Distinguishing Pneumonia From Pneumonitis to Safely Discontinue Antibiotics

Consequences of pulmonary aspiration can be biphasic with dissimilar sequelae. An early phase, coined pneumonitis, involves an inflammatory reaction to gastrointestinal contents with a pH typically less than 2.4 resulting... read more

Start a Neonatal ECMO Program: A Multistep Team Training

The multistep extracorporeal membrane oxygenation (ECMO) team training increased staff' knowledge, technical skills, teamwork, and self-confidence, allowing the successful development of a neonatal respiratory ECMO program.... read more

Non-invasive Ventilation in the ED: Whom, When, How?

Timely use of NIV in the ED may decrease the need for invasive ventilation and its associated complications. The appropriate device, interface and patient selection are, therefore, key components of NIV success. Once the... read more

Intubation in Special Patient Populations: Intracranial Hemorrhage

Lidocaine has weak evidence to support its ICP blunting effects. Fentanyl may be a better choice. Ketamine is a reasonable alternative to etomidate during induction. No differnce in mortality exists between usage of succinylcholine... read more

Lighter Emergency Breathing Tubes Associated with Higher Survival After OHCA

In the LT group, 18.3% of patients survived 72 hours in the hospital, compared to 15.4% in the intubation group. From the LT group, 10.8% survived to hospital discharge, and only 8.1% in the intubation group. The proportion... read more

Losing Sleep Over Delirium

Delirium is an acute cognitive disorder that presents with alterations in levels of consciousness accompanied by a change in cognition or perceptual disturbance that develops over a short period (hours to days) and fluctuates... read more

Current efforts to fight sepsis aren’t working. We need a bolder approach

Thanks to antibiotics, vaccinations, and public health advances like modern sanitation, it's easy to think that Americans live largely free of the infectious diseases that once took such a toll. That’s partially right:... read more

Management and Outcomes of ARDS Patients With and Without Comorbid Conditions

Half the patients with acute respiratory distress syndrome (ARDS) had major comorbidities, which were associated with severe ARDS, multiple organ dysfunction, and day‑28 mortality. These findings do not support the exclusion... read more

The Fluid Debate: Balanced or Unbalanced

Consider using balanced fluids in your ED unless you are treating a patient at risk for cerebral edema, or a patient with a chloride responsive metabolic alkalosis, e.g. from gastric losses. Although the superiority of balanced... read more

Very high intact-protein formula successfully provides protein intake according to nutritional recommendations in overweight critically ill patients

Enteral feeding with VHPF (8 g/100 kcal) resulted in higher protein intake and plasma amino acid concentrations than an isocaloric SHPF (5 g/100 kcal), without an increase in energy intake. This VHPF facilitates feeding according... read more

Immunocompromised Patients with ARDS

Immunosuppression is frequent in patients with acute respiratory distress syndrome (ARDS), and infections are the main risk factors for ARDS in these immunocompromised patients. Their management differs from that of immunocompetent... read more

Effects of Chlorhexidine Gluconate Oral Care on Hospital Mortality

Chlorhexidine oral care is widely used in critically and non-critically ill hospitalized patients to maintain oral health. We investigated the effect of chlorhexidine oral care on mortality in a general hospitalized population.... read more

The Role of Nutrition in Strong for Surgery

Host Paul Wischmeyer is joined by Thomas Varghese, MD, section head of General Thoracic Surgery at the University of Utah, to discuss the role of nutrition in the American College of Surgeons’ Strong for Surgery initiative.... read more

Sepsis Guidelines Spark EM Petition

It took all of one day for emergency physicians to organize opposition after an update to the Surviving Sepsis Campaign Bundle was released online. The day after the new version was released, Scott D. Weingart, MD, the editor-in-chief... read more

A Nightmare Airway with Rob Bryant

In terms of airway management, cricothyrotomy is one of the most advanced airway procedures an ED physician will perform. It is a last resort procedure when a patient is not able to be ventilated/oxygenated and/or intubated.... read more

AKI and Mild Therapeutic Hypothermia in Patients After Cardiopulmonary Resuscitation

The aim of this study was to investigate the influence of mild therapeutic hypothermia (MTH) on the incidence of and recovery from acute kidney injury (AKI). Mild therapeutic hypothermia seems to have a protective effect... read more

The Myth of Vasopressors and Ischemia

Despite the widespread clinical use, and their well-documented life-saving properties, vasopressors are often maligned, accused of causing ischemia to fingers, toes, mesentery, kidneys, and so forth. Not only is the evidence... read more

Hemodynamic Support of Pediatric and Neonatal Septic Shock

Margaret Parker, MD, MCCM, speaks with Joseph A. Carcillo, MD, about the article, "American College of Critical Care Medicine Clinical Practice Parameters for Hemodynamic Support of Pediatric and Neonatal Septic Shock," published... read more

Trophic or Full Nutritional Support?

A two-phase approach for nutritional support may more appropriately account for the physiologic changes during critical illness than one-phase approach. Further evidence is awaited for the optimal protein amount during critical... read more

Hyponatremia and Death in Healthy Children From Plain Dextrose and Hypotonic Saline Solutions after Surgery

Standards of practice should be established for postoperative IV solutions that are used to hydrate patients, particularly children. The standards should acknowledge that the administration of solutions with saline in maintenance... read more

Severity of Sepsis-Associated Coagulopathy Predicts Hospital Mortality

atients with sepsis-associated coagulopathy appear to be at heightened risk of death, according to results of a large retrospective cohort study. The risk of death in the study increased with the severity of the sepsis-associated... read more

Effectiveness of targeted enhanced terminal room disinfection on hospital-wide acquisition and infection with multidrug-resistant organisms and Clostridium difficile

The hospital environment is a source of pathogen transmission. The effect of enhanced disinfection strategies on the hospital-wide incidence of infection has not been investigated in a multicentre, randomised controlled trial.... read more