Critical Care Archives - Page 25 of 25

Critical Care

Diuretics in acute decompensated CHF

Randomized Controlled Trials, Cardiovascular Disease, Critical Care Add a Comment

Mar 062011

How “hard” should we “hit” our patients with Lasix? And does that hurt? Felker et al asked that (sort of) in a NHLBI-funded trial. They gave furosemide to 308 patients hospitalized for ADHF in an IV dose either equivalent to their home dose, or at 2.5 times their home dose, and either at q12-hour intervals [… read more]

Inspiratory muscle training liberated the hard-to-wean

Randomized Controlled Trials, Chronic Critical Illness, Critical Care, Mechanical Ventilation Add a Comment

Mar 022011

In a rare encouraging positive study in the chronically critically ill, 71% of vent-dependent patients (~6 weeks on MV) who did multiple sets of daily inspirations backwards through a PEEP valve weaned from mechanical ventilation (defined as >72 hrs off the vent), vs. 47% receiving a sham treatment. MIP also improved by 10 cmH2O in [… read more]

ARDS with multi-organ failure … and more (Reviews)

Review Articles, ARDS and ALI, Critical Care, Mechanical Ventilation Add a Comment

Feb 162011

ARDS and multi-organ failure: Curr Opin Crit Care 2011;17:1-6. Hemodynamic monitoring of ventilated patients: Ibid, pp. 36-42 The ‘ABCDE’ bundle for critical care: Ibid, pp. 43-49. Managing severely hypoxemic patients: Ibid.

DVT/PE in the ICU: Prevention (more heparin) beats screening (ultrasound) in cost-effectiveness model

Critical Care, Policy, Ethics, Education, Pulmonary Embolism / DVT / VTE Add a Comment

Jan 162011

ICU patients have a 5-10% risk of deep venous thrombosis, even with appropriate prophylaxis. Ultrasound screening can detect many of these asymptomatic and clinically unsuspected DVTs. However, since many DVTs disappear without incident, and complications can result from additional testing and treatment with anticoagulation, and all of this costs money, the best approach to prevention [… read more]

No, you can’t use the femoral vein line for central venous saturations.

Critical Care Add a Comment

Jul 022010

In case there was any question, no you can’t use the femoral vein to collect ScvO2 samples. Davison et al found a bias of 4% between femoral and nonfemoral sources in 39 critically ill patients (with an interestingly wide standard deviation of 12% in blood obtained from either source). In more than half the patients, [… read more]

Association Between Time of Admission to the ICU and Mortality: A Systematic Review and Meta-analysis

Review Articles, Critical Care Add a Comment

Jul 012010

Cavallazzi et al reviewed 10 cohort studies and concluded that compared to daytime admission, being admitted to an ICU at night did not increase the odds ratio for mortality. Being admitted on a weekend supposedly did, but the odds ratio was only 1.08. CHEST 2010;138:68-75. FREE FULL TEXT

Ventilation strategy using low tidal volumes, recruitment maneuvers, and high PEEP for ARDS/ALI (RCT)

ARDS and ALI, Critical Care, Mechanical Ventilation Add a Comment

Jan 242008

Meade MO et al. (Lung open ventilation study investigators) Ventilation strategy using low tidal volumes, recruitment maneuvers, and high positive end-expiratory pressure for acute lung injury and acute respiratory distress syndrome: a randomized controlled trial. JAMA 2008; 299:637-45. Higher PEEP provided no benefit in 28-day mortality (28 vs 32%, p = 0.2), although it reduced refractory hypoxia (~5% [… read more]

Higher versus lower positive end-expiratory pressures in patients with the acute respiratory distress syndrome

ARDS and ALI, Critical Care, Mechanical Ventilation Add a Comment

Aug 242004

Brower RG et al. Higher versus lower positive end-expiratory pressures in patients with the acute respiratory distress syndrome. N Engl J Med 2004;351:327-36. Randomized trial among 549 patients with ARDS/ALI conducted by NHLBI/ARDSNet. Compared high and low PEEP strategies, and found no significant difference in mortality, ventilator-free days, ICU-free days, or organ failure-free days between [… read more]

One-year outcomes in survivors of the acute respiratory distress syndrome

ARDS and ALI, Critical Care, Mechanical Ventilation Add a Comment

May 242003

Herridge MS et al. One-year outcomes in survivors of the acute respiratory distress syndrome. N Engl J Med. 2003; 348:683-93. Non-pulmonary problems are usually dominant in impairment of ARDS survivors. Low exercise tolerance, fatigue, and weakness are common a year after discharge. Pulmonary function tests usually normalized, other than a diffusion impairment. At 12 months, only 6% [… read more]

Ventilation with lower tidal volumes as compared with traditional tidal volumes for ALI and ARDS

ARDS and ALI, Critical Care Add a Comment

Jul 242000

ARDS Network. Ventilation with lower tidal volumes as compared with traditional tidal volumes for ALI and ARDS. N Engl J Med 2000;342:1301-8. The ARMA study found the use of low (6 ml/kg predicted weight) rather than “standard” (12 ml/kg predicted weight) tidal volumes reduced mortality from 40 to 30%. This paper established the standard of low [… read more]

Interobserver variability in applying a radiographic definition for ARDS

ARDS and ALI, Critical Care, Radiology & Imaging Add a Comment

Apr 241999

Rubenfeld GD, Caldwell E, Granton J, et al. Interobserver variability in applying a radiographic definition for ARDS. Chest 1999;116:1347-53. Interobserver agreement was only moderate for diagnosing ARDS among 21 experts using consensus radiographic criteria.

Clinical risks for development of ARDS

ARDS and ALI, Critical Care Add a Comment

Oct 241995

Hudson LD et al. Clinical risks for development of ARDS. Am J Respir Crit Care Med 1995;151:293-301. Incidence of ARDS in patients with various risk factors. Showed that ARDS develops within 48 to 72 hours of the time clinical risk is identified in the vast majority of patients.