Purpose Whether skin disinfection of the surgical site using chlorhexidine-alcohol is superior to povidone-iodine-alcohol in reducing reoperation and surgical site infection rates after major cardiac surgery remains unclear. Methods CLEAN 2 was a multicenter, open-label, randomized, two-arm, assessor-blind, superiority trial conducted in eight French hospitals. We randomly assigned adult patients undergoing

This review explores the current landscape and evolving understanding of sepsis, highlighting both challenges and future directions. Sepsis remains a major global health burden, with diverse clinical presentations complicating timely diagnosis and management. Existing definitions, including the Sepsis-3 criteria, emphasize the importance of organ dysfunction, yet early sepsis detection remains limited

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The European Society of Intensive Care Medicine, through its multi-disciplinary panel, is to be congratulated for developing fairly comprehensive guidelines on end-of-life and palliative care in the intensive care unit, which highlight the poor quality of evidence and the need for research in these domains [1]. Unfortunately, there is a significant and important omission in these guidelines which is

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Intensive care unit (ICU)-acquired infections can be serious complications of medical care of critically ill patients. Despite multiple tested and implemented preventive measures for such infections, their incidence is persistently high, whereas coherence of infection prevention practices in ICUs across the globe remains low. The heterogeneity in practice reflects the—perceived—low level of evidence

International guidelines recommend net extracorporeal fluid removal (i.e., net ultrafiltration [UFNET]) for critically ill patients with oliguric acute kidney injury (AKI) and fluid overload [1]. However, the optimal approach to UFNET remains unclear, with significant global variation in clinical practice [2, 3]. Key uncertainties include when to initiate fluid removal, the appropriate volume and rate

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Intensive Care Medicine (ICM) is a specialized field that has evolved significantly from its origins, where critically ill patients were managed by general hospital physicians [1]. Over time, ICM has developed into a distinct discipline requiring intensivists to possess a deep understanding of human pathophysiology, critical illness, and the management of life-threatening conditions, while also leading

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We would like to thank Mertzlufft for raising the issue of importance of the physiological composition of crystalloid fluids [1]. In the process of guideline generation, we selected questions with sufficient clinical evidence to support a recommendation [2]. In that regard, we have addressed the question of the balanced crystalloids versus saline, for which multiple randomized clinical trials have

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Correction: Intensive Care Medicine (2024) 50:1470-1483 https://doi.org/10.1007/s00134-024-07564-8

The recent study by Liu et al. published in Intensive Care Medicine aroused our great interest [1]. We greatly appreciate the authors’ focus on the quality of sleep in postoperative patients, which is critical to improving the quality of sleep in postoperative patients and facilitating the recovery of postoperative patients. This study has greatly improved our understanding of the effects of low-dose

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Gastric or duodenal mucosal erosions, or stress ulcers, are a known complication of critical illness [1]. General supportive care and treatment of the underlying cause of the critical illness are the cornerstones of intensive care medicine and may help minimize the risk of stress ulcer bleeding. Stress ulcer prophylaxis is often prescribed to prevent such ulcers and their consequences [2] which include

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We read with interest the FluDReSS trial by Walsham et al., which investigated the dose–response relationship of enteric fludrocortisone in patients with septic shock [1]. Notably, while significant changes in plasma concentrations were observed, these changes were not correlated with dosage. Furthermore, no benefits in terms of sepsis resolution or mortality were reported. While we commend the authors

We are grateful to Oud for his interest and comment [1] inquiring about the impact of the coronavirus disease 2019 (COVID-19) pandemic on the outcomes of patients enrolled in the COHO study [2]. Oud articulately highlighted that during the pandemic, there was: (1) a higher mortality rate in patients with hematologic malignancies admitted with COVID-19 compared to non-COVID19 diagnoses, and (2) an increased

A recent randomised clinical trial (RCT), BLING III, provided support for continuous infusion (CI) versus short intermittent infusions of meropenem and piperacillin/tazobactam in 7,000 critically ill adults with sepsis [1]. This was further supported by a simultaneously published systematic review and meta-analysis (SRMA) of 18 RCTs of CI or extended infusion (EI; 3–4 h infusions) of beta lactams [2]