Critical Care Alert
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Is There a Difference Between COVID-19 and Non-COVID-19 ARDS?
Comparison of a small COVID-19 acute respiratory distress syndrome (ARDS) cohort with a historical pre-COVID-19 ARDS cohort found some differences in physiologic parameters and biomarkers, but not enough evidence to warrant deviation from known management guidelines.
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Beyond Benzodiazepines: Adjuncts for the Management of Alcohol Withdrawal in the ICU
Although benzodiazepines are the mainstay of prevention and treatment of alcohol withdrawal syndrome, adjunct medications are used increasingly, with the goal of reducing cumulative benzodiazepine exposure and decreasing both hospital and intensive care unit admission and length of stay.
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Dexmedetomidine and Temperature Elevation: Is the Link Important?
In this post hoc analysis of the SPICE III trial, a greater percentage of patients receiving dexmedetomidine had temperatures greater than or equal to 38.3ºC and 39.0ºC compared to usual care. Although there was a significant dose response relationship between dexmedetomidine received and increase in temperature, there was no difference between groups in terms of paracetamol, antimicrobial, neuromuscular blocker, neuroleptic drug use, blood cultures performed, or initiation of renal replacement therapy. -
Lung Protective Ventilation in ARDS: What Is the Best Strategy?
Using newer methodology in network meta-analysis to compare various protective mechanical ventilation strategies, the authors concluded that a low tidal volume strategy combined with prone ventilation was associated with the greatest risk reduction in mortality for moderate to severe acute respiratory distress syndrome. -
Clinical Application of Biomarkers of Acute Kidney Injury in the ICU
Biomarkers have become an important tool for the early recognition and prognostication of acute kidney injury. In the last few years, several biomarkers have emerged that have shown promising results in large-scale clinical studies. -
Dexmedetomidine Compared to Propofol for Sedation in Mechanically Ventilated Patients with Sepsis
The MENDS2 trial found that dexmedetomidine, when used for light sedation, had outcomes similar to those for propofol. -
Interleukin-6 Antagonists in the Treatment of Severe COVID-19 Pneumonia
These two trials had disparate findings with respect to interleukin-6 inhibition, with REMAP-CAP showing a benefit and COVACTA showing none. -
Is There a Role for Immunomodulatory Therapy in COVID-19 Cytokine Storm?
In this retrospective analysis of COVID-19 patients hospitalized with cytokine storm, the use of corticosteroids combined with tocilizumab was associated with superior survival when compared to no immunomodulatory treatment; a combination of corticosteroids and anakinra; or corticosteroids, tocilizumab, or anakinra alone. Patients who received corticosteroids, either alone or in combination with anakinra, also experienced lower hospital mortality compared to no treatment. -
Driving Pressures More Strongly Predicted Survival than P/F Ratios in Patients with ARDS
Optimizing positive end-expiratory pressure to minimize driving pressure may be a better strategy for ventilator adjustment than maximizing partial pressure of arterial oxygen/fraction of inspired oxygen (P/F) ratios to improve outcomes in patients with acute respiratory distress syndrome. -
Elucidating the Long-Term Effects of COVID-19
In this prospective uncontrolled cohort study of COVID-19 survivors performed four months after their hospitalization, many patients reported at least one symptom not previously present, and abnormalities on lung computed tomography scan were common.