Journal Club-ish 1.0

This was sent out to my staff on 8/28

A Randomized Clinical Trial of Red Blood Cell Transfusion Triggers in Cardiac Surgery
http://www.annalsthoracicsurgery.org/article/S0003-4975(17)30781-6/fulltext
Bottom line: transfuse to Hb of 8 (HCT of 24). But I'll post something that contradicts this in Journal Club V2. 

A systematic review of diagnostic methods to differentiate acute lung injury/acute respiratory distress syndrome from cardiogenic pulmonary edema
https://ccforum.biomedcentral.com/articles/10.1186/s13054-017-1809-8
Bottom line: there's no one test to tell the difference. It's cool bc it describes a bunch of fancy biomarkers that we don't use in our clinical practice that ultimately don't make a difference. Hopefully one of these will show more promise. 

Below is a link to going to a whole journal issue focused on ARDS. It's all free, too!
http://atm.amegroups.com/issue/view/585
I like this for you all because they are review articles, no need to analyze confidence intervals. Someone smarter than me already did this for you!

Tidal volume in acute respiratory distress syndrome: how best to select it
http://atm.amegroups.com/article/view/15712/html
Basically 6cc/kg IBW. There are variations to this and recently Rory Speigel over at www.emcrit.org wrote this piece discussing the ARMA trial which I found to be quite interesting.
https://emcrit.org/emnerd/case-ugly-truth/

Prone positioning acute respiratory distress syndrome patients
http://atm.amegroups.com/article/view/15476/html
Just do it already. Recognize that barely anyone can afford those fancy beds. You can do it at your shop, too. 

Recruitment maneuvers in acute respiratory distress syndrome
http://atm.amegroups.com/article/view/15713/html
You've heard of recruitment maneuvers on the vent. Here they explain how to do them. 

Sedation and neuromuscular blocking agents in acute respiratory distress syndrome
http://atm.amegroups.com/article/view/15714/html

Right heart function during acute respiratory distress syndrome
http://atm.amegroups.com/article/view/15613/html
I love right heart pathology. This one is a bit basic but it's still good. One thing they fail to mention is how you should avoid large fluid boluses in patients with RV failure. That's a reason why bedside echocardiography is becoming so important for clinicians in the ICU. I've even heard of some curious nurses putting the echo probe on the chest to have a look (you know who you are!). Notice that the article says daily bedside echo's. If you've given a patient a generous amount of fluid and they're still really sick, a probe needs to be on the chest to see where it's going. 

High-flow nasal oxygen therapy and noninvasive ventilation in the management of acute hypoxemic respiratory failure
http://atm.amegroups.com/article/view/15608/html
A sweet little review on HFNC and NIV. The goodies in here live in the oxygenation and PEEP section. Also, if you're bored, the references are good here and in all these articles bc they contain the actual studies. 

The role of nutritional support in the physical and functional recovery of critically ill patients: a narrative review
https://ccforum.biomedcentral.com/articles/10.1186/s13054-017-1810-2
Still no definitive data on when and how much to feed our patients. Sigh. I personally like to start ASAP but that obviously doesn't mean I'm right. Too many confounders in every study which will make the likelihood of getting a definitive answer pretty challenging to obtain. 

Until the next one...
-EJ

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