Editorial October 21, 2019 Should Fibrinogen Concentrate Replace Cryoprecipitate in Cardiac Surgery? Aaron S. Hess, John R. Hess, Douglas B. Coursin JAMA. Published online October 21, 2019. doi:10.1001/jama.2019.17313 Excessive bleeding presents a critical medical challenge. Many of the problems encountered at the bedside, such as inadequate measures of coagulation, challenges in delivering blood components, uncertain role of prothrombotic drugs...

Emergency Department to ICU Time and Mortality Delays in transferring patients from the Emergency Department (ED) to the ICU could delay treatment, leaving the patient at risk. A recent study explored the impact of this and found that increased ED to ICU wait times were associated with increased hospital mortality. Data was used from the Dutch quality registry National Intensive Care Evaluation, covering 14,788 patients admitted to the ICU through the ED from 2009 ...

Mechanical Ventilation Effects on Neurocognitive Functions The hypothesis that mechanical ventilation (MV) can cause neurotoxicity in critically ill patients has long been debated. First reported in 1999, MV is thought to trigger chronic cognitive disorders. Brain damage induced by MV can be caused by alveolar stretching, abnormalities in PaO2/PaCO2, biotrauma and MV causing direct brain inflammation. Alveolar stretching, induced by MV, goes on to produce system...

Nighttime Intensivist Staffing The work hours and sleep schedules of physicians who have completed training have seldom been studied. But there is ample evidence that suggests that sleep deprivation can cause errors in decision-making even in easy and familiar circumstances. Keeping in mind that the critical care setting is usually quite stressful, long working hours and sleep deprivation can increase the likelihood of errors. The fact is that critical care pati...

Blood Cultures Before Sepsis Treatment Severe bacterial infections pose a significant threat to public health, with 1.7 million people in the U.S. infected with sepsis every year. There has been a constant debate within medicine as to when treatment should be administered. Current guidelines state that blood cultures should be taken before antimicrobial treatment is initiated, as is the common course of action for internal medicine physicians. However, common pr...

ED-Based ICU - An Effective Solution? Intensive care units (ICUs) have a considerable impact on the lives of the patients that are admitted there to their families and the society as a whole. The delivery of intensive care to these patients is considerably expensive and resource-intensive. With an ageing population and the rise in the volume and acuity of patients requiring critical care, the demand for intensive care continues to increase. This demand has made sig...

Predicting Mortality - The Simple Intensive Care Studies-I A clinical examination is usually made by caregivers as a way to detect signs of deterioration in critically ill patients. However, there have been some inconsistencies when it comes to the prognostic value of this exam. A recent prospective cohort study of 1075 patients assessed whether there was an independent association with the findings from clinical examinations and 90-day mortality for patients in th...

Neonatal Early-Onset Sepsis Calculator In 2007, a study funded by the National Institutes of Health assessed the use of predictive models to calculate the risk of early-onset sepsis (EOS) in neonatal patients, accounting for multiple variables. The main objectives of the study were to assess the links between the risk factors and the infection outcomes; use patient data collected from electronic medical records; and, to generate a predictive model to accurately det...

Large Decreases in ICU-Acquired Infections - National Infection Campaign ICUs in the UK have seen an 80% drop in bloodstream infections according to NIHR Guy's and St Thomas' Biomedical Research Centre-funded research. In collaboration with Guy's and St Thomas' clinicians and researchers from ICNARC (Intensive Care National Audit & Research Centre), the study analysed 1 million adult patients from 276 NHS ICUs across the UK from 2007-2012. Published in ...

Energy Balance in Obese, Mechanically Ventilated Patients in ICU Clinical evidence shows that overfeeding critically ill patients is associated with poor outcomes. Obesity is a major challenge in ICU patients because of the comorbidities and anomalies associated with it. Determining an appropriate dose of enteral nutrition is difficult in this patient population and the risk of overfeeding quite high. An association between negative energy balance and increased inf...