Intubation During CPR was Associated with Worse Survival and Brain Health
Intubating patients in cardiac arrest is widely considered ideal care. But in this analysis, the patients who were intubated were less likely to survive (16% vs 19%) or have a good functional outcome (~11% vs ~14%). Intubation... read more
How to Remove the Grey Area Between VAP and VAT?
We read with great interest the study performed by Paula Ramirez and colleagues. The study included 71 patients with ventilator-associated pneumonia (VAP) and the authors coined a new term called "gradual VAP".... read more
Low Levels of Physical Activity During Critical Illness and Weaning
Physical rehabilitation can benefit critically ill patients during ICU admission, but routine clinical practice remains inconsistent nor examined in prolonged mechanical ventilation patients transferred to a specialist ventilator... read more
The Role of Oliguria and the Absence of Fluid Administration and Balance Information in Illness Severity Scores
Urinary examination has formed part of patient assessment since the earliest days of medicine. Current definitions of oliguria are essentially arbitrary, but duration and intensity of oliguria have been associated with an... read more
The Complexities of Intravenous Fluid Research: Questions of Scale, Volume, and Accumulation
Despite near ubiquity, information regarding fluids consumption at a health care systems level, and patient exposure at an individual level, is surprisingly limited in the medical literature. The epidemiology of the foundational... read more
I’m your Anesthesiologist. Let me explain what that means
Anesthesiologists are the guardian angels of the operating room. Their primary purpose is to keep you alive so you can undergo whatever procedure you need. While we may only meet you shortly before we take you to the operating... read more
A population-based cohort study of rheumatoid arthritis-associated interstitial lung disease
ILD is a serious complication in RA, with a significantly increased mortality compared with a large matched cohort of RA comparisons without ILD. Mortality risks were assessed using Kaplan-Meier mortality curves, and hazard... read more
Thrombolytics for Stroke: The Evidence
Thrombolytics for stroke: undoubtedly the biggest controversy in emergency medicine. Also, the topic of this week’s Emergency Medicine Cases Journal Jam podcast. Rory Spiegel, Anton Helman, and I take a deep dive into the... read more
Aspirin therapy in patients with ARDS is associated with reduced ICU mortality
Acute respiratory distress syndrome (ARDS) is a common clinical syndrome with high mortality and long-term morbidity. To date there is no effective pharmacological therapy. Aspirin therapy has recently been shown to reduce... read more
Effective Care for High-Need Patients
To advance insights and perspectives on how to better manage the care of the high-need patient population, the National Academy of Medicine, with guidance from an expert planning committee, was tasked with convening three... read more
Sepsis-Associated 30-Day Risk-Standardized Readmissions
One third of sepsis survivors were readmitted and wide variation exists between hospitals. Several demographic and structural factors are associated with this variation. Measures of higher quality in-hospital care were correlated... read more
Analysis of Unplanned Postoperative Admissions to the ICU
Our study is the first diverse analysis of unplanned postoperative ICU admissions in the literature across multiple specialties and practice models. We found an association of advanced age, higher ASA PS class, and duration... read more
Impact of End-Stage Renal Disease and Acute Kidney Injury on ICU Outcomes in Patients With Sepsis
Patients with sepsis having AKI have a higher mortality rate than those with ESRD and non-KI. Hospital and ICU mortality rates for patients with ESRD were similar to non-KI patients. Late AKI compared to early AKI had a higher... read more
Electroencephalography Predicts Poor and Good Outcomes After Cardiac Arrest
The prognostic role of electroencephalography during and after targeted temperature management in postcardiac arrest patients, relatively to other predictors, is incompletely known. We assessed performances of electroencephalography... read more
Rescue Strategy for Treating Severe Carbapenemase-Producing Klebsiella Pneumoniae Infections
Recent reports have suggested the efficacy of a double carbapenem (DC) combination, including ertapenem, for the treatment of carbapenem-resistant Klebsiella pneumoniae (CR-Kp) infections. We aimed to evaluate the clinical... read more
Evaluating Transfusion Strategies
Cancer patients are at increased risk of septic shock. Therefore, Bergamin et al set out to assess whether a restrictive strategy of red blood cell (RBC) transfusion reduces 28-day mortality when compared with a liberal strategy... read more
A Year at the Bedside With Osler
Ask any resident, and he or she will tell you that this oft-quoted meditation from Sir William Osler, the father of modern medicine and guiding light for many an internist, is beautiful in its language yet quaint and seemingly... read more
Under-reporting of End-of-life Decisions in Critical Care Trials: A Call to Modify CONSORT Statement
Under-reporting of End-of-life Decisions in Critical Care Trials: A Call to Modify CONSORT Statement... read more
State Sepsis Mandates – A New Era for Regulation of Hospital Quality
New York State regulations mandating protocol-based sepsis care may have unintended consequences. Hospitals should have maximal flexibility in deciding how to implement protocol-guided care so that they can respond appropriately... read more
Analgosedation practices and the impact of sedation depth on clinical outcomes among patients requiring mechanical ventilation
Analgesia and sedation are cornerstone therapies for mechanically ventilated patients. Despite data showing that early deep sedation in the intensive care unit influences outcome, this has not been investigated in the emergency... read more
Trials directly comparing alternative spontaneous breathing trial techniques
The effect of alternative spontaneous breathing trial (SBT) techniques on extubation success and other clinically important outcomes is uncertain. Patients undergoing PS (vs T-piece) SBTs appear to be 6% (95% CI 2–10%)... read more
A Randomized Controlled Study to Evaluate the Effect of an Enteral Formulation
A randomized controlled pilot study to evaluate the effect of an enteral formulation designed to improve gastrointestinal tolerance in the critically ill patient - the SPIRIT trial. In this pilot study, we found a high incidence... read more
