Ludwig C, Koryllos A.; J Thorac Dis. 2017 Apr;9(Suppl 3):S172-S177
Trauma is the leading cause of death worldwide. Approximately 2/3 of the patients have a chest trauma with varying severity from a simple rib fracture to penetrating injury of the heart or tracheobronchial disruption. Blunt chest trauma is most common with 90% incidence, of which less than 10% require surgical intervention of any kind. Mortality is second highest after head injury, which underlines the importance of initial management. Many of these deaths can be prevented by prompt diagnosis and treatment. What is the role of the thoracic surgeon in the management of chest trauma in severely injured patients? When should the thoracic surgeon be involved? Is there a place for minimal invasive surgery in the management of severely injured patients? With two case reports we would like to demonstrate how the very specific knowledge of thoracic surgeons could help in the care of trauma patients.
2017 May - A Multicenter, Randomized Trial of Ramped Position versus Sniffing Position during Endotracheal Intubation of Critically Ill Adults
Semler MW, Janz DR, Russell DW, Casey JD, Lentz RJ, Zouk AN, deBoisblanc BP, Santanilla JI, Khan YA, Joffe AM, Stigler WS, Rice TW; Check-UP Investigators.; Pragmatic Critical Care Research Group..; Chest. 2017 May 6. pii: S0012-3692(17)30881-4.
BACKGROUND: Hypoxemia is the most common complication during endotracheal intubation of critically ill adults. Intubation in the ramped position has been hypothesized to prevent hypoxemia by increasing functional residual capacity and decreasing the duration of intubation, but has never been studied outside of the operating room.
2017 May - Decision-making on withholding or withdrawing life-support in the ICU: A worldwide perspective
Lobo SM, Barros de Simoni FH, Jakob SM, Estella A, Vadi S, Bluethgen A, Martin-Loeches I, Sakr Y, Vincent JL; ICON investigators..; Chest. 2017 May 5. pii: S0012-3692(17)30820-6
BACKGROUND: Many critically ill patients who die will do so after a decision has been made to withhold/withdraw life-sustaining therapy. Our objective was to document the characteristics of intensive care unit (ICU) patients with a decision to withhold/withdraw life-sustaining treatment, including the types of supportive treatments used, patterns of organ dysfunction, and international differences, including gross national income (GNI).
2017 May 15 - A Missense Genetic Variant in LRRC16A/CARMIL1 Improves Acute Respiratory Distress Syndrome Survival by Attenuating Platelet Count Decline
Yongyue Wei , Paula Tejera , Zhaoxi Wang , Ruyang Zhang , Feng Chen , Li Su , Xihong Lin , Ednan K. Bajwa , B. Taylor Thompson , and David C. Christiani Am. J. Resp. Crit. Care Med. May 15, 2017, vol. 195, no. 10: 1353 - 1361
Rationale: Platelets are believed to contribute to acute respiratory distress syndrome (ARDS) pathogenesis through inflammatory coagulation pathways. We recently reported that leucine-rich repeat–containing 16A (LRRC16A) modulates baseline platelet counts to mediate ARDS risk.
2017 May 15 - Balanced Crystalloids versus Saline in the Intensive Care Unit. The SALT Randomized Trial
Matthew W. Semler , Jonathan P. Wanderer , Jesse M. Ehrenfeld , Joanna L. Stollings , Wesley H. Self , Edward D. Siew , Li Wang , Daniel W. Byrne , Andrew D. Shaw , Gordon R. Bernard , and Todd W. Rice for the SALT Investigators* and the Pragmatic Critical Care Research Group Am. J. Resp. Crit. Care Med. May 15, 2017, vol. 195, no. 10: 1362-1372
Rationale: Saline is the intravenous fluid most commonly administered to critically ill adults, but it may be associated with acute kidney injury and death. Whether use of balanced crystalloids rather than saline affects patient outcomes remains unknown.
2017 May - A 10-Year Review of Total Hospital-Onset ICU Bloodstream Infections at an Academic Medical Center
Anna M. Civitarese, BS; Eric Ruggieri, PhD; J. Matthias Walz, MD; Deborah Ann Mack, RN, CIC; Stephen O. Heard, MD; Michael Mitchell, MD; Craig M. Lilly, MD; Karen E. Landry, BS; Richard T. Ellison, III, MD CHEST May 2017; 151(5): 1011-1017
Background: The rates of central line-associated bloodstream infections (CLABSIs) in U.S. ICUs have decreased significantly, and a parallel reduction in the rates of total hospital-onset bacteremias in these units should also be expected. We report 10-year trends for total hospital-onset ICU-associated bacteremias at a tertiary-care academic medical center.
2017 May - Prophylactic Corticosteroids for Prevention of Postextubation Stridor and Reintubation in Adults: A Systematic Review and Meta-analysis
Akira Kuriyama, MD, MPH; Noriyuki Umakoshi, MD; Rao Sun, MD, PhD CHEST May 2017; 151(5): 1002-1010
Background: Corticosteroid administration before elective extubation has been used to prevent postextubation stridor and reintubation. We updated a systematic review to identify which patients would benefit from prophylactic corticosteroid administration before elective extubation.
2017 Mar - Continuous chest compression versus interrupted chest compression for cardiopulmonary resuscitation of non-asphyxial out-of-hospital cardiac arrest
Zhan L, Yang LJ, Huang Y, He Q, Liu GJ.; Cochrane Database Syst Rev. 2017 Mar
BACKGROUND: Out-of-hospital cardiac arrest (OHCA) is a major cause of death worldwide. Cardiac arrest can be subdivided into asphyxial and non asphyxial etiologies. An asphyxia arrest is caused by lack of oxygen in the blood and occurs in drowning and choking victims and in other circumstances. A non asphyxial arrest is usually a loss of functioning cardiac electrical activity. Cardiopulmonary resuscitation (CPR) is a well-established treatment for cardiac arrest. Conventional CPR includes both chest compressions and 'rescue breathing' such as mouth-to-mouth breathing. Rescue breathing is delivered between chest compressions using a fixed ratio, such as two breaths to 30 compressions or can be delivered asynchronously without interrupting chest compression. Studies show that applying continuous chest compressions is critical for survival and interrupting them for rescue breathing might increase risk of death. Continuous chest compression CPR may be performed with or without rescue breathing.
Martinell L, Nielsen N, Herlitz J, Karlsson T, Horn J, Wise MP, Undén J, Rylander C.; Crit Care. 2017 Apr 13;21(1):96.
BACKGROUND: Early identification of predictors for a poor long-term outcome in patients who survive the initial phase of out-of-hospital cardiac arrest (OHCA) may facilitate future clinical research, the process of care and information provided to relatives. The aim of this study was to determine the association between variables available from the patient's history and status at intensive care admission with outcome in unconscious survivors of OHCA.
2017 May - New drugs, new toxicities: severe side effects of modern targeted and immunotherapy of cancer and their management
Kroschinsky F, Stölzel F, von Bonin S, Beutel G, Kochanek M, Kiehl M, Schellongowski P; Intensive Care in Hematological and Oncological Patients (iCHOP) Collaborative Group..; Crit Care. 2017 Apr 14;21(1):89.
Pharmacological and cellular treatment of cancer is changing dramatically with benefits for patient outcome and comfort, but also with new toxicity profiles. The majority of adverse events can be classified as mild or moderate, but severe and life-threatening complications requiring ICU admission also occur. This review will focus on pathophysiology, symptoms, and management of these events based on the available literature.
2017 May 1 - Favorable Neurocognitive Outcome with Low Tidal Volume Ventilation after Cardiac Arrest
Jeremy R. Beitler, Tiffany Bita Ghafouri, Sayuri P. Jinadasa, Ariel Mueller, Leeyen Hsu, Ryan J. Anderson, Jisha Joshua, Sanjeev Tyagi, Atul Malhotra, Rebecca E. Sell, and Daniel Talmor Am. J. Resp. Crit. Care Med. May 1, 2017, vol. 195, no. 9: 1198-1206
Rationale: Neurocognitive outcome after out-of-hospital cardiac arrest (OHCA) is often poor, even when initial resuscitation succeeds. Lower tidal volumes (Vts) attenuate extrapulmonary organ injury in other disease states and are neuroprotective in preclinical models of critical illness.
Tommaso Mauri , Cecilia Turrini , Nilde Eronia , Giacomo Grasselli , Carlo Alberto Volta , Giacomo Bellani , and Antonio Pesenti Am. J. Resp. Crit. Care Med. May 1, 2017, vol. 195, no. 9: 1207-1215
Rationale: High-flow nasal cannula (HFNC) improves the clinical outcomes of nonintubated patients with acute hypoxemic respiratory failure (AHRF).
Date: 20 Jun 2017; Time: 0815 - 1800
Venue: Clinical skills learning centre, PWH
2017 Apr 15 - Partial Neuromuscular Blockade during Partial Ventilatory Support in Sedated Patients with High Tidal Volumes
Jonne Doorduin, Joeke L. Nollet, Lisanne H. Roesthuis, Hieronymus W. H. van Hees, Laurent J. Brochard, Christer A. Sinderby, Johannes G. van der Hoeven, and Leo M. A. Heunks Am. J. Resp. Crit. Care Med. Apr 15, 2017, vol. 195, no. 8: 1033-1042
Rationale: Controlled mechanical ventilation is used to deliver lung-protective ventilation in patients with acute respiratory distress syndrome. Despite recognized benefits, such as preserved diaphragm activity, partial support ventilation modes may be incompatible with lung-protective ventilation due to high Vt and high transpulmonary pressure. As an alternative to high-dose sedatives and controlled mechanical ventilation, pharmacologically induced neuromechanical uncoupling of the diaphragm should facilitate lung-protective ventilation under partial support modes.
2017 Apr 15 - Comparison of Echocardiographic Indices Used to Predict Fluid Responsiveness in Ventilated Patients
Philippe Vignon, Xavier Repessé, Emmanuelle Bégot, Julie Léger, Christophe Jacob, Koceila Bouferrache, Michel Slama, Gwenaël Prat, and Antoine Vieillard-Baron Am. J. Resp. Crit. Care Med. Apr 15, 2017, vol. 195, no. 8: 1022-1032
Rationale: Assessment of fluid responsiveness relies on dynamic echocardiographic parameters that have not yet been compared in large cohorts.
Malhotra R, Kashani KB, Macedo E, Kim J, Bouchard J, Wynn S, Li G, Ohno-Machado L, Mehta R.; Nephrol Dial Transplant. 2017 Apr 10. doi: 10.1093/ndt/gfx026. [Epub ahead of print]
Background.: Acute kidney injury (AKI) is common in critically ill patients and is associated with high morbidity and mortality. Early identification of high-risk patients provides an opportunity to develop strategies for prevention, early diagnosis and treatment of AKI.
2017 Apr - Diagnostic accuracy of quantitative neuromuscular ultrasound for the diagnosis of intensive care unit-acquired weakness: a cross-sectional observational study
Witteveen E, Sommers J, Wieske L, Doorduin J, van Alfen N, Schultz MJ, van Schaik IN, Horn J, Verhamme C.; Ann Intensive Care. 2017 Dec;7(1):40. doi: 10.1186/s13613-017-0263-8. Epub 2017 Apr 5.
BACKGROUND: Neuromuscular ultrasound is a noninvasive investigation, which can be easily performed at the bedside on the ICU. A reduction in muscle thickness and increase in echo intensity over time have been described in ICU patients, but the relation to ICU-acquired weakness (ICU-AW) is unknown. We hypothesized that quantitative assessment of muscle and nerve parameters with ultrasound can differentiate between patients with and without ICU-AW. The aim of this cross-sectional study was to investigate the diagnostic accuracy of neuromuscular ultrasound for diagnosing ICU-AW.