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 …

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 a…

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…

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 me…

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 vasopressor…

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 tachy…

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, tr…

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…

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, par…

Af ESICM

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 underly…

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 ox…

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…

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, re…

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 …

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 a…

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…

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 heterogene…

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 Supp…

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 transfer…

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…

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…

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 …

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 Transportatio…

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 profile…