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

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 […]

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 […]

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 […]

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

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 […]

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 […]

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 […]

CCP Podcast 019 : SepsisPAM analysed. Gav and Jonathan try to work it out!

Podcast: Play in new window | DownloadSubscribe: Apple Podcasts | Android | RSSTweet In an attempt to further my understanding of some of the methods used in research Gavin Denton (@dentongavin) and I had a discussion about the SepsisPAM trial below. This is a new approach on the podcast and one which I hope people […]