Critical Care Alert
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Managing COVID-19 Respiratory Failure: Is There a Perfect Management Strategy?
COVID-19 is a systemic disease that primarily injures the vascular endothelium, causing a unique lung injury in which different management strategies may need to be considered to address the specific physiology of each patient.
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Antibiotic Therapy to Reduce the Incidence of Ventilator-Associated Pneumonia After Cardiac Arrest
In this prospective, randomized trial, intravenous amoxicillin-clavulanate (dosed three times daily and given for two days) administered to patients admitted with out-of-hospital cardiac arrest due to a shockable rhythm reduced the incidence of early ventilator-associated pneumonia.
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Maximal Lung Recruitment Strategy Does Not Reduce Ventilator-Free Days in the Setting of Acute Respiratory Distress Syndrome
In this randomized trial, daily maximal recruitment trials failed to reduce ventilator-free days in the setting of acute respiratory distress syndrome, but increased the risk of cardiovascular adverse effects.
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Impact of Intensive Care Unit Personnel Decisions and Staffing on Patient Outcomes
Nurses with relatively high autonomy, alongside a dedicated intensive care unit (ICU) clinical pharmacist and 24/7 intensivist coverage, were associated with the lowest hospital mortality, shortest ICU lengths of stay, and shortest mechanical ventilator durations compared to other staffing models.
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Vitamin C, Thiamine, and Hydrocortisone for Septic Shock
The combination of vitamin C, thiamine, and hydrocortisone did not improve outcomes compared with hydrocortisone alone in patients with septic shock.
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Pressure Support vs. T-Piece Trials for Successful Extubation: An End to the Controversy?
In a randomized clinical trial of 1,153 adults who were ready for weaning after at least 24 hours of mechanical ventilation, researchers found that a spontaneous breathing trial with 30 minutes of pressure support ventilation compared with two hours of T-piece ventilation led to significantly higher successful extubation rates.
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Critical Care in the Obese Patient
This article will highlight some important practical aspects of care that arise in the management of critically ill obese patients, along with the unique physiology resulting from obesity.
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Laryngeal Injury Is Common After 12 Hours of Intubation
After 12 hours of intubation, most patients showed laryngeal injury, including mucosal ulceration, that led to impaired breathing and voicing 10 weeks after extubation.
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Management of Nontraumatic Intracranial Emergencies: A Clinical Update
This article attempts to provide evidence-based, practical guidelines to the frontline clinician in the nontrauma intensive care setting.
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Efficacy of Vitamin C Infusion on Outcomes in Sepsis-Induced ARDS
In this randomized, double-blinded, placebo-controlled trial, intravenous vitamin C infusion did not influence a change in the modified Sequential Organ Failure Assessment score from the time of infusion to four days compared to placebo.