April / May 2017 Journal Club

A bit of a 2 for 1 job this month as we discussed two papers touching on similar themes; namely what’s the best “non-invasive” option to manage acute onset, non-cardiac, respiratory failure? Paper 1 (http://www.nejm.org/doi/full/10.1056/NEJMoa1503326#t=article) Paper 2 (http://journals.lww.com/ccmjournal/Abstract/2016/02000/Failure_of_Noninvasive_Ventilation_for_De_Novo.6.aspx) Have a read of the comments below and feel free to add your own! Re paper 1 “Hi … More April / May 2017 Journal Club

NICOM’s in ICU

Is there evidence of benefit from using non-invasive cardiac output monitors in particular ICU cohorts? From peoples experience, is there a particular variable or question that is answered well and conversely poorly with these monitors e.g. fluid status better, cardiac function etc.? A – I’ll start with a deliberately provocative opinion. Within the realms of general … More NICOM’s in ICU

Procalcitonin

How and when should we be using PCT (e.g. initiation, monitoring, cessation of antibiotics)? How is it more useful than CRP? What are it’s limitations? What type of values e.g whole numbers, double digits give us a ‘almost certainty’ as to the presence of infection? Does anyone who has worked with PCT have any advice/experience or … More Procalcitonin

Early enteral nutrition

Are there any contraindications or disadvantages in instituting early enteral nutrition (EN)? How soon after failure to provide EN should TPN be considered? A – From what I can gather from the literature, critical care patients who are not expected to be on a full oral diet within 3 days should be stared on EN. The best available evidence, although … More Early enteral nutrition