Critical Care
-
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.
-
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.
-
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…
-
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…
-
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…
-
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…
-
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…
-
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…
-
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…
-
Compassionate extubation and beyond: Is there a need for more guidance in managing end-of-life in the intensive care unit?
For providers caring for critically ill patients, navigating death and dying in the intensive care unit (ICU) with proficiency and empathy is essential. Approximately 20% of deaths in the United States occur during or shortly after a stay in the ICU and approximately 40% of ICU deaths involve withdrawal of artificial life support (WOALS) or…
-
Now we have MERCY
Beta-lactam antibiotics, including penicillin, carbapenems, and cephalosporins, exhibit time-dependent bacterial eradication. Prolonged infusions are thought to enhance the duration of effective bactericidal antibiotic exposure, decreasing the emergence of drug resistance due to reduced bacterial regrowth between doses – which may lead to cost savings by reducing drug acquisition costs and shortening hospital stays (Lodise TP…
-
Sepsis-induced cardiomyopathy: Is it time to establish a standard of care?
Sepsis and septic shock still carry high morbidity and mortality in ICU patients despite recent improvements in care. Sepsis-induced cardiomyopathy (SICM), which complicates greater than 10% of sepsis and septic shock cases, carries a worse prognosis and is often underrecognized. Unfortunately, no universal definition of SICM exists, making diagnosis and evaluation of novel therapeutic options…
