We rightly like to avoid intubation in COPD exacerbations. Extracorporeal CO2 removal or ‘pulmonary dialysis’ has been around for a while and many feel it is beneficial in COPD (eg this case) but who is it best used for? In an Italian matched cohort study Del Sorbo and colleagues looked at 200 patients with an exacerbation …
The PHARLAP open lung approach showed promising short term benefit earlier on in the year in ARDS, but now the evidence for recruitment manoeuvres alone has been meta-analysed by Suzumura. Nearly 1600 patients. No standardized strategy, illness severity or timing. They at least seem safe but outcome gain is less clear. An attempt at isolating the studies with …
Maggiore et al have looked at the use of nasal high-flow oxygen in 100-ish pneumonia/trauma patients and found, most significantly, a reduction in re-intubation rate. You also get more sats for your FiO2, and fewer mask-now-on-their-ear moments. We know it gives flow-related 2-5 cmH2O of CPAP and is preferred by claustrophobes, but this small study suggests …
Tracman said no, but others have shown benefit. Siempos’ meta-analysis of 13 trials suggests thinking again. Depending on which statistical model you use, it appears that early tracheostomy may reduce 30 day mortality, particularly, or exclusively in patients with high baseline risk of death. Less pneumonia and, unsurprisingly, shorter ICU stay is also suggested. However longer …
Proning in ICU is 40 years old now. Meta-analyse 11 high-quality studies in a thorough manner (including blinding to authors!) and it appears strikingly good, with an NNT of 11 – definitely better than protective ventilation alone. Do it in the severely hypoxic (P/F <100 mmHg), do it early (within 72 hours), do it for …
3 (fairly) recent studies (IMPROVE, PROVHILO, Defresne) show mixed benefit of using protective lung ventilation strategy with or without recruitment manoeuvres. Unimpressive results even in the obese. We know lungs de-recruit quickly under anaesthesia and that simple PEEP alone doesn’t help on radiological studies.
Cochranized in the past, macrolides (usually azithromycin) seem more convincingly beneficial regarding mortality and treatment failure in pneumonia (especially in the elderly). This large but retrospective VA registry analysis supports this suggestion. The finding of more MIs but fewer ‘cardiac events’ is confusing. First line for everyone, include it in the initial antimicrobials, continue it …
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Surely statins are useful for something on the ICU?
July 25, 2014
Recent articles on statins for ARDS treatment, VAP treatment and COPD excerbation prevention have all been disappointing. In the lab they are anti-inflammatory, protect coagulation pathways, and inhibit micro-organisms. On the unit there have been suggestions that they prevent the onset of, and reduce mortality in, severe infections and sepsis, but this has been difficult to replicate in …
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