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CriticalCare

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Critical Care

Whether hydroxyethyl starch (HES) is safe for perioperative use is not known. Evaluating HES in cardiac surgery, Jacob and colleagues suggested conclusion was of a more favorable safety profile for HES 130/0.4 [1]. The authors, however, wrongly stated that they followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines because the meta-analysis lacked a table of included study characteristics, an assessment of bias, identification of any pre-specified subgroup analyses, and tests of interaction to compare different HES solutions. In many included studies, the control group received HES, patients with heavy bleeding were excluded post hoc, and anti-fibrinolytic drugs were used to minimize bleeding. For instance, in two included trials the group assigned to gelatin actually received significantly more postoperative HES 130/0.4 than the group allocated to HES 130/0.4 [2,3]. In an included trial of HES 130/0.4, the results from one of the four study centers were excluded post hoc without explanation [4]. Other sources of bias were aggregation of intra- with postoperative blood loss and preferential use of calculated rather than measured blood loss. Furthermore, no tests of interaction were presented even to address the question of whether HES 130/0.4 differs from other HES solutions in its effect on bleeding risk after cardiac surgery.  
ccforum.com
over 5 years ago
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Critical Care

In a recent editorial in Critical Care, Monnet and Teboul emphasize the value of passive leg raising (PLR) as a reliable bedside indicator of fluid responsiveness in critically ill patients [1]. This is because PLR induces changes in venous return, regardless of the mode of ventilation or the underlying cardiac arrhythmias. In their eloquently written editorial, they provide five practical rules for performing a PLR maneuver.  
ccforum.com
over 5 years ago
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Critical Care

Esmolol may efficiently reduce heart rate (HR) and decrease mortality during septic shock. An improvement of microcirculation dissociated from its macrocirculatory effect may a role. The present study investigated the effect of esmolol on gut and sublingual microcirculation in a resuscitated piglet model of septic shock.  
ccforum.com
over 5 years ago
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Emergency Medicine Literature of Note: Where’s the Beef With TXA?

Despite the study many major concerns arused about CRASH 2. I am aware at least of 3 major of them1. Fewer than 2% of the patients in CRASH-2 were treated in countries that routinely provide rapid access to blood products, damage-control surgery and angiography, and advanced critical care.2. Unanswered question about safety of TxA when combined with other treatments targeting bleeding and coagulopathies.3. Unanswered question wich patients should receive TXAIn my opinion new and more accurate studies are needed build more solid evidences  
emlitofnote.com
over 5 years ago
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Work-based Assessment Programs for #Meded (Part 2)

By Teresa Chan  On Tuesday, I reflected on how junior faculty have a unique perspective on the assessment of trainees.   Today, I would like to link to an important medical education movement that has stemmed from the emergency medicine & critical care online education community: the free open access medical education (#FOAMed) movement.  I am…  
icenetblog.royalcollege.ca
over 5 years ago
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Critical Care

The purpose of this study was to investigate whether common variants across the nuclear factor erythroid 2-like 2 (NFE2L2) gene contribute to the development of the acute respiratory distress syndrome (ARDS) in patients with severe sepsis. NFE2L2 is involved in the response to oxidative stress, and it has been shown to be associated with the development of ARDS in trauma patients.  
ccforum.com
over 5 years ago
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Critical Care

Traditional risk scoring prediction models for trauma use either anatomically based estimations of injury or presenting vital signs. Markers of organ dysfunction may provide additional prognostic capability to these models. The objective of this study was to evaluate if urinary biomarkers are associated with poor outcomes, including death and the need for renal replacement therapy.  
ccforum.com
over 5 years ago
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Critical Care

Intravenous fluid administration is an essential component of sepsis management, but a positive fluid balance has been associated with worse prognosis. We analyzed whether a positive fluid balance and its persistence over time was an independent prognostic factor in septic patients.  
ccforum.com
over 5 years ago
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Critical Care

Intracerebral hemorrhage (ICH) at high altitude is not well understood to date. This study investigates the effects of high altitude on ICH, and examines the acute neuroprotection of hyperbaric oxygen (HBO) therapy against high-altitude ICH.  
ccforum.com
over 5 years ago
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Critical Care

I read with interest the recent systematic review of nebulized antibiotics for ventilator-associated pneumonia [1]. I congratulate and applaud Zampieri and colleagues’ important work, but several important issues should be noted.  
ccforum.com
over 5 years ago
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Critical Care

Although rapid response system teams have been widely adopted by many health systems, their effectiveness in reducing hospital mortality is uncertain. We conducted a meta-analysis to examine the impact of rapid response teams on hospital mortality and cardiopulmonary arrest.  
ccforum.com
over 5 years ago
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Critical Care

Fluid administration is a first-line therapy for acute kidney injury associated with circulatory failure. Although aimed at increasing renal perfusion in these patients, this intervention may improve systemic hemodynamics without necessarily ameliorating intrarenal flow distribution or urine output. We used Doppler techniques to investigate the effects of fluid administration on intrarenal hemodynamics and the relationship between changes in renal hemodynamics and urine output. We hypothesized that, compared to systemic hemodynamic variables, changes in renal hemodynamics would better predict increase in urine output after fluid therapy.  
ccforum.com
over 5 years ago
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Critical Care

Burns are a prevalent and burdensome critical care problem. The priorities of specialized facilities focus on stabilizing the patient, preventing infection, and optimizing functional recovery. Research on burns has generated sustained interest over the past few decades, and several important advancements have resulted in more effective patient stabilization and decreased mortality, especially among young patients and those with burns of intermediate extent. However, for the intensivist, challenges often exist that complicate patient support and stabilization. Furthermore, burn wounds are complex and can present unique difficulties that require late intervention or life-long rehabilitation. In addition to improvements in patient stabilization and care, research in burn wound care has yielded advancements that will continue to improve functional recovery. This article reviews recent advancements in the care of burn patients with a focus on the pathophysiology and treatment of burn wounds.  
ccforum.com
over 5 years ago
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Critical Care

Provision for the emergence of an influenza pandemic is an urgent issue. The discovery of a novel anti-influenza therapeutic approach would increase the effectiveness of traditional virus-based strategies. This study was undertaken to evaluate the therapeutic effects of anti-high mobility group box-1 (HMGB1) monoclonal antibody (mAb) treatment on influenza A virus (H1N1)-induced pneumonia in mice.  
ccforum.com
over 5 years ago
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Critical Care

Based on previously published case reports demonstrating dynamic left intraventricular obstruction (IVO) triggered by hypovolemia or catecholamines, this study aimed to establish: (1) IVO occurrence in septic shock patients; (2) correlation between the intraventricular gradient and volume status and fluid responsiveness; and (3) mortality rate.  
ccforum.com
over 5 years ago
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Critical Care

We agree with the recent commentary of Gonçalves-Pereira and Oliveira refuting a ‘one size fits all’ paradigm of antibiotic dosing in patients subjected to extracorporeal circulation [1] but want to focus somewhat further on meropenem pharmacokinetics (PK).  
ccforum.com
over 5 years ago