Goals and Objectives
- Develop an understanding of common clinical problems seen in the Medical ICU (MICU)
- PGY-1: Understand the basic principles of assessing and managing common presentations of disease in MICU patients
- PGY-2: Learn how to manage complex presentations of disease in MICU patients.
- PGY-3: Develop advanced processes to recognize and treat complications in MICU patients with multiple medical problems
- Competency: Patient care, Medical knowledge
- Understand the differential diagnosis of common clinical scenarios seen in the MICU
- PGY-1: Develop a basic differential diagnosis for common MICU clinical scenarios
- PGY-2: Develop an expanded differential diagnosis for common MICU clinical scenarios
- PGY-3: Recognize unusual presentations of common MICU clinical situations
- Competency: Medical knowledge
- Learn pharmacological management of common MICU clinical problems
- PGY-1: Learn the common medications utilized for the management of common MICU clinical problems
- PGY-2: Understand how to manage complicated clinical problems and develop specific therapeutic strategies
- PGY-3: Learn how to develop personalized care plans for patients with intersecting clinical problems in the MICU
- Competency: Medical knowledge
- Effectively admit patients to the medical intensive care unit (MICU), develop, and execute assessment and management plans.
- PGY-1: Learn the steps required to admit a patient and initiate admission orders to the MICU. Recognize how to prioritize patient problems in critically ill patients.
- PGY-2: Develop management plans for problems identified in patients admitted to the MICU
- PGY-3: Understand interactions between patient problems and develop advanced strategies to prioritize management in patients admitted to the MICU
- Competency: Patient care
- Effectively execute day-to-day management of patients in the MICU
- PGY-1: Learn the steps required to manage MICU patients on a daily basis including a daily assessment and determining progress in clinical problems
- PGY-2: Understand how to adjust treatment plans for MICU patients based on patient progress and determine the need for additional assistance such as subspecialty consultation
- PGY-3: Recognize how to manage complex medical problems and manage both expected and unexpected complications in MICU patients.
- Competency: Patient care
- Interdisciplinary care and discharge planning
- PGY-1: Learn how to communicate effectively with the interdisciplinary care team in the MICU and anticipate patient needs for discharge and effective follow-up
- PGY-2: Recognize the unique needs of MICU patients and help integrate patient needs with available resources
- PGY-3: Learn how to manage advanced situations in the MICU such as end-of-life decisions, complex transitions of care and advocate for patients when resources are limited
- Competency: Patient care, System-based practice
- Developing diagnosis skills
- PGY-1: Learn how to effectively use bedside clinical examination
- PGY-2: Demonstrate subtle bedside clinical findings
- PGY-3: Learn how to correlate bedside clinical findings with imaging and other data
- Competency: Patient care, Medical knowledge
- Rational ordering of lab tests and imaging studies
- PGY-1: Learn the indications for basic laboratory investigations and imaging commonly used in MICU patients
- PGY-2: Learn how to interpret laboratory findings and imaging in MICU patients
- PGY-3: Gain advanced knowledge of high value principles in the ordering of laboratory studies and imaging for patients in the MICU
- Competency: Practice-based learning and improvement, Medical knowledge
- Familiarity with the electronic health record and optimization of its use
- PGY-1: Develop a basic understanding of The EHR and its core components
- PGY-2: Understand and teach others on how to effectively use the electronic health record
- PGY-3: Develop an understanding of advanced medical informatics in the care of MICU patients by utilizing additional resources in the EHR
- Competency: Systems-based practice
- Communication and teamwork
- PGY-1: Recognize the core members of the MICU patient care team to include nurses, patient technicians, physical therapists, occupational therapists, discharge planners and hospital administration personnel
- PGY-2: Develop effective and timely communication strategies with the MICU interdisciplinary care team
- PGY-3: Use advanced communication methods to engage and coordinate care with the MICU interdisciplinary care team
- Competency: Professionalism, Interpersonal and communication skills
- Recognizing and responding to medical error
- PGY-1: Understand the basic principles of medical error that can result in diagnostic errors or management errors in the MICU
- PGY-2: Develop an advanced understanding of preventing medical errors in the MICU and recognize the role of cognitive heuristics
- PGY-3: Develop an advanced understanding of responding to medical errors, mitigating risk and communicating error to the MICU interdisciplinary team and the patient
- Competency: Practice-based learning and improvement
- Structure and Call Cycle
- Transfers
- Days off and Hours
- Ordersets
- MICU Guides
- When to Call Attending
- CODE Blue
Structure and Call Cycle
The MICU consists of two superteams (MICU I / III and MICU II / IV). The MICU I / III Superteam, for example, consists of the following:
- 1 attending
- 1 fellow (shared by the two Superteams)
- 2 residents (e.g. MICU I resident / MICU III resident)
- 3 interns (shared between MICU I / MICU III, can be IM, OB, or Neuro)
- 1 float resident (IM or ED)
- 1 night cross cover resident (shared by the two Superteams)
- 1 night intern (shared by the two Superteams)
Sample call cycle (for MICU I):
- Day 1:
- MICU I resident takes 28-hour call. Arrives no earlier than 7am. Admits new patients 7am-5am the following day.
- All three interns on the super team are present today. Two of the three interns are taking admissions.
- On-call interns arrive no earlier than 5:00am and see their old patients. Admit 7am-5pm, depart no later than 9pm.
- Non-call intern arrives no earlier than 5:00am, sees old patients. Assists call team in whatever ways are needed (procedures, etc.). Will be off the following day, so must provide sign-out to float resident with a “to do” list for the next day. Departs no later than 7:00pm.
- From 5pm-7pm (when the night intern arrives), the on-call resident admits without an intern. Once the night intern arrives, they admit together.
- MICU III resident (the buddy resident) might be off this day.
- Day 2
- Interns arrive no earlier than 5am.
- MICU I resident and night intern present overnight admissions at 8am. The overnight patients are distributed to the 2 post call interns. (MICU I resident should be sure to let the interns know which overnight patients they'll be taking before that patient is presented.)
- MICU I resident rounds until 10:30am, departs no later than 11am.
- The intern who wasn’t on call on day 1 is off. This intern has some patients on MICU I (resident will be leaving post call) and some on MICU III (resident present all day).
- The float resident will cover the intern’s MICU I patients.
- The MICU III resident (the buddy resident) will cover the intern’s MICU III patients.
- The intern should provide the float and the MICU III resident with sign-out and a “to do” list on their patients the day before.
- MICU III resident and the float resident assist w/ procedures, stabilizing new admissions, and assisting entire Superteam with any patient care needs.
- Day 3
- MICU I resident might have the day off today. All three interns should be in house and will come in earliest at 5:00am. They will cover all the old patients on MICU I.
- MICU III resident is on call. Arrives at 7am and admits from 7am-5am the following day. Just like on day 1, two of the interns will be admitting w/ MICU III and covering their old
patients. These interns will leave no later than 9pm. The other intern will have a regular day with their old patients and help the on-call interns, then leave by 7pm (or whenever his/her work is complete) and will be off the next day.
- Day 4
- MICU III resident presents overnight admissions with night intern and distributes patients to the two post call interns.
- The non-post call intern is off. The MICU I resident is present today and will cover this intern’s MICU I patients. The float resident will cover this intern’s MICU III patients. (Again, intern should give sign-out and “to do” list to MICU I resident and float resident the prior evening.)
- MICU I resident and the float resident assist w/ procedures, stabilizing new admissions, and assisting entire Superteam with any patient care needs
Night Intern Role
- The night intern will admit new patients with the on-call resident and assist with procedures.
- The night intern does NOT cross cover on MICU patients. They will be first-call on any new patients they admit.
Night Resident Role:
- The night resident will cross cover for all the non-call teams' patients overnight.
- The night resident should attempt to walk around the unit every 2-3 hours over the course of the night. When done properly, this has been extremely successful in terms of limiting low and intermediate priority pages. In addition, the nurses and house staff have found that it leas to an overall improvement in team functionality and satisfaction. These walk rounds should be quick.
- The night resident will help with overnight admissions whenever possible.
Float Resident Role
- Supervision of post-call interns
- First call provider for patients when an intern is off
- Hold team pagers during table rounds (8-10am)
- Assist during codes, with procedures, and with admissions as needed
- Is NOT there to do procedures by themselves. Should always offer procedures to available interns and offer to hold pagers so that interns can do procedures uninterrupted.
Transfers
Who can be transferred?
- Only patients that have been physically moved out of the ICU should be transferred to a floor service.
- If a Superteam has more than 15 patients, you may transfer patients that are still in an ICU bed.
When can we transfer?
- Transfers must be called into ADT by 11:00am, ideally by 8:00am
How many can we transfer?
- 5 patients maximum to the hospitalist service
- 2 patients to the teaching service (short call team, long call team)
Days off and Hours
Days off
- Interns: Take every 6th day off (the day before Call A).
- Residents: Days off are not scheduled in Amion and are taken at the discretion of the resident. Each resident should have 2 days off averaged over the 2 weeks. Every effort should be made to avoid taking the same day off as the ED float (having 2 residents present all day on each mega-team is the main function of the float). i.e. if your float is off on your post-post call day, you need to come in that day.
- Float Residents: Float residents take 1 weekend day off per week, typically on a call day (they should alternate days off and not take the same weekend day off). IM residents scheduled to this rotation will typically be on for 1 week (Saturday-Friday); their day off falls on the weekend their rotation starts (either Saturday or Sunday - coordinate with the other float resident and call residents as above).
Arrival/departure times
- Day interns
- Call days (Call A and B): Arrive no earlier than 5am (can arrive later if census is low), admit until 5pm, sign out to night resident and depart by 9pm.
- Non-call days: Arrive no earlier than 5am (can arrive later if census is low), sign out to night resident and depart by 7pm.
- Night intern: Arrives at 7pm, departs by 10:30am after presenting the overnight new patients.
- Residents:
- Call days: Arrive no earlier than 7am
- Post call: Depart no later than 11am
- Other days: Arrive no earlier than 5am, depart by 7pm
- Night resident: Arrives at 6:30pm and leaves at 7am, but may stay later for safe handoff, particularly if major cross-cover issues occurred overnight or patients still require stabilization/ active management while the day teams arrive in the morning.
- Float resident: Typically 6am-5pm
*** If all non-call interns and residents have completed their work early and the on-call team does not need assistance, non-call personnel can sign-out together to the pre-call resident and depart earlier than 7pm (residents not to leave until their non-call interns are ready as well). However, there should always be 2 residents present in the ICU - this can be the float and the on-call resident, or the buddy resident and the on-call resident.
Ordersets
- Sepsis Orderset
- MICU Rounding
- GI Bleed Order Set
- End of Life Care
- Transfusion Services Adult Order Set
- SEPSIS/SEPTIC SHOCK ORDER SET
- Thoracentesis Order Set
- ADULT HYPERKALEMIA
- Insulin Infusion
MICU Guides
Dr. Leveno's MICU Intern Orientation
Parkland MICU Rotation Guide 22-23
Fitzgerald's PowerPoint of all knowledge
When to Call Attending
You must call your attending at night:
Before doing any of the following (time allowing): | If any of the following happen: |
Procedures: Cardioversion, pericardiocentesis, thoracentesis, central line | BiPAP initiated for either hypoxic or hypercarbic respiratory failure |
Therapies: Emergency dialysis, exchange transfusion, thrombolytic therapy | Code blue or unexpected death |
Events: End of life discussions, Order of protective custody (OPC), transfer to higher level of care |
Patient/family grievance, inpatient suicide attempt, or patient leaves AMA |
Any acute clinical decompensation including, but not limited to:
- Whenever to plan to intubate, use paralytics
- Pressor requirements are increasing
CODE Blue
Code Pagers:
There are 2 MICU CODE pagers that will receive a notification whenever there is a code blue in the hospital. These should be carried by the on-call team during the day (resident and intern) and the on-call resident and cross-cover resident at night.
Codes are also called through the overhead speaker system.
There is a TEST PAGE every morning at 9:01AM. Please alert the Parkland Chiefs if you are not receiving the TEST PAGE or if you are receiving pages for things that are NOT a code blue (RAT calls, etc).
Code note:
We have created a new dot phrase to help make writing Code Notes (.codebluenote) easier. It also includes a check list of items we should be documenting to ensure we are meeting national code quality metrics. Please utilize this for documentation after every code event.
Targeted Temperature Management (TTM):
TTM (maintenance of normothermia with avoidance of fevers (>37.7 C)) is recommended for every patient who achieves ROSC after a cardiac arrest based on most recent literature. Parkland recently developed a new TTM order set to facilitate execution of this important aspect of post-cardiac arrest care. ICU leadership recommend this order set to be utilized after every cardiac arrest.
Please note that indications Targeted Hypothermia are more nuanced. For most of our MICU patients, the goal for TTM is maintenance of normothermia with avoidance of fevers (>37.7 C)
Reading List
MICU Resident Reading List
Acid Base
- Forsythe SM1, Schmidt GA. Sodium bicarbonate for the treatment of lactic acidosis. Chest. 2000 Jan;117(1):260-7.
Acute Respiratory distress Syndrome (ARDS)
- Acute Respiratory Distress Syndrome Network. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med. 2000;342:1301-8.
- Acute Respiratory Distress Syndrome Network. Comparison of two fluid-management strategies in acute lung injury. N Engl J Med. 2006;354:2564-75.
- Briel M, Meade M, et al. Higher vs lower PEEP in patients with acute lung injury and acute respiratory distress syndrome – systematic review and meta-analysis. JAMA. 2010;303(9):865-873.
- Herridge MS, Cheung AM, et al. One-year outcomes in survivors of the acute respiratory distress syndrome. N Engl J Med. 2003;348:683-93.
- Papazian L, Forel JM, et al. Neuromuscular blockers in early acute respiratory distress syndrome. N Engl J Med. 2010. 363(12): 1107-1116.
- Piantadosi CA and Schwartz DA. The Acute Respiratory Distress Syndrome. Ann Intern Med.2004;141:460-470. [Review of the physiology of ARDS]
Antibiotic Therapy
- Baddour LM, Wilson WR, et al. Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Scientific Statement for Healthcare Professionals From the American Heart Association. Circulation. 2015 Oct 13;132(15):1435-86. doi: 10.1161/CIR.0000000000000296. Epub 2015 Sep 15.
- Chastre J1, Wolff M. Comparison of 8 vs 15 days of antibiotic therapy for ventilator-associated pneumonia in adults: a randomized trial. JAMA. 2003 Nov 19;290(19):2588-98.
- Ibrahim EH, Sherman G, et al. The influence of inadequate antimicrobial treatment of bloodstream infections on patient outcomes in the ICU setting. Chest. 2000 Jul;118(1):146-55.
- Kalil AC, Metersky ML,et al. Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis. 2016 Sep 1;63(5):e61-e111. doi: 10.1093/cid/ciw353. Epub 2016 Jul 14.
- Kollef MH, Sherman G, et al. Inadequate antimicrobial treatment of infections: a risk factor for hospital mortality among critically ill patients. Chest. 1999 Feb;115(2):462-74.
- Mandell LA, Wunderink RG, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007 Mar 1;44 Suppl 2:S27-72.
- Marik PE, Careau P. The role of anaerobes in patients with ventilator-associated pneumonia and aspiration pneumonia: a prospective study. Chest. 1999 Jan;115(1):178-83.
- Tunkel AR, Hartman BJ,et al. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis. 2004 Nov 1;39(9):1267-84. Epub 2004 Oct 6.
Blood Products
- Hébert PC, Wells G, et al. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group. N Engl J Med. 1999 Feb 11;340(6):409-17.
- Villanueva C, Colomo A, et al. Transfusion strategies for acute upper gastrointestinal bleeding. N Engl J Med. 2013 Jan 3;368(1):11-21. doi: 10.1056/NEJMoa1211801.
Critical Care Ultrasound
- Boniface KS1, Calabrese KY. Intensive care ultrasound: IV. Abdominal ultrasound in critical care. Ann Am Thorac Soc. 2013 Dec;10(6):713-24. doi: 10.1513/AnnalsATS.201309-324OT.
- Cardenas-Garcia J, Mayo PH. Bedside ultrasonography for the intensivist. Crit Care Clin. 2015 Jan;31(1):43-66. doi: 10.1016/j.ccc.2014.08.003. Epub 2014 Oct 3.
- Lichtenstein D. Lung ultrasound in the critically ill. Curr Opin Crit Care. 2014 Jun;20(3):315-22. doi: 10.1097/MCC.0000000000000096.
- Lichtenstein DA. Ultrasound in the management of thoracic disease. Crit Care Med. 2007 May;35(5 Suppl):S250-61.
Endocrine issues in the ICU
- Marik PE, Pastores SM, et al. Recommendations for the diagnosis and management of corticosteroid insufficiency in critically ill adult patients: Consensus statements from an international task force by the American College of Critical Care Medicine. Crit Care Med. 2008; 36:1937–1949.
- NICE-SUGAR Study Investigators. Intensive versus conventional glucose control in critically ill patients. N Engl J Med. 2009;360:1283-97.
- NICE-SUGAR Study Investigators. Hypoglycemia and risk of death in critically ill patients. N Engl J Med. 2012 Sep 20;367(12):1108-18.
- van den Berghe G, Wouters P. et al. Intensive insulin therapy in critically ill patients. N Engl J Med. 2001 Nov 8;345(19):1359-67.
Fluid Management
- Boyd JH. Fluid resuscitation in septic shock: a positive fluid balance and elevated central venous pressure are associated with increased mortality. Crit Care Med. 2011 Feb;39(2):259-65. doi: 10.1097/CCM.0b013e3181feeb15.
- Durairaj L, Schmidt GA. Fluid therapy in resuscitated sepsis: less is more. Chest. 2008 Jan;133(1):252-63. doi: 10.1378/chest.07-1496.
- Finfer S. A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med. 2004 May 27;350(22):2247-56.
- Marik PE, et al. Hemodynamic parameters to guide fluid therapy. Ann Intensive Care. 2011 Mar 21;1(1):1. doi: 10.1186/2110-5820-1-1.
- Marik PE, Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares. Chest. 2008 Jul;134(1):172-8. doi: 10.1378/chest.07-2331.
- Murphy CV, et al. The importance of fluid management in acute lung injury secondary to septic shock. Chest. 2009 Jul;136(1):102-9. doi: 10.1378/chest.08-2706. Epub 2009 Mar 24.
- Myburgh JA. Hydroxyethyl starch or saline for fluid resuscitation in intensive care. N Engl J Med. 2012 Nov 15;367(20):1901-11. doi: 10.1056/NEJMoa1209759. Epub 2012 Oct 17.
- National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network. Comparison of two fluid-management strategies in acute lung injury. N Engl J Med. 2006 Jun 15;354(24):2564-75. Epub 2006 May 21.
- National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network. Pulmonary-artery versus central venous catheter to guide treatment of acute lung injury. N Engl J Med. 2006 May 25;354(21):2213-24. Epub 2006 May 21.
- Perel P, et al. Colloids versus crystalloids for fluid resuscitation in critically ill patients. Cochrane Database Syst Rev. 2013 Feb 28;(2):CD000567. doi: 10.1002/14651858.CD000567.pub6.
GI Bleeding in the ICU
- Cook DJ, Fuller HD, et al. Risk factors for gastrointestinal bleeding in critically ill patients. N Engl J Med. 1994; 330:377-381.
HIV in the ICU
- Huang L, Quartin A, et al. Intensive care of patients with HIV infection. N Engl J Med. 2006;355:173-81.
Mechanical ventilation
- Boles JM et al. Weaning from mechanical ventilation. Eur Respir J. 2007; May 29 (5): 1033-56.
- Brochard L. Comparison of three methods of gradual withdrawal from ventilatory support during weaning from mechanical ventilation. Am J Respir Crit Care Med. 1994 Oct;150(4):896-903.
- Ely EW, Baker AM, et al. Effect of the duration of mechanical ventilation of identifying patients capable of breathing spontaneously. N Engl J Med. 1996;335:1864-9.
- Esteban A, et al.Effect of spontaneous breathing trial duration on outcome of attempts to discontinue mechanical ventilation. Spanish Lung Failure Collaborative Group. Am J Respir Crit Care Med. 1999 Feb;159(2):512-8.
- Esteban A, et al. A comparison of four methods of weaning patients from mechanical ventilation. Spanish Lung Failure Collaborative Group. N Engl J Med. 1995 Feb 9;332(6):345-50.
- Girard TD, Kress JP, et al. Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): a randomized controlled trial. Lancet. 2008; 371: 126–34.
- MacIntyre M. Discontinuing mechanical ventilatory support. Chest. 2007; 132: 1049-1056.
- Tobin MJ. Advances in mechanical ventilation. N Engl J Med. 2001; 344:1986-96. [Intended for review of some basic concepts of the ventilator, including patient-ventilator interactions].
Pharmacology
- Jakob SM, Dexmedetomidine vs midazolam or propofol for sedation during prolonged mechanical ventilation: two randomized controlled trials. JAMA. 2012 Mar 21;307(11):1151-60. doi: 10.1001/jama.2012.304.
- Kress JP, et al., Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med. 2000 May 18;342(20):1471-7.
- Pandharipande PP, et al., Effect of sedation with dexmedetomidine vs lorazepam on acute brain dysfunction in mechanically ventilated patients: the MENDS randomized controlled trial. JAMA. 2007 Dec 12;298(22):2644-53.
- Riker RR, et al., Dexmedetomidine vs midazolam for sedation of critically ill patients: a randomized trial. JAMA. 2009 Feb 4;301(5):489-99. doi: 10.1001/jama.2009.56. Epub 2009 Feb 2.
Quality and safety issues in the ICU
- Pronovost P, Needham D, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med. 2006;355:2725-32.
Respiratory Failure and Mechanical Ventilation
- Acute Respiratory Distress Syndrome Network. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med. 2000 May 4;342(18):1301-8.
- Afshari A. Aerosolized prostacyclin for acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). Cochrane Database Syst Rev. 2010 Aug 4;(8):CD007733. doi: 10.1002/14651858.CD007733.pub2.
- Afshari A, et al. Inhaled nitric oxide for acute respiratory distress syndrome (ARDS) and acute lung injury in children and adults. Cochrane Database Syst Rev. 2010 Jul 7;(7):CD002787. doi: 10.1002/14651858.CD002787.pub2.
- ARDS Definition Task Force. Acute respiratory distress syndrome: the Berlin Definition. JAMA. 2012 Jun 20;307(23):2526-33. doi: 10.1001/jama.2012.5669.
- ARDS Net - Mechanical Ventilation Protocol Summary
- ARDS Net - Tidal Volume Table
- Briel M, et al. Higher vs lower positive end-expiratory pressure in patients with acute lung injury and acute respiratory distress syndrome: systematic review and meta-analysis. JAMA. 2010 Mar 3;303(9):865-73. doi: 10.1001/jama.2010.218.
- Chandra D. Outcomes of noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease in the United States, 1998-2008. Am J Respir Crit Care Med. 2012 Jan 15;185(2):152-9. doi: 10.1164/rccm.201106-1094OC. Epub 2011 Oct 20.
- Esan A, et al. Severe hypoxemic respiratory failure: part 1--ventilatory strategies. Chest. 2010 May;137(5):1203-16. doi: 10.1378/chest.09-2415.
- Ferguson ND, et al. High-frequency oscillation in early acute respiratory distress syndrome. N Engl J Med. 2013 Feb 28;368(9):795-805. doi: 10.1056/NEJMoa1215554. Epub 2013 Jan 22.
- Guérin C, et al. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med. 2013 Jun 6;368(23):2159-68. doi: 10.1056/NEJMoa1214103. Epub 2013 May 20.
- IMPROVE Study Group. A trial of intraoperative low-tidal-volume ventilation in abdominal surgery. N Engl J Med. 2013 Aug 1;369(5):428-37. doi: 10.1056/NEJMoa1301082.
- Keenan SP, et.al. Clinical practice guidelines for the use of noninvasive positive-pressure ventilation and noninvasive continuous positive airway pressure in the acute care setting. CMAJ. 2011 Feb 22;183(3):E195-214. doi: 10.1503/cmaj.100071. Epub 2011 Feb 14.
- Masip J, et al. Noninvasive ventilation in acute cardiogenic pulmonary edema: systematic review and meta-analysis. JAMA. 2005 Dec 28;294(24):3124-30.
- National Heart, Lung, and Blood Institute ARDS Clinical Trials Network. Higher versus lower positive end-expiratory pressures in patients with the acute respiratory distress syndrome. N Engl J Med. 2004 Jul 22;351(4):327-36.
- National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network. Efficacy and safety of corticosteroids for persistent acute respiratory distress syndrome. N Engl J Med. 2006 Apr 20;354(16):1671-84.
- Papazian L, et al. Neuromuscular blockers in early acute respiratory distress syndrome. N Engl J Med. 2010 Sep 16;363(12):1107-16. doi: 10.1056/NEJMoa1005372.
- Papazian L, et al. Neuromuscular blockers in early acute respiratory distress syndrome. N Engl J Med. 2010 Sep 16;363(12):1107-16. doi: 10.1056/NEJMoa1005372. Supplement.
- Pipeling MR, et al. Therapies for refractory hypoxemia in acute respiratory distress syndrome. JAMA. 2010 Dec 8;304(22):2521-7. doi: 10.1001/jama.2010.1752.
- Raoof S. et al. Severe hypoxemic respiratory failure: part 2--nonventilatory strategies. Chest. 2010 Jun;137(6):1437-48. doi: 10.1378/chest.09-2416.
- Singer BD, Corbridge TC. Basic invasive mechanical ventilation. South Med J. 2009 Dec;102(12):1238-45. doi: 10.1097/SMJ.0b013e3181bfac4f.
- Singer BD, Corbridge TC. Pressure modes of invasive mechanical ventilation. South Med J. 2011 Oct;104(10):701-9. doi: 10.1097/SMJ.0b013e31822da7fa.
Sedation management
- Kress JP, Pohlman AS, et al. Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med. 2000;342:1471-7.
- Pisani MA, Kong SYJ, et al. Days of delirium are associated with 1-year mortality in an older intensive care unit population. Am J Respir Crit Care Med. 2009; 180:1092-1097.
Sepsis, Severe Sepsis and Septic Shock
- Annane D. Corticosteroids for severe sepsis: an evidence-based guide for physicians. Ann Intensive Care. 2011 Apr 13;1(1):7. doi: 10.1186/2110-5820-1-7.
- Annane D, Bellissant E, et al. Corticosteroids for severe sepsis and septic shock: a systematic review and meta-analysis. BMJ. 2004 Aug 28;329(7464):480. Epub 2004 Aug 2.
- Annane D, Bellissant E, et al. Coritcosteroids in the treatment of severe sepsis and septic shock in adults – a systematic review. JAMA. 2009;301(22):2362-75.
- ARISE Investigators. Goal-Directed Resuscitation for Patients with Early Septic Shock. N Engl J Med. 2014 Oct 16;371(16):1496-506. doi: 10.1056/NEJMoa1404380. Epub 2014 Oct 1.
- Bernard GR, Vincent J-L, et al. Efficacy and safety of recombinant human activated protein C for severe sepsis. N Engl J Med. 2001;344:699-709.
- De Backer D, Biston P, et al. Comparison of Dopamine and Norepinephrine in the Treatment of Shock. N Engl J Med. 2010 Mar 4;362(9):779-89. doi: 10.1056/NEJMoa0907118.
- Dellinger RP, Levy MM, et al. Surviving Sepsis Campaign: International guidelines for the management of severe sepsis and septic shock: 2008. Crit Care Med. 2008; 36:296–327.
- Hollenberg SM. Vasopressor support in septic shock. Chest. 2007; 132:1678–1687.
- Kumar A, Roberts D, et al., Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med. 2006 Jun;34(6):1589-96.
- Morelli A, Ertmer C, et al. Effect of Heart Rate Control With Esmolol on Hemodynamic and Clinical Outcomes in Patients With Septic Shock A Randomized Clinical Trial. JAMA. 2013 Oct 23;310(16):1683-91. doi: 10.1001/jama.2013.278477.
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Therapeutic hypothermia for cardiac arrest
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Thromboembolic Disease
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