Update in the Management of Intensive Care Medicine

LIU Xiangde

Abstract：Findings of recent new clinical trials in critically ill patients indicate that several traditional treatment strategies in critical care need to be modified.The author reviewed recent literatures of clinical trials on critically ill patients and summa-rized as following changes in the practice.(1 )In patients with ARDS,fluid restriction gives better outcomes than a liberal fluid policy.A pulmonary arterial catheter is no longer necessary to be a routine procedure in ARDS.(2)Although cortico-steroids may improve oxygenation,late use of corticosteroids in ARDS patients (>14 days after diagnosis)is not indicated and may increase risk of death.(3)Daily interruption of sedation and early awakening of mechanically ventilated patients is safe and may shorten the length of ventilation.(4)Intensive insulin therapy in shock patient is associated with hypoglycemia and can cause many complications.(5 )Corticosteroids therapy can result in faster shock reversal,but its effect on mortality remain controversial.(6)Vasopressin can improve hemodynamic in shock patients,but its use is not associated with an im-provement in mortality rates.(7)Compared to norepinephrine,dopamine may result in a greater number of cardiac adverse events.