Infectious Disease and Sepsis Archives - PulmCCM
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Infectious Disease and Sepsis Articles

Apr 132014
 
Albumin for severe sepsis and septic shock: More confusing findings (ALBIOS Trial)

Source: KP Albumin: Better Than Crystalloid in Septic Shock? Human albumin boosts oncotic pressure, and has a number of important biologic functions (protein binding, antioxidant, etc.) that could in theory support the body during critical illness. In the 2004 SAFE study, which tested albumin against crystalloid solutions in ~7,000 critically ill patients of various etiologies, 4% [... read more]

Apr 032014
 
PulmCCM Roundup, Issue #2

PulmCCM Roundup #2 Welcome back to the PulmCCM Roundup, formerly the Critical Care Roundup. Let’s jump right in to issue #2. Browse all the PulmCCM Roundups here. Etomidate for intubation in sepsis: what’s the risk, really?  Etomidate has been suspected of causing adrenal insufficiency and potentially death in patients with severe sepsis, when used as an anesthesia-induction agent [... read more]

Mar 292014
 
No benefit from higher mean arterial pressure in most with septic shock

In Septic Shock, Goal of MAP > 65 mm Hg Remains Standard by Abhishek Biswas, MD In the 13 years since Rivers et al published their seminal paper that established “early goal directed therapy” for sepsis as the standard of care, treatment for severe sepsis and septic shock have evolved dramatically. Newer research questions the wisdom [... read more]

Mar 212014
 
Early goal directed therapy does not improve outcomes in septic shock (ProCESS)

Can we finally “Just Say No” to the mandatory use of central venous catheters and central venous saturation in severe sepsis and septic shock? by Muhammad Adrish, MD In a single center study published in 2001, Rivers et al reported that patients with severe sepsis and septic shock had significantly lower mortality (30.5% vs 46.5%) [... read more]

Mar 162014
 
Bleeding and Coagulation Disorders in the ICU (Review)

Because coagulopathies (an impairment of blood clotting), thrombotic states, and bleeding are all interrelated through the coagulation cascade, and because they occur often in critically ill patients, it makes sense to consider these bleeding and clotting disorders together. That’s what Beverly Hunt did in a review in the February 27 2014 New England Journal of [... read more]

Mar 082014
 
Community Acquired Pneumonia (Review)

Community-acquired pneumonia (CAP) is “ordinary” pneumonia, usually (but not always) caused by one of a short list of pathogens susceptible to common antibiotics. Pneumonia remains one of the main reasons for hospital admissions, and causes an estimated 3.5 million deaths yearly, including more than 50,000 in the U.S. Catching pneumonia also increases the risk for [... read more]

Mar 012014
 
Resuscitation Fluids in Critical Illness (Review)

Resuscitation fluids may be the most common intervention in critical care, with more than 200 million liters of normal saline infused each year in the U.S. alone. However, there is scarce evidence to guide the best use of resuscitation fluids in the ICU. John Myburgh and Michael Mythen’s review article in the September 26 2013 [... read more]

Feb 282014
 
Bloggers correct the New England Journal on ICU decontamination article

Blogger Peer Review Corrects NEJM Article’s Error In June 2013, PulmCCM unquestioningly reported the results of a major randomized trial in the New England Journal of Medicine by Susan S. Huang et al, showing that decontaminating patients upon arrival to the ICU with chlorhexidine baths and nasal mupirocin resulted in a dramatic drop in nosocomial infections [... read more]

Jan 262014
 
Antibiotics don't improve cough in acute bronchitis

Acute bronchitis with cough is overwhelmingly often due to viral infection, but that doesn’t stop coughers from seeking antibiotics, or their doctors from obligingly prescribing them. Most patients who ask for antibiotics get them, and the millions of excess antibiotic doses worldwide each year are believed to contribute to rising antibiotic resistance. Doctors seem almost [... read more]

Jan 122014
 
Cognitive impairment after critical illness as bad as Alzheimer's

People who survive critical illness often experience long-term cognitive impairment, even among those with normal or near-normal pre-hospital brain function. Cognitive impairment after critical illness is poorly understood; relatively few prospective clinical trials in critical care have followed patients after hospital discharge, and measuring cognitive impairment and determining its onset is difficult. Cognitive impairment reduces [... read more]

Jan 122014
 
Hypothermia might harm, not help, in bacterial meningitis

Hypothermia No Help for Bacterial Meningitis by Blair Westerly, MD Therapeutic hypothermia got “hot” after trials in the early 2000′s showed improvement in neurological outcomes in global cerebral hypoxia after cardiac arrest. (Any benefit of targeted temperature management below 36° Celsius is in serious doubt after a much larger randomized trial contradicted those earlier, smaller trials, showing no [... read more]

Dec 142013
 

The Glycocalyx: An Overview for the Clinician. by Dr. Phillipe Rola Ok, so I’d had a couple of glimpses at articles in the past few years which referred to the glycocalyx, but, in truth, I tend to read most of the “bench” studies a little, well…quickly. So basically, when I listened to Paul’s (Marik) recent lecture at [... read more]

Nov 162013
 
Shock Review: Mechanisms and Therapies

Shock Review (Part 1 of 2) (See also Shock Review Part 2: Goals of Therapy) Jean-Louis Vincent, editor in chief of Critical Care, has a new review article on circulatory shock in the New England Journal of Medicine, where he’s also the editor of their new critical care section. Daniel De Backer co-authors. (See also [... read more]

Nov 162013
 
Shock Review: Goals of Therapy

Shock Review (Part 2 of 2) (See also Shock Review Part 1: Mechanisms and Therapies) Shock results from serious illness compromising either vascular muscle tone (most commonly septic shock), the heart’s function, or the volume of plasma inside blood vessels. The true goal of treatment for shock is to correct the underlying cause, but except [... read more]

Nov 082013
 
Statins don't help in ventilator-associated pneumonia treatment

Statins have anti-inflammatory and immune-modulating effects, and among critically ill patients, continuing or starting statins have improved soft outcomes in observational and small randomized studies. For example, starting a statin reduced progression of sepsis in ward patients and statins improved organ failure scores in acute lung injury (the HARP trial). But in their first shot at [... read more]

Oct 292013
 
Esmolol infusion reduced septic shock mortality by 40% in RCT

Do I.V. Beta-Blockers Save Lives in Septic Shock? Catecholamines can be toxic — just ask anyone experiencing the heartbreak of tako-tsubo syndrome. Blocking the heart-flogging effects of the hormones epinephrine (adrenaline) and norepinephrine have long been known to improve long-term survival in congestive heart failure. People with septic shock might be the last group you’d consider giving [... read more]

Oct 222013
 

Ultrasound-guided central venous catheter insertion: Standard of care, or preventing procedural skills? By Dr. Philippe Rola Ok, so let me preface this with the fact that I walk around with a handheld ultrasound rather than a stethoscope, and that I examine ALL patients with a focused cardiopulmonary and abdominal exam. My bias towards bedside ultrasound is [... read more]

Oct 192013
 
Overnight intensivists unnecessary in well-staffed ICUs? (Meta-analysis)

24/7 Intensivist Coverage Does Not Improve Outcomes: Meta-Analysis The debate over whether ICUs should be staffed around the clock by intensivist physicians has simmered for more than 20 years, with opinions on both sides driven more by values and personal biases than evidence. Recent studies have confirmed the benefit of daytime intensivists in ICUs but failed [... read more]

Oct 062013
 
Mechanical ventilation in ARDS due to sepsis (Surviving Sepsis Guidelines)

Mechanical Ventilation in ARDS Due to Sepsis See All the Surviving Sepsis Guidelines Sepsis is one of the main causes of acute respiratory distress syndrome (ARDS), in which the lungs are injured by circulating inflammatory mediators, resulting in severely impaired gas exchange usually requiring invasive mechanical ventilation. ARDS also results in poor lung compliance in [... read more]

Sep 292013
 
Blood products for sepsis and septic shock (Surviving Sepsis Guidelines)

Transfusion of Blood Products for Sepsis and Septic Shock See all the Surviving Sepsis Guidelines People with severe sepsis and septic shock frequently experience what could be termed “hematologic failure” — abnormalities of blood cell lines and clotting / antithrombotic proteins that can occur in complex, protean patterns. Anemia, thrombocytopenia, leukopenia, disseminated intravascular coagulation, and [... read more]