Do We Need New Trials of Procalcitonin-Guided Antibiotic Therapy?

Do We Need New Trials of Procalcitonin-Guided Antibiotic Therapy?

Using biomarkers as a guide to tailor the duration of antibiotic treatment in respiratory infections is an attractive hypothesis assessed in several studies. Recent work aiming to summarize the evidence assessed the effect... read more

Prompt Administration of Antibiotics and Fluids in the Treatment of Sepsis

Prompt Administration of Antibiotics and Fluids in the Treatment of Sepsis

We conclude that antibiotic therapy is highly time sensitive, and efforts should be made to deliver this critical therapy as early as possible in sepsis, perhaps extending into the first point of medical contact outside the... read more

Association of ICH Among Patients Taking Non–Vitamin K Antagonist vs Vitamin K Antagonist Oral Anticoagulants With In-Hospital Mortality

Association of ICH Among Patients Taking Non–Vitamin K Antagonist vs Vitamin K Antagonist Oral Anticoagulants With In-Hospital Mortality

Among patients with ICH, prior use of NOACs or warfarin was associated with higher in-hospital mortality compared with no OACs. Prior use of NOACs, compared with prior use of warfarin, was associated with lower risk of in-hospital... read more

Advanced Hemodynamic and Cardiopulmonary Ultrasound for Critically Ill Patients

Advanced Hemodynamic and Cardiopulmonary Ultrasound for Critically Ill Patients

Focused echocardiography, advanced hemodynamic, and cardiopulmonary point-of-care ultrasound studies provide time-sensitive evaluation of critically ill patients, guiding and facilitating earlier implementation of life-preserving... read more

The Case of the Relative Insufficiency

The Case of the Relative Insufficiency

When it comes to the efficacy of glucocorticoid therapy for the treatment of septic shock, we have existed in a state of ambiguity, torn between the results of two contradictory RCTs. The first, the Annane et al trial published... read more

Adjunctive Glucocorticoid Therapy in Patients with Septic Shock

Adjunctive Glucocorticoid Therapy in Patients with Septic Shock

Among patients with septic shock undergoing mechanical ventilation, a continuous infusion of hydrocortisone did not result in lower 90-day mortality than placebo. We randomly assigned patients with septic shock who were undergoing... read more

ECMO for Severe Middle East Respiratory Syndrome Coronavirus

ECMO for Severe Middle East Respiratory Syndrome Coronavirus

Extracorporeal membrane oxygenation (ECMO) use, as a rescue therapy, was associated with lower mortality in MERS patients with refractory hypoxemia. The results of this, largest to date, support the use of ECMO as a rescue... read more

Acute Kidney Injury in Sepsis

Acute Kidney Injury in Sepsis

Acute kidney injury (AKI) and sepsis carry consensus definitions. The simultaneous presence of both identifies septic AKI. Septic AKI is the most common AKI syndrome in ICU and accounts for approximately half of all such... read more

Chloride and Other Electrolyte Concentrations in Commonly Available 5% Albumin Products

Chloride and Other Electrolyte Concentrations in Commonly Available 5% Albumin Products

This study is the first to identify and document a statistically significant variability in the chloride concentration of available 5% albumin products. This study has also informed a pilot randomized controlled trial examining... read more

The Fallacy of Time-to-Intervention Studies

The Fallacy of Time-to-Intervention Studies

We are barraged by time-to-intervention studies (door-to-balloon time, time-to-antibiotics, door-to-needle, etc.). However, it must be kept in mind that these studies are purely correlational in design. Such studies cannot... read more

Balanced Crystalloids vs Saline for Critically Ill Adults

Balanced Crystalloids vs Saline for Critically Ill Adults

Among critically ill adults, use of balanced crystalloids for intravenous fluid administration reduced the composite of death, new renal replacement therapy, and persistent renal dysfunction compared with use of saline. Patients... read more

PCI Strategies in Patients with Acute Myocardial Infarction and Cardiogenic Shock

PCI Strategies in Patients with Acute Myocardial Infarction and Cardiogenic Shock

In patients who have acute myocardial infarction with cardiogenic shock, early revascularization of the culprit artery by means of percutaneous coronary intervention (PCI) improves outcomes. However, the majority of patients... read more

Hope is a Therapeutic Tool

Hope is a Therapeutic Tool

Everyone who has been a patient, or accompanied a relative to see a doctor, recognises the importance of the doctor-patient relationship. At its heart is the patient's need to understand what is wrong, be understood, and... read more

Is Simvastatin the Miracle Drug We Think It Is?

Is Simvastatin the Miracle Drug We Think It Is?

Evaluation of early administration of simvastatin in the prevention and treatment of delirium in critically ill patients undergoing mechanical ventilation. This well designed and conducted trial demonstrates that there is... read more