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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.
Ranjit Deshpande, MD, and Simon W. Lam, PharmD, MS, BCPS, BCCCP, FCCM, discuss procalcitonin guidance during different phases of antibiotics management in patients admitted to intensive care units. This podcast originated from the article "Systematic Review and Meta-Analysis of Procalcitonin-Guidance Versus Usual Care for Antimicrobial Management in Critically Ill Patients: Focus on Subgroups Based on Antibiotic Initiation, Cessation, or Mixed Strategies" (Lam S, et al. Crit Care Med. 2018;46:684-690). Dr. Lam is a clinical specialist in pharmacoeconomics, outcomes research, and critical care at the Cleveland Clinic in Cleveland, Ohio, USA. He has no disclosures to report. This podcast is sponsored by Thermo Fisher Scientific.
Kyle Enfield, MD, speaks with Colin K. Grissom, MD, FCCM, and Matthew W. Semler, MD, about fluid management in the critically ill. Dr. Grissom presented his talk, entitled “Achieving Fluid Balance,” at the 47th Critical Care Congress in San Antonio, Texas. During this session he discussed the study by Semler et al. entitled “Balanced Crystalloids versus Saline in Critically Ill Adults,” published in the March 2018 issue of the New England Journal of Medicine. Dr. Grissom and Dr. Semler discuss the history of fluid management in the critically ill and how recent study findings are shaping future care. Dr. Grissom works as an attending physician at Intermountain Medical Center in Salt Lake City, Utah. Dr. Semler works as an attending physician at Vanderbilt University Medical Center in Nashville, Tennessee. Released: 8/9/18
Dr. Fraser, MD, speaks with Jean Baptiste Lascarrou, MD, about the article, "Antibiotic Therapy in Comatose Mechanically Ventilated Patients Following Aspiration: Differentiating Pneumonia from Pneumonitis," published in Critical Care Medicine. He discusses results from his team’s prospective observational study to determine the proportion of patients with documented bacterial aspiration pneumonia among comatose ICU patients with symptoms suggesting either bacterial aspiration pneumonia or non-bacterial aspiration pneumonitis. Dr. Lascarrou is a physician in the Medical Intensive Care Unit at CHU Nantes in Nantes, France. Crit Care Med. 2017; 45(8):1268-1275.
Todd Fraser, MD, speaks with Nick Daneman, MD, about the article, “Duration of Antimicrobial Treatment for Bacteremia in Canadian Critically Ill Patients,” published in Critical Care Medicine. Dr. Daneman is a scientist in the Evaluative Clinical Sciences, Trauma, Emergency & Critical Care Research Program at Sunnybrook Research Institute, and Assistant Professor of Medicine at the University of Toronto in Toronto, Ontario, Canada. In this article, Dr. Daneman and coauthors discuss duration of antimicrobial treatment provided to patients who have bacteremia in ICUs, and assess pathogen/patient factors related to treatment duration and the relationship between duration and survival.
Margaret Parker, MD, MCCM, speaks with SCCM President Todd Dorman, MD, FCCM. Dr. Dorman is Senior Associate Dean for Education Coordination, Associate Dean of Continuing Medical Education, and Professor and Vice Chair for Critical Care. He holds joint appointments in Medicine, Surgery and the School of Nursing at Johns Hopkins University School of Medicine in Baltimore, Maryland. Dr. Dorman discusses some of the challenges facing the critical care community today, as well as goals he would like to accomplish during his tenure as President.
Margaret Parker, MD, MCCM, speaks with Katherine J. Steineck, PharmD, pediatric clinical pharmacist at the University of Minnesota Amplatz Children’s Hospital. They discuss the article published in Pediatric Critical Care Medicine, “Evaluation of a Pharmacist-Managed Methadone Taper.” In this article, Dr. Steineck and coauthors evaluate the efficacy of pharmacist-managed methadone taper as to previous prescribing practices.
Troy E. Batterton, PharmD, a pharmacist at Lakeland Regional Medical Central, and Dean Sandifer, MD, an internist, both practicing at Lakeland Regional Medical Center in Lakeland, Florida, discuss sedation strategies in critical care, including designing, building and maintaining protocols in intensive care units.
Paul Marik, MD, FCCM, discusses the June Critical Care Medicine article, "Recommendations for the Diagnosis and Management of Corticosteroid Insufficiency in Critically Ill Adult Patients: Consensus Statements from an International Task Force by the American College of Critical Care Medicine." Marik is the chief of pulmonary and critical care medicine at Thomas Jefferson University in Philadelphia, Pennsylvania, USA.
Shannon S. Carson, MD, assistant professor of medicine at the University of North Carolina at Chapel Hill and associate medical director of the medical and respiratory ICUs at the UNC Medical Center, as well as John P. Kress, MD, assistant professor of medicine at the University of Chicago, discuss their article from the May 2006 Critical Care Medicine, "A Randomized Trial of Intermittent Lorazepam vs. Propofol With Daily Interruption in Mechanically Ventilated Patients."
Phil Barie, MD, MBA, FCCM, discusses his article from the April 2006 issue of Critical Connections on antibiotic prophylaxis. He addresses when this therapy is most useful as well as the consequences of overuse. Dr. Barie is professor of surgery and public health at Weill Medical College of Cornell University in New York City, and he sits on the executive committee of the Society of Critical Care Medicine.
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.
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.
Critical care teams should consider using remdesivir to treat patients with severe acute SARS-CoV-2 infection, but supply of the drug is limited and best practices for maximizing its effectiveness are not completely understood.
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.
Continuous renal replacement therapy (CRRT) is complex, and dosing varies among institutions. Host Michael Smith, MD, is joined by Melissa L. Thompson Bastin, PharmD, BS, BCPS, to review dosing regimens for CRRT, studies of CRRT antibiotic dosing, and CRRT utilization in COVID-19 patients. Dr. Thompson Bastin is a medical ICU and pulmonary critical care pharmacist and assistant adjunct professor at the University of Kentucky in Lexington, Kentucky, USA. This podcast is sponsored by Baxter Healthcare.
Ranjit Deshpande, MD, and Mark D. Cipolle, MD, PhD, FCCM, discuss Dr. Cipolle's talk from the 48th Critical Care Congress on what's new in anticoagulant reversal. Tune in to hear about the hottest topics and current research. Dr. Cipolle is director of outcomes research and surgical service line at Christiana Care Health System in Newark, Delaware, USA.
Margaret Parker, MD, MCCM, speaks with Thomas V. Brogan, MD, about the article “Variability in Antibiotic Use Across PICUs,” published in the June 2018 issue of Pediatric Critical Care Medicine. Dr. Brogan discusses study findings regarding the variation in antibiotic use in pediatric intensive care units (PICUs) across institutions. He considers how overuse or inappropriate use can be addressed in PICUs in the future. Dr. Brogan is a Professor of Pediatrics in the Division of Pediatric Critical Care Medicine at the Seattle Children’s Hospital and the University Washington School of Medicine in Seattle, Washington. Ped Crit Care Med. 2018; 19(6):519-527. Released: 7/26/18
Ludwig Lin, MD, speaks with Palash Kar, MBBS, about the article, “Liberal Glycemic Control in Critically Ill Patients With Type 2 Diabetes: An Exploratory Study," published in Critical Care Medicine. In this article, Dr. Kar and coauthors found that in critically ill patients with type 2 diabetes and chronic hyperglycemia, liberal glycemic control appears to attenuate glycemic variability and may reduce the prevalence of moderate-severe hypoglycemia. Dr. Kar is a senior registrar in intensive care at Royal Adelaide Hospital in South Australia. Dr. Kar has no relevant disclosures. Crit Care Med. 2016; 44(9):1695-1703. Released: 1/25/18
Todd Fraser, MD, speaks with Christopher W. Seymour, MD, MSc, about the article, “Delays From First Medical Contact to Antibiotic Administration for Sepsis,” published in Critical Care Medicine. Dr. Seymour's article contends that "the time from first healthcare contact to antibiotic administration in sepsis, termed 'total medical contact delay,'" is not fully understood. He discusses the association between total medical contact delay and in-hospital mortality among community-acquired sepsis patients in a large retrospective cohort. He also discusses strategies to help reduce delays. Dr. Seymour is Assistant Professor of Critical Care and Emergency Medicine at the University of Pittsburgh School of Medicine in Pittsburgh, Pennsylvania. He is also a core faculty member in the Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center in the Department of Critical Care, where he contributes to the Program on Critical Care Health Policy. Crit Care Med. 2017; 45(5):759-765. Released: 8/10/17