CCP Podcast 036: Head of Bed Elevation and Reflux.

Podcast: Play in new window | DownloadSubscribe: Apple Podcasts | Android | RSSTweet Lynn Schallom is a research scientist at the Barnes-Jewish Hospital in St. Louis. She published a paper ‘Head of Bed Elevation and Early Outcomes of Gastric Reflux, Aspiration, and Pressure Ulcers’ in the American Journal of Critical Care in January 2015. Head of Bed […]

Aneurysmal subarachnoid haemorrhage – series of presentations

Tweet A Pecha Kucha introducing the topic of aneurysmal subarachnoid haemorrhage. This includes some epidemiology, the initial management and some treatment options. This is the first of five Pecha Kuchas on this topic. Link here…

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 […]

When to transfuse?

Tweet The Gist: “Permissive _____” is becoming increasing popular in medicine-blood glucose, blood pressure, and oxygen saturation. Hemoglobin is similar, but common refrains may be heard “well, he looks puny, let’s give him a couple of units.” Currently, the best evidence suggests that transfusion of packed red blood cells (PRBCs) should be considered in most […]

Weaning From Mechanical Ventilation update

Tweet Nearly 800,000 patients require mechanical ventilation yearly. There’s no doubt it is a life-saving intervention, but it is one that is fraught with the potential for iatrogenesis, especially if continued for longer than necessary. That is the main message of this review in the NEJM by John F. McConville and John P. Kress (father of the sedation holiday) from the University of […]

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 […]

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 […]

CCP Podcast 039: Early Mobilisation- Get Them Moving!

Podcast: Play in new window | DownloadSubscribe: Apple Podcasts | Android | RSSTweet TEAM is a program of research to evaluate the effect of early mobilisation to assess functional recovery and patient-centered outcomes of ICU survivors. Carol Hodgson is one of the lead clinicians in this project, She will be presenting at the 2015 Intensive […]

Rapid sequence induction practices in the United States and the United Kingdom-a comparative survey study.

Tweet Purpose: We aimed to survey the members of anesthesia departments in two large university hospitals, University of Washington (Seattle, USA) (UW-US) and University of Nottingham (Nottingham, UK) (UN-UK) to compare differences in their current approach to rapid sequence induction (RSI). Link here..

International evidence-based recommendations for point-of-care lung ultrasound

Tweet This document reflects the overall results of the first consensus conference on “point of care” ultrasound. Statements were discussed and elaborated by experts who published the vast majority of papers on clinical use of lung ultrasound in the last 20 years. Recommendations were produced to guide implementation, development and standardisation of lung ultrasound in all relevant settings. Link Here…

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 […]

Delirium in the ICU: an overview

Tweet Delirium is common in ICU patients but often goes undetected. Different instruments have been designed to help in the identification of patients with delirium. Whether the implementation of these instruments leads to better outcomes is not fully established. Nonpharmacological approaches, such as physical and occupational therapy, decrease the duration of delirium and should be […]

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 […]

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…

Ultrasound in the septic patient – lets RUSH in!

Tweet The RUSH Protocol was first introduced in 2006 by Weingart SD et al, and later published in 2009. It was designed to be a rapid and easy to perform US protocol (link here