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Upvote Story 8
Dr. Jonathan Sevransky was intrigued when he heard that a well-known physician in Virginia had reported remarkable results from a simple treatment for sepsis. Could the leading cause of death in hospitals really be treated with intravenous vitamin C, the vitamin thiamine and doses of steroids? “Hundreds of thousands of people die in the U.S. every year and millions of people in the world die... Read More | Comment
Upvote Story 6
The idea of using beta-blockers as a treatment for ventricular fibrillation occurred to James Black over 60 years ago. He developed propranolol and cimetidine, among other pharmacologic agents, work for which he won the Nobel Prize in 1988. Beta-blockers were reported to lower blood pressure by Brian Pritchard in 1964, and he and John Cruickshank wrote Beta-blockers in Clinical Practice, a major early text on... Read More | Comment
Upvote Story 5
Resuming β blockers in chronic users by the end of the first postoperative day may be associated with lower odds of in-hospital atrial fibrillation. However, there seems to be little advantage to restarting on the day of surgery itself. Of propensity score–matched patients who resumed β blockers by end of postoperative day 1, 4.9% developed atrial fibrillation, compared with 7.0% (68 of 973) of those... Read More | Comment
Upvote Story 4
Patient mobilization and physical rehabilitation in the ICU appears safe, with a low incidence of potential safety events, and only rare events having any consequences for patient management. Heterogeneity in the definition of safety events across studies emphasizes the importance of implementing existing consensus-based definitions. Heterogeneity was assessed by I2 statistics, and bias assessed by the Newcastle-Ottawa Scale and Cochrane risk of bias assessment. The... Read More | Comment
Upvote Story 5
Most people have heard about antibiotic-resistant germs. But how about antibiotic-resistant dust? A new Northwestern University study has found that an antimicrobial chemical called triclosan is abundant in dust — and linked to changes in its genetic makeup. The result is dust with organisms that could cause an antibiotic-resistant infection. Hartmann’s study compared dust samples collected from 42 athletic facilities in the Pacific Northwest region.... Read More | Comment
Upvote Story 6
A 36-year-old man was admitted to the intensive care unit with an acute exacerbation of chronic heart failure. His medical history included heart failure with an ejection fraction of 20%, bioprosthetic aortic-valve replacement for bicuspid aortic stenosis, endovascular stenting of an aortic aneurysm, and placement of a permanent pacemaker for complete heart block. An Impella ventricular assist device was placed for management of acute heart... Read More | Comment
Upvote Story 8
Seven out of ten physicians would not recommend their profession to their children or other family members, and more than half are thinking about retiring within the next five years, including one-third of those under the age of 50, according to a new national survey by The Doctors Company, a physician-owned medical malpractice insurer. The survey of more than 3,400 US physicians uncovered a “complex... Read More | Comment
Upvote Story 5
Cardiogenic shock (CS) remains the most common cause of death in patients with acute myocardial infarction although mortality could be reduced from formerly ∼80% to 40–50%. In addition to percutaneous coronary intervention or coronary artery bypass grafting, catecholamines, fluids, intraaortic balloon pumping (IABP), and also active assist devices are widely used for CS management. However, there is only limited evidence for any of the above... Read More | Comment
Upvote Story 6
This single-center retrospective analysis shows promising results with NEWS as a screening tool primarily because it can be done at triage and does not require any laboratory evaluation. This study adds to the current knowledge that qSOFA should not be used as a sepsis screening tool as it has poor sensitivity and moderate specificity for short-term mortality. While the methodology of this study is extensively... Read More | Comment
Upvote Story 9
There was an influx of elves admitted into the ICU last year, but our community of exceptional nurses cared for them! This year, we invite you to participate in our AACN Elf on the Shelf social media contest! Simply take a photo of your Elf on the Shelf ICU scene and submit it in the comments below. One randomly selected submission will receive a $100... Read More | Comment
Upvote Story 5
Non-technical skills and human factors are increasingly recognized as critical ingredients in the success or failure of acute care delivery in a number of high stakes clinical domains. This is reflected in the evolution of life support courses, which now incorporate components of the zero point survey (ZPS). For example, the European Trauma Course emphasizes team briefs and equipment checks, and the Advanced Pediatric Life... Read More | Comment
Upvote Story 6
Trials in Australia could be signalling the way ahead for a new role for remotely piloted aircraft in the air medical sphere, as James Paul Wallis reports. Drones have long since proved their worth as an aerial search tool and this year have grabbed headlines by assisting in rescues of swimmers in the surf. Could they also assist in responding to trauma alongside traditional HEMS... Read More | Comment
Upvote Story 7
Overall, 18.4% of adults reported a mental illness in the past year, and 8.6% reported substance abuse/dependence during the same time. Nearly 40% had 1 or more chronic medical conditions in their lifetimes, and 14.7% were living in poverty. In general, increased numbers of reported mental health conditions were commensurate with higher overall poorer health and further elevated by the rate of poverty. Compared with... Read More | Comment
Upvote Story 5
Researchers at Massachusetts General Hospital (MGH; Boston, USA), Harvard Medical School (HMS; Boston, MA, USA), and other institutions conducted a trial to see if treating stored packed sheep RBCs with NO before transfusion could prevent PH. To do so, cohort sheep were transfused with autologous RBCs treated with NO and stored for 40 days; control sheep received stored RBCs not exposed to NO. Pulmonary and... Read More | Comment
Upvote Story 6
Survivors of critical illness frequently experience poor physical outcomes, including persistent impairments in muscle strength, exercise capacity and physical function. In this article, we review these impairments and recent clinical trials evaluating physical rehabilitation during critical illness as a potential means to improve these outcomes, and conclude with considerations for future studies in the field. Muscle wasting and weakness commonly develops within days of ICU... Read More | Comment
Upvote Story 8
Effect of Protocolized Weaning With Early Extubation to Noninvasive Ventilation vs Invasive Ventilation
This complex randomized, controlled trial failed to demonstrate that early extubation to non-invasive ventilation reduced the total time of mechanical ventilation. I will continue to extubate early and will use non-invasive mechanical ventilation or high-flow nasal oxygen therapy to support patients, with regular audit of re-intubation rates. The beneficial secondary outcomes demonstrated in this trial, such as reduced antibiotic use, reduced sedation requirement and reduced... Read More | Comment
Upvote Story 10
In this cohort, the major risk factors for septicemia death were similar to those for other causes of death, there was approximately a 2-fold Black-White disparity in septicemia deaths, and the strongest mediators of this disparity was across domains of socioeconomic status. Of 206,691 adult survey participants, 1,523 experienced a septicemia death. Factors associated with > 2-fold larger hazard of septicemia death included: need for... Read More | Comment
Upvote Story 12
The predictive models evaluated in this study demonstrated moderate to good discriminative ability to predict ICU patients’ risk of developing delirium. Models calculated at 24-hours post-ICU admission appear to be more accurate but may have limited utility in practice. There were 803 ICU admissions during the study period, of which 455 met inclusion criteria. 35.2% (n = 160) were Confusion Assessment Method for ICU positive... Read More | Comment
Upvote Story 6
In the study cohort, ICU admission pectoralis muscle area (PMA) was associated with survival during and following critical illness; it was unable to predict regaining an independent lifestyle following discharge. ICU admission SAT mass was not associated with survival or other measured outcomes. PMA of patients admitted to a medical intensive care unit (MICU) is associated with survival both during and after critical illness, but... Read More | Comment