Critical Care Archives

Critical Care Thoracic US Score Predicts Pleurodesis Success in Malignant Pleural Effusion

Thoracic US Score Predicts Pleurodesis Success in Malignant Pleural Effusion

A pleural adherence score derived from thoracic ultrasound at 24 hours post-talc administration is predictive of long-term pleurodesis success in patients with symptomatic malignant pleural effusion.

Critical Care Spontaneous Pneumothorax Hospital Admissions Have Increased

Spontaneous Pneumothorax Hospital Admissions Have Increased

Hospital readmission was also more likely in individuals whose first spontaneous pneumothorax occurred after 2008 compared with before 2008.

Critical Care Neither Haloperidol, Ziprasidone Shortens Delirium in ICU

Neither Haloperidol, Ziprasidone Shortens Delirium in ICU

No decrease in duration vs placebo in patients with hypoactive or hyperactive delirium in ICU.

Critical Care Remimazolam Safe, Effective for Sedation During Flexible Bronchoscopy

Remimazolam Safe, Effective for Sedation During Flexible Bronchoscopy

Remimazolam was safe and effective for achieving moderate sedation in patients undergoing flexible bronchoscopy.

Critical Care Prehospital Advanced Life Support Shortens Antibiotic Wait Times in Sepsis

Prehospital Advanced Life Support Shortens Antibiotic Wait Times in Sepsis

Antibiotic treatment started sooner in individuals with sepsis treated with advanced life support who did not have hypotension.

CHEST 2018 High Flow Nasal Cannula Oxygen Therapy May Benefit Elderly Patients in ICU

High Flow Nasal Cannula Oxygen Therapy May Benefit Elderly Patients in ICU

After high flow nasal cannula oxygen therapy, 15% of patients had to be intubated and mechanically ventilated, but the majority stepped down to regular oxygen therapy.

CHEST 2018 Factors Associated With Mechanical Ventilation Mortality in Pregnancy

Factors Associated With Mechanical Ventilation Mortality in Pregnancy

Vasopressor requirement, transfusions, neurologic dysfunction, coagulopathy, and acute respiratory distress syndrome were related to higher mortality after multivariate analysis.

CHEST 2018 Risk Factors for Multidrug-Resistant Pathogens in Pneumonia

Risk Factors for Multidrug-Resistant Pathogens in Pneumonia

Previous antibiotic use and mechanical invasive ventilation were risk factors for multidrug-resistant pathogens in hospital-associated or ventilator-associated pneumonia.

CHEST 2018 Invasive Ventilation Risk in COPD Exacerbation

Invasive Ventilation Risk in COPD Exacerbation

Alcohol abuse, fluid and electrolyte abnormalities, and pulmonary circulation disorders increased the risk for noninvasive ventilation in a COPD exacerbation.

CHEST 2018 Vitamin C Treatment May Be Beneficial for Sepsis, But Duration and Dose Unclear

Vitamin C Treatment May Be Beneficial for Sepsis, But Duration and Dose Unclear

Vitamin C was associated with lower mortality rates, shorter lengths of ICU stay, and shorter durations of vasopressor use in patients with sepsis.

Trial Tracker

Supraglottic airway resuscitation likely more or just as effective as endotracheal intubation for out-of-hospital cardiac arrest

In a randomized controlled trial, supraglottic airway resuscitation was associated with marginally better neurological outcomes and 72-hour survival compared with endotracheal intubation in patients with out-of-hospital cardiac arrests.

Critical Care Recommendations Issued for Enhancing ICU Diagnostic Safety

Recommendations Issued for Enhancing ICU Diagnostic Safety

The recommendations include enhancing recognition of potential errors, increasing teamwork, and patient-centeredness.

Critical Care Six-Point Risk Factor Score Predicts Hypoxemia During Tracheal Intubation

Six-Point Risk Factor Score Predicts Hypoxemia During Tracheal Intubation

Oxygen saturation at induction and acute hypoxemic respiratory failure were the risk factors most strongly associated with lower oxygen saturation.

Critical Care Tracheal Intubation vs Supraglottic Airway Device in Out-of-Hospital Cardiac Arrest

Tracheal Intubation vs Supraglottic Airway Device in Out-of-Hospital Cardiac Arrest

The use of a supraglottic airway device compared with tracheal intubation did not result in a favorable functional outcome in patients with out-of-hospital cardiac arrest.

Critical Care Tidal Breathing Fails to Identify Premature Infants at Risk for Respiratory Disease

Tidal Breathing Fails to Identify Premature Infants at Risk for Respiratory Disease

Although preterm infants had abnormal tidal breathing measurements, significant differences were not found to be associated with postdischarge respiratory disease.

Influenza Influenza an Independent Risk Factor for Invasive Pulmonary Aspergillosis

Influenza an Independent Risk Factor for Invasive Pulmonary Aspergillosis

Influenza proved to be an independent risk factor for invasive pulmonary aspergillosis.

Pneumonia CURB-65 Tool in Community-Acquired Pneumonia Useful But Has Limitations

CURB-65 Tool in Community-Acquired Pneumonia Useful But Has Limitations

The clinical prediction tool that uses confusion, uremia, elevated respiratory rate, and hypotension in community-acquired pneumonia demonstrated an association with ICU admittance.

Critical Care AMA Code of Medical Ethics: Guidelines for End-of-Life Care

AMA Code of Medical Ethics: Guidelines for End-of-Life Care

Compassion and communication for both patients and families are among the most important factors involved in providing end-of-life care.

Critical Care Daily Drainage in Malignant Pleural Effusion Could Improve Quality of Life

Daily Drainage in Malignant Pleural Effusion Could Improve Quality of Life

Spontaneous pleurodesis was achieved more frequently in the daily drainage group than in the symptom-guided drainage group.

Critical Care Completing Sepsis Bundle Within an Hour Cuts Pediatric Mortality

Completing Sepsis Bundle Within an Hour Cuts Pediatric Mortality

However, completing individual bundle elements in that timeframe does not reduce pediatric mortality.

Trial Tracker

Lower and higher oxygen saturation targets result in equal but contrasting outcomes for extremely preterm infants

In this meta-analysis, there was no significant difference between lower and higher oxygen saturation targets on a primary composite of mortality or major disability at a corrected age of 18-24 months for infants born extremely preterm.

Critical Care Thiamine Improves Lactate Clearance in Septic Shock

Thiamine Improves Lactate Clearance in Septic Shock

Lactate clearance improved in patients who presented with septic shock who were given thiamine within 24 hours of hospital admission.

Critical Care Indwelling Pleural Catheters an Option for Hepatic Hydrothorax Treatment

Indwelling Pleural Catheters an Option for Hepatic Hydrothorax Treatment

Indwelling pleural catheters can be used safely but with caution as a bridge to transplant or as palliative care.

Critical Care Extubation May Be Safe While on Vasoactive Infusions

Extubation May Be Safe While on Vasoactive Infusions

Overall outcomes of hospital mortality, unit mortality, and reintubation were similar between patients who were still on vasoactive infusions and those who were not.

Critical Care Reducing Computers in Surgical ICU May Cut Communication Barriers

Reducing Computers in Surgical ICU May Cut Communication Barriers

Reducing the number of computers in surgical intensive care units reduced barriers to communication.

Pulmonary Hypertension Prognostic Model for Mortality in Pediatric Pulmonary Hypertension

Prognostic Model for Mortality in Pediatric Pulmonary Hypertension

The Pediatric Index Pulmonary Hypertension Intensive Care Mortality model was compared with the Pediatric Risk of Mortality 2 and 3 models to determine the best model for predicting mortality.

Critical Care ICU Telemedicine Decreased Transfers to Other Acute Care Facilities

ICU Telemedicine Decreased Transfers to Other Acute Care Facilities

ICU telemedicine was associated with a reduction in interhospital transfers in patients with respiratory and gastrointestinal diagnoses.

Critical Care Initial Outcomes No Worse for Surgical ICU Patients With Cancer

Initial Outcomes No Worse for Surgical ICU Patients With Cancer

ICU and hospital mortality were lower for patients with cancer vs those without cancer.

Restrictive Lung Disease Venoarterial ECMO Improves Survival to Transplant in Interstitial Lung Disease

Venoarterial ECMO Improves Survival to Transplant in Interstitial Lung Disease

In patients with end-stage interstitial lung disease, there was a higher rate of survival to transplantation with venoarterial extracorporeal membrane oxygenation.

Critical Care Case Volume Affects Mortality for Immunosuppressed With Sepsis

Case Volume Affects Mortality for Immunosuppressed With Sepsis

Risk for death from sepsis was higher at hospitals with the lowest volume of immunosuppressed patients with sepsis.

Critical Care Delaying Lactate Draws in Sepsis Increases In-Hospital Death Risk

Delaying Lactate Draws in Sepsis Increases In-Hospital Death Risk

Systematic early lactate measurements speed antibiotic administration and improve outcomes in patients with sepsis.

Critical Care Early Flow Cytometry Predictive of Clinical Deterioration in Sepsis

Early Flow Cytometry Predictive of Clinical Deterioration in Sepsis

Increased circulating immature granulocytes at the acute phase of sepsis are linked to clinical worsening, especially when associated with T-cell lymphopenia.

Critical Care 60-Day Mortality Not Significantly Lower With ECMO in ARDS

60-Day Mortality Not Significantly Lower With ECMO in ARDS

In patients with very severe acute respiratory distress syndrome, 60-day mortality was not significantly lower with venovenous extracorporeal membrane oxygenation than with conventional treatment.

Critical Care Mortality Increased With Liberal Oxygen Therapy in Acutely Ill Patients

Mortality Increased With Liberal Oxygen Therapy in Acutely Ill Patients

Liberal supplemental oxygen therapy in acutely ill patients increased mortality during hospitalization, at 30 days, and at longest follow-up.

Critical Care High-Flow Nasal Cannula vs Conventional Oxygen Therapy for Acute Respiratory Failure

High-Flow Nasal Cannula vs Conventional Oxygen Therapy for Acute Respiratory Failure

In patients with acute respiratory failure, high-flow nasal cannula and conventional oxygen therapy provided similar benefits.

Critical Care Use of Predicted vs Measured Body Weight for Targeting Tidal Volumes in Children

Use of Predicted vs Measured Body Weight for Targeting Tidal Volumes in Children

It may be more lung protective to use the lower of either measured or predicted body weight when targeting tidal volume for mechanically ventilated children.

Critical Care Does Propofol Prevent Prolonged Desaturation During Neonatal Intubation?

Does Propofol Prevent Prolonged Desaturation During Neonatal Intubation?

A randomized clinical trial evaluated whether premedication with propofol reduced the frequency of prolonged desaturation during neonatal nasotracheal intubation compared with the combination of a rapid-onset short-acting opioid and a muscle relaxant.

Critical Care Molecular Laboratory Test Can Discriminate Sepsis From Noninfectious SIRS

Molecular Laboratory Test Can Discriminate Sepsis From Noninfectious SIRS

The SeptiCyteTM LAB may be an effective complementary diagnostic tool to clinical assessment of critically ill adult patients in discriminating between sepsis and noninfectious systemic inflammation syndrome.

Critical Care Talc Via Pleural Catheter vs Indwelling Pleural Catheter Alone for Pleurodesis

Talc Via Pleural Catheter vs Indwelling Pleural Catheter Alone for Pleurodesis

An indwelling pleural catheter and administration of talc may have a higher odds of achieving pleurodesis compared with an indwelling pleural catheter alone in individuals with malignant pleural effusions.

Critical Care Palliative Care Consult Can Cut Hospital Costs in Seriously Ill

Palliative Care Consult Can Cut Hospital Costs in Seriously Ill

Palliative care consultation was linked to a reduction in hospital costs for hospitalized adults with serious illness, such as COPD.

COPD Survival Predictors When Life Support Is Withheld in ICU

Survival Predictors When Life Support Is Withheld in ICU

Survival at 6 months was significantly associated with acute respiratory failure and history of COPD.

Trial Tracker

Balanced crystalloids decreases adverse kidney events compared to saline among critically ill patients: The SMART trial

Use of balanced crystalloids (lactated Ringers or Plasma-Lyte A) was associated with a significant reduction in acute kidney injury events compared with normal saline among intensive care unit (ICU) patients. Use of balanced crystalloids was also associated with lower though nonsignificant in-hospital mortality at 30-days after admission.

Critical Care Insulin-Treated Diabetes Reduces Dysglycemia-Related Mortality in Sepsis

Insulin-Treated Diabetes Reduces Dysglycemia-Related Mortality in Sepsis

In patients with insulin-treated diabetes and sepsis, increased highest glucose levels and glycemic variability have a significant illness severity-adjusted association with decreasing in-hospital mortality.

Pneumonia Mortality in Mechanically Ventilated Community-Acquired Pneumonia With or Without ARDS

Mortality in Mechanically Ventilated Community-Acquired Pneumonia With or Without ARDS

The risk for death in patients with community-acquired pneumonia who were given mechanical ventilation does not seem to be affected by the presence of acute respiratory distress syndrome.

Critical Care Specific Delirium Phenotypes May Predict Long-Term Cognitive Impairment

Specific Delirium Phenotypes May Predict Long-Term Cognitive Impairment

Sedative-associated, hypoxic, and septic delirium were predictive of long-term cognitive impairment in patients with a critical illness related to acute respiratory failure, shock, or both.

Critical Care Delirium in ICU Prevented With Nocturnal Administration of Dexmedetomidine

Delirium in ICU Prevented With Nocturnal Administration of Dexmedetomidine

A higher percentage of critically ill patients in the intensive care unit who were given nocturnal dexmedetomidine remained delirium free compared with placebo.

Critical Care High-Flow vs Standard Oxygen Therapy in Infants With Bronchiolitis

High-Flow vs Standard Oxygen Therapy in Infants With Bronchiolitis

High-flow oxygen therapy may be more effective in preventing care escalation in infants with bronchiolitis compared with standard oxygen therapy.

Trial Tracker

Prophylactic haloperidol not linked to improved survival in ICU patients: The REDUCE trial

Prophylactic haloperidol did not reduce delirium incidence, delirium-free days, duration of mechanical ventilation, or hospital length of stay in patients in the intensive care unit.

Trial Tracker

Adjunctive glucocorticoid therapy does not lower mortality in septic shock

Patients with septic shock in the intensive care unit undergoing mechanical ventilation and managed with adjunctive continuous hydrocortisone infusion did not have a lower 90-day mortality compared with placebo.

Critical Care Routine Chest Radiography After US-Guided CVC Insertion Often Unnecessary

Routine Chest Radiography After US-Guided CVC Insertion Often Unnecessary

A routine chest radiograph after ultrasound-guided central venous catheter insertion is now considered costly and unnecessary.

Critical Care Ventilator-Free Days in ICU With On-Demand vs Routine Nebulization

Ventilator-Free Days in ICU With On-Demand vs Routine Nebulization

On-demand nebulization of acetylcysteine with salbutamol did not result in an inferior number of ventilator-free days compared with routine nebulization.

Critical Care Revisit to ED May Indicate Poor Outcomes in Elderly Patients

Revisit to ED May Indicate Poor Outcomes in Elderly Patients

A revisit to the emergency department within 30 days of a previous visit predicted poor outcomes in elderly adults.

Critical Care Airway Management Methods During ACLS: Jury Still Out

Airway Management Methods During ACLS: Jury Still Out

A study sought to determine whether bag-mask ventilation was noninferior to endotracheal intubation as initial airway management during advanced cardiac life support during out-of-hospital cardiac arrest.

Critical Care Effect of Haloperidol in Critically Ill Patients at Risk for Delirium

Effect of Haloperidol in Critically Ill Patients at Risk for Delirium

Prophylactic haloperidol does not improve survival at 28 days compared with placebo in critically ill adults

Critical Care Effects of Lowering PEEP Below Recommended Values in Pediatric ARDS

Effects of Lowering PEEP Below Recommended Values in Pediatric ARDS

An overall higher mortality rate was associated with pediatric acute respiratory distress syndrome ARDS management with PEEP levels lower than those recommended by the ARDS Network PEEP/FiO2 protocol.

Treatments Neonates With Respiratory Distress Syndrome: Does Inhaled Nitric Oxide Reduce Mortality?

Neonates With Respiratory Distress Syndrome: Does Inhaled Nitric Oxide Reduce Mortality?

Off-label use of inhaled nitric oxide is not associated with reduced mortality in neonates born at 22 to 29 weeks'gestation with RDS.

COPD Palliative Care for COPD: Physicians' Views and Treatment Patterns

Palliative Care for COPD: Physicians' Views and Treatment Patterns

Researchers conducted an anonymous survey of medical trainees with a case vignette to determine attitudes regarding palliative care for chronic obstructive pulmonary disease.

Pneumonia Invasive Mechanical Ventilation in Severe CAP Increased Mortality Risk

Invasive Mechanical Ventilation in Severe CAP Increased Mortality Risk

Invasive mechanical ventilation in patients with severe community-acquired pneumonia appeared to increase their mortality risk.

Treatments Enteral vs Parenteral Nutrition in Critical Care Requiring Mechanical Ventilation

Enteral vs Parenteral Nutrition in Critical Care Requiring Mechanical Ventilation

Enteral nutritional support was not clinically superior to parenteral nutritional support in critically ill patients receiving mechanical ventilation.

Treatments Examining Compression-to-Ventilation Ratios for Optimal Neurologic, Survival Outcomes

Examining Compression-to-Ventilation Ratios for Optimal Neurologic, Survival Outcomes

Adults with cardiac arrest have better outcomes with continuous compressions with asynchronous ventilations or compression-to-ventilation ratios of 30:2.

Treatments Lung Recruitment Maneuver With Titrated PEEP Increases Mortality in Moderate to Severe ARDS

Lung Recruitment Maneuver With Titrated PEEP Increases Mortality in Moderate to Severe ARDS

A randomized trial sought to determine whether the use of titrated positive end-expiratory pressure influenced the 28-day mortality risk in patients with acute respiratory distress syndrome.

Critical Care Updated Guidelines for Noninvasive Ventilation in Acute Respiratory Failure

Updated Guidelines for Noninvasive Ventilation in Acute Respiratory Failure

The European Respiratory Society and American Thoracic Society have released updated guidelines on the use of noninvasive ventilation for acute respiratory failure.

Restrictive Lung Disease Low Tidal Volume Strategy in Acute Respiratory Distress Syndrome

Low Tidal Volume Strategy in Acute Respiratory Distress Syndrome

A low tidal volume ventilation strategy in patients with acute respiratory distress syndrome demonstrated a trend toward improved mortality.

Critical Care Medicine Extended VTE Pharmacologic Thromboprophylaxis Is Safe After Liver Surgery

Extended VTE Pharmacologic Thromboprophylaxis Is Safe After Liver Surgery

Extended pharmacologic thromboprophylaxis seems to be safe and effective for patients getting liver surgery.

Practice Management Transesophageal Echocardiography Training for Critical Care Fellows

Transesophageal Echocardiography Training for Critical Care Fellows

Transesophageal echocardiography can be used safely and effectively by critical care fellows to assess and manage cardiopulmonary failure when transthoracic echocardiography fails to provide adequate views.

Prevention Early Simvastatin Tx Does Not Decrease Delirium Duration in Criticall Ill Patients

Early Simvastatin Tx Does Not Decrease Delirium Duration in Criticall Ill Patients

Incidence of delirium and coma were not prevented with early initiation of simvastatin in patients on mechanical ventilation.

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