Shilpa Sharma, Yvelynne P. Kelly et el published a study in Chest comparing intense vs usual renal replacement therapy in patients undergoing mechanical ventilation. It was a secondary analysis of already completed ATN study. BACKGROUND Randomized clinical trials have failed to show benefit from increasing intensity of renal replacement therapy (RRT). RRT is associated with an increase in … Read more
Hanne T. Olsen, Helene K. Nedergaard et el published a trial of no sedation versus light sedation in mechanically ventilated patients in NEJM. WHAT Multi center randomized controlled trial, in a 1 : 1 ratio, comparing be mechanically ventilated ICU patients to no sedation versus light sedation strategy( RASS Richmond agitation and sedation Scale score … Read more
ProPublica published research done by Dr. Nick Asselin on cardiac arrests in Rhode Island and found esophageal intubation by EMS providers in 12 cases. All of the patients died. This story brings the attention back to skills needed to correctly intubate the patient in setting of stress of ongoing CPR. RESEARCH Rhode Island is the … Read more
Bruno François, Alain Cariou, Raphaël Clere-Jehl et el published a trial of intravenous amoxicillin-clavulanate versus placebo in patients undergoing targeted temperature management and mechanical ventilation for out of hospital cardiac arrest with shockable rhythm. BACKGROUND Targeted temperature management remains cornerstone of therapy for out of hospital cardiac arrest. however targeted temperature management is associated with … Read more
Y. Shehabi, B.D. Howe, R. Bellomo et el recently published results of SPICE III trial (Sedation Practice in Intensive Care Evaluation), dexmedetomidine as the sole or primary sedative comparing to receive usual care (propofol, midazolam, or other sedatives). BACKGROUND Dexmedetomidine was initially approved by the United States Food and Drug Administration (FDA) in 1999 for the … Read more
The National Heart, Lung, and Blood Institute PETAL Clinical Trials Network published a large randomized controlled trial comparing NMBs(neuromuscular blocker) to placebo in patients with moderate to severe adult respiratory distress syndrome(PEEP of at least >8 with ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen of <150 mm Hg). … Read more
Henry E.Wang, Robert H. Schmicker, Mohamud R. Daya et el published PART trial (Pragmatic Airway Resuscitation Trial) in which they compared laryngeal tube insertion with endotracheal intubation in out of hospital cardiac arrest. BACKGROUND About 350000 adults in the United States suffer out of hospital cardiac arrest each year, with less than 10%surviving to hospital discharge. More … Read more
Yongfang Zhou, Xiaodong Jin published a study in Intensive care medicine journal about using APRV early in ARDS. WHAT THEY DID Randomized adult patients with ARDS (Berlin definition, P:F ratio <250) who were on mechanical ventilation to APRV(Airway pressure release ventilation) or LTV(low tidal volume) mode of mechanical ventilation. Patients were enrolled within 48 hours. … Read more
Recently, two papers were published, one a trial and other one a meta analysis about lung recruitment in ARDS. First study, published in JAMA, was a trial of lung recruitment and Titrated Positive End-Expiratory Pressure (PEEP) vs Low PEEP in ARDS(ART Investigators), published by Cavalcanti AB, Suzumura ÉA et el. They compared total of 1010 patients of … Read more
Endotracheal intubation is one of the most common and critical procedure performed in intensive care unit. Two recent studies provide some insight in to the ideal position and use of bougie in intubation. Semler MW and Janz DR et el published in this month’s Chest about optimal positioning for successful intubation. In this Multi center, randomized trial they … Read more
European Respiratory Society (ERS), European Society of Intensive Care Medicine (ESICM), European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and Asociación Latinoamericana del Tórax (ALAT) Recently published guidelines for management of hospital acquired pneumonia(HAP), and ventilator associated pneumonia. These guidelines are sligtly different then presented by IDSA and ATS published in July 2016. Some of the differences in … Read more
Fan E, Del Sorbo L, Goligher EC, Hodgson CL et el published official guidelines for mechanical ventilation in ARDS which were published recently. Guidelines are in a question answer format and they answer 6 questions. They did not comment on Airway pressure release ventilation and use of NM blockade. Here is the summary Future studies are needed to resolve following … Read more