Critical Care Alert
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Is There a Role for Immunomodulatory Therapy in COVID-19 Cytokine Storm?
In this retrospective analysis of COVID-19 patients hospitalized with cytokine storm, the use of corticosteroids combined with tocilizumab was associated with superior survival when compared to no immunomodulatory treatment; a combination of corticosteroids and anakinra; or corticosteroids, tocilizumab, or anakinra alone. Patients who received corticosteroids, either alone or in combination with anakinra, also experienced lower hospital mortality compared to no treatment. -
Driving Pressures More Strongly Predicted Survival than P/F Ratios in Patients with ARDS
Optimizing positive end-expiratory pressure to minimize driving pressure may be a better strategy for ventilator adjustment than maximizing partial pressure of arterial oxygen/fraction of inspired oxygen (P/F) ratios to improve outcomes in patients with acute respiratory distress syndrome. -
Elucidating the Long-Term Effects of COVID-19
In this prospective uncontrolled cohort study of COVID-19 survivors performed four months after their hospitalization, many patients reported at least one symptom not previously present, and abnormalities on lung computed tomography scan were common. -
High Pleural Pressure Prevents Overdistension in ARDS Patients with High Body Mass Index
High airway pressure is required to recruit lung atelectasis in patients with acute respiratory distress syndrome and body mass index ≥ 35 kg/m2. -
Use Push-Dose Phenylephrine with Caution in Septic Patients
Phenylephrine pushes in septic patients were associated with early hemodynamic stability, but higher intensive care unit mortality.
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The Effect of Antiviral Drugs on COVID-19 Outcomes and Mortality
The WHO Solidarity Trial Consortium found that remdesivir, hydroxychloroquine, lopinavir, and interferon regimens had “little or no effect” on relevant outcomes. -
Prone Positioning May Improve Outcomes for Patients on ECMO for Severe ARDS
In patients on venovenous extracorporeal membrane oxygenation for acute respiratory distress syndrome, prone positioning is safe and feasible. Prone positioning appears to improve survival but increases length of stay. -
Ethics in the ICU: Negotiating Requests for Inappropriate Treatments
When requests for potentially inappropriate treatments occur, the initial steps include increasing communication and improving mutual understanding to find a path that is appropriate while honoring the goals and concerns expressed by patients and their families. -
Rapid Intermittent Bolus of Hypertonic Saline May Be a Better Way to Correct Symptomatic Hyponatremia
In this randomized clinical trial, hypertonic saline given via rapid intermittent bolus therapy was as effective and safe as slow continuous infusion, and was associated with a lower rate of recorrecting treatment and higher efficacy in achieving goal sodium within one hour.
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Using Procalcitonin to Limit Antibiotic Treatment for Sepsis Reduces Infection-Related Adverse Events
By shortening the duration of antibiotic therapy, a procalcitonin-guided protocol decreased the rate of infection-associated adverse effects, decreased costs, and reduced mortality in patient with sepsis.