Critical Care Network
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Capillary refill time: Advancing perfusion-targeted resuscitation in septic shock
Capillary refill time is a quick, noninvasive tool to assess perfusion and microvascular health in shock. It offers faster feedback than lactate levels and may improve resuscitation outcomes.
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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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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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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…
