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The average annual incidence of pediatric in-hospital cardiac arrest (IHCA) has recently been estimated at more than 15,000 cases.1 Survival rates for pediatric patients who have had pulseless cardiac arrest have remained below 50% for the past decade.2,3 The American Heart Association currently recommends epinephrine, the cornerstone medication for cardiac arrest, dosed every 3 to 5 minutes in adult and pediatric cardiac arrest, although there is conflicting evidence about whether this is the best interval.4,5 Epinephrine is believed to acutely increase coronary perfusion pressure by increasing diastolic blood pressure (DBP).
This Concise Critical Appraisal explores an article published in Critical Care Medicine on a program at Cooper University Hospital in Camden, New Jersey, USA, that implemented a previously published successful ECMO model, in which ECMO cannulation primarily performed by cardiothoracic surgeons is transitioned to medical intensivist-led cannulation. This article is significant in advancing the role of the medical intensivist in the cannulation of patients who require ECMO.
To help understand what moral distress looks like and how to manage and prevent it, the Society of Critical Care Medicine recently hosted the webcast Managing Moral Distress During a Pandemic.
Is hydrocortisone for septic shock best used alone or in combination with fludrocortisone? This Concise Critical Appraisal explores a retrospective cohort study that found that treatment with hydrocortisone plus fludrocortisone led to lower rates of mortality or discharge to hospice, hospital deaths, and fewer days on vasopressors than treatment with hydrocortisone alone.
The new Agency for Healthcare Research and Quality (AHRQ) Toolkit for Preventing CLABSI and CAUTI in ICUs offers customizable tools and training resources to help your facility prevent dangerous infections. Its unique design gives users resources to assess current clinical and safety practices, implement a reduction plan, and overcome common cultural and technical challenges in reduction efforts.
This Concise Critical Appraisal delves into a study published in Pediatric Critical Care Medicine that sought to determine whether early hemostatic intervention can prevent the development of DIC and improve outcomes.
Two recent trials suggest that immune-damping drugs such as tocilizumab may reduce mortality in patients with severe COVID-19.
How can clinical information gleaned from focused cardiac ultrasound (FCU) be used to augment clinical assessments in children with suspected septic shock? This month’s Concise Critical Appraisal analyzes a study published in Pediatric Critical Care Medicine that sought to show how often a clinician’s hemodynamic characterization of a child with septic shock was altered by FCU and to further validate an expert-developed algorithm for these assessments.
Clostrididioides difficile infection (CDI) occurs in about 4% of ICU patients, causing fulminant colitis and death in nearly 60% of symptomatic critically ill patients, so it is imperative for ICU professionals to stay abreast of the evidence-based advancements of CDI management. In June 2021, the Infectious Diseases Society of America and Society for Healthcare Epidemiology of America updated their recommendations on the management of CDI in adults. This Concise Critical Appraisal offers a review of the updated guidelines.
This Concise Critical Appraisal explores a meta-analysis showing that prone positioning is beneficial for patients meeting criteria for venovenous extracorporeal membrane oxygenation (ECMO), especially when initiated within five days after ECMO initiation. When initiated within five days, patients had lower intensive care unit (ICU) mortality rates, higher likelihood of being discharged alive, shorter ECMO duration, and cumulative 90-day probability of being discharged from the ICU.
The Society of Critical Care Medicine’s (SCCM) new global health initiative, Africa Infrastructure Relief and Support (AIRS), will ensure the availability of medical oxygen to patients in the Gambia, Liberia, and Sierra Leone, made possible by a $5.5 million grant from Direct Relief and in collaboration with the Johns Hopkins Global Alliance of Perioperative Professionals (GAPP) and the Institute of Global Perioperative Care. Officials in the Gambia, Liberia, and Sierra Leone will identify specific medical oxygen-related needs, including hospital-based infrastructure, oxygen-generating plants, and solar energy. SCCM plans to eventually expand the initiative to additional countries.
José L. Díaz-Gómez, MD, FASE, FCCM, rides his bicycle to work every day in Houston, Texas. He passes the Texas Medical Center, where he sees a large Ukrainian flag on one of the hospital buildings. The flag symbolizes support for Ukraine in its ongoing war with Russia, and now when Dr. Díaz-Gómez passes it, he sees something more. He sees courage, responsibility, and hope.
In 2014, Nibras F. Bughrara, MD, FASA, FCCM, joined Albany Medical Center (AMC) in Albany, New York, USA, after completing a critical care medicine fellowship and perioperative echocardiography training at Johns Hopkins School of Medicine. At the time, he was the only intensivist at AMC using point-of-care ultrasound (POCUS).
Members of the Society of Critical Care Medicine (SCCM) traveled from the United States to Lviv, Ukraine in March to train more than 140 clinicians on lifesaving critical care ultrasound. Learning and using point-of-care ultrasound (POCUS) skills allows Ukrainian medical professionals to quickly diagnose and care for critically ill and injured patients—all the more important as injuries continue to mount in the ongoing Ukrainian humanitarian crisis.
Are push-dose vasopressors (PDPs) safe and effective for patients with hypotension outside the operating room? This Concise Critical Appraisal covers a recent study that sought to determine whether phenylephrine and epinephrine are effective for acute hypotensive periods when PDP protocols are in place.
With children going back to school, continued outbreaks of respiratory syncytial virus (RSV), and the upcoming flu season, it is important to prepare for potential surges of pediatric patients with COVID-19.
Oxygen is essential for human life and has no substitute. Its importance was highlighted during the COVID-19 pandemic by the many patients who had difficulty breathing. Medical oxygen is used in many different settings, such as intensive care units, operating rooms, delivery rooms, and during emergency transport.
When should antibiotics be administered in septic patients with septic arthritis? This Concise Critical Appraisal reviews a recent study that sought to determine whether patients with septic arthritis should receive antibiotics prior to synovial fluid aspiration analysis or wait until synovial fluid analysis has been completed.
Independence Day is supposed to be a day of celebration, but for Cooper Roberts and Ian Azeredo, it was life changing. If it were not for their respective critical care teams, it would have been life ending. Today, both Cooper and Ian are alive and doing well with the help of their care teams, family, and fighting spirit. They are all the recipients of the Society of Critical Care Medicine’s (SCCM) ICU Heroes Award, which recognizes an ICU patient and family and the multidisciplinary team that delivered the care.
Should critically injured children receive balanced crystalloid (BC) solutions or normal saline (NS) during fluid resuscitation? This Concise Critical Appraisal explores a recent study examining whether the use of BC solutions versus NS is associated with the development of new or progressive acute kidney injury in children with septic shock.