Disclaimer and full disclosure: Bigtime bias alert: I LOVE HFNC! We haven’t even kissed the edge of it’s capacity. Here’s more data supporting how glorious it is!
"In the absence of high-quality data, nicotine replacement therapy cannot currently be recommended for routine use to prevent delirium or to reduce hospital or ICU mortality in critically ill smokers."
I do have to say, I was wrong on this. I thought that placing nicotine patches would make smokers on the vent less crazy but the data isn’t there. Guess I’ll stop using nicotine patches in the ICU.
“EN was associated with a significant reduction in overall mortality (risk ratio (RR)=0.36, 95%confidence interval (CI) 0.20–0.65, P=0.001) and the rate of multiple organ failure (RR=0.39, 95% CI 0.21–0.73, P=0.003). EN should be recommended as the preferred route of nutrition for critically ill patients with severe acute pancreatitis.”
Just another paper saying EN is superior to PN. TPN --> higher overall mortality and more organ failure. Think about this just about every time we have a patient on TPN.
Outcomes of restrictive versus liberal transfusion strategies in older adults from nine randomised controlled trials: a systematic review and meta-analysis
Outcomes of restrictive versus liberal transfusion strategies in older adults from nine randomised controlled trials: a systematic review and meta-analysis
Uh-oh. This is the first paper where it says that liberal transfusions are better in geriatric pts. Here goes the roller coaster of recommendations for blood transfusions! They consider geriatric pts to be >65yo. I think I posted something contrary to this in Journal Club-ish 1.0
Diagnostic testing for Legionnaires’ disease
Remember to send off the urine Legionella antigen. This should come back pretty quickly. Although they should still be sent out, the respiratory cultures take 3-5 days to return. There are other fancy tests described there but I honestly don’t know what our institution has the capacity to do.
Opioid-associated iatrogenic withdrawal in critically ill adult patients: a multicenter prospective observational study
We give just about every patient on the vent opioids, they’re going to withdraw of course, right? 17% withdrew per this study. No, this is not something that happened while the patient was in the ICU, but it could be something that creates some havoc on the floor once they’re transferred from the unit. Note that the largest group of the people in the study were trauma patients and only 15% were respiratory issues. Of note, needing more opioids led to more withdrawal, as one would think. Also, use of benzos led to more withdrawal, too. People on precedex and propofol had less withdrawal.
Percutaneous tracheostomy: a comprehensive review
Diagnostic testing for Legionnaires’ disease
Remember to send off the urine Legionella antigen. This should come back pretty quickly. Although they should still be sent out, the respiratory cultures take 3-5 days to return. There are other fancy tests described there but I honestly don’t know what our institution has the capacity to do.
Opioid-associated iatrogenic withdrawal in critically ill adult patients: a multicenter prospective observational study
We give just about every patient on the vent opioids, they’re going to withdraw of course, right? 17% withdrew per this study. No, this is not something that happened while the patient was in the ICU, but it could be something that creates some havoc on the floor once they’re transferred from the unit. Note that the largest group of the people in the study were trauma patients and only 15% were respiratory issues. Of note, needing more opioids led to more withdrawal, as one would think. Also, use of benzos led to more withdrawal, too. People on precedex and propofol had less withdrawal.
Percutaneous tracheostomy: a comprehensive review
Trach stuff. Self explanatory.
Heparin-Free Prolonged Intermittent Hemodialysis Using Calcium-Free Citrate Dialysate in Critically Ill Patients
Heparin-Free Prolonged Intermittent Hemodialysis Using Calcium-Free Citrate Dialysate in Critically Ill Patients
It's hard to believe that some shops still don't use citrate.
Patterns and Outcomes Associated With Timeliness of Initial Crystalloid Resuscitation in a Prospective Sepsis and Septic Shock Cohort
Patterns and Outcomes Associated With Timeliness of Initial Crystalloid Resuscitation in a Prospective Sepsis and Septic Shock Cohort
A cool study on resuscitation that you probably can guess what the outcome is, but it’s always good to know the data behind it. Published in SCCM.
Treatment of Hyponatremic Encephalopathy in the Critically Ill
This is extremely important and it’s a Concise Definitive Review from SCCM. These are the big papers. We have all been trained to have a health respect for hyponatremia and should not need nephrology to manage this for us. This is a good read, if you have access.
Central Venous Catheter Insertion and Bedside Ultrasound: Building a New Standard of Care?
Treatment of Hyponatremic Encephalopathy in the Critically Ill
This is extremely important and it’s a Concise Definitive Review from SCCM. These are the big papers. We have all been trained to have a health respect for hyponatremia and should not need nephrology to manage this for us. This is a good read, if you have access.
Central Venous Catheter Insertion and Bedside Ultrasound: Building a New Standard of Care?
Using ultrasound to get rid of CXR to confirm central line positioning. Sounds like we’re saving money here. Less radiation to the patients. I like this idea. Possibly too soon to implement, though.
Incorporating Dynamic Assessment of Fluid Responsiveness Into Goal-Directed Therapy: A Systematic Review and Meta-Analysis
Incorporating Dynamic Assessment of Fluid Responsiveness Into Goal-Directed Therapy: A Systematic Review and Meta-Analysis
Almost last, but definitely not least.
Don’t blindly give fluids. Have an objective and pursue it.
Dont use CVP: "Static indices such as the central venous pressure (CVP) consistently fail to predict fluid responsiveness, calling to question their utility in goal-directed therapy algorithms”
"goal-directed therapy guided by assessment of fluid responsiveness appears to be associated with reduced mortality, ICU length of stay, and duration of mechanical ventilation”
PS: I am definitely open to suggestions.
-EJ
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