New research shows why nutrition should be back on the table for surgical patients
More than 48 million people in the U.S. undergo surgery each year, and for decades the focus has been on making sure patients do not consume any food or drinks in the hours leading up to the surgery. Yet, 1 in 3 patients... read more
Guidelines for the Management of Tracheal Intubation in Critically Ill Adults
These guidelines describe a comprehensive strategy to optimize oxygenation, airway management, and tracheal intubation in critically ill patients, in all hospital locations. They are a direct response to the 4th National... read more
Understanding Central Nervous System Efficacy of Antimicrobials
Defining the optimal treatment of Central Nervous System (CNS) infections is one of the most challenging tasks for the intensivists; the therapeutic window is narrow, and the alternative drug options more limited than with... read more
Acute Skeletal Muscle Wasting in Critical Illness
Among these critically ill patients, muscle wasting occurred early and rapidly during the first week of critical illness and was more severe among those with multiorgan failure compared with single organ failure. These findings... read more
Critically Ill: A 5-Point Plan to Cure Healthcare Delivery
Two decades ago Dr. Fred Southwick witnessed the near demise of his wife while she was being cared for in a prominent academic medical center. For 15 years he blamed the individual physicians who cared for Mary. However five... read more
Rapid Sequence Intubation With Video Laryngoscopy Common for Difficult Airways
Predicted difficult airways in one emergency department are managed most often using rapid sequence intubation (RSI) and video laryngoscopy (VL), a recent study has found. Although difficult airways occur frequently in emergency... read more
Pressure ulcers in ICU patients: Incidence and clinical and epidemiological features
Pressure ulcers in ICU patients: Incidence and clinical and epidemiological features: A multicenter study in southern Brazil. The main objective is to evaluate the incidence and risk factors of pressure ulcers (PU) in adult... read more
The Elevated Troponin: What else besides ACS could cause troponin elevation?
The increased troponin used to be a straight ticket to the cardiology service. Now, the picture isn't so clear. What do you need to consider in the patient with elevated troponin? Cardiac troponins consist of three proteins:... read more
Tracheal extubation with a predicted difficult airway
Management of the difficult airway is an important, but as yet poorly-studied, component of intensive care management. Although there has been a strong emphasis on prediction and intubation of the difficult airway, safe extubation... read more
Antibiotic Decisions in the ICU: A Dragon’s Tale
Medical decision-making about antibiotic use in critically ill patients is challenging and complex. The need for antibiotic stewardship requires judicious prescription and choice of antimicrobials, as the need for effective... read more
Practice Change From Intermittent Medication Boluses to Bolusing From a Continuous Infusion in Pediatric Critical Care
Implementation of bolus medications from continuous infusion in PICUs significantly decreased time to begin a bolus dose and increased nursing satisfaction. The practice change also improved medication utilization without... read more
Utility of Adjunct Antibiotics After I+D – Systematic Review + Meta-Analysis
Skin and soft tissue abscesses are a common emergency department (ED) presentation. The approach to management has changed little in recent decades: incision and drainage (I+D) and then discharge home with follow up. However,... read more
What’s New in Severe Pulmonary Embolism?
Severe pulmonary embolism (PE) remains a major cause of mortality. For intensivists managing the most "severe" forms of PE, we highlight the main recent advances in the care of such patients including risk stratification,... read more
Nine Reasons to Quit Using Normal Saline for Resuscitation
Saline vs. balanced solutions has been a topic of ongoing debate. Two fresh studies will illuminate this: the SMART and SALT-ED trials. This post summarizes current knowledge, beginning with physiology and working our way... read more
Sevoflurane for the treatment of refractory status epilepticus in the critical care unit
A 50-year-old woman with liver failure was admitted to critical care for refractory status epilepticus (RSE). Following tracheal intubation, sevoflurane was administered via the MIRUS system (Pall Medical, Dreieich, Germany).... read more
The Efficacy of ECMO for Severe ARDS
The H1N1 epidemic demonstrated that extracorporeal membrane oxygenation (ECMO) use in the most critically ill patients with acute respiratory distress syndrome (ARDS) resulted in a substantial decrease in mortality. The CESAR... read more
Predictors of In-Hospital Mortality After RRT Calls
Despite wide adoption of rapid response teams across the United States, predictors of in-hospital mortality for patients receiving rapid response team calls are poorly characterized. Identification of patients at high risk... read more
At the Root: Defining and Halting Progression of Early COPD
Chronic obstructive pulmonary disease (COPD) is a heterogeneous disorder with varying presentations and progression, but limited disease-modifying therapies. Trajectories of lung function decline in COPD differ significantly... read more
The Practice of Respect in the ICU
Although "respect" and "dignity" are intuitive concepts, little formal work has addressed their systematic application in the ICU setting. After convening a multidisciplinary group of relevant experts, we undertook a review... read more
Fluid, Electrolyte and Acid-Base Disorders
This is a meaningful and concise review of common fluid, electrolyte, and acid-base disorders faced by clinicians in daily practice. Each chapter begins with pertinent basic physiology followed by its clinical disorder. Includes... read more
Intravenous Iron, Not Oral, Improves Functional Capacity in HF Patients
The oral iron supplement failed to be absorbed, while the successful IV formulation is not without significant logistical and cost issues. In one study testing a convenient and easy-to-use oral iron supplement, investigators... read more
When the Air Hits Your Brain: Tales from Neurosurgery
With poignant insight and humor, Frank Vertosick Jr., MD, describes some of the greatest challenges of his career, including a six-week-old infant with a tumor in her brain, a young man struck down in his prime by paraplegia,... read more
