Enteral Nutrition Practices in ICU Patients With Circulatory Shock Approximately one-third of patients admitted to the ICU are in circulatory shock, which increases the risk of mortality. Death from circulatory shock is preceded by multiple organ dysfunction syndrome with a high mortality rate of over 80%. Loss of gut epithelial barrier function contributes to gut-derived proinflammatory immune responses that contribute to multiple organ dysfunction.  Studi...

Therapeutic Hyperthermia and Survival in Afebrile Sepsis Patients Fever is an important feature of infection. However, fewer than half of patients with sepsis present with fever at the time of diagnosis. Afebrile sepsis patients have nearly twice the mortality and are at a higher risk of developing secondary infections than patients with fever.  Fever is an adaptive response to infection that may be critical for survival. Studies show that elevated temperat...

ICU Management & Practice, Volume 22 - Issue 1, 2022 Doing More Can Be Worse: Ten Common Errors in the ICU Some of the most common interventions in the ICU can be associated with poor results. We present ten situations in which doing less is better for the critically ill patient. Introduction For decades, the focus of patient management in the Intensive Care Unit (ICU) has been to perform a large number of interventions in critically ill patients, man...

Editorials Physician burnout undermines safe healthcare Matthias Weigl BMJ 2022; 378 doi: https://doi.org/10.1136/bmj.o2157 (Published 14 September 2022)Cite this as: BMJ 2022;378:o2157 Urgent action is required to protect patients, physicians, and health systems A substantial proportion of healthcare professionals report symptoms of burnout.12 Research into the negative ramifications of physician burnout is abundant, with key insights already establis...

ICU Management & Practice, Volume 22 - Issue 2, 2022 Sepsis in Critical Care: Effective Antimicrobial Strategies in ICU ICU sepsis is associated with a mortality rate >25%, with nosocomial infection most lethal, and community acquired infection more common. Optimal management requires identification of the site of infection (lung, abdomen and blood stream most commonly), a focus on the likely pathogens based on risk factors for resistance, and provision ...

Editorials Self-testing for covid-19 Timothy Feeney, Charles Poole BMJ 2022; 378 doi: https://doi.org/10.1136/bmj.o2055 (Published 14 September 2022)Cite this as: BMJ 2022;378:o2055 Adding oropharyngeal to nasal sampling is not the answer to underperforming tests In a linked paper, Schuit and colleagues (doi:10.1136/bmj-2022-071215) tackle the issue of self-testing for covid-19.1 Despite a recent meta-analysis of the sensitivity and specificity of sing...

ICU Management & Practice, Volume 22 - Issue 2, 2022 Rationale Behind Practice: Landiolol in Critical Care A summary of data regarding the use of landiolol as a potential immunomodulator in septic patients and its effectiveness and safety in the management of new-onset postoperative atrial fibrillation (POAF). Cardiovascular Dysfunction and Sepsis Cardiovascular dysfunction is a common complication of sepsis. Approximately 40 to 50% of patients with p...

VA-LRTI Infections in COVID-19 COVID-19 continues to create a strain on healthcare systems around the world. Approximately 10-30% of COVID-19 patients admitted to the hospital need ICUs, and 15-20% of these patients require ventilatory support. The available data shows an increased risk of ventilator-associated pneumonia (VAP) and ventilator-associated lower respiratory tract infections (VA-LRTI) in critically ill COVID-19 patients. VA-LRTIs can result in a prolong...

ICU Management & Practice, Volume 22 - Issue 2, 2022 ICU Management of the Very Old: The Evidence Base Anno 2022 This overview explores the publications concerning the very old ICU patients since 2011 and with a focus on publications from the VIP network on elderly COVID-19 patients. Introduction In 2017, an international group of intensivists with a particular interest for geriatric intensive care published a statement paper (Flaatten et al. 2017). T...

Editorials Can vitamin D protect against covid-19? Peter Bergman BMJ 2022; 378 doi: https://doi.org/10.1136/bmj.o1822 (Published 07 September 2022)Cite this as: BMJ 2022;378:o1822 Two new trials find no effect, but aren’t the final word Vitamin D is an important regulator of calcium balance. In addition, it has important effects on the immune system, directly inducing antimicrobial peptides at mucosal surfaces and modulating the function of T cells.12Observ...