Breakthroughs in global critical care medicine 2019

Abstract

The following trends emerged in international critical care practice in 2019: increasing analysis to phenotypes of sepsis and acute respiratory distress syndrome (ARDS), increasing evidences of early initiating of vasopressors and antibiotics for septic shock, also including the early furosemide stress test for critically ill patients with acute kidney injury (AKI). In addition, there are many significantly important trials with positive results: high dose vitamin C for septic shock, weaning strategy with pressure support ventilation (PSV) mode, tranexamic acid for patients with acute traumatic brain injury, and new monoclonal antibody for Ebola virus disease. And there are also negatives trials as following: individual mechanical ventilation, maximal recruitment open lung ventilation or early neuromuscular blockade for moderate-to-severe ARDS, N95 respirators preventing influenza, flexible family visit program against delirium or early sedation with dexmedetomidine to mechanically ventilated patients, intensive care unit (ICU) diary or nurse-led preventive psychological intervention against posttraumatic stress disorder (PTSD) in patients with mechanical ventilation, recombinant human soluble thrombomodulin (rhsTM) in patients with sepsis-associated coagulopathy, and so on. Further investigations should be focus on the phenotype analysis, by which individualized management fitting for specific pathophysiologic and immune characters for each patient could be clarified.