Update in critical care.

The current Update in Critical Care reviews the past year’s most important articles relevant to those practicing critical care. Critical care medicine continues to advance rapidly, particularly with results from large multicenter trials. Results from studies by the Acute Respiratory Distress Syndrome Clinical Trials Network have substantial implications for use of such diagnostic devices as the pulmonary artery catheter and for decisions about fluid therapy in sepsis. This update also reviews a follow-up study addressing use of intensive insulin therapy; several articles addressing such important aspects of infectious disease as timing of antibiotic therapy, role of daptomycin, and a comparison of diagnostic techniques for ventilator-associated pneumonia; and a recent study identifying important barriers to optimal end-of-life care. The Table shows changes to clinical practice that should emerge from these articles.