Persistent and Chronic Critical Illness Revised and reviewed 11 December 2016 Persistent and Chronic Critical Illness OVERVIEW Advances in intensive care have led to a growing cohort of patients of patients, who would have otherwise succumbed to acute illness, survive in a state dependent on prolonged intensive care therapies including mechanical ventilation heavy burden of costs to the individual, family and society requires extreme use of resources cause of considerabl...

The Top 10 Clinical Trends of Early 2017 Ryan Syrek, MA  |  March 21, 2017 Top 10 Clinical Trends of Early 2017 Every week, we identify the top search term and speculate as to what resulted in the increase in popularity. We then pair that with an infographic based on the related clinical condition. This year has already seen some surprising terms surge in popularity. Here are the top 10 clinical trends of early 2017. Trend 10: Breast Augmentation  In mid-January, a...

ORIGINAL ARTICLE Levosimendan in Patients with Left Ventricular Dysfunction Undergoing Cardiac Surgery Rajendra H. Mehta, Jeffrey D. Leimberger, Sean van Diepen, et al. March 19, 2017 DOI: 10.1056/NEJMoa1616218 BACKGROUND 背景 Levosimendan is an inotropic agent that has been shown in small studies to prevent or treat the low cardiac output syndrome after cardiac surgery. 左西孟旦是一种强心药物，小样本研究显示其能够预防或治疗心脏外科术后低心排综合征。 METHODS 方法 In a m...

ORIGINAL ARTICLE Levosimendan for Hemodynamic Support after Cardiac Surgery Giovanni Landoni, Vladimir V. Lomivorotov, Gabriele Alvaro, et al. BACKGROUND 背景 Acute left ventricular dysfunction is a major complication of cardiac surgery and is associated with increased mortality. Meta-analyses of small trials suggest that levosimendan may result in a higher rate of survival among patients undergoing cardiac surgery. 急性左心室功能不全是心脏术后的主要并发症，伴随病死率升高...

ORIGINAL ARTICLE Early, Goal-Directed Therapy for Septic Shock — A Patient-Level Meta-Analysis The PRISM Investigators March 21, 2017 DOI: 10.1056/NEJMoa1701380 BACKGROUND 背景 After a single-center trial and observational studies suggesting that early, goal-directed therapy (EGDT) reduced mortality from septic shock, three multicenter trials (ProCESS, ARISE, and ProMISe) showed no benefit. This meta-analysis of individual patient data from the three recent trials was desi...

Sevoflurane for Sedation in Acute Respiratory Distress Syndrome. A Randomized Controlled Pilot Study Matthieu Jabaudon, Pierre Boucher, Etienne Imhoff, et al. Am J Respir Crit Care Med 2017; 195: 792-800 Rationale: 背景 Sevoflurane improves gas exchange, and reduces alveolar edema and inflammation in preclinical studies of lung injury, but its therapeutic effects have never been investigated in acute respiratory distress syndrome (ARDS). 有关肺损伤的临床前研究显示，七...

Epidemiology of Weaning Outcome according to a New Definition. The WIND Study Gaëtan Béduneau, Tài Pham, Frédérique Schortgen, et al. Am J Respir Crit Care Med 2017; 195: 772-783 Rationale: 背景 The weaning process concerns all patients receiving mechanical ventilation. A previous classification into simple, prolonged, and difficult weaning ignored weaning failure and presupposed the use of spontaneous breathing trials. 脱机过程涉及所有接受机械通气的患者。既往分类方法将患...

Recovery after Acute Kidney Injury John A. Kellum, Florentina E. Sileanu, Azra Bihorac, et al Am J Respir Crit Care Med 2017; 195: 784-791 Rationale: 背景 Little is known about how acute kidney injury (AKI) resolves, and whether patterns of reversal of renal dysfunction differ among patients with respect to ultimate recovery. 有关急性肾损伤(AKI)的恢复过程，以及不同患者肾脏功能障碍的逆转模式知之甚少。 Objectives: 目的 We sought to examine different patterns for AKI revers...

High-flow warm humidified oxygen versus standard low-flow nasal cannula oxygen for moderate bronchiolitis (HFWHO RCT): an open, phase 4, randomised controlled trial Elizabeth Kepreotes, Bruce Whitehead, John Attia, et al Lancet 2017; 389: 930-939 Summary Background 背景 Bronchiolitis is the most common lung infection in infants and treatment focuses on management of respiratory distress and hypoxia. High-flow warm humidified oxygen (HFWHO) is increasingly used, but has...

Prophylactic hydration to protect renal function from intravascular iodinated contrast material in patients at high risk of contrast-induced nephropathy (AMACING): a prospective, randomised, phase 3, controlled, open-label, non-inferiority trial Estelle C Nijssen, Roger J Rennenberg, Patty J Nelemans, et al Lancet 2017 (Published 20 February 2017) DOI: http://dx.doi.org/10.1016/S0140-6736(17)30057-0   Background 背景 Intravenous saline is recommended in clinical pract...