Heyland, SIGNET, REDOXS, ARDNSNET’s OMEGA, INTERSEPT, and now the Metaplus study. Approximately 300 patients, critically ill (APACHE >15) and ventilated were all given high protein (>1.2g/Kg/day), normal calorie (25Kcal/Kg/day) feed, either with or without Omega-3 acids, glutamine and antioxidants. All were started within 48 hours and stopped within 28 days. No benefit in terms of length of …
In this recent re-look at patients from a previous seminal study, a ‘nested’ cohort from the RENAL study with RIFLE ‘I’ acute kidney injury (GFR<50%, creatinine rise to twice baseline, UOP <0.5ml/kg for 12hr).were selected. The APACHE III score for those supported late was significantly lower suggesting there may have been something different (a covariate, so not …
A number of articles in the last few months have focused on staffing structure in the ICU. Previously we’ve seen that ‘high intensity staffing‘ (a dedicated ICU team, or at least the obligatory consultation by one) reduces mortality, in the USA. However night-time intensivists don’t seem to do the same unless there’s a ‘low intensity’ …
SSC international data from more than 28,000 patients with severe sepsis or septic shock emphasises early source control is paramount (closely followed by BP management). Get antibiotics in within 1 hour (2 at the very most) – the clock is ticking! Here, this was timed from the moment of triage or, on the wards, the …
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 …
It’s clearly extremely unlikely but, particularly if you work near an airport…. The patient has been hot in the last day, maybe with sore throat, vomiting and diarrhoea, and travelled to affected area in last 21 days, or knows someone who has? Risk assess further with this algorithm. But basically – double protection including FFPP3, discuss …
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