Optimizing Therapy of Bloodstream Infection Due to Extended-spectrum β-lactamase-producing Enterobacteriaceae

Optimizing Therapy of Bloodstream Infection Due to Extended-spectrum β-lactamase-producing Enterobacteriaceae

Carbapenems should be used in patients with serious infections; alternatives could be used individually, particularly for definitive treatment of patients with milder presentations. Meropenem and imipenem are the drugs... read more

Assessment of Microcirculation in Cardiogenic Shock

Assessment of Microcirculation in Cardiogenic Shock

The parameter most frequently used to detect tissue malperfusion is serum lactate. Novel, noninvasive methods to quantify microvascular perfusion have the potential to guide treatment in terms of optimizing organ perfusion... read more

Risk Factors Associated with 30-day Mortality for Out-of-Center ECMO Support

Risk Factors Associated with 30-day Mortality for Out-of-Center ECMO Support

Out-of-hospital extracorporeal membrane oxygenation (ECMO) implantation and ECMO transport have become a growing field useful for emergent treatment of heart or lung failure with increasing number of centers launching such... read more

Early Goal-directed Therapy Using a Physiological Holistic View

Early Goal-directed Therapy Using a Physiological Holistic View

If peripheral perfusion-targeted resuscitation improves 28-day mortality, this could lead to simplified algorithms, assessing almost in real-time the reperfusion process, and pursuing more physiologically sound objectives.... read more

Sex-specific Differences in Survival After Out-of-hospital Cardiac Arrest

Sex-specific Differences in Survival After Out-of-hospital Cardiac Arrest

This nationwide, population-based observational study in Japan included 386,535 adult patients aged ≥ 18 years with out-of-hospital cardiac arrest (OHCA). In all these patients, resuscitation was attempted by EMS personnel... read more

Terlipressin for Septic Shock Patients

Terlipressin for Septic Shock Patients

Catecholamines are commonly used in septic shock but face limitations of their hypo-responsiveness and adverse events due to high dose. Terlipressin is a synthetic vasopressin analog with greater selectivity for the V1-receptor.... read more

Ideas for Future Intensive Care

Ideas for Future Intensive Care

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 accepted but... read more

Minimizing Catecholamines and Optimizing Perfusion

Minimizing Catecholamines and Optimizing Perfusion

The main goal of hemodynamic resuscitation in shock is to improve tissue perfusion and oxygenation. As these cannot be directly evaluated at bedside in routine practice, physicians are left with surrogates such as perfusion... read more

Measuring Lactate vs. Capillary Refill in Guiding Resuscitation in Shock

Measuring Lactate vs. Capillary Refill in Guiding Resuscitation in Shock

Capillary refill is as least as good as measuring lactate in guiding resuscitation efforts in septic shock. Moreover, using a lactate-driven resuscitation strategy led to use of more pressors and more IV fluid administration... read more

Excited Delirium: Acute Management in the ED Setting

Excited Delirium: Acute Management in the ED Setting

Excited delirium syndrome is a common yet poorly characterized ED presentation with a wide differential diagnosis. Patients are often identified initially by law enforcement, but attempts to control individuals experiencing... read more

Relationship of at Admission Lactate, Unmeasured Anions, and Chloride to the Outcome of Critically Ill Patients

Relationship of at Admission Lactate, Unmeasured Anions, and Chloride to the Outcome of Critically Ill Patients

Four thousand nine hundred one patients were admitted throughout the study period; 1,609 met criteria for metabolic acidosis and 145 had normal acid-base values. The association between at admission lactate, unmeasured anions,... read more

Lactate-Guided Resuscitation Only Encourages Over-Resuscitation and Downstream Harms

Lactate-Guided Resuscitation Only Encourages Over-Resuscitation and Downstream Harms

The Centers for Medicare and Medicaid Services and the Surviving Sepsis Campaign both rushed to offer guidance on the appropriate management strategies for patients presenting with septic shock. In both cases, a lactate-guided... read more

Prognostic Accuracy of the Serum Lactate Level, the SOFA Score and the qSOFA Score for Mortality Among Adults with Sepsis

Prognostic Accuracy of the Serum Lactate Level, the SOFA Score and the qSOFA Score for Mortality Among Adults with Sepsis

Sepsis is a common critical condition caused by the body’s overwhelming response to certain infective agents. Many biomarkers, including the serum lactate level, have been used for sepsis diagnosis and guiding treatment.... read more

Loss of Sphingosine 1-Phosphate in Septic Shock is Predominantly Caused by Decreased Levels of HDL

Loss of Sphingosine 1-Phosphate in Septic Shock is Predominantly Caused by Decreased Levels of HDL

Sphingosine 1-phosphate (S1P) is a signaling lipid essential in regulating processes involved in sepsis pathophysiology, including endothelial permeability and vascular tone. Serum S1P is progressively reduced in sepsis patients... read more