Critical Care
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Sepsis order sets good for patients, hospital bottom lines
Automating the mundane components of care delivery allows clinicians to focus more on the nuances of individualized evaluation and personalized care.
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Viscoelastic testing in sepsis-induced coagulopathy
SIC is a common ICU complication that clinicians are starting to identify in patients earlier through point-of-care viscoelastic testing such as rotational thromboelastometry and thromboelastography.
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Breathing room: Making space for palliative care in lung transplant programs
Transplant centers should consider additional research into palliative care integration to ultimately benefit the growing population of lung transplant recipients.
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Striking the right balance: Optimizing mechanical ventilation settings for diaphragm protection
Personalizing mechanical ventilation using noninvasive techniques, like ventilator graphics to monitor patient respiratory effort, offers a practical and effective strategy to prevent diaphragm dysfunction and optimize patient outcomes.
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The rising use of ketamine for airway management
Ketamine’s unique properties make it valuable for critical care treatments including airway management, sedation, and analgesia.
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RBC transfusion guidelines in critical care: Making the case for a restrictive approach
Author Angel Coz, MD, FCCP, makes the case for a restrictive RBC transfusion approach in critically ill adults based on a new guideline from CHEST.
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Mechanical power: A missing piece in lung-protective ventilation?
The ARDSNet trial demonstrated the importance of low tidal volume ventilation in patients with ARDS, and we have learned to monitor parameters such as plateau pressure and driving pressure (DP) to ensure lung-protective ventilation. However, severe hypercapnia can occur with low tidal volume ventilation and respiratory rate would often need to be increased. What role does the…
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Prediction models in sepsis
Early recognition is the linchpin of sepsis management, as mortality from sepsis increases by 4% to 9% for every hour that diagnosis and treatment are delayed.1 2 Artificial intelligence (AI) and machine learning (ML) are increasingly featured in discussions and publications about sepsis care. Already ML models are embedded in electronic medical records (EMR), driving…
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Advancements in nutritional management for critically ill patients
Nutrition plays an important role in the management and recovery of critically ill patients admitted to the ICU. Major guidelines recommend that critically ill patients should receive 1.2 to 2.0 g/kg/day of protein, with an emphasis on early (within 48 hours of ICU admission) enteral nutrition.1 2 3 In a randomized controlled trial involving 173…
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On thoughtful selection of medications in the acute critical care setting
As critical care medicine continues to advance understanding of ICU survivorship, thoughtful selection of medications in the acute setting can potentially mitigate long-term cognitive, physical, and affective effects. As of yet, no significant studies have linked opioid use in critical care to new diagnoses of opioid use disorder, but the opioid epidemic has taught us…
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APPs and POCUS: Overcoming credentialing challenges
Advanced practice providers (APPs) play an integral role in the care and management of patients both in the ICU and across the spectrum of health care. Due to reduced residency hours and the coming physician shortage, APPs are playing, and will continue to play, a greater role in the care and management of critically ill…
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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…
