Recent Critical Care News

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This JAMA Clinical Guidelines Synopsis summarizes the American College of Chest Physicians' 2016 recommendations on antithrombotic therapy for venous thromboembolism (VTE). The estimated annual incidence of VTE, defined as DVT of the leg or PE, ranges from 104 to 183 per 100 000 person-years. Compared with those without VTE, the 30-year mortality risk is increased for survivors of an episode of VTE and for survivors of... Read More | Comment
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In a single center’s experience, thrombolytic therapy is used infrequently for the management of cardiac arrest. Thrombolysis during cardiac arrest should be considered on a case-by-case basis and should be utilized only when there is a high suspicion for pulmonary embolism as the cause of arrest and when thrombolytic therapy is readily available. Twenty-six patients were identified. Patients were predominantly male (65%) and Caucasian (89%)... Read More | Comment
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A new report released Wednesday from the OECD estimates that antimicrobial resistant infection is on track to kill 30,000 Americans per year by 2050. The financial cost to the 33 developed countries included in the study could be as high as $3.5 billion a year. Three out of four deaths could be averted by investing just $2 per person per year in a comprehensive package... Read More | Comment
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Vitamin C, angiotensin-II, and methylene blue are emerging options on the cutting edge of refractory septic shock treatment that require more investigation, but nevertheless appear promising, Rishi Rattan, MD, said at the annual clinical congress of the American College of Surgeons. Trials evaluating vitamin C in this setting have demonstrated a large mortality impact with an absence of side effects, according to Dr. Rattan, a... Read More | Comment
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Intravenous caffeine is able to accelerate emergence from isoflurane anesthesia in healthy males without any apparent adverse effects. All randomized participants were included in the analysis. The mean time to emergence with saline was 16.5 ± 3.9 (SD) min compared to 9.6 ± 5.1 (SD) min with caffeine (P = 0.002), a difference of 6.9 min (99% CI, 1.8 to 12), a 42% reduction. Participants emerged at a higher expired... Read More | Comment
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The evidence-based ABCDEF bundle was successfully implemented in seven community hospital ICUs using an interprofessional team model to operationalize the Pain, Agitation, and Delirium guidelines. Higher bundle compliance was independently associated with improved survival and more days free of delirium and coma after adjusting for age, severity of illness, and presence of mechanical ventilation. Total and partial bundle compliance were measured daily. Random effects regression... Read More | Comment
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By incorporating algorithms into the electronic health record (EHR), UPMC was able to realize a “dramatic” 72% reduction in missed doses, from 4,331 missed doses in 2014 to 1,193 in 2015, Dr. Neal told attendees in a session focused on hot topics in surgical patient safety. That decrease in missed doses has translated into a decreased rate of VTE, from an already relatively low rate... Read More | Comment
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Mechanical ventilation is an essential life-sustaining therapy for many critically-ill patients. As technology has evolved, clinicians have been presented with an increasing number of ventilator options as well as an ever-expanding and confusing list of terms, abbreviations, and acronyms. Unfortunately, this has made it extremely difficult for clinicians at all levels of training to truly understand mechanical ventilation and to optimally manage patients with respiratory... Read More | Comment
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There were both similarities and differences in tracheal intubation practice and outcomes across international PICUs. Fewer adverse tracheal intubation–associated events were reported from International versus North American PICUs. International PICUs used cuffed endotracheal tube less often and had higher proportion of endotracheal tube change. Adverse tracheal intubation–associated events and desaturation occurrence (oxygen saturation < 80%) were evaluated. A total of 1,134 and 9,376 TIs from... Read More | Comment
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The Social Media Index’s correlation with multiple quality evaluation instruments over time supports the hypothesis that it is associated with overall Web site quality. It can play a role in guiding individuals to high-quality resources that can be reviewed with critical appraisal techniques. A total of 309 of 330 raters completed all ratings (93.6%). The Social Media Index correlated moderately to strongly with the mean... Read More | Comment
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Shock has potentially reversible causes of morbidity and mortality if appropriately diagnosed and managed. Older methods of invasive monitoring have significant limitations but are still critical for managing shock in certain patients and settings. Newer methods are easier to employ, but further validation is needed. Multiple modalities along with careful clinical assessment are often useful in distinguishing shock subtypes. Best practice standards for monitoring should... Read More | Comment
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Pediatric critical care nephrology is a complex and highly specialized field, presenting challenges and management strategies that are often quite distinct from those seen in adult practice. Therefore, it is high time to address all the topics in the field of critical care nephrology in children in a unique book which is the first of its kind. This book covers the basics as well as... Read More | Comment
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Use of renal replacement therapy (RRT) in sepsis varied widely among nationally sampled hospitals without associated differences in mortality. Improving renal replacement standards for the initiation of therapy for sepsis may reduce healthcare costs without increasing mortality. We identified 293,899 hospitalizations with sepsis and acute kidney injury at 440 hospitals, of which 6.4% (n = 18,885) received renal replacement therapy. After risk and reliability adjustment,... Read More | Comment
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We developed a computerized algorithm that accurately detects three types of ventilator dyssynchrony. Double-triggered and flow-limited breaths are associated with the frequent delivery of tidal volumes of greater than 10 mL/kg. Although ventilator dyssynchrony is reduced by deep sedation, potentially deleterious tidal volumes may still be delivered. However, neuromuscular blockade effectively eliminates ventilator dyssynchrony. A total of 4.26 million breaths were recorded from 62 ventilated patients.... Read More | Comment
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Acute kidney injury (AKI) is a frequent postoperative complication with a substantial risk for both short and long-term adverse events, and its incidence is likely to rise because of increasing major surgical procedures. Studies investigating better strategies to prevent and treat AKI in this population are urgently needed.Postoperative AKI affects approximately one-fifth of patients after major surgery, but the incidence varies according to the type... Read More | Comment