NHS ICUs Sending Patients Elsewhere Due to Lack of Beds

Six in ten UK ICUs cannot function normally because they are so short of nurses, a survey has found. Patients whose lives are at risk are being turned away from their local hospitals because of a lack of intensive care beds,... read more

Survival Benefit of a Low Ratio of Visceral to Subcutaneous Adipose Tissue Depends on LDL Clearance vs. Production in Sepsis

Patients with sepsis with a high ratio of visceral adipose tissue (VAT) to subcutaneous adipose tissue (SAT) have increased mortality. Our goal was to investigate the mechanism of this effect, noting that low LDL levels are... read more

Prehospital Antibiotics Improved Some Aspects of Sepsis Care

Training EMS personnel in early recognition of sepsis improved some aspects of care within the acute care chain, but did not reduce mortality, according to results of a randomized trial. Emergency medical service (EMS) personnel... read more

Hyperoxia and Hypocapnia During Pediatric ECMO

Hyperoxia is common during pediatric extracorporeal membrane oxygenation (ECMO) and associated with mortality. Hypocapnia appears to occur less often and although associated with complications, an association with mortality... read more

Pediatric Sepsis Endotypes Among Adults With Sepsis

Recent transcriptomic studies describe two subgroups of adults with sepsis differentiated by a sepsis response signature. The implied biology and related clinical associations are comparable with recently reported pediatric... read more

Outcomes in Patients with Vasodilatory Shock and RRT Treated with Intravenous Angiotensin II

Acute kidney injury (AKI) requiring renal replacement therapy in severe vasodilatory shock is associated with an unfavorable prognosis. Angiotensin II treatment may help these patients by potentially restoring renal function... read more

Lack of Association of High Backrest With Sacral Tissue Changes in Adults Receiving Mechanical Ventilation

Although higher backrest elevation may be a theoretical risk for integrity of sacral tissues, few data support use of high backrest elevation. Level of backrest elevation is not associated with changes in tissue integrity.... read more

The Inflammatory Response to ECMO

Extracorporeal membrane oxygenation (ECMO) is a technology capable of providing short-term mechanical support to the heart, lungs or both. Over the last decade, the number of centres offering ECMO has grown rapidly. At the... read more

Arterial Line Placement

Approximately eight million arterial lines are placed in the United States yearly. The main indication for arterial line placement is the need for close hemodynamic monitoring. The second-to-second blood pressure variations... read more

Critical Burn Patients in the ED/ICU

Dr. Djogovic completed training in Emergency Medicine and Critical Care Medicine from 1999-2005, and is currently employed at the University of Alberta Hospital as an Emergency Physician, and as an Intensivist in the General... read more

Noninvasive Ventilation in Patients With 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

Decision-making in the detection and management of patients with sepsis in resource-limited settings

We read with interest the study by Andrews et al. and the related correspondence from Shrestha et al. We share the concern that clinical examination (and observations) appear(s) to be perceived as relatively unimportant in... read more

Survival and Safety Outcomes of ICU Patients Discharged Directly Home

Recruited discharged directly to home patients experienced very good 8-week postdischarge outcomes with 0% mortality and a low rate of ICU readmission (1%) or ward readmission (4%), but not an insignificant rate of emergency... read more

Factors Associated With Bed Utilization and Development of a Benchmarking Model

ICU length of stay (LOS) is an important measure of resource use and economic performance. Our primary aims were to characterize the utilization of PICU beds and to develop a new model for PICU length of stay. PICU bed utilization... read more

Too Much SALT on the ICU?

There has a been a little flutter of activity in the #FOAMed world this week about two trials published in the NEJM on the subject of balanced fluids in the care of critically ill patients, and also on admitted patients in... read more

Why Do Nurses Quit?

Estimates are that up to 30-50% of nurses leave their position or quit nursing altogether in the first year. What drives nurses away? Some new grads do not survive the shock. Nursing school is insufficient preparation for... read more

Evidence-based Recommendations on the Use of Intravenous Lipid Emulsion Therapy in Poisoning

Although intravenous lipid emulsion (ILE) was first used to treat life-threatening local anesthetic (LA) toxicity, its use has expanded to include both non-local anesthetic (non-LA) poisoning and less severe manifestations... read more

Comparison of Etomidate and Ketamine for Induction During Rapid Sequence Intubation of Adult Trauma Patients

Induction doses of etomidate during rapid sequence intubation cause transient adrenal dysfunction, but its clinical significance on trauma patients is uncertain. Ketamine has emerged as an alternative for rapid sequence intubation... read more

Combined Intravenous Thrombolysis and Thrombectomy vs Thrombectomy Alone for Acute Ischemic Stroke

The results indicate that treatment of patients experiencing AIS due to a large vessel occlusion with IVT before MT does not appear to provide a clinical benefit over MT alone. A randomized clinical trial seems warranted.... read more

Sepsis: A Threat That Needs a Global Solution

Flavia R. Machado, MD, PhD, gives a plenary talk at the 47th Critical Care Congress, “Sepsis: A Threat That Needs a Global Solution.”... read more

Pandemics Cross Borders: How to Tackle Them From a Global Perspective

Steve A. Webb, MD, gives a plenary talk at the 47th Critical Care Congress, “Pandemics Cross Borders: How to Tackle Them From a Global Perspective.”... read more

Association Between Continuous Hyperosmolar Therapy and Survival in Patients with TBI

Intracranial hypertension (ICH) is a major cause of death after traumatic brain injury (TBI). Continuous hyperosmolar therapy (CHT) has been proposed for the treatment of ICH, but its effectiveness is controversial. We compared... read more