Ventilator-associated pneumonia: pathobiological heterogeneity and diagnostic challenges.

Ventilator-associated pneumonia (VAP) affects up to 20% of critically ill patients and induces significant antibiotic prescription pressure, accounting for half of all antibiotic use in the ICU. VAP significantly increases hospital length of stay and healthcare costs yet is also associated with long-term morbidity and mortality. The diagnosis of VAP continues to present challenges and pitfalls for the currently available clinical, radiological and microbiological diagnostic armamentarium. Biomarkers and artificial intelligence offer an innovative potential direction for ongoing future research. In this Review, we summarise the pathobiological heterogeneity and diagnostic challenges associated with VAP.

Spontaneous haemorrhagic cholecystitis secondary to the use of novel anticoagulants (rivaroxaban).

Haemorrhagic cholecystitis is a rare complication of acute cholecystitis. It carries a high risk of morbidity and mortality. Risk factors for haemorrhagic cholecystitis include cholelithiasis, trauma, malignancy and the use of anticoagulants. There have only been a few reported cases of haemorrhagic cholecystitis secondary to the use of novel oral anticoagulants (NOACs). The demographic transition of an ageing population will potentially increase the utilisation of NOACs. Therefore, the incidence of haemorrhagic cholecystitis secondary to NOACs will likely increase. Awareness and prompt diagnosis is paramount to avoid morbidity and mortality associated with haemorrhagic cholecystitis.

Systematic review of use of ß-blockers in sepsis.

BACKGROUND AND AIMS: We proposed a review of present literature and systematic analysis of present literature to summarize the evidence on the use of ß-blockers on the outcome of a patient with severe sepsis and septic shock. MATERIAL AND METHODS: Medline, EMBASE, Cochrane Library were searched from 1946 to December 2013. The bibliography of all relevant articles was hand searched. Full-text search of the grey literature was done through the medical institution database. The database search identified a total of 1241 possible studies. The citation list was hand searched by both the authors. A total of 9 studies were identified. RESULTS: Most studies found a benefit from ß-blocker administration in sepsis. This included improved heart rate (HR) control, decreased mortality and improvement in acid-base parameters. Chronic ß-blocker usage in sepsis was also associated with improved mortality. The administration of ß-blockers during sepsis was associated with better control of HR. The methodological quality of all the included studies, however, was poor. CONCLUSION: There is insufficient evidence to justify the routine use of ß-blockers in sepsis. A large adequately powered multi-centered randomized controlled clinical trial is required to address the question on the efficacy of ß-blocker usage in sepsis. This trial should also consider a number of important questions including the choice of ß-blocker used, optimal dosing, timing of intervention, duration of intervention and discontinuation of the drug. Until such time based on the available evidence, there is no place for the use of ß-blockers in sepsis in current clinical practice.