Limited critical care subspecialty training and experience is available in many low- and middle-income countries, creating barriers to the delivery of evidence-based critical care. We hypothesized that a struc...
Authors: Pedja Kovacevic, Sasa Dragic, Tijana Kovacevic, Danica Momcicevic, Emir Festic, Rahul Kashyap, Alexander S. Niven, Yue Dong and Ognjen Gajic
Progress toward determining the true worth of ongoing practices or value of recent innovations can be glacially slow when we insist on following the conventional stepwise scientific pathway. Moreover, a widely...
Authors: John J. Marini, Daniel DeBacker, Luciano Gattinoni, Can Ince, Ignacio Martin-Loeches, Pierre Singer, Mervyn Singer, Martin Westphal and Jean-Louis Vincent
Catecholamines are used to increase cardiac output and blood pressure, aiming ultimately at restoring/improving tissue perfusion. While intuitive in its concept, this approach nevertheless implies to be effect...
Critically ill patients require adequate nutritional support to meet energy requirements both during and after intensive care unit (ICU) stay to protect against severe catabolism and prevent significant decond...
Patients admitted to the intensive care unit (ICU) often require invasive mechanical ventilation. Ventilator-associated lower respiratory tract infections (VA-LRTI), either ventilator-associated tracheobronchi...
The founding tenet of evidence-based medicine is to combine best evidence with clinical expertise. As David Sackett opined ‘Without clinical expertise, practice risks becoming tyrannised by evidence’. Rigid pr...
This paper discusses the physiological and technological concepts that might form the future of critical care medicine. Initially, we discuss the need for a personalized approach and introduce the concept of p...
In the absence of evidence, therapies are often based on intuition, belief, common sense or gut feeling. Over the years, some treatment strategies may become dogmas that are eventually considered as state-of-t...
Until relatively recently, critical illness was considered as a separate entity and the intensive care unit (ICU), often a little cut-off from other areas of the hospital, was in many cases used as a last reso...
Our current understanding of protective measures for avoiding ventilator-induced lung injury (VILI) has evolved from targeting low tidal volumes to lowering plateau and driving pressure. Even when pressures ac...
Oesophageal pressure (PES) is used for calculation of lung and chest wall mechanics and transpulmonary pressure during mechanical ventilation. Measurements performed with a balloon catheter are suggested as a ...
Authors: Per Persson, Rebecca Ahlstrand, Magni Gudmundsson, Alex de Leon and Stefan Lundin
Annual seasonal influenza epidemics of variable severity result in significant morbidity and mortality in the United States (U.S.) and worldwide. In temperate climate countries, including the U.S., influenza a...
Authors: Eric J. Chow, Joshua D. Doyle and Timothy M. Uyeki
As more patients are surviving intensive care, mental health concerns in survivors have become a research priority. Among these, post-traumatic stress disorder (PTSD) can have an important impact on the qualit...
Authors: Cássia Righy, Regis Goulart Rosa, Rodrigo Teixeira Amancio da Silva, Renata Kochhann, Celina Borges Migliavaca, Caroline Cabral Robinson, Stefania Pigatto Teche, Cassiano Teixeira, Fernando Augusto Bozza and Maicon Falavigna
Aetiology and outcomes of sepsis in sub-Saharan Africa (sSA) are poorly described; we performed a systematic review and meta-analysis to summarise the available data.
Authors: Joseph M. Lewis, Nicholas A. Feasey and Jamie Rylance
Mottling score, a tissue perfusion parameter, is correlated with outcome in septic shock patients. However, its predictive value on mortality according to prognostic covariates such as vasopressor dose and oth...
Malignant stroke occurs in a subgroup of patients suffering from ischemic cerebral infarction and is characterized by neurological deterioration due to progressive edema, raised intracranial pressure, and cere...
Authors: Thomas Beez, Christopher Munoz-Bendix, Hans-Jakob Steiger and Kerim Beseoglu
The long-term ecological effects on the emergence of antimicrobial resistance at the ICU level during selective decontamination of the digestive tract (SDD) are unknown. We determined the incidence of newly ac...
Authors: Sophie Buitinck, Rogier Jansen, Saskia Rijkenberg, Jos P. J. Wester, Rob J. Bosman, Nardo J. M. van der Meer and Peter H. J. van der Voort
Known colloquially as the “weekend effect,” the association between weekend admissions and increased mortality within hospital settings has become a highly contested topic over the last two decades. Drawing in...
Authors: Louis Faust, Keith Feldman and Nitesh V. Chawla
In light of an aging population with increased cardiovascular comorbidity, the use of oral anticoagulation (OAC) is steadily expanding. A variety of pharmacological alternatives to vitamin K antagonists (VKA) ...
Authors: Joji B. Kuramatsu, Jochen A. Sembill and Hagen B. Huttner
The population pharmacokinetics of total and unbound posaconazole following intravenous administration has not yet been described for the critically ill patient population. The aim of this work was, therefore,...
Authors: Fekade B. Sime, Catherine J. Byrne, Suzanne Parker, Janine Stuart, Jenie Butler, Therese Starr, Saurabh Pandey, Steven C. Wallis, Jeffrey Lipman and Jason A. Roberts
Rapid detection, early resuscitation, and appropriate antibiotic use are crucial for sepsis care. Accurate identification of the site of infection may facilitate a timely provision of appropriate care. We aime...
Vitamin D supplementation has shown promise for reducing mortality in the intensive care setting. As a steroid prohormone with pleiotropic effects, there may be a lag between administration and observing clini...
Authors: Gennaro Martucci, Dayre McNally, Dhruv Parekh, Paul Zajic, Fabio Tuzzolino, Antonio Arcadipane, Kenneth B. Christopher, Harald Dobnig and Karin Amrein
In recent years, argon has been shown to exert neuroprotective effects in an array of models. However, the mechanisms by which argon exerts its neuroprotective characteristics remain unclear. Accumulating evid...
Authors: Jingjin Liu, Kay Nolte, Gary Brook, Lisa Liebenstund, Agnieszka Weinandy, Anke Höllig, Michael Veldeman, Antje Willuweit, Karl-Josef Langen, Rolf Rossaint and Mark Coburn
Septic shock is the most severe form of sepsis, in which profound underlying abnormalities in circulatory and cellular/metabolic parameters lead to substantially increased mortality. A clear understanding and ...
Authors: Jean-Louis Vincent, Gabriel Jones, Sholto David, Elena Olariu and Kevin K. Cadwell
Despite the essential functions of the intestinal microbiota in human physiology, little has been reported about the microbiome in neurocritically ill patients. This investigation aimed to evaluate the charact...
Authors: Ruoting Xu, Chuhong Tan, Jiajia Zhu, Xiuli Zeng, Xuxuan Gao, Qiheng Wu, Qiong Chen, Huidi Wang, Hongwei Zhou, Yan He, Suyue Pan and Jia Yin
Automated continuous noninvasive ward monitoring may enable subtle changes in vital signs to be recognized. There is already some evidence that automated ward monitoring can improve patient outcome. Before aut...
Authors: Ashish K. Khanna, Phillip Hoppe and Bernd Saugel
Quantification of intrinsic PEEP (PEEPi) has important implications for patients subjected to invasive mechanical ventilation. A new non-invasive breath-by-breath method (etCO2D) for determination of PEEPi is eva...
Authors: Sarah Heili-Frades, Fernando Suarez-Sipmann, Arnoldo Santos, Maria Pilar Carballosa, Alba Naya-Prieto, Carlos Castilla-Reparaz, Maria Jesús Rodriguez-Nieto, Nicolás González-Mangado and German Peces -Barba
Optimal infusion rate of colloids in patients with suspected hypovolemia is unknown, and the primary objective of the present study was to test if plasma volume expansion by 5% albumin is greater if fluid is a...
Authors: Svajunas Statkevicius, Johan Bonnevier, Jane Fisher, Björn P. Bark, Erik Larsson, Carl M. Öberg, Päivi Kannisto, Bobby Tingstedt and Peter Bentzer
Procalcitonin (PCT) is a biomarker used to assess systemic inflammation, infection, and sepsis and to optimize antimicrobial therapies. Its role in the in the differential diagnosis between candidemia and bact...
Authors: Andrea Cortegiani, Giovanni Misseri, Mariachiara Ippolito, Matteo Bassetti, Antonino Giarratano, Ignacio Martin-Loeches and Sharon Einav
Intensive care survivors suffer chronic and potentially life-changing physical, psychosocial and cognitive sequelae, and supporting recovery is an international priority. As survivors’ transition from the inte...
Authors: J. King, B. O’Neill, P. Ramsay, M. A. Linden, A. Darweish Medniuk, J. Outtrim and B. Blackwood
Multiple organ dysfunction is a common cause of morbidity and mortality in intensive care units (ICUs). Original development of the Sequential Organ Failure Assessment (SOFA) score was not to predict outcome, ...
Authors: Andrea Soo, Danny J. Zuege, Gordon H. Fick, Daniel J. Niven, Luc R. Berthiaume, Henry T. Stelfox and Christopher J. Doig
Antibiotic exposure in intensive care patients with sepsis is frequently inadequate and is associated with poorer outcomes. Antibiotic dosing is challenging in the intensive care, as critically ill patients ha...
Authors: Lucas M. Fleuren, Luca F. Roggeveen, Tingjie Guo, Petr Waldauf, Peter H. J. van der Voort, Rob J. Bosman, Eleonora L. Swart, Armand R. J. Girbes and Paul W. G. Elbers
Authors: Xavier Bemtgen, Florentine Schroth, Tobias Wengenmayer, Paul M. Biever, Daniel Duerschmied, Christoph Benk, Christoph Bode and Dawid L. Staudacher
Sepsis remains one of the most important causes of morbidity and mortality worldwide. In approximately 30–50% of cases of suspected sepsis, no pathogen is isolated, disabling the clinician to treat the patient...
Authors: Rishi S. Nannan Panday, Eline M. J. Lammers, Nadia Alam and Prabath W. B. Nanayakkara
The effect of high-flow nasal cannula (HFNC) therapy in patients after planned extubation remains inconclusive. We aimed to perform a rigorous and comprehensive systematic meta-analysis to robustly quantify th...
Authors: Youfeng Zhu, Haiyan Yin, Rui Zhang, Xiaoling Ye and Jianrui Wei
