A bad week on ICU! Pericardial tamponades, many of the sickest patients I have seen for quite some time, tight aortic valves and a lot of POCUS!!!
So..a lot going on this week, but I have been trawling and hope this gives you an idea of what’s been going on? Make sure the kids are entertained, put a brew on and have a skim through some of the best finds this week in the world of FOAMcc / FOAMed / POCUS.
Celebrating one of the best meetings of the year!
Fluids & Resuscitation
Don’t let me down, don’t let me drown!
Here is a paper looking at the association between ITU mortality and IV fluid resuscitation in the first 24h after admission. It seems, repeatedly, we are being told not to drown our patients as they SEEM intravascularly volume depleted…but are they?!
5 litres or more in the first 24hours of sepsis resuscitation may be detrimental to these guys, so we need to maintain equipoise on limiting our volumes. Many hospitals were very similar in approach in this large case serious from the US. It certainly goes a tad against the mantra of EGDT!
Suck, Blow…just POCUS!!
A great blog here regarding the use of POCUS in pneumothorax. A great site!
Would you thrombolyse a 23 year old?!
Have a look at this blog…difficult. See what you would have done in the same situation.
General ICU Papers
Keep a lid on ARDS!
Here is a nice review of ARDS know how. I would advise you look at this for a great little refresher on best approach, or share with trainees.
VAP…pfff! Just inhale heparin!!
The Bottom Line Crew debate this paper in their usual easy to digest style. This looks at whether nebulised heparin actually decreased VAP impact. This is a subject we are all interested in as it is such a nightmare for our ICU patients. So, did it work, read on here!
Don’t let me down!
The aim of this study was to evaluate whether subglottic suctioning using TaperGuard EVAC tubes was effective in decreasing the frequency of VAP. As mentioned below, nebbing heparin, posture etc etc…nothing seems to help us with VAP! Did this? See here.
Put out the Fire!?
Should we be intervening with pyrexia in ICU patients? This is a hugely controversial topic. Read on here to see what the verdict of this large meta analysis was.
Is Early Goal Directed Therapy Early GOLD directed therapy??
This meta analysis looked at many of the EGDT trials, but bare in mind it includes the recent trio of studies and could have a significant degree go methodological bias within. See here.
Just give them fluid!!!
We now know that liver-resuscitating our patients these days is NOT the way forward. There have been so many trials of late highlighting this point. This huge audit looked at 24hrs and 3 days after ICU admission and correlated fluid balance with outcome. Well done….see here.
Is it in your Genes??
This fascinating lab based study looked at possible genetic preponderance to septic myocarditis and measured messenger RNA alterations in hearts from patients who died from systemic sepsis. They compared it to changed messenger RNA expression in nonfailing and failing human hearts. See here.
IV Resuscitation – PEARLS, pitfalls and waterfalls
The crew at PulmCCM take us through the pearls and pitfalls of IV fluid resuscitation on the ICU in Part 1 and Part 2 (the glycocalyx theory). Worth a read and fits in with s section in our FOAM finds Part 4 here. The same was discussed in trauma resuscitation.
This is an interesting paper from Anaesthesia on a particular acupuncture point that may allay pre-op anxiety. As opposed to telling your patients to, ‘man up’! Perhaps its less harsh to needle them in the Yintang point! See here. Also, see here for another paper by some bloke years ago on the ancient chinese subject!
Check out this site. Some extremely clear and well simplified cases. Love the presentation and format here. Well done! Added to our side-bar! (click the image). This week they discuss pearls and pitfalls in aortic dissection!