Critical Care

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]

Feb 232014
 
Critical Care Roundup: Issue #1

Welcome to issue #1 of the Critical Care Roundup, a new occasional feature on PulmCCM. Here we’ll touch briefly on all the interesting stuff there wasn’t time to thoroughly review. Got a study that should go in the next roundup? Post a link in the comments or by emailing pulmccmcentral@gmail.com. Or, browse all the PulmCCM [… read more]

Feb 222014
 
Epitaph for nitric oxide for ARDS

Image: Dartmouth Nitric Oxide: No Benefit Even in Severe ARDS Giving inhaled nitric oxide to people with acute respiratory distress syndrome (ARDS) improves oxygenation, but has never been demonstrated to improve survival. Not many physicians seem to use nitric oxide for ARDS anymore, except possibly as salvage therapy in life-threatening refractory disease. Even that well-meaning [… read more]

Feb 152014
 
Tight glycemic control in critically ill kids: benefits, risks still unclear

Intensive insulin therapy for critically ill adults was rapidly adopted as standard care after 2001 when an apparent benefit was established after cardiac surgery, then medical ICU patients. Eleven years later, after a wave of minor harm signals, the NICE-SUGAR study confirmed for most intensivists that the excess hypoglycemia from intensive glucose control was potentially lethal in adults, and [… read more]

Feb 092014
 
Sedation and Analgesia in the Critically Ill (Review)

Pain, agitation, and delirium are all extremely common in ICU patients–so much so that they’ve been termed the “ICU triad.” No one knows exactly how common each is, because ICU patients are often too delirious to complain of pain; or their agitation hides their delirium; or their unidentified pain may cause their agitation; or …. [… read more]

Jan 292014
 
CCUS 2014: 7th Annual Critical Care Ultrasound Symposium

For the 7th edition of our Annual Symposium, we’ve assembled a great cast of characters to bring your bedside ultrasound game to a whole new level! Whether you’re a novice or have some experience in bedside ultrasound, we’re sure you’ll find our program very interesting, as the perspective we have chosen to take is patient-based, [… read more]

Jan 292014
 
Choosing Wisely's five top "no-no's" in critical care

Choosing Wisely is an initiative of the American Board of Internal Medicine (ABIM) with the stated goal of “promoting conversations between physicians and patients by helping patients choose care that is supported by evidence, not duplicative, free from harm, and truly necessary.” Sounds good, huh? Politically, ABIM’s Choosing Wisely demonstrates to policymakers responsible self-governance by us [… 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]

Jan 072014
 
Brain death equals death: says who?

Scott Aberegg, M.D., M.P.H. Oh, my, what a predicament.  Jahi McMath has been released from Oakland Hospital to the custody of the coroner and her family.  She has been issued a death certificate.  And she’s being transferred to an undisclosed care center, where it is hoped she will begin receiving artificial nutrition.  This is the height [… read more]

Jan 052014
 
Acute Liver Failure: Causes & Initial Management (Part 1 of 2)

Acute Liver Failure: Causes and Initial Management See also: Treatment of Acute Liver Failure Acute liver failure, also called fulminant liver failure, has been defined as “a severe liver injury, potentially reversible in nature and with onset of hepatic encephalopathy within 8 weeks of the first symptoms in the absence of pre-existing liver disease.” Acute [… read more]

Jan 052014
 
Acute Liver Failure: Treatment (Part 2 of 2)

Acute Liver Failure: Treatment (Part 2 of 2) See also: Acute Liver Failure: Causes & Initial Management Management of acute liver failure is largely supportive critical care for the multiorgan failure that frequently results. Severe acute liver failure results in rapidly progressive hepatic encephalopathy and lethal cerebral edema; this complication requires special vigilance and expert [… 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]

Dec 082013
 
Ventilator-Induced Lung Injury Review (Part 2 of 2)

Prevention and Management of Ventilator-Induced Lung Injury See also Part 1: Mechanisms of Ventilator-Induced Lung Injury The recognition that lifesaving mechanical ventilation can also be harmful, even lethal, has led to a sea change in the use of mechanical ventilation in critically ill patients — at least in theory. For people with acute respiratory distress [… read more]

Dec 072013
 
Ventilator-Induced Lung Injury Review (Part 1 of 2)

Mechanisms of Ventilator-Induced Lung Injury (Part 1) See also Part 2: Prevention and Management of Ventilator-Induced Lung Injury Although invasive mechanical ventilation saves tens of thousands of lives each year, it can also be harmful, causing or worsening acute respiratory distress syndrome (ARDS) when misapplied. The repetitive stretching of lung tissue during positive pressure ventilation [… read more]

Dec 012013
 
Do colloids save lives in hypovolemic shock?

So, your patient’s in shock: quick, give some fluids. But colloids or crystalloids? How to choose? They both raise blood pressure, they both improve organ perfusion — but one’s less filling, the other tastes great (what, you haven’t tried them?). It’s no wonder the question makes your head hurt; the evidence base is a jumble. The [… read more]

Nov 232013
 
Hypothermia did not help after out-of-hospital cardiac arrest, in largest study yet

No Improvement in Cardiac Arrest Outcomes With Hypothermia Therapeutic hypothermia, or targeted temperature management, has become a standard component of post-cardiac arrest care. The evidence supporting this practice came from two small-to-medium-sized randomized trials, both published in the New England Journal of Medicine in 2002: Among 273 patients with out-of-hospital cardiac arrest due to shockable [… read more]