Revisiting therapeutic hypothermia for severe traumatic brain injury...again. Critical Care 2014, 18: 160
Marion, D.W. and Regasa, L.E.
http://ccforum.com/content/18/3/160
Improved understanding of the molecular mechanisms of secondary brain injury has informed the optimum depth and duration of cooling and led to increased clinical interest in the therapeutic moderate hypothermia for severe traumatic brain injury over the past two decades. Although several large multi-center clinical trials have not found a treatment effect, multiple single-center trials have, and a recent meta-analysis by Crossley and colleagues now finds that the cumulative findings of those single-center trials dilute the multi-center trial results and show an overall reduction in mortality and poor outcomes associated with cooling. The need for consistent support of key physiologic parameters during cooling is emphasized by this finding.
Monday, 30 June 2014
It's not just the antibiotics, it's the treatment
It's not just the antibiotics, it's the treatment. Critical Care 2014, 18: 147
Guidry, C.A. and Sawyer, R.G.
http://ccforum.com/content/18/3/147
The recent study by Bloos and colleagues demonstrates that early initiation of antimicrobial therapy is not associated with improved survival in sepsis. We contend that these findings should not be surprising. This study is yet another part of the growing case against early and aggressive antimicrobial therapy and highlights the important roles resuscitation and source control play in the management of the septic patient. We suggest that, whenever possible, antimicrobial therapy should we withheld until objective evidence of infection has been obtained.
Guidry, C.A. and Sawyer, R.G.
http://ccforum.com/content/18/3/147
The recent study by Bloos and colleagues demonstrates that early initiation of antimicrobial therapy is not associated with improved survival in sepsis. We contend that these findings should not be surprising. This study is yet another part of the growing case against early and aggressive antimicrobial therapy and highlights the important roles resuscitation and source control play in the management of the septic patient. We suggest that, whenever possible, antimicrobial therapy should we withheld until objective evidence of infection has been obtained.
Intensive care unit admission in chronic obstructive pulmonary disease
Intensive care unit admission in chronic obstructive pulmonary disease: patient information and the physician's decision-making process. Critical Care 2014, 18: R115
Schmidt, M., et al.
http://ccforum.com/content/pdf/cc13906.pdf
ICU admission is required in more than 25% of patients with chronic obstructive pulmonary disease (COPD) at some time during the course of the disease. However, only limited information is available on how physicians communicate with COPD patients about ICU admission. COPD patients and relatives from 19 French ICUs were interviewed at ICU discharge about their knowledge of COPD. French pulmonologists self-reported their practices for informing and discussing intensive care treatment preferences with COPD patients. Finally, pulmonologists and ICU physicians reported barriers and facilitators for transfer of COPD
patients to the ICU and to propose invasive mechanical ventilation.
Schmidt, M., et al.
http://ccforum.com/content/pdf/cc13906.pdf
ICU admission is required in more than 25% of patients with chronic obstructive pulmonary disease (COPD) at some time during the course of the disease. However, only limited information is available on how physicians communicate with COPD patients about ICU admission. COPD patients and relatives from 19 French ICUs were interviewed at ICU discharge about their knowledge of COPD. French pulmonologists self-reported their practices for informing and discussing intensive care treatment preferences with COPD patients. Finally, pulmonologists and ICU physicians reported barriers and facilitators for transfer of COPD
patients to the ICU and to propose invasive mechanical ventilation.
Continuous glucose control in the ICU
Continuous glucose control in the ICU: report of a 2013 round table meeting. Critical Care 2014, 18: 226
Wernerman, J., et al.
http://ccforum.com/content/18/3/226
Achieving adequate glucose control in critically ill patients is a complex but important part of optimal patient management. Until relatively recently, intermittent measurements of blood glucose have been the only means of monitoring blood glucose levels. With growing interest in the possible beneficial effects of continuous over intermittent monitoring and the development of several continuous glucose monitoring (CGM) systems, a round table conference was convened to discuss and, where possible, reach consensus on the various aspects related to glucose monitoring and management using these systems. In this report, we discuss the advantages and limitations of the different types of devices available, the potential advantages of continuous over intermittent testing, the relative importance of trend and point accuracy, the standards necessary for reporting results in clinical trials and for recognition by official bodies, and the changes that may be needed in current glucose management protocols as a result of a move towards increased use of CGM. We close with a list of the research priorities in this field, which will be necessary if CGM is to become a routine part of daily practice in the management of critically ill patients.
Wernerman, J., et al.
http://ccforum.com/content/18/3/226
Achieving adequate glucose control in critically ill patients is a complex but important part of optimal patient management. Until relatively recently, intermittent measurements of blood glucose have been the only means of monitoring blood glucose levels. With growing interest in the possible beneficial effects of continuous over intermittent monitoring and the development of several continuous glucose monitoring (CGM) systems, a round table conference was convened to discuss and, where possible, reach consensus on the various aspects related to glucose monitoring and management using these systems. In this report, we discuss the advantages and limitations of the different types of devices available, the potential advantages of continuous over intermittent testing, the relative importance of trend and point accuracy, the standards necessary for reporting results in clinical trials and for recognition by official bodies, and the changes that may be needed in current glucose management protocols as a result of a move towards increased use of CGM. We close with a list of the research priorities in this field, which will be necessary if CGM is to become a routine part of daily practice in the management of critically ill patients.
Midazolam and propofol used alone or sequentially for long-term sedation in critically ill, mechanically ventilated patients
Midazolam and propofol used alone or sequentially for long-term sedated, critically ill patients: a prospective, randomized study. Critical Care 2014, 18: R122
Zhou, Y., et al.
http://ccforum.com/content/pdf/cc13922.pdf
Midazolam and propofol used alone for long-term sedation are associated with adverse effects. Sequential use may reduce the adverse effects, and lead to faster recovery, earlier extubation and lower costs. This study evaluates the effects, safety, and cost of midazolam, propofol, and their sequential use for long-term sedation in critically ill mechanically ventilated patients.
Zhou, Y., et al.
http://ccforum.com/content/pdf/cc13922.pdf
Midazolam and propofol used alone for long-term sedation are associated with adverse effects. Sequential use may reduce the adverse effects, and lead to faster recovery, earlier extubation and lower costs. This study evaluates the effects, safety, and cost of midazolam, propofol, and their sequential use for long-term sedation in critically ill mechanically ventilated patients.
Long-term outcome of delirium during intensive care unit stay in survivors of critical illness
Long-term outcome of delirium during intensive care unit stay in survivors of critical illness: a prospective cohort study. Critical Care 2014, 18: R125
Wolters, A.E., et al.
http://ccforum.com/content/pdf/cc13929.pdf
Delirium is associated with impaired outcome, but it is unclear whether this relationship is limited to in-hospital outcomes and whether this relationship is independent of the severity of underlying conditions. The aim of this study was to investigate the association between delirium in the intensive care unit (ICU) and long-term mortality, self-reported health-related quality of life (HRQoL), and self-reported problems with cognitive functioning in survivors of critical illness, taken severity of illness at baseline and throughout ICU stay into account.
Wolters, A.E., et al.
http://ccforum.com/content/pdf/cc13929.pdf
Delirium is associated with impaired outcome, but it is unclear whether this relationship is limited to in-hospital outcomes and whether this relationship is independent of the severity of underlying conditions. The aim of this study was to investigate the association between delirium in the intensive care unit (ICU) and long-term mortality, self-reported health-related quality of life (HRQoL), and self-reported problems with cognitive functioning in survivors of critical illness, taken severity of illness at baseline and throughout ICU stay into account.
Inflammation biomarkers and delirium in critically ill patients
Inflammation biomarkers and delirium in critically ill patients: new insights? Critical Care 2014, 18:153
Sobbi, S.C. and van den Boogaard, M.
http://ccforum.com/content/18/3/153
The pathophysiological mechanism of the serious and frequently occurring disorder delirium is poorly understood. Inflammation and sepsis are known risk factors for ICU delirium and therefore these patients are highly susceptible to delirium. Several studies have been performed to determine which cytokines are most associated with delirium but the results are inconclusive. Also, new biomarkers associated with brain dysfunction and cognitive impairment are still recognized and need to be studied to determine their relation with delirium. In this commentary we address some limitations concerning an interesting new study that warrants directions for future studies.
Sobbi, S.C. and van den Boogaard, M.
http://ccforum.com/content/18/3/153
The pathophysiological mechanism of the serious and frequently occurring disorder delirium is poorly understood. Inflammation and sepsis are known risk factors for ICU delirium and therefore these patients are highly susceptible to delirium. Several studies have been performed to determine which cytokines are most associated with delirium but the results are inconclusive. Also, new biomarkers associated with brain dysfunction and cognitive impairment are still recognized and need to be studied to determine their relation with delirium. In this commentary we address some limitations concerning an interesting new study that warrants directions for future studies.
Tight glycemic control in the ICU
Tight glycemic control in the ICU - is the earth flat? Critical Care 2014, 18: 159
Steil, G.M. and Agus, M.S.D.
http://ccforum.com/content/18/3/159
Tight glycemic control in the ICU has been shown to reduce mortality in some but not all prospective randomized control trials. Confounding the interpretation of these studies are differences in how the control was achieved and underlying incidence of hypoglycemia, which can be expected to be affected by the introduction of continuous glucose monitoring (CGM). In this issue of Critical Care, a consensus panel provides a list of the research priorities they believe are needed for CGM to become routine practice in the ICU. We reflect on these recommendations and consider the implications for using CGM today.
Steil, G.M. and Agus, M.S.D.
http://ccforum.com/content/18/3/159
Tight glycemic control in the ICU has been shown to reduce mortality in some but not all prospective randomized control trials. Confounding the interpretation of these studies are differences in how the control was achieved and underlying incidence of hypoglycemia, which can be expected to be affected by the introduction of continuous glucose monitoring (CGM). In this issue of Critical Care, a consensus panel provides a list of the research priorities they believe are needed for CGM to become routine practice in the ICU. We reflect on these recommendations and consider the implications for using CGM today.
Persistent inflammation and T cell exhaustion in severe sepsis in the elderly
Persistent inflammation and T cell exhaustion in severe sepsis in the elderly. Critical Care 2014, 18: R130
Inoue, S., et al.
http://ccforum.com/content/pdf/cc13941.pdf
Sepsis is known as a complex immunological response with hyperinflammation in the acute
phase followed by immunosuppression. Although aging is crucial in sepsis, the impact of
aging on inflammation and immunosuppression is still unclear. The purpose of this study was
to investigate the relationship between inflammation and immunosuppression in aged patients
and mice after sepsis.
Inoue, S., et al.
http://ccforum.com/content/pdf/cc13941.pdf
Sepsis is known as a complex immunological response with hyperinflammation in the acute
phase followed by immunosuppression. Although aging is crucial in sepsis, the impact of
aging on inflammation and immunosuppression is still unclear. The purpose of this study was
to investigate the relationship between inflammation and immunosuppression in aged patients
and mice after sepsis.
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