Critical Care General
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Can EEG and fMRI Help Predict Who Will Recover Consciousness After Brain Injury?
In conjunction with serial clinical examinations, electroencephalogram and functional magnetic resonance imaging may be helpful in predicting who will recover consciousness after an acute brain injury. However, in this study, early withdrawal of care leaves much uncertainty regarding the probability of eventual recovery.
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Diltiazem Found to Be Better than Metoprolol in Heart Rate Reduction for Atrial Fibrillation in Heart Failure
In patients with atrial fibrillation and heart failure, intravenous diltiazem results in greater heart rate reduction than metoprolol with a similar safety profile, but further research is needed in this patient population.
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Short-Term Use of Haloperidol Did Not Decrease Risk of Mortality in ICU Patients with Delirium
The use of scheduled intravenous haloperidol in intensive care unit patients with delirium did not result in additional days alive and out of the hospital at 90 days as compared to placebo.
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Antibacterial Therapy in the Critically Ill
Appropriate antibiotic therapy in the critically ill requires consideration of important patient-specific factors, such as antibiotic therapy in the preceding 30 days; culture and sensitivity data, if available, within the prior six months; and local resistance patterns.
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Family Members of Critically Ill Patients with SARS-CoV-2 Pneumonia Have a High Burden of Symptoms of PTSD
This multicenter cohort study found a high incidence of post-traumatic stress disorder symptoms among family members of COVID-19 patients at three months after the index intensive care unit admission.
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Appropriate Oxygenation Targets in the Treatment of Hypoxemic Respiratory Failure
The care of critically ill patients in the ICU remains challenging. Recent studies support current protocols for the delivery of oxygen to patients who require supplemental oxygen due to respiratory failure of varying etiologies. Broad oxygenation targets of SpO2 between 88% to 97% continue to be supported by recent trials.
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Family Members of Critically Ill Patients with SARS-CoV-2 Pneumonia Have a High Burden of Symptoms of PTSD
This multicenter cohort study revealed a high incidence of PTSD symptoms among family members of COVID-19 patients at three months after the ICU admission.
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Limitation of Tidal Volume Is Cardioprotective Among Mechanically Ventilated Patients Undergoing Cardiac Surgery
In this experimental study, rising tidal volume increased right ventricular afterload.
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New Requirements Are Discouraging Physicians from Writing DNR Orders
Ethicists should help develop related protocols. For practitioners, code status conversations should be treated with the seriousness of surgery. That means involving the right people and taking the time to ensure medical understanding and prognosis, as well as patient values and goals, before talking about a care plan. When possible, practitioners should bring up DNR at the end of a meaningful conversation.
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Court-Appointed Guardians for Unrepresented Patients
Ethicists are seeing a range of issues arise during consults involving unrepresented patients, including conflicts over how aggressive treatment should be, whether to treat at all, how to discharge, and how to follow up with compliance with treatment. Creating a template for actions to take related to unrepresented persons who present to the hospital is a proactive first step.