Tag: ARF

Upvote Story 6
Lower respiratory tract infections (LRTIs) are the leading cause of infectious disease-related deaths worldwide yet remain challenging to diagnose because of limitations in existing microbiologic tests. In critically ill patients, noninfectious respiratory syndromes that resemble LRTIs further complicate diagnosis and confound targeted treatment. This prospective observational study evaluated adults with acute respiratory failure requiring mechanical ventilation who were admitted to the University of California, San... Read More | Comment
Upvote Story 4
Use of initial tidal volumes less than 8 ml/kg PBW is common at hospitals participating in the NHLBI PETAL Network. After considering the size and budgetary requirement for a cluster-randomized trial of LTVV vs. usual care in acute respiratory failure (ARF), the PETAL network deemed the proposed trial infeasible. A rapid observational study and simulations to model anticipated power may help better design trials. We... Read More | Comment
Upvote Story 6
A new study finding that two antipsychotics were no more effective than placebo for delirium in critical illness spurs discussion about alternative methods for managing that care. Neither haloperidol nor ziprasidone — both antipsychotics — significantly alters the duration of delirium in critical illness, according to a new clinical trial published online October 22 in the New England Journal of Medicine. The trial randomized 566... Read More | Comment
Upvote Story 9
Among critically ill immunocompromised patients with acute respiratory failure (ARF), high-flow oxygen therapy did not significantly decrease day-28 mortality compared with standard oxygen therapy. Of 778 randomized patients (median age, 64 [IQR, 54-71] years; 259 [33.3%] women), 776 (99.7%) completed the trial. The primary outcome was day-28 mortality. Secondary outcomes included intubation and mechanical ventilation by day 28, Pao2:Fio2 ratio over the 3 days after... Read More | Comment
Upvote Story 8
High-flow conditioned oxygen therapy delivered through nasal cannulae and noninvasive mechanical ventilation (NIV) may reduce the need for reintubation. Therefore, Hernández et al set out to test if high-flow conditioned oxygen therapy is noninferior to NIV for preventing postextubation respiratory failure and reintubation in patients at high risk of reintubation. Among high-risk adults who have undergone extubation, high-flow conditioned oxygen therapy was not inferior to... Read More | Comment
Upvote Story 5
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
Upvote Story 9
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
Upvote Story 6
In this study, antipsychotics were used to treat nearly half of all antipsychotic-naïve ICU patients and were prescribed at discharge to 24% of antipsychotic-treated patients. Treatment with an atypical antipsychotic greatly increased the odds of discharge with an antipsychotic prescription, a practice that should be examined carefully during medication reconciliation since these drugs carry “black box warnings” regarding long-term use. After excluding 18 patients due... Read More | Comment
Upvote Story 7
A large proportion of patients with do-not-intubate orders who received noninvasive ventilation survived to hospital discharge and at 1 year, with limited data showing no decrease in quality of life in survivors. Provision of noninvasive ventilation in a well-equipped hospital ward may be a viable alternative to the ICU for selected patients. Crucial questions regarding quality of life in survivors, quality of death in nonsurvivors,... Read More | Comment
Upvote Story 6
Randomized clinical trials (RCTs) are conducted to guide clinicians’ selection of therapies for individual patients. Currently, RCTs in critical care often report an overall mean effect and selected individual subgroups. Yet work in other fields suggests that such reporting practices can be improved. Specifically, this Critical Care Perspective reviews recent work on so-called “heterogeneity of treatment effect” (HTE) by baseline risk and extends that work... Read More | Comment
Upvote Story 8
Dr. Fraser, MD, speaks with Bruce A. Mueller, PharmD, FCCP, FASN, about his talk presented at the 47th Critical Care Congress in San Antonio, Texas, entitled “Artificial Kidney Meets Mechanical Lung: Comanaging the Patient with Renal and Respiratory Failure.” Dr. Mueller discusses the concepts of drug dosing during renal replacement therapy. Dr. Mueller is a Professor and Associate Dean at University of Michigan College of... Read More | Comment
Upvote Story 6
The introduction of early mobilization for patients with mechanical ventilation (MV) in the ICU shortened MV durations and ICU stays. A multidisciplinary team that includes the patient’s family can work together to improve the patient’s clinical outcomes. We enrolled 63 patients in the before protocol group and 90 in the after protocol group. The 2 groups were well matched in age, sex, body height, body... Read More | Comment
Upvote Story 22
It is indisputable from the biological and clinical perspectives that not all cases of sepsis are the same. On the contrary, most have great many differences, that is, different portals of entry, clinical manifestations, immunologic responses, and survival outcomes. Therefore, why is there a single definition for something as complex and diverse as sepsis? This is the antithesis of precision medicine. We propose that all... Read More | Comment
Upvote Story 6
The optimal timing of endotracheal intubation in critically ill patients requiring invasive mechanical ventilation remains undefined. A new analysis of the large, prospective Intensive Care Over Nations (ICON) database compares patients who underwent intubation early – within two days of ICU admission – to those who underwent intubation later. Results show that later intubation (after two days) was associated with a greater hazard of death... Read More | Comment
Upvote Story 4
Extracorporeal membrane oxygenation (ECMO) is becoming a common procedure to support patients with severe cardio-circulatory or respiratory failure as well as in case of combined compromise of the two systems. Deciding which ECMO configuration and proceeding with an uneventful implantation, however, may present minor or major shortcomings. Cannulation techniques should be tailored to specific patient conditions to provide sufficient regional and systemic perfusion, both of... Read More | Comment