Critical Care
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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.
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Post-COVID-19: The Crisis After the Crisis
Critical care physicians have the opportunity to optimize long-term function and quality of life for COVID-19 survivors. It is paramount to prevent, recognize, and treat post-COVID-19 symptoms.
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Some Code Status Discussions Are Rushed, Incomplete, or Misleading
Learning how to engage in code status conversations is as important as learning how to perform medical procedures. Clinicians would not ask patients in completely neutral terms whether they want a procedure that has no chance of working or would inflict serious harm. Any conversation around resuscitation status should take into account patients' goals and values, what is important to them in life, and the minimum acceptable quality of life.
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Policies Support Clinicians if Asked to Provide Inappropriate Care
When a family demands possibly inappropriate life-sustaining interventions, clinicians often turn to hospital policies for guidance. The authors of a recent study examined the effectiveness of Yale New Haven Hospital’s Conscientious Practice Policy. A theme emerged, focused on the inconsistent use of the policy. Whether it was used depended mostly on how resistant the family was to limiting interventions.
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Blunt Abdominal Trauma
Blunt abdominal trauma is commonly encountered in any acute care center. Prompt recognition, assessment, diagnostic evaluation, and disposition are critical aspects that must be a part of every clinician’s expertise.
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Defining Patient- and Family-Centered Care Outcomes in the ICU
Using semi-structured interviews with intensive care unit (ICU) survivors and their family members, investigators identified several ICU processes of care and outcomes after the ICU that were important to this population.
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COVID-19 ARDS Is Associated with Higher Compliance and Lung Gas Volume Compared to Non-COVID-19 ARDS
This retrospective analysis compared historical cohorts with COVID-19-related acute respiratory distress syndrome (ARDS) with respect to compliance and arterial partial pressure of oxygen/fraction of inspired oxygen (P/F) ratios. For comparable P/F ratios, patients with ARDS caused by COVID-19 had higher lung compliance and more lung gas volume.
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Noninvasive Ventilation in Adult Acute Care: Beyond Clinical Indications
Noninvasive ventilation (NIV) is a commonly used modality in adult acute care. This article examines aspects of NIV that might affect the modality’s success or failure.
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Pressure Support Compared to T-Piece Trial: What Is the Optimal Strategy?
Post-hoc analysis of a multicenter, randomized clinical trial among adults receiving at least 24 hours of mechanical ventilation who were ready for ventilator weaning revealed that the use of pressure support significantly increased the proportion of patients successfully extubated compared to T-piece.