Prone Positioning in Severe Acute Respiratory Distress Syndrome May 27, 2013
Posted by admin in : Featured Articles, Strategies, Ventilation , comments closedN Engl J Med 2013.
DOI: 10.1056/NEJMoa1214103
Conclusions
In patients with severe ARDS, early application of prolonged prone-positioning ses- sions significantly decreased 28-day and 90-day mortality. (Funded by the Programme Hospitalier de Recherche Clinique National 2006 and 2010 of the French Ministry of Health; PROSEVA ClinicalTrials.gov number, NCT00527813.)
proning in ARDS
High Tidal Volumes in Mechanically Ventilated Patients Increase Organ Dysfunction after Cardiac Surgery June 17, 2012
Posted by admin in : Research/Studies/Education, Strategies, Ventilation , comments closedIn the multivariate analysis, high and traditional tidal volumes were independent risk factors for organ failure, multiple organ failure, and prolonged stay in the intensive care unit. Organ failures were associated with increased intensive care unit stay, hospital mortality, and long-term mortality.
Conclusion: Tidal volumes of more than 10 ml/kg are risk factors for organ failure and prolonged intensive care unit stay after cardiac surgery. Women and obese patients are particularly at risk of being ventilated with injurious tidal volumes.Download PDF
EMCrit Podcast 47 – Failure to Plan for Failure: A Discussion of Airway Disasters June 3, 2012
Posted by admin in : Education/Studies, Featured Articles , comments closedPoints that came out of the show
- Mortality is higher in the ED and ICU compared to the operating room. Our patients are sicker, so we must be more diligent in planning
- Quantitative wave-form ETCO2 should be the standard of care for EVERY ED and ICU intubation
- Needle cricothyrotomy seems to fail more often than surgical cricothyrotomy
- Awake intubation was not used when it was indicated
- Junior resident anesthesiologists were often responding to the ED and ICU
- There was a failure to plan for failure
- Obesity figured into a large percentage of the airway disasters
CLICK to hear PODCAST
The TORCH Study: Do you remember? March 30, 2011
Posted by admin in : Education/Studies, Quick Reference, Research/Studies/Education , comments closedThe sentinel Towards a Revolution in COPD Health (TORCH) trial represented an approach to such an aim. This study, which has been published,[2] examined whether combination therapy (salmeterol/fluticasone propionate combination [SFC]) with a high-dose inhaled steroid (fluticasone) and a long-acting beta2-agonist (salmeterol) could improve survival compared with placebo over 3 years in COPD patients with moderate-to-severe airflow obstruction (forced expiratory volume in 1 second [FEV1] < 60% predicted). The study included 2 additional arms (salmeterol and fluticasone alone) allowing additional prespecified comparisons. The primary results suggested a trend toward improved mortality with SFC compared with placebo (hazard ratio [HR] 0.825, 95% confidence interval [CI] 0.861-1.002; P = .052 after adjustment for 2 interim analyses).
Read the article
An introduction to Pulmonary Embolism. (updated links) October 20, 2010
Posted by PeterD in : CXR/Photos , comments closed- Pulmonary embolism is a life-threatening condition that occurs when a clot of blood or other material blocks an artery in your lungs.
- This is an extremely common and highly lethal condition that is a leading cause of death in all age groups.
- One of the most prevalent disease processes responsible for in-patient mortality (30%)
- Overlooked diagnosis.
View PPT Slides
Pulmonary Embolism > Radiologic Information<
Hyperoxia and Mortality After Cardiac Arrest September 20, 2010
Posted by admin in : Featured Articles, Research/Studies/Education , comments closedKilgannon JH, Jones AE, Shapiro NI, et al
JAMA. 2010;303:2165-2171Study Summary
Cardiac arrest is a devastating clinical situation, and the causes of out-of-hospital arrests often differ from those of in-hospital arrests.[1,2] Furthermore, survival after cardiac arrest is not improving.[3] Laboratory investigations suggest that exposure to hyperoxia after resuscitation from cardiac arrest can worsen anoxic brain injury.[4-6]
More information on heart attacks:
An introduction to Pulmonary Embolism. December 9, 2008
Posted by admin in : All Diseases , comments closed- Pulmonary embolism is a life-threatening condition that occurs when a clot of blood or other material blocks an artery in your lungs.
- This is an extremely common and highly lethal condition that is a leading cause of death in all age groups.
- One of the most prevalent disease processes responsible for in-patient mortality (30%)
- Overlooked diagnosis.
View PPT Slides
Toronto Critical Care Conference Recap November 28, 2008
Posted by admin in : News, Research/Studies/Education , comments closedSpontaneous breathing is good!?
- A combination of 18-69 hours of diaphragmatic inactivity and controlled mechanical ventilation results in 53-57% reduction of diaphragm muscle fibers!
- Asynchrony and over-assisting contribute to disappearing muscle… so tailor Ti, Insp Rise, and set rates appropriately!
Wake up and Breathe! (ABC trial)
- Paired sedation and ventilator weaning protocol consisting of daily SATs plus SBTs resulted in patients spending more time off mechanical ventilation, less time in coma, and less time in intensive care and the hospital, and the protocol improved 1-year survival compared with usual care.
The ICU patient remembers…
~20% of ICU patients suffer post-traumatic stress disorder leading to physical & mental health issues.
What they remember? (see Granja article)
1. Daily needle punctures
2. Tracheal tube aspiration
3. Nose tube
4. Bladder tube
5. Noise from conversation
6. Noise from engines and ventilators
7. Pain
8. Bedridden
9. Music in the intensive care unit
10. Comments from doctors and nurses
Lung Weight (Gattinoni lecture)
- A normal lung weighs 800-1200 grams
- An ARDS lung weighs 2000-4000 grams! At least 10-15 cm H2O PEEP to overcome the compressive forces in an ARDS lung.
Subclinical Delirium = Brain Failure?!
- Patients suffering subclinical or transient delirium are more likely to have a longer hospital stay, higher mortality rate and require increased assistance at home.
- Current debates about benzos altering the structure of the brain and increasing incidence of delirium
- Should ICUs move to Remifentanil, Propofol, Dexmedetomidine?