Gavin raises his legs!!

Tweet The assessment of fluid responsiveness in haemodynamically unstable patients. My good friend Gavin Denton (@dentongavin) has once again surpassed himself in analysing some of the evidence for the passive leg raise. Over to you Gav (I think I love him….ssshhhh).   Background. Clinical examination and findings have long been used to guide fluid resuscitation. […]

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 […]

Using Nasal Specs During Intubation Gives You More Time….

Tweet Abstract Study Objective: To evaluate the influence of nasal oxygen (O2) administration on the duration of arterial oxygen saturation (SpO2) ≥95% during simulated difficult laryngoscopy in obese patients. Design: Prospective, randomized, controlled trial. Setting: University hospital. Patients: 30 obese men undergoing general anesthesia. Interventions: After thorough preoxygenation, and using total intravenous anesthesia, simulated difficult […]

Lower tidal volume at initiation of mechanical ventilation may reduce progression to acute respiratory distress syndrome: a systematic review.

Tweet In mechanically ventilated patients without ARDS at the time of endotracheal intubation, the majority of data favors lower tidal volume to reduce progression to ARDS. However, due to significant heterogeneity in the data, no definitive recommendations can be made. Further randomized controlled trials examining the role of lower tidal volumes in patients without ARDS, […]

Cricoid Pressure – A Lack of Evidence

Tweet The Main Question: Is there any evidence for the efficacy of cricoid pressure in reducing aspiration? The short answer is no. A systematic review intended to answer this question was published in the Canadian Journal of Anaesthesia in 2007 and concluded, “Following our analysis of the literature it was apparent that there was no […]

Therapeutic Hypothermia…discussions abound!

Tweet Targeted temperature management at 33C versus 36C after cardiac arrest Nielsen et alNew England Journal of Medicine, 12 2013, vol./is. 369/23(2197-206), 0028-4793;1533-4406 “Unconscious survivors of out-of-hospital cardiac arrest have a high risk of death or poor neurologic function. Therapeutic hypothermia is recommended by international guidelines, but the supporting evidence is limited, and the target […]

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 […]

Noninvasive ventilation immediately after extubation improves weaning outcome after acute respiratory failure.

Tweet Noninvasive ventilation (NIV), as a weaning-facilitating strategy in predominantly chronic obstructive pulmonary disease (COPD) mechanically ventilated patients, is associated with reduced ventilator-associated pneumonia, total duration of mechanical ventilation, length of intensive care unit (ICU) and hospital stay, and mortality. However, this benefit after planned extubation in patients with acute respiratory failure of various etiologies […]

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 […]

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 […]

THERAPEUTIC HYPOTHERMIA FOR COMATOSE SURVIVORS OF IN-HOSPITAL CARDIAC ARREST

Tweet Large studies report 15 to 20% survival hospital discharge following IHCA1. Fifty-six percent of our patients survived to hospital discharge. The majority of survivors had a good neurologic outcome. Therapeutic hypothermia should be considered for any patient who is comatose following a witnessed, acute cardiac arrest, regardless of the arrest location or initial rhythm […]

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 […]

Test Characteristics of Ultrasonography for the Detection of Pneumothorax – Chest 2012

Tweet Performance of ultrasonography for the detection of pneumothorax is excellent and is superior to supine chest radiography. Considering the rapid access to bedside ultrasonography and the excellent performance of this simple test, this study supports the routine use of ultrasonography for the detection of pneumothorax. Link to research paper here…

CCP Podcast 014: How Much Fluid?

Podcast: Play in new window | DownloadSubscribe: Apple Podcasts | Android | RSSTweet I made contact with Dr Segun Olunsanya via Twitter to discuss some of the issues around the fluid management of the sick patient. He in turn persuaded a couple of others involved in ITU. This has led to this fascinating discussion around […]

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 […]

CCP Podcast 015: The Power of Practitioners?

Podcast: Play in new window | DownloadSubscribe: Apple Podcasts | Android | RSSTweet This is a discussion with Garry Swann. Garry is the Consultant nurse lead in the Emergency Department at the Heart of England NHS Trust and is one of the main driving forces behind the development of the Advanced Clinical Practitioner roles at this […]

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

Continuous Infusion of Beta-Lactam Antibiotics in Severe Sepsis: A Multicenter Double-Blind, Randomized Controlled Trial

Tweet Continuous administration of beta-lactam antibiotics achieved higher plasma antibiotic concentrations than intermittent administration with improvement in clinical cure. This study provides a strong rationale for further multicenter trials with sufficient power to identify differences in patient-centered endpoints….link here

Association between Antibiotic Treatment and Outcomes in Patients Hospitalized with Acute Exacerbation of COPD Treated with Systemic Steroids.

Tweet ABSTRACT BACKGROUND: Antibiotics are widely used in acute exacerbation of COPD (AE-COPD), but their additional benefit to a therapeutic regimen that already includes steroids is uncertain. We evaluated the association between antibiotic therapy and outcomes among a large cohort of steroid treated patients who were hospitalized with AE-COPD and compared the effectiveness of three […]

Etomidate is associated with mortality and adrenal insufficiency in sepsis: a meta-analysis*.

Tweet Administration of etomidate for rapid sequence intubation is associated with higher rates of adrenal insufficiency and mortality in patients with sepsis…..link here