Critical Care Topics
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Evaluation and Treatment of Severe Community-Acquired Pneumonia in the ICU
Community-acquired pneumonia is a common cause for hospital admission. This article serves to summarize new updates in the definition, prognosis, and treatment, specifically of bacterial, severe community-acquired pneumonia.
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Do Not Intubate Orders Becoming More Common
Rates increased over time, from about one in 10 patients 20 years ago to about one in three patients in the past five years. The exact reasons for this increase remain unclear.
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Dexamethasone for COVID-19 Inpatients Requiring Oxygen
Dexamethasone administration is associated with reduced 28-day mortality in oxygen-requiring COVID-19 patients, including those receiving mechanical ventilation.
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U.S. Obesity Rates on the Rise
News arrives on the heels of several recently published papers that indicate obesity can exacerbate COVID-19.
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Considerations and Concerns with Vitamin C in Sepsis and Septic Shock
Sepsis remains a major healthcare problem associated with significant morbidity and mortality. Roles for hydrocortisone, ascorbic acid (vitamin C), and thiamine (HAT therapy) as potential adjuvants remain controversial.
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ORANGES and ACTS Trials: No Mortality Benefit with Ascorbic Acid, Thiamine, and Hydrocortisone in Septic Shock Patients
Two double-blinded, placebo-controlled, randomized trials involving 337 patients (ORANGES, n = 137; ACTS, n = 200) with sepsis and septic shock have shown that administration of ascorbic acid, thiamine, and hydrocortisone did not reduce organ dysfunction or improve overall mortality. However, both trials showed that this combination therapy was effective in reducing the time to achieve shock resolution or shock-free days.
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A Combination of Both SIRS and SOFA Scores Enhances Recognition of Sepsis in the Emergency Department
Compared with either score alone, using both SIRS and SOFA scores led to earlier and more complete recognition of sepsis in patients presenting to the emergency department.
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Effect of Stress Ulcer Prophylaxis Choice on Mortality in Mechanically Ventilated Adults
Proton pump inhibitors reduce the risk of clinically important bleeding, but they may have no effect on the risk of 90-day mortality compared to histamine-2 receptor antagonists.
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Palliative Care and Ethical Considerations in the COVID-19 ICU
The COVID-19 pandemic has created an ICU environment different from what we have ever seen in our lifetimes that has deep palliative care and ethical repercussions.
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COVID-19 and Steroids: Is There a Consensus on the Controversy?
A retrospective, single-center cohort study among 201 adults admitted with COVID-19 pneumonia revealed that risk factors associated with the development of acute respiratory distress syndrome (ARDS) and progression from ARDS to death included older age, neutrophilia, organ dysfunction, and coagulation derangement. Treatment with methylprednisolone may be beneficial for these patients.