Weaning Analgosedation in Patients Requiring Prolonged Mechanical Ventilation.

Although research supports the minimization of sedation in mechanically ventilated patients, many patients with severe acute respiratory distress syndrome (ARDS) receive prolonged opioid and sedative infusions. ICU teams face the challenge of weaning these medications, balancing the risks of sedation with the potential to precipitate withdrawal symptoms. In this article, we use a clinical case to discuss our approach to weaning analgosedation in patients recovering from long-term mechanical ventilation.

First-to-second antibiotic delay and hospital mortality among emergency department patients with suspected sepsis.

Objective: To evaluate whether delay between the first and second antibiotic administered for suspected sepsis is associated with hospital mortality.

Design: Retrospective cohort.

Setting: Twelve hospitals in Southeastern United States from 2014 to 2017.

The Association Between Antibiotic Delay Intervals and Hospital Mortality Among Patients Treated in the Emergency Department for Suspected Sepsis.

Objectives: Rapid delivery of antibiotics is a cornerstone of sepsis therapy, although time targets for specific components of antibiotic delivery are unknown. We quantified time intervals comprising the task of antibiotic delivery and evaluated the association between interval delays and hospital mortality among patients treated in the emergency department for suspected sepsis.

Design: Retrospective cohort.

Awake Prone Positioning Strategy for Nonintubated Hypoxic Patients with COVID-19: A Pilot Trial with Embedded Implementation Evaluation.

Prone positioning is an appealing therapeutic strategy for nonintubated hypoxic patients with coronavirus disease (COVID-19), but its effectiveness remains to be established in randomized controlled trials. To identify contextual factors relevant to the conduct of a definitive clinical trial evaluating a prone positioning strategy for nonintubated hypoxic patients with COVID-19. We conducted a cluster randomized pilot trial at a quaternary care teaching hospital.

A rapid pre-implementation evaluation to inform a family engagement navigator program during COVID-19.

Background: Innovative models of family engagement and support are needed in the intensive care unit (ICU) during times of restricted visitation such as the COVID-19 pandemic. Limited understanding of the factors affecting the uptake and outcomes of different family support models hinders the implementation of best practices. We aimed to conduct a rapid pre-implementation evaluation of stakeholder-perceived facilitators and barriers to design implementation strategies to support a novel program using medical students to facilitate family-centered care in the ICU.

Association between Adherence to Recommended Care and Outcomes for Adult Survivors of Sepsis.

Postsepsis care recommendations target specific deficits experienced by sepsis survivors in elements such as optimization of medications, screening for functional impairments, monitoring for common and preventable causes of health deterioration, and consideration of palliative care. However, few data are available regarding the application of these elements in clinical practice. To quantify the delivery of postsepsis care for patients discharged after hospital admission for sepsis and evaluate the association between receipt of postsepsis care elements and reduced mortality and hospital readmission within 90 days.

Predictive Accuracy of Quick Sequential Organ Failure Assessment for Hospital Mortality Decreases With Increasing Comorbidity Burden Among Patients Admitted for Suspected Infection.

Objectives: Evaluate the accuracy of the quick Sequential Organ Failure Assessment tool to predict mortality across increasing levels of comorbidity burden.

Design: Retrospective observational cohort study.

Setting: Twelve acute care hospitals in the Southeastern United States.

Hospital Differences Drive Antibiotic Delays for Black Patients Compared With White Patients With Suspected Septic Shock.

Objective: Evaluate racial disparities in sepsis processes of care.

Design: Observational cohort study.

Setting: Nine hospitals in the Southeastern United States between 2014 and 2016.

Initial fluid resuscitation following adjusted body weight dosing is associated with improved mortality in obese patients with suspected septic shock.

Objective: The optimal initial fluid resuscitation strategy for obese patients with septic shock is unknown. We evaluated fluid resuscitation strategies across BMI groups.

Materials And Methods: Retrospective analysis of 4157 patients in a multicenter activation pathway for treatment of septic shock between 2014 and 2016.

A Case of Chyloperitoneum Secondary to Follicular Lymphoma and a Review of Prognostic Implications.

Chyloperitoneum, or chylous ascites, is a rare condition characterized by milky-appearing fluid with elevated triglyceride content and the presence of chylomicrons. Malignancy, specifically lymphoma, is reported to be the predominant cause in Western countries. Previously, the prognosis for patients with chyloperitoneum due to lymphoma has been reported as poor.

Azithromycin for the Prevention of COPD Exacerbations: The Good, Bad, and Ugly.

Long-term azithromycin therapy has been shown to reduce exacerbations of chronic obstructive pulmonary disease (COPD), and is recommended by recent society guidelines for use in COPD patients who are at risk for recurrent exacerbations. However, concerns about adverse effects have limited its widespread adoption. Physicians deciding whether to use long-term azithromycin therapy must weigh each patient's individual risk of cardiovascular complications and both the individual and population impact of macrolide resistance against the expected benefit.

Heart failure due to tension hydrothorax after left pneumonectomy.

Tension hydrothorax is a rare complication of pneumonectomy for pleural mesothelioma and an exceptionally rare cause of heart failure. We describe a patient who had undergone extrapleural pneumonectomy, chemotherapy, and radiation for pleural mesothelioma and who developed heart failure symptoms within months of the completion of treatment. Investigation showed a massive left pleural effusion resulting in tension hydrothorax, mediastinal shift, and evidence of right heart failure with constrictive physiology and low cardiac output.

Health care-associated pneumonia in haemodialysis patients: clinical outcomes in patients treated with narrow versus broad spectrum antibiotic therapy.

Background And Objective: Although the 2005 American Thoracic Society/Infectious Disease Society of America antibiotic guidelines classify pneumonia occurring in patients receiving chronic haemodialysis as health care-associated pneumonia (HCAP), and thus recommend treatment with broad-spectrum antibiotics for these patients, little data support this classification. We compared clinical outcomes in haemodialysis patients hospitalized with pneumonia, who were treated with broad-spectrum antibiotics versus narrow-spectrum antibiotics.

Methods: One hundred twenty-five haemodialysis patients with pneumonia met eligibility criteria.