The effects of vasopressin and its analogues on the liver and its disorders in the critically ill

Tweet The use of vasopressin and its synthetic analogues has shown beneficial effects in the management of patients with cirrhosis, especially in the context of variceal bleeding, the hepatorenal syndrome or both. In both cases, the use of terlipressin improved survival. Therefore, in these clinical indications, terlipressin is a part of recommendations. The role of […]

SECOND VASOPRESSOR CHOICE FOR PATIENTS WITH REFRACTORY SEPTIC SHOCK ON NOREPINEPHRINE IN THE INTENSIVE CARE UNIT

Tweet In septic shock patients requiring multiple vasopressors, hemoglobin, total fluids at 48 and 96 hours have significant effect on outcome. Dobutamine or dopamine may be the preferred second vasopressor when norepinephrine alone is inadequate. A prospective randomized trial examining the choice of second vasopressor is needed….link here

The ALBIOS Trial: Albumin in Severe Sepsis?

Tweet The New England Journal of Medicine. 2014. 370(15):1402-141 Among patients with severe sepsis or septic shock, does administration of albumin 20% solution to maintain serum albumin level ≥3 g/dL reduce all-cause mortality at 28 days when compared to no albumin? Multi centre, open label. randomised trial. Inclusion criteria Suspected or proven infection in one […]

CCP Podcast 050: LeoPARDS Trial

Podcast: Play in new window | DownloadSubscribe: Apple Podcasts | Android | RSSTweet Levosimendan for the Prevention of Acute Organ Dysfunction in Sepsis Gavin and I try to peel apart the layers of the LeoPARDS Trial which assesses the benefits of levosimendan for the prevention of organ dysfunction in sepsis. It’s another interesting study which actually asks […]

Continuous beta-lactam infusion in critically ill patients: the clinical evidence

Tweet Although numerous PK/PD data from various in vitro and in vivo experimental studies favor the use of continuous infusion, the current clinical data are less convincing and insufficient to instigate a global shift from conventional bolus dosing. However, this lack of convincing data may be due to several methodological flaws and inconsistencies among the […]

Colloids versus crystalloids for fluid resuscitation in critically ill patients.

Tweet Trauma, burns or surgery can cause people to lose large amounts of blood. Fluid replacement, giving fluids intravenously (into a vein) to replace lost blood, is used to try to maintain blood pressure and reduce the risk of dying. Blood products, non-blood products or combinations are used, including colloid or crystalloid solutions. Colloids are […]

Fluid Therapy in the Septic Critically Ill Patient

Tweet Introduction Sepsis and severe sepsis is a condition which, in my role as an Advanced Clinical Practitioner, I will encounter many times in my career in the Emergency Medicine Department. There is a high incidence (up to 300 cases per 100,000) reported in both the United Kingdom (P. Mouncey et al. 2015) and Australia […]

NOT Chloride!…(most of the time…)

Tweet Association Between a Chloride-Liberal vs Chloride-Restrictive Intravenous Fluid Administration Strategy and Kidney Injury in Critically Ill Adults Yunos NM, Bellomo R, Hegarty C, Story D, Ho L, Bailey M JAMA 2012 Does a chloride restrictive approach fluid replacement therapy reduce the risk of acute kidney injury in the critically ill patient? A prospective, open label, before-and-after pilot study. A […]

Choice of Fluid- John Myburgh Summary.

Tweet Fluid resuscitation in acute medicine: what is the current situation?  Journal of internal medicine (Accepted Article) Professor John A Myburgh AO, is Director of the Division of Critical Care and Trauma at the George Institute for Global Health, Professor of Critical Care at the Faculty of Medicine, University of New South Wales and senior […]

ARISE Trial- Early Goal Directed Therapy Is Not The Gold Standard…

Tweet Goal-Directed Resuscitation for Patients with Early Septic Shock The ARISE Investigators and the ANZICS Clinical Trials Group   Emmanuel Rivers trial found a big difference in 90 day mortality when using early goal directed therapy and as a consequence the Surviving Sepsis Guidelines have advocated the use of this algorithm.  The recent PROCESS trial […]

Jones- Is Lactate a Useful Indicator?

Tweet Lactate Clearance vs Central Venous Oxygen Saturation as Goals of Early Sepsis Therapy: A Randomized Clinical Trial Dr. Alan E. Jones, MD, Dr. Nathan I. Shapiro, MD, MPH, Dr. Stephen Trzeciak, MD, MPH, Dr. Ryan C. Arnold, MD, Ms. Heather A. Claremont, BFA, and Dr. Jeffrey A. Kline, MD for the Emergency Medicine Shock […]

ProCESS- Get rid of the central line?

Tweet And the debate goes on! How much fluid should we give our septic patients? The results from the ProCESS trial are out and I am still not sure that we have an answer. So I listened to one of my go to guys to help me understand…..Scott Weingart. The Method Patients enrolled were those […]

High-dose Norepinephrine Treatment

Tweet In conclusion, high 28-day mortality of critically ill patients with shock who received high-dose norepinephrine in the ICU does not seem to be associated with underlying disease and comorbid conditions, the cause of shock, or dose or duration of norepinephrine treatment. However, our data suggest that treatment with norepinephrine is futile in patients with […]

Mariks’ Deadly Trio!

Tweet Iatrogenic salt water drowning and the hazards of a high central venous pressure. Marik Annals of Intensive Care 2014, 4:21   Paul Marik has been investigating the effects of fluid on the septic patient over the years, publishing several important papers in the process. Does Central Venous Pressure Predict Fluid Responsiveness? CHEST 2008 Heamodynamic parameters […]

Vasopressin and terlipressin in adult vasodilatory shock: a systematic review and meta-analysis of nine randomized controlled trials

Tweet The present meta-analysis has demonstrated the benefit of the association of vasopressin and terlipressin in reducing norepinephrine requirements in patients with vasodilatory shock, particularly in patients with septic shock. Our results show that vasopressin treatment is not associated with decreased cardiac output or oxygen delivery and consumption, even in higher doses. However, the pooled […]

Single-Dose Etomidate Is Not Associated With Increased Mortality in ICU Patients With Sepsis: Analysis of a Large Electronic ICU Database

Tweet In a mixed-diagnosis group of critically ill patients with sepsis, severe sepsis, and septic shock, single-dose etomidate administration for intubation in the ICU was not associated with higher mortality or other adverse clinical outcomes….link here