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CriticalCare

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Critical Care

The Surviving Sepsis Campaign [1] advocates maintaining a mean arterial pressure (MAP) of at least 65 mm Hg in sepsis patients undergoing resuscitation. Leone and colleagues [2], in an article published in this journal, suggest considering higher MAP targets in the resuscitation of patients with a history of arterial hypertension so they do not progress to acute kidney injury. Asfar and colleagues [3], in a multicenter, open-label trial, showed no significant difference in mortality outcomes in septic shock patients undergoing resuscitation with an MAP target of either 80 to 85 mm Hg (high-target group) or 65 to 70 mm Hg (low-target group). However, the study did show that chronic hypertensive patients in the higher-target group had lower incidences of acute kidney injury and renal replacement therapy. This likely stems from the need for higher MAPs in chronic hypertensive patients in order to maintain organ blood flow because of a shift of the organ’s autoregulatory range to the right. Thus, targeting a higher MAP for chronic hypertensive patients may help avoid the development of acute kidney injury and the need for renal replacement therapy. Renal replacement therapy carries with it inherent morbidity as well as additional cost. These costs include the need for dialysate fluid and extra personnel and the use of anticoagulation and the extracorporeal circuit [2]. However, chronic hypertensive patients in the high-target group had a greater incidence of new-onset atrial fibrillation (5.2% in the low-target group versus 9% in the high-target group). Patients with new-onset atrial fibrillation during sepsis have been shown to have increased incidences of in-hospital stroke and in-hospital mortality [4] as well as subsequent recurrence of atrial fibrillation and increased long-term risks for heart failure, ischemic stroke, and death [5]. This may offset any benefit of a higher MAP. The ideal target MAP may have to be individualized for specific patient populations. More studies are needed to determine whether baseline blood pressure plays a role in the ultimate determination of the ideal MAP target for patients with sepsis.  
ccforum.com
over 5 years ago
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Critical Care

Neutrophil gelatinase-associated lipocalin (NGAL), cystatin C (Cys-C), and soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) are novel diagnostic biomarkers of acute kidney injury (AKI). We aimed to determine the diagnostic properties of these biomarkers for detecting AKI in critically ill patients with sepsis.  
ccforum.com
over 5 years ago
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Critical Care

Acute Kidney Injury (AKI) is common in critical ill populations and its association with high short-term mortality is well established. However, long-term risks of death and renal dysfunction are poorly understood and few studies exclude patients with pre-existing renal disease, meaning outcome for de novo AKI has been difficult to elicit. We aimed to compare the long-term risk of Chronic Kidney Disease (CKD), End Stage Renal Disease (ESRD) and mortality in critically ill patients with and without severe de novo AKI.  
ccforum.com
over 5 years ago
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Critical Care

Pseudomonas aeruginosa nosocomial pneumonia (Pa-NP) is associated with considerable morbidity, prolonged hospitalization, increased costs, and mortality.  
ccforum.com
over 5 years ago
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Critical Care

The modern-era abdominal compartment syndrome (ACS) was first described as a ‘new’ clinical entity in the 1980s in emergency surgery patients, despite being described over 100 years earlier [1]. This stimulated scientific research leading to a better understanding of ACS, and the development of strategies to prevent and treat the condition [2]. Simultaneously, several investigators described the impact of the prelude to ACS – intra-abdominal hypertension (IAH), where organ function is impaired at lower intra-abdominal pressure (IAP) in the range of 12–20 mmHg [3]. This new knowledge has improved our understanding of the interactions between the different body compartments and new pathophysiologic terms have been coined, such as the polycompartment syndrome [4]. Within this concept, abdominal wall compliance seems to be a key factor that has only recently been better investigated [5].  
ccforum.com
over 5 years ago
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Advanced Haemodynamic Simulation - Intensive Care Network

Dr Laurence Weinberg performs physiological experiments on his volunteer to demonstrate the use of the Flo Trac Advanced Haemodynamic Monitoring system. Presented at SMACCGold 2014.  
intensivecarenetwork.com
over 5 years ago
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Education in ICU - Intensive Care Network

Education is one of the core things that we do in our ICUs. It matters. One day, it might be us in that bed and at very least we want to know that the doctor or nurse making the decisions about our health and management knows what they are on about.  
intensivecarenetwork.com
over 5 years ago
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Myburgh Fluids 2015 - Intensive Care Network

Myburgh Fluids 2015: John takes us through 200 yrs of crit care fluids therapy in 1 powerful presentation. Warning - may leave you questioning everything.  
intensivecarenetwork.com
over 5 years ago
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Radiology Case 21 - Intensive Care Network

Aortic dissection case presentation & CT scan.  
intensivecarenetwork.com
over 5 years ago
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JICS Cast July 2014 - Intensive Care Network

JICS Cast July 2014 is a podcast featuring articles published in the Journal of the Intensive Care Society: Diabetic ketoacidosis, ECHO for PE and much more  
intensivecarenetwork.com
over 5 years ago
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CRRT Troubleshooting - Intensive Care Network

Dr Michaela Cartner and Dr Yogesh Apte troubleshoot common problems with CRRT. Presented at SMACCGold 2014.  
intensivecarenetwork.com
over 5 years ago
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Critical Care

Diffuse alveolar damage (DAD) is the pathological hallmark of acute respiratory distress syndrome (ARDS), however, the presence of DAD in the clinical criteria of ARDS patients by Berlin definition is little known. This study is designed to investigate the role of DAD in ARDS patients who underwent open lung biopsy.  
ccforum.com
over 5 years ago
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Critical Care

The purpose of this study was to evaluate the clinical relevance of high values of central venous-to-arterial carbon dioxide difference (PCO2 gap) in high-risk surgical patients admitted to a postoperative ICU. We hypothesized that PCO2 gap could serve as a useful tool to identify patients still requiring hemodynamic optimization at ICU admission.  
ccforum.com
over 5 years ago
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Critical Care

Acute respiratory distress syndrome (ARDS) is a major cause of mortality in intensive care units. As there is rising evidence about immuno-modulatory effects of lipid emulsions required for parenteral nutrition of ARDS patients, we sought to investigate whether infusion of conventional soybean oil (SO)-based or fish oil (FO)-based lipid emulsions rich in either n-6 or n-3 fatty acids, respectively, may influence subsequent pulmonary inflammation.  
ccforum.com
over 5 years ago
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Critical Care

The Tie2/angiopoietin (Tie2/Ang) and vascular endothelial growth factor receptor-ligand systems (VEGFR/VEGF) are recognized to play important roles in the regulation of microvascular endothelial function. Downregulation of these genes during sepsis has been implicated in the pathogenesis of sepsis-related microvascular leak and multiple organ dysfunction syndrome. Mechanisms responsible for dysregulation of angiogenic genes in sepsis are poorly defined.  
ccforum.com
over 5 years ago
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Critical Care

There is increasing recognition of the stress and burnout suffered by critical care workers. Physicians have a responsibility to teach learners the skills required not only to treat patients, but to cope with the demands of a stressful profession. Humor has been neglected as a strategy to help learners develop into virtuous and resilient physicians. Humor can be used to reduce stress, address fears, and to create effective health care teams. However, there are forms of humor which can be hurtful or discriminatory. In order to maximize the benefits of humor and to reduce its harms, we need to teach and model the effective and virtuous use of humor in the intensive care unit.  
ccforum.com
over 5 years ago
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Johnston: Artful Arrangement of Words - Intensive Care Network

Michelle Johnston, ED physician and author talks about the Artful Arrangement of Words and how we can improve our skills in writing.  
intensivecarenetwork.com
over 5 years ago
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Radiology Case 22 - Intensive Care Network

The CT Cerebral Angiogram and 3D Reconstruction confirmed a 12 x 18mm basilar tip aneurysm. Incidentally, the left posterior cerebral artery has a fetal origin (supplied by left posterior communicating artery) – a normal variant.  
intensivecarenetwork.com
over 5 years ago
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Research and Reviews in the Fastlane 083 | LITFL: Life in the Fast Lane Medical Blog

Research and Reviews (R&R) in the FastLane: experts worldwide tell us what they think is worth reading from emergency and critical care  
lifeinthefastlane.com
over 5 years ago