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

ATS/ESICM/SCCM Guidelines for mechanical ventilation : ARDS

Fan E, Del Sorbo L, Goligher EC, Hodgson CL et el published official guidelines for mechanical ventilation in ARDS which were published recently. Guidelines are in a question answer format and they answer 6 questions. They did not comment on  Airway pressure release ventilation and use of NM blockade. Here is the summary Future studies are needed to resolve following … Read more

Bundle to reduce ventilator associated events

Nishi Rawat, Ting Yang,  Kisha J. Ali et el  published a two state multifaceted intervention study showing benefits of improved compliance with evidence based practices can reduce ventilator-associated event, infection-related ventilator- associated complication, and probable ventilator-associated pneumonia. It was a longitudinal quasi-experimental study involving 56 ICUs at 38 hospitals in Maryland and Pennsylvania from October 2012 to March 2015. PROBLEM … Read more

Steroids to prevent post extubation stridor and reintubation

Kuriyama A, Umakoshi N, Sun R published a systemic review and meta- analysis of recent trials regarding use of steroids to prevent post extubation stridor and reintubation. BACKGROUND Earlier meta-analysis of trials of steroids by Fan T et el, Jaber S et el , Khemani RG et el and McCaffrey J et el suggested the potential of corticosteroids to … Read more

Difficult airway characteristics associated with video laryngoscopy failure

Raj Joshi , Cameron D. Hypes,  Jarrod M. Mosier et el published a single center prospective observational study looking at the risk factors for failure of first attempt at intubation using video laryngoscopy in intensive care unit.   Background Macintosh (1943) and Miller (1941) developed direct laryngoscopes and paved the way for modern direct laryngoscopy.  Mainstay of … Read more

Conservative Vs Conventional Oxygen therapy : How much or how low ?

Massimo Girardis, Stefano Busani and Mervin Singer et el  published a single center study in October, 2016 issue of JAMA comparing conservative oxygen therapy with conventional one in critically ill patients.    Who All adult patients admitted to an ICU in Italian hospital from 2010 to 2012. Following were excluded pregnancy, ICU readmission, a decision to withhold life-sustaining … Read more

Timing of intubation for in hospital cardiac arrest ?

Traditional wisdom taught us to secure airway as soon as possible in case of cardiac arrest(at least in hospital arrest), though over the course of years, American hearth association have moved their focus from “ABC” (airway-breathing-circulation) to “CAB” (circulation-airway-breathing). AHA also suggested that if a trained individual is not present to secure airway, bag mask ventilation … Read more

New Surviving Sepsis Guidelines

New surviving sepsis guidelines were just been released, incorporating new evidence and new sepsis definition. It is a 38 page document(excluding references) . Here is a concise summary of the new guidelines.   FOR RECOMMENDATIONS Treatment and resuscitation should begin immediately. 30 mL/kg of IV crystalloid fluid should be given within the first 3 hours. … Read more

What the hell is EIP ?

Low tidal volume ventilation in ARDS (acute respiratory distress syndrome) have been shown to improve mortality. However, low tidal volume ventilation invariably leads to hypercapnia. Many strategies have been employed to optimize the ventilation in ARDS using increases in respiratory rate , use of active humidifiers  and the tracheal gas insufflation or aspiration of dead space. … Read more

You may want this drug in your RSI box!

Finally, an alternative to Succinylcholine in USA (short duration paralytic)   In December, 2015, FDA approved Bridion (sugammadex) injection to reverse the effects of neuromuscular blockade induced by rocuronium bromide and vecuronium bromide. Now finally we have an alternative to succinylcholine (Mainly used for its very short duration of action).(1)   “Bridion provides a new treatment … Read more

Effective communication with mechanically ventilated patients

S. Ten Hoorn, P. W. Elbers and A. R. Girbes published a systemic review in critical care journal in Sept, 2016 about how to communicate with patients on mechanical ventilation.  Summary of the review is in this picture In the US, many ICUs use commercially available communication boards. One below is from Vidatak. In the current technology driven era, there are many … Read more

New recommendations for liberation from mechanical ventilation

Chest/ American thoracic society released new guidelines for liberation from mechanical ventilation. There are six key recommendations. They all are applicable to patients who are mechanically ventilated for more than 24 hours. For all recommendations, strength is conditional except recommendation for NIV after extubation where it is strong. Initial SBT or spontaneous breathing trial should … Read more

Remdesivir, Hydroxychloroquine, Lopinavir/Ritonavir and Interferon, all fail in Solidarity trial.Read more