Critical Care General
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Simple Aspiration for First-Episode Primary and Complete Pneumothorax
The investigators found a higher rate of failure with simple aspiration as a first-line intervention for primary spontaneous pneumothorax compared to chest tube drainage, but it was better tolerated with fewer adverse events.
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Benefits of Prophylactic Platelet Transfusion Before Central Venous Line Placement May Outweigh Risks in Patients with Severe Thrombocytopenia
In this multicenter, randomized, controlled, noninferiority trial of patients with severe thrombocytopenia, prophylactic platelet transfusion prior to central venous catheter (CVC) placement resulted in less CVC-related bleeding.
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Emerging Treatment for Refractory Vasodilatory Shock
Shock is a common cause for intensive care unit admission, necessitating rapid treatment of the underlying cause while supporting patients with fluids and vasopressor agents. Typical vasopressor agents include adrenergic agonists and vasopressin. When shock persists despite these interventions, this is labeled refractory shock.
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Patient Mortality Not Linked to Intensivist Caseloads
In this retrospective cohort study in the United States from 2018-2020, there was no significant association between intensivist-to-patient ratio and patient mortality and no effect modification by having physicians-in-training, nurse practitioners, and physician assistants present.
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Effectiveness of Aerosolized Bronchodilators in Patients Receiving High-Flow Nasal Cannula Oxygen Therapy
In a prospective, single-center study, bronchodilators delivered in line with a high-flow nasal cannula device improved forced expiratory volume in one second and forced vital capacity in patients with chronic obstructive pulmonary disease exacerbation.
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Older ICU Survivors Often Receive New and Persistent Prescriptions for Sedatives After Discharge
In this population-based cohort study of older intensive care unit survivors, one in 15 of them received a new prescription for a sedative within a week of discharge, and more than half had recurrent prescriptions.
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Videolaryngoscopy for Intubation of Critically Ill Patients
In a large, prospective, multicenter, randomized, pragmatic trial, the use of a video laryngoscope resulted in a higher incidence of successful intubation on the first attempt on critically ill patients in the emergency department and intensive care unit compared to the use of the direct laryngoscope.
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Direct Oral Anticoagulants vs. Warfarin When Treating Renal Dysfunction
A patient-level meta-analysis of five pivotal trials of direct oral anticoagulants (DOACs) vs. warfarin for patients with atrial fibrillation and creatinine clearance levels ranging from normal to 25 mL/min revealed standard-dose DOACs exhibit superior safety and efficacy compared to adjusted-dose warfarin and lower-dose DOACs.
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Patients with COVID-19 on ECMO Therapy Benefit from Early Guided Palliative Care Communication
Patients with severe COVID-19 acute respiratory distress syndrome that require extracorporeal membrane oxygenation support can benefit from implementing palliative care communication early in their treatment course.
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Cultural Sensitivity in End-of-Life Discussions in the Intensive Care Unit
When clinicians treat patients and communicate with families who come from cultures that are different from their own, cultural sensitivity can improve the experience for families.