Critical Care Alert
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Efficacy of Preoxygenation Methods Prior to Endotracheal Intubation
A post-hoc analysis of data from the MACMAN trial revealed noninvasive ventilation may be the preferred preoxygenation approach for intubation, especially in the setting of severe hypoxemia.
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Medication Errors When Patients Transition Out of ICU
Three factors associated with decreased odds of an error occurring were daily patient care rounds in the ICU, discontinuing and rewriting medication orders during the transition of care from the ICU to a non-ICU setting, and 16-20 ICU beds in the transferring ICU.
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Timing of Initiation of Renal Replacement Therapy in the ICU
Acute kidney injury is common in patients admitted to the ICU and is associated with high mortality. The decision to initiate renal replacement therapy (RRT) for these patients is complicated. Not only is the optimal time for starting therapy unclear, decisions to transfer patients to higher levels of care often are driven by the perceived need to initiate hemodialysis or continuous RRT.
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Physicians Cannot Agree on Who Benefits From ICU Care
The authors of a study randomizing U.S. critical care physicians to analyze hypothetical patient vignettes found that estimates of whether a patient would benefit from ICU care were widely dissimilar among those surveyed and influenced by factors unrelated to severity of illness.
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Maintaining Oxygenation Without Increasing Aspiration Risk During Induction
In this multicenter, randomized, unblinded trial, bag-mask ventilation from time of induction to laryngoscopy was associated with higher oxygen saturations and lower incidence of severe hypoxemia compared to those not “bagged.”
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Management Guidelines for Acute Pancreatitis
There are more than 275,000 hospitalizations for acute pancreatitis per year, with more than $2.6 billion spent on care worldwide. Many of these cases require ICU admission. Mortality rates vary between 2% and 17% depending on illness severity. Despite this burden of illness, questions remain regarding the most basic elements of care.
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Saline vs. Balanced Crystalloids in Critically Ill Adults
Balanced crystalloids appear to reduce in-hospital mortality in critically ill patients with sepsis or without traumatic brain injury and may reduce in-hospital mortality in the entire cohort of critically ill patients.
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Presepsis Pathways: Can We Predict Mortality After Sepsis Hospitalization?
Using a latent profile analysis in observational cohort studies of patients hospitalized for sepsis, investigators identified subtypes of patients based on inpatient healthcare facility use in the year prior to sepsis hospitalization and correlated to 90-day mortality.
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Ventilator-Associated Pneumonia and Hospital-Acquired Pneumonia: Prevention and Treatment
Ventilator-assisted pneumonia and hospital-acquired pneumonia pose significant risks to hospitalized patients and increase the cost of care. It is essential to institute measures to reduce the risk of these pneumonias and to recognize and treat them early when they occur. Treatment is a balance of ensuring adequate antimicrobial coverage in those who already are seriously ill while not unduly exposing them to the risks of medication side effects and higher rates of resistant organisms that come with the use of broad-spectrum antibiotics.
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Corticosteroid Administration in Sepsis May Be Associated With Lower 28-Day Mortality
In this systematic review and meta-analysis of randomized, controlled trials comparing administration of corticosteroids with placebo or standard supportive care in sepsis, corticosteroids were associated with reduced 28-day mortality.