Chasing Mortality Endpoints is a Fool’s Errand
"There is no mortality benefit for that." How many times have you heard that? The implication is usually the same: that intervention is a waste of time. A smart, evidence-based clinician wouldn't bother with it. But, what... read more
Effect of Early Sustained Prophylactic Hypothermia on Neurologic Outcomes Among Patients With Severe TBI
Among patients with severe traumatic brain injury (TBI), early prophylactic hypothermia compared with normothermia did not improve neurologic outcomes at 6 months. These findings do not support the use of early prophylactic... read more
Dopamine Antagonists in ICU Delirium
Perhaps the most vexing problem in a patient in an intensive care unit (ICU) is an unexpected change in mental status. Historically, "acute encephalopathy" was the term used to encompass such alterations, but "delirium" is... read more
RRT Board Exam: Mechanical Ventilation
There’s nothing better than feeling confident and relaxed on exam day! Knowing that years of late night study sessions and unpaid clinical rotations are coming to an end just feels….well, absolutely fantastic! Of course,... read more
Effect of Theophylline as Adjunct to Inhaled Corticosteroids on Exacerbations in Patients With COPD
Among adults with COPD at high risk of exacerbation treated with inhaled corticosteroids, the addition of low-dose theophylline, compared with placebo, did not reduce the number COPD exacerbations over a 1-year period. The... read more
Effect of Cricoid Pressure Compared With a Sham Procedure in the Rapid Sequence Induction of Anesthesia
This large randomized clinical trial performed in patients undergoing anesthesia with RSI failed to demonstrate the noninferiority of the sham procedure in preventing pulmonary aspiration. Further studies are required in... read more
Haloperidol and Ziprasidone for Treatment of Delirium in Critical Illness
The use of haloperidol or ziprasidone, as compared with placebo, in patients with acute respiratory failure or shock and hypoactive or hyperactive delirium in the ICU did not significantly alter the duration of delirium.... read more
Antipsychotic Drugs Don’t Ease ICU Delirium Or Dementia
Powerful drugs that have been used for decades to treat delirium are ineffective for that purpose, according to a study published online Monday in the New England Journal of Medicine. Antipsychotic medications, such as haloperidol... read more
Artificial intelligence system could improve survival for sepsis patients
Researchers supported by the NIHR have created an artificial intelligence system that could help identify the best way to treat patients with sepsis. The system 'learnt' the best treatment strategy for a patient by analysing... read more
Initial Trophic vs Full Enteral Feeding in Patients With Acute Lung Injury
In patients with acute lung injury, compared with full enteral feeding, a strategy of initial trophic enteral feeding for up to 6 days did not improve ventilator-free days, 60-day mortality, or infectious complications but... read more
Decontamination Strategies and Bloodstream Infections With Antibiotic-Resistant Microorganisms in Ventilated Patients
In this cluster randomized multicenter study in 13 European ICUs, decontamination strategies with either antibiotics (SDD or SOD) or CHX mouthwash were not associated with reductions in ICU-acquired BSI with MDRGNB, nor mortality,... read more
Decontamination of Oral or Digestive Tract for Patients in the ICU
The study by Wittekamp and colleagues in this issue of JAMA evaluating strategies for decontamination of mechanically ventilated patients in the intensive care unit (ICU) fills an important gap in the evidence regarding these... read more
Rudeness in Medical Settings Could Kill Patients
A recent study paints a grim picture of what rudeness does to doctors and nurses performance. The study, "The Impact of Rudeness on Medical Team Performance: A Randomized Trial," which was published in the September... read more
Fluid overload, de-resuscitation, and outcomes in critically ill or injured patients
Sepsis is associated with generalised endothelial injury and capillary leak and has traditionally been treated with large volume fluid resuscitation. Some patients with sepsis will accumulate bodily fluids. The aim of this... read more
Effect of Dexmedetomidine on Mortality and Ventilation in Sepsis Patients
Dexmedetomidine provides sedation for patients undergoing ventilation; however, its effects on mortality and ventilator-free days have not been well studied among patients with sepsis. This randomized clinical trial compares... read more
Implementing a bedside assessment of respiratory mechanics in patients with ARDS
Implementing a systematic respiratory mechanics test leads to frequent individual adaptations of ventilator settings and allows improvement in oxygenation indexes and reduction of the risk of overdistention at the same time.... read more
Policies That Limit Emergency Department Visits and Reimbursements Undermine the Emergency Care System
Emergency department (ED) visit rates in the United States have been rising over the past 2 decades, outpacing population growth.1 These visits are portrayed in the lay press as unnecessary visits that must be reduced or... read more
Effect of Targeted Polymyxin B Haemoperfusion on 28-Day Mortality in Patients With Septic Shock and Elevated Endotoxin Level
In adult patients with septic shock and high circulating endotoxin activity, does the use of polymyxin B hemoperfusion therapy significantly decrease 28-day mortality? Among patients with septic shock and high endotoxin activity,... read more
Conflicts of interest disclosure forms and management in critical care clinical practice guidelines
The current conflicts of interest (COIs) disclosure forms of selected professional societies provide more attention to financial disclosures and COIs and less attention to detecting and managing intellectual COIs, while rarely... read more
Effect of Bronchodilation, Exercise Training, and Behavior Modification on Symptoms and Physical Activity in COPD
Tiotropium/olodaterol, with or without ExT, improved EET in patients with Chronic Obstructive Pulmonary Disease (COPD) taking part in an SMBM program. Combination bronchodilation, with or without ExT, did not provide additional... read more
An Incurable Disease Is On The Rise In California, And Scientists Say Climate Change Could Cause It To Spread To Much Of The Western US
A fungus that thrives in dry soil and warm weather has caused a record number of infections in California. Experts fear climate change will cause it to spread across the western US. Valley fever, a fungal disease that infects... read more
Should Pediatric Intensive Care Be Centralized? Trent vs. Victoria
The mortality rate is lower among children admitted to specialist pediatric intensive care units (ICUs) than among those admitted to mixed adult and pediatric units in non-tertiary hospitals. In the UK, however, few children... read more
