Raj Joshi , Cameron D. Hypes, Jarrod M. Mosier et el published a single center prospective observational study looking at the risk factors for failure of first attempt at intubation using video laryngoscopy in intensive care unit. Background Macintosh (1943) and Miller (1941) developed direct laryngoscopes and paved the way for modern direct laryngoscopy. Mainstay of … Read more
Massimo Girardis, Stefano Busani and Mervin Singer et el published a single center study in October, 2016 issue of JAMA comparing conservative oxygen therapy with conventional one in critically ill patients. Who All adult patients admitted to an ICU in Italian hospital from 2010 to 2012. Following were excluded pregnancy, ICU readmission, a decision to withhold life-sustaining … Read more
Shipra Gupta, Ankit Sakhuja Gagan Kumar et el published a retrospective study of culture negative sepsis in December, 2016 issue of Chest. PATIENT POPULATION Nationwide Inpatient Sample (NIS) database (USA) from 2000 to 2010, total of 6,843,279 admissions of patients with severe sepsis were studied, 3,226,406 (47.1%) had culture-negative results. WHAT DID THEY … Read more
Michael J. Murray Heidi DeBlock et al published revised guidelines for use of sustained neuromuscular blocking agents in critical care in November issue of critical care medicine. It is an extensive review of current evidence. Here is a summary of recommendations Indications For recommendation Acute ARDS Continuous IV infusion early in the course … Read more
Traditional wisdom taught us to secure airway as soon as possible in case of cardiac arrest(at least in hospital arrest), though over the course of years, American hearth association have moved their focus from “ABC” (airway-breathing-circulation) to “CAB” (circulation-airway-breathing). AHA also suggested that if a trained individual is not present to secure airway, bag mask ventilation … Read more
New surviving sepsis guidelines were just been released, incorporating new evidence and new sepsis definition. It is a 38 page document(excluding references) . Here is a concise summary of the new guidelines. FOR RECOMMENDATIONS Treatment and resuscitation should begin immediately. 30 mL/kg of IV crystalloid fluid should be given within the first 3 hours. … Read more
Stephane Legriel, M.D., Virginie Lemiale, M.D., Maleka Schenck, M.D et al published study in NEJM on Dec 22,2016 evaluating use of hypothermia in status epilepticus. Therapeutic hypothermia does not improve outcome but can be a potential tool to treat seizures. The HYBERNATUS (Hypothermia for Brain Enhancement Recovery by Neuroprotective and Anticonvulsant Action After Convulsive Status … Read more
Low tidal volume ventilation in ARDS (acute respiratory distress syndrome) have been shown to improve mortality. However, low tidal volume ventilation invariably leads to hypercapnia. Many strategies have been employed to optimize the ventilation in ARDS using increases in respiratory rate , use of active humidifiers and the tracheal gas insufflation or aspiration of dead space. … Read more
Finally, an alternative to Succinylcholine in USA (short duration paralytic) In December, 2015, FDA approved Bridion (sugammadex) injection to reverse the effects of neuromuscular blockade induced by rocuronium bromide and vecuronium bromide. Now finally we have an alternative to succinylcholine (Mainly used for its very short duration of action).(1) “Bridion provides a new treatment … Read more
Rohan Khera, Paul S. Chan published in circulation about timing of epinephrine in non-shockable cardiac arrest (in hospital) across 548 hospitals who participate in “get on with the guidelines” database. What they did They looked at 103,932 adult patients with non-shockable cardiac arrests from 2001 to 2014. 13,213 (12.7%) patients had delays to epinephrine (more than 5 … Read more
Cristina Valencia, Naïma Hammami et el published a worldwide survey of healthcare professionals in this month’s Antimicrobial Resistance & Infection Control journal. Overall, only 23% of the ICUs strictly adhere to the guidelines to prevent CLABSI. Just for review, here are the components of CLABSI prevention bundle by the Joint Commission Hand hygiene Hands are … Read more
Neurocritical Care Society and Society of Critical Care Medicine just published guidelines for the reversal of antithrombotics in intracranial hemorrhage. Summary is here in this table. Antithrombotic agent Reversal agent Vitamin K antagonists If INR more than 1.4 vitamin K 10 mg IV, plus 3- or 4-factor PCC IV (dosing based on … Read more