Vascular Effects of Adrenomedullin and the Anti-Adrenomedullin Antibody Adrecizumab in Sepsis
Sepsis remains a major scientific and medical challenge, for which, apart from significant refinements in supportive therapy, treatment has barely changed over the last few decades. During sepsis, both vascular tone and vascular... read more
Thai cave rescue: The drug that allowed boys to survive rescue mission
Thai schoolboys were rescued from the cave using dissociative ketamine plus positive-pressure facemask ventilation (to prevent water from leaking into their masks), so they basically used delayed sequence intubation strategy.... read more
Over Half Of Patients And Families Hesitate To Raise ICU Safety Concerns
Imagine you're in the intensive care unit at the bedside of your loved one, and you think you see a medical mistake — a wrong pill, an unwashed hand. Do you speak up? Even if you're afraid that might annoy or alienate the... read more
Hemophagocytic Lymphohistiocytosis: Potentially Underdiagnosed in ICUs
Overall, 7 out of 9 patients (77.8%) suffering from aHLH remained undiagnosed. Awareness of this life-threatening syndrome, especially in ICUs, should be raised. The inclusion of ferritin into the admission lab panel for... read more
Choice of Fluid Therapy in the Initial Management of Sepsis, Severe Sepsis, and Septic Shock
Sepsis results in disruption of the endothelial glycocalyx layer and damage to the microvasculature, resulting in interstitial accumulation of fluid and subsequently edema. Fluid resuscitation is a mainstay in the initial... read more
Barriers to implementing expert safety recommendations for early mobilization in ICU during mechanical ventilation
Early mobilization in the intensive care unit (ICU) has been consistently reported as feasible and safe with minimal adverse events; however, invasive mechanical ventilation patients are rarely actively mobilized. An expert... read more
Noninvasive Ventilation in Patients With ARF and Do-Not-Intubate and Comfort-Measures-Only Orders
A large proportion of patients with do-not-intubate orders who received noninvasive ventilation survived to hospital discharge and at 1 year, with limited data showing no decrease in quality of life in survivors. Provision... read more
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
