Network News
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Electrical impedance tomography: Visualization and integration of the impact of mechanical ventilation
Lung protective ventilation (LPV) is the cornerstone to minimizing ventilator-induced lung injury. Hence, LPV is associated with better survival in patients both with and without ARDS.1 2 3 Continuous monitoring of the tidal volume, plateau pressure, and positive end-expiratory pressure (PEEP) is crucial to maintain LPV. Electrical impedance tomography (EIT) is a noninvasive, radiation-free, imaging…
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Primary vs secondary: A review of pneumothorax management
Optimal management of primary spontaneous (PSP) and secondary spontaneous pneumothorax (SSP) remains an area of ongoing debate, with both CHEST and the British Thoracic Society (BTS) offering guidelines to address management decisions. The consensus for treatment of PSP depends on the size of the pneumothorax; if smaller than 2-3 cm, the patient can be observed…
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The pendulum swings in favor of corticosteroids
The pendulum swings in favor of corticosteroids and endorses the colloquialism among intensivists that no patient shall die without steroids, especially as it relates to sepsis and septic shock. In 2018, we saw divergence among randomized controlled trials in the use of glucocorticoids for adults with septic shock such that hydrocortisone without the use of…
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Fighting for fresh air: RSV’s connection to environmental pollution
Poor air quality has numerous health hazards for patients with chronic lung disease. Now mounting evidence from pediatric studies suggests a concerning link between air pollution and viral infections, specifically respiratory syncytial virus (RSV). Multiple studies have shown increased incidence and severity of disease in children with exposure to air pollutants such as particulate matter…
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Is it time to embrace a multinight sleep study?
Since the 1960s, sleep researchers have been intrigued by the first-night effect (FNE) in polysomnography (PSG) studies. A meta-analysis by Ding and colleagues revealed FNE’s impact on sleep metrics, like total sleep time and REM sleep, without affecting the apnea-hypopnea index, highlighting PSG’s limitations in simulating natural sleep patterns.1 Lechat and colleagues conducted a study…
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Transesophageal ultrasound: The future of ultrasound in the ICU
Historically, transesophageal ultrasound (TEE) has been regarded as a diagnostic and management tool for structural heart disease in relatively stable patients. However, TEE is more commonly being utilized by intensivists as a first-line tool in the diagnostics and management of patients in the ICU. TEE, with its unobstructed superior cardiac views, facilitates rapid diagnosis in…
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Can VAP be prevented? New data suggest so
Ventilator-associated pneumonia (VAP) is a common cause of hospital-related morbidity in critically ill patients. The efficacy of prophylactic antibiotics in the prevention of VAP has been the subject of several studies in recent years. Three large randomized controlled trials, all published since late 2022, have investigated whether antibiotics can prevent VAP and the optimal method…
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Eradicating uncertainty: A review of Pseudomonas aeruginosa eradication in bronchiectasis
Bronchiectasis patients have dilated airways that are often colonized with bacteria, resulting in a vicious cycle of airway inflammation and progressive dilation. Pseudomonas aeruginosa is a frequent airway colonizer and is associated with increased morbidity and mortality in cystic fibrosis (CF) and noncystic fibrosis bronchiectasis (NCFB).1 Both CF and NCFB guidelines recommend eradication of P.…
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Complexity of hemodynamic assessment in patients with cirrhosis and septic shock
In patients with decompensated cirrhosis, there are multiple intrahepatic and extrahepatic factors contributing to hemodynamic alterations at baseline, including endothelial cell dysfunction, hepatic stellate cell activation promoting increase in vasoconstrictors, decrease in vasodilators, and angiogenesis leading to worsening of portal hypertension. Increased resistance to hepatic blood flow leads to increased production of nitric oxide and…
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CLAD prevention in lung transplant recipients: Tacrolimus vs cyclosporin
Chronic lung allograft dysfunction (CLAD) remains the leading cause of morbidity and mortality in lung transplant recipients (LTRs), accounting for around 40% of deaths.1 LTRs are typically maintained on a three-drug immunosuppressive regimen—a calcineurin inhibitor, antimetabolite agent, and corticosteroid—in order to prevent rejection. Strong randomized controlled trial-generated evidence guiding the choice of immunosuppressive therapy for…
