Editorial Published: 13 May 2022 Corticosteroids for severe community-acquired pneumonia: a story without an ending Bram Rochwerg  Intensive Care Medicine (2022) https://doi.org/10.1007/s00134-022-06699-w Regardless of pathogen, lower respiratory tract infection is associated with profound host response leading to altered permeability of the alveolar capillary membrane due to complex systemic and pulmonary inflammatory/immune responses [1,2,3]. As such, var...

Should We Wean Patients off Vasopressors before Weaning Them off Ventilation? Xavier Monnet Am J Respir Crit Care Med 2022; 205: 980-981 Failed extubation and subsequent reintubation are independently associated with mortality and morbidity of patients under mechanical ventilation (1). This is the reason why, before starting the weaning process, one carefully waits until the patient has reached a sufficient degree of autonomy (2). Among the criteria used to ensur...

The Job Crisis for Emergency Physicians Emergency physicians have always been guaranteed a good job after residency and have been able to find work wherever they wanted and whenever they wanted.  However, in recent years there has been a shift in the demand. According to data from the American College of Emergency Physicians (ACEP), in 2019, approximately 20% of emergency medicine residents reported that they had difficulty finding a job in their preferred ...

ICU Capacity Transfers and Mortality Transfers from one ICU to another ICU are associated with an increased length of stay in the ICU and the hospital. Inter-hospital ICU transfers occur for three main reasons: clinical transfers, capacity transfers and repatriations.  A study was conducted to show that different ICU transfers differ in risk-adjusted mortality rate. The primary endpoint of the study was survival to 30 days. The secondary endpoint included s...

ICU-Related Loss of Quality of Life After COVID-19 COVID-19 has had a significant impact on the number of hospital admissions, including many patients presenting acute respiratory failure. Approximately 15% of hospitalised COVID-19 patients require ICU admission.  It is well established that the physical and psychological impact of an ICU stay on patients can be quite significant and prolonged. Many ICU survivors report functional disability that can persis...

#ISICEM22: Vasodilatory Choice and Timing An article released in conjunction with the Intensive Care & Emergency Medicine (ISICEM) Congress helps clinicians understand the choice and timing of vasopressors in vasodilatory shock. It is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2022. Vasodilatory shock is one of the most common forms encountered in patients admitted to the ICU. The predominant aetiology of th...

EDITORIAL Does the World Still Need New Covid-19 Vaccines? Hanna Nohynek, Annelies Wilder-Smith N Engl J Med May 4, 2022DOI: 10.1056/NEJMe2204695 Although there was a global shortage of Covid-19 vaccines in 2021, by mid 2022, the vaccine supply will no longer be a limiting factor in efforts to provide more equitable coverage. As of April 19, 2022, approximately 11.5 billion Covid-19 vaccine doses have been administered globally.1 Scaling up manufacturing ...

传统观点认为，由于液体丢失和血管扩张，感染性休克患者可出现循环容量的绝对和相对不足，因此，积极的液体复苏是纠正循环功能障碍和（或）组织低灌注的重要手段[1]。然而，近年来的研究提示，液体正平衡或容量负荷过多是包括感染性休克在内的重症患者不良预后甚至死亡的独立危险因素[2]。基于这些发现，限制性液体（复苏）治疗成为感染性休克临床研究的热点问题。 刚刚在线发表的CLASSIC研究旨在评价限制静脉液体对ICU中感染性休克患者的病死率及其他重要预后指标的影响[3]。这是一项前瞻随机对照试验，在8个...

EDITORIAL Monoclonal Antibodies with Extended Half-Life to Prevent Covid-19 Jonathan Abraham N Engl J Med 2022; 386:2236-2238DOI: 10.1056/NEJMe2205563 Early treatment (i.e., soon after the onset of Covid-19 symptoms) with monoclonal antibodies that target the SARS-CoV-2 spike protein reduces the risks of Covid-19–related hospitalization and death.1-3 Yet, despite the success of these interventions, in response to continued pressure from human immune respo...

EDITORIALFREE PREVIEW Intravenous Fluids in Septic Shock — More or Less? Lauralyn A. McIntyre, John C. Marshall N Engl J Med June 17, 2022DOI: 10.1056/NEJMe2206160 …soon the sharpened features, and sunken eye, and fallen jaw, pale and cold, bearing the manifest impress of death’s signet, began to glow with returning animation…. “. . . 很快，瘦削的五官、凹陷的眼睛和下垂的下巴，苍白而冰冷的皮肤，这些明显的死亡迹象开始重新焕发活力。” — Dr. Thomas Latta D...