AWAreness during REsuscitation - II: A multi-center study of consciousness and awareness in cardiac arrest.

Introduction: Cognitive activity and awareness during cardiac arrest (CA) are reported but ill understood. This first of a kind study examined consciousness and its underlying electrocortical biomarkers during cardiopulmonary resuscitation (CPR).

Methods: In a prospective 25-site in-hospital study, we incorporated a) independent audiovisual testing of awareness, including explicit and implicit learning using a computer and headphones, with b) continuous real-time electroencephalography(EEG) and cerebral oxygenation(rSO) monitoring into CPR during in-hospital CA (IHCA).

Difficult Airway Response Team (DART) and Airway Emergency Outcomes: A Retrospective Quality Improvement Study.

Objective: Difficult airways can be associated with significant morbidity and mortality, particularly in the event of a delay in securing the airway. To improve the airway metrics at our institution, we implemented a multidisciplinary team of airway providers to respond to difficult and emergent airways, or the Difficult Airway Response Team (DART). The purpose of the present study is to assess the feasibility of a DART program at a tertiary care center.

Developing Cardiothoracic Surgical Critical Care Intensivists: A Case for Distinct Training.

Cardiothoracic surgical critical care medicine is practiced by a diverse group of physicians including surgeons, anesthesiologists, pulmonologists, and cardiologists. With a wide array of specialties involved, the training of cardiothoracic surgical intensivists lacks standardization, creating significant variation in practice. Additionally, it results in siloed physicians who are less likely to collaborate and advocate for the cardiothoracic surgical critical care subspeciality.

Case report: Disseminated herpes simplex virus 1 infection and hemophagocytic lymphohistiocytosis after immunomodulatory therapy in a patient with coronavirus disease 2019.

Corticosteroids and immunomodulatory therapies are widely used to treat patients with severe coronavirus disease 2019 (COVID-19). Janus kinase (JAK) inhibitors such as tofacitinib have been recently studied as adjuvants in the treatment of COVID-19. Although immunomodulatory therapies may be linked to decreased mortality rates in the acute phase, subsequent severe infectious complications may result from them.

Effect of intraoperative blood transfusion on Treg and FOXP3 in patients with digestive tract malignancies and different ABO blood types.

Background: Blood transfusion can cause immunosuppression and lead to worse outcomes in patients with digestive tract malignancies; however, the specific mechanism behind this is not completely understood. One theory is that increased numbers of regulatory CD3CD4CD25FOXP3 T cells (Tregs) and forkhead box protein-3 mRNA (FOXP3) expression in the blood after transfusion contribute to these outcomes. The effect of blood transfusion on immune function in patients with different ABO blood types is variable.

Mortality and readmission of outcomes after discharge from the surgical intensive care unit to long-term, acute-care hospitals.

Background: Patients with prolonged hospitalizations in the surgical intensive care unit often have ongoing medical needs that require further care at long-term, acute-care hospitals upon discharge. Setting expectations for patients and families after protracted operative intensive care unit hospitalization is challenging, and there are limited data to guide these conversations. The purpose of this study was to determine patient survival and readmission rates after discharge from the surgical intensive care unit directly to a long-term, acute-care hospital.

Methadone analgesia in the critically ill.

Purpose: Methadone is increasingly used as an analgesic or a bridge to weaning other analgesics and sedatives in critically ill patients. This review discusses the pharmacology of methadone, summarizes available evidence for its use in the intensive care unit setting, and makes suggestions for appropriate use and monitoring.

Materials/methods: Articles evaluating the efficacy, safety, and pharmacology of methadone were identified from a PubMed search through June 2015.

Excessive Dynamic Airway Collapse: An Unexpected Contributor to Respiratory Failure in a Surgical Patient.

Central airway collapse plays a significant, underrecognized role in respiratory failure after extubation of critically ill patients. Historically, airway collapse has been attributed to tracheomalacia (TM), softening of the cartilage in the trachea and other large airways. More recently, excessive dynamic airway collapse (EDAC) has been described as a distinct process unrelated to a loss of cartilaginous airway support.

An iatrogenic metabolic encephalopathy in a nonagenarian: The dilemma of a critical miss as a possible social dismissal.

Here we posit for discussion the example of a reversible metabolic encephalopthy in a very elderly male that was missed clinically. A metabolic encephalopathy in extrememly elderly patients may be confused with delerium or inattention. A reversible cause of cognative dysfunction in the aged may be missed by practitioners because the aged may be assumed to have some level of impaired cognition; this may lead to a "social dismissal" of mental status changes.

Arterial embolism.

Surgical and intensive care patients are at a heightened risk for arterial embolization due to pre-existing conditions such as age, hypercoagulability, cardiac abnormalities and atherosclerotic disease. Most arterial emboli are clots that originate in the heart and travel to distant vascular beds where they cause arterial occlusion, ischemia, and potentially infarction. Other emboli form on the surface of eroded arterial plaque or within its lipid core.

Septic embolism in the intensive care unit.

Septic embolism encompasses a wide range of presentations and clinical considerations. From asymptomatic, incidental finding on advanced imaging to devastating cardiovascular or cerebral events, this important clinico-pathologic entity continues to affect critically ill patients. Septic emboli are challenging because they represent two insults-the early embolic/ischemic insult due to vascular occlusion and the infectious insult from a deep-seated nidus of infection frequently not amenable to adequate source control.