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January 12, 2018

Intensive Care Medicine journal

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Yongfang Zhou et al. Early application of airway pressure release ventilation may reduce the duration of mechanical ventilation in acute respiratory distress syndrome. It was important to apply the physiology theoretical knowledge of APRV and the findings of recent experiment researches to standardise the APRV settings. The early use of the updated APRV methodology in patients with ARDS, was associated with better oxygenation and respiratory system compliance, lower plateau pressure, and lower analgesia and sedation requirements, and could increase the ventilator- free days at 28 days and reduce the duration of ICU stay, compared with the low tidal volume ventilation.

Melanie Meersch et al. Prevention of cardiac surgery-associated AKI by implementing the KDIGO guidelines in high risk patients identified by biomarkers: the PrevAKI randomised controlled trial. An implementation of the KDIGO-guidelines compared with standard care reduced the frequency and severity of AKI after cardiac surgery in high risk patients defined by renal biomarkers.

John Muscedere et al. The impact of frailty on intensive care unit outcomes: a systematic review and meta-analysis. Critically ill frail patients are at increased risk of mortality and adverse outcomes compared to non-frail patients admitted to an ICU

Rinaldo Bellomo et al. Acute kidney injury in sepsis. Septic AKI is the dominate AKI in ICU. This article reviews its definition, diagnosis, epidemiology, pathophysiology, treatment and prognosis.

Paul E. Marik et al. Fluid administration in severe sepsis and septic shock, patterns and outcomes: an analysis of a large national database. In patients with severe severe and septic shock administration of more the 5 litres of fluid in the first hospital day is an independent predictor of death. Fluid overload is an independent predictor of death in patients with severe sepsis and septic shock.

Sean M. Bagshaw et al. Current state of the art for renal replacement therapy in critically ill patients with acute kidney injury. State of the art review on provision of renal replacement therapy for ICU patients with acute kidney injury.

Massimo Cressoni et al. Opening pressures and atelectrauma in acute respiratory distress syndrome. At a given applied opening pressure, the amount of recruited lung tissue depends on ARDS severity. Whatever severity is, 30 cmH2O plateau pressure and 15 cmH2O of PEEP are ineffective to prevent atelectrauma (cyclic intratidal collapse) and to decrease lung inhomogeneities. In ARDS 15cmH2O PEEP neither prevent atelectrauma (~100g tissue in severe ARDS undergo intratidal collapse) nor reduce lung inhomogeneities.

Andrea Morelli et al. Extracorporeal carbon dioxide removal (ECCO2R) in patients with acute respiratory failure. ECCO2R is a promising strategy for patients with decompensated COPD or ARDS without life-threatening hypoxaemia; more research is needed.

Christophe Milési et al. High flow nasal cannula (HFNC) versus nasal continuous positive airway pressure (nCPAP) for the initial respiratory management of acute viral bronchiolitis in young infants: a multicentre randomised controlled trial (TRAMONTANE study). In young infants with acute viral bronchiolitis, the effectiveness of HFNC was not equivalent to that of nCPAP as the initial respiratory support. A majority of the failures with HFNC occurred within 6 hours following initiation, and worsening of respiratory distress was the leading cause. In young infants with acute viral bronchiolitis, initial management with HFNC did not have an effectiveness similar to that of nCPAP.

Paolo Taccone et al. Do we really need postoperative ICU management after elective surgery? No, not any more! Recently, the value of routine ICU admission after elective surgery has been questioned, given its costs and the lack of robust evidence supporting it. Taccone argues that it is a clear priority for perioperative medicine to find more efficient alternatives to traditional ICUs for postoperative care of elective surgical patients.

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