Dysphagia – A Common, Transient Symptom in Critical Illness Polyneuropathy
Dysphagia is frequent among patients with critical illness polyneuropathy treated in the ICU. Old age, chronic obstructive pulmonary disease, the mode of mechanical ventilation, the prevalence of tracheal tubes, and behavioral... read more
Why is trauma activation so expensive?
I can understand hospitals charging a fee for trauma activations to help recover some of the costs of having a trauma service. The staff may require some special training. Managing the service, collecting data, and other... read more
Trach Travails: Need-to-Know ED Tricks for Airway Emergencies in Tracheostomy Patients
The outside hospital emergency physician passed a bougie through the patient’s existing metal trach and exchanged the metal trach for a 6-0 endotracheal tube. After the exchange, the ETT cuff was inflated, and the patient... read more
Mechanical Ventilation Induces Desensitization of Lung Axl Tyrosine Kinase Receptors
These data suggest that lung endothelial cell overdistention activates ion channels, and the resultant influx of Ca2+ inactivates Axl. Downstream inactivation of Axl by stretch was not anticipated; preventing this would be... read more
C. difficile risk raised by using same hospital bed as antibiotic-treated patient
Antibiotic use is associated with greater risk of Clostridium difficile infection, but according to a new study, you do not necessarily need to take antibiotics for them to pose such a risk. Researchers suggest just using... read more
Pheochromocytoma Diagnosis
Pheochromocytoma is a catecholamine-producing tumor that originates from chromaffin cells of the adrenergic system, most commonly in the adrenal medulla. There are two main steps in the diagnosis of pheochromocytoma: biochemical... read more
ICU ventilators overused among advanced-dementia patients
Mechanical ventilation may be lifesaving, but in certain patient cases it may prolong suffering without a clear benefit. JAMA Internal Medicine published a study of 635,008 hospitalizations of nursing-home patients with advanced... read more
Mitochondrial Function in Sepsis
The authors were tasked with developing five specific questions regarding mitochondrial function in sepsis within the context of the Acute Dialysis Quality Initiative 14 (ADQI XIV) meeting held in Bogotá, Colombia, in late... read more
Positive End-Expiratory Pressure Lower Than the ARDS Network Protocol Is Associated with Higher Pediatric ARDS Mortality
Patients with PARDS managed with lower PEEP relative to FiO2 than recommended by the ARDSNet model had higher mortality. Clinical trials targeting PEEP management in PARDS are needed. This was a multicenter, retrospective... read more
Medications and RRT: We Know How to Dose, Right?
Dr. Fraser, MD, speaks with Bruce A. Mueller, PharmD, FCCP, FASN, about his talk presented at the 47th Critical Care Congress in San Antonio, Texas, entitled "Artificial Kidney Meets Mechanical Lung: Comanaging the Patient... read more
Methodologic Innovation in Creating Clinical Practice Guidelines
Our multifaceted, interdisciplinary approach and novel methodologic strategies can help inform the development of future critical care clinical practice guidelines. Critical illness survivors contributed to prioritizing topics,... read more
Sodium Bicarbonate Therapy for Patients with Severe Metabolic Acidaemia in the ICU
In patients with severe metabolic acidaemia, sodium bicarbonate had no effect on the primary composite outcome. However, sodium bicarbonate decreased the primary composite outcome and day 28 mortality in the a-priori defined... read more
Modes of Mechanical Ventilation Vary Between Hospitals and ICUs within a University Healthcare System
As evidence-based guidance to aid clinicians with mechanical ventilation mode selection is scant, we sought to characterize the epidemiology thereof within a university healthcare system and hypothesized that nonconforming... read more
Low Tidal Volume Ventilation in ARDS
In this "Breathe Easy Critical Perspective" podcast, Dr. Dominique Pepper interviews Dr. Allan Walkey. They discuss low tidal volume ventilation in ARDS. Dr. Walkey is the chair of the Early Career Professional Working Group... read more
Flexible Versus Restrictive Visiting Policies in ICUs
Flexible ICU visiting hours have the potential to reduce delirium and anxiety symptoms among patients and to improve family members' satisfaction. However, they may be associated with an increased risk of burnout among ICU... read more
Hospitalists Are the New Intensivists
Intensivists may get all the credit, but over 37,000 hospitalists provide much of the care for ICU patients in the U.S. According to a recent survey, they often do it without the presence or availability of intensivists for... read more
Metabolic Phenotype of Skeletal Muscle in Early Critical Illness
Decreased mitochondrial biogenesis and dysregulated lipid oxidation contribute to compromised skeletal muscle bioenergetic status. In addition, intramuscular inflammation was associated with impaired anabolic recovery with... read more
Study examines risks of physician burnout
Medical errors contribute to an estimated 100,000 to 200,000 deaths per year, according to the Institute of Medicine. Burnout — defined as emotional exhaustion or depersonalization — occurs in more than half of doctors,... read more
Neurally adjusted ventilatory assist
Several studies nowadays prove the physiological benefits of neurally adjusted ventilatory assist, as opposed to the conventional modes of partial support. Whether these advantages translate into improvement of clinical outcomes... read more
Intracranial Pressure Thresholds in Severe Traumatic Brain Injury: Pro
Teleologically, the mammalian brain has evolved to be the central component of life. It coordinates afferent and efferent neural pathways, integrates neurohormonal responses and, in humans, produces higher cortical effects... read more
Early application of continuous HVHF can reduce sepsis and improve the prognosis of patients with severe burns
Early application of high-volume haemofiltration (HVHF) benefits patients with severe burns, especially for those with a greater burn area (≥ 80% TBSA), decreasing the incidence of sepsis and mortality. This effect may... read more
