This study sought to answer the question of how much oxyen your patients are inspiring with different devices, with and without tachypea. They simulated tachypnea in healthy volunteers (by chest binding) and measured the Fi02 in the hypopharynx before and after tachypnea (RR>25). They found the Fi02 decreased by 12-24% in rebreathing masks after tachypnea, but did not change in non-rebreathing masks after tachypnea. However, they did find the hypopharynx Fi02 was only 68% in non-rebreathing masks (indicating the term “100% non-rebreather” is a misnomer). It is very important to know the amount of Fi02 your patients are actually inspiring, and to note that it significantly decreases with tachypnea in rebreather devices (abstract).
My patient was a 69 year old lady with metastatic small cell lung cancer. She was on experimental chemotherapy and was admitted from clinic with worsening lower extremity edema and a new oxygen requirement. She underwent a chest and abdominal CT that revealed new pulmonary masses, tumor and a mass invading her right pulmonary artery, […]
The large multi-center ICU trial randomized ICUs to 1 of 3 strategies: MRSA screening/isolation, MRSA screening/isolation/decolonization, or global decolonization (5 days BID nasal mupiricin and daily chlorhexidine bathing). The hazard ratios for MRSA isolates in the 3 groups were 0.92, 0.75, 0.63 respectively. The hazard ratios for any bloodstream infection in the 3 groups were […]
This trial found no difference in patient outcomes (mortality or LOS) if admitted during a time of 24/7 intensivist coverage, or during a time with only daytime intensivist coverage (with home call at night) in a medical ICU. This study does not show a patient benefit to a 24/7 intensivist staffing model in an academic […]