Tag: therapy

Upvote Story 6
Decisions to limit therapy (DTLT) are routine for ICU physicians. Although breaking bad news is one of the most difficult tasks clinicians face, ongoing communication is even more crucial as families (not necessary following a legal or genetic definition) of critically ill patients have heightened communication needs. Supporting families during the process of shared decision-making from the pursuit of cure/recovery to the pursuit of comfort/freedom... Read More | Comment
Upvote Story 7
Glycaemic Control in the EU. Following on from the poster we presented at the Intensive Care Society. We asked Sphere Medical's own Dr Gavin Troughton to present at our launch event. In the below video he goes into more detail on the poster study.  "A comparative survey of glycaemic control practice in the UK, Germany and BeNeLux". The study confirmed that there are still controversies over... Read More | Comment
Upvote Story 4
Levosimendan has been demonstrated to have potential utility in a range of critical illness scenarios. It must be acknowledged, however, that in each sphere of application, the evidence is incomplete or indicative rather than conclusive, and further clinical evaluation will be needed to substantiate the case for levosimendan and to refine the patient categories and dosage schedules likely to be associated with the greatest clinical... Read More | Comment
Upvote Story 14
Nurses handle supplementary oxygen to intensive care unit (ICU) patients as part of their daily practice. To secure patients of optimal and safe care, knowledge of nurses’ perception of this practice, including influencing factors for adjusting oxygenation levels is essential. This study aimed to explore intensive care nurses’ perception of handling oxygenation and of factors that govern and influence this practice. A mixed methods approach... Read More | Comment
Upvote Story 26
This recently released practically oriented book provides an up-to-date overview of all significant aspects of the pathogenesis of sepsis and its management, including within the ICU. Readers will find information on the involvement of the coagulation and endocrine systems during sepsis and on the use of biomarkers to diagnose sepsis and allow early intervention. International clinical practice guidelines for the management of sepsis are presented,... Read More | Comment
Upvote Story 8
Until modifications in chimeric antigen receptor T-cell therapy decrease their toxicities, the intensivist will play a leading role in the management of critically ill chimeric antigen receptor T-cell patients. As this novel immunotherapeutic approach becomes widely available, all critical care clinicians need to be familiar with the recognition and management of complications associated with this treatment. This article is a comprehensive review of the available... Read More | Comment
Upvote Story 9
A high-flow nasal cannula (HFNC) is a high-flow oxygen supply device developed in recent years and is increasingly being used to treat acute hypoxemic respiratory failure (AHRF) in intensive care unit (ICU). Patients with pre-existing chronic lung disease (CLD) often develop AHRF and require ICU admission. HFNC therapy is also used for these patients in clinical practice, although few studies have examined its efficacy. We... Read More | Comment
Upvote Story 9
There are only four major indications for fluid administration in the critically ill: resuscitation, maintenance, replacement and nutrition (enteral or parenteral). In this review, a conceptual framework is presented looking at fluids as drugs by taking into account the four D’s (drug selection, dose, duration and de-escalation) and the four phases of fluid therapy within the ROSE concept (resuscitation, optimization, stabilization and evacuation). The four... Read More | Comment
Upvote Story 6
These mechanistic simulations provide insight into the empiric basis of optimal cerebral perfusion pressure and the significance of PRx and Δ CPP. PRx and optimal cerebral perfusion pressure deviations do not directly reflect changes in cerebral autoregulation but are, in general, related to the presence of complex states involving well-described clinical progressions with raised intracranial pressure. In regard to targeting optimal cerebral perfusion pressure, a... Read More | Comment
Upvote Story 4
Despite various technological advances, it still usually takes at least 24 to 48 h to obtain a blood culture result. The subsequent delays in diagnosis and treatment of infection can negatively impact care in the intensive care unit (ICU). Biomarkers, such as procalcitonin (PCT), have been suggested as predictors of blood culture positivity in patients with different diseases. However, the performances of PCT, C-reactive protein (CRP),... Read More | Comment
Upvote Story 3
What is the role of dual antiplatelet therapy after high risk transient ischemic attack or minor stroke? Specifically, does dual antiplatelet therapy with a combination of aspirin and clopidogrel lead to a greater reduction in recurrent stroke and death over the use of aspirin alone when given in the first 24 hours after a high risk transient ischemic attack or minor ischemic stroke? An expert... Read More | Comment
Upvote Story 14
Lactate is an important parameter for monitoring tissue perfusion at present. Lactate kinetics are particularly important to evaluate the response of ICU patients. Therefore, lactate can be the starting point for resuscitation, and monitored during the process of resuscitation to assess whether tissue perfusion is being adequately restored. A large proportion of patients in the ScvO2 group (approximately 69% of the patients in our study)... Read More | Comment
Upvote Story 5
High-flow nasal cannula oxygen therapy may be considered as an initial respiratory therapy for trauma patients with blunt chest injury. High-flow nasal cannula therapy could improve lung aeration as noted by the transthoracic lung ultrasound assessment, and LUS may help the attending physicians identify the usefulness of HFNC therapy and decide whether to continue the use of HFNC therapy or intubate the patient. During the... Read More | Comment
Upvote Story 8
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 5
FMT has become an attractive option to mitigate multiple organ dysfunction in the ICU. This article discusses the physiology, rationale, early experience, and expectations for such therapy in the critically ill patient. The polymeric formulas utilized for enteral nutrition in the ICU are absorbed high in the gastrointestinal tract and may not reach the microbial burden in the cecum where their effect is most needed.... Read More | Comment