March 2014 archive

Dry lungs get less VAP

  • March 29, 2014

Using a ‘depletive’ strategy reduces VAP incidence says a study using data from a previous trial on the benefit of BNP in weaning.

3 sepsis papers at once

  • March 19, 2014

1. First of the 3 attempts to confirm goal-directed therapy benefit, PROCESS, has arrived and shows no benefit of a protocolised approach ‘v’ usual care. Look carefully at the details, particularly at the protocol changes. 2. MAP targeting in septic shock. 65-70 or 80-85 mmHg? No mortality difference in 776 patients but less kidney injury …

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ACEP guidelines for sedation in ED – don’t worry about fasting?

  • March 15, 2014

ACEP guidelines for ED sedation suggest that fasting is not strictly necessary, that capnography ‘may’ be used, and that a useful distinction is made between ‘deep sedation’ and general anaesthesia!

American winter flu experience

  • March 9, 2014

This Winter saw a resurgence of the 2009 strain of H1N1 in the USA.  This paper gathers together stats and lessons learned from 2009, such as: Beware a high incidence of ARDS, secondary bacterial infection and rhabdomyolysis. Steroids seem more than unhelpful. And protect your staff!

Worrying news about PPIs on ICU

  • March 4, 2014

GI haemorrhage, pneumonia and C.diff seem to be more frequent in those on PPIs, rather than H2 blockers, in this cohort study done over 5 years in 71 hospitals.

Intubating the critically ill? MACOCHA!

  • March 3, 2014

  Acknowledge that intubation of critically ill patients is more difficult. This prospective study  from last year suggests that coma, hypoxia and ‘non-anaesthetist’ status need to be taken into account.

Hyponatraemia – THE authoratative guideline

  • March 1, 2014

European guideline development group recommendations on managing low sodium. Everything you need to know, science, equations and algorithms.