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
Doubling Down on Re-Expansion Pulmonary Edema: Treatment Approach and Ventilator Management
The treatment of choice for a pneumothorax is a chest tube, and when the small pig-tail catheter doesn’t do the job, the answer is to replace it with a larger bore – right? Not so fast. The exact mechanism of REPE is... read more
Mentorship Malpractice
The word mentorship evokes strong emotional and intellectual chords. In formal parlance, mentorship has been defined as "a dynamic, reciprocal relationship in a work environment between an advanced-career incumbent (mentor)... read more
Stronger evidence for vitamin C use in sepsis treatment
A new meta-analysis reveals a positive correlation between incorporating vitamin C in the treatment of sepsis and favorable patient outcomes. Results of the meta-analysis showed a marked reduction in mortality and duration... read more
Clinical Trial Testing Vitamin and Steroid Combination in Sepsis Patients Underway at Emory
A new clinical trial at Emory University and 45 other sites around the U.S. will test a combination of vitamins and steroids in patients diagnosed with sepsis. Sepsis is caused by the body's overwhelming and life-threatening... read more
High-Acuity Nursing
High-Acuity Nursing provides a comprehensive knowledge set needed to care for adult patients with complex, unpredictable conditions across settings, from high-skill, long-term facilities to critical care units. Focusing... read more
Real-Time Patient-Provider Video Telemedicine Integrated with Clinical Care
Telemedicine by means of video visits can increase patient access to care, but there is little evidence about broad integration of video visits into existing clinical care, particularly for primary care.1,2 In an integrated... read more
Comparing Percutaneous to Open Access for Extracorporeal Membrane Oxygenation in Pediatric Respiratory Failure
The proportion of pediatric patients undergoing percutaneous extracorporeal membrane oxygenation cannulation is increasing. Mechanical and physiologic complications occur with both methods of cannulation, but percutaneous... read more
Last Year, The Flu Put Him In A Coma. This Year He’s Getting The Shot
Charlie Hinderliter wasn't opposed to the flu shot. He didn't have a problem with vaccinations. He was one of about 53 percent of Americans who just don't get one. An estimated 80,000 Americans died of the flu, or flu-related... read more
Approach to the Critically Ill Child: Shock
If you mainly treat adults or both adults and children like me, then you have probably heard the (very annoying) quote, "kids are not just small adults", and so I won't say it again. Well, I guess I just did, but at least... read more
Implementing a Standardized Nurse-driven Rounding Protocol in a Trauma-surgical ICU
We instituted several interventions in our trauma and surgical ICU aimed at improving communication and teamwork between RNs and MDs. Informal feedback indicated greater satisfaction among RNs and MDs with the working environment.... read more
Is this the real life… or is this just fantasy?
As Emergency physicians we need frequent exposure to critically unwell patients in order to hone our resuscitation skills. It is often said that the mark of a good critical care clinician is one who runs towards the sickest... read more
For Doctors, Delving Deeper as a Way to Avoid Burnout
The consequences of burning out — a phenomenon that rises linearly as a doctor matures, until it finally dies down at about 60 — can be hard to measure. Some solutions to fixing burnout are therefore pragmatic. They involve... read more
Adjunct and Rescue Therapies for Refractory Hypoxemia
Prone position, inhaled nitric oxide, high frequency oscillation, extra corporeal life support. The mortality of severe acute respiratory distress syndrome (ARDS), defined with a PaO2/FiO2 ratio of 100 mmHg... read more
Communicating with Conscious and Mechanically Ventilated Critically Ill Patients
Ventilator-dependent patients in the ICU often experience difficulties with one of the most basic human functions, namely communication, due to intubation. Although various assistive communication tools exist, these are infrequently... read more
Mechanical Ventilation/Ventricular Assist Devices, An Issue of Critical Care Clinics
This issue of Critical Care Clinics focuses on Mechanical Ventilation and Ventricular Assist Devices, with topics including: Targeted management approach to cardiogenic shock; Prevention and treatment of right heart failure... read more
