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Surviving Sepsis Campaign 2016 Guidelines Released
The Surviving Sepsis Campaign (SSC) ( survivingsepsis.org ), has released its 2016 guidelines for the management of sepsis and septic shock. The document, published simultaneously in Critical Care Medicine and Intensive Care Medicine , is an update to the 2012 SSC guidelines. The recommendations in the document cannot replace the clinician’s...
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Personalised Medicine in Intensive Care
The specialty of intensive care medicine grew out of the realisation that critically ill patients needed more attention and specialised treatment than could be provided on a general ward, and that many of these patients had similar clinical problems and processes, so management would be facilitated if they were grouped together in one place. Since...
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Precision Medicine in Sepsis
Multiple failed clinical trials testing immunomodulatory therapies for sepsis argue for a new approach. While precision medicine has been successfully implemented in other fields, testing it in sepsis poses challenges, which this review will discuss, along with potential implementation strategies. Sepsis has an estimated annual incidence of 1.3...
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ARDS and Precision Medicine
What is the path forward for treatment of acute respiratory distress syndrome (ARDS)? Is it big trials (favoured by clinical scientists) or further insight into disease physiopathology (favoured by basic scientists)? Or both? Funding resources are limited and the debate is wide open. In the post-genomic era, a new direction is needed. On 20 January 2015,...
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Antibiotic Resistance in the ICU: Time to Take Things Seriously!
Multidrug resistance (MDR) is increasing worldwide and has been acknowledged as one of the major threats to healthcare by the World Economic Forum and the World Health Organization (World Health Organization 2014). Intensive care unit (ICU) patients seem to be particularly susceptible for acquiring MDR organisms, either just as colonisers, or as pathogens...
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Antimicrobial Stewardship in the ICU
Treating patients with multidrugresistant (MDR) pathogens is an increasing challenge for intensive care unit (ICU) physicians. In the ICU, compared to other hospital departments, severe infections are most prevalent and antimicrobial use is most abundant. Not surprisingly, antimicrobial resistance (AMR) has emerged primarily in the intensive care setting, where...
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Towards Safer Ventilation in Critically ill Patients without ARDS
Invasive ventilatory support, one of the most frequently applied strategies in intensive care unit (ICU) patients, is increasingly recognised as a potentially dangerous intervention. Recognition of so–called ventilator– induced lung injury and the broad acceptance of lung–protective ventilation strategies in ICUs worldwide led to noticeable changes...
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Quantitative EEG in ICU: Useful and Feasible
EEG measures continuously at the bedside the human brain’s electrical activity. Its main advantages are noninvasiveness, good spatial and temporal resolution, and sensitivity to changes in both brain structure and function. In ICU, seizures are frequent in patients with/without acute brain injury. They are often difficult to recognise, because...
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Utility of Brain Ultrasound in Neurocritical care
Evidence shows that sonography of the brain can be used to visualise most of the intracranial structures, allowing estimation of the risk posed by life-threatening conditions, such as raised ICP, intracranial haematoma, hydrocephalus and midline shift. Brain ultrasound is increasingly used in the critical care setting. This technology is...
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Albumin Administration in Sepsis: The Case for and Against
Serum albumin is an essential plasma protein, with a variety of homeostatic and predictive roles in health and disease (Figure 1) . Hypoalbuminaemia is common in critical illness. Human albumin solution has been administered clinically for more than five decades, but its use has been subject to marked controversy for the last twenty years (Fanali...
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