Update in Critical Care Medicine

• Respiration, artificial
• Nitric oxide
• Respiratory distress syndrome, adult
• Thromboembolism
• Pneumonia, pneumocystis carinii

We begin this survey with reports describing advances in mechanical ventilatory assistance, including maximization of oxygenation by inhaled nitric oxide and a lung-protective ventilatory regimen that seems to improve the outlook for patients with the acute respiratory distress syndrome (ARDS). We also discuss extubation, both planned (by use of a simple index of readiness) and unplanned. Reports dealing with sepsis and infection cover the detection of Pneumocystis carinii infection by endotracheal aspiration and the dependence of survival on how well a patient can utilize oxygen. Another topic covered is the value of gastrointestinal decontamination in the intensive care unit (ICU). The subject of thromboembolism is represented by a meta-analysis seeking to learn whether prophylactic heparin can prevent catheter-related venous thrombosis and by a trial combining heparin with a vena caval filter in patients with deep venous thrombosis. Finally, other interesting reports address how often autopsies of patients in a coronary ICU reveal important unexpected findings, whether colloid fluid is really better than crystalloid fluid, the value of intensivist care in the medical ICU, and a simple preadmission tool for predicting the outcome of gastrointestinal bleeding.