May 2017

Stop the fags! Well, at least do it for all other reasons other than for ARDS!

Screen Shot 2017-06-03 at 10.50.11

In aggregate, the study demonstrates that cigarette smoking is not associated with increased risk of ALI/ARDS in critically ill patients. However, the relationship in general population is still controversial and requires further confirmation.

SBT’s..we all need them!

Screen Shot 2017-06-02 at 10.31.31.png

Patients undergoing PS (vs T-piece) SBTs appear to be 6% (95% CI 2–10%) more likely to be extubated successfully and, if the results of an outlier trial are excluded, 6% (95% CI 1–12%) more likely to pass an SBT. Future trials should investigate patients for whom SBT and extubation outcomes are uncertain and compare techniques that maximize differences in support.

ARDS…it still follows you; even after discharge!

Screen Shot 2017-06-02 at 10.21.43.png

This multicenter longitudinal study found that 40% of ARDS survivors reported at least one post-discharge hospitalization during 12-month follow-up. Few patient- or ICU-related variables were associated with hospitalization; however, physical, psychiatric, and quality of life measures at 6-month follow-up were associated with subsequent hospitalization. Interventions to reduce post-ARDS morbidity may be important to improve patient outcomes and reduce healthcare utilization.

Hypertonic saline…scary stuff, but maybe ok in aneurysmal SAH?

Screen Shot 2017-06-02 at 10.14.11.png

The current evidence suggests that HTS is as effective as mannitol at reducing raised ICP in aSAH. However, there is not enough data to recommend the optimal and safest dose concentration or whether HTS significantly improves outcomes in aSAH.

All about Contact!?

Screen Shot 2017-06-01 at 17.16.50.png

Whether the contact system is not as relevant in humans as it is in animals or there is only lack of evidence remains to be explained. The subject is an attractive open field for further research aiming to aid in tackling such a burdensome condition.

Are they really that old!? [ITU Frailty]

Screen Shot 2017-06-01 at 10.26.10

Rockwood Frailty Index 

Slam in the Vitamin d?? [Vitamin D supplementation]

Screen Shot 2017-05-31 at 17.41.44

In critically ill patients, Vitamin D administration does not improve clinical outcomes. The statistical imprecision could be explained by the sparse number of trials.

Humidification…does it worsen pneumonia / occlude the airway..who knows?! [Humidification and airway complications]

 

In this meta-analysis we found no superiority of HMEs and HHs, in terms of artificial airway occlusion, pneumonia and mortality. A trend favoring HMEs was observed in studies including a high percentage of patients with pneumonia diagnosis at admission and those with prolonged MV. However, the choice of humidifiers should be made according to the clinical context, trying to avoid possible complications and reaching the appropriate performance at lower costs.

University Hospitals do it better…well, maybe in Germany?! [University hospital Vs DGH ARDS Outcomes]

Screen Shot 2017-05-31 at 14.10.59

Mortality risk of ARDS patients was considerably higher in non-university compared with university hospitals. Differences in ventilatory care between hospitals might explain this finding and may at least partially imply regionalization of care and the export of ventilatory strategies to non-university hospitals.

Get those Antibiotics in E A R L Y! [Timing of antibiotic therapy on mortality]

Screen Shot 2017-05-28 at 12.22.41.png

The time from triage to administration of appropriate antimicrobials is one of the primary determinants of mortality. The optimum timing of appropriate antimicrobial administration is the first 48 hours after non-critically ill patients arrive at the ED. As bacteremia severity increases, effective antimicrobial therapy should be empirically prescribed within 1 hour after critically ill patients arrive at the ED

Echo so the RIGHT thing to do! [Pulmonary hypertension and Echo]

Screen Shot 2017-05-28 at 12.32.08.png

For all other patients our data emphasize that echocardiography is an accurate tool to estimate pulmonary pressure in patients with advanced lung disease.

All about timing [Sepsis bundles in the USA]

Screen Shot 2017-06-19 at 16.18.12.png

More rapid completion of a 3-hour bundle of sepsis care and rapid administration of antibiotics, but not rapid completion of an initial bolus of intravenous fluids, were associated with lower risk-adjusted in-hospital mortality. (Funded by the National Institutes of Health and others.)

 

 Survival of the Fattest?! [The Obesity Paradox!]

Screen Shot 2017-05-28 at 12.04.15.png

 Traumatic Fluids! [IV Fluid Management in Trauma]

Screen Shot 2017-05-28 at 14.05.40.png

“Fluids are drugs and should be managed as such. Appropriate early fluid resuscitation in trauma patients is a challenging task. Care should be taken in selecting both the type and volume to promote appropriate perfusion and oxygen delivery, avoiding the adverse effects seen when giving too little or too much. Ongoing fluid strategies following resuscitation should incorporate dynamic markers of volume status whenever possible. All aspects of fluid administration should be incorporated into daily fluid plans, including feeding and infusions of medications. A sound knowledge of the differences and physiological consequences of specific trauma groups is essential for all practitioners delivering care for trauma patients”

 Statins Ahoy! [Simvastatin and ARDS Outcome]

Screen Shot 2017-05-18 at 11.12.26.png

Simvastatin was found to be cost-effective for the treatment of ARDS, being associated with both a significant QALY gain and a cost saving. There was no significant reduction in mortality at 12 months

Angiotensin 2…well at least synthetic! [ATHOS-3 NEJM]

Screen Shot 2017-06-02 at 14.58.48

Angiotensin II effectively increased blood pressure in patients with vasodilatory shock that did not respond to high doses of conventional vasopressors.