Measuring Lactate vs. Capillary Refill in Guiding Resuscitation in Shock
Capillary refill is as least as good as measuring lactate in guiding resuscitation efforts in septic shock. Moreover, using a lactate-driven resuscitation strategy led to use of more pressors and more IV fluid administration... read more
Serotonin Syndrome
Serotonin syndromes comes up a lot in critical care medicine. Sometimes we are admitting patients because of a primary diagnosis of serotonin syndrome. Other times we are afraid of causing serotonin syndrome ourselves, due... read more
Midazolam Dose Optimization in Critically Ill Pediatric Patients with ARF
This work leveraged available knowledge on non-heritable and heritable factors affecting midazolam pharmacokinetic in pediatric subjects with primary respiratory failure requiring mechanical ventilation, providing the basis... read more
Artificial Liver Support in Acute and Acute-on-Chronic Liver Failure
Liver support systems such as MARS and TPE may temporarily improve systemic hemodynamics and the degree of encephalopathy. However, TPE is the only procedure that improves survival in patients with ALF. The role of TPE in... read more
It Is Important to Talk About Death
Changes to the rules on organ donation will "reframe" the way people talk about death, a top critical care doctor said today. Dr Matt Morgan said the introduction of "deemed consent" in Wales almost four years ago – a similar... read more
Antibiotics for Sepsis
Antibiotics for Sepsis - Does Each Hour Really Count? Or is it Incestuous Amplification? - by Prof Mervyn Singer "Each hour's delay in initiating antibiotics costs lives" is a doctrine that has attained quasi religious status.... read more
Similar Metabolic, Innate Immunity, and Adipokine Profiles in Adult and Pediatric Sepsis vs. SIRS
Sepsis presents with similar profiles in adult and pediatric patients, characterized by enhanced inflammatory hormonal response and by repressed innate immunity, metabolism, and myocardial contractility. These features early... read more
A Trial of Goal-oriented Hemodynamic Therapy in Critically Ill Patients
Hemodynamic therapy aimed at achieving supranormal values for the cardiac index or normal values for mixed venous oxygen saturation does not reduce morbidity or mortality among critically ill patients. A total of 10,726 patients... read more
Early Prediction of Prognosis in Elderly Acute Stroke Patients
Acute stroke has a high morbidity and mortality in elderly population. Baseline confounding illnesses, initial clinical examination, and basic laboratory tests may impact prognostics. In this study, we aimed to establish... read more
Evaluation of a Safer Opioid Prescribing Protocol (SOPP) for Patients Being Discharged From a Trauma Service
The aims of this study were to evaluate the effects on opioid medication prescribing, patient opioid safety education, and prescribing of naloxone following implementation of a Safer Opioid Prescribing Protocol (SOPP) as... read more
Association of Age With Short-term and Long-term Mortality Among Patients Discharged From ICUs in France
Results of this study suggest that aging was associated with an increased risk of mortality in the 3 years after hospital discharge that included an ICU admission, with a sharp increase in those 80 years and older. However,... read more
Level and Prevalence of Spin in Published Cardiovascular Randomized Clinical Trial Reports With Statistically Nonsignificant Primary Outcomes
In this systematic review that included 93 reports of Randomized Clinical Trials (RCTs) from 6 high-impact journals, positive spin of statistically nonsignificant primary outcomes was found in 57% of abstracts and 67% of... read more
Clinician Perception of a Machine Learning–Based Early Warning System Designed to Predict Severe Sepsis and Septic Shock
In general, clinical perceptions of Early Warning System 2.0 were poor. Nurses and providers differed in their perceptions of sepsis and alert benefits. These findings highlight the challenges of achieving acceptance of predictive... read more
In-hospital Mortality Associated with the Misdiagnosis or Unidentified Site of Infection at Admission
Rapid detection, early resuscitation, and appropriate antibiotic use are crucial for sepsis care. Accurate identification of the site of infection may facilitate a timely provision of appropriate care. We aimed to investigate... read more
The Rise of the Healthcare Administrator
Here's some food for thought: The number of physicians in the United States grew 150 percent between 1975 and 2010, roughly in keeping with population growth, while the number of healthcare administrators increased 3,200... read more
Effect of a Low vs Intermediate Tidal Volume Strategy on Ventilator-Free Days in ICU Patients Without ARDS
In patients in the Intensive Care Unit (ICU) without acute respiratory distress syndrome (ARDS) who were expected not to be extubated within 24 hours of randomization, a low tidal volume strategy did not result in a greater... read more
Effect of High-Flow Nasal Oxygen vs Standard Oxygen on 28-Day Mortality in Immunocompromised Patients With ARF
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... read more
Angiotensin II For Septic Shock Treatment
Angiotensin II has been studied for many years and has consistently shown to increase MAP. This medication adds a new mechanism of action to the vasopressor arsenal that is already used for septic shock. Angiotensin II should... read more
Identifying At-Risk Patients for Sub-optimal Beta-lactam Exposure in Critically Ill Patients with Severe Infections
Conventional beta-lactam dosing is flawed in critically ill patients. Useful tools such as the MeroRisk Calculator need to be comprehensively evaluated clinically, and if successful should be added into clinical practice... read more
Pretreating red blood cells with nitric oxide may reduce side effect linked to transfusions
A new treatment may diminish a dangerous side effect associated with transfusions of red blood cells (RBCs) known as pulmonary hypertension, an elevated blood pressure in the lungs and heart that can lead to heart failure.... read more
Sedation in the ICU – Good Past – Better Future?
The concepts for good sedation include defining the range of sedation, the need for agents with rapid response that can be easily and rapidly varied in restless and confused patients, various modes of ventilation, continuous... read more
Closed Chest Compressions in Traumatic Cardiac Arrest
This study demonstrated that fluid resuscitation with whole blood is significantly better than resuscitation with compressions alone or with normal saline. It further showed that there was no difference between whole blood... read more
