Critical Care
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Ethics Consults Focus on the Criteria Used to Determine Death
Some families simply need more time to process strong emotional reactions and grief. Establishing trust can help resolve these cases. Particularly in critical care, it is important from the moment that clinicians meet a family to start to build a good therapeutic relationship with them.
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Intravenous vs. Nebulized Tranexamic Acid and Hemoptysis: Which Strategy Is Better?
A pragmatic, open-label, randomized, parallel, single-center pilot trial investigating nebulized vs. intravenous tranexamic acid in patients with non-massive hemoptysis showed that nebulized tranexamic acid may be more effective in reducing the amount of hemoptysis and the need for interventional procedures.
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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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Physicians Suggest Small But Important Update to Standards for Determining Death
The Uniform Law Commission is debating possible revisions to the Uniform Determination of Death Act.
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CDC Publishes Guide to Help Hospitals Diagnose, Treat Sepsis
The agency details seven pillars upon which leaders can build a successful program.
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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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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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Simple Aspiration for First-Episode Primary and Complete Pneumothorax
The investigators found a higher rate of failure with simple aspiration as a first-line intervention for primary spontaneous pneumothorax compared to chest tube drainage, but it was better tolerated with fewer adverse events.
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Benefits of Prophylactic Platelet Transfusion Before Central Venous Line Placement May Outweigh Risks in Patients with Severe Thrombocytopenia
In this multicenter, randomized, controlled, noninferiority trial of patients with severe thrombocytopenia, prophylactic platelet transfusion prior to central venous catheter (CVC) placement resulted in less CVC-related bleeding.