Recent Critical Care News

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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
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The Advanced Ventilator Book is a companion to the best-selling The Ventilator Book and is written for clinicians who already have a solid foundation in the basics of mechanical ventilation. It goes beyond the ventilator itself to discuss strategies for severe hypoxemia and rescue maneuvers for refractory respiratory failure. Subjects covered in The Advanced Ventilator Book include: Optimal PEEP, Treatment of severe bronchospasm, Prone positioning,... Read More | Comment
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In this multicentre study, we could not demonstrate any difference between Lp299 and CHX used in oral care procedures regarding their impact on colonisation with emerging potentially pathogenic enteric bacteria in the oropharynx and trachea. Potentially pathogenic enteric bacteria not present at inclusion were identified in oropharyngeal samples from 29 patients in the CHX group and in 31 samples in the probiotic group. One hundred... Read More | Comment
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In this article, we review physiologic principles of global oxygen delivery, and discuss the bedside approach to assessing the adequacy of oxygen delivery in critically ill patients. Although there have been technological advances in the assessment of oxygen delivery, we revisit and emphasize the importance of a ‘tried and true’ method – the physical examination. Also potentially important in the evaluation of oxygen delivery is... Read More | Comment
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This oft-quoted all-time favorite of the medical community will gladden – and strengthen – the hearts of patients, doctors, and anyone entering medical study, internship, or practice. With unassailable logic and rapier wit, the sage Dr. Oscar London muses on the challenges and joys of doctoring, and imparts timeless truths, reality checks, and poignant insights gleaned from 30 years of general practice – while never... Read More | Comment
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Recently the MINDS-USA trial evaluated the use of haloperidol or ziprasidone for delirium in critical illness. Before jumping into the results of this study, it will help to establish a couple of foundational principles. Overall, antipsychotics don’t reverse the underlying pathophysiologic causes of delirium. However, antipsychotics can be useful to alleviate symptoms of agitation and insomnia, allowing the patient to be managed safely while delirium... Read More | Comment
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In patients with respiratory failure and metabolic alkalosis, carbonic anhydrase inhibitor therapy may have favorable effects on blood gas parameters. In mechanically ventilated patients, carbonic anhydrase inhibitor therapy may decrease the duration of mechanical ventilation. A major limitation of this finding was that only two trials assessed this clinically important outcome. Six eligible studies were identified with a total of 564 participants. The synthesized data... Read More | Comment
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Although real-time ultrasound guidance during central venous catheter insertion has become a standard of care, postinsertion chest radiograph remains the gold standard to confirm central venous catheter tip position and rule out associated lung complications like pneumothorax. Transthoracic echocardiography and lung ultrasound are noninferior to chest x-ray for screening of pneumothorax and accurate central venous catheter positioning. Thus, the point of care use of ultrasound... Read More | Comment
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Consider sitting deep within the hull of this cruise ship, ignorant to the outside. A leak is sprung and ocean begins to rush in. Thinking quickly you activate the bilge pump which, appropriately, ejects the ocean outside again. You note that the bilge pump has a number of settings from "low" to "high" corresponding to the rate at which it evacuates ocean from inside the... Read More | Comment
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The majority of respondents reported targeting moderate to deep sedation following cannulation, with the use of sedative and opioid infusions. There is considerable variability surrounding early physical therapy and mobilization goals for patients with acute respiratory failure (ARF) supported by venovenous extracorporeal membrane oxygenation. We analyzed responses from 209 respondents (53%), mostly from academic centers (63%); 41% respondents provide venovenous extracorporeal membrane oxygenation to adults... Read More | Comment