Journal of critical care
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Journal of critical care · Feb 2022
Review Case ReportsCOVID 19 and the risk of gastro-intestinal perforation: A case series and literature review.
COVID19 is a viral disease with pneumonia as its most common presentation. Many presentations and complications have been reported, but gastro-intestinal perforation has not received much attention. ⋯ Gastro-intestinal perforation is a rare but dangerous complication of COVID19. Treatment with tocilizumab and steroids may both increase the risk of this complication, and hamper diagnosis.
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Journal of critical care · Feb 2022
Observational StudyTrough concentrations of meropenem and piperacillin during slow extended dialysis in critically ill patients with intermittent and continuous infusion: A prospective observational study.
Beta-lactam dosing is challenging in critically ill patients with slow extended daily dialysis (SLEDD). This prospective observational study aimed to investigate meropenem and piperacillin concentrations and half-lives during SLEDD and in SLEDD-free intervals. Critically ill patients with SLEDD-therapy and meropenem or piperacillin therapy were included. ⋯ However, none of the measured trough concentrations were subtherapeutic during SLEDD. SLEDD leads to a reduction in meropenem and piperacillin concentrations of approximately 50% independently of the initial concentration. If the concentration is twice as high as the breakpoint of target attainment before SLEDD-therapy, subtherapeutic levels can be avoided.
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The COVID-19 pandemic taxed critical care and its leaders in unprecedented ways. Medical directors, nursing directors, division chiefs and department chairs were forced to lead their staff through a pandemic wrought with personal and professional safety concerns, uncertainty, and more death than most critical care practitioners had ever seen. No leader was fully prepared for the COVID-19 pandemic. Herein, we describe what we believe are the three most important qualities of a leader in times of crisis: presence, transparency, and empathy.
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Journal of critical care · Feb 2022
Meta AnalysisHigher PEEP versus lower PEEP strategies for patients in ICU without acute respiratory distress syndrome: A systematic review and meta-analysis.
To evaluate the effects of high and low levels of PEEP on ICU patients without ARDS. ⋯ Although ventilation with high PEEP in ICU patients without ARDS may not reduce in-hospital mortality, the decreased incidences of ARDS and hypoxemia and the improvement in PaO2/FIO2 were found in the high PEEP arm.