This week’s issue of NEJM features another in a long debated series of trials that investigates the benefits of “tight” vs “conventional” glycemic control in the ICU. Is this the one that finally gives us the answer? Let’s find out…
The NICE-SUGAR Study Investigators are a multinational, multicenter and multidisciplinary collaboration. The primary objective of this trial was to find the optimal glycemic level for critically ill patients. Patients expected to stay in the ICU for >3 days were enrolled within 24 hours of admission to the ICU. They were randomized to either recive INTENSIVE (81-108 mg/dl) or CONVENTIONAL (<180 mg/dl) therapy. The primary endpoint was 90 day mortality (any cause / after randomization).
After enrolling 6104 patients, 3054 received intensive rx and 3050 received conventional rx. Groups were relatively well matched at baseline. The major difference in primary outcome was a RRR of ~ 9% in the conventional group (24.5% vs 27.5%). This corresponded to an odds ratio of 1.14 (95% CI 1.02-1.28), p=0.02. There was no differernce in the treatment effect when looking at medical vs. surgical patients. Of note, severe hypoglycemia (<40) occured ~13x more often in the intensive group (0.5% vs 6.8% p<0.001). No other significant differences upon subgroup analysis or secondary outcomes were found.
Read more…
Here is another excellent and thorough resource I found online in the blogger community that reviews several procedures including Central Line Placement, Thoracentesis, Paracentesis, Arterial Line, Lumbar Puncture, etc. The review is not video based but does have very detailed images used to illustrate the techniques as well as nice decriptive explanations. ClinicalCases.org is a free online case-based curriculum of clinical medicine and is one of the most popular medical blogs on internet. A lot of the information may not be relevant to the ICU but it is still a good resource for topic reviews. I would encourage you to browse the site and get your learn on 
Incidentally, this website has significant input from the Cleveland Clinic and the Case Western Lerner College of Medicine – The blog was developed by Dr. Vesselin Dimov (Internal Medicine, CCF).
ClinicalCases.org was featured in the British Medical Journal and Medscape.com, and was referenced several times in the medical education literature. The project is hyperlinked in the web sites of 11 medical schools in the U.S., Canada and Europe. This case-based curriculum was started by physicians at Cleveland Clinic and Case Western Reserve University (St. Vincent/St. Luke) Internal Medicine Residency Program for the purpose of medical education.
Check it out Clinicalcases.org.
Here is a link to the Procedural guides.
***Excerpt taken from SICU Handbook Cleveland Clinic SICU
1. Maintain your availability in the SICU
The nurses and other personnel who work in the unit are seasoned, experienced professionals. Unfortunately, as in other aspects of health care, they are being forced to “do more with less,” which means that frequently there is one nurse to two (or three!) patients; so-called one-on-one nursing assignments are extremely rare. This means that the nurses are busier, and the one thing that they shouldn’t have to do is constantly hunt for you. The usual response to this statement is “I have Read more…
Wander over to the Evidence Based Medicine section of the website which has recently been opened!
Here you will have an opportunity to review an excellent series from the BMJ by senior lecturer Trisha Greenhalgh entitled “How to read a paper.” This series goes through the basics of a systematic approach on reading, analyzing and critiquing a scientific paper. The BMJ has consistently been a reliable resource for evidence based medical practice sticking to their motto “Helping doctors make better decisions.” Enjoy!
This should at least provide a starting point for our young medical colleagues as well as a good review for the more experienced ones in the art of scientific investigation and evidence based medical decision making. As always please feel free to leave comments and suggestions. Remember, this is an open forum, become part of it!
Here is a five part series nicely done by an ER resident from University of Chicago that goes over step by step what is requires to place a central line. This is directed towards an ER resident but certainly the techniques can be applied to the SICU as well. This is a good review for the new residents who have may have never seen the inside of the kits and who have never seen a line performed. Soon we will have our own videos and then you might be able to see another way this is done.
Part 1 of 5 of the series is included here: (view the rest on YouTube.com by clicking here) Read more…
Sorry for the delay over the past year and a half!! Wow has it really been that long…Been really busy with the new job, new house and etc….Either way the Minutes are back on and you should be expecting frequent updates and exciting new ICU 2.0 features. Stay tuned !!
