ESICM Talk
ESICM Talk is the official podcast of the European Society of Intensive Care Medicine. It covers topics related to intensive care medicine, including research, clinical practice, and professional development. The podcast features interviews with experts and discussions on the latest advancements in the field.
Episodes
Is the curtain falling on pre-hospital whole blood?
Whole blood has made a remarkable comeback in trauma care—but is it here to stay? In this thought-provoking podcast, leading experts unpack the latest evidence comparing whole blood with component therapy in the pre-hospital setting, challenge current practices, and explore what the future may hold. From military experience to civilian emergency care, discover how research is reshaping transfusion
Switching from controlled to assisted ventilation: evidence, risks, and opportunities in AHRF?
What are the benefits of moving from controlled to assisted mechanical ventilation in patients with Acute Hypoxemic Respiratory Failure (AHRF)? In this podcast, experts discuss the physiological rationale behind this transition, the potential advantages for patient recovery, and the risks clinicians need to consider. Join us as we explore the latest evidence and practical approaches to optimising
Biomarkers in Severe Infections and Sepsis - Moving from Trials to the Bedside
Sepsis care is evolving fast. Are you keeping up? Don’t miss this podcast episode, where we explore the latest clinical trials reshaping antibiotic therapy for severe infections, from optimised treatment durations to precision-driven de-escalation strategies. What does this new evidence mean for your day-to-day decisions in the ICU?We then turn to one of the most exciting frontiers in intensive ca
Advanced Practice in Nursing and Allied Health Professionals
What does advanced practice really look like in the ICU? In this podcast episode, we are joined by two advanced intensive care practitioners who share their roles, career journeys, and impact within the multidisciplinary team.Through real-world perspectives, this episode highlights the growing influence of nursing and allied health professionals in intensive care and how their expertise enhances p
Unmet Needs in PICS: Are We Measuring What Matters?
What truly matters in recovery after critical illness? In this episode, we explore the unmet needs in Post-Intensive Care Syndrome (PICS) and question whether current approaches are capturing the outcomes that matter most to patients and families.Join us as we discuss the challenges of measuring physical, cognitive, and psychological recovery after ICU, the gaps that still exist in long-term follo
Redefining Precision Nutrition: Where Science Meets the patient’s bedside
In this episode of the educational podcast, we explore what precision nutrition truly means in intensive care. While the concept is widely discussed in research, many studies remain descriptive or rely mainly on adjusted data, raising important questions about their real clinical impact. Together with the Editor-in-Chief of the Journal of Parenteral and Enteral Nutrition, Prof. Kenneth B. Christop
Why does renal recovery from AKI matter to us intensivists?
Acute Kidney Injury (AKI) is a frequent complication in critically ill patients and is associated with significant morbidity and mortality. However, the clinical relevance of AKI extends well beyond the acute episode. Renal recovery plays a crucial role in determining long-term patient outcomes, including the risk of chronic kidney disease, long-term dialysis dependence, and overall quality of lif
Kids visitations in the ICU. Ten recommendations for child-friendly visiting policies in critical care
Covert Consciousness
Prehabilitation in the ICU
Did you know that preparing patients before an ICU stay can lead to better recovery after? Prehabilitation programmes focus on strengthening physical, cognitive, and metabolic health before critical illness, ensuring a smoother rehabilitation journey post-discharge.Our NEXT colleagues dive into this crucial topic with expert guests, exploring how early intervention can transform patient outcomes.T
Post ICU outcomes and follow up
Post-Intensive Care Syndrome (PICS) refers to the prolonged impairment of physical, cognitive, and mental health that can occur after an intensive care stay. Its effects may last for over a decade after discharge. Our NEXT colleagues have explored this important topic in their podcast featuring Dr. Anne-Francoise Rousseau who addresses key questions and future strategies for managing PICS. Do not
Dose Optimisation in the ICU: The Role of TDM and Model-Based Solutions
A randomised controlled trial of a nurse facilitator to promote communication for family members of critically ill patients
Admission to the intensive care unit (ICU) can be a challenging experience for patients and their families. Psychological burdens, including symptoms of anxiety, depression and post-traumatic stress, are among the most reported during the ICU stay.A recent study has been carried out as a joint project between France and the United States in which the experts have designed an intervention to improv
European Society of Intensive Care Medicine guidelines on end of life and palliative care in the intensive care unit
The latest guidelines released from the European Society of Intensive Care Medicine (ESICM) are about end-of-life (EOL) and palliative care for critically ill adults! This comprehensive work, developed by an international, multi-disciplinary team of clinical experts, a methodologist, and patient and family representatives, is now accessible to all clinicians. We had the privilege of interviewing
Fluid management and mechanical ventilation strategies
Mechanical ventilation (MV) can impair gas exchange, destabilise hemodynamics, and injure endothelial cells. Intravenous (IV) fluid therapy helps to restore hemodynamics and ensure adequate distal organ perfusion. However, the interplay between restrictive and liberal fluid strategies due to the complex physiological interaction between the heart and lungs may affect ventilation and risk organ dam
When and how vasopressors in Sepsis?
The early initiation of vasopressors, ideally within the first hour of diagnosing septic shock, is emerging as a preferred strategy. This approach offers a multimodal action with potential benefits, including reduced morbidity and mortality. Prompt vasopressor therapy is crucial for effective management in septic shock patients. To dive deeper into the timing and administration of vasopressors, jo
Respiratory support in acute exacerbation in COPD
Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) represent sudden and severe declines in airway function and respiratory symptoms in COPD patients. The clinical presentation of AECOPD is diverse, demanding a treatment approach tailored to disease severity—beginning with antibiotic therapy and, in critical cases, advancing to mechanical ventilation for respiratory support. Tune
Multimodal approach to vascular failure in Sepsis
Septic shock triggers a dangerous drop in blood pressure and restricts blood flow to vital organs, making rapid intervention essential to prevent organ failure. This podcast will explore the power of a multimodal treatment approach—combining tailored medications, precise dosing, and supportive therapies—to amplify the body’s response to vasopressors.Don’t miss this insightful discussion!
Landiolol and Organ Failure in Patients With Septic Shock: The STRESS-L Randomized Clinical Trial
Autonomic dysfunction and tachycardia are strongly linked to poor outcomes in septic shock, contributing to high mortality rates. In the upcoming podcast, we explore whether β-blockade with landiolol for up to 14 days can reduce organ failure, as measured by the Sequential Organ Failure Assessment (SOFA) score, in critically ill patients with tachycardia and septic shock who have been on high-dose
Updates on the contemporary management of aneurysmal subarachnoid haemorrhage
Aneurysmal subarachnoid hemorrhage (aSAH) is a rare but devastating condition, marked by high global rates of fatality and long-term disability. Key factors influencing patient outcomes include early brain injury, aneurysm rebleeding, and delayed cerebral ischemia. In this podcast, Dr. Chiara Robba and Dr. Laura Galarza explore the epidemiology, treatment strategies, and the identification and man
Esophageal pressure: use in acute hypoxemic respiratory failure
Esophageal pressure measurement plays a crucial role in estimating transpulmonary pressure, with both its absolute values and variations being key factors in assessing lung injury from mechanical forces during ventilation. To gain deeper insights into esophageal pressure monitoring and the essential equipment required for accurate measurement, tune in to the NEXT podcast. Luigi Zattera, the NEXT r
Inspiratory muscle training
Inspiratory muscle training (IMT) aims to enhance the strength and endurance of respiratory muscles. Numerous clinical trials have explored the effectiveness of IMT using various training protocols, devices, and respiratory assessments. However, its adoption in clinical practice remains limited. The extent to which IMT offers clinical benefits, particularly in conjunction with pulmonary rehabilita
TTP Centenary by Takeda
ARDS Phenotyping: from disease understanding to future bedside perspectives
To date, no specific pharmacotherapy has proven effective against acute respiratory distress syndrome ARDS. Results on the research domain have been ineffective in human trials, a gap attributed in part to clinical and biological heterogeneity in human ARDS. Therefore, a precision medicine approach is intended to address explicitly how such underlying heterogeneity influences response to therapy a
Mechanical circulatory support for cardiogenic shock: a network meta-analysis of randomized controlled trials and propensity score-matched studies
Cardiogenic shock accounts for up to 5% of acute heart failure presentations and around 14–16% of patients reported in cardiac intensive care datasets. It complicates up to 15% of all myocardial infarctions and is the leading cause of death post-infarction. Using pharmacological agents alone may increase left ventricular afterload and myocardial oxygen demand, resulting in complications. Thus, mec
N&AHP – ICU diaries
The communication between families of critically ill patients who manifest prolonged disturbances in the consciousness such as patients under sedation, in a coma, or delirium, and the caregivers became very difficult during the stay of the patient in the ICU. On the other side, the memories of the patients are distressing and confusing and make the ICU experience for this patient very unpleasant.T
Burned out in ICU professionals
Professional burnout has been described by WHO as a syndrome conceptualised as resulting from chronic workplace stress that has not been successfully managed. Intensive care unit (ICU) professionals are at high risk of experiencing burnout due to the presence of patients with life-threatening illnesses, the observed discrepancies in job demands, responsibility overload, workload, end-of-life issue
Inflammatory subphenotypes in patients at risk of ARDS: evidence from the LIPS-A trial
Acute respiratory distress syndrome (ARDS) remains a life-threatening syndrome, resulting in high morbidity and mortality. In ARDS patients and mechanically ventilated critically ill patients, two distinct subphenotypes, presenting hyper- and non-hyperinflammatory characteristics, have been identified. Studies show that early identification of the inflammatory subphenotypes in patients at risk of
Brain ultrasound for the general intensivist
Cerebral ultrasound is a developing point-of-care tool for intensivists and emergency physicians, with an important role in diagnosing acute intracranial pathology. The use of transcranial Doppler has expanded over the last years, opening a new window to the assessment of cerebral anatomy not only in neurocritical patients but also in general ICU and emergency room patients. To discuss the use of
Phenotyping and endotyping patients to optimally set nutrition targets
Nutrition plays a vital role in the management of critically ill patients, and a tailored approach based on patient assessment, nutritional requirements, and clinical status is essential for optimising outcomes and promoting recovery.The concept of patient phenotyping and endotyping will help clinicians to better target nutrition interventions for a patient by categorising patients based on observ
Uncovering heterogeneity in sepsis: a comparative analysis of subphenotypes
Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to an infection. Despite progress in the understanding of sepsis pathophysiology, no specific treatment has proven successful. The precision therapy, a greater understanding of the heterogeneity of sepsis is needed.Recent approaches to measuring sepsis heterogeneity used unsupervised computational methods o
ECMO PAL: using deep neural networks for survival prediction in venoarterial extracorporeal membrane oxygenation
VA-ECMO outcome scores have been previously developed and used extensively for risk adjustment, patient prognostication, and quality control across time and centres. The limitation of such scores is the derivation by using traditional statistical methods which are not capable of covering the complexity of ECMO outcomes. The Extracorporeal Life Support Organization Member Centres have developed a s
Towards model-informed precision dosing of piperacillin: multicenter systematic external evaluation of pharmacokinetic models in critically ill adults with a focus on Bayesian forecasting
Numerous Population Pharmacokinetic (PopPK) models have been developed for Piperacillin (PIP), most of which are based on small monocentric studies and may not be generalizable to other populations. A recent evaluation of six PIP models in 30 ICU patients receiving CI demonstrated large inter-model variability regarding predictability. The transferability of these results to other populations is u
Green ICU - Environmental Sustainability in intensive care
The concept of a "green ICU" is increasingly important in today's world, as sustainability and environmental considerations become integral to healthcare practices. Hospitals, including ICUs, can have a substantial environmental footprint due to energy consumption, waste generation, and resource use. Implementing green practices reduces this impact and contributes to overall environmental sustaina
Diving into ARDS with Prof. Gattinoni. From the new guidelines to bedside applied physiology.
Acute respiratory distress syndrome (ARDS) is the term applied to a spectrum of conditions with different etiologies that share common clinical-pathological characteristics including: increased permeability of the alveolo-capillary membrane, resulting in inflammatory edema; increased non-aerated lung tissue resulting in higher lung elastance (lower compliance); and increased venous admixture and
Sepsis-associated acute kidney injury in the intensive care unit. A multicenter observational study
Sepsis‐associated acute kidney injury (SA‐AKI) is a common, increasingly prevalent problem in the intensive care unit (ICU). The association between sepsis and AKI has been studied previously. However, the lack of a reproducible and standardized consensus definition has limited the interpretability of available knowledge. In order to assess SA-AKI incidence, patient characteristics, timing, trajec
Patient Transportation in Critical Care: introduction to our ACE course
Transportation of critically ill patients is inevitable in most health systems. Prehospital transportation (PHT) may be necessary after a major injury or as a result of a life-threatening illness – for example, myocardial infarction, intracranial haemorrhage, or metabolic coma. On our ESICM Academy, we offer a course series on Patient Transportation, from the general introduction to conducting int
Interprofessional teamwork in ICU
Intensive care units (ICU) are the most peculiar units in hospitals where the quality and safety of health care delivery should be at the highest level. The most critical patients are treated in this unit, posing all healthcare professionals working there with continuous physical and emotional challenges. ICU teams are composed of different profiles with the same goal of satisfying the needs
Artesunate treatment in severely injured patients with traumatic haemorrhage
Multiple organ dysfunction syndrome (MODS) is common after major trauma, affecting up to two-thirds of patients with critical injuries. Post-trauma MODS is associated with a mortality of over 20% and poor long-term outcomes in those who survive. Current management is supportive, and there are no specific pharmacological agents that prevent organ dysfunction. The TOP-ART randomised clinical trial,
Life after sepsis in adult and paediatric patients
Sepsis is a life-threatening acute organ dysfunction secondary to infection and affects more than 19 million people annually. In 2017, it was estimated that almost 49 million people were infected by sepsis, and half of those cases occurred in children under 5. In-hospital mortality has declined over the years, resulting in a large number of sepsis survivors. Emerging data suggest that patients who
Severe meningoencephalitis in the ICU: results from the EURECA study
Central nervous system (CNS) infections significantly burden ICU physicians' daily clinical work. Diagnosis can be challenging, and timely management is of the utmost importance. Meningoencephalitis is one of the CNS infections for which the epidemiological studies conducted in adult patients suggest that approximately one in two will require care in an intensive care unit. In those patients requi
Diabetes mellitus in old critically ill COVID-19 patients
Several studies have found an association between diabetes mellitus, disease severity and outcome in COVID-19 patients. Old, critically ill patients are particularly at risk. A recent multicentre international prospective cohort study was performed in 151 ICUs across 26 countries to investigate the impact of diabetes mellitus on 90-day mortality in a high-risk cohort of critically ill patients ove
Results from the TAME trial
International guidelines recommend targeting normocapnia in adults with coma resuscitated after out-of-hospital cardiac arrest. However, normocapnia may be insufficient to restore and maintain adequate cerebral perfusion. Conversely, mild hypercapnia increases cerebral blood flow and may improve neurologic outcomes. Nevertheless, the most effective Paco2 target in adults with coma resuscitated aft
Guidelines for the management of severe community-acquired pneumonia
Severe community‐acquired pneumonia (sCAP) is a clinical entity to describe ICU-admitted patients with community‐acquired pneumonia (CAP) as they might require organ support, and it is associated with high morbidity and mortality. While European and non‐European guidelines are available for CAP, there are no specific guidelines for sCAP. Therefore, a team of experts have joined efforts to prepare
Permissive azotemia during AKI enables more rapid renal recovery and less renal fibrosis
Preclinical models of acute kidney injury (AKI) consistently demonstrate that a uremic milieu enhances renal recovery and decreases kidney fibrosis. Reduced renal clearance has the surprising and counterintuitive effect of being an effective treatment for AKI. In this perspective, Dr Lakhmir S. Chawla suggests a hypothesis describing why the uremic milieu is kidney protective and proposes a clinical
How to manage coagulopathies in critically ill patients
Coagulopathy is a severe and frequent complication in critically ill patients, for which the pathogenesis and presentation may be variable depending on the underlying disease. Therefore, a review has been conducted to differentiate between hemorrhagic coagulopathies, characterised by a hypercoagulable and hyperfibrinolysis state, and thrombotic coagulopathies with a systemic prothrombotic and anti
End of Life Care concepts in intensive care
End-of-life care is an approach to a terminally ill patient that shifts the focus of care to symptom control, comfort, dignity, quality of life, and quality of dying rather than treatments aimed at cure or prolongation of life. A detailed description of the concept of the end of life care and as well how to deal with end-of-life situations are discussed in the podcast. SpeakersJulie BENBENISHTY. H
Machine-learning-derived sepsis bundle of care
The Surviving Sepsis Campaign (SSC) produces and regularly updates guidelines for managing patients with sepsis and septic shock. However, deviation from guidelines is frequently observed in the intensive care unit. The last iteration of the SSC includes 79 recommendations where the impact on mortality remains unclear for some of them. Prioritising the recommendations based on their relative impac
How to use biomarkers of infection or sepsis at the bedside
Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. In this context, biomarkers could be considered indicators of either infection or dysregulated host response or response to treatment and/or aid clinicians in prognosticating patient risk.A recently published narrative review provides current data on the clinical utility of pathogen-specific and hos
MIPD of beta-lactam antibiotics and ciprofloxacin in critically ill patients
Individualising drug dosing using model-informed precision dosing (MIPD) of beta-lactam antibiotics and ciprofloxacin has been proposed as an alternative to standard dosing to optimise antibiotic efficacy in critically ill patients. However, randomised clinical trials (RCT) on clinical outcomes have been lacking.In this podcast, Drs Ewoldt and Abdulla relate how they conducted a multicentre RCT in
Management of severe bronchiolitis in infants <12 months old admitted to paediatric ICU
Bronchiolitis is a common lung infection in young children and infants. Approximately one-tenth of the affected children are admitted, and between 2 and 6% of them present a severe form and are referred to paediatric intensive care units. Nevertheless, the definition of severe acute bronchiolitis is mainly clinical and based on low levels of evidence.In this podcast, Dr Milési presents guidelines
Clustering analysis of geriatric and acute characteristics in very old patients on ICU admission
The outcome of very old patients admitted to the intensive care unit (ICU) is determined by both the severity of the acute condition and the age-related decline of resilience to stress. However, that decline is characterised by substantial inter-individual heterogeneity, which is considered a hallmark of the ageing process. A recent study investigated the heterogeneity within the very old populati
My evidence-based nutrition protocol
Nutrition is an essential care we provide to critically ill patients aiming to avoid severe muscle wasting and weakness, which correlate with mortality and long-term burdens. Considering that the ICU patients' nutritional needs vary with the phase of critical illness, evidence-based nutrition protocols are so much needed. Dr Tarcukovic, one of the participants of the ESICM Nutrition Pathway, share
Management and outcomes of pregnant women with COVID-19
Pregnant women with COVID-19 are more likely to be admitted to the ICU and require invasive mechanical ventilation or venovenous extracorporeal membrane oxygenation (VV-ECMO). Nevertheless, only a few case series have focused on ventilatory management and outcomes of pregnant women with COVID-19 admitted to the ICU.COVIDPREG study primarily aimed to assess the ventilatory management of pregnant wo
Evolution of sedation management in the ICU
Intensive care unit (ICU) sedation practices have dramatically changed over the last 20 years. Nowadays, they include light levels of sedation, SAT, and the use of non-benzodiazepines. An overview of ICU sedation practices’ evolution over the years has been recently published in the ICM Journal.This publication highlights the challenge faced by clinicians during the COVID-19 pandemic regarding sed
When to initiate RRT?
Acute kidney injury is common in critically ill patients, and 10-15% of ICU patients receive renal replacement therapy (RRT). The timing of therapy initiation is limited by heterogeneity, but until 10-15 years ago there was a trend toward early initiation, as noted by several meta-analyses.In the past 5 years, several large PRCTs have addressed this topic: ELAIN, AKIKI, IDEAL-ICU, STARRT-AKI, and
Frailty and the COVIP study
Over the last few years, the assessment of frailty at admission to the ICU has become increasingly popular. Frailty is also considered one of the potential prognostic indicators in patients with COVID-19. The degree of frailty could be used to assist both the triage into intensive care and decisions regarding treatment limitations.The COVIP study led by prof Jung sought to determine the interactio
Clinical course of children with acute liver failure admitted to the ICU
A recent outbreak of acute non-A-E hepatitis with serum transaminases greater than 500 IU/L identified in children under 16 years reported in the United Kingdom (UK) has become a serious cause for concern for public health authorities and paediatric liver and critical care services. From 1 January to 16 May 2022, UK public health authorities have reported 197 cases with a median age of 3 years, ma
Echocardiography findings in COVID-19 patients admitted to ICU
The ECHO-COVID study investigated the effects on cardiac function in critically ill COVID -19 patients. The primary aim of this study was to investigate the incidences and patterns of left and right ventricular dysfunction in the first echocardiographic examination performed after admission to the intensive care unit (ICU) in a large series of patients hospitalised for severe COVID-19. The study r
Results from the UNITE-COVID study
The European Society of Intensive Care Medicine (ESICM), initiated a study to describe the extent of the COVID-19 ICU surge worldwide and the clinical characteristics, management, and outcomes of critically ill COVID-19 patients. Additionally, the goal was to study the impact of critically ill COVID-19 patients admitted to a surge capacity bed on the treatment and outcomes. The study hypothesised
Bullets in haemodynamics
The haemodynamic instability most patients present in the ICU may lead to organ dysfunction, deterioration into multi-organ failure, and eventually death. Proper medical management is essential to prevent or treat organ failure and improve the outcomes for these patients. This podcast will tackle a few crucial points regarding haemodynamic monitoring starting from the first hours of patients admit
The brain in paediatric critical care
The practice of neurocritical care for children with injured or vulnerable brains entails clinical assessment, a range of monitoring methods within the paediatric intensive care unit (PICU), and the follow-up of children's long-term neurodevelopment. These activities involve inherent challenges related to the diversity of the case mix and age range. Different concepts were discussed in a recently
The role of acute hypercapnia on mortality and short-term physiology in patients mechanically ventilated for ARDS
Recent evidence suggests that acute hypercapnia could have harmful physiological and clinical effects in patients with ARDS, particularly impacting the haemodynamic system. A review and meta-analysis were performed to summarise the clinical consequences of acute hypercapnia in mechanically ventilated patients. The primary objective was to determine the association between acute hypercapnia and mor
Sepsis hospitalisation and risk of subsequent cardiovascular events in adults
Sepsis refers to a dysregulated response to infection-causing end-organ dysfunction. It is associated with short-term risks such as shock and in-hospital death. Meanwhile, long-term consequences among sepsis survivors can include clinical deconditioning, recurrent sepsis, mental health issues, and increased risk of long-term mortality. Moreover, recent investigations have demonstrated a possible a
Prophylactic melatonin for delirium in intensive care (Pro-MEDIC)
Delirium is a condition of acute organic brain dysfunction with fluctuating disturbances of attention and cognition, and its prevalence in intensive care units (ICUs) is recorded as high as 80%.Delirium is highly distressing for patients and families and commonly reported as the worst experience of ICU admission. Melatonin has been described as an attractive intervention for delirium prevention, a
Role of pre-clinical experimentation in intensive care: from ethical to clinical practice
Preclinical studies precede most clinical trials. They help identify criteria for evaluating human safety, including signs and symptoms that should be monitored closely during early clinical trials.The importance of these preclinical studies in intensive care medicine starts from developing new surgical procedures, and hands-on training to new medical devices and prescription drugs. To have more i
Mental health symptoms in family members of COVID-19 ICU survivors
The prevalence of long-term mental health symptoms in the family members of COVID-19 ICU survivors is unknown and may differ from the prevalence rate in the family members of non-COVID-19 ICU survivors, given the pandemic circumstances.A better understanding of the impact of COVID-19 ICU admission on family members is needed to provide adequate support during and after the ICU stay. Therefore, the
ERC-ESICM guidelines on temperature control after cardiac arrest in adults
The aim of the ERC-ESICM guidelines on temperature control after cardiac arrest in adults is to provide evidence-based guidance in adults who are comatose after resuscitation from either in-hospital or out-of-hospital cardiac arrest, regardless of the underlying cardiac rhythm. These guidelines replace the recommendations on temperature management after cardiac arrest included in the 2021 post-res
Effect of therapeutic drug monitoring-based dose optimisation of piperacillin/tazobactam in sepsis patients
Growing evidence suggests that insufficient antibiotic exposure (defined as failure to achieve the pharmacokinetic/pharmacodynamic (PK/PD) target to kill or inhibit the growth of a pathogen) is associated with worse clinical outcomes in sepsis patients.Moreover, up to 50% of critically ill patients receiving a β-lactam antibiotic with regimens based on manufacturers' recommendations fail to reach
Current practice and evolving concepts in septic shock resuscitation
Clinical and pathophysiological understanding of septic shock has progressed exponentially in the previous decades, translating into a steady decrease in septic shock-related morbidity and mortality. Even though large randomised, controlled trials have addressed fundamental aspects of septic shock resuscitation, many questions still exist. A comprehensive review was carried out to describe the cur
Non-invasive respiratory support following extubation in critically ill adults
Clinicians use noninvasive respiratory support interventions in the post-extubation period to mitigate the risk of extubation failure. These interventions [noninvasive positive pressure ventilation (NIPPV) and high-flow nasal cannula (HFNC)] have been shown to be efficacious in preventing initial intubation in patients with hypoxemic respiratory failure, but their efficacy in preventing post-extub
Challenges of renal transplant patients in intensive care
Kidney transplantation is the most common solid organ transplant performed worldwide. New advances in transplant medicine have expanded the indications for kidney transplantation, and nowadays, many kidney recipients are elderly patients who possibly have more comorbidities. Up to 6% of kidney transplant recipients experience a life-threatening complication requiring intensive care unit admission,
Practicalities of Neuromonitoring
Neuromonitoring is considered a crucial and fundamental process to monitor patients in critical care settings. In this podcast, ESICM NEXT member Denise Battagliani interviews Chiara Robba on the ultimate findings regarding neuromonitoring, including:basics of neuromonitoring research;indications for neuromonitoring of patients who do (not) suffer any direct brain injury;the rationale in neuromoni
Dexamethasone 12 mg versus 6 mg for patients with COVID-19 and severe hypoxaemia
Systemic corticosteroids decrease mortality in critically ill patients with COVID-19, and the World Health Organization, therefore, recommends dexamethasone 6 mg daily for up to 10 days for patients with severe or critical COVID-19. In addition, higher doses of systemic corticosteroids have been used in patients with COVID-19 and non-COVID-19 acute respiratory distress syndrome [3, 5, 6], and high
Extracorporeal cardiopulmonary resuscitation in adults: evidence and implications
Attempts at improving cardiac arrest outcomes have increasingly included extracorporeal techniques to re-establish circulation. In particular, the application of veno-arterial extracorporeal membrane oxygenation (ECMO) during cardiac arrest is called extracorporeal cardiopulmonary resuscitation (ECPR).However, there is much debate about the impact of ECPR use on survival and neurological and funct
Effect of adjunctive vitamin C, glucocorticoids, and vitamin B1 on longer-term mortality in adults with sepsis or septic shock
Metabolic resuscitation is an adjunctive therapy for sepsis and septic shock, which consists of a combination of vitamin C, glucocorticoids, and vitamin B1 or their components. Recently, there has been considerable interest in this treatment. However, due to the wide range of combinations of its components, there is no evidence for the effectiveness of this therapy.To fill this gap, a network meta
Palliative care interventions in intensive care unit patients
Integrating palliative care in critical care is advocated as a way to mitigate physical and psychological burdens for patients and their families and improve end-of-life care. Despite the emerging literature published that supports this positive association, the quality of evidence remains limited, in large part due to limitations in the definition of interventions, poor precision of effect estima
Transfusion strategies in bleeding critically ill adults
Given the rapidity with which critically ill patients with bleeding can deteriorate, having a standardised approach to transfusion in these patients can be of great assistance to clinicians working in time-pressured circumstances.An expertise task force created within ESICM has developed an international guideline that provides guidance for clinicians caring for critically ill patients with massiv
ESICM consensus guidelines on basic ultrasound head-to-toe skills for intensivists
Ultrasonography is an evolving skill in critically ill patients. We provide a large number of statements regarding the required ultrasonographic basic skills for the management of critically ill patients.Original article: Speakers: Basic ultrasound head-to-toe skills for intensivists in the general and neuro intensive care unit population: consensus and expert recommendations of the European Socie
Critical illness in patients with hematologic malignancy
Critical illness occurs frequently after a new diagnosis of hematologic malignancy and has high associated mortality. Baseline characteristics at diagnosis can help identify those patients at the highest risk of critical illness.Original article: Critical illness in patients with hematologic malignancy: a population-based cohort studySpeakers:Bruno L. FERREYRO. Interdepartmental Division of Critic
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