Journal of critical care
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Journal of critical care · Dec 2024
ReviewVenoarterial extracorporeal membrane oxygenation in high-risk pulmonary embolism: A narrative review.
Emergent reperfusion, most commonly with the administration of thrombolytic agents, is the recommended management approach for patients presenting with high-risk, or hemodynamically unstable pulmonary embolism. However, a subset of patients with a more catastrophic presentation, including refractory shock and impending or active cardiopulmonary arrest, may require immediate circulatory support. ⋯ Retrospective studies and registry data suggest favorable clinical outcomes with the use of VA-ECMO as an upfront stabilization strategy even among patients presenting with cardiopulmonary arrest. In this review, we discuss the physiologic rationale, evidence base, and an approach to ECMO deployment and subsequent management strategies among select patients with high-risk pulmonary embolism.
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Journal of critical care · Dec 2024
Multicenter Study Observational StudyAssociation of second antibiotic dose delays on mortality in patients with septic shock.
Determine whether a delay in the administration of the second dose of antibiotics is associated with an increased risk of mortality for patients admitted with septic shock. ⋯ Delays in second antibiotic dose administration in septic shock patients were present but lower than previous studies. These delays were associated with increased mortality, increased ICU and hospital length of stay.
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Journal of critical care · Dec 2024
Observational StudyEnd-tidal carbon dioxide during spontaneous breathing trial to predict extubation failure: A prospective observational study.
Despite advances in weaning protocols, extubation failure (EF) is associated with poor outcomes. Many predictors of EF have been proposed, including hypercapnia at the end of the spontaneous breathing test (SBT). However, performing arterial blood gases at the end of SBT is not routinely recommended, whereas end-tidal carbon dioxide (EtCO2) can be routinely monitored during SBT. ⋯ EtCO2 measured before successful SBT was lower in patients with EF compared to those with successful extubation (27 [24-29] vs 30 [27-47] mmHg, p = 0.02), while EtCO2 measured at five minutes and at the end of the SBT was not different between the two groups (26 [22-28] vs. 29 [28-49] mmHg, p = 0.06 and 26 [26-29] vs. 29 [27-49] mmHg, p = 0.09, respectively). Variables identified by multivariable analysis as independently associated with EF were acute respiratory failure as the cause of intubation and ineffective cough. Our study suggests that recording EtCO2 during successful SBT appears to have limited predictive value for EF.