COVID 19 for critical care

Updated 7/22/2020 Since the discovery of Covid 19(Coronavirus SARS COV 2) in December 2019, flow of information and circumstances are changing everyday. It is hard to keep up with so much information and sort out real from myths. In general, following points are important to remember which are referenced from reputable sources Tolicizumab is the … Read more COVID 19 for critical care

Intense renal replacement therapy may lead to delayed extubation

Shilpa Sharma, Yvelynne P. Kelly et el published a study in Chest  comparing  intense vs usual renal replacement  therapy in patients  undergoing mechanical  ventilation. It was a secondary analysis of already completed ATN study. BACKGROUND Randomized clinical trials have failed to show benefit from increasing intensity of renal replacement therapy (RRT). RRT is associated with an increase in … Read more Intense renal replacement therapy may lead to delayed extubation

Mechanical ventilation without sedation

Hanne T. Olsen, Helene K. Nedergaard et el published a trial of no sedation versus light sedation in mechanically ventilated patients in NEJM. WHAT Multi center  randomized controlled trial,  in a 1 : 1 ratio,  comparing be mechanically ventilated ICU patients to  no sedation  versus  light sedation strategy( RASS  Richmond agitation and sedation Scale score … Read more Mechanical ventilation without sedation

‘Wrong-Pipe’ Intubation Deaths still common

ProPublica published research done by Dr. Nick Asselin on cardiac arrests in Rhode Island and found esophageal intubation by EMS providers in 12 cases.  All of the patients died.  This story brings the attention back to skills needed to correctly intubate the patient in setting of stress of ongoing CPR. RESEARCH Rhode Island is the … Read more ‘Wrong-Pipe’ Intubation Deaths still common

Prevention of Early Ventilator-Associated Pneumonia after Cardiac Arrest

Bruno François, Alain Cariou, Raphaël Clere-Jehl et el published a trial of  intravenous amoxicillin-clavulanate versus placebo  in patients undergoing  targeted temperature management and mechanical ventilation for out of hospital cardiac arrest  with shockable rhythm. BACKGROUND  Targeted temperature management remains  cornerstone of therapy for  out of hospital cardiac arrest.  however targeted temperature management is associated with … Read more Prevention of Early Ventilator-Associated Pneumonia after Cardiac Arrest

Dexmedetomidine in Critically Ill patients

Y. Shehabi, B.D. Howe, R. Bellomo et el recently published results of SPICE III trial (Sedation Practice in Intensive Care Evaluation), dexmedetomidine as the sole or primary sedative comparing to receive usual care (propofol, midazolam, or other sedatives). BACKGROUND Dexmedetomidine was initially approved by the United States Food and Drug Administration (FDA) in 1999 for the … Read more Dexmedetomidine in Critically Ill patients

Paralytics in ARDS

The National Heart, Lung, and Blood Institute PETAL Clinical Trials Network published a large randomized controlled trial comparing NMBs(neuromuscular blocker) to placebo in patients with moderate to severe adult respiratory distress syndrome(PEEP of at least >8 with ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen of <150 mm Hg). … Read more Paralytics in ARDS

Laryngeal tube insertion in out of hospital cardiac arrest may save lives

Henry E.Wang, Robert H. Schmicker,  Mohamud R. Daya et el  published PART trial (Pragmatic Airway Resuscitation Trial) in which they compared laryngeal tube insertion with endotracheal intubation in out of hospital cardiac arrest.  BACKGROUND About 350000 adults in the United States suffer out of hospital cardiac arrest each year, with less than 10%surviving to hospital discharge.  More … Read more Laryngeal tube insertion in out of hospital cardiac arrest may save lives

Early APRV in ARDS

Yongfang Zhou, Xiaodong Jin published a study in Intensive care medicine journal about using APRV early in ARDS. WHAT THEY DID Randomized adult patients with ARDS (Berlin definition, P:F ratio <250) who were on mechanical ventilation to APRV(Airway pressure release ventilation) or LTV(low tidal volume) mode of mechanical ventilation. Patients were enrolled within 48 hours. … Read more Early APRV in ARDS

Intubation : Optimal position and Bougie

Endotracheal intubation is one of the most common and critical procedure performed in intensive care unit. Two recent studies provide some insight in to the ideal position and use of bougie in intubation. Semler MW and Janz DR et el published in this month’s Chest about optimal positioning for successful intubation.  In this Multi center, randomized trial they … Read more Intubation : Optimal position and Bougie

ESICM/ESCMID/ALAT guidelines for the management of HAP and VAP

European Respiratory Society (ERS), European Society of Intensive Care Medicine (ESICM), European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and Asociación Latinoamericana del Tórax (ALAT) Recently published guidelines for management of hospital acquired pneumonia(HAP), and ventilator associated pneumonia. These guidelines are sligtly different then presented by IDSA and ATS published in July 2016. Some of the differences in … Read more ESICM/ESCMID/ALAT guidelines for the management of HAP and VAP

Out-of-Hospital Tranexamic Acid does not improve neurological outcomes in trauamtic brain injury.Read more
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