Critical Care Topics
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Midline Catheters May Be a Safe Alternative to PICCS for Vasopressor Infusion
In this study evaluating safety outcomes of infusing vasopressors through a midline catheter, there was no increase in catheter-related complications when comparing administration of vasopressors through a midline to administration through a peripherally inserted central catheter (PICC) or when compared to midline use with vasopressor infusion via a different catheter. There was an overall greater risk of systemic thromboembolism when midlines were used for vasopressor administration vs. PICCs or midlines with vasopressors administered through a different catheter.
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Re-Evaluation of Dosing for Venous Thromboembolism Prophylaxis
Prevention of venous thromboembolism (VTE) is important for all hospitalized patients to prevent additional morbidity and costs during hospitalization. Critically ill patients in the intensive care unit (ICU) may have additional risk factors that predispose them to VTE.
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Ethicists Often Called to Resolve Conflicts Over Aggressive Care
Quality, compassionate communication with families is critical to prevent further escalation of conflict and to preserve trust in the therapeutic relationship.
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High-Intensity End-of-Life Care Remains the Default at Hospitals
Ethicists can help by assisting in developing hospital policies and crafting ethics committees in a way that does not pose unnecessary bureaucratic challenges or prevent physicians from acting in the patient’s best interest.
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Ethical Guidance for Research on Dying or Recently Deceased ICU Patients
There are no authoritative international ethical guidelines governing research on dying or recently deceased individuals. A group of investigators sought to start a conversation about challenges and potential solutions. They developed a preliminary framework for the ethical conduct of research with imminently dying patients.
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ICU Staff Report Severe Moral Distress, But Resources Are Underused
Unresolved ethical concerns not only cause individual moral distress, but can also change the staff relationships and clinical cohesiveness.
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Ethicists Hold Debriefings After Critical Patient Events
In the emotionally charged, fast-paced ICU, clinicians are faced with death and dying daily. Engaging in open, honest communication about these situations will help build a moral and ethical community.
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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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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.