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Tag: Concise Critical Appraisal

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Concise Critical Appraisal: Quality Improvement Intervention on Sleep and Delirium

Does your hospital use a checklist or bundle to minimize risk factors for delirium? Delirium is common in surgical and medical intensive care units (ICUs) and has shown to be associated with longer mechanical ventilation duration and longer ICU and hospital lengths of stay. This Concise Critical Appraisal explores a study that evaluated a multicomponent nonpharmacologic quality improvement intervention aimed at the sleep-wake cycle for reducing delirium in critically ill patients in the surgical critical care setting.


Increased Mental Disorder Diagnoses in Children After Invasive Mechanical Ventilation

This Concise Critical Appraisal highlights an article in Pediatric Critical Care Medicine that sought to determine the association between invasive mechanical ventilation—a known predictor of adverse outcomes in children—and subsequent new neurodevelopmental and psychiatric disorders after pediatric intensive care unit hospitalization by reviewing Texas Medicaid Analytic eXtract data.


Effect of Bougie Versus Endotracheal Tube With Stylet on Successful Tracheal Intubation

Tracheal intubation is a high-risk procedure that is frequently performed in the emergency department and intensive care unit. Failure of first-pass success (FPS) when intubating has been shown to be associated with major adverse events, so maximizing FPS is paramount for improving patient outcomes. This Concise Critical Appraisal explores a study published in JAMA that sought to determine the effect of using a bougie (tracheal tube introducer) versus an endotracheal tube with stylet when intubating.


Concise Critical Appraisal: Vasopressin and Methylprednisolone for In-Hospital Cardiac Arrest

Although several trials have examined in-hospital cardiac arrest (IHCA), only two trials in the past decade have examined the use of vasopressin and glucocorticoids for IHCA. Both trials found improved survival and favorable neurologic outcome with a vasopressin-epinephrine-methylprednisolone combination. Because of a lack of additional supporting evidence, neither the American nor European international guidelines have recommended this combination for IHCA. This Concise Critical Appraisal examines an article by Andersen et al that attempted to validate the results of these trials.
 


Concise Critical Appraisal: Rapid Implementation of an Intensivist-Led VV ECMO Cannulation Program

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.


Concise Critical Appraisal: Epinephrine Dosing Intervals on Outcomes From Pediatric In-Hospital Cardiac Arrest

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).


Concise Critical Appraisal: Awake Prone Positioning For COVID-19 Acute Hypoxemic Respiratory Failure

This Concise Critical Appraisal explores an article in The Lancet Respiratory Medicine that evaluated the efficacy of awake prone positioning to prevent intubation or death in patients with severe COVID-19. This meta-trial used a new study design that allowed for the combination of six simultaneous national randomized, controlled, open-label trials.


Updated Guidelines on Management of Clostridioides difficile Infection in Adults

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.


Concise Critical Appraisal: Improving Training for Invasive Bedside Procedures

Invasive bedside procedures (IBPs) require a high degree of familiarity and skillful expertise. Yet effective and thorough bedside training can be haphazard or unattainable. Chest published a systematic review and meta-analysis that highlights gaps in research on IBP training in critical care. The study included four focus groups of pulmonary and critical care medicine faculty and fellows from four U.S. medical centers. The focus groups identified traits, behaviors, and context as common themes of effective teachers. This Concise Critical Appraisal takes a deep dive into the study and the takeaways for experts and novices seeking to improve procedural knowledge and increase patient safety.


Concise Critical Appraisal: Cardiac Ultrasound in Pediatric Septic Shock Assessment

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.


Concise Critical Appraisal: Development of the CCEeXAM

Bedside echocardiography has become increasingly widespread among physicians caring for critically ill patients. The Examination of Special Competence in Critical Care Echocardiography (CCEeXAM) was administered for the first time in 2019 to 524 physicians from multiple specialties. The examination was designed for physicians to demonstrate an objective competence and obtain certification in advanced critical care echocardiography (CCE).


Concise Critical Appraisal: Surviving Sepsis Campaign COVID-19 Guidelines Update

The updated Surviving Sepsis Campaign (SSC) COVID-19 guidelines are now available, reflecting the learnings from the latest major studies. This month’s Concise Critical Appraisal dives into the update to outline the changes and new recommendations made by the international panel and discusses limitations of the available data.


Concise Critical Appraisal: Asynchronous and Distance Learning in the Age of COVID-19 and Beyond

The medical community has faced many challenges as a result of the COVID-19 pandemic, including ensuring continued medical education in the face of social distancing guidelines and the increased workloads of faculty and trainees. This Concise Critical Appraisal explores an article published in ATS Scholar that sought to outline distance learning options and develop a practical framework for transitioning content to a virtual platform.


Concise Critical Appraisal: Early Hemostatic Management of Disseminated Intravascular Coagulopathy

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.


Concise Critical Appraisal: ARREST Trial: ECMO Versus Advanced Cardiac Life Support

The ARREST Trial compared extracorporeal membrane oxygenation (ECMO)-facilitated resuscitation to advanced cardiac life support (ACLS) treatment in patients with out-of-hospital cardiac arrest (OHCA). This month’s Concise Critical Appraisal takes a deep dive into the trial, published in The Lancet.


Concise Critical Appraisal: Is CPR Futile for COVID-19 Patients?

Is cardiopulmonary resuscitation (CPR) futile in hospitalized patients with COVID-19 experiencing cardiac arrest? A study recently published in Critical Care Medicine sought to answer this question and provide more data around outcomes of in-hospital cardiac arrest in patients with COVID-19.


Impact of Rapid Exome Sequencing on Management of Critically Ill Children

Dive into a study that evaluates a standardized process of using rapid exome sequencing to help diagnose critically ill children with suspected genetic diseases in this Concise Critical Appraisal.


Concise Critical Appraisal: Dexamethasone Use in the Treatment of COVID-19

This Concise Critical Appraisal offers a look into the results of the RECOVERY trial published in the New England Journal of Medicine, which demonstrated that dexamethasone improved mortality in hospitalized patients with COVID-19.


Concise Critical Appraisal: Early Use of Tranexamic Acid in the Treatment of Gastrointestinal Bleeds

This Concise Critical Appraisal offers a deep dive into the HALT-IT trial, which investigated whether early use of tranexamic acid to treat acute severe gastrointestinal bleeds would reduce overall mortality while limiting the burden of thromboembolic events.


Concise Critical Appraisal: PERSEVERE Biomarkers in Predicting AKI in Pediatric Septic Shock

Can the biomarkers identified in the Pediatric Sepsis Biomarker Risk Model (PERSEVERE II) be used to predict acute kidney injury and renal recovery in pediatric septic shock? This Concise Critical Appraisal explores a study in which Stanski et al (Am J Respir Crit Care Med. 2020;201:848-855) sought to answer this question.


Concise Critical Appraisal: Use of Early Versus Late Enteral Nutrition in Critically Ill Children

What is the benefit of early versus late nutrition in critically ill children? In this Concise Critical Appraisal, Daniel E. Sloniewsky, MD, FCCM, offers a deep dive on this Pediatric Critical Care Medicine article by Srinivasan et al, which sought to answer this question using data from the Heart and Lung Failure-Pediatric Insulin Titration (HALF-PINT) study.


Concise Critical Appraisal: Dexamethasone Use in the Treatment of ARDs

Villar et al (Lancet Respir Med. 2020;8:267-276) attempted to demonstrate the effect of steroids in patients with moderate to severe acute respiratory distress syndrome (ARDS) along with modern standard ICU practices, including lung-protective mechanical ventilation.