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Intensive Care

August 11, 2014
In an effort to identify clinical findings associated with deterioration and mortality after PE, the authors prospectively monitored 298 pts admitted through the ED with documented PE.  34% of pts experienced clinical deterioration, which was associated with hypotension, hypoxia, residual DVT, CAD, and right heart strain on echocardiogram.  In contra
August 6, 2014
This prospective trial from 14 ICUs in northern Europe evaluated the potential benefit of adding immune-modulating nutrients (IMHP) to standard enteral nutrition in reducing infectious complications in ventilated patients.  The addition of IMHP did not alter the incidence of infectious complications, but was associated with much worse 6 month surviva
August 5, 2014
This study investigated failure to rescue from cardiac arrest after cardiac surgery in a data set of nearly 80,000 pts in order to determine whether variability in this outcome might provide an opportunity for quality improvement in low-performing hospitals.  The overall failure to rescue rate was 60% among over 4,100 pts who experienced postoperativ
June 22, 2014
This prospective study evaluated the relationship of inflammatory gene polymorphisms and postoperative pneumonia after esophagectomy in 120 pts.  One genotype for IL-10 was significantly associated with reduced postoperative serum IL-10 levels and an increased rate of postoperative pneumonia.  IL-10 polymorphism was an independent predictor of pneumo
June 22, 2014
This multicenter prospective study evaluated indications for and outcomes of ICU admission for 449 patients with lung cancer.  Most patients had a newly diagnosed lung cancer, and the most common indication for ICU admission was airway compromise.  Hospital and 6-month mortality rates were 39% and 55%.  Determinants of mortality were severity of orga
June 1, 2014
This is a nice video that demonstrates what items are required to safely perform an emergency resternotomy.    Might be a nice video to show to your ICU nurses or those who might be required to assist in an emergency resternotomy. 
May 23, 2014
In this extensive review, the authors focus on extracorproreal membrane oxygenation (ECMO), both for cardiac and respiratory failure. They describe the explosive increase in ECMO use, the expanding indications, and the need for more evidence-based use.
May 6, 2014
The authors reviewed transfusion practices after cardiac surgery in Australia and New Zealand using a database of nearly 43,000 patients.  Transfusion rates for >=1 unit varied 3-fold (22% to 67%), for >=5 units varied 5-fold, >=1 platelet pack varied 3-fold, >=1 FFP varied 4 fold, and >=1 cryoprecipitate varied 20-fold.  The differenc
April 24, 2014
The authors, well-known experts in critical care medicine, provide a detailed and usedful overview of critical illness polyneuropathy.  This affects 25% to 100% of ICU patients and is associated with impaired recovery after cricial illness.
April 14, 2014
This study evaluated the use of ultrasound to assess diaphragm thickening, rather than diaphragm motion, to predict extubation success.  Measurements were made in 63 ventilated patients, end-expiration and end-inspiration differences in thickness during spontaneous breathing were calculated, and the outcome was extubation within 48 hr.  The ROC AUC w