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Auto-PEEP

9/1/2017

4 Comments

 
The use of positive end expiratory pressure (PEEP) when ventilating patients in critical care is pretty universal, but it’s also true that we don’t entirely know how much to use and when.  The rationale for PEEP is to prevent alveolar collapse (and possibly to take some role in recruiting areas already collapsed) and improve oxygenation.  The costs of PEEP however are a rise in intrathoracic pressure (with the associated haemodynamic effects) and the risk of overdistension of lung units (leading to cytokine release etc.).

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Subglottic suction (and meta-analysis)

3/11/2016

2 Comments

 
​If ever there was a publication type that encourages me to just read the abstract it’s a meta-analysis.  Essentially the abstracts all seem to say the same thing:

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Trophic vs Full Feeding in Acute Lung Injury

17/6/2016

4 Comments

 
​The EDEN trial is one of the go-to trials for feeding in the ICU.   The paper can be found here, but essentially it recruited 1000 patients with respiratory failure, comparing different calorie targets for a period of 6 days.  One group received 25% of requirements (the trophic feeding group), with the other aiming for full requirements (receiving 80% of goal).*  The primary outcome was ventilator free days to day 28, with the study powered to detect a 2.25 day difference.  60 day mortality was a secondary outcome.

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Thrombolysis for Intermediate PE

9/12/2014

8 Comments

 
Link to paper (PEITHO Trial).
Massive PE causes haemodynamic collapse up to and including cardiac arrest.  Although the evidence is unlikely to be strong, the recommendation is that thrombolysis should be given. 

But what about the patient who has not collapsed, but shows signs of a struggling RV (raised Tn, strain on echo).  Should they be thrombolysed?

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8 Comments

When a trial is not worth continuing...

1/8/2014

0 Comments

 
statins_ards.pdf
File Size: 652 kb
File Type: pdf
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The SAILS (Statins in Acutely Injured Lungs in Sepsis) trial is the latest output (and probably the last) from the ARDS clinical trials network.

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Measuring Gastric Residual Volume - a waste of time?

17/12/2013

4 Comments

 

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Procalcitonin Guided Antibiotic Therapy

30/10/2013

7 Comments

 
This trial looks at the use of PCT (Procalcitonin) to guide the starting and stopping of antibiotics in respiratory infection.  We use PCT in Sunderland, and have done for quite a while.

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    About

    This is a collection of blog posts written about new research or topics of interest.

    ​The posts are ordered as written, so it might make more sense to search by category below.  Failing that, to browse just click 'previous' ayty the bottom of the page and keep going.

    The opinions expressed here are those of the author (Dr P Hersey unless stated otherwise).  You may well disagree, and I certainly don't claim to be an expert or always correct in what I write.

    Conducting research is a nightmare, and any 'criticism' is made on the background of enormous respect for those who can get something from idea to publication.

    If interested, there are some articles about critical appraisal in the 'further reading' section of this website. 

    ​Finally, feel free to leave comments; they add a great deal to the posts.

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This site is written for healthcare professionals.  Nothing on it constitutes medical advice, and opinions expressed are those of the authors.

​Dr Peter Hersey & Dr Laura O'Connor
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