The Effect of Dexmedetomidine on Outcomes of Cardiac Surgery in Elderly Patients

The Effect of Dexmedetomidine on Outcomes of Cardiac Surgery in Elderly Patients

The goal of this retrospective study was to investigate the effects of perioperative use of dexmedetomidine (Dex) on outcomes for older patients undergoing cardiac surgery. A total of 505 patients (equal or greater than 65... read more

Catheter Type in Pulmonary Embolism Intervention

Catheter Type in Pulmonary Embolism Intervention

Catheter based interventions for pulmonary embolism is on the rise. The rise in mainly in patients who present with submassive PE. The intent of intervention is to reduce clot burden. This is done to improve acute symptoms... read more

Catheter-Directed Therapy for PE Built on Fallacy

Catheter-Directed Therapy for PE Built on Fallacy

Tissue plasminogen activator has a notoriously checkered past within emergency medicine, and its controversial use continues with the advent of targeted therapy for pulmonary embolism. Catheter-directed administration of... read more

Dosing Adjuvant Vitamin C in Critically Ill Patients Undergoing CRRT

Dosing Adjuvant Vitamin C in Critically Ill Patients Undergoing CRRT

We read with great interest the recent letter to Critical Care by Marik and Hooper. Vitamin C is increasingly recognized as a crucial compound to alleviate morbidity in critically ill patients. Vitamin C concentrations, however,... read more

Vitamin C: Should We Supplement?

A short course of intravenous vitamin C in pharmacological dose seems a promising, well tolerated, and cheap adjuvant therapy to modulate the overwhelming oxidative stress in severe sepsis, trauma, and reperfusion after ischemia.... read more

Effect of Levocarnitine vs Placebo as an Adjunctive Treatment for Septic Shock

Effect of Levocarnitine vs Placebo as an Adjunctive Treatment for Septic Shock

In this dose-finding, phase 2 adaptive randomized trial, patients with septic shock and moderate organ dysfunction were treated early in the course of illness with low (6 g), medium (12 g), or high (18 g) doses of levocarnitine... read more

A Multicentre Randomised Controlled Trial of Levetiracetam vs. Phenytoin for Convulsive Status Epilepticus in Children

A Multicentre Randomised Controlled Trial of Levetiracetam vs. Phenytoin for Convulsive Status Epilepticus in Children

Convulsive status epilepticus (CSE) is the most common life-threatening childhood neurological emergency. Despite this, there is a lack of high quality evidence supporting medication use after first line benzodiazepines,... read more

Ketamine Continuous Infusion: A Reasonable Alternative to Traditional Sedatives and Analgesics?

Ketamine Continuous Infusion: A Reasonable Alternative to Traditional Sedatives and Analgesics?

Propofol, dexmedetomidine, and opioids are commonly used for patients requiring continuous sedation or analgesia, such as for those receiving mechanical ventilation. Although these medications are generally safe, some may... read more

Caffeine Accelerates Emergence from Isoflurane Anesthesia in Humans

Caffeine Accelerates Emergence from Isoflurane Anesthesia in Humans

Intravenous caffeine is able to accelerate emergence from isoflurane anesthesia in healthy males without any apparent adverse effects. All randomized participants were included in the analysis. The mean time to emergence... read more

Hemodynamic Tolerance to IV Clonidine Infusion in the PICU

Hemodynamic Tolerance to IV Clonidine Infusion in the PICU

Although administration of clonidine is often associated with bradycardia and hypotension, these complications do not seem clinically significant in a mixed PICU population with a high degree of disease severity. Clonidine... read more

Practice Change From Intermittent Medication Boluses to Bolusing From a Continuous Infusion in Pediatric Critical Care

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

Nine Reasons to Quit Using Normal Saline for Resuscitation

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

Tomorrow’s ICU

Tomorrow’s ICU

Johns Hopkins clinicians and engineers are creating a model for a safer, less costly and more productive clinical unit that can be adopted anywhere. With clinicians spending less time on documenting and gathering supplies,... read more

Sodium Lactate Improves Hemodynamics

Sodium Lactate Improves Hemodynamics

Sodium lactate has been shown to improve hemodynamics and avoid fluid overload. The objective of this study was to confirm a beneficial effect on fluid balance with sodium lactate infusion and to specify whether the advantage... read more

A supplemental intravenous amino acid infusion sustains a positive protein balance for 24 hours in critically ill patients

A supplemental intravenous amino acid infusion sustains a positive protein balance for 24 hours in critically ill patients

Providing supplemental amino acids to ICU patients during a 3-h period results in improved whole-body net protein balance, without an increase in amino acid oxidation. The primary objective was to investigate if a 24-h intravenous... read more

Adverse Effects of Crystalloid and Colloid Fluids

Adverse Effects of Crystalloid and Colloid Fluids

Volume therapy can be managed according to the fluid balance method, the outcome-guided method, or the goal-directed method. One reason why fluid is needed is that anesthesia disrupts the normal autonomic control of the circulation,... read more

A comparison of two insulin infusion protocols in the ICU by continuous glucose monitoring

A comparison of two insulin infusion protocols in the ICU by continuous glucose monitoring

The Yale protocol provided better average glycemia, more time spent in normoglycemia, less time in hypoglycemia, and less glycemic variability than the Leuven protocol, but was not independently associated with strict glycemic... read more