Timely administration of broad-spectrum antibiotics is a critical pillar in the resuscitation of patients with sepsis. B-lactam antibiotics are an important class of antibiotics commonly administered to patients with sepsis. Typically, B-lactam antibiotics are administered over 30 minutes, but optimal bactericidal activity requires the concentration of free drug to be above the MIC of the organism for 40-70% of the dosing interval. In this podcast we discuss two recent publications that compare continuous infusions of B-lactam antibiotics with intermittent effusions in patients with sepsis.
.What Oxygenation Strategy Should We Use for COVID-19 Patients?
Patients with COVID-19 can require supplemental oxygen for acute hypoxemic respiratory failure. While international guidelines recommend a target SpO2 between 90-96%, a safe oxygenation strategy has not been identified. In this podcast, we discuss the recently published HOT-COVID Trial, which compared a lower oxygenation strategy with a higher oxygenation strategy in adult ICU patients with COVID-19.
Should We Use NIPPV for Preoxygenation for All Intubations?
Over 1 million critically ill patients are intubated each year in the US. Hypoxemia occurs in up to 20% of patients and can lead to peri-intubation cardiovascular collapse and cardiac arrest. As such, adequate and appropriate preoxygenation is critical in increasing the safe apnea time and decreasing the risk of hypoxemia. At present, the majority of patients receive preoxygenation through a non-rebreather mask. In this podcast, we discuss a recent study that evaluated the use of noninvasive ventilation for preoxygenation in critically ill patients.
Cefepime vs. Piperacillin-Tazobactam for Infection? The ACORN Trial
Timely and appropriate administration of empiric broad-spectrum antibiotics for adult patients with sepsis is critical. Current guidelines recommend an antipseudomonal antibiotic for those at risk of a resistant gram-negative organism. The two most common antipseudomonal antibiotics prescribed in this setting are cefepime and piperacillin-tazobactam. In recent years, observational studies have reported an association with cefepime and neurotoxicity, whereas piperacillin-tazobactam has been associated with AKI especially when given with vancomycin. In this podcast, we discuss the recently published ACORN Trial, a randomized trial that evaluated cefepime and piperacillin-tazobactam for adult patients with suspected infection.
Are We Ventilating our OHCA Patients?
In recent years, there has been intense focus on delivering high-quality compressions during the resuscitation of patients with OHCA. In contrast, ventilation metrics in OHCA resuscitation have not been well studied. In this podcast, we discuss a recent publication from Circulation that evaluated ventilation waveforms during OHCA resuscitation and the association of these metrics on patient outcomes. Can we do better?
Steroids in Sepsis, ARDS, and CAP – A Focused Clinical Update
Critically ill patients commonly develop a dysregulated inflammatory response. Corticosteroids are hypothesized to be beneficial due to their anti-inflammatory properties. In recent years, several studies have been published on the use of corticosteroids in select critical illnesses. In this podcast, we review a recently published clinical update on the use of corticosteroids in sepsis, ARDS, and community acquired pneumonia.
A Year in Review – The 2023 Critical Care and Resuscitation Literature
In this podcast we review a few key articles from the 2023 critical care, emergency medicine, and resuscitation literature that pertain to our care of the critically ill ED patient.
Should We Intubate For GCS < 8?
Acute mental status changes after the ingestion of alcohol or other substances are a common presentation to the ED. Those with severe obtundation may require intubation for airway protection while the substance metabolizes. In fact, more than 20,000 patients are intubated each year in the United States for acute poisoning or intoxication. Notwithstanding, intubation and mechanical ventilation are not benign procedures. In this podcast we discuss the recently published NICO Trial, that evaluated a strategy of withholding intubation in patients with coma due to acute poisoning.
Should We Be Placing REBOA?
REBOA is a relatively new and novel technique that in animal studies has demonstrated benefit in controlling hemorrhage. However, the evidence for the efficacy of REBOA in humans remains scant. In this podcast, we discuss the recently published UK-REBOA Trial, which randomized patients to receive REBOA with standard care compared to those randomized to standard care alone. You may be surprised by these results!
SCCM Guidelines for RSI in the Critically Ill
RSI is one of the most common procedures in critically ill patients. Despite its frequency, there remains significant practice variation on numerous aspects of RSI in the critically ill. In this podcast, we review pertinent recommendations from the recently published SCCM Guidelines on RSI in the critically ill patient.