Sorry about the > 1 week lapse folks. ITU has been busy!
Another one for Sunday coffee and the best of #FOAMed #FOAMcc. Lots from many of our brilliant sites out there, including the usual quality stuff from the Bottom Line crew and Emdocs too. Loads of you get a mention from Twitter posts as well. Remember to rest the mouse over many of the pics, they take you to external links.
The Bottom Liners!
Don’t be Blue in Sepsis!?
The crew take us through an appraisal of the latest papers in style, as ever. Here is their take on Methylene blue Vs. Vasopressin in refractory septic shock (vasoplegia). I have to say, something so novel as MB actually reducing Norad requirements in sepsis would be so good! But….things are perhaps not what they seem…single centre, minimal numbers etc etc. Take a look, and the original paper can be found here too.
Just eat an orange…well it stopped scurvy anyway!
Loved this one by them too. This paper looks at whether intravenous vitamin C, hydrocortisone and thiamine in addition to standard treatment improves mortality in ICU patients with severe sepsis or septic shock when compared with standard treatment alone? Again, here is the original abstract. There were promising results in this series too, but this one was compounded by the fact it wasn’t a RCT, had small numbers and there were a cacophony of other interventions impeding clear hypothesis.
General ICU Papers
Don’t panic about IV!
Here is a great reminder that perhaps we should panic a bit less about having to give peripheral vasopressors as a bridge to definitive central access….it may just save a life! Single centre trial bare in mind!
We all allow Hypercapnia in ARDS…but should we worry?
Well, seemingly so. We stop chasing this parameter as much when we are so desperately struggling to get ARDS under control and focussing on PaO2. But…we could also be doing harm…see here.
HACOR…You Know the Score!!
Heart rate, acidosis, consciousness, oxygenation and respiratory rate. These all surmount to a pretty useful scoring system to indicate when your NIV patients may be taking a trip towards ‘blue cigar land’! See here.
Pearls and Pitfalls in Neurotrauma
I loved this blog, again from the EmDocs lot! Absolutely everything and the kitchen sink you need to know about resuscitation and ideal targeted therapy for the he’d you don’t want to make any worse! See here
Who needs NIPPV!!?
Here is a nice blog from the EmDocs on this topic, keeping it nice and simple. Hopefully, reading this will improve the understanding of this useful respiratory modality. See here.
Beyond the basics
The JICS highlight the use of Echocardiography in the ICU. The sonic ammunition we have in diagnostics these days is immense! Most CC physicians are more than competent, some beyond FICE and up to BSE level. This article here highlights points that perhaps we should all strive to hurdle FICE…AND beyond!
How to assess PE with your TTE!
Here is a brilliant guide from Phillips on how to assess PE on TTE.
Cardiology for ITU
It’s all about relaxation!?
Here is a very useful article on diastolic heart failure, which we always seem to hear more and more about these days. Having read it, I certainly feel more at one with this concept and am more aware of it and it’s management while performing Echocardiography by the ICU bed space.
It’s more than easy to label it as endocarditis!
The crew at Ultrasound of the week point out many variances (some normal), that can lead us to diagnose this condition. This is particularly the case when swayed by the patient history! See here for case 77.
Other Interesting Bits!
Metformin does other stuff then!
This interesting article highlights the fact improved sensitivity to circulating insulin is what we thought this drug did. But…it may also favourably alter the gut microbiome to also aid this cause….
Forget MAP … you might get lost!
Have a look at this paper on perfection pressure. This may be the one to chase Vs good old MAP!
1 Litre may be all you need
This paper here is interesting. It postulates that in trauma resuscitation, the response to one litre could be the golden gate to further resuscitation. Ploughing in any more than this may be too much and may blunt the true physiological responder. Many caveats and obvious difficulties in heterogenous population selection, but a good read and food for thought!
Plugs for Thoracic POCUS again!
This article here re-enforces the fact we can combine TUS and CXR to aid in the differentiation of pathologies in the chest.
Grab that portable!
Nice video below…everyone can ‘nail’ the Oxylog 3000 transport ventilator!
How the heart fails!
Good old vagal manoeuvres
Remember this?! See also a video on how to do this vagal manoever.
Also…have a look at this novel new way to perform the Valsalva. See here for the Lancet paper on the same.
IV Anaesthetics…so you remember!
And now the inhaled agents!