Speakers: Tamas Szakmany MBE, MD, PhD, EDIC, DESA, FRCA, FFICM, FCCM
Tamas Szakmany MBE, MD, PhD, EDIC, DESA, FRCA, FFICM, FCCM: Hello, my name is Tamas Szakmany, the Associate Editor for Social Media at Critical Care Explorations. Here are my top reads from Critical Care Explorations this month. Alcohol withdrawal syndrome is a common cause of ICU admission and the safe management of these patients creates burden on nursing and medical staff. Traditionally, benzodiazepine based treatment regimes were used. However, in the recent before- after study, Dr. Alwakeel and colleagues described the safety and effective use of phenobarbital based protocol. They found in their single center study that implementing the new protocol resulted in reduced length of stay and significantly less use of other concomitant medications during the treatment period. They found an excellent safety profile despite the rapidly escalating doses. Their findings could pave the way for further larger controlled trials. Establishing if the patient presents with fluid responsiveness in the operating room and on the ICU is an important aspect of diagnostic workup. Several applications have been tested to find reliable markers of the fluid responsiveness state. Dr. Munding and her colleagues presented a small study of 14 patients undergoing cardiopulmonary bypass where they were able to reliably track the flow velocity of the common carotid artery, using a small wearable Doppler probe. They were able to correlate the flow changes during bypass with the flow changes measured at the carotid artery and concluded that this wearable Doppler patch might provide a window to monitor the cardiac output if the other external factors are standardized. When treating sepsis or other syndromic disease with numerous interventions and drugs, order sets thought to be helpful to standardize care, reduce provider variability and provide consistency. However, there is not a lot of data available if this approach is indeed associated with better outcomes. Dr. Dale and colleagues present a large multi-center observational study where in the cohort of over 100,000 patients, the use of sepsis order sets was independently associated with survival, shorter hospital stay and more frequent discharged to home. They found that patients where the order set was used had more aggressive fluid resuscitation and earlier antibiotic administration. They concluded that enabling the providers to do the right thing very easily created a shared mental model which also allowed the care providers to communicate more effectively with each other. Please take time to read these articles and more by visiting ccejournal.org Also follow us on social media @critcareexplore Stay safe, everyone.
