Podcasts about intensive care med

In this episode of the Saving Lives Podcast, we discuss a study from Intensive Care Medicine that explores whether baseline serum chloride and pH affect outcomes with balanced fluids versus saline. The findings from the PLUS trial show no significant interaction, but intriguing trends suggest that hyperchloremic patients may benefit more from balanced fluids. The Vasopressor & Inotrope HandbookI have written "The Vasopressor & Inotrope Handbook: A Practical Guide for Healthcare Professionals," a must-read for anyone caring for critically ill patients (check out the reviews)! You have several options to get a physical copy. Amazon: ⁠⁠⁠⁠⁠⁠⁠https://amzn.to/47qJZe1⁠⁠⁠⁠⁠⁠⁠ (Affiliate Link)My Store: ⁠⁠⁠⁠⁠⁠⁠https://eddyjoemd.myshopify.com/products/the-vasopressor-inotrope-handbook⁠⁠⁠⁠⁠⁠⁠ (Use "podcast" to save 10%)Citation: Ramanan M, Hammond N, Billot L, Delaney A, Devaux A, Finfer S, Li Q, Micallef S, Venkatesh B, Young PJ, Myburgh J; PLUS Investigators. Serum chloride concentration and outcomes in adults receiving intravenous fluid therapy with a balanced crystalloid solution or 0.9% sodium chloride. Intensive Care Med. 2025 Feb;51(2):249-258. doi: 10.1007/s00134-024-07764-2. Epub 2025 Feb 10. PMID: 39928118.

In a previous episode, Dr. Sergio Zanotti explored the importance of challenging dogma, particularly when the supporting evidence is weak or absent. Today, he continues that discussion by examining critical care practices that persist despite a lack of strong scientific validation. He's joined by Dr. Mervyn Singer, an internationally recognized leader in critical care medicine. Dr. Singer is a professor of intensive care medicine at University College London and a distinguished clinician, researcher, and educator. Through his research, publications, and dynamic presentations, he has inspired Dr. Zanotti — and countless intensivists worldwide — to think critically, challenge conventions, and push the boundaries of our field. Additional resources: Challenging management dogma where evidence is non-existent, weak, or outdated: part II. DA Hofmaennner and M. Singer. Intensive Care Med2024: https://pubmed.ncbi.nlm.nih.go Challenging management dogma where evidence is non-existent, weak, or outdated. DA Hofmaennner and M. Singer. Intensive Care Med 2022: https://pubmed.ncbi.nlm.nih.gov/35303116/ Biomarker-Guided Antibiotic Duration for Hospitalized Patients with Suspected Sepsis. The ADAPT-Sepsis Randomized Clinical Trial. JAMA 2025: https://pubmed.ncbi.nlm.nih.gov/39652885/ Hyperglycemic Crises in Adults with Diabetes: A Consensus Report. Diabetes Care 2024: https://pubmed.ncbi.nlm.nih.gov/38907161/ Books and music mentioned in this episode. Influenza: The Hundred-Year Hunt to Cure the 1918 Spanish Flu Pandemic. By. Jeremy Brown: https://amzn.to/3Ftb0mO Beethoven: 9 Symphonies / Karajan 1963: https://amzn.to/3R1M9ZO

Acute kidney injury is a frequent complication of critical illness, and a subgroup of these patients will require renal replacement therapy. In this episode. Dr. Sergio Zanotti discusses optimizing renal replacement therapy in the ICU. He is joined by Dr. Michael J. Connor, Jr., a practicing intensivist and nephrologist. He is a professor and senior physician of critical care medicine and nephrology at the Divisions of Pulmonary, Allergy, Critical Care, & Sleep Medicine and Renal Medicine at Emory University School of Medicine. In addition, he is the director of critical care nephrology at the Emory Critical Care Center at Grady Memorial Hospital. Additional resources: Delivering optimal renal replacement therapy to critically ill patients with acute kidney injury. Wald R, et al. Intensive Care Med 2022: https://pubmed.ncbi.nlm.nih.gov/36066597/ Initiation Strategies for Renal-Replacement Therapy in the Intensive Care Unit. AKIKI Study Group. N Engl J Med 2016: https://pubmed.ncbi.nlm.nih.gov/27181456/ Effect of Early vs Delayed Initiation of Renal Replacement Therapy on Mortality in Critically Ill Patients with Acute Kidney Injury. ELAIN Trial. JAMA 2016: https://pubmed.ncbi.nlm.nih.gov/27209269/ Timing of Renal-Replacement Therapy in Patients with Acute Kidney Injury and Sepsis. IDEAL-ICU Investigators. N Eng J Med 2018: https://pubmed.ncbi.nlm.nih.gov/30304656/ Timing of Initiation of Renal-Replacement Therapy in Acute Kidney Injury. STARRT-AKI Investigators. N Engl J Med 2020: https://pubmed.ncbi.nlm.nih.gov/32668114/ Comparison of two delayed strategies for renal therapy initiation for severe acute kidney injury. AKIKI 2 Trial. Lancet 2021: https://pubmed.ncbi.nlm.nih.gov/33812488/ Books and Music mentioned in this episode: The Invisible Life of Addie LaRue. By V.E. Schwab: The Invisible-Life-Addie-LaRue Moon Music. By Coldplay: Moon-Music-Coldplay

In this episode, Dr. Sergio Zanotti discusses rational fluid therapy. He is joined by Dr. Adrian Wong, a practicing intensive care medicine and anesthesia physician. Dr. Wong is a consultant and clinical lead at King's College Hospital, London. He also serves as a committee member for the Intensive Care Society FUSIC, examiner for the European Diploma of Intensive Care Medicine, on the executive committee of the International Fluid Academy. Additional resources: Intravenous fluid therapy in the perioperative and critical care setting” Executive summary of the International Fluid Academy (IFA). Malbrain ML, et al. Ann. Intensive Care 2020: https://pubmed.ncbi.nlm.nih.gov/32449147/ Multidisciplinary expert panel report on fluid stewardship: perspectives and practice. Malbrain ML, et al. Annals of Intensive Care 2023: https://pubmed.ncbi.nlm.nih.gov/37747558/ The emerging concept of fluid tolerance: A position paper. Kattan E, et al. Journal of Critical Care 2022: https://pubmed.ncbi.nlm.nih.gov/35660844/ Everything you need to know about derescuscitation. Malbrain ML, et al. Intensive Care Med 2022: https://pubmed.ncbi.nlm.nih.gov/35932335/ Start with Why. TED Talk presented by Simon Sinek: https://simonsinek.com/videos/ted-talks/ Books mentioned in this episode: Thinking Fast and Slow. By Daniel Kahneman: https://amzn.to/4hicUoj Start with Why: How Great Leaders Inspire Everybody to Take Action. By Simon Sinek: https://bit.ly/42hzt8n

Carbapenemase producers are a nightmare for clinicians. Not only are they resistant to carbapenems, a last resort β-lactam antibiotic, they are notorious for developing multidrug and pandrug resistances resulting in limited to no treatment options.  In this episode of Communicable, hosts Angela Huttner and Thomas Tängdén sit down with Dr. David Paterson (National University of Singapore) and Dr. Souha Kanj (American University of Beirut Medical Center, Lebanon), two ID physicians from regions where carbapenem-resistant Enterobacteriaceae or CRE, and carbapenem-resistant Acinetobacter are widespread.  The episode begins with the history and emergence of CRE and reviews current epidemiology, diagnosis (including the Ambler classification of β-lactamases) and treatment options. Lessons and insights from personal experiences are shared to reflect the current clinical challenges caused by carbapenem-resistant bacteria and the importance of infection prevention and control measures to mitigate further spread. This episode was edited by Kathryn Hostettler and peer-reviewed by Dr. Filippo Medioli of Policlinico di Modena, Italy. For more related content on the WHO Priority Pathogens List and new antibiotics in the pipeline, check out our previous episodes, Communicable E3 and E10 (see Literature).Literature Communicable E3 - The New WHO Priority Pathogens List: which bugs to target first? June 2024. https://communicable.transistor.fm/episodes/communicable-e3-the-new-who-priority-pathogens-list-which-bacteria-to-target-first  Communicable E10 - Pipeline update: new antibiotics & other antimicrobials that you might actually use. Sep 2024. https://communicable.transistor.fm/episodes/communicable-e10-pipeline-update-new-antibiotics-other-antimicrobials-that-you-might-actually-use  Wagenlehner FM, et al. Cefepime-Taniborbactam in Complicated Urinary Tract Infection. N Engl J Med 2024 Feb. doi: 10.1056/NEJMoa2304748 Cohn J, et al. Accelerating antibiotic access and stewardship: a new model to safeguard public health. Lancet Infect Dis 2024 Sep. doi:  10.1016/S1473-3099(24)00070-7 Timsit JF, et al. When should I start broad-spectrum antibiotics? Intensive Care Med 2024 Sep. doi: 10.1007/s00134-024-07654-7  Paterson DL. Antibacterial agents active against Gram Negative Bacilli in phase I, II, or III clinical trials. Expert Opin Investig Drugs 2024 Apr. doi: 10.1080/13543784.2024.2326028 

In this episode of Critical Matters, Dr. Zanotti discusses the use of intravenous albumin in critical care. He is joined by D. Jeannie Callum, Director of Transfusion Medicine and Professor of Pathology and Molecular Medicine at Queens University in Ontario, Canada. Dr. Callum's research focuses on blood utilization, hemostasis in the bleeding patient, and transfusion-related errors. She has received numerous awards and published extensively. Dr. Callum is the lead author of “Use of Intravenous Albumin: A Guidelines from the International Collaboration for Transfusion Medicine Guidelines,” published earlier this year in CHEST. Additional Resources: Use of Intravenous Albumin. A Guideline from the International Collaboration for Transfusion Medicine Guidelines. CHEST 2024: https://journal.chestnet.org/article/S0012-3692(24)00285-X/fulltext International Collaboration for Transfusion Medicine Guidelines Website: https://www.ictmg.org/ Ten myths about albumin. M Joannidis, et al. Intensive Care Med 2022: https://pubmed.ncbi.nlm.nih.gov/35247060/ A comparison of albumin and saline for fluid resuscitation in the intensive care unit. SAFE Study Investigators. N Engl J Med 2004: https://pubmed.ncbi.nlm.nih.gov/15163774/ Albumin Replacement in Patients with Severe Sepsis or Septic Shock. ALBIOS Study Investigators. N Engl J .Med 2014: https://www.nejm.org/doi/full/10.1056/NEJMoa1305727 Books mentioned in this episode: Ending Medical Reversal: Improving Outcomes, Saving Lives. By Vinayak K. Prasad: https://bit.ly/4dAimRa The Time Machine. By H.G. Wells: https://amzn.to/4eK4apG

Contributor: Travis Barlock MD Educational Pearls: Recent study assessed outcomes after ROSC with epinephrine vs. norepinephrine Observational multicenter study from 2011-2018 285 patients received epineprhine and 481 received norepinephrine Epinephrine was associated with an increase in all-cause mortality (primary outcome) Odds ratio 2.6; 95%CI 1.4-4.7; P = 0.002 Higher cardiovascular mortality (secondary outcome) Higher proportion of unfavorable neurological outcome (secondary outcome) Norepinephrine is the vasopressor of choice in post-cardiac arrest care References Bougouin W, Slimani K, Renaudier M, et al. Epinephrine versus norepinephrine in cardiac arrest patients with post-resuscitation shock. Intensive Care Med. 2022;48(3):300-310. doi:10.1007/s00134-021-06608-7 Summarized by Jorge Chalit, OMSIII | Edited by Meg Joyce & Jorge Chalit  

Un nouveau podcast Ligne de MIR en collaboration avec la commission des Urgences Vitales de la SRLF ! Le Dr Brétagnol, qui est médecin réanimatrice en médecine intensive réanimation et responsable de coordination hospitalière des prélèvements d'organes et de tissus au CHU d'Orléans, nous parle du prélèvement multi-organes et de comment défaire les idées reçues. Aucun conflit d'intérêt n'est déclaré. Sommaire : L'abord anticipé : quand le faire ? comment le faire ? Existe-t-il encore des contre-indications au PMO ? (Sujet très âgé par exemple) Comment connaître les réseaux inter-hospitaliers existants ? Qui contacter ? État des lieux sur le développement d'unités mobiles de PMO. Références : Prise en charge de l'accident vasculaire cérébral chez l'adulte et l'enfant par le réanimateur (nouveau-né exclu), (hémorragie méningée exclue). Recommandations formalisées d'experts sous l'égide de la Société de réanimation de langue française, avec la participation du groupe francophone de réanimation et urgences pédiatriques (GFRUP), de la société française neurovasculaire (SFNV), de l'association de neuro-anesthésie et réanimation de langue française (ANRLF), de l'agence de la Biomédecine (ABM). P.-E. Bollaert, I. Vinatier, D. Orlikowski, P. Meyer, Groupe d'experts. Réanimation (2010) 19,471-478. Conditions à respecter pour réaliser des prélèvements d'organes sur des donneurs décédés après arrêt circulatoire de la catégorie III de Maastricht dans un établissement de santé. Coordination du travail: Dr Corinne Antoine, Dr Régis Bronchard, Dr Jacqueline Silleran Chassany, Direction générale médicale et scientifique de l'Agence de la Biomédecine. Protocole de prélèvement d'organes Maastricht III -version numéro 10- décembre 2023. Management of the brain-dead donor in the intensive care unit. Gunst J. , Souter MJ. , Intensive Care Med. 2024 june, 50(6): 964-967. The association of donor hepatitis C virus infection with 3-year kidney transplant outcomes in the era of direct-acting antiviral medications. Sutcliffe S. , Mengmeng J. , Am J Transplant. 2023 May ; 23(5): 629-635.The future of organ perfusion and re-conditioning (review). Weissenbacher A., Vrakas G. Transplant International 2019; 32: 586-597.

Disturbances in neurological function due to primary neurological disorders or organ failure from critical illness are common in patients admitted to the ICU. In this episode, Dr. Zanotti discusses the neurological physical exam in the ICU. He is joined by Dr. Adam Rizvi, a neurologist with Neurocritical care and vascular neurology fellowship training who currently practices critical care, neurocritical care, and tele-neurology/tele-stroke in several hospitals in California. In addition to his clinical work, Dr. Rizvi is an accomplished educator and researcher. Additional Resources: Neurological examination of critically ill patients: a pragmatic approach: Report of an ESICM expert panel. Intensive Care Med 2014. https://pubmed.ncbi.nlm.nih.gov/24522878/ Critical Matters Podcast episode: Brain Death / Death by Neurological Criteria. Host: S. Zanotti. Guest: D. Greer: https://soundphysicians.com/podcast-episode/?podcast_id=342&track_id=1677810255 Clinical Neuroanatomy Made Ridiculously Simple. Edition 6. Stephan Goldberg, MD: https://amzn.to/4cC34uZ Books mention in the episode: Meditations. By Marcus Aurelius. Translation by Gregory Hayes: https://amzn.to/4eBxK1d

In this episode, Eddy Joe delves into the intensive care management of brain-dead donors, based on a recent article from Intensive Care Medicine. Learn about hemodynamic support, endocrine treatment, and respiratory management strategies to optimize organ procurement. Tune in for an in-depth discussion on improving donor organ viability while maintaining the dignity of the deceased. The Vasopressor & Inotrope Handbook I have written "The Vasopressor & Inotrope Handbook: A Practical Guide for Healthcare Professionals," a must-read for anyone caring for critically ill patients (check out the reviews)! You have several options to get a physical copy while supporting my endeavors. If you're in the US, you can order ⁠⁠⁠A SIGNED & PERSONALIZED COPY for $29.99⁠⁠⁠ or via ⁠⁠⁠AMAZON⁠⁠⁠ (for orders outside the US). Ebook versions: ⁠⁠⁠AMAZON KINDLE for $9.9⁠⁠⁠⁠⁠⁠9⁠⁠⁠. ⁠⁠⁠APPLE BOOKS⁠⁠⁠ and ⁠⁠⁠GOOGLE PLAY⁠⁠⁠.  ¡Excelentes noticias! Mi libro ha sido traducido al español y las versiones electrónicas están disponibles para su compra for solo $9.99 en ⁠⁠⁠AMAZON KINDLE⁠⁠⁠, ⁠⁠⁠APPLE BOOKS⁠⁠⁠ y ⁠⁠⁠GOOGLE PLAY⁠⁠⁠. When you use these affiliate links, I earn an additional commission at no extra cost to you, which is a great way to support my work. Citation: Gunst J, Souter MJ. Management of the brain-dead donor in the intensive care unit. Intensive Care Med. 2024 Jun;50(6):964-967. doi: 10.1007/s00134-024-07409-4. Epub 2024 Apr 10. PMID: 38598128. --- Support this podcast: https://podcasters.spotify.com/pod/show/eddyjoemd/support

Le Dr Lise Piquilloud, qui est médecin soin intensif adulte au CHUV Centre Hospitalier Universitaire Vaudois, nous parle de la place de l'utilisation du Helmet en réanimation. Aucun conflit d'intérêt n'est déclaré. Sommaire Pourquoi la question d'une nouvelle interface en ventilation non invasive ? Quelles modalités de support ventilatoire non invasifs avec le « Helmet » ? Quelles sont les indications du « Helmet » en réanimation ? Quels sont les avantages et les inconvénients du « Helmet » par rapport aux autres interfaces ? Quelles sont les particularités de la mise en place, des réglages et de la surveillance du « Helmet » ? Les références Coppadoro et al. Crit Care (2021) 25:327 Grieco et al. Am J Respir Crit Care Med 2020; 3: 303–312 Grieco et al. JAMA. 2021;325:1731-1743 Arabi YM, Patel BK, Antonelli M. Intensive Care Med. 2023

In this second of a two part podcast special Iain and Simon go through twenty of the top papers from the last year or so, as presented by Simon at the Big Sick Conference in Zermatt earlier this year. All the details and more discussion can be found on the blog site. In Part 2 they discuss papers about major haemorrhage, trauma, cardiac arrest and more.  In Part 1 they discuss all things airway, including where we should be intubating patients needing immediate haemorrhage control. VL vs DL, the effect of blade size on intubation success, whether small adult ventilation bags are better than larger versions, intubating comatose poisoned patients, and more.  Papers Jansen JO et al. Emergency Department Resuscitative Endovascular Balloon Occlusion of the Aorta in Trauma Patients With Exsanguinating Hemorrhage: The UK-REBOA Randomized Clinical Trial. JAMA. 2023 Nov 21;330(19):1862-1871. doi: 10.1001/jama.2023.20850. PMID: 37824132; PMCID: PMC10570916. Davenport R et al. Early and Empirical High-Dose Cryoprecipitate for Hemorrhage After Traumatic Injury: The CRYOSTAT-2 Randomized Clinical Trial. JAMA. 2023 Nov 21;330(19):1882-1891. doi: 10.1001/jama.2023.21019. PMID: 37824155; PMCID: PMC10570921. PATCH-Trauma Investigators and the ANZICS Clinical Trials Group; Prehospital Tranexamic Acid for Severe Trauma. N Engl J Med. 2023 Jul 13;389(2):127-136. doi: 10.1056/NEJMoa2215457. Epub 2023 Jun 14. PMID: 37314244. Shepherd JM et al Safety and efficacy of artesunate treatment in severely injured patients with traumatic hemorrhage. The TOP-ART randomized clinical trial. Intensive Care Med. 2023 Aug;49(8):922-933. doi: 10.1007/s00134-023-07135-3. Epub 2023 Jul 20. PMID: 37470832; PMCID: PMC10425486. Bouzat P et al. Efficacy and Safety of Early Administration of 4-Factor Prothrombin Complex Concentrate in Patients With Trauma at Risk of Massive Transfusion: The PROCOAG Randomized Clinical Trial. JAMA. 2023 Apr 25;329(16):1367-1375. doi: 10.1001/jama.2023.4080. PMID: 36942533; PMCID: PMC10031505. Torres CM, Kent A, Scantling D, Joseph B, Haut ER, Sakran JV. Association of Whole Blood With Survival Among Patients Presenting With Severe Hemorrhage in US and Canadian Adult Civilian Trauma Centers. JAMA Surg. 2023 May 1;158(5):532-540. doi: 10.1001/jamasurg.2022.6978. Erratum in: JAMA Surg. 2023 Apr 5;: PMID: 36652255; PMCID: PMC9857728. Marsden MER, Kellett S, Bagga R, Wohlgemut JM, Lyon RL, Perkins ZB, Gillies K, Tai NR. Understanding pre-hospital blood transfusion decision-making for injured patients: an interview study. Emerg Med J. 2023 Nov;40(11):777-784. doi: 10.1136/emermed-2023-213086. Epub 2023 Sep 13. PMID: 37704359; PMCID: PMC10646861. Wohlgemut JM, Pisirir E, Stoner RS, Kyrimi E, Christian M, Hurst T, Marsh W, Perkins ZB, Tai NRM. Identification of major hemorrhage in trauma patients in the prehospital setting: diagnostic accuracy and impact on outcome. Trauma Surg Acute Care Open. 2024 Jan 12;9(1):e001214. doi: 10.1136/tsaco-2023-001214. PMID: 38274019; PMCID: PMC10806521. Cheskes S, Verbeek PR, Drennan IR, McLeod SL, Turner L, Pinto R, Feldman M, Davis M, Vaillancourt C, Morrison LJ, Dorian P, Scales DC. Defibrillation Strategies for Refractory Ventricular Fibrillation. N Engl J Med. 2022 Nov 24;387(21):1947-1956. doi: 10.1056/NEJMoa2207304. Epub 2022 Nov 6. PMID: 36342151. Siddiqua N, Mathew R, Sahu AK, Jamshed N, Bhaskararayuni J, Aggarwal P, Kumar A, Khan MA. High-dose versus low-dose intravenous nitroglycerine for sympathetic crashing acute pulmonary edema: a randomised controlled trial. Emerg Med J. 2024 Jan 22;41(2):96-102. doi: 10.1136/emermed-2023-213285. PMID: 38050078. Wilkinson-Stokes M, Betson J, Sawyer S. Adverse events from nitrate administration during right ventricular myocardial infarction: a systematic review and meta-analysis. Emerg Med J. 2023 Feb;40(2):108-113. doi: 10.1136/emermed-2021-212294. Epub 2022 Sep 30. PMID: 36180168. Patterson T, Perkins GD, Perkins A, Clayton T, Evans R, Dodd M, Robertson S, Wilson K, Mellett-Smith A, Fothergill RT, McCrone P, Dalby M, MacCarthy P, Firoozi S, Malik I, Rakhit R, Jain A, Nolan JP, Redwood SR; ARREST trial collaborators. Expedited transfer to a cardiac arrest centre for non-ST-elevation out-of-hospital cardiac arrest (ARREST): a UK prospective, multicentre, parallel, randomised clinical trial. Lancet. 2023 Oct 14;402(10410):1329-1337. doi: 10.1016/S0140-6736(23)01351-X. Epub 2023 Aug 27. PMID: 37647928. Issa EC, Ware PJ, Bitange P, Cooper GJ, Galea T, Bengiamin DI, Young TP. The “Syringe Hickey”: An Alternative Skin Marking Method for Lumbar Puncture. J Emerg Med. 2023 Mar;64(3):400-404. doi: 10.1016/j.jemermed.2023.01.013. PMID: 37019501.

Which comes first epinephrine or airway? Out of hospital cardiac arrests involve critical and often complex decisions with sequence and timing of various procedure. What should you prioritize? We examine the nuances of advanced interventions, such as epinephrine and advanced airway placement, through the lens of recent studies, including a notable piece of research published recently in JAMA Network Open. Take a deep dive into the practicalities and philosophies that underpin prehospital cardiac arrest management, emphasizing the significance of basic life support skills and the role of advanced techniques in the pre-hospital setting. This episode engages, educates, and challenges EMS providers on the best practices that could potentially save lives during those critical first minutes of a cardiac emergency.   Articles-  Sequence of Epinephrine and Advanced Airway Placement After Out-of-Hospital Cardiac Arrest. JAMA Netw Open. 2024 Feb 5;7(2):e2356863. doi: 10.1001/jamanetworkopen.2023.56863. Association of timing of epinephrine administration with outcomes in adults with out-of-hospital cardiac arrest.  JAMA Netw Open. 2021;4(8):e2120176. doi:10.1001/jamanetworkopen.2021.20176 Epinephrine in Out of Hospital Cardiac Arrest: A Network Meta-analysis and Subgroup Analyses of Shockable and Nonshockable Rhythms. Chest. 2023 Aug;164(2):381-393. DOI: 10.1016/j.chest.2023.01.033 A Randomized Trial of Epinephrine in Out of Hospital Cardiac Arrest. (PARAMEDIC2) New Eng J Med. DOI: 10.1056/NEJMoa1806842 The influence of time to adrenaline administration in the Paramedic 2 randomised controlled trial.  Intensive Care Med. 2020;46(3):426-436. doi:10.1007/s00134-019-05836-2

https://www.cursotdc.com.br/antibiotico/lead/

Dr. Casey Clements spent two hours breaking down the history and influences in sepsis care over the past three decades and going through the best practices in today's emergency medicine. This is the second part of the two part series. Do you know how Sepsis is defined currently? What is the difference between SEP - 1 and surviving sepsis campaign? What is the role of steroids or vitamin C? Can you resuscitate these patients with albumin? These and so many more questions will be answered in this two part series. We review the PROCESS, PROMISE, and ARISE trials and provide pragmatic approach to your septic patients.  So join Venk like vancomycin, and Alex (aka Zosyn) and Casey "not-cidal" Clements in these amazing episodes.   CONTACTS X - @AlwaysOnEM; @VenkBellamkonda YouTube - @AlwaysOnEM; @VenkBellamkonda Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch Email - AlwaysOnEM@gmail.com REFERENCES & LINKS Intravascular volume assessment Azadian M, Win S, Abdipour A, et al. Mortality benefit from the passive leg raise maneuver in guiding resuscitation of septic shock patients: A systematic review and meta-analysis of randomized trials. J Intensive Care Med. 2022 May;37(5):611-617 Spiliotaki E, Saranteas T, Moschovaki N, et al. Inferior vena cava ultrasonography in the assessment of intravascular volume status and fluid responsiveness in the emergency department and intensive care unit: a critical analysis review. J Clin Ultrasound. 2022 Jun;50(5):733-744   Chest radiography paper referenced Poku JK, Bellamkonda-Athmaram VR, Bellolio F, Nestler DM, Stiell IG, Hess EP. Failure of prospective validation and derivation of a refined clinical decision rule for chest radiography in emergency department patients with chest pain and possible acute coronary syndrome. Acad Emerg Med. 2012 Sep;19(9):E1004-10   Albumin Caironi P, Tognoni G, Masson S, Fumagalli R, Presenti A, Romero M, Fanizza C, Caspani L, Faenza S, Grasselli G, Iapichino G, Antonelli M, Parrini V, Fiore G, Latini R, Gattinoni L, ALBIOS Study Investigators. Albumin Replacement in patients with severe sepsis or septic shock. NEJM. 2014;370(15):1412 Xu JY, Chen QH, Xie JF, Pan C, Liu SQ, Huang LW, Yang CS, Liu L, Huang YZ, Guo FM, Yang Y, Qiu HB. Comparison of the effects of albumin and cyrstalloid on mortality in adult patients with severe sepsis and septic shock: a meta-analysis of randomized clinical trials. Crit Care. 2014;18(6):702 Jiang L, Jiang S, Zhang M, Zheng Z, Ma Y. Albumin versus other fluids for fluid resuscitation in patients with sepsis: A meta-analysis. PloS One. 2014;9(12):e114666   Unbundling studies ProCESS Trial: ProCESS Investigators, Yealy DM, Kellum JA, Huang DT, Barnato AE, Weissfeld LA, PIke F, Terndrup T, Wang HE, Hou PC, LoVecchio F, Filbin MR, Shapiro NI, Angus DC. A randomized trial of protocol based care for early septic shock. NEJM  2014;370(18):1683 ProMISE Trial: Mouncey PR, Osborn ™, Power GS, Harrison DA, Sadique MZ, Grieve RD, Jahan R, Harvey SE, Bell D, Bion JF, Coats TJ, Singer M, Young JD, Rowan KM, ProMISe Trial Investigators. Trial of early, goal directed resuscitation for septic shock. NEJM 2015;372(14):1301 ARISE Trial: ARISE investigators, ANZICS Clinical Trials Group, Peake SL, Delaney A, Bailey M, Bellomo R, Cameron PA, Cameron PA, Cooper DJ, Higgins AM, Holdgate A, Howe BD, WEbb SA, Williams P. Goal-directed resuscitation for patients with early septic shock. NEJM 2014;371(16):1496 Angus DC, Barnato AE, Bell D, Bellomo R, Chong CR, Coats TJ, Davies A, Delaney A, Harrison DA, Holdgate A, Howe B, Huang DT, Iwashyna T, Kellum JA, Peake SL, Pike F, Reade MC, Rowan KM, Singer M, Webb SA, Weissfeld LA, Yealy DM, Young JD. A systematic review and meta-analysis of early goal-directed therapy for septic shock: the ARISE, ProCESS, and ProMISE investigators. Intensive Care Med. 2015 SEp;41(9):1549-60 PRISM Investigators. Early Goal-Directed Therapy for Septic Shock - A Patient-Level Meta-Analysis. NEJM 2017 Lu Y, Zhang H, Teng F, Xia WJ, SUn GX, Wen AQ. Early goal-directed therapy in severe sepsis and septic shock: A meta-analysis and Trial sequential analysis of randomized controlled trials. J Intensive Care Med. 2018;33(5):296   Vitamin C Sevransky JE, et al. Effect of vitamin C, thiamine, and hydrocortisone on ventilator- and vasopressor-free days in patients with sepsis: The VICTAS randomized clinical trial. JAMA. 2021 Feb 23;325(8):742-750  

In this episode, Dr. Zanotti is joined by Dr. Eddy Fan for a discussion about Respiratory Support in ARDS. Dr. Fan is an associate professor in the Interdepartmental Division of Critical Care Medicine and the Institute of Health Policy, Management, and Evaluation at the University of Toronto. He is also a staff intensivist at the University Health Network/Mount Sinai Hospital. Dr. Fan is currently the Medical Director of the Extracorporeal Life Support Program at the Toronto General Hospital and the Director of Critical Care Research at the University Health Network/Mount Sinai Hospital. Dr. Fan's research has focused on advanced life support for acute respiratory failure and patient outcomes from critical illness. He is a co-author of the ESICM ARDS Clinical Guidelines. Additional Resources: ESICM guidelines on acute respiratory distress syndrome: definition, phenotyping, and respiratory support strategies. Intensive Care Med 2023: https://pubmed.ncbi.nlm.nih.gov/37326646/ An Update on Management of Adult Patients with ARDS. Official ATS Clinical Practice Guideline. Am J Respir Crit Care Med 2024; https://www.atsjournals.org/doi/full/10.1164/rccm.202311-2011ST Prone Positioning in Severe Acute Respiratory Distress Syndrome. PROSEVA Clinical Trial. N Engl J of Med 2013: https://www.nejm.org/doi/full/10.1056/nejmoa1214103 Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome. The EOLIA Trial. N Eng J of Med 2018: https://www.nejm.org/doi/full/10.1056/NEJMoa1800385 Books mentioned in this episode: A Portrait of the Artist as a Young Man. By James Joyce: https://bit.ly/49kzmtn

Dr. Casey Clements spent two hours breaking down the history and influences in sepsis care over the past three decades and going through the best practices in today's emergency medicine. Do you know how Sepsis is defined currently? What is the difference between SEP - 1 and surviving sepsis campaign? What is the role of steroids or vitamin C? Can you resuscitate these patients with albumin? These and so many more questions will be answered in this two part series. So join Venk like vancomycin, and Alex (aka Zosyn) and Casey "not-cidal" Clements in these amazing episodes.   CONTACTS X - @AlwaysOnEM; @VenkBellamkonda YouTube - @AlwaysOnEM; @VenkBellamkonda Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch Email - AlwaysOnEM@gmail.com REFERENCES & LINKS SOFA Score: Vincent JL, MOreno R, Takala J, et al. The SOFA (Sepsis-related organ failure assessment) score to describe organ dysfunction / failure. On Behalf of the working group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med. 1996 Jul;22(7):707-10 Vincent JL, de Mendonca A, Cantraine F, et al. Use of the SOFA score to assess the incidence of organ dysfunction / failure in intensive care units: results of a multicenter, prospective study. Working group on ‘sepsis-related problems' of the European Society of Intensive Care Medicine. Crit Care Med. 1998;26(11):1793-1800 Ferreira FL, Bota DP, Bross A, Merlot C, Vincent JL. Serial evaluation of the SOFA score to predict outcomes in critically ill patients. JAMA. 2001 Oct 10;286(14):1754-8 Cardenas-Turanzas M, Ensor J, Wakefield C, Zhang K, Wallace SK, Price KJ, Nates JL. Cross-validation of a sequential organ failure assessment score-based model to predict mortality in patients with cancer admitted to the intensive care unit. J Crit Care. 2012 Dec;27(6):673-80 qSOFA score Seymour CW, Liu VX, Iwashyna TJ, et al. Assessment of clinical criteria for sepsis: for the Third International Consensus Definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315(8):762-774 Shankar-Hari M, Phillips GS, Levy ML, et al. Developing a new definition and assessing new clinical criteria for septic shock: For the Third International Consensus Definitions for Sepsis and SEptic Shock (Sepsis-3). JAMA. 2016;315(8):775-787 Freund Y, Lemachatti N, Krastinova E, et al. Prognostic accuracy of Sepsis-3 Criteria for in-hospital mortality among patients with suspected infection presenting to the emergency department. JAMA. 2017;317(3):301-308 Raith EP, Udy AA, Bailey M, et al. Prognostic accuracy of the SOFA score, SIRS criteria, and qSOFA score for in-hospital mortality among adults with suspected infection admitted to the intensive care unit. JAMA. 2017;317(3):290-300 Comparing Prognostic scores Henning DJ, Puskarich MA, Self WH, Howell MD, Donnino MW, Yealy DM, Jones AE, Shapiro NI. An Emergency Department validation of the SEP-3 Sepsis and Septic Shock definitions and comparison with 1992 consensus definitions. Ann Emerg Med. 2017 Oct;70(4):544-552 IDSA concern Rhee C, Chiotos K, Cosgrove SE, Heil EL, Kadri SS, Kalil AC, Gilbert DN, Masur H, Septimus EJ, Sweeney DA, Strich JR, Winslow DL, Klompas M. Infectious diseases society of america position paper: Recommended revisions to the National Severe Sepsis and Septic Shock early management bundle (SEP-1) Sepsis Quality Measure. Clin Infect Dis. 2021 Feb 16;72(4):541-552 About Barcelona Declaration Slade E, Tamber PS, Vincent JL. The Surviving Sepsis Campaign: raising awareness to reduce mortality. Crit Care. 2003;7:1-2 1- hour surviving sepsis bundle guidance Freund Y, Khoury A, Mockel M, et al. European Society of Emergency Medicine position paper on the 1-hour sepsis bundle of the Surviving Sepsis Campaign: expression of concern. Eur J Emerg Med. 2019 Aug;26(4):232-233 Early Goal Directed Therapy Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. NEJM. 2001 Nov 8;345(19):1368-77 SEP - 1 Quality Measure National Quality Forum Measure submission and evaluation worksheet 5.0 for NQF #0500 Severe Sepsis and Septic Shock: Management Bundle, last updated Date: Oct 05, 2012. Website link Accessed 01-31-2024: https://www.qualityforum.org/Projects/i-m/Infectious_Disease_Endorsement_Maintenance_2012/0500.aspx  National Quality Forum: NQF Revises Sepsis Measure. Website link accessed 01-31-2024: https://www.qualityforum.org/NQF_Revises_Sepsis_Measure.aspx  Faust JS, Weingart SD. The Past, Present, and Future of the Centers for Medicare and Medicaid Services Quality Measure SEP-1 - the early management bundle for severe sepsis / septic shock. Emerg Med Clin N Am. 2017; 35:219-231 Affordable care act Patient Protection and Affordable Care Act, Public Law 148, U.S. Statutes at Large 124 (2010):119-1024. Website link accessed 01-31-2024: https://www.govinfo.gov/app/details/STATUTE-124/STATUTE-124-Pg119/summary.  Fluids for sepsis in concerning populations Pence M, Tran QK, Shesser R, Payette C, Pourmand A. Outcomes of CMS-mandated fluid administration among fluid-overloaded patients with sepsis: A systematic review and meta-analysis. Am J Emerg Med. 2022 May:55:157-166 Zadeh AV, Wong A, Crawford AC, Collado E, Larned JM. Guideline-based and restricted fluid resuscitation strategy in sepsis patients with heart failure: A systematic review and meta-analysis. Am J Emerg Med. 2023 Nov:73:34-39   WANT TO WORK AT MAYO? EM Physicians: https://jobs.mayoclinic.org/emergencymedicine EM NP PAs: https://jobs.mayoclinic.org/em-nppa-jobs   Nursing/Techs/PAC: https://jobs.mayoclinic.org/Nursing-Emergency-Medicine EMTs/Paramedics: https://jobs.mayoclinic.org/ambulanceservice All groups above combined into one link: https://jobs.mayoclinic.org/EM-Jobs  

In this episode of The Saving Lives Podcast, "Integrating Palliative Care in the ICU: Enhancing Quality of Life," host EddyJoe discusses the article 'Palliative Care in Intensive Care' from 'Intensive Care Medicine.' The episode examines how palliative care improves patient quality of life and reduces ICU stays, highlighting its role beyond end-of-life care. It emphasizes the need for training and changing perceptions among healthcare professionals. Essential for medical practitioners, this episode offers insights into incorporating palliative care into ICU practices for better patient outcomes. The Vasopressor & Inotrope Handbook: ⁠⁠Amazon Affiliate Link⁠⁠ (I will earn an extra small commission) and ⁠⁠Signed Copies⁠⁠. TrueLearn Link: ⁠⁠⁠⁠⁠⁠⁠⁠https://truelearn.referralrock.com/l/EDDYJOEMD25/⁠⁠⁠⁠⁠⁠⁠⁠ Discount code: EDDYJOEMD25 Citation: Neukirchen M, Metaxa V, Schaefer MS. Palliative care in intensive care. Intensive Care Med. 2023 Dec;49(12):1538-1540. doi: 10.1007/s00134-023-07260-z. Epub 2023 Nov 27. PMID: 38010381; PMCID: PMC10709230. --- Support this podcast: https://podcasters.spotify.com/pod/show/eddyjoemd/support

In this episode, we delve into the groundbreaking DAMIS trial, exploring the impact of sublingual microcirculation assessment on treatment decisions for ICU patients with shock. We discuss the methodology, findings, and implications of this extensive multicenter study, offering insights into how real-time microcirculatory data influences clinical outcomes in critical care. Join us for an in-depth analysis and expert opinions on this pivotal topic in intensive care medicine. Show Notes: https://eddyjoemd.com/damis-trial-microcirculation/ The Vasopressor & Inotrope Handbook: ⁠Amazon Affiliate Link⁠ (I will earn an extra small commission) and ⁠Signed Copies⁠. Citation: Bruno RR, Wollborn J, Fengler K, Flick M, Wunder C, Allgäuer S, Thiele H, Schemmelmann M, Hornemann J, Moecke HME, Demirtas F, Palici L, Franz M, Saugel B, Kattan E, De Backer D, Bakker J, Hernandez G, Kelm M, Jung C. Direct assessment of microcirculation in shock: a randomized-controlled multicenter study. Intensive Care Med. 2023 Jun;49(6):645-655. doi: 10.1007/s00134-023-07098-5. Epub 2023 Jun 6. Erratum in: Intensive Care Med. 2023 Oct;49(10):1279. PMID: 37278760; PMCID: PMC10242221. This Podcast was edited using Descript: ⁠⁠⁠⁠⁠https://www.descript.com?lmref=BGOxjQ⁠⁠⁠⁠ --- Support this podcast: https://podcasters.spotify.com/pod/show/eddyjoemd/support

We recently made a significant vasopressor protocol change at MCHD, prioritizing norepinephrine in all shock situations except anaphylaxis and bradycardia. The evidence supporting norepinephrine in septic and even cariogenic shock is relatively solid. However, recent data has emerged suggesting norepinephrine may be safer in post-ROSC shock as well. REFERENCES 1. Bougouin W, Slimani K, Renaudier M, et al; Sudden Death Expertise Center Investigators. Epinephrine versus norepinephrine in cardiac arrest patients with post-resuscitation shock. Intensive Care Med. 2022 Mar;48(3):300-310. 2. Wender ER, Counts CR, Van Dyke M, et al. Prehospital Administration of Norepinephrine and Epinephrine for Shock after Resuscitation from Cardiac Arrest. Prehosp Emerg Care. 2023 Sep 14:1-6.

Dr. Mark Oldham, Associate Professor of Psychiatry at University of Rochester Medical Center, President-Elect of the American Delirium Society, and Deputy Editor of the Journal of the Academy of Consultation-Liaison Psychiatry, takes us through a deep dive on delirium. This episode covers an enormous amount of material. Contrast  encephalopathy and delirium before diving into the dangerousness of delirium and prevention strategies. Explore the neurobiology of delirium and tie it to validated assessment tools and treatment approaches. We also discuss areas for future research, and learn to appreciate the evolutionary function that delirium serves.This episode also deserves some references! (3:38) Lipowski ZJ. Delirium: Acute Brain Failure in Man. Springfield, IL: Charles C Thomas, 1980.  (7:55) Slooter AJC, Otte WM, Devlin JW, et al. Updated nomenclature of delirium and acute encephalopathy: statement of ten Societies. Intensive Care Med. 2020;46(5):1020-1022.  (21:46)  Marcantonio ER, Ngo LH, O'Connor M, et al. 3D-CAM: derivation and validation of a 3-minute diagnostic interview for CAM-defined delirium: a cross-sectional diagnostic test study [published correction appears in Ann Intern Med. 2014 Nov 18;161(10):764]. Ann Intern Med. 2014;161(8):554-561.   (29:50) Kunicki ZJ, Ngo LH, Marcantonio ER, et al. Six-Year Cognitive Trajectory in Older Adults Following Major Surgery and Delirium. JAMA Intern Med. 2023;183(5):442-450.   (41:40) Mews MR, Tauch D, Erdur H, Quante A. Comparing consultation-liaison psychiatrist's and neurologist's approaches to delirium - A retrospective analysis. Int J Psychiatry Med. 2016;51(3):284-301. = (1:08:08) Girard TD, Exline MC, Carson SS, et al. Haloperidol and Ziprasidone for Treatment of Delirium in Critical Illness. N Engl J Med. 2018;379(26):2506-2516.   (1:09:33) Hui D, Frisbee-Hume S, Wilson A, et al. Effect of Lorazepam With Haloperidol vs Haloperidol Alone on Agitated Delirium in Patients With Advanced Cancer Receiving Palliative Care: A Randomized Clinical Trial. JAMA. 2017;318(11):1047-1056.   (1:31:36) By the 2023 American Geriatrics Society Beers Criteria® Update Expert Panel. American Geriatrics Society 2023 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2023;71(7):2052-2081.  (1:33:54) Burton JK, Craig LE, Yong SQ, et al. Non-pharmacological interventions for preventing delirium in hospitalised non-ICU patients. Cochrane Database Syst Rev. 2021;7(7):CD013307. Published 2021 Jul 19.   (1:35:41) Skrobik Y, Duprey MS, Hill NS, Devlin JW. Low-Dose Nocturnal Dexmedetomidine Prevents ICU Delirium. A Randomized, Placebo-controlled Trial. Am J Respir Crit Care Med. 2018;197(9):1147-1156.   (1:36:00) Subramaniam B, Shankar P, Shaefi S, et al. Effect of Intravenous Acetaminophen vs Placebo Combined With Propofol or Dexmedetomidine on Postoperative Delirium Among Older Patients Following Cardiac Surgery: The DEXACET Randomized Clinical Trial [published correction appears in JAMA. 2019 Jul 16;322(3):276]. JAMA. 2019;321(7):686-696. 

João e Fred discutem sobre tratamento de pneumonia, incluindo as diferenças de tratmento do paciente internado e o paciente ambulatorial, quando usar terapia dupla e uso de corticoide. Referências: 1. Metlay JP, Waterer GW, Long AC, Anzueto A, Brozek J, Crothers K, Cooley LA, Dean NC, Fine MJ, Flanders SA, Griffin MR, Metersky ML, Musher DM, Restrepo MI, Whitney CG. Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019 Oct 1;200(7):e45-e67. doi: 10.1164/rccm.201908-1581ST. PMID: 31573350; PMCID: PMC6812437. 2. Martin-Loeches I, Torres A, Nagavci B, Aliberti S, Antonelli M, Bassetti M, Bos LD, Chalmers JD, Derde L, de Waele J, Garnacho-Montero J, Kollef M, Luna CM, Menendez R, Niederman MS, Ponomarev D, Restrepo MI, Rigau D, Schultz MJ, Weiss E, Welte T, Wunderink R. ERS/ESICM/ESCMID/ALAT guidelines for the management of severe community-acquired pneumonia. Intensive Care Med. 2023 Jun;49(6):615-632. doi: 10.1007/s00134-023-07033-8. Epub 2023 Apr 4. Erratum in: Intensive Care Med. 2023 May 17;: PMID: 37012484; PMCID: PMC10069946. 3. Corrêa RA, Costa AN, Lundgren F, Michelin L, Figueiredo MR, Holanda M, Gomes M, Teixeira PJZ, Martins R, Silva R, Athanazio RA, Silva RMD, Pereira MC. 2018 recommendations for the management of community acquired pneumonia. J Bras Pneumol. 2018 Sep-Oct;44(5):405-423. doi: 10.1590/S1806-37562018000000130. Erratum in: J Bras Pneumol. 2018 Nov-Dec;44(6):532. Erratum in: J Bras Pneumol. 2019 May 13;45(2):e20180130. PMID: 30517341; PMCID: PMC6467584. 4. Dequin PF, Meziani F, Quenot JP, Kamel T, Ricard JD, Badie J, Reignier J, Heming N, Plantefève G, Souweine B, Voiriot G, Colin G, Frat JP, Mira JP, Barbarot N, François B, Louis G, Gibot S, Guitton C, Giacardi C, Hraiech S, Vimeux S, L'Her E, Faure H, Herbrecht JE, Bouisse C, Joret A, Terzi N, Gacouin A, Quentin C, Jourdain M, Leclerc M, Coffre C, Bourgoin H, Lengellé C, Caille-Fénérol C, Giraudeau B, Le Gouge A; CRICS-TriGGERSep Network. Hydrocortisone in Severe Community-Acquired Pneumonia. N Engl J Med. 2023 May 25;388(21):1931-1941. doi: 10.1056/NEJMoa2215145. Epub 2023 Mar 21. PMID: 36942789.

Contributor: Travis Barlock MD Educational Pearls: Common sedatives used in the Emergency Department and a few pearls for each. Propofol Type: Non-barbiturate sedative hypnotic agonizing GABA receptors. Benefit: Quick on and quick off (duration of action is approximately 2-7 minutes), helpful for suspected neurologic injury so the patient can wake up and be re-evaluated. Also has the benefit of reducing intracranial pressure (ICP). Downsides: Hypotension, bradycardia, respiratory depression. What should you do if a patient is getting hypotensive on propofol? Do not stop the propofol. Start pressors. May have to reduce the propofol dose if delay in pressors. Dexmedetomidine (Precedex) Type: Alpha 2 agonist - causes central sedation Uses: Patients are more alert and responsive and therefore can be on BiPAP instead of being intubated. Does not cause respiratory depression. Downsides: Hypotension and Bradycardia. Caution in using this for head injuries, its side effects can mask the Cushing reflex and make it more difficult to spot acute elevations in ICP and uncal herniation. Ketamine Type: NMDA antagonist and dissociative anesthetic, among other mechanisms. Benefits: Quick Onset (but slower than propofol). Does not cause hypotension, but can even increase HR and BP (Thought to potentially cause hypotension if patient is catecholamine-depleted (ie. sepsis, delayed trauma)). Dosing ketamine can be challenging. Typically low doses (0.1-0.3mg/kg (max ~30mg)) can give good pain relief. Higher doses (for intubation/procedural sedation) are generally thought to have a higher risk of dissociation. Downsides: Emergence reactions which include hallucinations, vivid dreams, and agitation. Increased secretions. Benzos Type: GABA agonists. Benefits: Seizure, alcohol withdrawal, agitation due to toxic overdoses.  Push doses are useful because doses can stack. Longer half-life than propofol.   Downsides: Respiratory depression. Longer half-life can make neuro assessments difficult to complete. Etomidate MOA: Displaces endogenous GABA inhibitors. Useful as a one-time dose for quick procedures (cardioversion, intubation). Often drug of choice for intubation since it is thought to have no hemodynamic effects.  Downsides; If used without paralytic - myoclonus. Though to have some adrenal suppression. Fentanyl Type: Opioid analgesic. Not traditional sedative. Benefits: There are many instances in emergency medicine in which sedation can be avoided by prioritizing proper analgesia. Fentanyl can even be used to maintain intubated patients without needing to keep them constantly sedated. Downsides: Respiratory depression. Patients may have tolerance. References Chawla N, Boateng A, Deshpande R. Procedural sedation in the ICU and emergency department. Curr Opin Anaesthesiol. 2017 Aug;30(4):507-512. doi: 10.1097/ACO.0000000000000487. PMID: 28562388. Keating GM. Dexmedetomidine: A Review of Its Use for Sedation in the Intensive Care Setting. Drugs. 2015 Jul;75(10):1119-30. doi: 10.1007/s40265-015-0419-5. PMID: 26063213. Lundström S, Twycross R, Mihalyo M, Wilcock A. Propofol. J Pain Symptom Manage. 2010 Sep;40(3):466-70. doi: 10.1016/j.jpainsymman.2010.07.001. PMID: 20816571. Matchett G, Gasanova I, Riccio CA, Nasir D, Sunna MC, Bravenec BJ, Azizad O, Farrell B, Minhajuddin A, Stewart JW, Liang LW, Moon TS, Fox PE, Ebeling CG, Smith MN, Trousdale D, Ogunnaike BO; EvK Clinical Trial Collaborators. Etomidate versus ketamine for emergency endotracheal intubation: a randomized clinical trial. Intensive Care Med. 2022 Jan;48(1):78-91. doi: 10.1007/s00134-021-06577-x. Epub 2021 Dec 14. PMID: 34904190. Mihaljević S, Pavlović M, Reiner K, Ćaćić M. Therapeutic Mechanisms of Ketamine. Psychiatr Danub. 2020 Autumn-Winter;32(3-4):325-333. doi: 10.24869/psyd.2020.325. PMID: 33370729. Nakauchi C, Miyata M, Kamino S, Funato Y, Manabe M, Kojima A, Kawai Y, Uchida H, Fujino M, Boda H. Dexmedetomidine versus fentanyl for sedation in extremely preterm infants. Pediatr Int. 2023 Jan-Dec;65(1):e15581. doi: 10.1111/ped.15581. PMID: 37428855. Summarized by Jeffrey Olson MS2 | Edited by Jorge Chalit, OMSII  

Contributor: Aaron Lessen MD Educational Pearls: Why is airway management more difficult in obesity? Larger body habitus causes the chest to be above the head when the patient is lying supine, creating difficult angles for intubation. Reduced Functional Residual Capacity (FRC) causes these patients to deoxygenate much more quickly, reducing the amount of time during which the intubation can take place. What special considerations need to be made? Positioning. The auditory canal and sternal notch should be aligned in a horizontal plane. Do this by stacking blankets to lift the neck and head. Also, try to make the head itself parallel to the ceiling. Pre-oxygenation. Use Bi-level Positive Airway Pressure (BiPAP) with Positive End Expiratory Pressure (PEEP) or a Bag-Valve-Mask (BVM) with a PEEP valve. PEEP helps prevent alveoli from collapsing after every breath and improves oxygenation. Dosing of paralytics. Succinylcholine is dosed on total body weight so the dose will be much larger for the obese patient. Rocuronium is dosed on ideal body weight, but adjusted body weight may also be used in obese cases.  References De Jong A, Wrigge H, Hedenstierna G, Gattinoni L, Chiumello D, Frat JP, Ball L, Schetz M, Pickkers P, Jaber S. How to ventilate obese patients in the ICU. Intensive Care Med. 2020 Dec;46(12):2423-2435. doi: 10.1007/s00134-020-06286-x. Epub 2020 Oct 23. PMID: 33095284; PMCID: PMC7582031. Langeron O, Birenbaum A, Le Saché F, Raux M. Airway management in obese patient. Minerva Anestesiol. 2014 Mar;80(3):382-92. Epub 2013 Oct 14. PMID: 24122033. Sharma S, Arora L. Anesthesia for the Morbidly Obese Patient. Anesthesiol Clin. 2020 Mar;38(1):197-212. doi: 10.1016/j.anclin.2019.10.008. Epub 2020 Jan 2. PMID: 32008653. Singer BD, Corbridge TC. Basic invasive mechanical ventilation. South Med J. 2009 Dec;102(12):1238-45. doi: 10.1097/SMJ.0b013e3181bfac4f. PMID: 20016432. Summarized by Jeffrey Olson, MS2 | Edited by Jorge Chalit, OMSII  

In this episode, we will discuss the evaluation and initial management of acute disorders of consciousness in the ICU. Our guest is Dr. Cherylee Chang, a practicing neuro intensivist, a Professor of Neurology, and the Division Chief of Neurocritical Care, in the Department of Neurology, at Duke University, in Durham, North Carolina. Additional Resources State-of-the-Art Evaluation of Acute Adult Disorders of Consciousness for the General Intensivist. Chang C, et al. Critical Care Medicine 2023: https://pubmed.ncbi.nlm.nih.gov/37070819/ Neurocritical Care Society Curing Coma Campaign. Provencio J, et al. Neurocrit Care 2020: https://pubmed.ncbi.nlm.nih.gov/32578124/ NIH Stroke Scale: https://www.ninds.nih.gov/health-information/public-education/know-stroke/health-professionals/nih-stroke-scale Updated nomenclature of delirium and acute encephalopathy: statement of ten Societies. Intensive Care Med 2020: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7210231/ Critical Matters podcast episode on CNS Infections: https://soundphysicians.com/podcast-episode/?podcast_id=342&track_id=1533382963 Books mentioned in this episode: Bed Number Ten. By Sue Baier and Mary Zimmeth Schomaker: amzn.to/3O8Fmgp The Diving Bell and the Butterfly. By Jean-Dominique Bauby: bit.ly/44Hxhon Clinical Neuroanatomy Made Ridiculously Simple. By Stephen Goldberg: https://amzn.to/3PUF7Xu

Contributor: Aaron Lessen, MD Educational Pearls: Hyperkalemia may cause cardiac arrest  Treatment of suspected hyperkalemic cardiac arrest begins with typical management of cardiac arrest including high-quality CPR, defibrillation if appropriate, and resuscitation medications  Administer calcium products to stabilize cardiac membrane and potassium shifting medications  If ROSC is achieved, initiate dialysis  There are several case reports of patients being dialyzed while CPR is ongoing, with some success   Dialysis during resuscitation may be an appropriate treatment for some patients  References Jackson MA, Lodwick R, Hutchinson SG. Hyperkalaemic cardiac arrest successfully treated with peritoneal dialysis. BMJ. 1996;312(7041):1289-1290. doi:10.1136/bmj.312.7041.1289 Kao KC, Huang CC, Tsai YH, Lin MC, Tsao TC. Hyperkalemic cardiac arrest successfully reversed by hemodialysis during cardiopulmonary resuscitation: case report. Chang Gung Med J. 2000;23(9):555-559. Torrecilla C, de la Serna JL. Hyperkalemic cardiac arrest, prolonged heart massage and simultaneous hemodialysis. Intensive Care Med. 1989;15(5):325-326. doi:10.1007/BF00263870 Summarized by Kirsten Hughes, MS4 | Edited by John Spartz, MD, & Erik Verzemnieks, MD   The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at https://emergencymedicalminute.org/cme-courses/ and create an account. 

Le Dr Jean-Philippe Rigaud, qui est chef du service de Réanimation à l'hôpital de Dieppe, nous parle aujourd'hui de la consultation post-réanimation en 2022. Aucun conflit d'intérêt n'est déclaré. Sommaire Que représente la consultation post-réanimation ? Quel en est l'intérêt pour les patients, leurs familles et les médecins réanimateurs ? Comment peut se mettre en place une activité de consultation post-réanimation ? Références Rigaud JP, Gélinotte S, Beuzelin M, Marchalot A, Eraldi JP, Bougerol F, Ecarnot F, Quenot JP, Declercq PL (2022) Consultation post-réanimation : un outil désormais indispensable en 2022. Méd Intensive Réa 2002 31(HS1) 79-86 Jensen JF, Thomsen T, Overgaard D, et al (2015) Impact of follow-up consultations for ICU survivors on post-ICU syndrome: a systematic review and meta-analysis. Intensive Care Med 41:763-75. DOI : 10.1007/s00134-015-3689-1 Davidson JE, Aslakson RA, Long AC, et al (2017) Guidelines for Family-Centered Care in the Neonatal, Pediatric and Adult ICU. Crit Care Med 45(1): 103-128DOI : 10.1097/CCM.0000000000002169

Join us as we discuss Neuroprognostication after Cardiac Arrest with Clinician-Scientist, Dr Gord Boyd. Dr Boyd has dual certification in Neurology and Critical Care Medicine and is a Clinician Scientist at Queens University, Kingston, Canada. He works at the Kingston General Hospital as an Intensivist and heads a research program aimed at understanding the relationship between cerebral perfusion, delirium, and long-term neurological outcomes for ICU survivors. He received his undergraduate degree (Psychology) from Lakehead University in his hometown of Thunder Bay, Ontario. That was followed by his PhD in Neuroscience from the University of Alberta, where he studied the role of growth factors in peripheral nerve regeneration. In 2001 he moved to Kingston to do a post-doctoral fellowship in the Queen's Department of Anatomy and Cell biology, examining the potential of glial cell transplantation to treat spinal cord injury. He stayed in Kingston to do his undergraduate degree in Medicine, which was followed by his residency in Neurology and fellowship in Adult Critical Care. He is an active musician and plays the drums in an all-physician band. In this episode we discuss the importance of admitting uncertainty when it comes to neuroprognostication following cardiac arrest, allowing enough time to pass, some of the best and worst tests for clinical prognostication, usefulness of biomarkers, EEG, seizure treatment and the risk of persistent neurovegetative states. Further Reading: 1. Nakstad ER, Stær-Jensen H, Wimmer H, et al. Late awakening, prognostic factors and long-term outcome in out-of-hospital cardiac arrest - results of the prospective Norwegian Cardio-Respiratory Arrest Study (NORCAST). Resuscitation. 2020;149:170-179. doi:10.1016/j.resuscitation.2019.12.031 https://pubmed.ncbi.nlm.nih.gov/31926258/ 2. Nolan JP, Sandroni C, Böttiger BW, et al. European Resuscitation Council and European Society of Intensive Care Medicine guidelines 2021: post-resuscitation care. Intensive Care Med. 2021;47(4):369-421. doi:10.1007/s00134-021-06368-4 https://pubmed.ncbi.nlm.nih.gov/33765189/ 3. Sandroni C, D'Arrigo S, Cacciola S, et al. Prediction of good neurological outcome in comatose survivors of cardiac arrest: a systematic review. Intensive Care Med. 2022;48(4):389-413. doi:10.1007/s00134-022-06618-z https://pubmed.ncbi.nlm.nih.gov/35244745/ 4. Beuchat I, Novy J, Barbella G, Oddo M, Rossetti AO. EEG patterns associated with present cortical SSEP after cardiac arrest. Acta Neurol Scand. 2020;142(2):181-185. doi:10.1111/ane.13264 EEG patterns associated with present cortical SSEP after cardiac arrest - PubMed (nih.gov)

ECMO Anticoagulation with Dr. Ali McMichael and Dr. Lisa Settle--Part 2After listening to this series, learners should be able to:Briefly describe neonatal and pediatric developmental hemostasis. Recognize the key differences in anticoagulation of neonates, children and adults.Describe the advantages and disadvantages of commonly used anticoagulants: unfractionated heparin, bivalirudin and argatroban.Describe common laboratory testing for anticoagulation on ECMO and their limitations: ACT, aPTT, anti Xa, VHAsTroubleshoot discrepant anticoagulation laboratory testing. Discuss future research in ECMO and anticoagulation  About our guests:Dr. Ali McMichael who was previously with us here in Dallas is now an Associate Professor of Pediatrics at the University of Arizona and a pediatric intensivist at Phoenix Children's Hospital. Her interests include medical education and ECMO anticoagulation. She is the first author of the 2021 ELSO Adult and Pediatric anticoagulation guidelines.Dr. Lisa Settle is a pediatric critical care fellow at UT Southwestern and Children's Medical Center in Dallas. Her research interests include anticoagulation management in ECMO, specifically focusing on the utilization of TEG data in the neonatal ECMO population.References:Levy JH, Staudinger T, Steiner ME. How to manage anticoagulation during extracorporeal membrane oxygenation. Intensive Care Med. 2022 Jun 11:1–4. doi: 10.1007/s00134-022-06723-z. Epub ahead of print. PMID: 35689697; PMCID: PMC9187844.McMichael ABV, Ryerson LM, Ratano D, Fan E, Faraoni D, Annich GM. 2021 ELSO Adult and Pediatric Anticoagulation Guidelines. ASAIO J. 2022 Mar 1;68(3):303-310. doi: 10.1097/MAT.0000000000001652. PMID: 35080509.Ryerson LM, McMichael ABV. Bivalirudin in pediatric extracorporeal membrane oxygenation. Curr Opin Pediatr. 2022 Jun 1;34(3):255-260. doi: 10.1097/MOP.0000000000001131. PMID: 35634698.Saini A, Spinella PC. Management of anticoagulation and hemostasis for pediatric extracorporeal membrane oxygenation. Clin Lab Med. 2014 Sep;34(3):655-73. doi: 10.1016/j.cll.2014.06.014. Epub 2014 Jul 24. PMID: 25168949.How to support PedsCrit:Please rate and review on Spotify or Apple Podcasts!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show.Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.com for detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.Support the show

ECMO Anticoagulation with Dr. Ali McMichael and Dr. Lisa Settle--Part 1After listening to this series, learners should be able to:Briefly describe neonatal and pediatric developmental hemostasis. Recognize the key differences in anticoagulation of neonates, children and adults.Describe the advantages and disadvantages of commonly used anticoagulants: unfractionated heparin, bivalirudin and argatroban.Describe common laboratory testing for anticoagulation on ECMO and their limitations: ACT, aPTT, anti Xa, VHAsTroubleshoot discrepant anticoagulation laboratory testing. Discuss future research in ECMO and anticoagulation  About our guests:Dr. Ali McMichael who was previously with us here in Dallas is now an Associate Professor of Pediatrics at the University of Arizona and a pediatric intensivist at Phoenix Children's Hospital. Her interests include medical education and ECMO anticoagulation. She is the first author of the 2021 ELSO Adult and Pediatric anticoagulation guidelines.Dr. Lisa Settle is a pediatric critical care fellow at UT Southwestern and Children's Medical Center in Dallas. Her research interests include anticoagulation management in ECMO, specifically focusing on the utilization of TEG data in the neonatal ECMO population.References:Levy JH, Staudinger T, Steiner ME. How to manage anticoagulation during extracorporeal membrane oxygenation. Intensive Care Med. 2022 Jun 11:1–4. doi: 10.1007/s00134-022-06723-z. Epub ahead of print. PMID: 35689697; PMCID: PMC9187844.McMichael ABV, Ryerson LM, Ratano D, Fan E, Faraoni D, Annich GM. 2021 ELSO Adult and Pediatric Anticoagulation Guidelines. ASAIO J. 2022 Mar 1;68(3):303-310. doi: 10.1097/MAT.0000000000001652. PMID: 35080509.Ryerson LM, McMichael ABV. Bivalirudin in pediatric extracorporeal membrane oxygenation. Curr Opin Pediatr. 2022 Jun 1;34(3):255-260. doi: 10.1097/MOP.0000000000001131. PMID: 35634698.Saini A, Spinella PC. Management of anticoagulation and hemostasis for pediatric extracorporeal membrane oxygenation. Clin Lab Med. 2014 Sep;34(3):655-73. doi: 10.1016/j.cll.2014.06.014. Epub 2014 Jul 24. PMID: 25168949.How to support PedsCrit:Please rate and review on Spotify or Apple Podcasts!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show.Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.com for detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.Support the show

Contributor: Aaron Lessen, MD Educational Pearls: The management of severe asthma or COPD exacerbation is complex, especially when the patient requires intubation/ventilation Asthma is an obstructive airway disease that can cause air trapping and hyperinflation of the lungs To avoid worsening hyperinflation patients typically require slower respiratory rates, lower tidal volumes, and increased expiratory time when on a ventilator Patients on a ventilator require very close monitoring to prevent worsening hyperinflation and associated complications including barotrauma and hypotension/cardiac arrest secondary to decreased venous return  If patient condition starts to worsen, decrease respiratory rate and tidal volume  In these cases, a decreased oxygen saturation is acceptable until their condition improves If patient status continues to worsen, consider disconnecting the ventilator and pushing on the chest for approximately 30 seconds to help force out trapped air If patient continues to decompensate, consider the possibility of a pneumothorax and determine if a chest tube is necessary Remember to continue asthma/COPD management including albuterol/duonebs, steroids, magnesium, and alternatives including as heliox References Demoule A, Brochard L, Dres M, et al. How to ventilate obstructive and asthmatic patients. Intensive Care Med. 2020;46(12):2436-2449 Garner O, Ramey JS, Hanania NA. Management of Life-Threatening Asthma: Severe Asthma Series. Chest. 2022 Laher AE, Buchanan SK. Mechanically Ventilating the Severe Asthmatic. J Intensive Care Med. 2018;33(9):491-501   Summarized by Mark O'Brien, MS4 | Edited by John Spartz MD & Erik Verzemnieks, MD   In an effort to promote diversity, equity, and inclusion in Emergency Medicine, The Emergency Medical Minute is proud to present our 2nd annual Diversity and Inclusion Award. We support increasing the representation of underrepresented groups in medicine and extend this award to individuals applying to emergency medicine residencies during the 2022-2023 cycle. For information on award eligibility and the application process, visit https://emergencymedicalminute.com/edi-award/

Join us for a brief review of the recently published article "Association of vancomycin plus piperacillin-tazobactam with early changes in creatinine versus cystatin C in critically ill adults: a prospective cohort study". Published in Intensive Care Med in Aug 2022

In the second episode of Breakpoints' Dosing Consult series, Drs. Ryan Crass (@crasspofungin) and Amit Pai (@DosingMatters) join Dr. Jillian Hayes (@thejillianhayes) to break down the 5 Ws and 1 H of linezolid TDM.  LinkedIn: https://www.linkedin.com/company/sidp/ Learn more about the Society of Infectious Diseases Pharmacists: https://sidp.org/About Twitter: @SIDPharm (https://twitter.com/SIDPharm) Instagram: @SIDPharm (https://www.instagram.com/sidpharm/) Facebook: https://www.facebook.com/sidprx Bibliography Abdul-Aziz MH, et al. Intensive Care Med. 2020 Jun;46(6):1127-1153. doi: 10.1007/s00134-020-06050-1. Epub 2020 May 7. PMID: 32383061. Abdul-Aziz MH, et al. Ther Drug Monit. 2022 Feb 1;44(1):19-31. doi: 10.1097/FTD.0000000000000940. PMID: 34750338. Andes D, et al. Antimicrob Agents Chemother. 2002;46(11):3484-3489. doi:10.1128/AAC.46.11.3484-3489.2002. PMID: 12384354. Bandín-Vilar E, et al. Clin Pharmacokinet. 2022;61(6):789-817. doi:10.1007/s40262-022-01125-2. PMID: 35699914. Boak LM, Rayner CR, Grayson ML, et al. Clinical population pharmacokinetics and toxicodynamics of linezolid. Antimicrob Agents Chemother. 2014;58(4):2334-2343. doi:10.1128/AAC.01885-13. PMID: 24514086.   Crass RL, et al. Antimicrob Agents Chemother. 2019 Jul 25;63(8):e00605-19. doi: 10.1128/AAC.00605-19. PMID: 31109977.   Cojutti P, et al. Clin Pharmacokinet. 2018 Aug;57(8):989-1000. doi: 10.1007/s40262-017-0606-5. PMID: 29080937. Dong HY, et al. Eur J Clin Microbiol Infect Dis. 2014;33(6):1029-1035. doi:10.1007/s10096-013-2041-3. PMID: 24515096.  Matsumoto K, et al. Int J Antimicrob Agents. 2014;44(3):242-247. doi:10.1016/j.ijantimicag.2014.05.010. PMID: 25108880.  Meagher AK, et al. Antimicrob Agents Chemother. 2003;47(2):548-553. doi:10.1128/AAC.47.2.548-553.2003. PMID: 12543657.  Obach RS. Drug Metab Dispos. 2022 Apr;50(4):413-421. doi: 10.1124/dmd.121.000776. PMID: 35042700. Pea F, et al. Antimicrob Agents Chemother. 2010 Nov;54(11):4605-10. doi: 10.1128/AAC.00177-10. Epub 2010 Aug 23. PMID: 20733043.  Pea F, et al. J Antimicrob Chemother. 2012 Aug;67(8):2034-42. doi: 10.1093/jac/dks153. Epub 2012 May 2. PMID: 22553142. Rao GG, et al. Ther Drug Monit. 2020 Feb;42(1):83-92. doi: 10.1097/FTD.0000000000000710. PMID: 31652190. Rayner CR, et al. Clin Pharmacokinet. 2003;42(15):1411-23. doi: 10.2165/00003088-200342150-00007. PMID: 14674791. Taubert M, et al. Antimicrob Agents Chemother. 2016 Aug 22;60(9):5254-61. doi: 10.1128/AAC.00356-16. PMID: 27324768.  Society of Infectious Diseases Pharmacists | Contagion Live Laboratories that offer linezolid assay results: Infectious Disease Pharmacokinetics Laboratory (https://idpl.pharmacy.ufl.edu/ ) Atlantic Diagnostics Laboratories (https://atlanticdiagnosticlaboratories.com/lab-tests ) National Jewish Health PK Laboratory (ttps://www.nationaljewish.org/for-professionals/diagnostic-testing/adx/tests/linezolid,-level) Check out our podcast host, Pinecast. Start your own podcast for free with no credit card required. If you decide to upgrade, use coupon code r-7e7a98 for 40% off for 4 months, and support Breakpoints.

Contributor: Aaron Lessen, MD Educational Pearls: Septic shock management has traditionally endorsed rapid fluid resuscitation and the administration of vasopressors Current guidelines are for patients to initially receive a 30 ml/kg fluid bolus then additional fluid as needed for continued hypotension The ideal volume of fluid needed to maximize patient outcomes has been debated A recent ICU-based study examined mortality differences between patient receiving restricted vs standard fluid therapy for septic shock There was no significant difference in the rate of mortality or adverse outcomes between the two groups indicating that the amount of fluid used after the initial bolus does not affect patient outcomes More research needed to evaluate the ideal  fluid volumes used in the initial resuscitation of septic shock   Errata: *** “The primary outcome was death within 90 days after randomization”   References Evans L, Rhodes A, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med. 2021;47(11):1181-1247. Meyhoff TS, Møller MH, Hjortrup PB, Cronhjort M, Perner A, Wetterslev J. Lower vs higher fluid volumes during initial management of sepsis: a systematic review with meta-analysis and trial sequential analysis. Chest. 2020;157(6):1478-1496. Meyhoff TS, Hjortrup PB, Wetterslev J, et al. Restriction of Intravenous Fluid in ICU Patients with Septic Shock. N Engl J Med. 2022;386(26):2459-2470.   Summarized by Mark O'Brien, MS4 | Edited by John Spartz, MD & Erik Verzemnieks, MD   The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at https://emergencymedicalminute.org/cme-courses/ and create an account.  Donate to EMM today!

In this World Shared Practice Forum podcast, Dr. Akash Deep, Director of the Pediatric Intensive Care Unit, Staff Governor, and Professor in Pediatric Critical Care at King's College Hospital, discusses his recent publication on non-transplant options in pediatric acute liver failure. He describes important considerations for the management of acute liver failure and commonly associated toxicities, and offers insights into the paradigm shift currently evolving in the field and what we can expect in the trends of future treatment pathways. Upon listening to this presentation, learners should be able to: - Apply strategies for management of acutely ill children with acute liver failure - Describe various forms of toxicity commonly associated with acute liver failure Publication date: June 28, 2022. Articles Referenced: • Deep A, Nagakawa S, Tissieres P. Non-transplant options in paediatric acute liver failure-what is new?. Intensive Care Med. 2022;48(1):114-117. (00:49) • Habib M, Roberts LN, Patel RK, Wendon J, Bernal W, Arya R. Evidence of rebalanced coagulation in acute liver injury and acute liver failure as measured by thrombin generation. Liver Int. 2014;34(5):672-678. (7:03) • Slack AJ, Auzinger G, Willars C, et al. Ammonia clearance with haemofiltration in adults with liver disease. Liver Int. 2014;34(1):42-48. (13:27) • Hunt A, Tasker RC, Deep A. Neurocritical care monitoring of encephalopathic children with acute liver failure: A systematic review. Pediatr Transplant. 2019;23(7):e13556. (17:39) • Kochanek PM, Adelson PD, Rosario BL, et al. Comparison of Intracranial Pressure Measurements Before and After Hypertonic Saline or Mannitol Treatment in Children With Severe Traumatic Brain Injury. JAMA Netw Open. 2022;5(3):e220891. (19:51) Citation: Deep A, Daniel D, Burns JP. Non-transplant Options in Pediatric Acute Liver Failure. 6/2022. Online Podcast. OPENPediatrics. https://youtu.be/iSvZ26drzy0. Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu Please note: OPENPediatrics does not support nor control any related videos in the sidebar, these are placed by Youtube. We apologize for any inconvenience this may cause.

An immersive reading of excerpts from ‘The South' by Jorge Louis Borges with reflection on the experience of critical illness, iatrogenesis and communication. Work:Fever wasted him and the pictures in The Thousand and One Nights served to illustrate nightmares. Friends and relatives paid him visits and, with exaggerated smiles, assured him that they thought he looked fine. Dahlmann listened to them with a kind of feeble stupor and he marveled at their not knowing that he was in hell. A week, eight days passed, and they were like eight centuries. One afternoon, the usual doctor appeared, accompanied by a new doctor, and they carried him off to a sanitarium on the Calle Ecuador, for it was necessary to Xray him. […] When he arrived at his destination, they undressed him, shaved his head, bound him with metal fastenings to a stretcher; they shone bright lights on him until he was blind and dizzy, auscultated him, and a masked man stuck a needle into his arm. He awoke with a feeling of nausea, covered with a bandage, in a cell with something of a well about it; in the days and nights which followed the operation he came to realize that he had merely been, up until then, in a suburb of hell. Ice in his mouth did not leave the least trace of freshness. During these days Dahlmann hated himself in minute detail: he hated his identity, his bodily necessities, his humiliation, the beard which bristled up on his face. He stoically endured the curative measures, which were painful, but when the surgeon told him he had been on the point of death from septicemia, Dahlmann dissolved in tears of self-pity for his fate. Physical wretchedness and the incessant anticipation of horrible nights had not allowed him time to think of anything so abstract as death.ReferencesThe South: https://www.medina502.com/classes/ml260_2017/readings/Borges-The_South.pdf Jorge Luis Borges: https://www.poetryfoundation.org/poets/jorge-luis-borges  An Autobiographical Essay: Newyorker https://www.gwern.net/docs/borges/1971-borges-anautobiographicalessay.pdf  Campbell C, Scott K, Skovdal M, Madanhire C, Nyamukapa C, Gregson S. A good patient? How notions of 'a good patient' affect patient-nurse relationships and ART adherence in Zimbabwe. BMC Infect Dis. 2015;15:404. Stollings JL, Kotfis K, Chanques G, Pun BT, Pandharipande PP, Ely EW. Delirium in critical illness: clinical manifestations, outcomes, and management. Intensive Care Med. 2021;47(10):1089-1103. Cutler LR, Hayter M, Ryan T. A critical review and synthesis of qualitative research on patient experiences of critical illness. Intensive Crit Care Nurs. 2013;29(3):147-157.

Contributor: Aaron Lessen, MD Educational Pearls: Hypotension after cardiac arrest often requires a vasopressor to improve blood pressure Recent observational study from France examined outcomes of patients who received either epinephrine or norepinephrine for post-resuscitation shock Norepinephrine had significantly better outcomes  Death from shock was 35% in the epinephrine group vs. 9% in the norepinephrine group Recurrent cardiac arrest was 9% in epinephrine group vs. 3% in norepinephrine group For epinephrine: The all cause mortality was 2.5 times higher than norepinephrine Cardiovascular mortality was 5 times higher than norepinephrine Favorable neurological outcomes was 3 times worse than norepinephrine References Bougouin W, Slimani K, Renaudier M, Binois Y, Paul M, Dumas F, Lamhaut L, Loeb T, Ortuno S, Deye N, Voicu S, Beganton F, Jost D, Mekontso-Dessap A, Marijon E, Jouven X, Aissaoui N, Cariou A; Sudden Death Expertise Center Investigators. Epinephrine versus norepinephrine in cardiac arrest patients with post-resuscitation shock. Intensive Care Med. 2022 Mar;48(3):300-310. doi: 10.1007/s00134-021-06608-7. Epub 2022 Feb 7. PMID: 35129643. Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD   The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at https://emergencymedicalminute.org/cme-courses/ and create an account.  Donate to EMM today!

En este nuevo episodio intento analizar una pregunta clásica, ¿Qué es mejor los sueros balanceados o el suero salino para el paciente crítico? Para ello, me basaré en el articulo publicado en marzo de 2022 en la New England Journal of Medicine “Solución multielectrolito equilibrada frente a salina en adultos gravemente enfermos” La bibliografía utilizada para el episodio: Finfer, S., Micallef, S., Hammond, N., Navarra, L., Bellomo, R., Billot, L., Delaney, A., Gallagher, M., Gattas, D., Li, Q., Mackle, D., Mysore, J., Saxena, M., Taylor, C., Young, P., Myburgh, J., PLUS Study Investigators and the Australian and New Zealand Intensive Care Society Clinical Trials Group, & PLUS Study Investigators and Australian New Zealand Intensive Care Society Clinical Trials Group (2022). Balanced Multielectrolyte Solution versus Saline in Critically Ill Adults. The New England journal of medicine, 386(9), 815–826. https://doi.org/10.1056/NEJMoa2114464 Zampieri FG, Machado FR, Biondi RS, et al. Effect of intravenous fluid treatment with a balanced solution vs 0.9% saline solution on mortality in critically ill patients: the BaSICS randomized clinical trial. JAMA 2021;326:818-829. Hammond NE, Zampieri FG, Di Tanna GL, et al. Balanced crystalloids versus saline in critically ill adults — a systematic review with meta-analysis. NEJM Evid 2022;1(2). DOI: 10.1056/EVIDoa2100010. Ramanan M, Attokaran A, Murray L, et al. Sodium chloride or Plasmalyte-148 evaluation in severe diabetic ketoacidosis (SCOPE-DKA): a cluster, crossover, randomized, controlled trial. Intensive Care Med 2021;47:1248-1257. Self WH, Evans CS, Jenkins CA, et al. Clinical effects of balanced crystalloids vs saline in adults with diabetic ketoacidosis: a subgroup analysis of cluster randomized clinical trials. JAMA Netw Open 2020;3(11):e2024596-e2024596.

Growing evidence suggests that insufficient antibiotic exposure (defined as failure to achieve the pharmacokinetic/pharmacodynamic (PK/PD) target to kill or inhibit the growth of a pathogen) is associated with worse clinical outcomes in sepsis patients. Moreover, up to 50% of critically ill patients receiving a β-lactam antibiotic with regimens based on manufacturers' recommendations fail to reach the target. Therapeutic drug monitoring (TDM)-guided therapy has been proposed as a strategy to further optimise the achievement of the PK/PD target of β-lactam antibiotics. However, there are no data on whether piperacillin/tazobactam TDM can improve clinical outcomes. In this context, a large RCT was performed to investigate whether TDM-based dose optimisation versus fixed dosing could improve clinical outcomes in patients with sepsis treated with piperacillin/tazobactam as a continuous infusion. Dr Hagel shares with us the results of this study published in the ICM Journal. Original study: Hagel S et al. https://pubmed.ncbi.nlm.nih.gov/35106617/ (Effect of therapeutic drug monitoring-based dose optimization of piperacillin/tazobactam on sepsis-related organ dysfunction in patients with sepsis: a randomized controlled trial). Intensive Care Med. 2022 Mar;48(3):311-321. doi: 10.1007/s00134-021-06609-6 Speakers Stefan HAGEL. Assistant medical director and consultant at the Institute for Infectious Diseases and Infection Control and Center for Sepsis Control and Care at the Jena University Hospital (DE). Laura BORGSTEDT. Department of Anesthesiology, Klinikum rechts der Isar, Technical University of Munich, Munich (DE).

In this episode, I talk about incorporating checklists in our daily emergency medicine practice. Why is it important? How does it help and how do you use them? I would be discussing these in this episode with some anecdotes sprayed in. You can go through the following resources if you need help in using an airway checklist in your department or can hit me up on twitter (@anksv25) or Instagram @anksv. Hope you enjoy listening. Here are the resources - 1. Pronovost P, Needham D, Berenholtz S, Sinopoli D, Chu H, Cosgrove S, Sexton B, Hyzy R, Welsh R, Roth G, Bander J, Kepros J, Goeschel C. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med. 2006 Dec 28;355(26):2725-32. doi: 10.1056/NEJMoa061115. Erratum in: N Engl J Med. 2007 Jun 21;356(25):2660. PMID: 17192537. 2. Smith KA, High K, Collins SP, Self WH. A preprocedural checklist improves the safety of emergency department intubation of trauma patients. Acad Emerg Med. 2015 Aug;22(8):989-92. doi: 10.1111/acem.12717. Epub 2015 Jul 20. PMID: 26194607. 3. Kerrey BT, Mittiga MR, Rinderknecht AS, Varadarajan KR, Dyas JR, Geis GL, Luria JW, Frey ME, Jablonski TE, Iyer SB. Reducing the incidence of oxyhaemoglobin desaturation during rapid sequence intubation in a paediatric emergency department. BMJ Qual Saf. 2015 Nov;24(11):709-17. doi: 10.1136/bmjqs-2014-003713. Epub 2015 Jul 16. PMID: 26183713. 4. Jaber S, Jung B, Corne P, Sebbane M, Muller L, Chanques G, Verzilli D, Jonquet O, Eledjam JJ, Lefrant JY. An intervention to decrease complications related to endotracheal intubation in the intensive care unit: a prospective, multiple-center study. Intensive Care Med. 2010 Feb;36(2):248-55. doi: 10.1007/s00134-009-1717-8. Epub 2009 Nov 17. PMID: 19921148. 5. https://emcrit.org/wp-content/uploads/2013/02/emcrit-airway-checklist-2013-02-05.pdf 6. https://das.uk.com/guidelines/icu_guidelines2017 7. https://intensiveblog.com/alfred-icu-intubation-checklist/

ATS 2022 starts May 13. Register today: conference.thoracic.orgPodcast CreditsWriter: Ryan Thomas, MDProducer: Ryan Thomas, MDReviewers: Christina Barreda, MDElizabeth Fiorino, MDReferences: Andreeva AV Regulation of surfactant secretion in alveolar type II cells 2007 AmJPhyLung Banfi C, Agostoni P. Surfactant protein B: From biochemistry to its potential role as diagnostic and prognostic marker in heart failure. Int J Cardiol. 2016 Oct 15;221:456-62 Chroneos ZC, et al. Pulmonary surfactant: an immunological perspective. Cell Physiology and Biochemistry 2010; 25: 13-26. Cole FS, Nogee LM, Hamvas A. Defects in surfactant synthesis: clinical implications. Pediatr Clin N Am 2006; 53: 911-927. Guillot-Alveolar epithelial cells Master regulators of lung homeostasis 2013 IntJBiochemCellBio Frerking I, et al. Pulmonary surfactant: functions, abnormalities, and therapeutic options. Intensive Care Med 2001; 27: 1699-1717. Herzog EL Knowns and Unknowns of the Alveolus PROCATS57778 Mason RJ. Biology of alveolar type II cells-2006-Respirology Murray and Nadel's Textbook of Respiratory Medicine 5th ed. Accessed via MDConsult. Nathan N Surfactant protein A: A key player in lung homeostasis IntJBioCellBio 2016 Nkadi PO, et al. An overview of pulmonary surfactant in the neonate: genetics, metabolism, and the role of surfactant in health and disease. Mol Genet Metab 2009; 97: 95-101. Whitsett JA, Wert SE, Weaver TE. Alveolar surfactant homeostasis and the pathogenesis of pulmonary disease. Annual Review of Medicine 2010; 61: 105-119. Wert SE, Whitsett JA, Nogee LM. Genetic disorders of surfactant dysfunction. Pediatr Dev Pathol. 2009; 12(4): 253-274.

Reviewing a recently published article on Cardiac Injury in COVID-19 that was published in the Intensive Care Medicine Journal by Julie Helms, Alain Combes and Nadia Aissaoui. Show Notes: https://eddyjoemd.com/foamed Although great care has been taken to ensure that the information in this podcast are accurate, eddyjoe, LLC shall not be held responsible or in any way liable for the continued accuracy of the information, or for any errors, omissions or inaccuracies, or for any consequences arising therefrom. Website: www.eddyjoemd.com Instagram: www.instagram.com/eddyjoemd Twitter: www.twitter.com/eddyjoemd Facebook: www.facebook.com/eddyjoemd Podcast: https://anchor.fm/eddyjoemd My Amazon store for resources you may find helpful: www.amazon.com/shop/eddyjoemd Citation: Helms J, Combes A, Aissaoui N. Cardiac injury in COVID-19. Intensive Care Med. 2022 Jan;48(1):111-113. doi: 10.1007/s00134-021-06555-3. Epub 2021 Nov 2. PMID: 34727214; PMCID: PMC8562019. --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app Support this podcast: https://anchor.fm/eddyjoemd/support

En este nuevo episodio me inspiro de la increíble entrevista del gran Antonio Pérez y la increible Susana Simó en el "Café Club del Conocimiento" y os hablo de la Dopamina según la evidencia. ¿Aumenta la mortalidad? ¿Es buena en pacientes en shock? Vamos a intentar poner luz al uso tan extendido de la Dopa e intentemos con este episodio retirarla poco a poco de los ampularios. Espero que os guste y sea de utilidad. Bibliografía: - Susana Simó. Café club del conocimiento. Shock. Disponible en: https://www.youtube.com/watch?v=U7khSoWgk0s - James A. Russell, Anthony C. Gordon, Mark D. Williams, John H. Boyd, Keith R. Walley, Niranjan Kissoon. Vasopressor Therapy in the Intensive Care Unit. Semin Respir Crit Care Med 2021; 42(01): 059-077 - De Backer D, Biston P, Devriendt J. et al; Investigadores de SOAP II. Comparación de dopamina y norepinefrina en el tratamiento del shock. N Engl J Med 2010; 362 (09) 779-789 - Allwood MJ, Ginsburg J. Efectos vasculares periféricos y de otro tipo de las infusiones de dopamina en el hombre. Clin Sci 1964; 27: 271-281 - Bennett ED, Tighe D, Wegg W. Abolición, por bloqueo de dopamina, de la respuesta natriurética producida por la presión positiva de la parte inferior del cuerpo. Clin Sci (Lond) 1982; 63 (04) 361-366 - Juste RN, Panikkar K, Soni N. Los efectos de las infusiones de dosis bajas de dopamina sobre los parámetros hemodinámicos y renales en pacientes con shock séptico que requieren tratamiento con noradrenalina. Intensive Care Med 1998; 24 (06) 564-568 - Holmes CL, Walley KR. Mala medicina: dosis bajas de dopamina en la UCI. Pecho 2003; 123 (04) 1266-1275 - D'Orio V, el Allaf D, Juchmès J, Marcelle R. El uso de dosis bajas de dopamina en medicina intensiva. Arch Int Physiol Biochim 1984; 92 (04) S11-S20 - Olsen NV, Hansen JM, Ladefoged SD, Fogh-Andersen N, Leyssac PP. Reabsorción tubular renal de sodio y agua durante la infusión de dosis bajas de dopamina en el hombre normal. Clin Sci (Lond) 1990; 78 (05) 503-507 - Yard B, Beck G, Schnuelle P. et al. Prevención de lesiones por preservación del frío de las células endoteliales cultivadas por catecolaminas y compuestos relacionados. Am J Trasplante 2004; 4 (01) 22-30 - Schnuelle P, Gottmann U, Hoeger S. et al. Efectos del pretratamiento del donante con dopamina sobre la función del injerto después del trasplante renal: un ensayo controlado aleatorio. JAMA 2009; 302 (10) 1067-1075 - Kotloff RM, Blosser S, Fulda GJ. et al; Society of Critical Care Medicine/American College of Chest Physicians/Association of Organ Procurement Organizations Donor Management Task Force. Gestión del posible donante de órganos en la UCI: Declaración de consenso de la Sociedad de Medicina de Cuidados Críticos/American College of Chest Physicians/Association of Organ Procurement Organizations. Crit Care Med 2015; 43 (06) 1291-1325 - Juste RN, Moran L, Hooper J, Soni N. Aclaramiento de dopamina en pacientes críticamente enfermos. Intensive Care Med 1998; 24 (11) 1217-1220

Le Pr Alain Cariou, qui est Professeur de Médecine Intensive à l'Hôpital Cochin à Paris et qui a participé à l'élaboration des recommandations européennes post arrêt cardiaque, notamment en réanimation, nous parle de l'actualité dans l'ACR. Sommaire Comment envisager l'enquête étiologique de l'arrêt cardiaque ? (indication coronarographie, scanner cérébral ? thoracique ?) Quelles sont les modalités de prise en charge en réanimation ? (Objectifs de PA ? Épilepsie ? Température ?) Comment établir le pronostic neurologique de ces patients ? Quelle est la place de la rééducation ? RéférenceNolan, J.P., Sandroni, C., Böttiger, B.W. et al. European Resuscitation Council and European Society of Intensive Care Medicine guidelines 2021: post-resuscitation care. Intensive Care Med 47, 369–421 (2021). https://doi.org/10.1007/s00134-021-06368-4https://www.srlf.org/article/reco-prise-charge-apres-recuperation-larret-cardiaque

On his IG page (@zentensivist) Dr. Siuba asked the question, "are we intubating COVID patients too late?" As another wave of COVID lingers over our head, this question is an important one. One year ago, we watched as COVID patients were intubated early only to face the cascade of complications to follow. Similarly, now we watch some COVID patients struggle on noninvasive ventilation only to inevitably need emergent intubation. Is there a right time to intubate these patients? Will we ever find the sweet spot? Dr. Matt Siuba is a medical intensivist at the Cleveland Clinic in Cleveland, OH. He focuses on circulatory shock as well as severe forms of respiratory failure, especially Acute Respiratory Distress Syndrome (ARDS). Additionally, he's interested in ICU procedures, particularly point-of-care ultrasound (POCUS) and difficult vascular access. He's a passionate medical educator and serves as the associate program director for the Critical Care Medicine fellowship. He's also a senior editor and regular content contributor at CriticalCareNow.com, focused on mechanical ventilation, respiratory care, and airway management. References for the episode: 2020 Lippincott Advisor - Nursing Care Plans for Medical Diagnoses: Coronavirus disease 2019 (COVID-19) https://www.nursingcenter.com/nursingcenter_redesign/media/nursingcenter/coronavirus%20files%20from%20Lippincott%20Solutions/©-2020-Lippincott-Advisor-Nursing-Care-Plans-for-Medical-Diagnoses_-Coronavirus-disease-2019-(COVID-19).pdf Ricard, JD., Roca, O., Lemiale, V. et al. Use of nasal high flow oxygen during acute respiratory failure. Intensive Care Med 46, 2238–2247 (2020). https://doi.org/10.1007/s00134-020-06228-7 Topics: When should we intubate a COVID patient? COVID invasive vs noninvasive ventilation Would you agree to be intubated as a COVID patient? Work of breathing vs respiratory rate What happened with the different COVID phenotypes theory? RNMD interventions for COVID Focusing on the process of care vs outcomes Instagram: @Zentensivist @RNMDPodcast⁣ @TheNocturnalNurse Please subscribe and rate the podcast, that’s a free way you can really help us out!⁣⁣ Email us your topics or if you’d like to be a guest: RNMDPodcast@gmail.com --- Support this podcast: https://anchor.fm/rnmd/support

Kontakt: ivajuntan@gmail.com       Musik: Blind Love Dub by Jeris (c) copyright 2017 Licensed under a Creative Commons Attribution (3.0) license. http://dig.ccmixter.org/files/VJ_Memes/55416 Ft: Kara Square (mindmapthat)       Om du gillar du det vi gör - stöd Life Support Foundation! www.lifesupportfoundation.org     Bli månadsgivare eller använd Swish: 1234610804 Några bra artiklar på dagens ämne:  Aspide, R., et al., A Proposal for a New Protocol for Sonographic Assessment of the Optic Nerve Sheath Diameter: The CLOSED Protocol. Neurocrit Care, 2019. Lochner, P., et al., Optic nerve sheath diameter: present and future perspectives for neurologists and critical care physicians. Neurol Sci, 2019. Robba, C., et al., Brain ultrasonography: methodology, basic and advanced principles and clinical applications. A narrative review. Intensive Care Med, 2019. 45(7): p. 913-927. Robba, C., et al., Multimodal non-invasive assessment of intracranial hypertension: an observational study. Crit Care, 2020. 24(1): p. 379. Robba, C., et al., Optic nerve sheath diameter measured sonographically as non-invasive estimator of intracranial pressure: a systematic review and meta-analysis. Intensive Care Med, 2018. 44(8): p. 1284-1294. See omnystudio.com/listener for privacy information.

Kontakt: ivajuntan@gmail.com       Musik: Blind Love Dub by Jeris (c) copyright 2017 Licensed under a Creative Commons Attribution (3.0) license. http://dig.ccmixter.org/files/VJ_Memes/55416 Ft: Kara Square (mindmapthat)       Om du gillar du det vi gör - stöd Life Support Foundation! www.lifesupportfoundation.org     Bli månadsgivare eller använd Swish: 1234610804 Några bra artiklar på dagens ämne:  Lochner, P., et al., Optic nerve sheath diameter: present and future perspectives for neurologists and critical care physicians. Neurol Sci, 2019. Robba, C., et al., Brain ultrasonography: methodology, basic and advanced principles and clinical applications. A narrative review. Intensive Care Med, 2019. 45(7): p. 913-927. Robba, C., et al., Multimodal non-invasive assessment of intracranial hypertension: an observational study. Crit Care, 2020. 24(1): p. 379. Robba, C., et al., Optic nerve sheath diameter measured sonographically as non-invasive estimator of intracranial pressure: a systematic review and meta-analysis. Intensive Care Med, 2018. 44(8): p. 1284-1294. See omnystudio.com/listener for privacy information.

No dia 02.02.2021, a revista científica Intensive Care Med publicou um emocionante texto escrito por quatro médicos franceses, intitulado “Carta para Denise”, Denise teve Covid-19 em março de 2020 e recusou internação na UTI e ventilação mecânica. Ela tinha muitas comorbidades e, apesar de não faltar recurso no hospital naquele momento, quis que eles estivessem disponíveis para outras pessoas. Denise morreu em paz, com seus familiares, com “serenidade e gentileza em seus grandes olhos pretos”. Não foi fácil para os profissionais de saúde aceitarem a decisão: “Por um longo momento, ficamos preocupados que poderíamos ter influenciou sua decisão por nossas respostas às suas perguntas.” Então, eles decidiram compartilhar com toda a equipe de saúde: “Sentamos para conversar com o médico emergencista, a enfermeira e o auxiliar de enfermagem que estavam cuidando de você naquela noite. Juntos, tentamos analisar sua situação com base nas informações objetivas de que dispúnhamos. Queríamos tomar a melhor decisão, com você, com seu filho, para você, e sentimos como era vital respeitar seus desejos.” Esses profissionais perceberam “que muitas vezes é mais fácil fazer e intensificar a terapia de suporte de vida, em vez de ponderar meticulosamente os benefícios potenciais de cada decisão” e que é emocionalmente difícil resolver esse conflito. Para isso, eles sugerem uma solução: “identificar cuidadosamente o paciente com mais probabilidade de se beneficiar da admissão na UTI, em termos de duração ou qualidade de vida. Isso é totalmente diferente de uma escolha feita, por exemplo, por sorteio ou por ordem de prioridade.” Terminam o artigo agradecendo à Denise pelos ensinamentos e afirmando que se lembrarão dela em todas as decisões difíceis que tiverem que tomar, pois entenderam que é obrigatório olhar para cada paciente antes de tomar uma decisão. “Carta para Denise” é uma homenagem, uma despedida e um ritual de luto desses profissionais - que sempre encorajaram os familiares a dizerem adeus: “É a nossa vez agora, querida Denise, de dizer adeus.” Mas é, acima de tudo, uma lição de humildade e respeito. Fonte: https://bit.ly/3p1tlK9

Contributor: Aaron Lessen, MD Educational Pearls: Early antibiotics have been shown to improve outcomes in septic patients time after time Emerging evidence challenges the concept of one-size-fits-all large fluid boluses for septic shock patients and fluid may worsen patients who have underlying sepsis-induced pulmonary capillary leak Starting peripheral vasopressors early, and relaxing if fluid resuscitation is successful, is appearing to be a more appropriate strategy than fluids first, then vasopressors References CLASSIC Trial Group; Scandinavian Critical Care Trials Group. Restricting volumes of resuscitation fluid in adults with septic shock after initial management: the CLASSIC randomised, parallel-group, multicentre feasibility trial. Intensive Care Med. 2016 Nov;42(11):1695-1705. doi: 10.1007/s00134-016-4500-7. Epub 2016 Sep 30. PMID: 27686349. Permpikul C, Tongyoo S, Viarasilpa T, Trainarongsakul T, Chakorn T, Udompanturak S. Early Use of Norepinephrine in Septic Shock Resuscitation (CENSER). A Randomized Trial. Am J Respir Crit Care Med. 2019 May 1;199(9):1097-1105. doi: 10.1164/rccm.201806-1034OC. PMID: 30704260. Summarized by Jackson Roos, MS4 | Edited by Erik Verzemnieks, MD

Ryan Shields and Erin McCreary discuss notable infectious diseases publications from the first half of 2020. Papers discussed: 1) Van Duin D, et al. Lancet Infect Dis. 2020 Jun;20(6):731-741. doi: 10.1016/S1473-3099(19)30755-8. 2) Livermore DM, et al. Clin Infect Dis. 2020 Feb 6;ciaa122. doi: 10.1093/cid/ciaa122. 3) Falcone M, et al. Clin Infect Dis. 2020 May 19;ciaa586. doi: 10.1093/cid/ciaa586. 4) Lodise TP, et al. J Antimicrob Chemother. 2020 May 28;dkaa197. doi: 10.1093/jac/dkaa197. 5) O’Donnell JN, et al. Clin Ther. 2020 Jul 16;S0149-2918(20)30315-5. doi: 10.1016/j.clinthera.2020.06.005. 6) Abdul-Aziz MH, et al. Intensive Care Med. 2020 Jun;46(6):1127-1153. doi: 10.1007/s00134-020-06050-1. 7) Cusumano JA, et al. Am J Health Syst Pharm. 2020 Jul 7;77(14):1104-1112. doi: 10.1093/ajhp/zxaa128. 8) Roberts JA, et al. Clin Infect Dis. 2020 Mar 9;ciaa224. doi: 10.1093/cid/ciaa224. 9) Ackerman A, et al. Antimicrob Agents Chemother. 2020 May 21;64(6):e00066-20. doi: 10.1128/AAC.00066-20. 10) Tong SYC, et al. JAMA. 2020 Feb 11;323(6):527-537. doi: 10.1001/jama.2020.0103. 11) Jones BE, et al. JAMA Intern Med. 2020 Feb 17;180(4):552-560. doi: 10.1001/jamainternmed.2019.7495. 12) Cheng MP, et al. Clin Infect Dis. 2020 Jul 15;ciaa1000. doi: 10.1093/cid/ciaa1000. For BCIDP credit, visit https://sidp.org/BCIDP Follow SIDP on Twitter: @SIDPharm

Can we wean patients off of vasopressors faster by providing them with Midodrine? The MIDAS trial (Effect of midodrine versus placebo on time to vasopressor discontinuation in patients with persistent hypotension in the intensive care unit) published on September 3rd, 2020 is a randomized-controlled trial looking at this question. Show Notes: https://eddyjoemd.com/midodrine/ Receive a FREE audiobook (TWO for Amazon Prime members) with your FREE 30-day trial by using my link for Audible: CLICK HERE! You will be reminded when your trial is ending, by the way.

Público Alvo: Médicos, Enfermeiros e Farmacêuticos Link dos Episódios Anteriores: https://blog.pacientegraveuti.com.br/pguti-podcast-serie-drogas-vasoativas-ep-1-0-norepinefrina/ Referências: 1. Russell JA, Walley KR, Singer J, Gordon AC, Hébert PC, Cooper DJ, et al. Vasopressin versus norepinephrine infusion in patients with septic shock. N Engl J Med. 2008 2. Russell JA, Lee T, Singer J, Boyd JH, Walley KR. The septic shock 3.0 definition and trials: a vasopressin and septic shock trial experience*. Critical Care Med. 2017 3. Russell JA, Walley KR, Gordon AC, Cooper DJ, Hébert PC, Singer J, et al. Interaction of vasopressin infusion, corticosteroid treatment, and mortality of septic shock. Crit Care Med. 2009 4. Gordon AC, Russell JA, Walley KR, Singer J, Ayers D, Storms MM, et al. The effects of vasopressin on acute kidney injury in septic shock. Intensive Care Med. 2010 5. Gordon AC, Mason AJ, Thirunavukkarasu N, Perkins GD, Cecconi M, Cepkova M, et al. Effect of early vasopressin vs norepinephrine on kidney failure in patients with septic shock: the VANISH randomized clinical trial. JAMA. 2016 6. Jiang L, Sheng Y, Feng X, Wu J. The effects and safety of vasopressin receptor agonists in patients with septic shock: a meta-analysis and trial sequential analysis. Crit Care. 2019 7. Nagendran M, Russell JA, Walley KR, Brett SJ, Perkins GD, Hajjar L, et al. Vasopressin in septic shock: an individual patient data meta-analysis of randomised controlled trials. Intensive Care Med. 2019 8. McIntyre WF, Um KJ, Alhazzani W, Lengyel AP, Hajjar L, Gordon AC, et al. Association of vasopressin plus catecholamine vasopressors vs catecholamines alone with atrial fibrillation in patients with distributive shock: a systematic review and meta-analysis. JAMA. 2018 9. Hajjar LA, Vincent JL, Barbosa Gomes Galas FR, Rhodes A, Landoni G, Osawa EA, et al. Vasopressin versus norepinephrine in patients with vasoplegic shock after cardiac surgery: the VANCS randomized controlled trial. Anesthesiology. 2017 10. Demiselle J, Fage N, Radermacher P, Asfa P. Vasopressin and its analogues in shock states: a review. Annals of Intensive Care, 2020. 11. Mehta S, Granton J, Gordon AC, Cook DJ, Lapinsky S, Newton G, et al. Cardiac ischemia in patients with septic shock randomized to vasopressin or norepinephrine. Crit Care. 2013 Sonoplastia: Intro - https://www.youtube.com/watch?v=fh-o8Bxc3Ys&list=PLWL6Z6XABuJTcdk401tdB29L8eAy-SrnH Fundo - https://www.youtube.com/watch?v=A3MGsOxz96o - https://theartistunion.com/tracks/909010?download=true - https://theartistunion.com/tracks/b1a1ef - https://www.youtube.com/watch?v=8ZZbAkKNx7s - https://www.youtube.com/watch?v=l8DzQzJ3BZo - https://www.bensound.com/royalty-free-music/track/birth-of-a-hero - https://www.youtube.com/watch?v=XnYh2ZaiLdE - https://www.youtube.com/watch?v=DP1O4Ucq_hI - https://www.youtube.com/watch?v=fzz9JutOt38 - https://www.youtube.com/watch?v=5q2bm69BJo4 - https://www.youtube.com/watch?v=uHdIpTEcxcY - https://youtu.be/RdeKtS7WWTM - https://www.youtube.com/watch?v=LQImu6cW8b0 - https://www.youtube.com/watch?v=xSuSkjhzOF0&list=TLPQMDEwMzIwMjDs9bx5doayjA&index=1 - https://www.youtube.com/watch?v=LNmuGe8rNOo - https://www.youtube.com/watch?v=joj5jrNqs9g - https://www.youtube.com/watch?v=LtEBz_E6wPk - https://www.youtube.com/watch?v=5CXymrxLq9k - https://www.youtube.com/watch?v=cRiRzocKMqI Final - https://theartistunion.com/tracks/af8a3c - https://www.youtube.com/watch?v=Rq5byzVVFB4

Público Alvo: Médicos, Enfermeiros e Farmacêuticos Link dos Episódios Anteriores: https://blog.pacientegraveuti.com.br/pguti-podcast-serie-drogas-vasoativas-ep-1-0-norepinefrina/ Referências: 1. Russell JA, Walley KR, Singer J, Gordon AC, Hébert PC, Cooper DJ, et al. Vasopressin versus norepinephrine infusion in patients with septic shock. N Engl J Med. 2008 2. Russell JA, Lee T, Singer J, Boyd JH, Walley KR. The septic shock 3.0 definition and trials: a vasopressin and septic shock trial experience*. Critical Care Med. 2017 3. Russell JA, Walley KR, Gordon AC, Cooper DJ, Hébert PC, Singer J, et al. Interaction of vasopressin infusion, corticosteroid treatment, and mortality of septic shock. Crit Care Med. 2009 4. Gordon AC, Russell JA, Walley KR, Singer J, Ayers D, Storms MM, et al. The effects of vasopressin on acute kidney injury in septic shock. Intensive Care Med. 2010 5. Gordon AC, Mason AJ, Thirunavukkarasu N, Perkins GD, Cecconi M, Cepkova M, et al. Effect of early vasopressin vs norepinephrine on kidney failure in patients with septic shock: the VANISH randomized clinical trial. JAMA. 2016 6. Jiang L, Sheng Y, Feng X, Wu J. The effects and safety of vasopressin receptor agonists in patients with septic shock: a meta-analysis and trial sequential analysis. Crit Care. 2019 7. Nagendran M, Russell JA, Walley KR, Brett SJ, Perkins GD, Hajjar L, et al. Vasopressin in septic shock: an individual patient data meta-analysis of randomised controlled trials. Intensive Care Med. 2019 8. McIntyre WF, Um KJ, Alhazzani W, Lengyel AP, Hajjar L, Gordon AC, et al. Association of vasopressin plus catecholamine vasopressors vs catecholamines alone with atrial fibrillation in patients with distributive shock: a systematic review and meta-analysis. JAMA. 2018 9. Hajjar LA, Vincent JL, Barbosa Gomes Galas FR, Rhodes A, Landoni G, Osawa EA, et al. Vasopressin versus norepinephrine in patients with vasoplegic shock after cardiac surgery: the VANCS randomized controlled trial. Anesthesiology. 2017 10. Demiselle J, Fage N, Radermacher P, Asfa P. Vasopressin and its analogues in shock states: a review. Annals of Intensive Care, 2020. 11. Mehta S, Granton J, Gordon AC, Cook DJ, Lapinsky S, Newton G, et al. Cardiac ischemia in patients with septic shock randomized to vasopressin or norepinephrine. Crit Care. 2013 Sonoplastia: Intro - https://www.youtube.com/watch?v=fh-o8Bxc3Ys&list=PLWL6Z6XABuJTcdk401tdB29L8eAy-SrnH Fundo - https://www.youtube.com/watch?v=A3MGsOxz96o - https://theartistunion.com/tracks/909010?download=true - https://theartistunion.com/tracks/b1a1ef - https://www.youtube.com/watch?v=8ZZbAkKNx7s - https://www.youtube.com/watch?v=l8DzQzJ3BZo - https://www.bensound.com/royalty-free-music/track/birth-of-a-hero - https://www.youtube.com/watch?v=XnYh2ZaiLdE - https://www.youtube.com/watch?v=DP1O4Ucq_hI - https://www.youtube.com/watch?v=fzz9JutOt38 - https://www.youtube.com/watch?v=5q2bm69BJo4 - https://www.youtube.com/watch?v=uHdIpTEcxcY - https://youtu.be/RdeKtS7WWTM - https://www.youtube.com/watch?v=LQImu6cW8b0 - https://www.youtube.com/watch?v=xSuSkjhzOF0&list=TLPQMDEwMzIwMjDs9bx5doayjA&index=1 - https://www.youtube.com/watch?v=LNmuGe8rNOo - https://www.youtube.com/watch?v=joj5jrNqs9g - https://www.youtube.com/watch?v=LtEBz_E6wPk - https://www.youtube.com/watch?v=5CXymrxLq9k - https://www.youtube.com/watch?v=cRiRzocKMqI Final - https://theartistunion.com/tracks/af8a3c - https://www.youtube.com/watch?v=Rq5byzVVFB4

In this episode I talk about what’s been recently published in the medical literature to help you master intensive care from a humanity point of view. In a departure from the usual interview episode, and as a trial, I searched the December 2019 issues of 8 well-respected journals and found a large number of articles focused on non-technical aspects of intensive care. Not the drugs, devices, procedures or interventions, but the person-based and human-focused topics I like to concentrate this podcast on. As I’ve transitioned in my own career from being a researcher of interventions to a producer of a podcast focused on being the best all-round intensive care-givers we can be, I’ve realised there is a growing literature on non-technical topics, some of which I’m not well enough aware of on a day to day basis. So in this episode I found numerous articles from December 2019 which I believe can help you and your colleagues humanise the intensive care you give at the bedside. Some are research studies, some are reviews, and others are stories, essays, poems, or simply writings. I focus in some detail on 3 specific journal articles on the topics of (1) family engagement, (2) family support and (3) early palliative care consultation. I then refer you briefly to 10 other articles so you can read these in full if you are interested. There are links to all of these articles below. I really hope you enjoy and value this episode. I learnt a lot from reading these articles myself. Please send any feedback, questions or comments to andrew@masteringintensivecare.com.   Andrew Davies   --------------------   About the Mastering Intensive Care podcast: The podcast is aimed to inspire and empower you to bring your best self to the intensive care unit, through conversations with thought-provoking guests. The hope is you’ll glean insights to move you closer towards being the best and most human healthcare professionals you can be, so you can make the most valuable contribution to your patient’s lives.   --------------------   Links to 3 Journal articles reviewed in detail Kleinpell R, Zimmerman J, Vermoch KL, et al. Promoting Family Engagement in the ICU: Experience From a National Collaborative of 63 ICUs. Crit Care Med. 2019;47(12):1692–1698. doi:10.1097/CCM.0000000000004009   PubMed link   Associated editorial Lee HW, Park Y, Jang EJ, Lee YJ. Intensive care unit length of stay is reduced by protocolized family support intervention: a systematic review and meta-analysis [published correction appears in Intensive Care Med. 2019 Oct 8;:]. Intensive Care Med. 2019;45(8):1072–1081. doi:10.1007/s00134-019-05681-3   PubMed link Ma J, Chi S, Buettner B, et al. Early Palliative Care Consultation in the Medical ICU: A Cluster Randomized Crossover Trial. Crit Care Med. 2019;47(12):1707–1715. doi:10.1097/CCM.0000000000004016   PubMed link   Links to 10 Journal articles mentioned briefly Barreto BB, Luz M, Rios MNO, Lopes AA, Gusmao-Flores D. The impact of intensive care unit diaries on patients' and relatives' outcomes: a systematic review and meta-analysis. Crit Care. 2019; 23(1):411. Published 2019 Dec 16. doi:10.1186/s13054-019-2678-0   PubMed link Ramchand P. The gift. Lancet. 2020; 394(10216):2283–2284. doi:10.1016/S0140-6736(19)32961-7   PubMed link Harrington JL. The Case for Waking. JAMA. 2019; 322(22):2251. doi:10.1001/jama.2019.17962   PubMed link Maskell G. True candour. BMJ. 2019; 367:l6754. Published 2019 Dec 3. doi:10.1136/bmj.l6754   PubMed link Rimmer A. Bring me joy. BMJ. 2019; 367:l6745. Published 2019 Dec 16. doi:10.1136/bmj.l6745   PubMed link Klaber RE, Bailey S. Kindness: an underrated currency. BMJ. 2019; 367:l6099. Published 2019 Dec 16. doi:10.1136/bmj.l6099   PubMed link Morgan M. Matt Morgan: Cold food on hot desks. BMJ. 2019; 367:l6829. Published 2019 Dec 10. doi:10.1136/bmj.l6829   PubMed link Rimmer A. Suicide in anaesthetists: five minutes with . . . Samantha Shinde. BMJ. 2019;367:l6781. Published 2019 Dec 2. doi:10.1136/bmj.l6781   PubMed link Auriemma CL, Van den Berghe G, Halpern SD. Less is more in critical care is supported by evidence-based medicine. Intensive Care Med. 2019;45(12):1806–1809. doi:10.1007/s00134-019-05771-2   PubMed link Auñón-Chancellor S. Earthling. Ann Intern Med. 2019; 171(12):937–938. doi:10.7326/M19-2759   PubMed link   Links to 8 Journals searched New England Journal of Medicine JAMA: Journal of the American Medical Association BMJ: British Medical Journal The Lancet Annals of Internal Medicine Critical Care Medicine ICM Journal: Intensive Care Medicine American Journal of Respiratory and Critical Care Medicine Critical Care   Links to other resources mentioned Mastering Intensive Care podcast - Episode 3 with Rinaldo Bellomo Critical Care Reviews Link to sign up to Critical Care Reviews newsletter PRISMA statement Mastering Intensive Care podcast - Episode 32 with Kate Harding   Links related to Mastering Intensive Care podcast Mastering Intensive Care podcast - Episode 50 with Andrew Davies Mastering Intensive Care podcast - Episode 51 - A Recap of 2019 Mastering Intensive Care podcast Mastering Intensive Care page on Facebook Mastering Intensive Care at Life In The Fast Lane Andrew Davies on Twitter: @andrewdavies66 Andrew Davies on Instagram: @andrewdavies66 Andrew Davies on LinkedIn Email Andrew Davies Audio Producer Chris Burke Burke Sound & Media

Drs. Robert Neumar and Cindy Hsu (both at University of Michigan) continue their discussion with Dr. Felipe Teran following the plenary “Year in Review” presentation by Dr. Neumar at the American Heart Association Resuscitation Science Symposium (ReSS) in Philadelphia. If you missed ReSS, this is your chance to hear summaries of the top studies that impacted cardiac arrest and post-arrest care in the past 12 months. Note that this is the second part of a two-part podcast: Check your earlier in this feed for Episode 14 contains the first half of this conversation. Key readings for this podcast include: Nordberg P et al. Effect of Trans-Nasal Evaporative Intra-arrest Cooling on Functional Neurologic Outcome in Out-of-Hospital Cardiac Arrest: The PRINCESS Randomized Clinical Trial. JAMA2019 May 7;321(17):1677-1685. https://www.ncbi.nlm.nih.gov/pubmed/31063573 Lascarrou JB et al. Targeted Temperature Management for Cardiac Arrest with Nonshockable Rhythm. N Engl J Med. 2019 Dec 12;381(24):2327-2337. https://www.ncbi.nlm.nih.gov/pubmed/31577396 Scarpino et al. Neurophysiology and neuroimaging accurately predict poor neurological outcome within 24 hours after cardiac arrest: The ProNeCA prospective multicentre prognostication study. Resuscitation. 2019 Oct;143:115-123. https://www.ncbi.nlm.nih.gov/pubmed/31400398 Moseby-Knappe M et al. Serum Neurofilament Light Chain for Prognosis of Outcome After Cardiac Arrest. JAMA Neurol. 2019 Jan 1;76(1):64-71. https://www.ncbi.nlm.nih.gov/pubmed/30383090 Oddo M et al. Quantitative versus standard pupillary light reflex for early prognostication in comatose cardiac arrest patients: an international prospective multicenter double-blinded study. Intensive Care Med. 2018 Dec;44(12):2102-2111. https://www.ncbi.nlm.nih.gov/pubmed/30478620 Vreselja Z et al. Restoration of brain circulation and cellular functions hours post-mortem. Nature. 2019 Apr;568(7752):336-343. https://www.ncbi.nlm.nih.gov/pubmed/30996318

      Kontakt: ivajuntan@gmail.com       Musik: Blind Love Dub by Jeris (c) copyright 2017 Licensed under a Creative Commons Attribution (3.0) license. http://dig.ccmixter.org/files/VJ_Memes/55416 Ft: Kara Square (mindmapthat)       Om du gillar du det vi gör - stöd Life Support Foundation! www.lifesupportfoundation.org     Bli månadsgivare eller använd Swish: 1234610804       Dagens huvudartiklar: Abstract: McGrath BA, Wallace S, Wilson M, Nicholson L, Felton T, Bowyer C, et al. Safety and feasibility of above cuff vocalisation for ventilator-dependant patients with tracheostomies. J Intensive Care Soc. 2019;20(1):59-65. Abstract: McGrath B, Lynch J, Wilson M, Nicholson L, Wallace S. Above cuff vocalisation: A novel technique for communication in the ventilator-dependent tracheostomy patient. J Intensive Care Soc. 2016;17(1):19-26.        Case-rapport om subcutant emfysem efter ACV: Länk: Calamai I, Giuntini R, Tomeo F, Spina R. Sudden appearance of neck and face emphysema during above cuff vocalisation. Intensive Care Med. 2018;44(11):1951-2.         Länk till instruktionsfilm om ACV här          Meta-analysen om lungrekrytering: Abstract: Pensier J, de Jong A, Hajjej Z, Molinari N, Carr J, Belafia F, et al. Effect of lung recruitment maneuver on oxygenation, physiological parameters and mortality in acute respiratory distress syndrome patients: a systematic review and meta-analysis. Intensive Care Med. 2019;45(12):1691-702.  

Le Docteur Contou, praticien hospitalier dans le service de médecine intensive et réanimation du centre hospitalier d'Argenteuil, nous parle du Purpura fulminans. Sommaire : Comment reconnaître un Purpura fulminans et chez quels patients ? Quelle est la place de la ponction lombaire dans le diagnostic de Purpura fulminans ? Quels sont les germes responsables et quelle est la prise en charge initiale d'un patient ayant un Purpura fulminans ? Quels est le pronostic à court et à long terme ? Références : Clinical spectrum and short-term outcome of adult patients with purpura fulminans: a French multicenter retrospective cohort study.HOPEFUL Study Group. Intensive Care Med. 2018 Sep;44(9):1502-1511. doi: 10.1007/s00134-018-5341-3 Diagnostic yield of lumbar puncture in adult patients with purpura fulminans.HOPEFUL Study group. Intensive Care Med. 2019 Oct;45(10):1487-1489. doi: 10.1007/s00134-019-05676-0. Long-term Quality of Life in Adult Patients Surviving Purpura Fulminans: An Exposed-Unexposed Multicenter Cohort Study.HOPEFUL Study Group. Clin Infect Dis. 2019 Jul 2;69(2):332-340. doi: 10.1093/cid/ciy901.

Välkommen till decemberavsnittet av AKUTBOKEN podcast. Här är ämnena och artiklarna i detta avsnitt: Venös eller arteriell blodgas Zeserson et al. (2018) Correlation of venous blood gas and pulse oximetry with arterial blood gas in the undifferentiated critically ill patient. J. Intensive Care Med. 33:176-181. PMID: 27283009 Mekaniska hjärtkompressioner Zhu et al. (2019) A meta-analysis […]

Le professeur Nseir, PUPH en médecine intensive et réanimation au CHU de Lille, nous parle du traitement antifongique empirique.Articles en lien : Intensive Care Med. ESICM/ESCMID task force on practical management of invasive candidiasis in critically ill patients. doi: 10.1007/s00134-019-05599-w. JAMA. Empirical Micafungin Treatment and Survival Without Invasive Fungal Infection in Adults With ICU-Acquired Sepsis, Candida Colonization, and Multiple Organ Failure: The EMPIRICUS Randomized Clinical Trial. doi: 10.1001/jama.2016.14655. Intensive Care Med. Biomarker-based strategy for early discontinuation of empirical antifungal treatment in critically ill patients: a randomized controlled trial. doi: 10.1007/s00134-017-4932-8.

Dr. Geert Meyfroidt, intensivist, and Dr. Bart Depreitere, neurosurgeon, from KU Leuven, share their thoughts on the ICP 2019 meeting in Leuven, Belgium and discuss their research activities at the university.Guiza, F., Depreitere, B., Piper, I., Citerio, G., Chambers, I., Jones, P. A., . . . Meyfroidt, G. (2015). Visualizing the pressure and time burden of intracranial hypertension in adult and paediatric traumatic brain injury. Intensive Care Med, 41(6), 1067-1076.The views and opinions expressed on this podcast do not necessarily reflect those of Moberg Research, Inc. Moberg Research, Inc. makes no clinical claims or recommendations regarding the information described in this podcast.Music from https://filmmusic.io "Wholesome" by Kevin MacLeod (https://incompetech.com) License: CC BY (http://creativecommons.org/licenses/by/4.0/)

If you're involved in the care of critically unwell patients then you will frequently encounter patients who are shocked. The European Society of Intensive Care Medicine defines shock as; 'Life-threatening, generalized form of acute circulatory failure associated with inadequate oxygen utilization by the cells. It is a state in which the circulation is unable to deliver sufficient oxygen to meet the demands of the tissues, resulting in cellular dysfunction.’ The assessment for shock needs to be part of the routine workup of every potentially unwell patient. Shock carries with it a high mortality rate, a range of meaningful interventions and the potential to make a real difference to our patients' outcomes.  In this podcast we cover Defining shock in adults Significance of shock What shock looks like A recap of cardiac physiology Causes of shock Ultrasound evaluation Fluid therapy Inotropes and vasopressors As always we’d love to hear any thoughts or comments you have on the website and via twitter, we look forward to hearing from you. Enjoy! Simon, Rob & James References Consensuson circulatory shockand hemodynamic monitoring. Task forceof the EuropeanSociety of Intensive Care Medicine. Cecconi M. Intensive Care Med.2014 NICE Intravenous fluid therapy in adults in hospital. Clinical guideline. December 2013 ALIEM; Choosing the right vasopressor agent in hypotension Resus; The Shock Index ALIEM; Shock Index: A Predictor of Morbidity and Mortality? A comparisonof the shockindexand conventionalvital signsto identifyacute, critical illnessin the emergency department. Rady MY. Ann Emerg Med.1994  TheResusRoom; Sepsis RCEM guidance; Noradrenaline Infusion Association between timing of antibiotic administration and mortality from septic shock in patients treated with a quantitative resuscitation protocol. Puskarich MA. Crit Care Med. 2011 Early goal-directed therapy in the treatment of severe sepsis and septic shock.Rivers E. N Engl J Med. 2001 Early lactate clearance is associated with improved outcome in severe sepsis and septic shock.Nguyen HB. Crit Care Med. 2004  Lactate clearance vs central venous oxygen saturation as goals of early sepsis therapy: a randomized clinical trial.Jones AE. JAMA. 2010 A randomized trial of protocol-based care for early septic shock.ProCESS Investigators. N Engl J Med. 2014 Early goal-directed therapyin the treatmentof severe sepsisand septic shock. Rivers E. N Engl J Med.2001 The significance of non-sustained hypotension in emergency department patients with sepsis.Marchick MR. Intensive Care Med. 2009 Risks and benefits of hypotensive resuscitation in patients with traumatic hemorrhagic shock: a meta-analysis.Natthida Owattanapanich. Scand J Trauma Resusc Emerg Med. 2018. TheResusRoom; The Crystalloid Debate

Author: Dylan Luyten, MD Educational Pearls:   Extracorporeal membrane oxygenation (ECMO) is similar to bypass ECMO is being utilized routinely at some centers and even prehospital in cardiac arrest There are two general types of ECMO: Venovenous (VV-ECMO) is useful when the patient cannot oxygenate but has adequate heart function. Venoarterial (VA-ECMO) is more like typical bypass and can be used in a pulseless patient   References: Ouweneel DM, Schotborgh JV, Limpens J, Sjauw KD, Engström AE, Lagrand WK, Cherpanath TGV, Driessen AHG, de Mol BAJM, Henriques JPS. Extracorporeal life support during cardiac arrest and cardiogenic shock: a systematic review and meta-analysis. Intensive Care Med. 2016 Dec;42(12):1922-1934. doi: 10.1007/s00134-016-4536-8. Epub 2016 Sep 19. Review. PubMed PMID: 27647331; PubMed Central PMCID: PMC5106498. Tonna JE, Johnson NJ, Greenwood J, Gaieski DF, Shinar Z, Bellezo JM, Becker L, Shah AP, Youngquist ST, Mallin MP, Fair JF 3rd, Gunnerson KJ, Weng C, McKellar S; Extracorporeal REsuscitation ConsorTium (ERECT) Research Group.. Practice characteristics of Emergency Department extracorporeal cardiopulmonary resuscitation (eCPR) programs in the United States: The current state of the art of Emergency Department extracorporeal membrane oxygenation (ED ECMO). Resuscitation. 2016 Oct;107:38-46. doi: 10.1016/j.resuscitation.2016.07.237. Epub 2016 Aug 11. PubMed PMID: 27523953; PubMed Central PMCID: PMC5475402.   Summary by Travis Barlock, MS4  | Edited by Erik Verzemnieks, MD

This week we dive into the rare but potentially fatal, and difficult to diagnose, air embolism. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_132_0_Final_Cut.m4a Download 2 Comments Tags: Air Embolism, Central Lines, Hyperbaric Oxygen Show Notes Take Home Points Air embolism is a rare but potentially fatal complication of central line placement and some surgical procedures and of course of as the result of barotrauma. Recognizing the signs and symptoms of air embolism can be tricky because it will look like any other ischemic process.  Consider air embolism if you have a patient that rapidly decompensates after placement of a central line, the most likely culprit for those of us in the ED. Treatment should focus on supportive cares.  Give supplemental O2, IV fluids and hemodynamic support and consider hyperbarics and cardiopulmonary bypass for the super sick patient. Show Notes Core EM: Air Embolism Blanc et al. Iatrogenic cerebral air embolism: importance of an early hyperbaric oxygenation. Intensive Care Med. 2002; 28(5): 559-63. PMID 12029402

This week we dive into the rare but potentially fatal, and difficult to diagnose, air embolism. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_132_0_Final_Cut.m4a Download 2 Comments Tags: Air Embolism, Central Lines, Hyperbaric Oxygen Show Notes Take Home Points Air embolism is a rare but potentially fatal complication of central line placement and some surgical procedures and of course of as the result of barotrauma. Recognizing the signs and symptoms of air embolism can be tricky because it will look like any other ischemic process.  Consider air embolism if you have a patient that rapidly decompensates after placement of a central line, the most likely culprit for those of us in the ED. Treatment should focus on supportive cares.  Give supplemental O2, IV fluids and hemodynamic support and consider hyperbarics and cardiopulmonary bypass for the super sick patient. Show Notes Core EM: Air Embolism Blanc et al. Iatrogenic cerebral air embolism: importance of an early hyperbaric oxygenation. Intensive Care Med. 2002; 28(5): 559-63. PMID 12029402

Most hospitals develop a disaster plan, but few jurisdictions develop a plan for triaging or rationing scarce resources when the existing supply is overwhelmed. Rather than leaving individual health care workers to make these decisions, we should work together as a community of experts to develop ethical, practical and appropriate policies for triaging scarce resources during a disaster. Come and learn what the literature suggests, and join the global debate about this controversial topic. Prefer a paper to a podcast? Find solid overviews here: 1. Devereaux A V. Definitive care for the critically ill during a disaster: a framework for allocation of scarce resources in mass critical care. Task Force for Mass Critical Care summit meeting, January 26-27, 2007, Chicago, IL. Chest. 2008;133(5 Suppl):51S - 66S. 2. Christian M et al. Chapter 7. Critical care triage. Recommendations and standard operating procedures for intensive care unit and hospital preparations for an influenza epidemic or mass disaster. Intensive Care Med. 2010;36 Suppl 1:S55-S64. doi:10.1007/s00134-010-1765-0. And nice reviews of the ethics here: 1. Upshur R SP. Stand on guard for thee: ethical considerations in preparedness planning for pandemic influenza: a report of the University of Toronto Joint Centre for Bioethics Pandemic Influenza Working Group. Univ Toronto Jt Cent Bioeth. 2005;(November). 2. Gostin LO, Powers M. What does social justice require for the public’s health? Public health ethics and policy imperatives. Health Aff (Millwood). 2006;25:1053-1060. doi:10.1377/hlthaff.25.4.1053.

The host response to injury is inflammation. The inflammatory response may have been naturally selected over millions of years of evolution to give the injured tissue the best chance of healing and recovering. On the other hand, over the last 50 years animal models of traumatic brain injury (TBI) suggest that fever, occurring as part of the inflammatory response, may be harmful to neuronal recovery. Some observational clinical studies support this. However we lack high quality clinical trials.At present clinicians commonly use drugs and physical cooling techniques to suppress fever after TBI and stroke. These approaches have costs and can be resource intensive, as well as be associated with side-effects. We will share with you some of the results from our program in this area. We will discuss ... What is normothermia? How effective are the interventions we use? What temperature do/should we target? What do we achieve? Surely we need a reliable answer to the question of whether the strict maintenance of normothermia (36-37°C) reduces disability and death after TBI? References1.Saxena M, Andrews PJ, Cheng A, Deol K, Hammond N. Modest cooling therapies (35ºC to 37.5ºC) for traumatic brain injury. Cochrane Database of Systematic Reviews 2014.2.Saxena M, Young P, Pilcher D, et al. Early temperature and mortality in critically ill patients with acute neurological diseases: trauma and stroke differ from infection. Intensive Care Med 2015:1-10.3.Young P, Saxena MK, Beasley CRW, et al. Early peak temperature and mortality in critically ill patients with or without infection. Intensive Care Med 2011;38:437-44.4.Saxena MK, Taylor CB, Hammond NE, et al. Temperature management in patients with acute neurological lesions: an Australian and New Zealand point prevalence study. Crit Care Reusc 2013;15:110-8.5.Saxena MK, Taylor C, Hammond N, et al. A Multi-Centre Audit of Temperature Patterns After Traumatic Brain Injury. . Crit Care Reusc 2015 (June);17:129-34.

This podcast highlights pearls, pitfalls and take home points from our conference on ID emergencies as well as a sepsis update for 2015 https://media.blubrry.com/coreem/content.blubrry.com/coreem/Core_EM_Podcast_Episode_2.mp3 Download Leave a Comment Tags: Ebola, Endocarditis, Infectious Diseases, Myocarditis, Sepsis Show Notes SIRS Criteria Read More REBELCast: Sepsis Care in 2015 References Tattevin P et al. Does this patient have Ebola virus disease? Intensive Care Med 2014; 40(11): 1738-41. PMID: 25183574 Rivers E et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. NEJM 2001; 345(19): 1368-77.