Since the publication of the retrospective before and after study by Dr. Marik and colleagues, in which administration of hydrocortisone, intravenous (IV) vitamin C, and thiamine was indicated to provide a survival advantage in septic patients [1], there has been a prevalence of clinical trials of variable quality and subsequent meta-analyses indicating variable outcomes [2]. Unlike previous combination

Alarms from monitors, medical devices and staff activities increase noise levels in the Intensive Care Unit (ICU) and may disrupt sleep patterns [1] contributing to the development of delirium and post-intensive care syndrome [2]. The World Health Organization (WHO) recommend that hospital noise levels should not exceed 35 A-weighted decibels (dBA) during the day and 30 dBA at night [3]. However, daytime

Extracorporeal membrane oxygenation (ECMO) is used to provide temporary cardiorespiratory support to critically ill children. While short-term outcomes and costs have been evaluated in this population, less is known regarding long-term survival and costs. Population-based cohort study from Ontario, Canada (October 1, 2009 to March 31, 2017), of pediatric patients (< 18 years of age) receiving ECMO

In December 2019, a newly identified coronavirus (SARS-CoV-2) major outbreak appeared in Wuhan City, Hubei Province, and it is now termed the Covid-19. The SARS-CoV-2 infection moved rapidly through China [1, 2] and spread to more than 90 countries. As of February 26, 2020, 78,064 patients were cumulative diagnosed, 12,224 cases were accumulative severe status. On January 29, 2020, the Chinese Society

Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence

The authors have retracted this case report [1] because the head of the snake shown in Figure 1 and described as being that of a viper (Echis occellatus) is identical to the head of a snake shown in Figure 1 of a different case report [2] where it was identified as being Naja melanoleuca, a member of the Elapidae family.

The level of automation in mechanical ventilation has been steadily increasing over the last few decades. There has recently been renewed interest in physiological closed-loop control of ventilation. The development of these systems has followed a similar path to that of manual clinical ventilation, starting with ensuring optimal gas exchange and shifting to the prevention of ventilator-induced lung

Dear Editor, Use of high-flow nasal cannula (HFNC) is common in critically ill patients with or at risk of respiratory failure. Its benefits include accurate delivery of the set fraction of inspired oxygen (FiO2), carbon dioxide washout from nasopharyngeal dead space, provision of small degree of positive end-expiratory pressure, and improved tolerance due to the comfortable interface [1,2,3]. To continuously

E-PRE-DELIRIC is a point-of-admission ICU delirium risk prediction tool [1], with reported good or moderate performance [2,3,4]. In this study, we assessed its performance in a large UK teaching hospital general ICU using routinely collected data, as approved by the local Research Data Governance Committee. We retrospectively analysed data for 2445 consecutive ICU admissions (November 2014 to June

Abstract Background The outbreak of a novel coronavirus (2019-nCoV)-infected pneumonia (NCIP) is currently ongoing in China. Most of the critically ill patients received high-flow nasal cannula (HFNC) oxygen therapy. However, the experience of HFNC in this population is lacking. Methods We retrospectively screened 318 confirmed patients with NCIP in two hospitals of Chongqing, China, from January 1st

Almost one third of the patients with candidemia develop septic shock. The understanding why some patients do and others do not develop septic shock is very limited. The objective of this study was to identify variables associated with septic shock development in a large population of patients with candidemia. A post hoc analysis was performed on two prospective, multicenter cohort of patients with

Recently, Wong et al. reported increased 28-day mortality among 328 children with pediatric acute respiratory distress syndrome (PARDS) managed with high-frequency oscillatory ventilation (HFOV) [1]. This study is an excellent example of gaining a better understanding of pediatric critical care through multicenter collaboration. Nonetheless, there are some nuances one should consider before interpreting

Since December 2019, the first case of a novel coronavirus (COVID-19) infection pneumonia was detected in Wuhan, and the outbreak has been spreading rapidly in the world. As of February 18, 2020, a total of 73,332 cases of confirmed COVID-19 infection have been detected in the world as reported by the WHO [1, 2]. Given that the asymptomatic persons are potential sources of COVID-19 infection [3], we

As of March 8, 2020, the novel coronavirus disease 2019 (COVID-19) had caused 80,815 human infections and 3073 deaths in China, including more than 3000 infections among medical staff. Guangdong Second Provincial General Hospital (Guangzhou, Guangdong Province, China), a provincial emergency hospital, has treated more than 35 confirmed cases of COVID-19 and more than 260 suspected cases. Most of nurses’

We read with interest the analysis comparing outcomes in paediatric acute respiratory distress syndrome (pARDS) among those who required high-frequency oscillatory ventilation (HFOV) as ‘rescue therapy’, compared to those who did not [1]. The authors must be congratulated for using multiple matching techniques to account for some confounders. We also commend them for making the code used for analysis

Abstract Background Lactate is a robust prognostic marker for the outcome of critically ill patients. Several small studies reported that metformin users have higher lactate levels at ICU admission without a concomitant increase in mortality. However, this has not been investigated in a larger cohort. We aimed to determine whether the association between lactate levels around ICU admission and mortality

This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2020. Other selected articles can be found online at https://www.biomedcentral.com/collections/annualupdate2020. Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/8901.

This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2020. Other selected articles can be found online at https://www.biomedcentral.com/collections/annualupdate2020. Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/8901.

This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2020. Other selected articles can be found online at https://www.biomedcentral.com/collections/annualupdate2020. Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/8901.

This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2020. Other selected articles can be found online at https://www.biomedcentral.com/collections/annualupdate2020. Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/8901.

This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2020. Other selected articles can be found online at https://www.biomedcentral.com/collections/annualupdate2020. Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/8901.

This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2020. Other selected articles can be found online at https://www.biomedcentral.com/collections/annualupdate2020. Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/8901.

This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2020. Other selected articles can be found online at https://www.biomedcentral.com/collections/annualupdate2020. Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/8901.

This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2020. Other selected articles can be found online at https://www.biomedcentral.com/collections/annualupdate2020. Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/8901.

This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2020. Other selected articles can be found online at https://www.biomedcentral.com/collections/annualupdate2020. Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/8901.

This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2020. Other selected articles can be found online at https://www.biomedcentral.com/collections/annualupdate2020. Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/8901.

Abstract Background Ventilation/perfusion inequalities impair gas exchange in acute respiratory distress syndrome (ARDS). Although increased dead-space ventilation (VD/VT) has been described in ARDS, its mechanism is not clearly understood. We sought to evaluate the relationships between dynamic variations in VD/VT and extra-pulmonary microcirculatory blood flow detected at sublingual mucosa hypothesizing

Abstract Background Evidence supporting corticosteroids adjunctive treatment (CAT) for Pneumocystis jirovecii pneumonia (PCP) in non-HIV patients is highly controversial. We aimed to systematically review the literature and perform a meta-analysis of available data relating to the effect of CAT on mortality of PCP in non-HIV patients. Methods We searched Pubmed, Medline, Embase, and Cochrane database

Decreased monocytic (m)HLA-DR expression is the most studied biomarker of sepsis-induced immunosuppression. To date, little is known about the relationship between sepsis characteristics, such as the site of infection, causative pathogen, or severity of disease, and mHLA-DR expression kinetics. We evaluated mHLA-DR expression kinetics in 241 septic shock patients with different primary sites of infection

Patients in need of acute health care do not always contact the most suitable health care service provider. Contacting out-of-hours primary care for an urgent problem may delay care, whereas contacting emergency medical services for a non-urgent problem could ultimately affect patient safety. More insight into patient motives for contacting a specific health care provider may help optimise patient

An overwhelming proportion of road traffic deaths and injuries in low- and middle-income countries (LMICs) occur in prehospital environments. Lay first responders such as police officers play an important role in providing initial assistance to victims of road traffic injuries either alone or in collaboration with others. The present study evaluated a postcrash first aid (PFA) educational program developed

Just imagine this possible scenario: it is summer 2020 and our intensive care unit (ICU) is full of patients with COVID-19 and severe respiratory failure as a result of the newly described coronavirus, SARS-CoV-2 [1,2,3]. We have decreased virtually all the other activities in the hospital, so that there are not many critically ill patients with other problems. We have cancelled all non-urgent (and

Coronavirus disease (COVID-19), which appeared in December 2019, presents a global challenge, particularly in the rapid increase of critically ill patients with pneumonia and absence of definitive treatment. To date, over 81,000 cases have been confirmed, with over 2700 deaths. The mortality appears to be around 2%; early published data indicate 25.9% with SARS-CoV-2 pneumonia required ICU admission

Jia and colleagues have concluded that plasma endostatin shows a useful value for predicting failure to recover from acute kidney injury (AKI) [1]. They studied two populations of patients with AKI following non-cardiac major surgery, with the primary endpoint of recovery or “non-recovery” from AKI. Patients classified as “non-recovery” from AKI in fact consisted of two groups, a cohort receiving renal

Custodero et al. conclude that N-terminal pro-brain natriuretic peptide (NT-proBNP) levels during the acute phase of sepsis may be a useful indicator of higher risk of long-term impairments in physical function and muscle strength in sepsis survivors [1]. A letter from Jiarong et al. has challenged this assertion, pointing to the exponential increase in the plasma level of NT-proBNP with a declining

Dear Editor, Although COVID-19 has not been officially labelled as a pandemic yet, the global burden of disease is significant and continues to rise. The virus has a high human-to-human transmissibility via airborne, droplet and contact routes [1]. Patient numbers can surge, and hospitals should be ready not just with the infrastructure, but also staff to be familiar with workflows. Kain and Fowler

Concomitant vasoactive drugs are often required to maintain adequate perfusion pressure in patients with acute myocardial infarction (AMI) and cardiogenic shock (CS) receiving hemodynamic support with an axial flow pump (Impella CP). To compare the effect of equipotent dosages of epinephrine, dopamine, norepinephrine, and phenylephrine on cardiac work and end-organ perfusion in a porcine model of profound

Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection. Numerous studies have explored the complex and dynamic transcriptome modulations observed in sepsis patients, but a large fraction of the transcriptome remains unexplored. This fraction could provide information to better understand sepsis pathophysiology. Multiple levels of interaction between

In late December 2019, an outbreak of the 2019-novel coronavirus (COVID-19) caused a substantial public health crisis in Wuhan, China, and then expeditiously spread all over China [1,2,3]. As of March 4, 2020, 80,409 cases of COVID-19 had been confirmed in mainland China [4]. While in Heilongjiang province, which locates in northeastern China with 38.24 million residents and an area of 473,000 km2

The recent outbreak of coronavirus disease 2019 (COVID-19), caused by a new zoonotic coronary virus, SARS-CoV-2 [1], is being a great threat to public health. Up to February 11, 2020, it is reported that over 70,000 persons have been infected with SARS-CoV-2 in China [2]. The COVID-19 caused by SARS-CoV-2 infection represents a spectrum of clinical severity [3,4,5]. Some patients are asymptomatic or

Candidemia is an opportunistic infection associated with high morbidity and mortality in patients hospitalized both inside and outside intensive care units (ICUs). Identification of patients at risk is crucial to ensure prompt antifungal therapy. We sought to assess risk factors for candidemia and death, both outside and inside ICUs. This prospective multicenter matched case-control study involved

This article is a report of designing a rapid and effective guide for paramedics who take care of patients in a pre-hospital setting to answer developing demands. The relevant literature was reviewed, and the topics were extracted. Then, the extracted items were discussed in an expert panel. Finally, items were discussed in a meeting including emergency technicians and emergency technical assistants

Simple mnemonics can help prevent inappropriate or unnecessary therapeutic interventions in the ICU. Some years ago, the “FAST-HUG” acronym was developed [1], summarizing key aspects of routine ICU patient management (feeding, analgesia, sedation, thromboembolic prevention, head-of-bed elevation, ulcer prophylaxis, glucose control); this acronym is now used in many ICUs worldwide. Management of patients

Diaphragm atrophy and dysfunction are consequences of mechanical ventilation and are determinants of clinical outcomes. We hypothesize that partial preservation of diaphragm function, such as during assisted modes of ventilation, will restore diaphragm thickness. We also aim to correlate the changes in diaphragm thickness and function to outcomes and clinical factors. This is a prospective, multicentre

Whereas ICU-acquired weakness may delay extubation in mechanically ventilated patients, its influence on extubation failure is poorly known. This study aimed at assessing the role of ICU-acquired weakness on extubation failure and the relation between limb weakness and cough strength. A secondary analysis of two previous prospective studies including patients at high risk of reintubation after a planned

The publication by Schlapbach et al. used a sepsis mortality prediction model to define a mortality threshold above which patients suffering from septic shock could benefit from venoarterial ECMO (VA-ECMO). When predicted mortality was lower than 47.1%, the measured mortality was 11.8% higher, while when the predicted mortality was higher than 47.1%, the measured mortality was 16.2% lower. Seventy-one

Point of care serum lactate measurement is emerging as an adjunct to prehospital clinical assessment and has the potential to guide triage and advanced treatment decision-making. In this study we aimed to assess which factors potentially affect prehospital lactate levels. We performed a retrospective cohort study of all trauma patients attended by the Air Ambulance, Kent, Surrey & Sussex (AAKSS) between

Dear Editor, Historically, fungal infections have not been considered an important influenza complication. In 2018, a retrospective multicenter cohort study in Belgium and the Netherlands identified aspergillosis in 19% of patients with severe influenza. As influenza seemed independently associated with IPA, the term influenza-associated pulmonary aspergillosis (IAPA) was introduced [1, 2]. In contrast

There are many high-volume trauma centers in limited resource environments where a thorough clinical examination of patients may contribute to a more economical, accurate, and widely applicable method of determining the proper management of patients with penetrating neck injuries. The purpose of this study was to validate thorough physical examination as a reliable diagnostic tool in these patients

Dear Editor, About a third of patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) become critically ill and require intensive care unit (ICU) admission [1]. As the COVID-19 (coronavirus disease-19) outbreak spreads [2], ICUs outside of China need to prepare for a potential surge of critically ill patients and counter the high transmissibility of SARS-CoV-2 [3]. Liu et

Mechanical ventilation to alter and improve respiratory gases is a fundamental feature of critical care and intraoperative anesthesia management. The range of inspired O2 and expired CO2 during patient management can significantly deviate from values in the healthy awake state. It has long been appreciated that hyperoxia can have deleterious effects on organs, especially the lung and retina. Recent

The aim of this study is to validate a previously published consensus-based quality indicator set for the management of patients with traumatic brain injury (TBI) at intensive care units (ICUs) in Europe and to study its potential for quality measurement and improvement. Our analysis was based on 2006 adult patients admitted to 54 ICUs between 2014 and 2018, enrolled in the CENTER-TBI study. Indicator

In the publication of this article [1], there was an error in the Family Name of one of the authors. This has now been updated in the original article.

The association of central venous pressure (CVP) and mortality and acute kidney injury (AKI) in critically ill adult patients remains unclear. We performed a meta-analysis to determine whether elevated CVP is associated with increased mortality and AKI in critically ill adult patients. We searched PubMed and Embase through June 2019 to identify studies that investigated the association between CVP

BACKGROUND Although studies on the effectiveness of the use of ICU diaries on psychiatric disorders and quality of life have been published, the results still seem to be controversial. The study aimed to determine the effects of using an ICU diary on psychiatric disorders, sleep quality, and quality of life (QoL) in adult ICU survivors in China. METHODS One hundred and twenty-six patients who underwent

BACKGROUND Postextubation high-flow nasal cannula (HFNC) is used as a support therapy in high-risk patients in ICU. This study aimed to determine the effects of HFNC therapy on lung recruitment and overdistension assessed by electrical impedance tomography (EIT). METHODS Twenty-four patients who received HFNC within 24 h after extubation were prospectively enrolled in this study. EIT was used to monitor

Severe acute kidney injury (AKI), especially when caused or accompanied by sepsis, is associated with prolonged hospitalization, progression to chronic kidney disease (CKD), financial burden, and high mortality rate. Continuous renal replacement therapy (CRRT) is a predominant form of renal replacement therapy (RRT) in the intensive care unit (ICU) due to its accurate volume control, steady acid-base

BACKGROUND High-frequency oscillatory ventilation (HFOV) may theoretically provide lung protective ventilation. The negative clinical results may be due to inadequate mean airway pressure (mPaw) settings in HFOV. Our objective was to evaluate the air distribution, ventilatory and hemodynamic effects of individual mPaw titration during HFOV in ARDS animal based on oxygenation and electrical impedance

Patient safety and critical care quality remain a challenging issue in the ICU. However, the effects of the national quality improvement (QI) program remain unknown in China. A national ICU QI program was implemented in a controlled cohort of 586 hospitals from 2016 to 2018. The effects of the QI program on critical care quality were comprehensively investigated. A total of 81,461,554 patients were

Pseudomonas aeruginosa infections are a serious threat in intensive care units (ICUs). The aim of this confirmatory, randomized, multicenter, placebo-controlled, double-blind, phase 2/3 study was to assess the efficacy, immunogenicity, and safety of IC43 recombinant Pseudomonas aeruginosa vaccine in non-surgical ICU patients. Eight hundred patients aged 18 to 80 years admitted to the ICU with expected