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Intensive Care

March 4, 2016
Lactic acidosis is a very common biological issue for the postoperative patient with shock. This very nice review addresses thehemodynamic consequences of shock-associated lactic acidosis and highlights the various therapeutic options that can be considered by the bedside clinician.
March 4, 2016
The optimal timing of tracheotomy in critically ill patients remains a topic of debate. The Authors performed a systematic review to clarify the potential benefits of early versus late tracheotomy. Three categories of timing of tracheotomy (within 4 versus after 10 days, within 4 versus after 5 days, within 10 versus after 10 days) were analyzed.
February 23, 2016
This consensus effort provides a new definition for septic shock, which affects a subset of patients with sepsis.   The definition requires the presence of circulatory disturbances (BP unresponsive to fluids and requiring pressors), cellular and metabolic abnormalities (serum lactate level >2 mmol/L).  The presence of these criteria is associated
February 18, 2016
The authors studied the relationship of outcomes after non-cardiac surgery to blood transfusion among over 7,300 patients.   Patients with significant bleeding were excluded.  Patients were stratified according to the occurence of postoperative MI and the nadir hematocrit value (20-24%, 24-27%, 27-30%).  The outcome was 30-day mortality.   In the no-
January 30, 2016
Outcomes of CABG for patients in cardiogenic shock after acute MI were evaluated using data from the STS Database.  The study group of nearly 5,500 patients comprised 1.5% of all CABG patients during the study period.  Operative mortality was 18.7%.  Mechanical circulatory support use was most common in patients with more risk factors or high clinica
December 27, 2015
The authors tested a group of 176 patients undergoing cardiac surgery for dysphagia both preoperatively and postoperatively.  Preoperatively, 8.5% of patients failed the swallow test.  Postoperatively, 21.6% failed the test.  All patients who failed preoperatively also failed postoperatively.
November 16, 2015
Data from a large multicenter registry were evaluated to determine whether there is a sex difference in susceptibility to acute kidney injury after CBP related to nadir hematocrit levels.  Based on a 21% hematocrit threshold, 9.5% of men and 31.9% of women were affected.  Rates of AKI were similar between the sexes.  There was a strong interaction be
September 4, 2015
This study from the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative evaluated outcomes of CABG in 33 hospitals 2011-2013, assessing the association of blood transfusion (39.9% of pts) and the incidence of postoperative pneumonia (3.6% of pts).   Blood transfusion was associated with an increased risk of pneumonia (OR 3.
July 14, 2015
This small randomized trial evaluated the potential benefits of ghrelin, an anti-inflammatory agent, in reducing the SIRS response after esophagectomy.  The ghrelin group had a reduced SIRS duration, lower CRP levels, and lower IL-6 levels compared to controls.  Pulmonary complications were reduced in the ghrelin group, but other complication inciden
July 6, 2015
This is a provocative study questioning the current practice of using blood pressure targets perioperatively to ensure adequate perfusion.  Plasma levels of a brain-specific injury biomarker (GFAP) were measured in 121 patients undergoing cardiac surgery.

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