Critical Connections Blog

Anti-Factor Xa-Based Monitoring of Unfractionated Heparin
Saini et al (J Pediatr. 2019;209:212-219.e1) sought to evaluate the clinical outcomes in pediatric patients receiving UFH while being monitored using anti-factor Xa and to determine the correlation between anti-factor Xa heparin and aPTT.
Posted: 9/4/2019 | 0 comments

Concise Critical Appraisal: Early Sedation Using Dexmedetomidine in Critically Ill Patients
Shehabi et al (N Engl J Med. 2019;380:2506-2517) set out to examine the effects of using dexmedetomidine as the primary agent for early sedation among patients receiving ventilatory support and found that the dexmedetomidine group had a higher risk of adverse events and needed additional sedatives to achieve sedation goals.
Posted: 8/12/2019 | 1 comments

Concise Critical Appraisal: Mentorship in Academic Medicine

Disch (Crit Care Med. 2018;46:437-441) set out to highlight the benefits of mentorship and its lack in underrepresented groups. Although women and minorities make up an increasing percentage of physicians and medical school faculty, they are underrepresented at higher ranks. She cites a study surveying over 1,100 women faculty members that found that only 54% felt they had a mentor.

Posted: 7/1/2019 | 0 comments

Concise Critical Appraisal: Effect of Community-Acquired Pediatric Sepsis on Survivors
Killien et al (Pediatr Crit Care Med. 2019;Epub ahead of print) set out to evaluate the prevalence of health-related quality of life (HRQL) decline in pediatric survivors of community-acquired sepsis, severe sepsis, and septic shock and to determine which factors are associated with a failure to return to baseline HRQL.
Posted: 6/13/2019 | 0 comments

Working Together to Advance Diversity and Inclusion
Read about the Society of Critical Care Medicine's (SCCM) efforts to seek diversity and inclusion within the critical care profession and SCCM organization.
Posted: 6/3/2019 | 0 comments

Concise Critical Appraisal: Impact of Mentoring in Academic Medicine
Efstathiou et al (PLoS One. 2018;13:e0207634) developed a standardized mentorship program and a series of surveys to evaluate the program’s impact, specifically measuring faculty satisfaction and productivity.
Posted: 5/9/2019 | 0 comments

Concise Critical Appraisal: Effect of a Resuscitation Strategy Targeting Peripheral Perfusion Status Versus Serum Lactate
Hernández et al (JAMA. 2019;321:654-664) set out to address that question with a multicenter randomized trial in which they compared two resuscitative targets: the normalization of blood lactate and the normalization of peripheral perfusion as quantified by capillary refill time.
Posted: 4/11/2019 | 0 comments

Concise Critical Appraisal: Epinephrine Versus Norepinephrine for Cardiogenic Shock
Levy et al (J Am Coll Cardiol. 2018;72:173-182) conducted a prospective, double-blind, multicenter RCT comparing epinephrine to norepinephrine in the setting of CS in patients who underwent AMI treated with percutaneous coronary intervention.
Posted: 3/12/2019 | 0 comments

Concise Critical Appraisal: Effect of Low Versus Intermediate Tidal Volume Strategy
Simonis et al (JAMA. 2018;320;1872-1880) set out to evaluate the effect of an LTVV strategy versus an intermediate tidal volume ventilation strategy in intensive care unit patients without ARDS.
Posted: 2/12/2019 | 0 comments

Concise Critical Appraisal: Antipsychotic Medications for Delirium in the ICU
Girard et al (N Engl J Med. 2018;379:2506-2516) and Page et al (Lancet Respir Med. 2013;1:515-523) evaluated the treatment of acute delirium with antipsychotics.
Posted: 1/8/2019 | 1 comments

Concise Critical Appraisal: Use of Telemedicine During Interhospital Transport of Children
Jackson et al (Ped Crit Care Med. 2018;19:1033-1038) set out to analyze the impact telemedicine had on time to surgery in children with intracranial hemorrhage (ICH).
Posted: 12/10/2018 | 0 comments

Concise Critical Appraisal: Epinephrine in Out-of-Hospital Cardiac Arrest
Perkins et al (N Engl J Med. 2018;379:711-721) set out to examine the effects of epinephrine during OHCA.
Posted: 11/8/2018 | 0 comments

Concise Critical Appraisal: Ultra-Low Tidal Volume Ventilation During CPR
Ruemmler et al (Resuscitation. 2018;132:56-62) set out to compare intermittent positive pressure ventilation to passive oxygenation (continuous positive airway pressure) and a novel ultra-low tidal volume ventilation (ULTVV) regimen.
Posted: 10/9/2018 | 0 comments

Concise Critical Appraisal: Effect of Sodium Bicarbonate Infusion on Patient Outcomes
Jaber et al (Lancet. 2018;392:31-40) set out to evaluate the effect of sodium bicarbonate infusion on critically ill patient outcomes.
Posted: 9/13/2018 | 0 comments

Concise Critical Appraisal: The Effect of Ramelteon Administration on the Duration of ICU Stay
Nishikimi et al (Crit Care Med. 2018;46:1099-1105) set out to identify the effects of ramelteon, a melatonin agonist, on ICU length of stay for critically ill patients.
Posted: 8/9/2018 | 0 comments

Concise Critical Appraisal: Fluid Administration and Diabetic Ketoacidosis
Kuppermann et al (N Engl J Med. 2018;378:2275-2287) sought to prospectively determine the role that fluid makeup and rate have on the development of neurologic injury in children with DKA.
Posted: 7/12/2018 | 0 comments

Concise Critical Appraisal: The Efficacy of ECMO for Severe ARDS
Combes et al (N Engl J Med. 2018;378:1965-1975) set out to determine whether the use of ECMO reduced mortality in patients with ARDS when defined by one of three criteria: P/F ratio < 50 mm Hg for > 3 hours, P/F ratio < 80 mm Hg for > 6 hours, or pH < 7.25 coupled with Paco2 ≥ 60 mm Hg for > 6 hours (with respiratory rate < 35 beats/min and plateau pressure ≤ 32 cm H2O). 
Posted: 6/21/2018 | 0 comments

Concise Critical Appraisal: Cerebral Oxygen Metabolism and RBC Transfusion in Infants
Neunhoeffer et al (Pediatr Crit Care Med. 2018;19:318-327) sought to use noninvasive means to determine the changes in cerebral oxygen metabolism in infants younger than 6 months who have undergone major surgery.  
Posted: 6/15/2018 | 0 comments