Randomised clinical trials in cardiogenic shock in the PCI era
Treatment considerations for patients with AMI-cardiogenic shock
Enrolment data for major randomised cardiogenic shock trials (EuroIntervention 2021; 17: 451-65)
Determination of the Society for Cardiovascular Angiography and Intervention (SCAI) Shock stage using the revised SCAI Shock Classification
Conceptual model showing the overlap between
different states of hemodynamic compromise. Shock is defined by presence of hypoperfusion; most, but NOT ALL, patients will also be hypotensive. Pts w hemodynamic instability who do not meet criteria for shock are labeled as pre-shock
Management algorithm for patients with or at risk for cardiogenic shock (CS) tailored to the Society for Cardiovascular Angiography and Intervention (SCAI) Shock stage
Framework of clinical parameters to follow in patients with heart failure-related cardiogenic shock in the critical care unit
Considerations for invasive hemodynamic assessment in HF-CS
It seems that the most controversial issue is the use of short-term mechanical circulatory support for cardiogenic shock. So, a very recent publication deals with this:
Proposed overview of selection of patients to pVAD based on SCAI shock class A-E
Flowchart to identify and handle potential need for escalation of mechanical circulatory support in patients supported by axial flow pump (AFP)
Flowchart to identify and handle potential need for venting during V-A ECMO support
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Noninvasive ventilation (NIV) has been standard of care treatment for acute exacerbation of COPD (AECOPD) for > 30 years. In this article, the authors describe an evidence-based algorithm of the initiation, titration, monitoring, and weaning of NIV in AECOPD
An interesting study was recently published in @yourICM and the authors made some sensible - IMHO - suggestions about how to use echocardiography to guide fluid management in critically ill patients
They recognized 3 scenarios where echo can predict fluid responsiveness (FR):
1. Do NOT fill
2. Fill
3. Optional fill
I tried to tabulate their scenarios and recommendations/limitations extracting only information from their paper and not adding any thoughts of mine
ICU ID Secrets (following up on my post* from last week):
Ten things to remember about methicillin-resistant Staphylococcus aureus (MRSA) polymerase chain reaction (PCR) nasal swabs:
1. The MRSA nasal PCR is mostly helpful in patients with pneumonia or at least high suspicion of it since nasal colonization correlates with MRSA presence in the rest of the respiratory tract
2. The MRSA nasal PCR is mostly useful for its high negative predictive value (NPV) for MRSA pneumonia. The NPV number to remember is 95%. The use of MRSA PCR screening in pneumonia can reduce length of stay and antibiotic costs
Patient underwent laparoscopic colectomy complicated by R paracolic abscess (s/p drainage) & fascial dehiscence. On post-op day 8, at 20:30, he called out for his nurse stating he was having trouble breathing & back pain. He was diaphoretic w O2 sat in 70s at 2 l/m.
He was placed on 6 l/m nasal cannula w O2 sat 92%. A rapid response was called at 20:45. Pt was then placed on a non-rebreather mask; stat chest x-ray, ECG & blood gases ordered. CXR was later read as "small L basilar atelectasis". ECG (was read as "no acute MI"):
Assuming we are at end-expiration (the phase where CVP is least affected by the intra-thoracic pressure), at which point should we measure it?
There are other options: v, mean etc. However, most would measure CVP at the base of the "c" wave, especially if they wanted to use CVP as a surrogate of '"preload". OK, now we are in a slippery slope, since "preload" & "fluid responsiveness" are vague concepts. Having said that,