All Articles
Gut microbes protect against sepsis
2018 16 Mar
New research published in Cell Host & Microbe suggests that gut bacteria may help in the fight against sepsis. In the study, mice were given particular microbes, which increased blood levels of immunoglobulin A (IgA) antibodies, protecting the mice against polymicrobial sepsis.You might also like: Study: Microbiome Disruption May Have Key Role in ARDS,... Read more
Glycaemic control in critically ill patients: how tight should it be?
2018 16 Mar
There is still no widespread agreement around optimal targets for glucose control in the ICU: some clinicians maintain that glucose control is unnecessary and harmful, while others claim that blood glucose control is essential to improve prognosis.1-3 Those who favour liberal glycaemic control assert that hyperglycaemia is simply a beneficial adaptation... Read more
Dysglycaemia in the critically ill
2018 16 Mar
As has been pointed out, the benefits of tight glycaemic control in the ICU have by no means been clearly established or accepted. In 2010 a meta-analysis of seven prospective randomised studies concluded that intensive insulin therapy in mixed ICU patients was not supported by evidence.19 Today we understand that hyperglycaemia, hypoglycaemia, and high... Read more
Facilitated glucose control in the ICU through nutrition
2018 16 Mar
As recently as 2010, the view of metabolic requirements for patients admitted to ICU was that all patients had the same metabolic needs and could therefore be managed with the same nutritional product. In general, critically ill patients were fed along the same lines as healthy people in the ratio of around 50% carbohydrates, 35% lipids and 15% protein.... Read more
The increased recognition of proteins in critical illness
2018 16 Mar
There are many new concepts and old controversies surrounding nutrition in critical care such as: the role of trophic feeding, permissive underfeeding, the use of immune modulating agents, and the optimal timing of nutrient delivery. However, enteral nutrition and protein delivery have consistently been found to be beneficial. Traditionally, the concerns... Read more
Multiple organ support
2018 16 Mar
Interventions intended to support one organ can have unexpected implications on the patient, presenting physicians with critical decisions. These can be aided with innovative technologies and new techniques, but only if well understood. We often come across multiple organ dysfunction syndrome (MODS), with incremental degrees of physiologic derangements... Read more
Out with the saline?
2018 16 Mar
Reduced use linked to better outcomesTwo companion studies have shown that use of saline as intravenous fluid therapy, compared to crystalloids, was associated with poor survival and increased risk of kidney complications.Matthew Semler, MD, MSc, assistant professor of Medicine at Vanderbilt University School of Medicine, told ICU Management & Practice... Read more
ICU delirium a distinct indicator of acute brain injury
2018 16 Mar
More than half of ICU patients in a new study experienced delirium for long periods during their stay. Sedative-associated delirium was most common, while longer periods of hypoxic delirium and unclassified delirium were associated with worse cognitive function at follow-up one year after hospital discharge.You might also like: Sedative prevents delirium... Read more
Introduction to multiple organ support
2018 16 Mar
There is a renewed interest in novel extracorporeal technologies as a means of supporting individual organ failures. An emphasis should be placed on characterising the spectrum of extracorporeal devices for various organs and understanding how devices intended for support of one organ can have an indirect or direct impact on other organs, which is particularly... Read more
From multiple organ support therapy to extracorporeal organ support in critically ill patients
2018 16 Mar
The complex nature of the multiple organ dysfunction syndrome (MODS) requires an integrated supportive therapy. Native organs have a continuous crosstalk and have in common in most cases an altered composition of the blood circulating and perfusing them. In this article we describe the concept of extracorporeal organ support (ECOS) for the treatment... Read more
Chronic respiratory dialysis
2018 16 Mar
Extracorporeal carbon dioxide removal is emerging as a potential strategy to manage acute hypercapnic respiratory failure. There may be an opportunity to use similar techniques to manage chronic hypercapnic respiratory failure, in what may be termed "chronic respiratory dialysis", potentially altering the physiological and clinical effects of chronic... Read more
Understanding LVAD & artificial hearts
2018 16 Mar
Regarding the growing number of patients with long-term mechanical assist devices, intensivists need to understand the physiology of the devices, their functioning, potential complications and their management.Long-term mechanical circulatory support (MCS) is being used increasingly for patients at risk of dying from heart failure and cardiogenic shock... Read more
Optimising patient-ventilator synchronisation
2018 16 Mar
Dr. Lluís Blanch, Dr. Jean-Michel Arnal and Prof. Francesco Mojoli discuss why patient-ventilator synchrony is important, how to detect asynchronies, and technical solutions for optimising synchronisation. Definition and clinical effects Patient-ventilator asynchrony occurs when there is a mismatch between the patient’s inspiratory time and the mechanical... Read more
Nutritional challenges in ICU patients
2018 16 Mar
This symposium explored controversial aspects of the nutritional management of patients in the ICU. There are new concepts and old controversies such as the role of permissive underfeeding and the optimal timing of nutrient delivery. Glucose control is also one such area where there is still no widespread agreement on optimal targets for blood glucose... Read more
CO2 in the critically ill
2018 16 Mar
CO2 exerts potent effects on lung biology that could be clinically relevant in critically ill patients, in particular those with acute respiratory distress syndrome (ARDS). The impact of hypercapnia on outcome in these patients is yet to be determined.The physiological effects of hypercapnia are increasingly well understood, but the literature remains... Read more
Improving diagnostic stewardship by using new microbiological technologies
2018 16 Mar
Describes an episode of sepsis in a leukaemia patient, whose treatment was early guided by using rapid diagnostics technology to identify the cause of infection. A 4-year-old patient under treatment for acute lymphoblastic leukaemia, diagnosed 6 months before, was admitted to the emergency room (ER) at midnight (00h33) due to a fever episode of less... Read more
Immune dysfunction in sepsis
2018 16 Mar
An overview of the recent advances in the diagnosis and treatment of immune system dysfunction in sepsis.Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection (Singer et al. 2016). Sepsis-induced immune system dysfunction is an important sequelae of sepsis. The persistence of immune system dysfunction... Read more
Hypothermia in neurocritical care patients other than cardiac arrest
2018 16 Mar
Hypothermia (HT) is a cornerstone of neuroprotective strategies and has been used in critical care for acutely brain injured adult patients for many years. This review aims to discuss the clinical evidence supporting the use of HT in neurocritical care patients beyond care after cardiac arrest (CA), such as traumatic brain injury (TBI), acute ischaemic... Read more
Intracranial pressure monitoring devices
2018 16 Mar
Intracranial pressure (ICP) monitoring is the cornerstone for treatment and management of patients, especially following traumatic brain injury (TBI) but also other clinical conditions such as non-traumatic bleeds, hydrocephalus, space-occupying lesions and cerebral oedema. The key target to monitor and treat ICP is to optimise the cerebral perfusion... Read more
Complications of decompressive craniectomy in neurological emergencies
2018 16 Mar
There are a number of complications related to the use of decompressive surgery. The most important thing to bear in mind is these complications can impair recovery.What is a decompressive craniectomy?Decompressive craniectomy is a surgical procedure where a large section of the skull is removed and the underlying dura mater exposed. Primary decompressive... Read more