International practice guidelines for the care of patients with valvular heart disease were most recently updated in 2017, before the publication of the results of the COAPT and MITRA-FR trials in 2018, and these guidelines were conservative in their recommendations regarding surgery for secondary mitral regurgitation.
Patients
Criteria for Consideration of ICU Admission for Patients without an Obvious Need
A patient without an obvious need was defined as one who did not require endotracheal intubation and mechanical ventilation or as one who did not have hypotension requiring vasopressors while in the emergency department. Risk increases proportionally with the presence of more than three criteria.
Scoring Systems for the Diagnosis of Delirium in Critically Ill Patients
Two scales are in common use, the Confusion Assessment Method for the ICU (CAM-ICU) and the Intensive Care Delirium Screening Checklist (ICDSC).
Sedation Scales for Patients in the ICU
Of the sedation scales described, the Riker Sedation–Agitation Scale and the Richmond Agitation–Sedation Scale are the most commonly reported, but in head-to-head comparison, neither is demonstrably superior Sedation Scales for Patients in the intensive care unit (ICU).
Recommendations for Fluid Resuscitation in Acutely Ill Patients
Although the use of resuscitation fluids is one of the most common interventions in medicine, no currently available resuscitation fluid can be considered to be ideal. In light of recent high quality evidence, a reappraisal of how resuscitation fluids are used in acutely ill patients is now required. The selection, timing, and doses of intravenous fluids should be evaluated as carefully as they are in the case of any other intravenous drug, with the aim of maximizing efficacy and minimizing iatrogenic toxicity.
Indications for Antiviral Treatment in Patients with Herpes Zoster
Primary infection with varicella–zoster virus (VZV) results in chickenpox, characterized by viremia with a diffuse rash and seeding of multiple sensory ganglia, where the virus establishes lifelong latency. Herpes zoster is caused by reactivation of latent VZV in cranial-nerve or dorsal-root ganglia, with spread of the virus along the sensory nerve to the dermatome.
Management Guidelines for Patients with Thyroid Nodules
As defined by the American Thyroid Association’s task force on the management of thyroid nodules and differentiated thyroid cancer, a thyroid nodule is a discrete lesion within the thyroid gland that is radiologically distinct from the surrounding thyroid parenchyma.
Guidelines for the Use of Erythropoietic Proteins in Anaemic Patients with Cancer
Anaemia is a frequent finding in cancer patients and should be carefully assessed. Additional causes of anaemia such as iron deficiency, bleeding, nutritional defects or haemolysis should be corrected prior to erythropoietic protein therapy. The following recommendations are related to adult cancer patients with solid tumours or haematological malignancies:
Indications and Contraindications for Targeted Temperature Management in Comatose Patients after Cardiac Arrest
Targeted temperature management should be implemented in the context of a broader strategy of critical care for a comatose patient with the post-cardiac arrest syndrome.
Indications for Therapy and for Neurosurgery in Patients with Prolactinomas
In contrast to macroadenomas, for which therapy is routinely indicated, microadenomas do not always require treatment. For patients with microadenomas who do not have these indications, symptoms and prolactin levels can be monitored, and MRI can be used to follow the size of the tumor.