July 2014 archive

ICU echocardiography – fully in focus

  • July 31, 2014

The ILC-FoCUS focused echocardiography recommendations are a product of 4 conferences, 33 experts and a Delphi process, giving a useful set of statements on everything from training to equipment to volume status.

Which co-morbidities really matter (at least in Scotland!)?

  • July 30, 2014

For over 1000 Scottish teaching hospital admissions, using univariate logistic regression: IHD, ALD, COPD, obesity, rheumatological disease, functional status and, just barely, age all impact upon unit or hospital death. Surprisingly many conditions such as DM, malignancy, tromboembolic disease, CVA and several others did not.

Early tracheostomy? Definitely maybe.

  • July 29, 2014

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 …

Continue reading

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 …

Continue reading

Be balanced when resuscitating sepsis?

  • July 25, 2014

Raghunathan has used some interesting statistics to try and extract the effects of using Saline or Ringer’s lactate in resuscitating sepsis. Elixhauser comborbidities, 5:1 greedy matching, Generalized Estimating Equation models, and “missing-ness” are just a few of the terms I didn’t understand. Nevertheless this appears to be a retrospective study that suggests there’s measurable mortality benefit in using balanced …

Continue reading

Stress hyperglycaemia and lactataemia

  • July 17, 2014

Australian lactate enthusiasts have taken a huge dataset and discovered high sugar is not an independent risk factor when the lactate is also high. Given they both take part in the Cori cycle and glycolysis maybe this shouldn’t be a surprise but maybe it also explains NICE-SUGAR and should reassure us that semi-tight control is …

Continue reading

Chlorhexidine dressings do work for CLABSI prevention

  • July 17, 2014

Safdar et al have combined 9 studies and found an NNT of 77 which may not seem fantastic but where the complication is a quality indicator… Time to add them to the line pack for non-tunnelled catheters at least? The varied but often high background CLABSI rate may make you hesitate though.

Prone who, when and for how long? Are we clear now?

  • July 13, 2014

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 …

Continue reading