemoadsorption may represent the new frontier in extracorporeal blood purification. Haemoadsorption has demonstrated effective extraction of a variety of toxins and drugs during episodes of sepsis, acute kidney injury or intoxication. Selective haemoadsorption can be performed by endotoxin-binding polymyxin B functionalised polystyrene fibres. The c...

ICU Management & Practice, Volume 24 - Issue 1, 2024 Corticosteroids in the Intensive Care Unit: Evidence-Based Recommendations Corticosteroids are commonly used drugs in multiple diseases and conditions of critically ill patients. In this article, we review the pharmacology of corticosteroids and provide recommendations for their use in the ICU based on the best available evidence. Corticosteroids: Pharmacology and General Aspects Corticosteroids are...

Editorial Venous Doppler for Echocardiographic Right Atrial Pressure Estimation: Ready for Primetime? Jean Deschamps, William Beaubien-Souligny Chest 2024; 165: 478-481 https://doi.org/10.1016/j.chest.2023.11.007 For the last decade, inferior vena cava (IVC) measurements and variability have been the de facto noninvasive echocardiographic measurement to infer right-sided filling pressures and remain at the forefront of current echocardiography guidelines.1D...

Improving Management of ARDS Acute respiratory distress syndrome (ARDS) poses a significant global health challenge, with high in-hospital mortality rates of approximately 40% despite advancements in supportive care. There's notable variability in patient management across different regions, with proven life-saving treatments like low tidal volume ventilation not uniformly implemented. ARDS is a diverse condition, suggesting that therapeutic responses can vary amon...

Monotherapy or Combination Therapy for Septic Shock International guidelines recommend using corticosteroids for adults with septic shock who require vasopressor therapy, supported by moderate-quality evidence. While corticosteroids may shorten the duration of shock, their impact on mortality remains uncertain. A recent meta-analysis found no significant reduction in mortality among septic shock patients treated with hydrocortisone compared to those given a placebo...

Invited Commentary  Nephrology March 8, 2024 Dialysis-Dependent Acute Kidney Injury—A Risk Factor for Adverse Outcomes Marlies Ostermann, Nuttha Lumlertgul, Matthew T. James JAMA Netw Open. 2024;7(3):e240346. doi:10.1001/jamanetworkopen.2024.0346 Acute kidney injury (AKI), acute kidney disease (AKD), and chronic kidney disease (CKD) have been defined as discrete entities but in practice can form a continuum whereby an initial kidney insult...

Informative Subtyping, Targeted Immunomodulatory Therapies for Sepsis Sepsis is characterised by dysregulated immune responses. Traditional approaches to treating sepsis by targeting proinflammatory and immunosuppressive responses have been largely unsuccessful. Recent efforts have shifted towards identifying subtypes of sepsis to enable personalised treatment. However, many important immunological concepts, such as resistance, disease tolerance, resilience, resolu...