Original Investigation July 20, 2021 Effect of Canakinumab vs Placebo on Survival Without Invasive Mechanical Ventilation in Patients Hospitalized With Severe COVID-19: A Randomized Clinical Trial Roberto Caricchio, Antonio Abbate, Ivan Gordeev, et al JAMA. 2021;326(3):230-239. doi:10.1001/jama.2021.9508 Abstract Importance  Effective treatments for patients with severe COVID-19 are needed. Objective  To evaluate the efficacy of canakinuma...

ORIGINAL ARTICLE Milrinone as Compared with Dobutamine in the Treatment of Cardiogenic Shock Rebecca Mathew, Pietro Di Santo, Richard G. Jung, et al N Engl J Med 2021; 385:516-525DOI: 10.1056/NEJMoa2026845 Abstract BACKGROUND Cardiogenic shock is associated with substantial morbidity and mortality. Although inotropic support is a mainstay of medical therapy for cardiogenic shock, little evidence exists to guide the selection of inotropic agents in clinic...

Original Investigation August 10, 2021 Effect of Intravenous Fluid Treatment With a Balanced Solution vs 0.9% Saline Solution on Mortality in Critically Ill Patients: The BaSICS Randomized Clinical Trial Fernando G. Zampieri, Flávia R. Machado, Rodrigo S. Biondi, et al JAMA. Published online August 10, 2021. doi:10.1001/jama.2021.11684 Abstract Importance  Intravenous fluids are used for almost all intensive care unit (ICU) patients...

ORIGINAL ARTICLE Therapeutic Anticoagulation with Heparin in Noncritically Ill Patients with Covid-19 The ATTACC, ACTIV-4a, and REMAP-CAP Investigators N Engl J Med August 4, 2021DOI: 10.1056/NEJMoa2105911 Abstract BACKGROUND Thrombosis and inflammation may contribute to the risk of death and complications among patients with coronavirus disease 2019 (Covid-19). We hypothesized that therapeutic-dose anticoagulation may improve outcomes in noncritically i...

Original Investigation July 6, 2021 Association Between Administration of IL-6 Antagonists and Mortality Among Patients Hospitalized for COVID-19: A Meta-analysis The WHO Rapid Evidence Appraisal for COVID-19 Therapies (REACT) Working Group JAMA. Published online July 6, 2021. doi:10.1001/jama.2021.11330 Abstract Importance  Clinical trials assessing the efficacy of IL-6 antagonists in patients hospitalized for COVID-19 have various...

ORIGINAL ARTICLE Therapeutic Anticoagulation with Heparin in Critically Ill Patients with Covid-19 The REMAP-CAP, ACTIV-4a, and ATTACC Investigators N Engl J Med August 4, 2021DOI: 10.1056/NEJMoa2103417 Abstract BACKGROUND Thrombosis and inflammation may contribute to morbidity and mortality among patients with coronavirus disease 2019 (Covid-19). We hypothesized that therapeutic-dose anticoagulation would improve outcomes in critically ill patients with...

ORIGINAL ARTICLE Tofacitinib in Patients Hospitalized with Covid-19 Pneumonia Patrícia O. Guimarães, Daniel Quirk, Remo H. Furtado, et al N Engl J Med June 16, 2021DOI: 10.1056/NEJMoa2101643 Abstract BACKGROUND The efficacy and safety of tofacitinib, a Janus kinase inhibitor, in patients who are hospitalized with coronavirus disease 2019 (Covid-19) pneumonia are unclear. METHODS We randomly assigned, in a 1:1 ratio, hospitalized adults with Covid-1...

ICU Management & Practice, Volume 21 - Issue 2, 2021 Top Five Priorities for a New ICU Director During the First Year During the first year, the ICU director should take a snapshot of the ICU situation and invest time and resources to acquire good and real data that will drive priorities of care and management. After that, implementation of basic protocols and creating a programme to engage and protect the staff against burnout should be considered. Finally...

ORIGINAL ARTICLE Treatment of Multisystem Inflammatory Syndrome in Children Andrew J. McArdle, Ortensia Vito, Harsita Patel, et al N Engl J Med June 16, 2021DOI: 10.1056/NEJMoa2102968 Abstract BACKGROUND Evidence is urgently needed to support treatment decisions for children with multisystem inflammatory syndrome (MIS-C) associated with severe acute respiratory syndrome coronavirus 2. METHODS We performed an international observational cohort ...

ICU Management & Practice, Volume 21 - Issue 2, 2021 The Challenge of Admitting a Very Old Patient with Sepsis to an Intensive Care Unit Sepsis incidence in very old patients is high and related mortality and morbidity are a major health concern. Frailty and severity of illness, not just age or sepsis diagnosis, are the determinant factors in outcome. Early identification and treatment are decisive in their survival. Nowadays, we are facing some importan...