Gram Stain-Guided Antibiotic Therapy in Patients With VAP The increase of multidrug-resistant (MDR) organisms in ICUs is a well-recognised threat. Due to a lack of development of new pharmaceutical agents, there are now only a few antibiotics that are effective against these organisms. The World Health Organization (WHO) has also highlighted the need to develop a global action plan to address antimicrobial resistance and optimise the use of antibiotic age...

Editorial  October 26, 2022 Early Oxygen Supplementation After Resuscitation From Cardiac Arrest Jonathan Elmer, Francis X. Guyette JAMA. Published online October 26, 2022. doi:10.1001/jama.2022.18620 Supplemental oxygen administration was first noted to correct signs and symptoms of hypoxic respiratory failure more than a century ago.1,2 Since that time, oxygen has become one of the most widely administered therapeutic interventions in ...

Response to PEEP in COVID-19 ARDS With & Without ECMO There have been conflicting results concerning lung recruitability of COVID-19 acute respiratory distress syndrome (ARDS) and the use of techniques derived from changes in respiratory mechanics and/or gas exchange in response to positive end-expiratory pressure (PEEP) increase. Various factors may explain the heterogeneity of reports regarding recruitability of COVID-19 ARDS. These include time from ARDS ons...

Noninvasive Respiratory Support in Intensive Care Most forms of ventilatory support in intensive care before the 1950s were noninvasive without direct access to the lower airways, using face mask for positive pressure or generating negative pressure around the chest. Ventilators stimulating negative pressure were designed in the late 19th century. The first application of positive end-expiratory pressure (PEEP) was first described in the 1930s.  After the i...

Trends in Antimicrobial Prescribing During Hospitalisation for Sepsis There have been concerns that the emphasis on rapid administration of antimicrobials for sepsis may result in an increase in the overall use of antimicrobials, even in patients without sepsis. In a study of 1,559,523 patients hospitalised at 152 hospitals in two health care delivery systems, researchers aimed to determine whether shortening the time to treatment for sepsis was associated ...

Serial Measurement of Pancreatic Stone Protein for Detection of Sepsis Sepsis continues to be a challenging health problem associated with high morbidity and mortality. Approximately 48.9 million cases of sepsis were recorded worldwide in 2017, with 11 million related deaths. Sepsis guidelines emphasise the early recognition and aggressive management of this condition with early antibiotic treatment and support. If not treated early, sepsis can evolve into life-thr...

EDITORIAL Early Mobilization of Critical Care Patients — Still More to Learn Marc Moss N Engl J Med October 26, 2022DOI: 10.1056/NEJMe2212360 Each year, intensive care unit (ICU)–acquired weakness occurs in approximately 1 million critically ill patients who are undergoing mechanical ventilation worldwide.1 ICU-acquired weakness begins early in the course of critical illness and is related to multiple mechanisms, including deconditioning, myopathy, and ne...

COVID-19 Vaccines Prevented 20 Million Deaths Worldwide Findings from the first modelling study to quantify the impact of COVID-19 vaccines show that nearly 19.9 million out of a potential 31.4 million deaths were prevented in the first year (December 2020-December 2021) after the introduction of the vaccine. The findings are based on data from 185 countries using COVID-19 death records and total excess deaths from each country.  It is not possible to measu...

Early Deep Sedation in Mechanically Ventilated COVID-19 Patients Sedation management is a critical component when managing mechanically ventilated patients. It is important to use a protocol-driven approach, which favours paired spontaneous awakening (SAT) and breathing (SBT) trials, along with light levels of sedation. The initial period of respiratory failure in the emergency department and the first 48 hours in the ICU are critical to ensure reduced overall time...

Renal Replacement Therapy in Patients With Sepsis-Associated AKI Acute kidney injury (AKI) is a serious complication of sepsis. According to data from several clinical studies, AKI can occur in nearly 50% of patients with sepsis and has a mortality rate of approximately 60% at three months.  Renal replacement therapy (RRT) is used to treat AKI, but some data show that it exerts only a limited effect in patients with sepsis-associated AKI (SA-AKI). ...