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Until a randomized prospective controlled trial is available, the clinician should exercise clinical judgment regarding extubation in VA-ECMO patients as it may result in adverse outcome (this study has about 25% extubation failure). Patients with extubation had a higher prevalence of ventilator-associated pneumonia than those who did not have extubation (Supplementary Table 2 in [1]). The authors studied the benefit of ventilator liberation in patients treated with venoarterial extracorporeal membrane oxygenation therapy (VA-ECMO). [Extracted from the article]

The authors illustrated that "Biomarkers of systemic inflammation are associated with longer delirium duration, higher delirium severity, and in-hospital mortality." Delirium is a complex and dynamic process determined by many variables; patient risk factors, disease-related factors, treatment-related factors, environment, and surrounding related factors. [Extracted from the article]

Although ultrasound is emerging gold standard for critically ill patient at bedside, many physicians frequently consider CT scan to confirm diagnosis, especially for disorders like pulmonary gangrene as soon as patient becomes stable to undergo CT scanning because patient will have to be moved for surgery anyway. B Rashid Nadeem, MD FACP FCCP FAASM b B Rami Mohammed Osman Abdalla Satti, MD, CCUST b Department of Intensive Care, Dubai Hospital, Dubai, United Arab Emirates Footnotes 1 The authors have disclosed that they do not have any potential conflicts of interest. [Extracted from the article]

Shinn et al (1) reported prevalence of ALgI (mucosal ulceration or granulation tissue in the larynx) in 57% of patients, which appears to be high for patients who have prolong MV for only greater than 12 hours. We noticed that supplementary material titled as standard protocols for nasolaryngoscopy provided all standard protocols for ICU patient although there was no standard protocol defined for intubation or nasolaryngoscopy. [Extracted from the article]

The authors have done a great job of reporting prevalence and outcome trends in care of patients with variceal bleeding admitted to ICU. Majeed et al ([1]) excluded; same episode hospital readmission, transfers and patients with unknown outcomes, what was the proportion of these patients?. [Extracted from the article]

Increase in post discharge, out of hospital mortality suggests that patients on midodrine may be discharged with subclinical hypoperfusion secondary to pseudo-normalization of vital signs, although it may be more complex. Last, authors mention that among the 909 patients (81%) who survived to hospital discharge, 53% (484/909) received midodrine in the 24 hours before hospital discharge and midodrine was listed on 34% (311/909) of the hospital discharge summaries. [Extracted from the article]