New Guidelines for Hospital-acquired Pneumonia/Ventilator-associated Pneumonia
American and European guidelines have many areas of common agreement such as limiting antibiotic duration. Both guidelines were in favor of a close clinical assessment. Neither recommended a regular use of biomarkers but... read more
Clinics Aim to Improve Post-ICU Recovery
Ten days after arriving in the emergency department with pneumonia, 58-year-old Connie Bovier woke up in the intensive care unit (ICU). She survived acute respiratory distress syndrome (ARDS), sepsis, and a host of other... read more
Selected Imaging Controversies in ED Trauma
Traumatic injuries are amongst the most common presentations for all emergency departments (ED). In 2010, there were over 1 million patients in Canada who visited the ED for trauma, result in an cost of almost 9 billion dollars.... read more
Long-Term Mortality and Hospital Resource Use in ICU Patients With Alcohol-Related Liver Disease
ICU patients with alcohol-related liver disease have higher 5-year mortality and emergency readmission rates than ICU patients with other severe comorbidities and matched general ICU patients. These data can contribute to... read more
Sepsis Test Could Show Results In Minutes
A new rapid test for earlier diagnosis of sepsis is being developed by University of Strathclyde researchers. The device, which has been tested in a laboratory, may be capable of producing results in two-and-a-half minutes,... read more
Antibiotic Treatment of Hospital-acquired Pneumonia
Although more prospective therapy trials of Hospital-acquired Pneumonia (HAP) are needed, based on currently available data, it is possible to use an approach that provides appropriate therapy without the overuse of broad-spectrum... read more
Effect of a Resuscitation Strategy Targeting Peripheral Perfusion Status vs Serum Lactate Levels on 28-Day Mortality Among Patients With Septic Shock
Among patients with septic shock, a resuscitation strategy targeting normalization of capillary refill time, compared with a strategy targeting serum lactate levels, did not reduce all-cause 28-day mortality. Among 424 patients... read more
Effect of Intravenous Acetaminophen vs Placebo Combined With Propofol or Dexmedetomidine on Postoperative Delirium Among Older Patients Following Cardiac Surgery
Among older patients undergoing cardiac surgery, postoperative scheduled IV acetaminophen, combined with IV propofol or dexmedetomidine, reduced in-hospital delirium vs placebo. Additional research, including comparison of... read more
Bag-Mask Ventilation during Tracheal Intubation of Critically Ill Adults
Among critically ill adults undergoing tracheal intubation, patients receiving bag-mask ventilation had higher oxygen saturations and a lower incidence of severe hypoxemia than those receiving no ventilation. Among the 401... read more
Should We Stop Trending Lactate in Septic Shock?
There may be a tendency to cement guideline recommendations into our collective minds as inalienable and sacrosanct – as if carved onto stone tablets and brought down to us from the heights of Mount Sinai. Thoughtful medicine,... read more
Implementing Early Mobilization in the ICU
The use of a quality improvement appraisal tool can help identify high quality projects when planning a similar mobility program. Even though projects were conducted in a variety of intensive care unit settings, and implementation... read more
RBC Transfusions Are Associated With Prolonged Mechanical Ventilation in Pediatric ARDS
RBC transfusion was independently associated with longer duration of mechanical ventilation in pediatric acute respiratory distress syndrome. Hemoglobin transfusion thresholds should be tested specifically within pediatric... read more
Catheter Directed Thrombolysis for Intermediate Risk Pulmonary Embolism
Intermediate risk pulmonary embolism is common and carries a risk of progression to hemodynamic collapse and death. Catheter directed thrombolysis is an increasingly utilized treatment option, based largely on the assumptions... read more
The Clinical Impacts and Risk Factors for Non-central Line-associated Bloodstream Infection in 5046 ICU Patients
Most of the previous studies focused on central line-associated bloodstream infection (CLABSI), while non-central line-associated bloodstream infection (N-CLABSI) was poorly studied. This study was performed to investigate... read more
Graceful Exit: How to Advocate Effectively, Take Care of Yourself, and Be Present for the Death of a Loved One
When we are thrust into the role of caregiver for a loved one who is in the process of dying, it's easy to get overwhelmed. Yet it's a situation millions of us face every year with virtually no sort of preparation or guidance.... read more
The PreVent Trial, Assessing the Role of Bag-mask Ventilation During Tracheal Intubation in Critically Ill Adults
In this "Breathe Easy Critical Perspective" podcast, Dr. Dominique Pepper interviews Dr. Matthew Semler. They discuss the PreVent trial, a recent publication in the 2019 issue of the NEJM that assessed the role of bag-mask... read more
Muscle Atrophy in Mechanically-ventilated Critically Ill Children
In children receiving invasive mechanical ventilation, diaphragm and other skeletal muscle atrophy is common and rapid. Increasing age and TBI may increase severity of limb muscle atrophy. Prospective studies are required... read more
Improved Guideline Adherence and Reduced Brain Dysfunction After a Multicenter Multifaceted Implementation of ICU Delirium Guidelines in 3,930 Patients
This large pre-post implementation study of delirium-oriented measures based on the 2013 Pain, Agitation, and Delirium guidelines showed improved health professionals’ adherence to delirium guidelines and reduced brain... read more
Did I Start the Opioid Epidemic?
Prescription opioid abuse is at epidemic levels. Opioids diverted from friends and family members who have legitimate prescriptions are a major source of abused prescription opioids. Nurses are vital to any effort to combat... read more
In Shock: My Journey from Death to Recovery and the Redemptive Power of Hope
In Shock is a riveting first-hand account from a young critical care physician, who in the passage of a moment is transfigured into a dying patient. This transposition, coincidentally timed at the end of her medical training,... read more
Design and Implementation of a Pediatric ICU Acuity Scoring Tool as Clinical Decision Support
Pediatric in-hospital cardiac arrest most commonly occurs in the pediatric intensive care unit (PICU) and is frequently preceded by early warning signs of clinical deterioration. In this study, we describe the implementation... read more
Antibiotic timing in Severe Sepsis
Severe sepsis is a time dependent condition and this study builds on previous literature which supports that early identification and treatment of sepsis with antibiotics decreases mortality. Retrospective analysis of a large... read more
