Articles related to CRITICAL CARE

In this video, Zack Shinar, MD, discusses the future of cardiac arrest and the role of extracorporeal membrane oxygenation (ECMO) in the emergency department (ED). Dr. Shinar is a leading expert in ECMO and has been instrumental in developing new protocols for its use in the ED. Dr. Shinar begins by discussing the current state of CPR. He notes that CPR is only effective in about 10% of cases, and that even when it is successful, patients often suffer significant brain damage. He then discusses ECMO, which is a life-support machine that can oxygenate the blood outside of the body. ECMO has been shown to be effective in saving the lives of patients with cardiac arrest, and Dr. Shinar believes that it should be used more widely in the ED. Dr. Shinar then discusses the challenges of using ECMO in the ED. He notes that ECMO is a complex procedure that requires specialized training and equipment. He also notes that ECMO can be expensive, and that it is not always available in all hospitals.

In this study, 800 patients admitted to ICU for severe CAP were andomized to 200mg IV hydrocortisone daily for 4 to 8 days or to placebo. By day 28, mortality rate was 6.2% versus 11.9% for the steroid and placebo groups, respectively. Rates for intubation and vasopressors were both approximately 40% lower in the test group as well.

In a randomized study involving 750 ICU patient on mechanical ventilation, minimizing sedation and employing daily physiotherapy did not yield better outcomes vs. standard care – but did increase the number of adverse events.

This study of 2,500 adults receiving mechanical ventilation randomized 1/3 were assigned to an exigent saturation target pf 90%, 1/3 to a target of 94%, and 1/3 to a target of 98%. The median number of ventilator-free days was 20, 21, and 21 for the three target groups, respectively. In-hospital death by day 28 was 34.8%, 34.0%, and 33.2% for the three groups, respectively.

In this randomized study of 1,000 patients with delirium admitted to the ICU, patients receiving haloperidol showed no significant difference in survival compared with patients who received placebo.

The first set of guidelines for critical illness-related corticosteroid insufficiency (CIRCI) was published in 2008. In this review of critical illness-related corticosteroid insufficiency, the author reviews the current thinking regarding this relatively newly defined complex and the changing recommendations for management.