Journal Clubs
July18th, 2007 - SICU Journal Club
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. It was identified that early sepsis maybe a state in which physiologically the body is depleted of vasopressin because the hypothalamic stores empty fast hence theoretically it makes sense to proceed with AVP infusions early in sepsis, however, there are poor outcome studies out there to show any therapeutic benefit. Early goal directed therapy (Rivers et al) may be of some benefit as mortality rates were improved ~16% however these studies are also flawed with biases and a baseline high mortality rate which is of concern. The data on “tight” glycemic control shows that mortality rates were cut in half in post-cardiac surgery patients as well as a 41% reduction in incidence of ARF - but why were they on TPN on day 1 post-op? These are some of the issues raised in this review along with steroid therapy and frequency of RRT. This article can be downloaded for review here.
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July18th, 2007 - SICU Journal Club
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.
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July25th, 2007 - SICU Journal Club
The articles for the next journal club are linked for download below:
- Boyle et al. Disclosing errors and adverse events in the intensive care unit. CCM 2006
- Rothschild et al. The Critical Care Safety Study: The incidence and nature of adverse events and serious medical errors in intensive care. CCM 2005
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.
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August 8th, 2007 - SICU Journal Club
Dr. Joseph Abdelmalak discusses the cost effectiveness of critical care medicine. Do we really contain the cost of critical care or are we wasting money on unnecessary therapies and tests? This challenging literature review is presented below. The article reviewed is referenced below:
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September 5th, 2007 - SICU Journal Club
Dr. Dana Darwish presents an excellent review of one of the classic papers in critical care literature by Rivers et al. This landmark study looks at Early Goal-Directed Therapy in the treatment of Septic Shock. Do we finally have an answer to the near 40% mortality rate from this morbidity? The review of the stud below may help you figure that out.This presentation is archived in the section of Journal Club Presentations.
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September 5th, 2007 - SICU Journal Club
Dr. Tim Sable’s review of a common and recurrent issue in critical care practice: therapy misalignment. Review the presentation to see how current practitioners use randomized controlled trials to manage ICU patients and whether or not these therapies are in line with the results of the studies. Dr. Sable reviews the TRICC and ARMA trials as examples.
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Comments»
[…] Journal Clubs […]
very interesting, but I don’t agree with you
Idetrorce
yes i’m gonna have to agree with idetrorce
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