Critical Care
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Intimate Partner Violence
Domestic violence and abuse is a national and global healthcare problem with massive consequences, affecting men, women, and children. Awareness, recognition, and resource allocation, in addition to trauma management, is an important aspect of emergent care of the trauma patient possibly injured in a domestic violence incident.
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Early Extubation to Noninvasive Ventilation Does Not Reduce Time to Liberation From All Mechanical Ventilation
In this multicenter, randomized, open-label trial of patients who failed a spontaneous breathing trial, those who were extubated to noninvasive ventilation did not have a shorter time to liberation from any form of mechanical ventilation compared to those who were randomized to protocolized standard weaning.
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Thiamine for Septic Shock: Is There a Benefit?
Based on a retrospective review, septic shock patients who were administered thiamine within 24 hours of admission showed improved lactate clearance and reduced 28-day mortality.
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Liberal Oxygen Therapy in the ICU: Time to Change Practice?
Over the last decade, more clinical studies have shown adverse effects of hyperoxia in different patient populations and its association with increased mortality. In a meta-analysis, investigators synthesized data from 25 randomized, controlled trials comparing a liberal oxygen approach to a conservative approach. They included thousands of patients with sepsis, critical illness, stroke, trauma, myocardial infarction, cardiac arrest, and emergency surgery. The authors found that liberal oxygen therapy was associated with increased in-hospital mortality, 30-day mortality, and mortality at longest follow-up. Read on to learn more details about specific subgroups relevant to ICU practice and to see a review of the current data on oxygen therapy in these patients.
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Early Rehospitalization Among ICU Survivors: How Can We Do Better?
Based on inductive analysis of a large sample of patients and caregivers, this study provides an organizational framework on which to focus efforts to develop complex healthcare interventions aimed at reducing readmission after critical illness.
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Diagnosis Sepsis: Is Newer Better?
Sepsis-3 criteria may be the favored method for prognostication, whereas SIRS-based criteria may be the preferred method to screen patients for consideration of ICU admission. Future studies are necessary to continue to explore the benefits of qSOFA and potentially reveal a more precise and reliable screening tool. Most importantly, it is paramount to remember that neither set of criteria is diagnostic. Using clinical judgment along with these guides remains the ideal approach.
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A Combination of Commonly Measured Clinical Variables May Predict Prolonged Mechanical Ventilation
The results of this study validate a clinical tool using common ICU variables for predicting prolonged mechanical ventilation. However, one must consider both the implications and strength of any predictive model for clinical decision-making.
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Antipsychotics Do Not Shorten the Duration of ICU Delirium
These results support minimizing the use of haloperidol and ziprasidone in delirious patients who are not agitated. Current best practice is to adhere to the ABCDE bundle, remove causative agents when possible, and continue antipsychotics (only if they appear effective and for the minimum time necessary). The jury is still out regarding how to manage agitated delirium.
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Management of Burn Injuries
Burn injuries are complex injuries that the acute care physician must be prepared to assess and manage. In addition, an understanding of potential systemic effects from inhalation of toxic components in fires is critical to guide management. The authors provide a timely review of the critical aspects of assessment and management of burn patients.
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Finding a Consensus on ARDS Diagnostics and Determining a Relationship to Hospital Mortality
Critical care physicians reviewed more than 700 mechanically ventilated patients with acute hypoxemia and reached a consensus on the presence of acute respiratory distress syndrome (ARDS) in 15% of patients and nonconsensus on the presence of ARDS in an additional 14% of cases. Hospital mortality was not different between these cohorts (37% and 35%, respectively).