What is the real impact of no sedation during mechanical ventilation?

What is the real impact of no sedation during mechanical ventilation? EJRC ARTICLE REVIEW   For many years, standard therapy for patients undergoing mechanical ventilation included sedation. It was seen as a way to ease patients and help them to accept the procedure. In the last decade, randomised controlled trials (RCTs) have shown that utilising […]

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My ICU patient with acute hypoxaemic respiratory failure is immunocompromised

My ICU patient with acute hypoxaemic respiratory failure is immunocompromised: Results from the EFRAIM study EJRC Article Review   Over the past decades, the number of immunosuppressed patients admitted to ICUs has increased. This may be the consequence of increased use of chemotherapy, bone marrow and solid organ transplantation, as well as the increased life […]

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Improving antibiotic stewardship in pneumonia: Is more aggressive viral testing the key?

Improving antibiotic stewardship in pneumonia: Is more aggressive viral testing a key to success? EJRC Article Review   Pneumonia has a substantial impact in the ICU, as a leading reason of acute respiratory failure and for mechanical ventilation. Since appropriate antibiotic use is crucial to limiting morbidity and mortality in pneumonia, intensivists normally prescribe broad-spectrum […]

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Terminal weaning or immediate extubation: the ARREVE observational study

EJRC Article Review Terminal weaning or immediate extubation for withdrawing mechanical ventilation in critically ill patients (the ARREVE observational study) Worldwide, an increasing number of deaths occur in the intensive care unit (ICU) after a decision to withdraw life support [1, 2]. Relatives of patients who die in the ICU have been reported to experience […]

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Identifying community-acquired pneumonia (CAP)

Is the clinical significance of community-acquired pneumonia (CAP) visualised on CT scans only the same as of CAP visualised on chest x-rays? EJRC Article Review   The clinical significance of radiological signs of pneumonia visualised only on CT imaging is largely unknown, which creates uncertainty about the appropriate management: Should the management approach be according […]

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Oxygen Therapy in AMI?

EJRC Article Review A new perspective for Oxygen Therapy in Suspected Acute Myocardial Infarction   Traditional treatment for patients with suspected acute myocardial infarction (AMI) includes morphine, oxygen, nitroglycerine and aspirin. According to the European Society of Cardiology Guidelines for the management of AMI, oxygen is recommended in patients with ST-segment elevation in case of […]

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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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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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