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 […]

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

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 […]

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..

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 […]

Using health IT to triage decisions may help understaffed ICUs facing aging population, growing critical care demand

Tweet Medicine and the Society of Hospital Medicine — the critical care certification of hospitalists. Congress has taken notice as well: members proposed a bill (H.R. 971) to direct the Institute of Medicine and the Comptroller General to examine the effectiveness of ICU care and the supply of critical care physicians and beds…link here

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…

Online Emergency Ultrasound Exam

Tweet A website made possible by support from the American College of Emergency Physicians. This has a wide range of teaching videos with testing covering aspects such as Cardiac and Lung imaging. Very useful voice over added to clarify the points made in the tests with videos of actual ultrasound imaging. Highly recommended. Link Here

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 […]

Ventilator-Associated Complications on Length of Stay and Antibiotic Use in Patients in Intensive Care Units

Tweet Surveillance for VAP is subjective and labor intensive. VAC is an objective measure which can be readily obtained from electronic records. It is associated with adverse outcomes and increased broad-spectrum antibiotic usage. VAC may be a useful surveillance tool. The utility of VAC prevention bundles merits assessment….link here