Personalising Fluid Therapy in Septic Shock Volume expansion, the initial therapeutic measure for septic shock, involves the intravenous injection of a few hundred millilitres of fluid over a few minutes. However, using fluids in septic patients is a complex strategy, with various types of fluids available. The effects of fluid boluses are inconsistent and transient, and fluids carry risks, especially during septic shock. There are also questions about which fluid ...

Invited Commentary  May 10, 2023 Surgical Palliative Care—Who, When, and Why? Jason Michael Johanning, Ana Berlin, Pringl Miller JAMA Surg. 2023;158(7):755. doi:10.1001/jamasurg.2023.1406 Palliative care services for patients with inoperable cancer and end-stage chronic medical conditions have been shown to improve quality of life, reduce consumption of medical services, and overall increase long-term survival.1 In surgical populations, palliative...

ICU Management & Practice, Volume 23 - Issue 1, 2023 From the Other Side: Humanising Critical Medicine Support in intensive care has undergone unprecedented development, with proven technology and protocols, but at the same time, it constitutes an environment that often makes empathy and humanisation difficult. This article reviews current concepts of care for critically ill patients from the point of view of health providers who were also patients in some ...

Invited Commentary  August 7, 2023 There Is No 1-Size-Fits-All to Blood Pressure Measurement—Cuff Size Matters Mathias Lalika, Stephen P. Juraschek, LaPrincess C. Brewer JAMA Intern Med. Published online August 7, 2023. doi:10.1001/jamainternmed.2023.3277 In this issue of JAMA Internal Medicine, Ishigami and colleagues1 reported a randomized crossover trial quantifying the effect of miscuffing on blood pressure (BP) measurement when...

#ISICEM23: Time to Get Strategic About ICU Burnout In an interesting session at #ISICEM23, Michelle Chew, Professor of Anesthesiology, Intensive care, and Acute Medicine Care at Linköping University Hospital, Sweden, talked about stress, anxiety, and burnout. Prof Chew discussed a study conducted by her group on perceived and physiological stress, anxiety, and burnout among ICU staff in an area with two million inhabitants. The study focused on staff in two majo...

Editorials Antenatal corticosteroids and longer term outcomes Jessica Kimpton, Audrienne Sammut, David J Cox BMJ 2023; 382 doi: https://doi.org/10.1136/bmj.p1722 (Published 02 August 2023)Cite this as: BMJ 2023;382:p1722 New evidence to consider before prescribing antenatal corticosteroids Antenatal corticosteroids are considered one of the most important interventions available to improve outcomes for preterm infants. They are recommended for women at risk...

#ISICEM23: Findings from the PROCOAG Clinical Trial Findings from the PROCOAG randomised clinical trial were presented for the first time during the #ISICEM23 opening. The best way to manage transfusions in traumatic haemorrhage remains unclear. However, there are indications that using a 4-factor prothrombin complex concentrate (4F-PCC) could have a beneficial effect on blood product consumption. The PROCOAG study aimed to evaluate the efficacy and safety of...

Postextubation Noninvasive Respiratory Support in Patients with Acute Brain Injury: Not a Panacea, but Don’t Throw the Baby Out with the Bathwater! Romain Pirracchio and  Alejandro A. Rabinstein Am J Respir Crit Care Med 2023; 208: 225-226 Extubation failure is a common problem in patients with acute brain injury, with rates ranging from 15% to 25% across studies (1–3). Older age, longer duration of mechanical ventilation, and impaired airway protective reflexes ...

ICU Management & Practice, Volume 23 - Issue 1, 2023 Utility of Biomarkers in Obstetric Patients With Preeclampsia Preeclampsia is a complex syndrome whose complications bear an impact on perinatal morbidity and mortality. Angiogenic biomarkers may significantly impact both the decision to admit patients and risk stratification and may also help guide patient management and level of care. Preeclampsia is one of the main causes of maternal and foetal morb...

Enhancing the Efficacy of Mesenchymal Stromal Cells in COVID-19–related Acute Respiratory Distress Syndrome Haibo Zhang and  Arthur S. Slutsky Am J Respir Crit Care Med 2023; 208: 222-224 Mesenchymal stromal cells (MSCs) have garnered considerable attention as a potential therapeutic option for patients with acute respiratory distress syndrome (ARDS) because of their capacity to modulate inflammation and promote tissue repair (1, 2). In this editorial, we su...