Nothing is obvious

https://www.nejm.org/doi/full/10.1056/NEJMoa1800385

Lactate Clearance in Sepsis

Lactate as a goal of what?  

The complexity of lactate as a molecule, substrate, biomarker, energy source, component of some intravenous fuids, and major modulator of cellular bioenergetics during physiological stress is formidable . Such complexity makes it impossible to defne what goal it should be a marker or target of. Seeking to lower lactate levels (by whatever means given the multiple events that regulate its blood levels) has no credibility and no logic in terms of hemodynamics, bioenergetics, or tissue protection. In fact, it could make more biological sense to assist the natural process of lactate utilization and generation during sepsis or during other physiological stress situations by administering lactate. Until we are able to defne the goals that we wish to achieve by manipulating lactate and have the means of measuring whether we have achieved such goals or not, the idea of seeking to lower lactate by increasing its “clearance” in sepsis is both an illusion and a folly

WHAT’S NEW IN INTENSIVE CARE: The ten pitfalls of lactate clearance in sepsis

Jan Bakker, Department of Intensive Care, Erasmus MC University Medical Center, Rotterdam, Netherlands

https://twitter.com/gdegent : link to Twitter posting and Read Cube

Can rest after a spontaneous breathing trial reduce reintubation?

Free Access to this article: Fernandez et al. Reconnection to mechanical ventilation for 1 h after a successful spontaneous breathing trial reduces reintubation in critically ill patients: a multicentre randomised controlled trial. Intensive Care Med, Nov 2017, Vol 43, Iss 11, pp 1660-1667 DOI: 10.1007/s00134-017-4911-0. LINK - https://bit.ly/2wpM8bR

Patient-Ventilator Asynchrony Dr. Luigi Camporota

Severe Sepsis and Septic Shock Management Bundle (SEP-1)

Evidence Underpinning the Centers for Medicare & Medicaid Services' Severe Sepsis and Septic Shock Management Bundle (SEP-1)

Conclusion: No high- or moderate-level evidence shows that SEP-1 or its hemodynamic interventions improve survival in adults with sepsis.

What Does Aortic Stenosis Have to Do With Heme Positive Stool?

Presentations at ESCIM Brussels 2018

EXTRACOPOREAL BLOOD PURIFICATION SYSTEM:

CytoSorb is an extracorporeal blood purification therapy designed to reduce excessive levels of inflammatory mediators such as cytokines, or “cytokine storm”, from blood. In doing so, the goal is to reduce the potentially deadly systemic inflammatory response syndrome (SIRS) seen in life-threatening inflammatory conditions. Use of the therapy may help to mitigate or even avoid deadly complications such as organ failure in this hyper-inflammatory response, helping to stabilize patients and reduce the severity of illness .

CytoSorb Website

ACUMEN HYPOTENSION PROBABILITY INDICATOR SOFTWARE:

With increasing evidence of the risks associated with hypotension during surgery, the Acute Hypotension Probability Indicator Software (HPI) offers the ability to detect and respond to developing hypotension by recognizing trends and providing alerts before they impact your patients. Enabling you to react earlier and positively impact patient outcomes.

Part of the Acumen decision support software suite, HPI is compatible with the IQ family of hemodynamic solutions - including the FloTrac IQ sensor.

Hypotension Clarity Brochure