Oxygen Therapy in Acute Resuscitation

At present, evidence is lacking to support routine liberal oxygen administration in acutely ill patients and, in most circumstances, a reasonable approach is to titrate supplemental oxygen to achieve an arterial oxygen saturation... read more

Characteristics, risk factors and outcomes of Clostridium difficile infections in Greek ICU

Clostridium difficile is one of the major causes of diarrhea among critically ill patients and its prevalence increases exponentially in relation to the use of antibiotics and medical devices. We sought to investigate the... read more

Diagnosis and Management of Acute Exacerbations of COPD – Pharmacology CME

As more and more patients present to the ED with symptoms that suggest an acute exacerbation of Chronic Obstructive Pulmonary Disease (COPD) –worsening dyspnea, cough and sputum production – emergency clinicians can... read more

Meaningful Experiences and End-of-life Care in the ICU

The purpose of this study was to provide a comprehensive exploration of nurses' meaningful experiences of providing end-of-life care to patients and families in the intensive care unit (ICU). This study utilised an interpretive... read more

Noninvasive Ventilation as Acute Therapy

Noninvasive ventilation (NIV) is widely used in ICU patients to treat or to prevent acute respiratory failure (ARF). Whereas its physiological effects are clearly beneficial in hypercapnic patients, it could be deleterious... read more

Incidence, Severity, and Detection of Blood Pressure Perturbations after Abdominal Surgery

Intraoperative and postoperative hypotension are associated with myocardial and kidney injury and 30-day mortality. Intraoperative blood pressure is measured frequently, but blood pressure on surgical wards is usually measured... read more

Insidious Harm of Medication Diluents as a Contributor to Cumulative Volume and Hyperchloremia

This study identified that medication diluents contribute substantially to the total IV volume received by critically ill patients. Saline as the primary medication diluent compared with dextrose 5% in water is associated... read more

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