June 2017

Are early calories bad for ARDS??

Higher calorie exposure between ICU days 1 and 7 was associated with higher subsequent hazard of mortality, and provision of high-calorie exposure after day 8 decreased the hazards of death.

Poor rats…but their endothelia may point the way; against N Saline!

Resuscitation with NS failed to inhibit syndecan-1 shedding and to repair the EG, which led to loss of endothelial barrier function (edema), decline in tissue perfusion and pronounced leukocyte rolling and adhesion. Detrimental effects of NS on endothelial and microvascular stabilization post shock may provide a pathophysiological basis to understand and prevent morbidity associated with iatrogenic resuscitation after hemorrhagic shock.

EAT…early is often wrong!

Despite the use of updated guidelines and a good com- pliance rating from physicians, one out of every six ICU patients receive inappropriate EAT. In more cases, empirical antimicrobial therapy is too broad-spectrum, which negatively impacts patients’ and hospital’s bacter- ial ecologies. The BLT is a simple, accurate, inexpensive susceptibility test, which is promising for early beta- lactam adaptation from the first 24 hours following the beginning of sepsis management. A randomized, con- trolled trial is needed to definitely demonstrate the im- pact of a BLT-guided strategy on the patient’s outcome.

Is it a HAP…is it a VAP??

Our results show significant heterogeneity in the enrollment criteria, endpoints and statistical design that may influence the ability of studies to demonstrate differences between the drugs studied. Although the methodological quality of studies seems to improve over time, some pitfalls remain.

Van Den Berg / NICE-sugar…who is right?

The results we report show equivalent metabolic variability between survivors and non-survivors and that non-survivors had higher SI.

Can RBC’s predict the future?!

In critically ill patients who survive hospitalization, the presence of nucleated red blood cells is a robust predictor of postdischarge mortality and unplanned hospital readmission.

How low can you go??

Time to full support is an important and alterable predictor of patient survival in eCPR, suggesting that VA-ECMO therapy should be established as fast as possible in the selected patients destined for eCPR.

All about those proteins…but not nutrition

The allocated target temperature did not affect S100 to a clinically relevant degree. High S100 values are predictive of poor outcome but do not add value to present prognostication models with or without NSE. S100 measured at 24 h and afterward is of limited value in clinical outcome prediction after OHCA.

What form of CO monitoring is best…is the tale in the lung?!

Transpulmonary thermodilution provides a full cardiovascular evaluation that allows one to answer many questions regarding haemodynamic management. It belongs to the category of “advanced” devices that are indicated for the most critically ill and/or complex patients.

Gram staining…the key to VAP?

Antimicrobial treatment based on Gram stain results may restrict the administration of broad- spectrum antimicrobial agents without increasing the risk of treatment failure.

Timing for RRT…when when when??!

Because of the substantial differences in study design, patient population, AKI definition, and RRT indication, no conclusive consensus can be generated from existing prospective and retrospective cohort studies, meta- analyses, and the two recent large RCTs which evaluated the relationship between the timing of RRT initiation and patient outcome. There is an urgent need for a cause-specific diagnostic criterion of AKI. We suggest that implementing a sensitive biomarker (panel) on top of current staging classification may allow defining a homogeneous study population to assess the impact of early versus late initiation of RRT on patient outcome.

RRT…get it in early post cardiac surgery!

Early RRT initiation decreased 28-day mortality, especially when it was started within 24 hours after cardiac surgery in patients with AKI.

What are we all doing with fluids??!

This self-reported account of practice by United Kingdom and Australia and New Zealand intensivists demonstrates that fluid overload remains poorly defined with variability in both management and practice.

Up and about….and more!

There was no statistically significant difference in the primary outcome measure of self-reported physical function following this 6-week exercise programme. Secondary outcome results will help inform future studies

Have a look through, loads of good stuff here!

More EGDT, for god’s sake…it doesn’t make a difference; or does it?!

This systematic review of available evidence suggests that the use of perioperative GDHT may facilitate recovery in patients undergoing major abdominal surgery.

Stop the squits…does feed make a difference?

In this pilot study, we found a high incidence of diarrhea, which was not attenuated by Peptamen® AF. Patients with diarrhea stayed longer in the ICU.

Top em’ up…whether they are fat or thin!

Provision of SPN + EN significantly increased calorie/protein delivery over the first week of ICU residence versus EN alone. This was achieved with no increased infection risk. Given feasibility and consistent encouraging trends in hospital mortality, QoL, and functional endpoints, a full-scale trial of SPN powered to assess these clinical outcome endpoints in high-nutritional-risk ICU patients is indicated—potentially focusing on the more poorly EN-fed surgical ICU setting.

Echo is best…and so say all of us!

In critically ill mechanically ventilated patients, CO-TTE is an accurate and precise method for estimating CO. Furthermore, CO-TTE can accurately track variations in CO.

Whack in the high dose steroids?!!

A tapering regimen after high-dose corticosteroids is likely to increase ventilator dependency and might aggravate the prognosis of patients with ARDS diagnosed according to the Berlin definition.