ICM Year in Review 1

Acute respiratory failure (Jaber)

Guerin et al: Assessement of the rate of diffuse alveolar damage on open lung biopsy performed in the ICU for nonresolving ARDS. The systematic use of steroids in nonresolving ARDS is not recommended.

Zhang et al:  PiCCO does not improve outcome when compared to CVP-based fluid management

Prophylactic extubation onto high flow nasal cannulae does not improve atelectasis

No difference between HFNC and HFFM for preoxygenation before intubation in ICU hypoxemic patients

There is no effect on outcome of sedative/analgesic therapy during NPPV

Implementing a quality improvement program for protocol-directed weaning showed an association with better outcomes in mechanically ventilated patients

Asynchronies during mechanical ventilation are associated with worse outcome

References

ARDS and steroids http://www.ncbi.nlm.nih.gov/pubmed/25476984

Transpulmonary thermodilution in ARDS http://www.ncbi.nlm.nih.gov/pubmed/25605469

HFNC and HFFM and intubation http://www.ncbi.nlm.nih.gov/pubmed/25869405

Outcome study http://www.ncbi.nlm.nih.gov/pubmed/?term=muriel+a+sedation

Quality improvement in weaning http://www.ncbi.nlm.nih.gov/pubmed/26156108

Asynchronies during mechanical ventilation http://www.ncbi.nlm.nih.gov/pubmed/?term=blanch+l+asynchronies

 

Randomized controlled trials (Perner)

There is no effect of EGDT on mortality in ED patients with septic shock and, therefore, no support for the inclusion of EGDT in the surviving sepsis guidelines

Thromboprophylaxis: there is good evidence for the beneficial effects of LMWH (vs. UFH) in ICU patients

Multicentre study: Amino acids vs. standard care: no difference in the duration of renal dysfunction in ICU patients but increasement in eGFR and urine output

 

References

EGDT vs. usual care in ED patients with septic shock http://www.ncbi.nlm.nih.gov/pubmed/25952825

Surviving sepsis campaign guidelines http://www.ncbi.nlm.nih.gov/pubmed/23361625

Thoromboprophylaxis http://www.ncbi.nlm.nih.gov/pubmed/25971389

 

 

Sepsis and septic shock (Benoit)

Risk of AKI in septic shock depends on source of infection but not organism

De-escalation of antimicrobial treatment in sepsis – no difference in survival rates and higher number of super-infections in the de-escalation group.

The capillary refill time (measured on index tip or knee area) is higher in non-survivors. Strong predictive factor of 14-day mortality

 

References

De-escalation of antimicrobial treatment in sepsis patients http://www.ncbi.nlm.nih.gov/pubmed/25091790

http://www.ncbi.nlm.nih.gov/pubmed/24231857

Volume expansion in septic and hypovolemic shock patients http://www.ncbi.nlm.nih.gov/pubmed/25447804

Capillary refill time in septic shock http://www.ncbi.nlm.nih.gov/pubmed/24811942

 

By Dr Julia Wagner