Sleep like a baby?

The effect of a multicomponent multidisciplinary bundle of interventions on sleep and delirium in medical and surgical intensive care patients.
Patel J, Baldwin J, Bunting P, Laha S
Anaesthesia. 2014 Jun;69(6):540-9

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Trop tops?

Role of troponin in patients with chronic kidney disease and suspected acute coronary syndrome: a systematic review.

Sylvie R. Stacy, et al

Ann Intern Med. Published online 12 August 2014 doi:10.7326/M14-0746 Read more »

Esmolol in septic shock

Effect of heart rate control with esmolol on hemodynamic and clinical outcomes in patients with septic shock: a randomized clinical trial.

Morelli A1 et al

JAMA. 2013 Oct 23;310(16):1683-91. doi: 10.1001/jama.2013.278477.

STUDY APPRAISER: Dr David Smith Read more »

Hear no Evil?

The effect of earplugs during the night on the onset of delirium and sleep perception: a randomized controlled trial in intensive care patients

Van Rompaey et al. Critical Care 2012, 16:R73. (full text available)

 

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Extubation to NIPPV

Non-invasive ventilation immediately after extubation improves weaning outcome after acute respiratory failure: a randomized controlled trial.

Ornico SR, Lobo SM, Sanches HS, Deberaldini M, Tófoli LT, Vidal AM, Schettino GP, Amato MB, Carvalho CR, Barbas CS. Crit Care. 2013 Mar 4;17(2):R39. (full text available)

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Xtravent

Lower Tidal Volume Strategy (3ml/kg) Combined with Extracorporeal CO2 Removal Versus ‘Conventional’ Protective Ventilation (6 ml/kg) in Severe ARDS (Bein et al)

Intensive Care Med Vol 39, Issue 5, pg 847–856, May 2013

QMC AICU Journal Club, April 2013.

Dr Amit Pancholi 

 

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Salt is better than sugar

danharvey:

Here’s a taster of the excellent stuff available over at sthjournalclub. Go & follow this blog now!

Originally posted on STH Journal Club:

Myburgh JA, Finfer S, Bellomo R et al. Hydroxyethyl starch or saline for fluid resuscitation in intensive care. New England Journal of Medicine 2012; 367: 1901-1911.

RHH Journal Club. November 22nd, 2012. Dr Balaji Kasa

No free full-text available

To evaluate the safety and efficacy of 6% HES (130/0.4) in 0.9% saline as compared to 0.9% saline alone for fluid resuscitation in ICU.

Type of Study: Multicentre, Prospective, Blinded, Parallel group, Randomised controlled trial

Methodology:

Population:

7000 patients from 32 hospitals in Australia and New Zealand, 18 years or older eligible for admission to ICU and who met the criteria for fluid resuscitation

Exclusions: more than 1000mls of HES is administered to patient before screening, those with impending or current dialysis dependent renal failure and those with intracranial haemorrhage on CT scan.

Intervention /Control

HES(130/0.4) in 0.9% saline or 0.9% saline

Outcomes

Primary-…

View original 115 more words

STH Journal Club

STH Journal Club

An excellent new resource from our colleagues in Sheffield has arrived! They are now publishing short summaries of their “live” journal club on a blog (link above) and on a twitter stream (@sthjournalclub). We are planning to collaborate in the future, and I’d encourage all followers of Critical Insight to check them out and join in the discussions! In fact this resource is so good its rather put our recent output (zero) to shame…..I will put this right over the coming couple of months! 

A Black Water Day ?

Mortality after Fluid Bolus in African Children with Severe Infection. Maitland, K et al. New England Journal of Medicine, May 26th 2011 (epub ahead of print) (DOI: 10.1056/NEJMe1105490)
An interesting paper published in this weeks NEJM will cause substantial comment and concern after it’s headline result showed increased mortality with rapid fluid resuscitation in paediatric sepsis. This surprising result is potentially extremely important as, if verified, undermines much of peadiatric (and adult)emergency care.

Before examining the paper in detail it’s worth making a few comments on what we think we know already….

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The Pinocchio Effect

An interesting editorial published a couple of months ago in Anaesthesia by Neil Soni. It adds to the growing disquiet that our understanding of disease, and attempts to find effective remedies, are being hampered by the tendency to treat all organ failures equally. I agree that there seems little reason to believe that meningococal sepsis in an 18 year old will behave the same as peritonitis in an 80 year old, nor that ARDS following pancreatitis is the same as that following FFP. However, these syndromes were designed partly to make research into rare presentations possible. If we define patients according to causative factor and co-morbidity how are we ever to recruit enough to power even the most basic trial ?

ARDS, acronyms and the Pinocchio effect. Soni N.Anaesthesia. 2010 Oct;65(10):976-9. doi: 10.1111/j.1365-2044.2010.06508.x.PMID: 21198467

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