Tag: guidelines

Upvote Story 5
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
Upvote Story 4
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
Upvote Story 7
It is a longstanding cultural norm to provide supplemental oxygen to sick patients regardless of their blood oxygen saturation. A recent systematic review and meta-analysis has shown that too much supplemental oxygen increases mortality for medical patients in hospital. Patients randomised to liberal oxygen therapy were more likely to die (risk ratio 1.21 (95% confidence interval 1.03 to 1.43)). The increase in mortality was highest... Read More | Comment
Upvote Story 4
The current conflicts of interest (COIs) disclosure forms of selected professional societies provide more attention to financial disclosures and COIs and less attention to detecting and managing intellectual COIs, while rarely addressing institutional COIs. We provide some suggestions for guideline developers on the classification and management of different COIs in the context of CPGs. All selected professional critical care societies require that members declare direct... Read More | Comment
Upvote Story 11
This book establishes the indications for the use of NIV in the context of weaning from invasive mechanical ventilation. It provides a comprehensive overview of key topics relevant for correct practical application, including NIV and weaning principles, important aspects of patient care before and after weaning, and pediatric and neonatology weaning. Finally, the book summarizes international guidelines and new perspectives of NIV during weaning. With... Read More | Comment
Upvote Story 11
Following the new ESPEN Standard Operating Procedures, the previous guidelines to provide best medical nutritional therapy to critically ill patients have been updated. These guidelines define who are the patients at risk, how to assess nutritional status of an ICU patient, how to define the amount of energy to provide, the route to choose and how to adapt according to various clinical conditions. When to... Read More | Comment
Upvote Story 5
Acute kidney injury (AKI) in the perioperative period is a common complication and is associated with increased morbidity and mortality. A standard definition and staging system for AKI has been developed, incorporating a reduction of the urine output and/or an increase of serum creatinine. Novel biomarkers may detect kidney damage in the absence of a change in function and can also predict the development of... Read More | Comment
Upvote Story 13
Sepsis is medicine’s last remaining preserve for unrestrained antibiotic prescribing. The Surviving Sepsis Campaign guidelines recommend empirical broad-spectrum therapy within one hour of triage for both sepsis and septic shock. This recommendation, and mandates that compel it, encourage clinicians to adopt an approach of “treat first, ask questions later” for patients with any possibility of serious infection. This approach fails to account for the difficulties... Read More | Comment
Upvote Story 7
Writing in the MJA, researchers have reported the findings of a prospective cohort study comparing estimates of the incidence and mortality of sepsis using clinical diagnosis or the Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation (ANZICS CORE) database methodology. The researchers found that when compared with clinical diagnosis, the ANZICS CORE database criteria significantly underestimated the incidence of sepsis... Read More | Comment
Upvote Story 5
Since bronchiolitis is a clinical diagnosis, there is no test, including viral testing and radiography, which rules it in or out (Schuh et al 2007). Sadly, despite multiple guidelines (NICE, AAP, CPS), there has also been no “magic bullet” in terms of treatment. Hypertonic saline has been tried for acute bronchiolitis. A systematic review of this treatment modality was covered on SGEM#157. The bottom line... Read More | Comment
Upvote Story 4
This is a prospective, multicenter, observational study performed during a 5-month period in 2011 in a network of 11 intensive care units (ICUs). We compared our findings with those obtained in the same ICUs in a study conducted in 2002. Although the incidence of sepsis/septic shock remained unchanged during a 10-year period, the implementation of the SSC guidelines resulted in a marked decrease in the... Read More | Comment
Upvote Story 5
A new international guideline has been developed to help physicians diagnosis idiopathic pulmonary fibrosis (IPF), a rare and often fatal lung disease whose cause is unknown. IPF is the most common and deadly form of a group of more than 200 conditions known broadly as interstitial lung disease. Most often, IPF is diagnosed in adults over age 60 and more often in men than women.... Read More | Comment
Upvote Story 7
Among patients with severe secondary mitral regurgitation, the rate of death or unplanned hospitalization for heart failure at 1 year did not differ significantly between patients who underwent percutaneous mitral-valve repair in addition to receiving medical therapy and those who received medical therapy alone. At 12 months, the rate of the primary outcome was 54.6% (83 of 152 patients) in the intervention group and 51.3%... Read More | Comment
Upvote Story 7
Clostridium difficile infection (CDI) is less common than antibiotic-associated diarrhea and irritable bowel syndrome. There is significant concern about overdiagnosis and subsequent overtreatment of CDI with increasing use of NAATs, especially when applied inappropriately to patients who do not have diarrhea or for patients with another cause of diarrhea. This can lead to CDI overdiagnosis and delay in diagnosis and treatment of the actual underlying... Read More | Comment
Upvote Story 5
In patients with endocarditis on the left side of the heart who were in stable condition, changing to oral antibiotic treatment was noninferior to continued intravenous antibiotic treatment. After randomization, antibiotic treatment was completed after a median of 19 days (interquartile range, 14 to 25) in the intravenously treated group and 17 days (interquartile range, 14 to 25) in the orally treated group (P=0.48). In... Read More | Comment