The obesity paradox in the ICU: real or not? Critical care, June 2013, 17: 154.
Dickerson, R.N.
[no link available]
The obesity paradox has been used to describe the observed phenomenon described by several studies that indicated improved survival for critically ill patients with mild to moderate obesity when compared with their lean counterparts. The study by Arabi and coworkers challenges the obesity paradox concept for critically ill obese patients with septic shock. Their data indicate that obesity, per se, does not significantly improve mortality when outcomes are adjusted for differences in baseline characteristics and sepsis interventions. Further studies are needed to assess the influence of body weight, lean weight, and fat mass for optimizing fluid resuscitation, pharmacotherapy, and nutritional therapy for critically ill patients with sepsis.
Thursday, 13 June 2013
Intensive care sedation
Intensive care sedation: the past, present and the future. Critical care, June 2013, 17: 332.
Shehabi, Y., et al.
[no link available]
Despite the universal prescription of sedative drugs in the intensive care unit (ICU), current practice is not guided by high-level evidence. Landmark sedation trials have made significant contributions to our understanding of the problems associated with ICU sedation and have promoted changes to current practice. We identified challenges and limitations of clinical trials which reduced the generalizability and the universal adoption of key interventions. We present an international perspective regarding current sedation practice and a blueprint for future research, which seeks to avoid known limitations and generate much-needed high-level evidence to better guide clinicians' management and therapeutic choices of sedative agents.
Shehabi, Y., et al.
[no link available]
Despite the universal prescription of sedative drugs in the intensive care unit (ICU), current practice is not guided by high-level evidence. Landmark sedation trials have made significant contributions to our understanding of the problems associated with ICU sedation and have promoted changes to current practice. We identified challenges and limitations of clinical trials which reduced the generalizability and the universal adoption of key interventions. We present an international perspective regarding current sedation practice and a blueprint for future research, which seeks to avoid known limitations and generate much-needed high-level evidence to better guide clinicians' management and therapeutic choices of sedative agents.
Monday, 10 June 2013
Hospital variation and temporal trends in palliative and end-of-life care in the ICU
Hospital variation and temporal trends in palliative and end-of-life care in the ICU. Critical care medicine, June 2013, Vol. 41(6), p.1404-11
DeCato, T.W., et al.
http://journals.lww.com/ccmjournal/Abstract/2013/06000/Hospital_Variation_and_Temporal_Trends_in.3.aspx
Although studies have shown regional and interhospital variability in the intensity of end-of-life care, few data are available assessing variability in specific aspects of palliative care in the ICU across hospitals or interhospital variability in family and nurse ratings of this care. Recently, relatively high family satisfaction with ICU end-of-life care has prompted speculation that ICU palliative care has improved over time, but temporal trends have not been documented.
DeCato, T.W., et al.
http://journals.lww.com/ccmjournal/Abstract/2013/06000/Hospital_Variation_and_Temporal_Trends_in.3.aspx
Although studies have shown regional and interhospital variability in the intensity of end-of-life care, few data are available assessing variability in specific aspects of palliative care in the ICU across hospitals or interhospital variability in family and nurse ratings of this care. Recently, relatively high family satisfaction with ICU end-of-life care has prompted speculation that ICU palliative care has improved over time, but temporal trends have not been documented.
Physical therapy for the critically ill in the ICU
Physical therapy for the critically ill in the ICU: A systematic review and meta-analysis. Critical care medicine, June 2013, Vol. 41(6), p.1543-54.
Kayambu, G., et al.
http://journals.lww.com/ccmjournal/Abstract/2013/06000/Physical_Therapy_for_the_Critically_Ill_in_the.19.aspx
The purpose of this systematic review was to review the evidence base for exercise in critically ill patients.
Kayambu, G., et al.
http://journals.lww.com/ccmjournal/Abstract/2013/06000/Physical_Therapy_for_the_Critically_Ill_in_the.19.aspx
The purpose of this systematic review was to review the evidence base for exercise in critically ill patients.
Physicians' decision-making roles for an acutely unstable critically and terminally ill patient
Physicians' decision-making roles for an acutely unstable critically and terminally ill patient. Critical care medicine, June 2013, Vol. 41(6), p.1511-17
Uy, J., et al.
http://journals.lww.com/ccmjournal/Abstract/2013/06000/Physicians__Decision_Making_Roles_for_an_Acutely.15.aspx
There is substantial variation in use of life sustaining technologies in patients near the end of life but little is known about variation in physicians’ initial ICU admission and intubation decision making processes. Our objective is to describe variation in hospital-based physicians’ communication behaviors and decision-making roles for ICU admission and intubation decisions for an acutely unstable critically and terminally ill patient.
Uy, J., et al.
http://journals.lww.com/ccmjournal/Abstract/2013/06000/Physicians__Decision_Making_Roles_for_an_Acutely.15.aspx
There is substantial variation in use of life sustaining technologies in patients near the end of life but little is known about variation in physicians’ initial ICU admission and intubation decision making processes. Our objective is to describe variation in hospital-based physicians’ communication behaviors and decision-making roles for ICU admission and intubation decisions for an acutely unstable critically and terminally ill patient.
Early alterations of B cells in patients with septic shock
Early alterations of B cells in patients with septic shock. Critical care, 2013, 17: R105
Monserrat, J., et al.
http://ccforum.com/content/17/3/R105/abstract
It has been recently proposed that B-lymphocytes are involved in sepsis pathogenesis. The goal of this study is to investigate potential abnormalities in subset distribution and activation of circulating B-lymphocytes in patients with septic shock.
Monserrat, J., et al.
http://ccforum.com/content/17/3/R105/abstract
It has been recently proposed that B-lymphocytes are involved in sepsis pathogenesis. The goal of this study is to investigate potential abnormalities in subset distribution and activation of circulating B-lymphocytes in patients with septic shock.
Dexmedetomidine use in the ICU
Dexmedetomidine use in the ICU: Are we there yet? Critical care, 2013, 17: R320.
Ahmed, S. and Murugan, R.
http://ccforum.com/content/17/3/320
Long-term sedation with midazolam or propofol in intensive care units (ICUs) has serious adverse effects. Dexmedetomidine, an alpha-2 agonist available for ICU sedation, may reduce the duration of mechanical ventilation and enhance patient comfort.
Ahmed, S. and Murugan, R.
http://ccforum.com/content/17/3/320
Long-term sedation with midazolam or propofol in intensive care units (ICUs) has serious adverse effects. Dexmedetomidine, an alpha-2 agonist available for ICU sedation, may reduce the duration of mechanical ventilation and enhance patient comfort.
Assessment and clinical course of hypocalcemia in critical illness
Assessment and clinical course of hypocalcemia in critical illness. Critical care, 2013, 17: R106.
Steele, T., et al.
http://ccforum.com/content/17/3/R106/abstract
Hypocalcemia is common in critically ill patients. However, its clinical course during the early days of admission and the role of calcium supplementation remain uncertain, and the assessment of calcium status is inconsistent. We aimed to establish the course of hypocalcemia during the early days of critical illness in relation to mortality and to assess the impact of calcium supplementation on calcium normalization and mortality.
Steele, T., et al.
http://ccforum.com/content/17/3/R106/abstract
Hypocalcemia is common in critically ill patients. However, its clinical course during the early days of admission and the role of calcium supplementation remain uncertain, and the assessment of calcium status is inconsistent. We aimed to establish the course of hypocalcemia during the early days of critical illness in relation to mortality and to assess the impact of calcium supplementation on calcium normalization and mortality.
Early parenteral nutrition in critically ill patients
Early parenteral nutrition in critically ill patients with short-term relative contraindications to early enteral nutrition: a randomized controlled trial. JAMA, 309, 20; p.2130-38
Doig, G.S., et al.
http://jama.jamanetwork.com/article.aspx?articleid=1689534
Doig, G.S., et al.
http://jama.jamanetwork.com/article.aspx?articleid=1689534
Systematic reviews suggest adult patients in intensive care units (ICUs) with relative contraindications to early enteral nutrition (EN) may benefit from parenteral nutrition (PN) provided within 24 hours of ICU admission. Objective: To determine whether providing early PN to critically ill adults with relative contraindications to early EN alters outcomes.
Continuous electroencephalography monitoring in critically ill patients
Continuous electroencephalography monitoring in critically ill patients: indications, limitations and strategies. Critical care medicine, April 2013, Vol. 41(4), p.1124-32
Sutter, R., et al.
[Link not available]
OBJECTIVE: Continuous electroencephalography as a bedside monitor of cerebral activity has been used in a range of critically ill patients. This review compiles the indications, limitations, and strategies for continuous electroencephalography in the ICU. DATA SOURCE: The authors searched the electronic MEDLINE database.
STUDY SELECTION AND DATA EXTRACTION: References from articles of special interest were selected.
DATA SYNTHESIS AND CONCLUSION: Electroencephalographically-defined suppression is routinely used as the basis for titration of pharmacologic therapy in refractory status epilepticus and intracranial hypertension. The increasing use of continuous electroencephalography reveals a clinically underappreciated burden of epileptiform and epileptic activity in patients with primary acute neurologic disorders, and also in critically ill patients with acquired encephalopathy. Status epilepticus is reported with continuous electroencephalography in 1% to 10% of patients with ischemic stroke, 8% to 14% with traumatic brain injury, 10% to 14% with subarachnoid hemorrhage, 1% to 21% with intracerebral hemorrhage, and 30% of patients following cardiorespiratory arrest. These figures underscore the importance of continuous electroencephalography in the critically ill. The interpretation of continuous electroencephalography in the ICU is challenged by electroencephalography artifacts and the frequent subtle differences between ictal and interictal patterns.
Sutter, R., et al.
[Link not available]
OBJECTIVE: Continuous electroencephalography as a bedside monitor of cerebral activity has been used in a range of critically ill patients. This review compiles the indications, limitations, and strategies for continuous electroencephalography in the ICU. DATA SOURCE: The authors searched the electronic MEDLINE database.
STUDY SELECTION AND DATA EXTRACTION: References from articles of special interest were selected.
DATA SYNTHESIS AND CONCLUSION: Electroencephalographically-defined suppression is routinely used as the basis for titration of pharmacologic therapy in refractory status epilepticus and intracranial hypertension. The increasing use of continuous electroencephalography reveals a clinically underappreciated burden of epileptiform and epileptic activity in patients with primary acute neurologic disorders, and also in critically ill patients with acquired encephalopathy. Status epilepticus is reported with continuous electroencephalography in 1% to 10% of patients with ischemic stroke, 8% to 14% with traumatic brain injury, 10% to 14% with subarachnoid hemorrhage, 1% to 21% with intracerebral hemorrhage, and 30% of patients following cardiorespiratory arrest. These figures underscore the importance of continuous electroencephalography in the critically ill. The interpretation of continuous electroencephalography in the ICU is challenged by electroencephalography artifacts and the frequent subtle differences between ictal and interictal patterns.
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