Critical Care Alert
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Negative Fluid Balance on Day 3 Associated With Improved Outcomes in Critical Illness
In critically ill patients, a negative fluid balance on day 3 either spontaneously or with deresuscitative measures may be associated with lower mortality.
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ECMO vs. Optimal Protective Ventilation and Ancillary Therapies in Severe ARDS
Treatment of very severe acute respiratory distress syndrome with venovenous extracorporeal membrane oxygenation vs. lung-protective ventilation with aggressive ancillary therapy use demonstrated only a trend toward improved 60-day mortality.
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The Opioid Crisis in the ICU
A detailed exploration of the background of the opioid crisis and how it affects the ICU.
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Are In-hospital Deaths Related to Community-acquired Pneumonia Preventable?
This secondary analysis of data from five tertiary care centers found that among patients hospitalized for community-acquired pneumonia, very few deaths potentially were related to a lapse in in-hospital quality of pneumonia care.
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Neighborhood Socioeconomic Status Associated With Infection Risk, But Not Sepsis
Based on a large, national, prospective cohort study, lower neighborhood socioeconomic status was associated with a higher incidence of hospitalizations for infection (but not sepsis) at presentation.
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Post-intensive Care Syndrome: What Happens After the ICU?
The number of ICU patients admitted annually continues to grow, with most recent estimates reaching 5.7 million. As there are growing numbers of critically ill patients, sepsis survivorship also has grown as a substantial public health concern, with a significant number of survivors diagnosed with post-intensive care syndrome (PICS). It is important to go beyond saving lives in the ICU and devote additional time and attention to preventing and treating the psychiatric, cognitive, and physical sequalae of ICU illness in the follow-up setting.
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Sepsis-related Neurologic Dysfunction Strongly Associated With Long-term Mortality
In this multicenter, retrospective study, acute neurologic dysfunction was the organ dysfunction most strongly associated with short- and long-term mortality in patients surviving a sepsis hospitalization.
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Selection of Isotonic Crystalloid for Fluid Resuscitation: How Much Does It Matter?
Using balanced crystalloids rather than normal saline for intravenous fluid administration in critically ill adults leads to statistically significant lower rates of major adverse kidney events, including death from any cause, new renal replacement therapy, and persistent renal dysfunction, compared to normal saline in critically ill adults. Clinical judgment should be applied when selecting fluid.
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Re-evaluating Steroid Therapy in Septic Shock
Septic shock carries a significant risk of mortality despite increasing knowledge of its pathophysiology and clinical management. Studies dating back to the 1960s suggested steroid treatment may alter the course of septic shock and led to the concept of critical illness-related corticosteroid insufficiency. Two recent trials have provided more data regarding steroid therapy for septic shock. Comparing these seminal studies provides context for the decision about whether to treat septic shock with steroid therapy.
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An International Survey of Ventilator Weaning Practices
A cross-sectional, multinational survey of adult intensivists revealed significant regional variation in several weaning practices, including screening, weaning modes, techniques to conduct spontaneous breathing trials, the use of written directives, and use of non-invasive ventilation in the peri-extubation period.