Critical Care Alert
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Emergent Vascular Access: Is Intraosseous Better Than Central Venous Catheter Placement?
In this single-center, prospective, observational study, intraosseous access outperformed central venous catheter placement in terms of first-pass success rates, mean placement times, and complication rates.
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Is Peripheral Intravenous Administration of Vasopressors Really Safe?
The administration of vasoactive medications by peripheral intravenous access is safe and feasible in critically ill, hypotensive patients.
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What's in a Name: Should Protocols for Sepsis Treatment Be So Complete?
ABSTRACT & COMMENTARY: Early and aggressive goal-directed therapy treatment for sepsis leads to a decrease in mortality.
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When Do Ventilator Modes Matter?
Although pressure-controlled ventilation and volume-controlled ventilation approach mechanical breath delivery differently in terms of inspiratory flow and airway pressure characteristics, this comprehensive review found no significant differences in terms of their impact on breathing mechanics or gas exchange in patients with various forms of acute respiratory failure.
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Inferior Vena Cava Filters and Recurrent Pulmonary Embolism
Even in patients who seem most vulnerable to additional embolism, retrievable inferior vena cava filter placement plus anticoagulation did not improve outcomes vs. anticoagulation alone.
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Decreasing Cross-Transmission of Carbapenemase-Producing Enterobacteriaceae
The implementation of a bundled infection control intervention was able to significantly decrease cross-transmission of a multi-drug-resistant pathogen and decrease healthcare-associated infections in an long-term acute care hospitals population.
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Is Fresh Blood Better?
The Age of Blood Evaluation trial supports the notion that the relative expiration date of red blood cells is not important.
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See No Lights, Hear No Alarms: Sleeping in the ICU
ABSTRACT & COMMENTARY: Sleep quality in the ICU can improve. Here's how.
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Right Heart Protective Ventilation Strategies
ABSTRACT & COMMENTARY: Right ventricle performance is vulnerable to the effects of both pulmonary disease and positive pressure ventilation.
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Corticosteroids in Severe Community-Acquired Pneumonia: The Controversy Continues
Treatment failure in hospitalized patients with severe community-acquired pneumonia (CAP) is associated with an excessive inflammatory response and worse outcomes. Torres and colleagues sought to determine the effect of corticosteroids in patients with severe CAP and a significant inflammatory response. In this multicenter, randomized, double-blind, placebo-controlled trial, 120 severe CAP patients with C-reactive protein (CRP) levels >150 mg/L were randomized to receive either an IV methylprednisolone bolus of 0.5 mg/kg every 12 hours or placebo. Treatment began within 36 hours of hospital admission and lasted for 5 days. Severe CAP was defined as two out of the three minor criteria independently associated with severity including PaO2 /FiO2 < 250, multilobar involvement, and systolic blood pressure < 90 mmHg, or one out of two major criteria, including a requirement for mechanical ventilation or septic shock.1 Risk class V for the Pneumonia Severity Index was also considered severe CAP.2 The primary outcome was early or late treatment failure. Early treatment failure was defined as the development of shock, need for mechanical ventilation not present at baseline, or death within 72 hours of treatment. Late treatment failure was defined as radiographic progression, persistence of severe respiratory failure, development of shock, need for invasive mechanical ventilation not present at baseline, or death between 72 hours and 120 hours after treatment.