Hyponatremia: A Review
Hyponatremia is the most frequently occurring electrolyte abnormality and can lead to life-threatening complications. This disorder may be present on admission to the intensive care setting or develop during hospitalization as a result of treatment or multiple comorbidities. Patients with acute hyponatremia or symptomatic chronic hyponatremia will likely require treatment in the intensive care unit (ICU). Immediate treatment with hypertonic saline is needed to reduce the risk of permanent neurologic injury. Chronic hyponatremia should be corrected at a rate sufficient to reduce symptoms but not at an excessive rate that wo...
Source: Journal of Intensive Care Medicine - April 9, 2016 Category: Intensive Care Authors: Buffington, M. A., Abreo, K. Tags: Analytic Reviews Source Type: research
Low-Dose Ketamine in Chronic Critical Illness
We report a case series on the observed effects of low-dose ketamine infusions in 4 critically ill patients with varying complications related to prolonged critical illness. Doses of ketamine infusion ranged from 0.5 to 4 μg/kg/min. A low-dose ketamine infusion was used to reduce agitation in a patient requiring high doses of sedatives and analgesics. In a second patient, ketamine improved depression and anxiety symptoms. In a third patient, ketamine may have facilitated liberation from mechanical ventilation. In a fourth patient, ketamine was used for palliation to avoid lethargy. Ketamine may be considered to help dec...
Source: Journal of Intensive Care Medicine - January 26, 2016 Category: Intensive Care Authors: Moitra, V. K., Patel, M. K., Darrah, D., Moitra, A., Wunsch, H. Tags: Case Report Source Type: research
A Technique for Bronchoscopic Intubation During High-Flow Nasal Cannula Oxygen Therapy
We describe a technique of high-flow nasal cannula oxygen support during bronchoscopic intubation (Source: Journal of Intensive Care Medicine)
Source: Journal of Intensive Care Medicine - January 26, 2016 Category: Intensive Care Authors: Berlin, D., Singh, I., Barjaktarevic, I., Friedman, O. Tags: Techniques and Procedures Source Type: research
The Effect of an Electronic Checklist on Critical Care Provider Workload, Errors, and Performance
Conclusion:
The electronic checklist significantly reduced provider workload and errors without any measurable difference in the amount of time required for checklist completion. This demonstrates that electronic checklists are feasible and desirable in the ICU setting. (Source: Journal of Intensive Care Medicine)
Source: Journal of Intensive Care Medicine - January 26, 2016 Category: Intensive Care Authors: Thongprayoon, C., Harrison, A. M., OHoro, J. C., Berrios, R. A. S., Pickering, B. W., Herasevich, V. Tags: Original Research Source Type: research
Evaluation of Early Dexmedetomidine Addition to the Standard of Care for Severe Alcohol Withdrawal in the ICU: A Retrospective Controlled Cohort Study
Conclusions:
This study suggests DEX is associated with a reduction in BZD requirement when utilized as adjunctive therapy for AWS. A larger prospective trial is needed to evaluate the clinical impact of DEX for AWS. (Source: Journal of Intensive Care Medicine)
Source: Journal of Intensive Care Medicine - January 26, 2016 Category: Intensive Care Authors: VanderWeide, L. A., Foster, C. J., MacLaren, R., Kiser, T. H., Fish, D. N., Mueller, S. W. Tags: Original Research Source Type: research
A Model for Identifying Patients Who May Not Need Neurologic Intensive Care Unit Admission: Resource Utilization Study
Conclusion:
The outcome for LRM patients in our neuro-ICU suggests they may not require admission to neurologic intensive care. This may provide a measure of neuro-ICU resource use. Improved resource use and reduced costs might be achieved by strategies to provide care for these patients on floors or intermediate care units. This model will need to be validated in other neuro-ICUs and prospectively studied before it can be adopted for triaging admissions to neuro-ICUs. (Source: Journal of Intensive Care Medicine)
Source: Journal of Intensive Care Medicine - January 26, 2016 Category: Intensive Care Authors: Sadaka, F., Cytron, M. A., Fowler, K., Javaux, V. M., OBrien, J. Tags: Review of a Large Clinical Series Source Type: research
The Association Between Admission Magnesium Concentrations and Lactic Acidosis in Critical Illness
Conclusions:
Magnesium deficiency is a common finding in patients admitted to the ICU and is associated with lactic acidosis. Our findings support the biologic role of magnesium in metabolism and raise the possibility that hypomagnesemia is a correctable risk factor for lactic acidosis in critical illness. (Source: Journal of Intensive Care Medicine)
Source: Journal of Intensive Care Medicine - January 26, 2016 Category: Intensive Care Authors: Moskowitz, A., Lee, J., Donnino, M. W., Mark, R., Celi, L. A., Danziger, J. Tags: Review of a Large Clinical Series Source Type: research
Damage Control Resuscitation
Resuscitation of the hemorrhaging patient has undergone significant changes in the last decade resulting in the concept of damage control resuscitation (DCR). Hemostatic resuscitation aims to address the physiologic derangements found in the hemorrhaging patient, namely coagulopathy, acidosis, and hypothermia. Strategies to achieve this are permissive hypotension, high ratio of plasma and platelet transfusion to packed red blood cell transfusion, and limitation of crystalloid administration. Damage control surgery aims for early hemorrhage control and minimizing operative time by delaying definitive repair until the patien...
Source: Journal of Intensive Care Medicine - January 26, 2016 Category: Intensive Care Authors: Bogert, J. N., Harvin, J. A., Cotton, B. A. Tags: Analytic Reviews Source Type: research
Antibiotic Dosing in Patients With Acute Kidney Injury: "Enough But Not Too Much"
This article examines the pharmacokinetic and pharmacodynamic consequences of critical illness, AKI, and renal replacement therapy and describes potential solutions to help clinicians give "enough but not too much" in these very complicated patients. (Source: Journal of Intensive Care Medicine)
Source: Journal of Intensive Care Medicine - January 26, 2016 Category: Intensive Care Authors: Lewis, S. J., Mueller, B. A. Tags: Analytic Reviews Source Type: research
Infective Endocarditis
Infective endocarditis (IE) is a noncontagious infection of the endocardium and heart valves. The epidemiology of IE has shifted recently with an increase in health care-associated IE. Infective endocarditis requiring intensive care unit stay is increasing, and nosocomial IE is frequently responsible. Diagnosis of IE requires multiple clinical data points encompassing history and physical examination, microbiology, and cardiac imaging as no one test is sufficiently sensitive or specific. The modified Duke criteria algorithm is the standard of care in the clinical diagnosis of IE. Complications from IE are common, particula...
Source: Journal of Intensive Care Medicine - January 26, 2016 Category: Intensive Care Authors: Klein, M., Wang, A. Tags: Analytic Reviews Source Type: research
The Use of Modafinil in the Intensive Care Unit
As patients recover from their critical illness, the focus of intensive care unit (ICU) care becomes rehabilitation. Fatigue, excessive daytime somnolence (EDS), and depression can delay their recovery and potentially worsen outcomes. Psychostimulants, particularly modafinil (Provigil), have been shown to alleviate some of these symptoms in various patient populations, and as clinical trials are underway exploring this novel use of the drug, we present a case series of 3 patients in our institution’s Thoracic Surgery Intensive Care Unit. Our 3 patients were chosen as a result of their fatigue, EDS, and/or depression,...
Source: Journal of Intensive Care Medicine - January 4, 2016 Category: Intensive Care Authors: Gajewski, M., Weinhouse, G. Tags: Case Report Source Type: research
A Review of Multifaceted Care Approaches for the Prevention and Mitigation of Delirium in Intensive Care Units
Conclusion:
Although multifaceted care approaches may reduce delirium and improve patient outcomes, greater improvements may be achieved by deploying a comprehensive bundle of care practices including awakening and breathing trials, delirium monitoring and treatment, and early mobility. Further research to address this knowledge gap is essential to providing best care for ICU patients. (Source: Journal of Intensive Care Medicine)
Source: Journal of Intensive Care Medicine - January 4, 2016 Category: Intensive Care Authors: Collinsworth, A. W., Priest, E. L., Campbell, C. R., Vasilevskis, E. E., Masica, A. L. Tags: Original Research Source Type: research
Daytime Versus Nighttime Extubations: A Comparison of Reintubation, Length of Stay, and Mortality
Conclusions:
Intensive care unit extubations at night did not have higher likelihood of reintubation, LOS, or mortality compared to those during the day. Since patients should be extubated as soon as they meet parameters in order to potentially decrease complications of mechanical ventilation, these data provide no support for delaying extubation until daytime. (Source: Journal of Intensive Care Medicine)
Source: Journal of Intensive Care Medicine - January 4, 2016 Category: Intensive Care Authors: Tischenkel, B. R., Gong, M. N., Shiloh, A. L., Pittignano, V. C., Keschner, Y. G., Glueck, J. A., Cohen, H. W., Eisen, L. A. Tags: Review of a Large Clinical Series Source Type: research
Two Methods of Hemodynamic and Volume Status Assessment in Critically Ill Patients: A Study of Disagreement
Conclusions:
The lack of concordance between PAC and AWA in critically ill surgical patients undergoing active resuscitation raises doubts regarding the interchangeability and relative accuracy of these modalities in clinical use. Lack of awareness of these limitations can lead to errors in clinical decision making when managing critically ill patients. (Source: Journal of Intensive Care Medicine)
Source: Journal of Intensive Care Medicine - January 4, 2016 Category: Intensive Care Authors: Eiferman, D. S., Davido, H. T., Howard, J. M., Gerckens, J., Evans, D. C., Cook, C. H., Stawicki, S. P. A. Tags: Review of a Large Clinical Series Source Type: research
Biomarkers in Hepatic Disease: A Review Focused on Critically Ill Patients
The ability to make a diagnosis early and appropriately is paramount for the survival of the critically ill ICU patient. Along with the myriad physical examination and imaging modalities available, biomarkers provide a window on the disease process. Herein we review hepatic biomarkers in the context of the critical care patient. (Source: Journal of Intensive Care Medicine)
Source: Journal of Intensive Care Medicine - January 4, 2016 Category: Intensive Care Authors: Kubilay, N. Z., Sengel, B. E., Wood, K. E., Layon, A. J. Tags: Analytic Reviews Source Type: research
