Is this the end of the road for synthetic starches in critical illness? BMJ 2013, 346:f1805.
Prowle, J.R. and Pearse, R.M.
http://www.bmj.com/content/346/bmj.f1805.pdf%2Bhtml
Maintaining effective plasma volume is, perhaps, the most persistent challenge faced by clinicians who treat critically ill patients, in particular those with sepsis. In patients with sepsis, increased capillary permeability and loss of vascular tone cause loss of circulating plasma volume, which contributes to inadequate cardiac output and tissue perfusion.
Monday, 25 March 2013
The effect of a quality improvement intervention on perceived sleep quality and cognition in a medical ICU
The effect of a quality improvement intervention on perceived sleep quality and cognition in a medical ICU. Critical care medicine, March 2013, Vol. 41(3), p.800-09.
Kamdar, B.B., et al.
http://journals.lww.com/ccmjournal/Abstract/2013/03000/The_Effect_of_a_Quality_Improvement_Intervention.12.aspx
An ICU-wide quality improvement intervention to improve sleep and delirium is feasible and associated with significant improvements in perceived nighttime noise, incidence of delirium/coma, and daily delirium/coma-free status. Improvement in perceived sleep quality did not reach statistical significance.
Kamdar, B.B., et al.
http://journals.lww.com/ccmjournal/Abstract/2013/03000/The_Effect_of_a_Quality_Improvement_Intervention.12.aspx
An ICU-wide quality improvement intervention to improve sleep and delirium is feasible and associated with significant improvements in perceived nighttime noise, incidence of delirium/coma, and daily delirium/coma-free status. Improvement in perceived sleep quality did not reach statistical significance.
Hydroxyethyl starch in severe sepsis: End of starch era?
Hydroxyethyl starch in severe sepsis: End of starch era? Critical care, March 2013, 17: 310.
Estrada, C.A. and Murugan, R.
http://ccforum.com/content/17/2/310
Hydroxyethyl starch (HES) is widely used for fluid resuscitation in ICUs, but its safety and efficacy have not been established in patients with severe sepsis.
Estrada, C.A. and Murugan, R.
http://ccforum.com/content/17/2/310
Hydroxyethyl starch (HES) is widely used for fluid resuscitation in ICUs, but its safety and efficacy have not been established in patients with severe sepsis.
Characterisation of sleep in intensive care using 24 hour polysomnography : An observational study
Characterisation of sleep in intensive care using 24 hour polysomnography: An observational study. Critical care, March 2013, 17:R46.
Elliott, R., et al.
http://ccforum.com/content/17/2/R46/abstract
Many intensive care patients experience sleep disruption potentially related to noise, light and treatment interventions. The purpose of this study was to characterise, in terms of quantity and quality, the sleep of intensive care patients, taking into account the impact of environmental factors.
Elliott, R., et al.
http://ccforum.com/content/17/2/R46/abstract
Many intensive care patients experience sleep disruption potentially related to noise, light and treatment interventions. The purpose of this study was to characterise, in terms of quantity and quality, the sleep of intensive care patients, taking into account the impact of environmental factors.
The influence of gender on the epidemiology of and outcome from severe sepsis
The influence of gender on the epidemiology of and outcome from severe sepsis. Critical care, March 2013, 17: R50.
Sakr, Y., et al.
http://ccforum.com/content/17/2/R50/abstract
The impact of gender on outcome in critically ill patients is unclear. We investigated the influence of gender on the epidemiology of severe sepsis and associated morbidity and mortality in a large cohort of ICU patients in the region of Piedmont in Italy.
Sakr, Y., et al.
http://ccforum.com/content/17/2/R50/abstract
The impact of gender on outcome in critically ill patients is unclear. We investigated the influence of gender on the epidemiology of severe sepsis and associated morbidity and mortality in a large cohort of ICU patients in the region of Piedmont in Italy.
Assessment of volume responsiveness during mechanical ventilation: Recent advances
Assessment of volume responsiveness during mechanical ventilation: Recent advances. Critical care, March 2013, 17: 217.
Monnet, X. and Teboul, J-L.
http://ccforum.com/content/pdf/cc12526.pdf
Predicting which patients with acute circulatory failure will respond to fluid by a significant increase in cardiac output is a daily challenge, in particular in the setting of the intensive care unit. This challenge has become even more crucial because evidence is growing that administering excessive amounts of fluid is a risk factor in critically ill patients, in particular in patients with lung injury.
Monnet, X. and Teboul, J-L.
http://ccforum.com/content/pdf/cc12526.pdf
Predicting which patients with acute circulatory failure will respond to fluid by a significant increase in cardiac output is a daily challenge, in particular in the setting of the intensive care unit. This challenge has become even more crucial because evidence is growing that administering excessive amounts of fluid is a risk factor in critically ill patients, in particular in patients with lung injury.
Point-of-care coagulation management in intensive care medicine
Point-of-care coagulation management in intensive care medicine. Critical care, March 2013, 17:218.
Meybohm, P., et al.
http://ccforum.com/content/pdf/cc12527.pdf
Coagulopathy in critically ill patients is common and of multifactorial origin. Coagulopathy-associated risk of bleeding and the use of allogeneic blood products are independent risk factors for morbidity and mortality. Therefore, prompt and correct identification of the underlying causes of these coagulation abnormalities is required, since each coagulation abnormality necessitates very different therapeutic management strategies.
Meybohm, P., et al.
http://ccforum.com/content/pdf/cc12527.pdf
Coagulopathy in critically ill patients is common and of multifactorial origin. Coagulopathy-associated risk of bleeding and the use of allogeneic blood products are independent risk factors for morbidity and mortality. Therefore, prompt and correct identification of the underlying causes of these coagulation abnormalities is required, since each coagulation abnormality necessitates very different therapeutic management strategies.
Measurement of kidney perfusion in critically ill patients
Measurement of kidney perfusion in critically ill patients. Critical care, March 2013, 17: 220.
Schneider, AG, et al.
http://ccforum.com/content/pdf/cc12529.pdf
Acute kidney injury (AKI) is a major complication of critical illness occurring in 30 to 40% of all critically ill patients and in its severe form requires renal replacement therapy in approximately 5% of patients. AKI has been shown to be an independent predictor for mortality and is associated with invasive therapy and substantial costs.
Schneider, AG, et al.
http://ccforum.com/content/pdf/cc12529.pdf
Acute kidney injury (AKI) is a major complication of critical illness occurring in 30 to 40% of all critically ill patients and in its severe form requires renal replacement therapy in approximately 5% of patients. AKI has been shown to be an independent predictor for mortality and is associated with invasive therapy and substantial costs.
Clinical practice guidelines for the management of pain, agitation and delirium in adult patients in the intensive care unit
Clinical practice guidelines for the management of pain, agitation and delirium of adult patients in the intensive care unit. Crit. Care Med. Jan 2013, Vol. 41(1), p.263-306
Barr, J. et al.
http://www.ncbi.nlm.nih.gov/pubmed/23269131?dopt=Abstract
Barr, J. et al.
http://www.ncbi.nlm.nih.gov/pubmed/23269131?dopt=Abstract
Objective: To revise the "Clinical Practice Guidelines for the Sustained Use of Sedatives and Analgesics in the Critically Ill Adult" published in Critical Care Medicine in 2002. The American College of Critical Care Medicine assembled a 20-person, multidisciplinary, multi-institutional task force with expertise in guideline development, pain, agitation and sedation, delirium management, and associated outcomes in adult critically ill patients.
In-facility delirium prevention programme as a patient safety strategy: A systematic review
In-facility delrium prevention programme as a patient safety strategy: A systematic review. An. Intern. Med., March 2013, Vol. 158(5, Pt. 2), p.375-80.
Reston, J.T., and Schoelles, KM
http://annals.org/article.aspx?articleid=1656429
Delirium, an acute decline in attention and cognition, occurs among hospitalized patients at rates estimated to range from 14% to 56% and increases the risk for morbidity and mortality. The purpose of this systematic review was to evaluate the effectiveness and safety of in-facility multicomponent delirium prevention programs.
Reston, J.T., and Schoelles, KM
http://annals.org/article.aspx?articleid=1656429
Delirium, an acute decline in attention and cognition, occurs among hospitalized patients at rates estimated to range from 14% to 56% and increases the risk for morbidity and mortality. The purpose of this systematic review was to evaluate the effectiveness and safety of in-facility multicomponent delirium prevention programs.
Weaning patients from the ventilator
Weaning patients from the ventilator. NEJM, 2013, 368: p.1067-69.
Various [correspondence]
http://www.nejm.org/doi/full/10.1056/NEJMc1300398?af=R&rss=currentIssue
Various [correspondence]
http://www.nejm.org/doi/full/10.1056/NEJMc1300398?af=R&rss=currentIssue
Reduced cortisol metabolism during critical illness
Reduced cortisol metabolism during criticall illness. NEJM, March 2013 [online]
Boonen, E., et al.
http://www.nejm.org/doi/full/10.1056/NEJMoa1214969?af=R&rss=currentIssue#t=articleTop
Critical illness, an example of severe acute physical stress, is often accompanied by hypercortisolemia that is proportionate to the severity of illness.1,2 This observation has traditionally been attributed to stress-induced activation of the hypothalamic–pituitary–adrenal (HPA) axis and increased corticotropin-driven cortisol production.3 However, this stress response may not be sufficient for a good prognosis in patients with relative adrenal insufficiency.
Boonen, E., et al.
http://www.nejm.org/doi/full/10.1056/NEJMoa1214969?af=R&rss=currentIssue#t=articleTop
Critical illness, an example of severe acute physical stress, is often accompanied by hypercortisolemia that is proportionate to the severity of illness.1,2 This observation has traditionally been attributed to stress-induced activation of the hypothalamic–pituitary–adrenal (HPA) axis and increased corticotropin-driven cortisol production.3 However, this stress response may not be sufficient for a good prognosis in patients with relative adrenal insufficiency.
Adrenal dysfunction in critically ill patients
Adrenal dysfunction in critically ill patients. NEJM, March 2013 [online]
Gomez-Sanchez, C.E.
http://www.nejm.org/doi/full/10.1056/NEJMoa1214530?af=R&rss=currentIssue
Critical illness elicits a major stress response that activates the hypothalamic–pituitary–adrenal (HPA) axis. Furthermore, the administration of corticotropin stimulates cortisol secretion and causes structural changes in the adrenal gland that include adrenal-cell hypertrophy and hyperplasia. Adrenal glands that are obtained on autopsy from patients who have died after a prolonged critical illness are relatively heavy, and progressively compact lipid-depleted cells replace lipid-laden fasciculata cells.
Gomez-Sanchez, C.E.
http://www.nejm.org/doi/full/10.1056/NEJMoa1214530?af=R&rss=currentIssue
Critical illness elicits a major stress response that activates the hypothalamic–pituitary–adrenal (HPA) axis. Furthermore, the administration of corticotropin stimulates cortisol secretion and causes structural changes in the adrenal gland that include adrenal-cell hypertrophy and hyperplasia. Adrenal glands that are obtained on autopsy from patients who have died after a prolonged critical illness are relatively heavy, and progressively compact lipid-depleted cells replace lipid-laden fasciculata cells.
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