Category: Critical Care
Posted: 1/5/2010 by Mike Winters, MBA, MD
(Updated: 7/16/2024)
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AKI and the Critically Ill
Dennen P, Douglas IS, Anderson R. Acute kidney injury in the intensive care unit: An update and primer for the intensivist. Crit Care Med 2010; 38:261-27
Category: Critical Care
Posted: 12/28/2009 by Evadne Marcolini, MD
(Emailed: 12/29/2009)
(Updated: 7/16/2024)
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Category: Critical Care
Posted: 12/22/2009 by Mike Winters, MBA, MD
(Updated: 7/16/2024)
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Appropriate Antimicrobial Therapy for Sepsis
Kumar A, Ellis P, Arabi Y, et al. Initiation of inappropriate antimicrobial therapy results in a fivefold reduction of survival in human septic shock. Chest 2009; 136:1237-48.
Category: Critical Care
Posted: 12/15/2009 by Evadne Marcolini, MD
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Red blood cell transfusion in the critically ill patient has been and continues to be surrounded by controversy and lack of hard data. Up to 90 percent of transfusions in the ICU are given for anemia, an indication which is least supported by the data. The joint taskforce of EAST, ACCM and SCCM has published a clinical practice guideline which outlines recommendations and rationale. These recommendations are summarized as follows:
Napolitano LM et al: Clinical practice guideline: Red blood cell transfusion in adult trauma and critical care: Crit Care Med 2009;37:3124-3157
Category: Critical Care
Posted: 12/8/2009 by Mike Winters, MBA, MD
(Updated: 7/16/2024)
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Early Recognition of Shock
Strehlow MC. Early identification of shock in critically ill patients. Emerg Med Clin N Am 2010:28:57-66.
Category: Critical Care
Posted: 11/30/2009 by Evadne Marcolini, MD
(Emailed: 12/1/2009)
(Updated: 7/16/2024)
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Calciphylaxis is a rare disorder caused by systemic arteriolar calcification which leads to ischemia and necrosis. It is characterized by painful ischemic necrotic lesions on adipose tissue areas such as abdomen, buttock and thighs. This commonly occurs in patients with ESRD on hemodialysis or after transplant, but can also occur with other patients, such as those with hyperparathyroidism.
Diagnosis is made clinically, with the help of a skin biopsy as needed. Differential diagnosis includes cholesterol embolization, warfarin necrosis, cryoglobulinemia, cellulitis and vasculitis. There are no specific laboratory findings, although patients may manifest elevated PTH, phosphorous, calcium or calcium x phosphorous product.
Infection is usually the cause of the high mortality rate of this condition, which has a reported mortality of 46%, or 80% if ulceration is present.
Treatment includes local wound care, trauma avoidance, electrolyte correction, increased frequency of dialysis or parathyroidectomy as needed. Surgical debridement is controversial; as the risk of infection may outweigh the benefit in terms of outcome.
Reference:
Category: Critical Care
Posted: 11/17/2009 by Evadne Marcolini, MD
(Updated: 7/16/2024)
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There is no prospective, randomized study to elucidate propofol’s effect on the critically ill patient. By definition, Propofol Infusion Syndrome (PRIS) has the following characteristics:
It has been thought that PRIS was limited to patients with prolonged use, but we now know that this is not necessarily true.
It has been shown that PRIS is more likely with the following risk factors:
The treatment for suspected PRIS is:
Fudickar A, Bein B Propofol infusion syndrome: update of clinical manifestation and pathophysiology. Minerva Anestesiologica 2009;75:339-44.
Vernooy K, Delhaas T, et al. Electrocardiographic changes predicting sudden death in propofol-related infusion syndrome. Heart Rhythm 2006;3:131-7
Category: Critical Care
Posted: 11/10/2009 by Mike Winters, MBA, MD
(Updated: 7/16/2024)
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Severe Acute Pancreatitis
Greer SE, Burchard KW. Acute pancreatitis and critical illness: A pancreatic tale of hypoperfusion and inflammation. Chest 2009;136:1413-19.
Category: Critical Care
Posted: 11/3/2009 by Mike Winters, MBA, MD
(Updated: 7/16/2024)
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Hypoxemia in the Intubated Asthmatic
Brenner R, Corbridge T, Kazzi A. Intubation and mechanical ventilation of the asthmatic patient in respiratory failure. JEM 2009;37(2S):S23-34.
Category: Critical Care
Posted: 10/27/2009 by Mike Winters, MBA, MD
(Updated: 7/16/2024)
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This week's pearl is courtesy of Dr. Evie Marcolini. Thanks Evie!
Abdominal Compartment Syndrome in Burn Patients
Latenser BA. Critical care of the burn patient: The first 48 hours. Crit Care Med 2009;37:2819-2826.
Category: Critical Care
Posted: 10/20/2009 by Mike Winters, MBA, MD
(Updated: 7/16/2024)
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Extracorporeal Membrane Oxygenation
Schuerer DJE, Kolovos NS, Boyd KV, Coopersmith CM. Extracorporeal membrane oxygenation: Current clinical practice, coding, and reimbursement. Chest 2008;134:`79-84.
Category: Critical Care
Posted: 10/13/2009 by Mike Winters, MBA, MD
(Updated: 7/16/2024)
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Critically Ill Patients with H1N1
Dominguez-Cherit G, Lapinsky SE, Macias AE, et al. Critically ill patients with 2009 influenza A (H1N1) in Mexico. JAMA (published online October 12, 2009) doi:10.1001/jama.2009. 1536.
Kumar A, Zarychanski R, Pinto R, et al. Canadian Critical Care Trials Group H1N1 Collaborative. Critically ill patients with 2009 influenza A (H1N1) infection in Canada. JAMA (published online October 12, 2009) doi:10.1001/jama.2009. 1496.
The Australia and New Zealand Extracorporeal Membrane Oxygenation (ANZ ECMO) influenza Investigators. Extracorporeal membrane oxygenation for 2009 influenza A (H1N1) acute respiratory distress syndrome. JAMA (published online October 12, 2009) doi.10.1001/jama.2009. 1535.
Category: Critical Care
Posted: 10/6/2009 by Mike Winters, MBA, MD
(Updated: 7/16/2024)
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Damage Control Resuscitation
Beekley, AC. Damage control resuscitation: A sensible approach to the exsanguinating surgical patient. Crit Care Med 2008;36:S267-74.
Category: Critical Care
Posted: 9/22/2009 by Mike Winters, MBA, MD
(Updated: 7/16/2024)
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Mechanically Ventilated ED Patients and Secretion Mobilization
Robinson BRH, Athota KP, Branson RD. Inhalational therapies in the ICU. Curr Opin Crit Care 2009;15:1-9.
Category: Critical Care
Posted: 9/8/2009 by Mike Winters, MBA, MD
(Updated: 7/16/2024)
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Complications of Resuscitation
Buschmann CT, Tsokos M. Frequent and rare complications of resuscitation attempts. Intensive Care Med 2009;35:397-404.
Category: Critical Care
Posted: 9/1/2009 by Mike Winters, MBA, MD
(Updated: 7/16/2024)
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The Supraclavicular Subclavian Central Venous Cathetherization
Patrick SP, Tijunelis MA, Johnson S, Herbert ME. Supraclavicular subclavian vein catheterization: The forgotten central line. West J Emerg Med 2009;10(2):110-4.
Category: Critical Care
Posted: 8/25/2009 by Mike Winters, MBA, MD
(Updated: 7/16/2024)
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Pulse Pressure Variation and Volume Responsiveness
Marik PE, Cavallazzi R, Vasu T, Hirani A. Dynamic changes in arterial waveform derived variables and fluid responsiveness in mechanically ventilated patients: A systematic review of the literature. Crit Care Med 2009;37(9):2642-7.
Category: Critical Care
Posted: 8/18/2009 by Mike Winters, MBA, MD
(Updated: 7/16/2024)
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High Frequency Oscillatory Ventilation (HFOV)
Stawicki SP, Goyal M, Sarani B. High frequency oscillatory ventilation and airway pressure release ventilation: a practical guide. Journal of Intensive Care Medicine 2009:24(4):215-229.
Category: Critical Care
Posted: 8/11/2009 by Mike Winters, MBA, MD
(Updated: 7/16/2024)
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Airway Pressure Release Ventilation (APRV)
Stawicki SP, Goyal M, Sarani B. High-frequency oscillatory ventilation and airway pressure release ventilation: A practical guide. Journal of Intensive Care Medicine 2009;24(4):215-29.
Category: Critical Care
Posted: 8/4/2009 by Mike Winters, MBA, MD
(Updated: 7/16/2024)
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Antibiotic Dosing in the Critically Ill Septic Patient
Pea F, Viale P. Bench to bedside review: Appropriate antibiotic therapy in severe sepsis and septic shock - does the dose matter? Crit Care 2009;13:214.