Critical Care Minutes

Dr. Christofer Utz did an excellent review of the Critical Care Safety Study published in 2005 Critical Care Medicine. The primary objective of this study was to identify the incidence and rates of adverse events in critical care units per 1000 patient days. Dr. Utz reports the study design, methods as well as resuts and finished the presentation with a nice critique on several limitations of this study. The discussion was very engaging and raised several important questions regarding how should we truly define a medical error. The audience also questioned whether we should be reporting some of these errors at all vs. should we be reporting more than we already do today. This presentation is archived in the section of Journal Club Presentations.

The summer edition of the North Eastern Ohio Critical Care Society (NEOCCS) was held at Johnny’s Downtown in Cleveland, OH. The event was sponsored by Hospira. The meetings featured Intensivists-Anesthesiologists, Critical Care Fellows, Residents and an ICU Nurse Practitioner.  The discussion was related to sedation in the ICU and specifically addressed the “almost impossible” to sedate post op patient at risk for respiratory collapse. Dr. Ali Jahan (CCF) was the presenter for the evening. He moderated a heated debate upon the use of several different pharmacological agents (such as haldol, propofol, benzodazepines, narcotics, dexemetetomidine) as well as ventilation techniques (NIPPV vs. intubation) in Read more…

Dr. Michael Fernando (CA-2) did an excellent presentation of Acute Renal Failure and Sepsis featured in the July 2004 New England Journal of Medicine. With the significant morbidity and mortality associated with sepsis, septic shock and acute renal failure it is prudent to understand the mechanisms of this disease process as well as evaluate which interventions make therapeutic sense! This review in NEJM gives us some insight and may help intensivists answer some of these questions. This is archived in the collection of Journal Club Presentations.

It was identified that early sepsis maybe a state in which physiologically the body is depleted of Read more…

Dr. Ricardo Riveros (CA-2) presents a thorough review of Mechanisms of Sepsis-Induced Cardiac Dysfuntion featured in the May 2007 Critical Care Medicine. This was a very difficult review of basic science as well as the mechanistic molecular biology of the cardiac dysfunction that occurs in septic patients with myocardial dysfunction. This article focuses on the intracellular pathways that are disrupted by sepsis hence leading to cell death, apoptosis. Dr. Riveros points out the animal models and patient studies used to study these mechanisms as well as their downfalls. A great resource for basic review of what goes wrong within the cell during sepsis. This is archived in the collection of Journal Club Presentations.

Dr. Martin L. Smith (Dept. of Bioethics CCF) led a thought provoking discussion on the controversial and sometimes very difficul issues dealing with end of life care and decision making abilities in the ICU. Several of the patients in the ICU are unable to make the decisions for themselves and it is up to the physician, family, friend or DPOA to make the decision on behalf of the patient and in the patient’s best interest. This can turn out to be quite a complicated path because as Dr. Smith reveas in his presentation, sometimes no one can clearly tell what the patient would have wanted if he/she were in their current position. Issues of family wishes, moral, legal and religious obligations can quickly bring us into merky water. Enjoy the presentation and please feel free to comment below.