Archive for the ‘Uncategorized’ Category

Early NA in sepsis

Early vs delayed administration of norepinephrine in patients with septic shock. Bai et al. Critical Care 2014, 18:532

Appraisal by Dr. Peter Tsim.  Continue reading

Advertisements

Procalcitonin – D Dimer for sepsis?

The following discussion is taken from a presentation given at JC by Dr Dave Hewson, ST5 Anaesthetics, in which he explores the utility of PROCALCITONIN: Continue reading

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)

 

Continue reading

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 

 

Continue reading

Salt is better than sugar

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

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 post 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! 

Oxygen – too much of a good thing ?

We’ve known for sometime that high inspired oxygen fractions (>0.8) are associated with atelechasis (and decruitment / shunt) and lung injury and suspected that hyperoxia also leads to the generation of toxic oxygen free radicals, which may have deleterious effects in other pathologies. A recent paper adds to this story;

Association between arterial hypoxia following resuscitation from cardiac arrest and In Hopsital mortality. Hope, J et al. JAMA. 2010;303(21):2165-2171 (doi:10.1001/jama.2010.707).

This paper has been appraised by a colleague, Paul Townsley, and you can download his presentation from the blue box on the right. Although the methodology has some potential flaws (which is probably inevitable), the paper provides evidence of definite harm of hyperoxia in ischemic brain injury.

Of course, there is an alternative weight of evidence of the harm associated with even short periods of desaturation in traumatic brain injury (and presumably also brain injury from poor perfusion). How to square this circle? The devil as always is in the detail. Controlling hyperoxia is probably important, but whether the benefits of avoiding hyperoxia outweigh the additional risk of periods of desaturation, or how often those periods occur within patient populations, is unknown. There is sufficient evidence to warrant a carefully designed RCT in the post resuscitation phase, (and maybe also in ARDS while we’re at it).

Derby’s Finest

Two excellent recent articles from local clinicians that had to be featured on Critical Insight. An upcoming post will include a review article on Ketamine in ICU, but first…

Should we really be more “balanced” in our fluid prescribing ? Morris, C. Boyd, A. Reynolds, N. Anaesthesia, 2009 Jul;64(7):703.

A very good editorial questioning the rush away from hypercholreamic solutions despite the lack of clear evidence of benefit. They’re making a habit of insightful editorials. Without stealing their thunder, they make some excellent points regarding the potential physiological impact of negative anions (such as lactate and acetate) in situations of poor organ perfusion. A question the editorial doesn’t ask which springs to mind – how are we to assess the risk of fluid regimens without having to repeat the SAFE study for every potential option? At the same time can we tolerate the introduction of new fluids into the critically ill with very little evidence base ?

Dexmedetomidine vs Midazolam

Dexmedetomidine vs Midazola for sedation of critically ill patients : A randomised control trial. Riker, R. et al. JAMA 301 (5) 489-99.

This prospective, double blind, multicentred RCT compared the alpha agonist dexmedotomdine against midazolam. It was designed to assess safety & efficacy. A total of 375 patients expected to be ventilated for > 24hrs were randomised to either agent targeted to a RASS score of between -2 to +1. Primary outcome measure was period of time within target range, secondary end points included delirium scores & duration of ventilation Continue reading

Academy of Royal Colleges – Diagnosis of Death

After a long process of consultation the Academy of Medical Royal Colleges have released the Code of Practise for the Diagnosis and Confirmation of Death. Always a topic likely to cause controversy – see previous posts! The document can be downloaded from the blue box, or here. I’m sure there will be plenty of comments, I’ll be posting my own shortly…….