Critical Care Topics
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Do We Really Know the Optimal Oxygen Target in Patients with ARDS?
In the LOCO2 study, a conservative oxygen strategy with SpO2 goals of 88% to 92% was not shown to improve mortality over a liberal oxygen strategy as hypothesized, but rather was found to have a worrisome signal of increased mortality and increased mesenteric ischemia.
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Management of Pulmonary-Renal Syndrome
The role of the intensivist in the management of pulmonary-renal syndrome includes appropriate respiratory support and recognition and management of concurrent infection, hypovolemia, acute anemia, and coagulopathy.
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Targeting 100% or 70% of Enteral Calorie Requirements During Critical Illness Results in Equivalent Outcomes at Six Months
This was a multicenter, blinded, parallel-group, randomized trial of mechanically ventilated critically ill patients. Achieving 100% calorie requirements did not change outcomes at six months when compared to a more modest goal of 70% of predicted calorie requirements.
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Evaluation and Treatment of Severe Community-Acquired Pneumonia in the ICU
Community-acquired pneumonia is a common cause for hospital admission. This article serves to summarize new updates in the definition, prognosis, and treatment, specifically of bacterial, severe community-acquired pneumonia.
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Do Not Intubate Orders Becoming More Common
Rates increased over time, from about one in 10 patients 20 years ago to about one in three patients in the past five years. The exact reasons for this increase remain unclear.
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Dexamethasone for COVID-19 Inpatients Requiring Oxygen
Dexamethasone administration is associated with reduced 28-day mortality in oxygen-requiring COVID-19 patients, including those receiving mechanical ventilation.
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U.S. Obesity Rates on the Rise
News arrives on the heels of several recently published papers that indicate obesity can exacerbate COVID-19.
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Considerations and Concerns with Vitamin C in Sepsis and Septic Shock
Sepsis remains a major healthcare problem associated with significant morbidity and mortality. Roles for hydrocortisone, ascorbic acid (vitamin C), and thiamine (HAT therapy) as potential adjuvants remain controversial.
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ORANGES and ACTS Trials: No Mortality Benefit with Ascorbic Acid, Thiamine, and Hydrocortisone in Septic Shock Patients
Two double-blinded, placebo-controlled, randomized trials involving 337 patients (ORANGES, n = 137; ACTS, n = 200) with sepsis and septic shock have shown that administration of ascorbic acid, thiamine, and hydrocortisone did not reduce organ dysfunction or improve overall mortality. However, both trials showed that this combination therapy was effective in reducing the time to achieve shock resolution or shock-free days.
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A Combination of Both SIRS and SOFA Scores Enhances Recognition of Sepsis in the Emergency Department
Compared with either score alone, using both SIRS and SOFA scores led to earlier and more complete recognition of sepsis in patients presenting to the emergency department.