How should we relate to “unreasonable” families in the ICU?
Most families have never suffered through a loved one experiencing prolonged critical illness and respiratory failure (defined as ventilator dependence for weeks, usually with a tracheostomy). But each...
View ArticleSepsis drives far more readmissions than we realized
Sepsis may contribute to far more hospital readmissions than previously recognized -- more than any other monitored condition. Recognition of this by federal and private payers could result in...
View ArticleDoes intensive rehab and physical therapy in the ICU really help?
Every year, over a million people in the U.S. suffer respiratory failure requiring mechanical ventilation. They experience enormous catabolic stress, extended periods of inactivity, and usually go...
View ArticleMedicare will pay for death panels, I mean end-of-life counseling
Medicare announced last week it will finally pay doctors for their time spent talking to patients about their end-of-life preferences, among the most important medical decisions most people will make....
View ArticleFamilies stall end of life talks, say doctors. True?
Doctors and nurses said patients and their families created the largest obstacles to end-of-life decision making in the ICU, in a large survey published in JAMA Internal Medicine. About 1,300 staff at...
View ArticleDiaphragmatic ultrasound could predict extubation success
Source: criticalecho.com Diaphragmatic Ultrasonography to Assess Readiness for Extubation By Muhammad Adrish, MD Weaning a patient from mechanical ventilation is a challenge that intensivists face...
View ArticleCognitive impairment after critical illness as bad as Alzheimer’s
People who survive critical illness often experience long-term cognitive impairment, even among those with normal or near-normal pre-hospital brain function. Cognitive impairment after critical illness...
View ArticleDysphagia and swallowing disorders in the ICU (Review)
ICU-related Dysphagia and Swallowing Disorders More than 700,000 people develop respiratory failure requiring mechanical ventilation each year in the U.S. alone, and those that survive are at elevated...
View ArticleEarly tracheostomy does not improve survival or other outcomes (TracMan trial)
image: CUHK Early Tracheostomy Does Not Help in Large "TracMan" Trial More than 100,000 tracheostomies are performed worldwide each year for people requiring prolonged periods of mechanical...
View Article“Trach collar” beats pressure support trials for long-term ventilator weaning...
"Trach Collar" Trials Beat Pressure Support for Long-Term Ventilator Weaning By Blair Westerly, MD Patients requiring prolonged mechanical ventilation linger in ICUs and long-term acute care hospitals...
View ArticleKnowing When, When Knowing Is Impossible (Paul McLean)
Knowing When, When Knowing Is Impossible By Paul C. McLean The child was her first, and there were complications and aggressive therapies from the start and for months. She was unaware that the medical...
View ArticleIntubation in pre-hospital cardiac arrest strongly associated with worse...
Intubation for Out-of-Hospital Cardiac Arrest May Harm, Not Help by Blair Westerly, MD Out of hospital cardiac arrest is a major public-health problem, and despite advances in care, survival is still...
View ArticleFor some LTAC patients, pessimism is the new kindness
(image: flickrCC) Half of patients transferred to long-term acute care facilities (LTACs) on prolonged mechanical ventilation will die within a year, according to a 2010 review. Only a small minority...
View ArticleWithhold CPR from some patients, Harvardians advise. OK — you go first!
This post was featured on KevinMD.com; an excerpt follows. "Full code" is the universal default status for patients who haven't chosen otherwise. Yet I suspect most physicians believe this policy is...
View ArticleWalk to wean: Early mobilization for ventilated patients (Review, CHEST)
Daily interruption of sedation (daily awakening or sedation holidays) works like a charm to get patients off the ventilator, faster. After proving that a decade or so ago, practice-changers John Kress...
View ArticleElderly critically ill who survive ICU rationing live well (CHEST)
Many argue that as a limited resource serving unlimited needs, medical care is "rationed" by definition, and ICU resources (being more limited and expensive) are simply more overtly rationed. For...
View ArticleMore are surviving severe sepsis … to go to LTACs
Severe sepsis has had a 35-45% mortality rate in clinical trials. Gagan Kumar et al use national observational data to suggest that while population rates of severe sepsis are increasing, survival has...
View ArticleMost with ALS getting tracheotomy live longer than 1 year
As Sancho et al point out here, there is a paucity of information available about tracheotomy in amyotrophic lateral sclerosis -- when it's best to perform the life-prolonging surgery, as well as what...
View ArticleEven extreme obesity doesn’t reduce survival in critical illness
Obesity may impose extra burdens on critical care staff (think turning, transport, intubation and central line placement), but reviews suggest people with "ordinary" obesity (BMI 30-39) with have the...
View ArticleThe reaper rarely phones ahead: Mortality prediction tools good, not great...
Doctors are generally lousy at predicting death in terminally ill patients, and in ICU patients with indeterminate outcomes. Mortality prediction models have proliferated to improve our performance,...
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