Critical Care
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Failure to Wean From the Ventilator: Is Pleural Effusion the Culprit?
The authors of a multicenter, prospective cohort study did not find an association between the presence of moderate or large pleural effusion and ventilator weaning failure.
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Functional Outcomes After Receiving Life-sustaining Therapy in the ICU
Among patients who have spent at least three days in an ICU and required even brief mechanical ventilation and/or vasopressor support, almost half are dead and only one-third return to their baseline at six months. Several factors present on the first day of admission are associated with not returning to baseline status.
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Thrombocytopenia in the Critically Ill
Thrombocytopenia is not only a pathologic entity, but the severity of thrombocytopenia and the recovery time of the platelets often predicts outcome, including overall mortality of ICU patients. Critically ill patients with moderate and severe thrombocytopenia demonstrate higher ICU and hospital mortality. If the recovery is delayed beyond day four, several studies have demonstrated higher morbidity and mortality.
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Penetrating Chest Injury
Penetrating trauma of the chest can have severe and devastating consequences. Advances in ultrasound and treatment therapies have improved survival. A high degree of suspicion is indicated to identify the more subtle injuries associated with penetrating trauma to the chest.
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Distinguishing Ischemic from Non-ischemic Cardiomyopathy Clinically
SYNOPSIS: This cardiac catheterization-based study of patients with newly diagnosed reduced left ventricular ejection fraction of unknown etiology showed that 15% had ischemic cardiomyopathy and they could be identified by clinical characteristics and an ECG-based risk score.
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B-type Natriuretic Peptide Is Less Useful in Elderly Patients with Dyspnea
SYNOPSIS: Among patients ≥ 80 years of age presenting with acute dyspnea, B-type natriuretic peptide level was not useful for differentiating cardiac vs. respiratory etiologies when added to a model of clinical predictors.
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Sepsis Management: What We Think We Know
SYNOPSIS: In the Protocolized Resuscitation in Sepsis Meta-Analysis (PRISM), 3,723 patients’ outcomes from the ProCESS, ARISE, and ProMISe randomized, controlled trials of early goal-directed therapy (EGDT) were evaluated. EGDT did not result in better outcomes than usual care and was associated with higher costs. The authors of a second study looked at outcomes of 49,331 patients with sepsis treated in New York from April 2014 to June 2016. More rapid completion of the three-hour sepsis bundle and antibiotic administration (but not rapid bolus administration of IV fluids) was associated with reduced in-hospital mortality.
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Dual Antibiotic Therapy Is Not Routinely Necessary for Uncomplicated Cellulitis
SYNOPSIS: A randomized, multicenter, placebo-controlled clinical trial that enrolled patients presenting to emergency departments with uncomplicated cellulitis found the addition of trimethoprim-sulfamethoxazole to cephalexin did not lead to better outcomes.
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Does Dexmedetomidine Improve Patient Outcomes in Sepsis?
In patients with sepsis requiring mechanical ventilation, use of dexmedetomidine compared with no dexmedetomidine did not result in an improvement in 28-day mortality or ventilator-free days.
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Resilience in the ICU: A Valuable Asset for Families
Interventions that teach resilience may improve family members’ experiences in the ICU.