Critical Care Alert
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Antipsychotics Do Not Shorten the Duration of ICU Delirium
These results support minimizing the use of haloperidol and ziprasidone in delirious patients who are not agitated. Current best practice is to adhere to the ABCDE bundle, remove causative agents when possible, and continue antipsychotics (only if they appear effective and for the minimum time necessary). The jury is still out regarding how to manage agitated delirium.
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Finding a Consensus on ARDS Diagnostics and Determining a Relationship to Hospital Mortality
Critical care physicians reviewed more than 700 mechanically ventilated patients with acute hypoxemia and reached a consensus on the presence of acute respiratory distress syndrome (ARDS) in 15% of patients and nonconsensus on the presence of ARDS in an additional 14% of cases. Hospital mortality was not different between these cohorts (37% and 35%, respectively).
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Preventive Tactics and Management of Acute Kidney Injury in the ICU
Acute kidney injury (AKI) is a sudden decline in renal function due to nephron dysfunction and/or damage that results in nitrogenous waste product accumulation and acid-base, electrolyte, and fluid disturbances. It is estimated to occur in 16-67% of critically ill patients admitted to the ICU. Common inciting causes include major surgery, iatrogenic interventions, and sepsis. Advanced age and comorbidities increase kidney susceptibility to various exposures and insults. Severe AKI requiring renal replacement therapy (RRT) is associated with a 10-fold increase in mortality and increases length of stay an average of 5.7 days. Preventive tactics and RRT remain the cornerstones of AKI management in critically ill patients.
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Limited English Proficiency Associated With Significant Differences in End-of-life Care
In a retrospective cohort study, patients with limited English proficiency had lower rates of do not resuscitate orders, comfort measures orders, and advanced directives; higher rates of receiving certain types of life support; and longer hospital stays compared to their English-speaking counterparts.
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Can We Prevent Delirium in the ICU?
Low-dose nocturnal dexmedetomidine infusion was shown to prevent delirium in critically ill patients.
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Massive Hemorrhage and Transfusion Protocols in Trauma and Nontrauma Patients
Massive hemorrhage with hemodynamic instability or shock may arise from multiple causes and is a medical emergency requiring intensive care. Hemorrhagic shock typically develops with the loss of 30-40% of blood volume. Thankfully, its incidence is likely low. Treatment is focused on resuscitative efforts to restore blood volume and stop bleeding. Time is required to locate and secure the sources of blood loss. It is in this setting that resuscitation to maintain oxygen concentration, cardiac output, and circulating blood volume is necessary for survival. Massive transfusion protocols have been developed to provide rapid access to and administration of blood products in these situations.
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Metabolic Acidosis in the ICU
Sodium bicarbonate therapy for severe metabolic acidemia did not affect a primary composite outcome of all-cause mortality at 28 days and at least one organ failure at day 7. However, in an a priori-defined stratum of patients with acute kidney injury, sodium bicarbonate therapy decreased 28-day mortality and the primary outcome.
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Severe Sepsis and Septic Shock Early Management Bundle
When the Severe Sepsis and Septic Shock Early Management Bundle was used to identify patients with severe sepsis or patients in septic shock, delays in lactate measurements for patients with abnormal lactate levels were associated with delayed initiation of antibiotic therapy and increased mortality.
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Should We Use Early Physical Therapy for Respiratory Muscles?
Mechanically ventilated patients undergoing inspiratory muscle training demonstrated significant increases in both maximum inspiratory and expiratory muscle pressures; the training was associated with reduced weaning duration of 2.3 days.
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A Novel Prediction Tool for Hypoxemia During ICU Intubation
The authors of this retrospective analysis of data from two prospective randomized trials of tracheal intubation created a new risk score calculator to identify patients who may develop severe hypoxemia during this procedure.