Critical Care Alert
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Implementing Restrictive Transfusion Strategies to Improve Patient Outcomes
There is extensive evidence supporting a restrictive transfusion approach in critically ill patients and cardiac surgery patients. The data favor restrictive strategies in hip and knee surgery, except in geriatric patients for whom evidence favors a more liberal transfusion strategy. Evidence is sparse in sepsis, oncology, and acute coronary syndrome patients, warranting further study.
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Restrictive Transfusion Threshold Non-inferior to Liberal Threshold in High-risk Cardiac Surgery
In patients at moderate to high risk of complications with cardiac surgery, a transfusion threshold of hemoglobin < 7.5 g/dL showed similar outcomes to a threshold of < 9.5 g/dL.
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Targeted Temperature Management: Determining Optimal Hypothermia Duration
In unconscious survivors of out-of-hospital cardiac arrest who are admitted to the ICU, targeted temperature management at 33°C for 48 hours failed to significantly improve neurologic outcomes at six months when compared to 24 hours.
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Atrial Fibrillation in Sepsis: Should We Worry?
New-onset atrial fibrillation (AF) is a common occurrence in the ICU. Over the past decade, there is increasing interest in its epidemiology, specifically in the population of critically ill patients with sepsis. Recent literature suggests that far from a transient complication of sepsis, new-onset AF is associated with worse short- and long-term outcomes. As such, exploring its potential causes and evaluating its overall management is warranted in hopes of discovering ways to prevent and treat AF with the goal of improving outcomes for patients with sepsis.
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Urine Output: The New Vital Sign?
An analysis of a large ICU database showed that hourly monitoring of urine output was associated with improved detection of acute kidney injury (AKI) and lower 30-day mortality in patients with AKI.
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More ICU Care Does Not Equal Better Survival for Elderly Patients
Using a systematic strategy for promoting ICU admission for elderly patients resulted in a higher ICU admission rate but the strategy produced no effect on six-month mortality.
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Implementing Noninvasive Ventilation: If You Build It, They Will Come
Hospitals that have been highly effective in implementing noninvasive ventilation as front-line therapy for acute exacerbation of chronic obstructive pulmonary disease recognized that a combination of allied health autonomy, interdisciplinary teamwork, and devoting sufficient resources are essential features for success.
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Crystalloid Resuscitation in Sepsis and Septic Shock: The Earlier, the Better
Although the most recent Surviving Sepsis Campaign guidelines authorized completion of 30 mL/kg of IV crystalloid within three hours of the recognition of sepsis and septic shock, there remains controversy regarding the benefits and harms of early, aggressive crystalloids, especially in specific patient populations.
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Oncologists and Intensivists Perceive Prognosis Differently for Critically Ill Patients With Cancer
When considering prognostication or limitation of care in critically ill patients with different cancers, oncologists may focus on cancer characteristics, whereas intensivists may focus on multiple organ failure.
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Deflating Recruitment Maneuvers
Compared to the ARDSNet lower positive end-expiratory pressure (PEEP)/low tidal volume strategy, use of an “open lung ventilation” strategy consisting of aggressive alveolar recruitment maneuvers and higher PEEP is associated with higher mortality in patients with moderate to severe acute respiratory distress syndrome.