Electronic Smart Order-Set for Diagnostic Stewardship of C. difficile Infection
2024 28 Jun
A new study published in the American Journal of Infection Control highlights a novel approach to testing for Clostridioides difficile (C. diff) based on the principles of diagnostic stewardship. At Memorial Healthcare System in Hollywood, Fla., revised guidelines for ordering C. diff tests reduced inappropriate testing by 20%, which can help...Read more
Economic Evaluation of the OPTI-MEND Trial
2024 26 Jun
The evaluation of the OPTI-MEND trial reveals that adding a dedicated professional team to existing emergency department (ED) care significantly enhances patients’ quality of life and saves an average of €6,128 per person. ED crowding is a growing issue globally, negatively impacting healthcare outcomes and patient satisfaction. Researchers...Read more
Organ Donation After Extracorporeal Cardiopulmonary Resuscitation
2024 22 Jun
With the global demand for organ transplants on the rise, the shortage of available organs has worsened, leaving the supply insufficient to meet the growing need. One way to address this crisis is to identify potential organ donors, particularly by screening for brain death in ICUs, especially after cardiac arrest. Extracorporeal cardiopulmonary...Read more
CENTER-TBI - Haemoglobin Values, Transfusion Practices, Outcomes
2024 19 Jun
Severe traumatic brain injury (TBI) can cause lasting cognitive, motor, and emotional issues. Despite advances in emergency care and neurosurgery, the long-term effects of TBI remain challenging for patients, caregivers, and healthcare providers. Managing TBI focuses on preventing secondary brain injuries, which can develop hours to days...Read more
Proton-Pump Inhibitors to Prevent Gastrointestinal Bleeding
2024 18 Jun
A recent systematic review evaluated the effectiveness and safety of proton-pump inhibitors (PPIs) for preventing stress ulcers in critically ill patients. The review included randomised trials that compared PPIs with placebo or no prophylaxis in critically ill adults. Meta-analyses were performed, and evidence was assessed using the Grading...Read more
NIH Intervention to Reduce Opioid-Related Overdose Deaths
2024 16 Jun
A National Institutes of Health’s HEALing (Helping to End Addiction Long-Term) Communities Study evaluated a data-driven intervention aimed at reducing opioid-related overdose deaths by engaging communities to implement evidence-based practices, such as increasing naloxone distribution and enhancing access to medication for opioid use disorder....Read more
Machine Learning Alerts to Prevent Escalation of Care
2024 14 Jun
Deploying and evaluating a machine learning intervention to improve clinical care and patient outcomes is a key step in moving clinical deterioration models from byte to bedside. A Mount Sinai study found that hospitalised patients were 43% more likely to have their care escalated and significantly less likely to die if their care team received...Read more
Noninvasive Ventilation During Emergency Intubation
2024 13 Jun
In current clinical practice, most critically ill adults undergoing emergency tracheal intubation receive preoxygenation through an oxygen mask. Administering supplemental oxygen before intubation increases the oxygen content in the patient’s lungs, reducing the risk of hypoxaemia. Despite this, hypoxaemia occurs during 10% to 20% of tracheal...Read more
Effectiveness of Alternative Spontaneous Breathing Trial Techniques
2024 11 Jun
For intubated critically ill adults and children, minimising invasive mechanical ventilation to reduce complications is crucial. Early identification of when patients can safely transition to spontaneous breathing aims to shorten ventilation duration. However, clinicians must balance this with the risk of reintubation, which occurs in about 10%...Read more
LLM Capabilities in Perioperative Risk Prediction, Prognostication
2024 11 Jun
General-domain large language models may perform risk stratification and predict postoperative outcome measures using procedure descriptions and a patient's electronic health record notes. A recent study examined the predictive performance of a model on eight tasks: prediction of American Society of Anesthesiologists Physical Status (ASA-PS),...Read more
VV-ECMO, Prone Position and Supine MV for Hypoxaemic ARDS
2024 11 Jun
Severe acute respiratory distress syndrome (ARDS) with PaO2/FiO2 < 80 mmHg is life-threatening, and its optimal management strategy is unclear. This meta-analysis aimed to compare the effects of low tidal volumes (Vt), moderate Vt, prone ventilation, and venovenous extracorporeal membrane oxygenation (VV-ECMO) on mortality in severe ARDS. ...Read more
Nirmatrelvir-Ritonavir for Long-COVID
2024 09 Jun
In a recent clinical trial, a 15-day course of nirmatrelvir-ritonavir targeting SARS-CoV-2 was found to be safe as an extended-duration treatment. However, it did not alleviate specific symptoms of long COVID. These findings are published in JAMA Internal Medicine. The combination of nirmatrelvir-ritonavir is approved by the FDA for treating...Read more
Inequities in Nurses’ Moral Distress
2024 08 Jun
Research indicates that when nurses feel blocked from taking morally justifiable actions or achieving ethical outcomes, it leads to poor mental health, burnout, and a desire to leave their jobs. During the COVID-19 pandemic, surveys revealed that shortages of personal protective equipment (PPE) and lack of support from hospital administrators were...Read more
Novel Lipopeptide Effective Against Staphylococcus Aureus
2024 07 Jun
A novel antibacterial lipopeptide produced by the bacterium Serratia marcescens is highly effective in killing Staphylococcus aureus , one of the most significant pathogens in humans. Staphylococcus aureus is among the five most common causes of hospital-acquired infections, often leading to life-threatening infections following surgery....Read more
Expanding Patient Care in Community Pharmacies
2024 05 Jun
Expanding the role of pharmacists in treating minor illnesses could potentially save millions in healthcare costs, according to new research led by Washington State University. The findings suggest that increasing pharmacists' clinical services, including prescribing medications, can enhance healthcare access amid a shortage of primary care providers....Read more
Artificial Intelligence and Human Values
2024 04 Jun
Recent advancements in generative AI have produced large language models (LLMs) capable of writing persuasive articles, passing professional exams, and crafting empathetic messages. While their potential in medicine and healthcare is significant, concerns about their accuracy, reliability, and alignment with human values persist. These concerns...Read more
Incidence of Traumatic Brain Injury in Older Adults
2024 02 Jun
According to a study by UC San Francisco and the San Francisco VA Health Care System, approximately 13% of older adults are diagnosed with traumatic brain injury (TBI), typically caused by ground-level falls. The findings are published in JAMA. Researchers tracked around 9,200 Medicare enrollees, with an average age of 75 at the study’s outset....Read more
Ethical, Religious Barriers to Providing Medical Aid in Dying
2024 02 Jun
Recently published research by the University of Colorado Anschutz Medical Campus examines the prevalence and impact of physicians’ ethical or religious barriers to involvement in medical aid in dying (MAiD). MAiD is a multi-step process where a physician provides a terminally ill adult with decision-making capacity a lethal dose of medication...Read more
Prompt Antimicrobial Therapy in Adults with Bacteraemia
2024 30 May
Bloodstream infections significantly impact morbidity, mortality, and healthcare costs despite advancements in critical care and antimicrobial strategies. Prompt assessment and source control, as recommended by the Surviving Sepsis Campaign, are important to improve outcomes for severe sepsis and septic shock patients. Timely source control is crucial...Read more
Nutrition: From Acute Phase to Beyond
2024 30 May
In acute critical illness, catabolism leads to muscle wasting, weakness, and difficulty in weaning from ventilation. Low intake of protein, energy, and micronutrients can worsen catabolism, leading to infections, delayed recovery, and increased mortality. Traditionally, it was believed that nutrition could counteract catabolism and improve outcomes....Read more
Emergency Nurses Face Issues Related to Training, Staffing, Stress, Overflowing EDs
2024 23 May
Nurses working in emergency departments seek more training, stating that the high-pressure environment can negatively affect their decision-making. Researchers from the University of East Anglia (UEA) conducted the first-ever U.K. survey of triage nurses to explore their backgrounds, training, and decision-making processes. The study is published in...Read more
ESICM/NACCS Recommendations: Targeted Temperature Control Following TBI
2024 22 May
Traumatic brain injury (TBI) is a highly prevalent global health issue, causing significant mortality and disability. It results from external forces affecting brain function or structure. TBI involves primary damage from the initial impact, followed by secondary injury processes such as ischaemia, swelling, and metabolic changes, which worsen...Read more
Expiratory Flow Limitation During Mechanical Ventilation
2024 22 May
Expiratory flow limitation (EFL) occurs when the expiratory flow cannot increase despite higher driving pressure at a given lung volume. In airway disease patients, this can happen during tidal expiration (tidal EFL - EFLT). The prevalence of EFLT in intubated patients varies with population, PEEP settings, and detection methods, with up to one-third...Read more
Corticosteroids in Critically Ill Patients With Sepsis, ARDS and CAP
2024 14 May
Critical illness-related corticosteroid insufficiency (CIRCI) is commonly seen in criticall ill patients and involves systemic inflammation, hypothalamus–pituitary–adrenal axis dysregulation, altered cortisol metabolism, and tissue glucocorticoid resistance. A task force of international experts from the Society of Critical Care Medicine...Read more
Past, Present, and Future of Sustainable Intensive Care
2024 14 May
Climate change is a critical challenge of the 21st century, with fossil fuel combustion being the largest contributor, responsible for over 75% of greenhouse gas (GHG) emissions. The global healthcare industry significantly impacts the environment, accounting for up to 5% of global carbon emissions, with the U.S. contributing the largest share....Read more
Specialty Emergency Departments - The Future of Emergency Care?
2024 14 May
Specialised emergency departments (EDs) are emerging, focusing on specific patient populations such as oncologic, geriatric, or orthopaedic cases. Advocates argue that these specialised centres can provide more targeted and cost-effective care. They may alleviate pressure on general EDs while potentially improving overall care quality. However, the...Read more
Evaluating Remote Patient Monitoring for Reducing Return Visits to the Emergency Department
2024 30 Apr
Return visits to the emergency department (ED) pose a challenge to healthcare organisations, with significant financial and care implications. About 20% of patients return to the ED within 30 days, with some visits being preventable. Factors contributing to return visits include fear, anxiety, convenience, and expedited evaluation. While the correlation...Read more
Understanding Respiratory Drive
2024 30 Apr
Understanding respiratory drive is crucial in managing critically ill patients. Recent data suggest high and low respiratory drive can negatively impact patient outcomes. However, “respiratory drive” can be ambiguous without understanding its determinants and underlying pathophysiology. In critically ill patients, ventilatory demands reflected...Read more
Transforming Research to Improve Therapies for Trauma
2024 30 Apr
The impact of trauma on global health is significant, resulting in millions of deaths and disabilities annually, with a particularly high toll on young people. However, the elderly are also increasingly affected. Variances in trauma-related death patterns worldwide are influenced by factors such as prompt treatment availability and the prevalence...Read more
Low vs High Blood Pressure Targets in Critically Ill and Surgical Patients
2024 25 Apr
The treatment of critically ill and perioperative patients often involves targeting blood pressure as a cornerstone of haemodynamic management. Current guidelines suggest maintaining high blood pressure targets for these patients based on observational studies linking hypotensive events to adverse outcomes. However, these recommendations are not based...Read more
