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
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
