Pathophysiology, echocardiographic evaluation, biomarker findings, and prognostic implications of septic cardiomyopathy
As a result of conflicting data, echocardiographic measures of left ventricular (systolic or diastolic) or right ventricular function cannot currently provide reliable prognostic information in patients with sepsis. Natriuretic... read more
A modified Delphi process to identify, rank and prioritize quality indicators for CRRT care in critically ill patients
We developed a prioritized list of 13 QIs for continuous renal replacement therapy (CRRT) care. Future work should focus on developing validated benchmarks for these QIs and implementing them into CRRT programs. We conducted... read more
Effect of position and positive pressure ventilation on functional residual capacity in morbidly obese patients
In awake morbidly obese volunteers, an increase in the FRC is observed when spontaneous ventilation at zero inspiratory pressure is switched to positive pressure. Compared with S positioning, the BC position had no measurable... read more
Updates and Controversies in the Early Management of Sepsis and Septic Shock
For patients in the ED who are suspected of having sepsis, swift, effective management is vital to improving outcomes. This issue reviews the latest evidence on the diagnosis and treatment of sepsis and septic shock: ... read more
Low-dose Nocturnal Dexmedetomidine Prevents ICU Delirium
Dexmedetomidine is associated with less delirium than benzodiazepines, and better sleep architecture than either benzodiazepines or propofol; its effect on delirium and sleep when administered at night to patients requiring... read more
Tracheal Intubation Practice and Safety Across International PICUs
There were both similarities and differences in tracheal intubation practice and outcomes across international PICUs. Fewer adverse tracheal intubation–associated events were reported from International versus North American... read more
A Protocol of No Sedation for Critically Ill Patients Receiving Mechanical Ventilation
Standard treatment of critically ill patients undergoing mechanical ventilation is continuous sedation. Daily interruption of sedation has a beneficial effect, and in the general ICU of Odense University Hospital, Denmark,... read more
The Importance of Skeletal Muscle Ultrasound in Critical Care
With growing interest in understanding muscle atrophy and function in critically ill patients and survivors, ultrasound is emerging as a potentially powerful tool for skeletal muscle quantification. However, there are key... read more
Clostridium difficile infection in the ICU
About 10% of patients with diarrhea will test positive for CDI. Around 2% of ICU patients develop an episode of CDI. Estimating the severity of CDI is essential for prognosis and therapy. Diagnosis and estimation of disease... read more
Prolonged acute and post-acute care recovery of physical function in survivors of acute respiratory failure
The proportion of survivors of acute respiratory failure is growing; yet, many do not regain full function and require prolonged admission in an acute or post-acute care facility. Patients who require prolonged admission... read more
Management of Refractory Vasodilatory Shock
Refractory shock is a lethal manifestation of cardiovascular failure defined by an inadequate hemodynamic response to high doses of vasopressor medications. Approximately 7% of critically ill patients will develop refractory... read more
Vasopressors in Sepsis in 2050
Vasopressors are used in sepsis when hypotension is assumed to be mainly due to a decreased arterial tone. However, the appropriate time to initiate vasopressors is not clearly defined, and fluid administration is most... read more
Corticosteroids for Treating Pneumonia
Pneumonia remains a major cause of morbidity and mortality in the United States.1 There is both theoretical and laboratory evidence that corticosteroids may have beneficial effects in pneumonia through local pulmonary and... read more
Critical Care Controversies: The REBEL vs The SKEPTIC at #SMACC 2019
On the last day of the last SMACC conference, Dr. Ken Milne (The SGEM) and I had a cage match debating four critical care controversies. It was all done in good fun with both of us taking our opportunities to poke a little... read more
Effects of High-Flow Nasal Cannula on the Work of Breathing in Patients Recovering From ARF
High-flow nasal cannula, when set at 60 L/min, significantly reduces the indexes of respiratory effort in adult patients recovering from acute respiratory failure (ARF). This effect is associated with an improvement in... read more
Safety of Early Tracheostomy in Trauma Patients After Anterior Cervical Fusion
Cervical spine injuries (CSIs) can have major effects on the respiratory system and carry a high incidence of pulmonary complications. Respiratory failure can be due to spinal cord injuries, concomitant facial fractures or... read more
Threshold Analysis as an Alternative to GRADE for Assessing Confidence in Guideline Recommendations Based on Network Meta-analyses
Guideline development requires the synthesis of evidence on several treatments of interest, typically by using network meta-analysis (NMA). Because treatment effects may be estimated imprecisely or be based on evidence lacking... read more
Dysphagia in the ICU: Epidemiology, Mechanisms, and Clinical Management
In the light of the fact that the clinical consequences of ICU-acquired dysphagia (e.g., aspiration-induced pneumonitis/pneumonia) can often be observed on ICUs, more data on underlying mechanisms and/or risk factors seems... read more
Indications and Outcomes of Extracorporeal Life Support in Trauma Patients
Data from the largest registry of critically ill trauma patients receiving extracorporeal life support (ECLS) demonstrates reasonable survival. With growing experience and improved safety profile, trauma should not be considered... read more
Unsupervised Analysis of Transcriptomics in Bacterial Sepsis Across Multiple Datasets Reveals Three Robust Clusters
The three sepsis subtypes may represent a unifying framework for understanding the molecular heterogeneity of the sepsis syndrome. Further study could potentially enable a precision medicine approach of matching novel immunomodulatory... read more
Sepsis and Septic Shock – What Matters from EM Cases Course
In this podcast Dr. Sara Gray, intensivist and emergency physician, co-author of The CAEP Sepsis Guidelines, answers questions such as: How does one best recognize occult septic shock? How does SIRS, qSOFA and NEWS compare... read more
Thromboelastography Predicts Thromboembolism in Critically Ill Coagulopathic Patients
Critically ill patients with deranged conventional coagulation tests are often perceived to have an increased bleeding risk. Whether anticoagulant prophylaxis for these patients should be withheld is contentious. This study... read more
