Critical Care
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Crystalloid Resuscitation in Sepsis and Septic Shock: The Earlier, the Better
Although the most recent Surviving Sepsis Campaign guidelines authorized completion of 30 mL/kg of IV crystalloid within three hours of the recognition of sepsis and septic shock, there remains controversy regarding the benefits and harms of early, aggressive crystalloids, especially in specific patient populations.
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Airway Management in Trauma
The process of airway management has evolved considerably to include rapid sequence intubation (RSI), the use of various procedures, and sophisticated devices designed to assist in the placement of an endotracheal tube. This article summarizes the basic concepts of airway management, the technique of RSI, and post-intubation management in trauma patients.
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Do Antibiotics Reduce Hormonal Contraceptive Effectiveness?
This is a systematic review of studies evaluating the effect of concomitant non-rifamycin antibiotics use on hormonal contraceptive effectiveness. Although data are limited, there is no evidence to support the existence of drug interactions.
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Patent Foramen Ovale Intervention Rises to Occasion in Cryptogenic Stroke
After years of uncertainty, three large randomized trials have shown a benefit to patent foramen ovale closure in reducing recurrence after cryptogenic stroke in the right patients.
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In-hospital vs. Telephone Availability of an Intensivist at Night
When overnight shifts were staffed by nighttime intensivists rather than residents with attending intensivists on call remotely, most nurses perceived improvements in clinical care, procedures, efficiency, communication, and job place comfort.
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Antibiotics and Adverse Events: Doctors, Do No Harm!
A retrospective study found that among 1,488 hospitalized patients who received an antibiotic, 298 (20%) experienced at least one antibiotic-associated adverse drug event.
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Oncologists and Intensivists Perceive Prognosis Differently for Critically Ill Patients With Cancer
When considering prognostication or limitation of care in critically ill patients with different cancers, oncologists may focus on cancer characteristics, whereas intensivists may focus on multiple organ failure.
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Deflating Recruitment Maneuvers
Compared to the ARDSNet lower positive end-expiratory pressure (PEEP)/low tidal volume strategy, use of an “open lung ventilation” strategy consisting of aggressive alveolar recruitment maneuvers and higher PEEP is associated with higher mortality in patients with moderate to severe acute respiratory distress syndrome.
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Right Heart Failure in the ICU
Right ventricular (RV) failure continues to be a formidable clinical challenge in critical care medicine. Regardless of the etiology, pulmonary hypertension and RV failure carries a poor prognosis. Prompt identification and treatment is warranted. Unfortunately, there is considerable lack of evidence in the management of RV failure in the medical ICU. Most recommendations are based on expert opinion or low-quality evidence.
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Caring for Providers: Mindfulness for Healthcare Practitioners
Preliminary studies show some promise for use of mindfulness interventions in healthcare practitioners, but the time required for training medical providers in these techniques is identified as a limitation to implementation.