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

Culture Negative Severe Sepsis

Shipra Gupta, Ankit Sakhuja Gagan Kumar et el published a retrospective study of culture negative sepsis in December, 2016  issue of Chest.   PATIENT POPULATION Nationwide Inpatient Sample (NIS) database (USA) from 2000 to 2010, total of 6,843,279 admissions of patients with severe sepsis were studied, 3,226,406 (47.1%) had culture-negative results.   WHAT DID THEY … Read more

Neuromuscular blockade in Critical Care

Michael J. Murray  Heidi DeBlock et al published revised guidelines for use of sustained neuromuscular blocking agents in critical care in November issue of critical care medicine.  It is an extensive review of current evidence. Here is a summary of recommendations   Indications   For recommendation   Acute ARDS Continuous IV infusion early in the course … 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

Hypothermia in Status Epilepticus does not improve outcome

Stephane Legriel, M.D., Virginie Lemiale, M.D., Maleka Schenck, M.D et al published study in NEJM on Dec 22,2016  evaluating use of hypothermia in status epilepticus. Therapeutic hypothermia does not improve outcome but can be a potential tool to treat seizures. The HYBERNATUS (Hypothermia for Brain Enhancement Recovery by Neuroprotective and Anticonvulsant Action After Convulsive Status … 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

Give that EPI early in non-shockable arrest in hospital cardiac arrest

Rohan Khera, Paul S. Chan published in circulation about timing of epinephrine in non-shockable cardiac arrest (in hospital) across 548 hospitals who participate in “get on with the guidelines” database. What they did They looked at 103,932 adult patients with non-shockable cardiac arrests from 2001 to 2014. 13,213 (12.7%) patients had delays to epinephrine (more than 5 … Read more

Poor adherence to CLABSI prevention guidelines worldwide

Cristina Valencia, Naïma Hammami et el published a worldwide survey of healthcare professionals in this month’s Antimicrobial Resistance & Infection Control journal. Overall, only 23% of the ICUs strictly adhere to the guidelines to prevent CLABSI. Just for review, here are the components of CLABSI prevention bundle by the Joint Commission  Hand hygiene Hands are … 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

Fentanyl better than morphine for mechanically ventilated patients.Read more