Critical Care
- What fluids should I order for my patient with acute pancreatitis?
Recent data show that moderate fluid resuscitation is associated with fewer adverse events and that lactated Ringer’s may be superior to normal saline.
- Do patients with sepsis benefit from intravenous albumin?
Patients with sepsis who do not need vasopressors do not benefit from intravenous albumin compared with intravenous crystalloid therapy alone.
- Does my patient with acute variceal hemorrhage need a transjugular intrahepatic portosystemic shunt?
Placement of a transjugular intrahepatic portosystemic shunt can be used as salvage therapy to control bleeding when endoscopic management fails and as a means of secondary prophylaxis in select patients.
- Do I always need a central venous catheter to administer vasopressors?
Although generally preferred, central venous catheters carry risks such as procedural complications, infection, and thrombosis. Clinicians must assess, case by case, whether a peripheral intravenous catheter can be used.
- What is the role for terlipressin in hepatorenal syndrome?
The drug is recommended as a first-line treatment of hepatorenal syndrome-related acute kidney injury, but it is associated with respiratory failure, especially in the setting of albumin administration, and certain comorbidities may increase the risk.
- COVID-19: A management update
The authors examine current guidelines of the Infectious Diseases Society of America and the National Institutes of Health.
- Should midodrine be used as an intravenous vasopressor-sparing agent in septic shock?
Research and robust data are still lacking regarding use of midodrine in this setting.
- Which patients hospitalized with alcohol withdrawal syndrome should receive high-dose parenteral thiamine?
The authors briefly outline risk factors for Wernicke encephalopathy and when high-dose parenteral thiamine is indicated.
On the horizon: Extracorporeal carbon dioxide removalExtracorporeal carbon dioxide removal to treat hypercapnic respiratory failure has been studied in acute respiratory distress syndrome, chronic obstructive pulmonary disease, asthma, and other conditions.
- Steroids in the acutely ill: Evolving recommendations and practice
New information has been generated with regard to what causes critical illness-related corticosteroid insufficiency, how to diagnose it, who should receive corticosteroid treatment, and what regimens to use.