EDITORIAL| VOLUME 164, ISSUE 4, P816-817, OCTOBER 2023 The Emulated Targeted Trial: A Causal, But Never Casual, Surrogate for Randomized Clinical Trials Pedro D. Wendel-Garcia, Lieuwe D.J. Bos Chest 2023; 164: 816-817 DOI: https://doi.org/10.1016/j.chest.2023.06.016 Randomization properly carried out […] relieves the experimenter from the anxiety of considering and estimating the magnitude of the innumerable causes by which his data may be disturbed.R. A. ...

Time Definition of Reintubation Mechanical ventilation is crucial for supporting critically ill patients, and a timely extubation strategy is essential for improved patient outcomes. Despite standard weaning procedures, a significant percentage of patients (3-20%) require reintubation. Post-extubation respiratory failure can cause respiratory fatigue, requiring additional mechanical ventilation. This results in prolonged ICU stay, increased costs, and increased in-...

Invited Commentary  November 6, 2023 The Risks of Being in Limbo in the Emergency Department Timothy S. Anderson, Shoshana J. Herzig JAMA Intern Med. Published online November 6, 2023. doi:10.1001/jamainternmed.2023.5953 Overcrowding of emergency departments (EDs) and hospitals is a growing public health concern in response to a confluence of increased demand for ED care, staffing shortages, and hospital consolidation—all overlaying a witheri...

Data to Track Incidence, Mortality for SARS-CoV-2–Associated Sepsis Sepsis is a life-threatening condition resulting from a dysregulated response to infection, historically associated with bacterial infections. However, viral infections are increasingly recognised as significant contributors to sepsis, especially with events like the SARS-CoV-2 pandemic and surges of respiratory viruses like RSV and influenza. Despite this, comprehensive data on the incidence and m...

Tight Blood-Glucose Control Without Early Parenteral Nutrition Randomised, controlled trials conducted in ICUs show mixed results regarding the benefits and risks of tight blood glucose control. This inconsistency in findings may be attributed to differences in the administration of early parenteral nutrition and the occurrence of insulin-induced severe hypoglycaemia. In this study, patients admitted to the ICU were randomly assigned to two groups: one receiving...

Virtual and Augmented Reality in the ICU Virtual reality (VR) and augmented reality (AR) are emerging technologies with diverse applications, from entertainment and education to medical care. VR immerses users in a virtual three-dimensional environment, while AR retains connection to the real world while increasing information through the use of virtual elements. Both require specialised VR/AR glasses. These technologies have already found extensive use in healt...

Vasopressin Loading for Refractory Septic Shock Vasopressin is a potent vasopressor used to treat septic shock, acting via a different receptor than catecholamines. Previous randomised control trials have demonstrated its efficacy. However, its use can also lead to adverse effects such as ischaemia events. Therefore, it is recommended as a second-line agent after noradrenaline. Typically, vasopressin is given as a continuous infusion up to 0.03 U/min (1.8 U/h). ...

Single-Plane vs Real-Time Biplane Approaches for Ultrasound-Guided CVC Central venous catheterisation (CVC) is a lifesaving procedure for critically ill patients, commonly used during fluid resuscitation, safe intravenous administration of medication, and to facilitate haemodialysis and monitor haemodynamic variables in the ICU. Over 15 million CVCs are performed annually in the United States, and nearly 70 CVCs per 100 patient-days are performed in European I...

Editor's Note  October 30, 2023 Gender Equity in Clinical Trial Leadership—A Win-Win for Everyone Grace Y. Zhang, Ishani Ganguli, Tracy Y. Wang JAMA Intern Med. Published online October 30, 2023. doi:10.1001/jamainternmed.2023.5091 Gender disparity in clinical trial leadership has been described previously in fields such as cardiology.1 In this issue of JAMA Internal Medicine, Waldhorn et al2 demonstrate that this issue is more...

Ventilator-Induced Lung Injury and the Circadian Clock Patients diagnosed with acute respiratory distress syndrome (ARDS) often require mechanical ventilation (MV) as a life-saving intervention. However, mechanical ventilation can aggravate lung injury, leading to a condition known as ventilator-induced lung injury (VILI). Although using low tidal volume (VT) ventilation has become the standard in clinical practice for patients with ARDS, lung-protective ventila...