Critical Care Alert
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Using Ketamine in the Critically Ill: A Clinical Review
This is a guideline for ketamine use in the appropriate clinical setting from the practicing intensivist’s perspective.
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Rethinking the Prophylactic Use of Proton Pump Inhibitors in the ICU
The authors of this multicenter, blinded, randomized trial found that among critically ill adults at risk for gastrointestinal (GI) bleeding, fewer patients in the pantoprazole group exhibited clinically important GI bleeding compared to placebo, although mortality at 90 days was similar in both groups.
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Late Awakening Among Cardiac Arrest Survivors Predicts Worse Short- and Long-Term Outcomes
In this retrospective single-center study, late awakening after cardiac arrest was associated with a higher rate of unfavorable outcomes immediately after awakening and at three months.
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Mechanical Circulatory Support for Cardiogenic Shock
Exploring what options exist for temporary percutaneous mechanical support for cardiogenic shock associated with acute myocardial infarction?
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Early Extubation to Noninvasive Ventilation Does Not Reduce Time to Liberation From All Mechanical Ventilation
In this multicenter, randomized, open-label trial of patients who failed a spontaneous breathing trial, those who were extubated to noninvasive ventilation did not have a shorter time to liberation from any form of mechanical ventilation compared to those who were randomized to protocolized standard weaning.
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Thiamine for Septic Shock: Is There a Benefit?
Based on a retrospective review, septic shock patients who were administered thiamine within 24 hours of admission showed improved lactate clearance and reduced 28-day mortality.
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Liberal Oxygen Therapy in the ICU: Time to Change Practice?
Over the last decade, more clinical studies have shown adverse effects of hyperoxia in different patient populations and its association with increased mortality. In a meta-analysis, investigators synthesized data from 25 randomized, controlled trials comparing a liberal oxygen approach to a conservative approach. They included thousands of patients with sepsis, critical illness, stroke, trauma, myocardial infarction, cardiac arrest, and emergency surgery. The authors found that liberal oxygen therapy was associated with increased in-hospital mortality, 30-day mortality, and mortality at longest follow-up. Read on to learn more details about specific subgroups relevant to ICU practice and to see a review of the current data on oxygen therapy in these patients.
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Early Rehospitalization Among ICU Survivors: How Can We Do Better?
Based on inductive analysis of a large sample of patients and caregivers, this study provides an organizational framework on which to focus efforts to develop complex healthcare interventions aimed at reducing readmission after critical illness.
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Diagnosis Sepsis: Is Newer Better?
Sepsis-3 criteria may be the favored method for prognostication, whereas SIRS-based criteria may be the preferred method to screen patients for consideration of ICU admission. Future studies are necessary to continue to explore the benefits of qSOFA and potentially reveal a more precise and reliable screening tool. Most importantly, it is paramount to remember that neither set of criteria is diagnostic. Using clinical judgment along with these guides remains the ideal approach.
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A Combination of Commonly Measured Clinical Variables May Predict Prolonged Mechanical Ventilation
The results of this study validate a clinical tool using common ICU variables for predicting prolonged mechanical ventilation. However, one must consider both the implications and strength of any predictive model for clinical decision-making.