July 2014 archive

More power to the probe – lung US for pneumonia

  • July 8, 2014

Chavez confirms the great predictive value of ultrasound in detecting pneumonia. We know more than 80% of pneumonia patients have disease extending to the pleura so this is no real surprise. How well trained do you need to be though?

Blood boosting no good in TBI

  • July 7, 2014

This 2 by 2 study looking at both Epo and transfusion triggers in closed TBI makes interesting reading and re-reading. Although large outcome benefit levels were sought (20%) there was no difference in neurological outcome (or mortality, ARDS, infection rate) between Epo and placebo or between a transfusion trigger of 7 and 10. Nor did Epo seem …

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Recruit and protect in theatre too?

  • July 3, 2014

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.

Dignified death on the ICU

  • July 3, 2014

The ABCD approach to holistic care in the patient who is dying on the ICU. We know it’s not all about opiate but it’s useful to acknowledge that death needs managing as well as any other stage in a disease process.