Critical care : the official journal of the Critical Care Forum
-
Arterial blood gases (ABG) are obtained commonly in dyspneic persons presenting to emergency departments. The study by Burri and colleagues found that the information contained in ABG fails to distinguish between pulmonary and other causes of dyspnea. On the other hand, arterial pH was highly predictive of ICU admission and outcome. Until large clinical studies show equivalence between peripheral venous and ABG, we will continue to advocate the use of ABG in the evaluation of acute dyspnea.
-
Endothelial progenitor cell (EPC) mobilization from the bone marrow was considered to improve outcome after ischemic stroke. Erythropoietin (EPO) might be a potential candidate stroke drug that increases the number of circulating EPCs. In the previous issue of Critical Care, Yip and colleagues investigated the effect of EPO in stroke patients on both clinical outcome and EPC stimulation. Although beneficial effects of EPO were observed, several issues regarding EPO's suitability as a stroke drug remain.
-
Critical care is formulated and delivered by a team. Accordingly, behavioral scientific principles relevant to teams, namely psychological safety, transactive memory and leadership, apply to critical care teams. ⋯ A clinician then applies those principles to two routine critical care paradigms: daily rounds and resuscitations. Since critical care is a team endeavor, methods to maximize teamwork should be learned and mastered by critical care team members, and especially leaders.
-
Weaning from prolonged mechanical ventilation is a complex, time-consuming process that involves the loss of force/generating capacity of the inspiratory muscle. In their study 'Inspiratory muscle strength training improves the outcome in failure to wean patients: a randomized trial', Martin and colleagues showed that the use of an inspiratory muscle strength program increased the maximal inspiratory pressure and improved weaning success compared to a control group. The study was performed mainly in post-surgical patients, however, and the results, therefore, may not be generalizable to other subsets of patients, such as those with chronic obstructive pulmonary disease or congestive heart failure. Indeed, the study applied so-called 'strength training' and not 'endurance training', which may be more appropriate in certain circumstances.
-
Frozen plasma (FP) is commonly used for the treatment of bleeding or the prevention of bleeding in critically ill patients, but clinical evidence to help aid the critical care clinician make decisions on whether to transfuse or not is at present limited. Despite the limited evidence, it appears FP is administered not infrequently in the absence of bleeding or with no required procedure when the international normalized ratio (INR) is essentially normal (<1.5) or only mildly deranged (<2.5). The study by Stanworth and colleagues in a recent issue of Critical Care raises awareness of FP transfusion use in the critically ill, should prompt a consideration of curbing its use when it is not clearly appropriate, and illustrates the need for future high quality evidence to guide FP use in the critically ill when the risk:benefit ratio is less clear.