Critical Care Alert
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Right Heart Failure in the ICU
Right ventricular (RV) failure continues to be a formidable clinical challenge in critical care medicine. Regardless of the etiology, pulmonary hypertension and RV failure carries a poor prognosis. Prompt identification and treatment is warranted. Unfortunately, there is considerable lack of evidence in the management of RV failure in the medical ICU. Most recommendations are based on expert opinion or low-quality evidence.
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In-hospital vs. Telephone Availability of an Intensivist at Night
When overnight shifts were staffed by nighttime intensivists rather than residents with attending intensivists on call remotely, most nurses perceived improvements in clinical care, procedures, efficiency, communication, and job place comfort.
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Is There Still a Role for High-frequency Oscillatory Ventilation in ARDS?
In this patient-level meta-analysis of four well-known randomized, controlled trials of high-frequency oscillatory ventilation (HFOV) in acute respiratory distress syndrome (ARDS), the authors found that HFOV increases mortality for most patients with ARDS but may improve survival among patients specifically with severe ARDS.
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Hyponatremia in the Critically Ill
Hyponatremia is the most common electrolyte disorder encountered in hospitalized patients (30-40%) and is present in 17.7% of patients admitted to the ICU. A recent registry demonstrated significant practice variation regarding this common disorder, underlining the frequent diagnostic and therapeutic challenges clinicians face in this area.
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Angiotensin II Raises Blood Pressure in Patients with Vasodilatory Shock
Infusion of recombinant angiotensin II improved blood pressure control in patients with vasodilatory shock already receiving conventional vasopressors.
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Spontaneous Breathing Trials and Occam’s Razor
Different ventilator modes used for a spontaneous breathing trial affected a patient’s work of breathing (WOB) variously and differed regarding WOB measured after extubation. The clinical relevance of these differences is uncertain.
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Intensive Care Enteral Nutrition in 2017
Enteral nutrition, defined as any method of feeding that uses the gastrointestinal (GI) tract (including oral feeding), usually refers to the delivery of nourishment to the GI tract through a tube. Nutrition is of utmost importance for patients suffering from a critical illness, and EN is a mainstay of nutrition in the ICU. Malnutrition and nutritional risk are common in patients admitted to the ICU. The presence of critical illness causes the body to enter a catabolic state, putting patients at risk of development or worsening of malnutrition. The Society of Critical Care Medicine and the American Society for Parenteral and Enteral Nutrition have published and revised joint guidelines to offer evidence-based recommendations for how best to feed critically ill patients.
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Failure to Wean From the Ventilator: Is Pleural Effusion the Culprit?
The authors of a multicenter, prospective cohort study did not find an association between the presence of moderate or large pleural effusion and ventilator weaning failure.
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Functional Outcomes After Receiving Life-sustaining Therapy in the ICU
Among patients who have spent at least three days in an ICU and required even brief mechanical ventilation and/or vasopressor support, almost half are dead and only one-third return to their baseline at six months. Several factors present on the first day of admission are associated with not returning to baseline status.
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Thrombocytopenia in the Critically Ill
Thrombocytopenia is not only a pathologic entity, but the severity of thrombocytopenia and the recovery time of the platelets often predicts outcome, including overall mortality of ICU patients. Critically ill patients with moderate and severe thrombocytopenia demonstrate higher ICU and hospital mortality. If the recovery is delayed beyond day four, several studies have demonstrated higher morbidity and mortality.