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This Week in JAMA
October 24/31, 2012

This Week in JAMA

JAMA. 2012;308(16):1607. doi:10.1001/jama.2012.3288

Among critically ill patients, tight glucose control is associated with less morbidity and mortality; however, transient hypoglycemic episodes could have adverse effects, particularly on the developing brain. Mesotten and colleagues assessed neurocognitive function in 569 children who, approximately 4 years prior, participated in a randomized clinical trial comparing tight glucose control with usual care in critically ill children. The authors report that children treated with tight glucose control did not have worse measures of intelligence or cognitive function than those who received usual care. In an editorial, Tasker discusses glycemic control in critical care.

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Lung-protective mechanical ventilation using lower tidal volumes is associated with improved outcomes in acute lung injury. In a meta-analysis of data from 20 studies (2822 patients) that evaluated the use of lower vs higher tidal volumes in patients without acute lung injury at the onset of mechanical ventilation, Neto and colleagues found that protective ventilation was associated with better clinical outcomes including less lung injury, pulmonary infection, atelectasis, and biochemical alterations. In an editorial, Fergusson discusses whether current evidence supports low tidal volumes for all mechanically ventilated patients.