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ARDS: What is the optimal PEEP?

EJRC Article Review Effect of lung recruitment and titrated positive end-expiratory pressure (PEEP) vs. low PEEP on mortality in patients with ARDS   Acute Respiratory Distress Syndrome (ARDS) is a clinical syndrome with various etiologies that usually occurs between 24 and 48 hours after local injury (pulmonary ARDS) or generalised acute illness (extrapulmonary ARDS). It […]

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Sepsis: Effect of a multifaceted educational intervention for anti-infectious measures on mortality

icTV interview with author Frank Bloos   In this icTV interview, Frank Bloos discusses the results of his prospective cluster-randomised trial MEDUSA – Medical Education for Sepsis Source Control and Antibiotics, which aimed to confirm that shortening the time to initiation of AT improves patient survival and evaluated the potential benefit of a multifaceted educational […]

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Can education improve Sepsis source control & antimicrobial therapy?

EJRC Article Review   In severe sepsis and septic shock, timing and appropriateness of antimicrobial therapy (AT) and source control have been associated with good outcome in many retrospective studies. Thus, guidelines recommend providing antibiotics in the first hour and source control in 6 to 12 hours despite the lack of randomised trials confirming this association. […]

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Early APRV: A strategy that reduces mortality and ventilator days?

EJRC Article Review Reducing the duration and harm of mechanical ventilation remains a major focus within intensive care medicine. The two predominant mechanisms of ventilator induced lung injury are volutrauma and atelectrauma [1]. Mortality from ARDS remains elevated despite significant improvements following the ARDSNet and PROSEVA studies [2,3]. Airway pressure release ventilation (APRV) has been […]

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Can KDIGO panel guidelines prevent cardiac surgery-associated AKI?

The PrevAKI RCT EJRC Article Review Patient morbidity associated with post-operative AKI following cardiac surgery is significant. Despite this we lack any specific therapy for post-cardiac surgery AKI. The management is limited to preventative and supportive measures, for which the evidence is limited. Novel biomarkers including urinary tissue inhibitor of metalloproteinase- 2 (TIMP-2) and insulin-like […]

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Want to reduce reintubation rates?

Reconnect to Mechanical Ventilation for 1h after a successful spontaneous breathing trial EJRC Article Review Post-extubation respiratory failure causes between 5-30% of patients to require reintubation, which is associated with increased mortality. Spontaneous breathing trials aim to evaluate when a patient is ready for extubation and involves a trial of T-tube, low level pressure support […]

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Prevention & Control of Multidrug-Resistant Gram-Negative Bacteria in ICUs

A Systematic Review and Network Meta-analysis EJRC Article Review Both the Healthcare Infection Control Practices Advisory Committee (2,3), the Centers for Disease Control & Prevention (6) and multiple other organisations (4,5) have published guidelines for the management of the increasing public health concern that is Multi-drug resistant Organisms. This is a meta-analysis into the effectiveness […]

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