Category Archives: Intensive Care

DAILY SEDATION INTERRUPTION STILL CONTROVERSIAL

Posted on April 27, 2013 by K

 The average intensive care patient spends 40% of her/his ICU time being weaned from the ventilator. Reduced weaning times means freeing up an enormous amount of floor-space, manpower and resources. Two important causes for prolonged weaning are over-hydration and excessive … Continue reading →

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RINGER’S A LOUSY VOLUME EXPANDER

Posted on April 18, 2013 by Thomas D

With colloids being miscredited by Cochrane and synthetic colloids being hammered by RCTs, it might seem we’re left with crystalloids. So how good is our standard crystalloid, Ringer’s Lactate, at volume replacing a volume depleted patient? This study withdrew blood … Continue reading →

Posted in Anesthesia, Emergency Medicine, Intensive Care | 5 Comments

CODE BROWN: CENTRAL LINE GOES WRONG

Posted on March 15, 2013 by Thomas D

This one I got from a colleague of mine at a Scandinavian hospital, and it’s a scary reminder of the dangers of central cannulations. Placement of a large dialysis catheter went wrong – very wrong.

Posted in Code Brown, Intensive Care | 26 Comments

NOREPINEPHRINE AND CO

Posted on March 5, 2013 by K

A small study in Crit Care Med reminds me how it is really hard to anticipate the effects of systemic vasoconstrictors. Norepinephrine/noradrenaline is more likely to reduce cardiac output than maintain it.

Posted in Anesthesia, Emergency Medicine, Intensive Care | 1 Comment

CVC AND US

Posted on February 23, 2013 by K

A meta-analysis in Anesthesiology confirms how central line cannulation is a lot safer when guided by ultrasound. Does that mean we don’t need blind landmark techniques?

Posted in Emergency Medicine, Intensive Care | 7 Comments

BNP AND WEANING

Posted on February 16, 2013 by K

B-type or Brain Natiuretic Peptide (BNP) is secreted by the heart ventricles in response to excessive stretching of the heart. It’s physiologic actions is to decrease vascular resistance and increase natiuresis, thereby off-loading the strained heart ventricle. Recently BNP is finding … Continue reading →

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IVC DIAMETER AND HYPOVOLEMIC SHOCK

Posted on January 28, 2013 by K

AJEM recently published a meta-analysis of the evidence supporting making blood volume assessments in hypovolemic patients based on the ultrasound diameter of the inferior vena cava. Five studies met the authors’ selection criteria.

Posted in Emergency Medicine, Intensive Care | 2 Comments

FLUID CHALLENGES AND ARTERIAL BLOOD PRESSURE

Posted on January 4, 2013 by K

A study in Intensive Care Med reminds me of how arterial blood pressure is a crappy substitute for proper invasive monitoring or echo when treating hypovolemic sepsis patients.

Posted in Emergency Medicine, Intensive Care | 1 Comment

LUNG PROTECTIVE VENTILATION STILL GOOD

Posted on December 6, 2012 by Thomas D

Even if you don’t have ARDS or risk factors for ARDS, a lung protective ventilation strategy seems to be good for your patients according to a recent meta-analysis published in JAMA.

Posted in Anesthesia, Intensive Care | 2 Comments

COLLOIDS VS CRYSTALLOIDS

Posted on December 3, 2012 by Thomas D

Synthetic colloids have gotten a beating lately. First, the Cochrane group released their meta analysis on evidence supporting colloid use. They found none. Then HES colloids got hit hard by the 6S and CHEST studies. Are there any good indications … Continue reading →

Posted in Emergency Medicine, Intensive Care | 1 Comment