Sepsis is a leading cause of death worldwide, disproportionately affecting low-resource settings. Limited diagnostics, antimicrobial resistance, and scarce critical care capacity compound the burden. Areas for improved c...Sepsis is a leading cause of death worldwide, disproportionately affecting low-resource settings. Limited diagnostics, antimicrobial resistance, and scarce critical care capacity compound the burden. Areas for improved care include physiology-based triage, point-of-care lactate testing, and simplified severity scores for early recognition. Context-specific strategies favor cautious fluid resuscitation, safe peripheral vasopressor use, improved oxygen systems, and portable ultrasound for monitoring and source control. Expanding access to microbiology and tailored antimicrobial stewardship remain critical. Sustainable progress depends on workforce training, system strengthening, and context-appropriate guidelines. Locally driven research and global investment are essential to achieve equity in sepsis care delivery.
The anticipated "tripledemic" during the 2023-2024 season-in which simultaneous epidemics of SARS‑CoV‑2, influenza, and respiratory syncytial virus were projected-ultimately fell short of early forecasts. Nevertheless, e...The anticipated "tripledemic" during the 2023-2024 season-in which simultaneous epidemics of SARS‑CoV‑2, influenza, and respiratory syncytial virus were projected-ultimately fell short of early forecasts. Nevertheless, each virus remains a significant public health concern in its own right. This article reviews the microbiology, diagnosis, and treatment of these three pathogens (including the role of immunomodulatory therapies), as well as key considerations for hospital infection prevention in the care of critically ill patients. The piece highlights the clinical indistinguishability of these viral infections and acknowledges the evolving public health discourse surrounding the role of vaccination in preventing disease.
Intensive care units (ICUs) care for the most severely ill patients and consequently account for the largest volume of antibiotic use in the hospital. Critically ill patients must receive optimal, timely empiric antibiot...Intensive care units (ICUs) care for the most severely ill patients and consequently account for the largest volume of antibiotic use in the hospital. Critically ill patients must receive optimal, timely empiric antibiotic therapy. However, there are opportunities to improve overall antibiotic use in the ICU by ensuring that antibiotics are de-escalated based on culture and clinical data or stopped if an alternative, noninfectious diagnosis is determined. Further, shorter durations of therapy based on clinical trials should be selected to minimize antibiotic exposure. ICUs should work with hospital antibiotic stewardship programs to review antibiotic use and determine areas for improvement.
Health care-associated infections are common and burdensome in intensive care units, contributing to increased costs, morbidity, and mortality. The coronavirus disease 2019 (COVID-19) pandemic led to an increase in the i...Health care-associated infections are common and burdensome in intensive care units, contributing to increased costs, morbidity, and mortality. The coronavirus disease 2019 (COVID-19) pandemic led to an increase in the incidence of intensive care unit (ICU)-acquired infections and multidrug-resistant organisms (MDROs), highlighting the urgent need for effective prevention strategies. This article summarizes core infection prevention practices in the ICU, examines risk factors, reviews approaches to limit the spread of MDROs and explores innovations in infection prevention.
Treating infections in critically ill patients is uniquely challenging because of diverse disease states, high rates of antimicrobial resistance, pharmacokinetic changes, and a high risk of mortality that leaves little m...Treating infections in critically ill patients is uniquely challenging because of diverse disease states, high rates of antimicrobial resistance, pharmacokinetic changes, and a high risk of mortality that leaves little margin for error. Optimal management requires balancing early, appropriate antimicrobial therapy with risks of toxicity and resistance. To do so, clinicians must integrate microbiologic diagnostics, pathogen epidemiology, patient-specific risk factors, and local resistance rates with an understanding of antimicrobial agents' spectrum and pharmacologic properties and patients' altered pharmacokinetics and pharmacodynamics.
Crit Care Clin
· 2026 Jul · PMID 42173644
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Hemophagocytic lymphohistiocytosis is a life-threatening hyperinflammatory syndrome increasingly recognized across age groups. This syndrome is driven by pathologic interferon-γ production, which leads to a self-sustaini...Hemophagocytic lymphohistiocytosis is a life-threatening hyperinflammatory syndrome increasingly recognized across age groups. This syndrome is driven by pathologic interferon-γ production, which leads to a self-sustaining positive feedback loop resulting in multi-organ dysfunction with a high mortality. Early recognition is essential, and clinical evaluation should prioritize identifying any predisposing diseases and acute triggers. Treatment requires a multi-faceted approach, including dampening the hyperinflammation, eliminating acute triggers and infectious complications, and optimizing management of all underlying predispositions. Novel prognostic markers (C-X-C motif ligand-9), and cytokine-directed therapies (ruxolitinib, emapalumab) show promise to help improve outcomes of patients with these complex hyperinflammatory syndromes in the future.
Lower respiratory tract infections are the most common cause of death globally, representing the leading source of infection among patients admitted to the intensive care unit. Rapid and accurate pathogen identification...Lower respiratory tract infections are the most common cause of death globally, representing the leading source of infection among patients admitted to the intensive care unit. Rapid and accurate pathogen identification allows a targeted therapy, yet most diagnostic tests require an extended processing time that can be detrimental in critically ill patients. New molecular and microbiological tools are now routinely available for precise pathogen identification, although important limitations remain that must be known prior to their use and when interpreting their results.
Source control is a cornerstone of managing infections and sepsis in the intensive care unit, requiring rapid recognition of infection, targeted diagnostic evaluation, and timely procedural or surgical intervention. This...Source control is a cornerstone of managing infections and sepsis in the intensive care unit, requiring rapid recognition of infection, targeted diagnostic evaluation, and timely procedural or surgical intervention. This article presents a systems-based approach to identifying infection sources in critically ill patients through clinical assessment, targeted imaging, laboratory testing, and multidisciplinary collaboration. It outlines indications for conservative versus operative management across multiple organ systems. Emphasis is placed on early detection, anatomically focused intervention, prompt drainage of closed-space infections, judicious antibiotic use, and the role of coordinated care among intensivists, surgeons and proceduralists, and infectious disease specialists to optimize outcomes.
More than 80% of the world's population lives in low-income and middle-income countries, yet access to critical care remains limited in these regions. Infectious diseases, especially human immunodeficiency virus, tubercu...More than 80% of the world's population lives in low-income and middle-income countries, yet access to critical care remains limited in these regions. Infectious diseases, especially human immunodeficiency virus, tuberculosis, and malaria, remain leading causes of critical care admissions and are associated with high mortality. Early recognition and timely initiation of appropriate therapies are important in improving outcomes. In this article, we aim to highlight the burden of disease, clinical presentation, diagnostic strategies, and management principles for these diseases in critically ill patients.
Meningitis and encephalitis are neurologic emergencies that require rapid recognition and treatment. Prompt diagnosis and administration of antimicrobials, alongside adjuvant steroids in select cases, are crucial for tre...Meningitis and encephalitis are neurologic emergencies that require rapid recognition and treatment. Prompt diagnosis and administration of antimicrobials, alongside adjuvant steroids in select cases, are crucial for treatment and improvement in outcomes. Severe complications of meningitis and encephalitis may include seizures, hyponatremia, elevated intracranial pressure (ICP), cerebral edema and herniation, vasculitis and cerebral ischemia. Critical care management focuses on appropriate antimicrobials, seizure control, ICP monitoring and optimization, and, if severe, neurosurgical intervention for cerebrospinal fluid diversion or decompression.
Emerging and high-consequence infectious diseases pose substantial critical care challenges because of diagnostic uncertainty and limited targeted medical countermeasures. Presentations are nonspecific, and patients can...Emerging and high-consequence infectious diseases pose substantial critical care challenges because of diagnostic uncertainty and limited targeted medical countermeasures. Presentations are nonspecific, and patients can rapidly progress to shock, ARDS, or multiorgan dysfunction syndrome. Because these conditions can mimic common causes of sepsis or respiratory failure, management focuses on early, optimized supportive care (including volume resuscitation, ventilatory and oxygenation support, and management of potential coinfections), appropriate infection prevention and control practices (utilizing the identify-isolate-inform principles), and multidisciplinary care. Critical care clinicians should maintain heightened vigilance for atypical presentations and remain aware of available diagnostic methods, vaccines, and therapeutics.
A Learning Health System (LHS) integrated within a Critical Care Organization (CCO) enhances clinical care, research, and education by systematically utilizing real-world data, quality improvement, implementation science...A Learning Health System (LHS) integrated within a Critical Care Organization (CCO) enhances clinical care, research, and education by systematically utilizing real-world data, quality improvement, implementation science, and clinical trials. CCOs, with their collaborative culture and data-rich environment, are well suited to develop and sustain an LHS, enabling continuous learning and rapid translation of evidence into practice. This approach supports observational studies, operational decision-making, and pragmatic clinical trials, fostering innovation and efficiency. Ultimately, transforming a CCO into an LHS aligns clinical excellence with academic missions, driving improved patient outcomes and organizational performance through active, data-driven inquiry.
The practice of caring for the critically ill has changed dramatically over the past 75 years, and the next 75 years will likely see similar dramatic changes. Integrating new models of care, where technology-dependent cr...The practice of caring for the critically ill has changed dramatically over the past 75 years, and the next 75 years will likely see similar dramatic changes. Integrating new models of care, where technology-dependent critical care can be provided anywhere, and where new models of data integration through artificial intelligence and novel monitoring techniques can all be transformative to how patients with critical illness receive care. This article will describe some possibilities for the future of critical care, while also emphasizing the importance of focusing on patient well-being and health equity during periods of rapid technological innovation.
Uncertainty is the only constant in critical care medicine leadership, ranging from unexpected staff attrition to global pandemics. Developing skills to retain experienced staff, manage conflict, and handle failure are e...Uncertainty is the only constant in critical care medicine leadership, ranging from unexpected staff attrition to global pandemics. Developing skills to retain experienced staff, manage conflict, and handle failure are essential to be effective. Successful leaders have knowledge of the challenges experienced by front-line clinicians and clearly communicate with their teams. By creating a culture of safety and making clinicians feel valued, leaders can help their Critical Care Organization not just survive, but thrive.
In recent years health care institutions have embraced the High Reliability Organization (HRO) paradigm as a way to enhance outcomes, reduce error, and improve safety. Furthermore, since large health care systems have al...In recent years health care institutions have embraced the High Reliability Organization (HRO) paradigm as a way to enhance outcomes, reduce error, and improve safety. Furthermore, since large health care systems have also been organizing their critical care programs-typically multiple intensive care units across hospitals-into alliances known as Critical Care Organizations (CCOs), the conditions are ripe for CCOs to embrace the HRO methodology. This article is designed to introduce the HRO concepts, relate them into a critical care context, and suggest how a CCO may start and sustain a high reliability venture.
Critical care quality metrics are evolving from simple mortality tracking toward patient-centered, real-time analytics. Anchored in 6 principles-meaningful, evidence-based, timely, responsive, integrated, and comparable-...Critical care quality metrics are evolving from simple mortality tracking toward patient-centered, real-time analytics. Anchored in 6 principles-meaningful, evidence-based, timely, responsive, integrated, and comparable-these metrics can drive sustained improvement when paired with advanced analytics. The challenge is to harness these tools without introducing bias, burden, or complexity. ICU leaders are pivotal in setting priorities, governing responsibly, and fostering a culture in which measurement fuels lasting gains in patient outcomes and system performance.
Documentation and billing for the services provided to a critically ill patient can be complex and challenging. Critical care, evaluation and management, and procedures can be billed to get reimbursed for the services pr...Documentation and billing for the services provided to a critically ill patient can be complex and challenging. Critical care, evaluation and management, and procedures can be billed to get reimbursed for the services provided. An understanding of the documentation requirements and contextual application is fundamentally important to optimize revenue capture. Billing correctly for situations such as advance care planning and extracorporeal membrane oxygenation requires special considerations and supportive documentation. A compliance program that oversees accurate documentation and billing not only provides for clinician education but also minimizes risk to the organization.
Intensive care units (ICUs) require carefully managed capacity, balancing beds, staffing, equipment, and policies to deliver timely care under routine and surge conditions. This article distinguishes ICU capacity from ca...Intensive care units (ICUs) require carefully managed capacity, balancing beds, staffing, equipment, and policies to deliver timely care under routine and surge conditions. This article distinguishes ICU capacity from capability and emphasizes patient flow, discharge planning, and interdepartmental coordination to minimize delays and bottlenecks. It outlines surge readiness, including scalable infrastructure, predictive analytics, real-time monitoring, and ethical resource allocation, with disasters. Centralized, decentralized, or hybrid governance guides surge responses, whereas flexible staffing, cross-training, and mutual aid sustain workforce capacity. Data-driven approaches, telemedicine, and interhospital collaboration underpin resilient capacity management during crises operations for patients and providers across settings.