SARS 15 years on - My reflection on how to motivate your team to overcome the crisis?

Severe acute respiratory syndrome (SARS) was a new infectious disease that emerged in mid-November 2003 in Guangdong, southern China. By the time this global pandemic was declared contained on 5 July 2003 by WHO, it had afflicted 8090 patients in 29 countries.

No other disease had such a phenomenal impact on healthcare workers (HCWs), as they formed about 21% of SARS patients. In Vietnam, Canada and Singapore, the percentages of HCWs were 57%, 43% and 41%, respectively. The SARS crisis had become a medical plague.


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Three years after the REDOXS study: What we have learned in the use of glutamine in ICU patients?

Abstract

Critical illness has been associated with glutamine (Gln) plasma levels depletion and its supplementation is related with better outcomes. In 2013 the Reducing Deaths due to Oxidative Stress (REDOXS) study, showed that the supplementation of Gln to total parenteral nutrition was associated with higher mortality without conferring beneficial effects. These conclusions had a high impact in the clinical field: two of the main guidelines downgraded its recommendation. However, recent studies are answering questions regarding the safety use of this amino acid use and even suggesting new potential beneficial effects.

It is important to understand the main lessons learned of the REDOXS study related to the correct use of Gln intra venous and do not rule out its use for the intensive care unit patients. The scientific community is actively working in the field and we expect to have more evidence to guide the correct of this amino acid in parenteral nutrition.


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Trying to get out of the box

Abstract
Dr. Paul E. Marik suggests thinking outside the box when we use enteral nutrition support in the intensive care unit where the administration of formula in bolus theoretically presents greater benefit in preserving lean mass against continuous feeding. But what happens when we use parenteral nutrition support? It is to this that we propose a new administration scheme based on amino acids bolus and safety limits by a central line.

Trying to get out of the box


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Precision medicine and the federal sepsis initiative!

In his State of the Union address before both chambers of the US Congress on 20 January 2015, President Barack Obama announced the launch of a new initiative called Precision Medicine, “I want the country that eliminated polio and mapped the human genome to lead a new era of medicine – one that delivers the right treatment at the right time.”
At a White House Press briefing on 30 January 2015 President Obama further commented that “Doctors have always recognized that every patient is unique, and doctors have always tried to tailor their treatments as best they can to individuals.”


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Less oxygen for cardiac arrest patients is better

Abstract
There is no doubt that oxygen is necessary to sustain life. We have been using oxygen since the late 19th century with its use taken for granted. However, administering oxygen above atmospheric concentration should be prescribed as a medication accounting for potential adverse effects. Exposure to high dose of supplemental oxygen has been associated with pulmonary and cardiac toxicity. Moreover, an increase in oxygen radicals was found to be involved in cell death after cerebral ischemia. Cardiac arrest, both in and out of hospital, is a major cause of death worldwide. Brain injury, myocardial dysfunction and multi-organ failure comprise post cardiac arrest syndrome and reactive oxygen species play a central role in initiating and exacerbating the damage. Studies in animal models of cardiac arrest have found that the administration of 100% oxygen following return of spontaneous circulation (ROSC) may cause neurological harm in comparison to low-dose oxygen. Hyperoxia (PaO2>300 mmHg) is not uncommon among patients after ROSC however, since oxygen therapy is considered integral during resuscitation and post resuscitation care there are no large randomized controlled trials in humans. The existing data from retrospective studies demonstrates correlation between hyperoxia after ROSC and increased in-hospital mortality as well as poor neurological outcome. Hence, we should regard oxygen therapy carefully and use the lowest fraction of inspired oxygen to ensure adequate arterial saturation while avoiding hyperoxia and hypoxia.

Less oxygen for cardiac arrest patients is better


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Nitroglycerin, stroke and hypertension: a word of caution

The ENOS trial investigators performed a large multicenter trial investigating the role of a daily nitroglycerine patch in hypertensive patients with an acute stroke. (1) The reasoning for the choice of this agent in patients with an acute stroke is puzzling. Nitroglycerine is a potent veno-dilator and only in high doses does this drug reduce arterial tone. (2) This agent reduces blood pressure predominantly by reducing venous return and cardiac output. (2) It would appear counter-institutive to use a drug which reduces cardiac output, and therefore organ blood flow, in patients who have suffered an acute ischemic stroke. Rashid and...
Nitroglycerin, stroke and hypertension- a word of caution


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