COMMENT|ONLINE FIRST Six pills less: no benefit for bicarbonate supplementation in renal allograft recipients Klemens Budde, Fabian Halleck Lancet Published:January 25, 2023 DOI:https://doi.org/10.1016/S0140-6736(22)02630-7 Metabolic acidosis (defined as serum bicarbonate <22 mmol/L) is frequent in patients with chronic kidney disease and is associated with disease progression.1Several prospective trials and meta-analyses2, 3, 4, 5, 6...

Nutrition Therapy and Clinical Outcomes in Critically Ill Patients Nutrition therapy is an important component of care for critically ill patients. The European Society for Clinical Nutrition and Metabolism (ESPEN) critical care guidelines recommend a progressive ramp-up of medical nutrition therapy, providing < 70% of measured energy expenditure or estimated needs during the early phase of acute illness and up to 80–100% after day three.  The clinical o...

Source Control and Sepsis Management Source control is important in the treatment of sepsis and septic shock. Lack or delay of source control can result in worse outcomes for patients.   The 2021 Surviving Sepsis Campaign guidelines recommend identifying the anatomical source of infection that requires source control and implementing it as soon as possible. However, adequate source control is difficult to define, and its optimal timing is difficult to ...

Closed-Loop Oxygen Control in Patients With AHRF High flow nasal oxygen (HFNO) has many physiological benefits in patients with acute hypoxaemic respiratory failure (AHRF). It can also help reduce the need for intubation. However, optimal flow settings are unknown and are generally based on expert recommendations.  Maintaining oxygenation within a given target range requires intensive patient monitoring and frequent manual adjustment of the fraction of insp...

Feature Covid Unanswered Questions How are covid-19 symptoms changing? Mun-Keat Looi BMJ 2023; 380 doi: https://doi.org/10.1136/bmj.p3 (Published 18 January 2023)Cite this as: BMJ 2023;380:p3 With new variants and a changing landscape of vaccination and immunity, what do the symptoms of covid-19—and our understanding of them—now look like? Mun-Keat Looireports How have covid symptoms changed since the start of the pandemic? In the short space o...

Editorial  January 17, 2023 TRANSFORM-HF—Can We Close the Loop on Diuretics in Heart Failure? Michelle M. Kittleson JAMA. 2023;329(3):211-213. doi:10.1001/jama.2022.21692 Fluid overload is the cardinal manifestation of heart failure, and prior to the 20th century, treatment options were limited to purgatives, bloodletting, leeching, or lancing. It was not until 1920 that the concept of a diuretic was first appreciated, when physicians observe...

COMMENT|ONLINE FIRST COVID-19 infection, reinfection, and the transition to endemicity Cheryl Cohen, Juliet Pulliam Lancet Published: February 16, 2023 DOI:https://doi.org/10.1016/S0140-6736(22)02634-4 Understanding the protection conferred by previous infection against repeat infection, illness, and severe disease is key to projecting the future epidemiology of COVID-19 and to guiding vaccine policy decisions. In The Lancet, The COVID-19 Forecasting Team1 ...

Viewpoint  January 20, 2023 The Importance of Shifting Sepsis Quality Measures From Processes to Outcomes Michael Klompas, Chanu Rhee, Mervyn Singer JAMA. Published online January 20, 2023. doi:10.1001/jama.2023.0340 Sepsis continues to be a leading cause of death and disability worldwide. In the US alone, more than a quarter million adults hospitalized with sepsis die each year. Clinicians, patients, regulators, and quality improvement advoc...

Ten Areas to Help Retain Critical Care Nurses The shortage of nurses in the ICU has been a problem for several years. However, the issue has become an even bigger problem because of the COVID-19 pandemic. Some of the most common reasons driving critical care nurses to leave include excessive workload, distress, and burnout. A shortage of nurses will likely impact the quality of patient care and quality-of-work life for all ICU staff. Hospital managers, nurse leader...

EDITORIAL Thromboprophylaxis after Extremity Fracture — Time for Aspirin? Matthew Costa N Engl J Med 2023; 388:274-275DOI: 10.1056/NEJMe2214045 Hospital-acquired venous thromboembolism remains a common and preventable cause of death, so many health care systems around the world mandate that all patients who are admitted to the hospital undergo a risk assessment for venous thromboembolism.1,2 Patients who have had traumatic injuries are at particular risk ...