Critical Care – JournalFeed

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This single center RCT found no difference in maximum Sequential Organ Failure Assessment (SOFA) score between critically ill adult ED patients receiving ketamine vs etomidate for rapid sequence intubation (RSI).

Source
The Effect of Ketamine Versus Etomidate for Rapid Sequence Intubation on Maximum Sequential Organ Failure Assessment Score: A Randomized Clinical Trial. The Journal of Emergency Medicine, Volume 65, Issue 5, 2023, Pages e371-e382, ISSN 0736-4679, https://doi.org/10.1016/j.jemermed.2023.06.009.

Nov 27 2023

Early or Delayed Intubation in Critically Ill Patients?

Airway, Critical Care

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Advanced statistics emulating clinical trial protocols from an ICU database did not identify consistent differences in 30-day mortality when ICU patients were intubated early (within 8 hours of admission) or late (after 48 hours).

Source
Emulating Target Trials Comparing Early and Delayed Intubation Strategies. Chest. 2023 Oct;164(4):885-891. doi: 10.1016/j.chest.2023.04.048. Epub 2023 May 5.

Nov 21 2023

High or Low Fluid Volume in Sepsis? New Meta-analysis

Critical Care

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This updated systematic review and meta-analysis showed no statistically significant difference in all-cause mortality or serious adverse events in sepsis patients given low vs higher fluid volumes.

Source
Lower vs Higher Fluid Volumes in Adult Patients With Sepsis: An Updated Systematic Review With Meta-Analysis and Trial Sequential Analysis. Chest. 2023 Oct;164(4):892-912. doi: 10.1016/j.chest.2023.04.036. Epub 2023 May 2.

Nov 3 2023

ACORN RCT – Piperacillin-Tazobactam or Cefepime?

Critical Care, Infectious Disease, Pharmacy/Pharmacology, Renal

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In this randomized control trial of patients receiving cefepime or piperacillin-tazobactam, there was no difference in risk of acute kidney injury between the two groups. However, those who received cefepime were more likely to have neurologic side effects.

Source
Cefepime vs Piperacillin-Tazobactam in Adults Hospitalized With Acute Infection: The ACORN Randomized Clinical Trial. JAMA. 2023 Oct 14:e2320583. doi: 10.1001/jama.2023.20583. Online ahead of print.

Oct 25 2023

AHA Guideline | 10 Tips Life-Threatening Toxicity From Poisoning

Cardiology, Critical Care, Pharmacy/Pharmacology, Toxicology

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Here are ten tips from the AHA for the next super-sick poisoned patient you encounter.

Oct 20 2023

How Useful Is Lactate Clearance Anyway?

Critical Care, Infectious Disease

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Don’t hang your hat on lactate clearance to assess therapeutic response to resuscitation in sepsis; there are too many confounders, and initial clearance does not necessarily project clinical course.

Source
Initial Lactate Clearance Is Confounded Highly by Comorbidities and Poorly Predicts Subsequent Lactate Trajectory. Chest. 2023 Sep;164(3):667-669. doi: 10.1016/j.chest.2023.04.023. Epub 2023 Apr 20.

Oct 18 2023

Hot Topics in RSI – Guidelines from The Society of Critical Care Medicine

Airway, Critical Care, Pain/Sedation/Procedure, Pharmacy/Pharmacology

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Positioning, preoxygenation, medication selection, and other questions surrounding emergent rapid sequence intubation (RSI) are addressed by an expert panel.

Oct 11 2023

1-Plane, 2-Plane, X-plane? Ultrasound-Guided Central Lines

Critical Care, Ultrasound

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In a small, randomized trial, placing an ultrasound-guided central venous catheter (CVC) using 2 planes simultaneously was more likely to be successful on the first attempt and performed more quickly. Both groups had a 100% procedural success rate.

Oct 3 2023

Peripheral Pressors Prevent Patient Pokes

Critical Care, Pharmacy/Pharmacology

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This prospective observational cohort study found implementing a protocol for peripheral norepinephrine (NE) decreased median number of central venous catheter (CVC) days per patient by one, and 51.6% avoided a CVC entirely.

Source
Peripheral administration of norepinephrine: a prospective observational study. Chest, S0012-3692(23)05350-3. 21 Aug. 2023, doi:10.1016/j.chest.2023.08.019

Sep 8 2023

How to Manage Blast Injuries

Critical Care, EMS, Trauma

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Blast injuries combine common polytrauma mechanisms – blunt, penetrating, burns – with the unique pathophysiology of blast wave injuries, and mass casualty scenarios. While rare, these patients are resource-intensive, prone to delayed yet rapid clinical deterioration, and carry high morbidity and mortality.

Source
High risk and low prevalence diseases: Blast injuries. Am J Emerg Med. 2023 Aug;70:46-56. doi: 10.1016/j.ajem.2023.05.003. Epub 2023 May 5.