An interview with Dr John Kress, an ITU physician from the University of Chicago. Dr Kress is a highly respected and well published doctor with an interest in ICU acquired weakness or polyneuropathy, one of his more well known papers being " Daily Interruption of Sedative Infusions in Critically Ill Patients Undergoing Mechanical Ventilation" which discussed the use of sedation breaks in the critically ill patients in intensive care.
Dr Kress very kindly agreed to help me understand some of the principles involved in this paper.
This article discusses the effects ICU acquired weakness or polyneuropathy can have on the recovery of the patient and some of the causes of it. It then goes onto to describe some of the simple approaches the nurse and medical staff can take to help the patient recover form this debilitating condition.
Early mobilisation of the patient was one of the main principles and this is highlighted in one of his other papers "
" - even having patients who could stand up and walk whilst still intubated and on the ventilator.
Minimising sedation is another way to improve the patients progress in the intensive care unit and Dr Kress wrote an editorial on this topic clarifying some of the thinking; "
.
If you have any experience of any of the issues raised then please get in touch...I would love to talk.
[table id=1 /]
[Stitcher_Radio_Logo]
[get_in_touch_with_jonathan]
[123-contact-form i882618]
Tom, one of my colleagues from the Critical Care Outreach Team and I discuss this paper and its findings reaching our own conclusions. Deferring Arterial Catheterisation in Patients with Septic Shock.
Read More
We return to our 48-year-old patient: jaundiced, hypotensive, drowsy, and bleeding. In decompensated cirrhosis, every treatment targets a disrupted system — splanchnic vasodilation, portal hypertension, toxin accumulation, and renal hypoperfusion.Although these patients look fluid overloaded, they are effectively hypovolaemic. Start with small aliquots of balanced crystalloid, avoiding 0.9% saline. In hepatorenal syndrome or tense ascites, 20% albumin is
Read More
In this episode, I walk through the real-world critical care management of acute decompensated alcohol-related liver disease, using a high-risk ICU case to anchor the discussion. The focus is on understanding the underlying physiology—portal hypertension, rebalanced haemostasis, hepatic encephalopathy, infection, and hepatorenal syndrome—and translating that physiology into clear first-hour priorities at the bedside. Listeners are
Read More
