The Jury is Still Out on Whether Awake Prone Positioning in Non-intubated Patients with COVID-19 Pneumonia Decreases Mortality or Endotracheal Intubation

https://hospitalprocedures.org/endotracheal-intubation-course/
Joseph Esherick, M.D., FAAFP, FHM
More Articles – Acute respiratory distress syndrome, Airway management, Anti-coagulant, ARDS, Bilevel noninvasive positive pressure ventilation, BiPAP, corticosteroids, COVID, CPAP, Endotracheal Intubation, Featured, HPC Updates, Mechanical Ventilation, noninvasive positive pressure ventilation, noninvasive ventilation, NPPV, respiratory failure
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COVID-19 pneumonia can be a frustrating infection to treat because we have limited medications that have proven benefit in moderate-severe infections. Patients with COVID-19 pneumonia who require up to 2L/min supplemental oxygen have at least moderate infection. Patients with severe…
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Dexmedetomidine and Propofol performed equally well for the sedation of mechanically ventilated patients with sepsis

Joseph Esherick, M.D., FAAFP, FHM
More Articles – BLOG OF THE WEEK, Delirium, Featured, Fentanyl-Based Ventilator, HPC Updates, Mechanical Ventilation, RASS, Richmond Agitation-Sedation Scale, Sedation, Sepsis, Septic Shock, severe sepsis, Ventilation, Wake-up and Breath Protocol
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The Society of Critical Care Medicine (SCCM) recommends that all mechanically ventilated patients receive analgesia, sedation, and delirium assessment and management while intubated. SCCM reinforced these principles in their 2018 clinical practice guideline on the prevention and management of pain,…
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Protocolized Sedation is Recommended Over Usual Care for Mechanical Ventilation

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Delirium, Featured Procedure, HPC Updates, Mechanical Ventilation, Protocolized Sedation, Sedation, Wake-up and Breath Protocol
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A systematic review and meta-analysis of randomized controlled trials was conducted to determine the effects of protocolized sedation in mechanically ventilated adult intensive care unit patients. Six randomized controlled trials and 1243 patients were studied. The results showed that protocolized…
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Airway Management Pearls to Optimize Your Chances of Securing an Airway

https://hospitalprocedures.org/endotracheal-intubation-course/
Joseph Esherick, M.D., FAAFP, FHM
More Articles – advanced airway, Airway management, difficult airway, difficult airway management, Difficult Intubation, direct laryngoscopy, emergency procedures, emergency procedures course, emergent intubation, Endotracheal Intubation, Featured, Glidescope Intubation, hospital procedures, hospital procedures course, HPC Updates, Hypoxia, Intubation, King Tube, Laryngeal Mask Airway, LMA, Mechanical Ventilation, medical procedures, medical procedures course, preoxygenation, rapid sequence intubation, respiratory failure, supraglottic airway, supraglottic airways, surgical airway, video laryngoscopy, Videolaryngoscopy
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TOP TEN AIRWAY MANAGEMENT PEARLS TO OPTIMIZE YOUR CHANCES OF SECURING AN AIRWAY Develop a difficult airway management plan Huddle with your nurse and respiratory therapist in advance to alert everybody what plan A/B/C/D are for the patient If plan…
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Tips for Management and Bedside Procedures in Critically Ill Patients with COVID Pneumonia

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Acute respiratory distress syndrome, advanced airway, Airway management, ARDS, Arterial Line, Arterial line insertion, Arterial line placement, Arterial Lines, asystole, Cardiac Arrest, cardiac arrest survival, Central Line, Central line insertion, central line placement, central lines, Central Venous Catheter, central venous catheters, COVID, CPR, difficult airway, difficult airway management, Difficult Intubation, emergent intubation, Endotracheal Intubation, Featured, Glidescope Intubation, hospital procedures, hospital procedures course, HPC Conference, HPC Updates, ICU, Intubation, Mechanical Ventilation, PEA, preoxygenation, prone positioning, pulseless electrical activity, Radial Artery Catheterization, respiratory failure, Simulation Based Training, Simulation-based procedural training, ultrasound-guided arterial lines, Ultrasound-Guided Central Line Insertion, video laryngoscopy, Videolaryngoscopy
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The SARS-COV-2 pandemic started in January 2020 and has decimated the majority of U.S. hospitals for the past 18 months. The impact of COVID-19 has not only affected available hospital beds, but has limited the ability of hospitals to perform…
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Open-Lung Recruitment Maneuvers Increased Mortality Compared with Standard PEEP titration for Moderate-Severe Acute Respiratory Distress Syndrome (ARDS)

Joseph Esherick, M.D., FAAFP, FHM
More Articles – ARDS, Featured, HPC Updates, Intubation, Mechanical Ventilation
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There have been multiple strategies to determine the “optimal PEEP” in acute respiratory distress syndrome (ARDS).  One strategy is to perform a recruitment maneuver using an “Open Lung” approach and neuromuscular blockade (with pressures as high as 60 cm H2O),…
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New GOLD Guidelines for COPD Exacerbations

Joseph Esherick, M.D., FAAFP, FHM
More Articles – COPD, HPC Updates, Mechanical Ventilation, noninvasive ventilation, procalcitonin, steroids
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Beta2-agonists and anticholinergics are the initial bronchodilators Prednisone 1 mg/kg/day (up to 60 mg/day) or steroid equivalent for moderate-severe exacerbations x 5-7 days Antibiotics indicated for moderate-severe exacerbations with pulmonary infiltrate or sputum purulence –procalcitonin level >0.25 ng/mL supports antibiotic…
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Prophylactic Corticosteroids Decrease Stridor and Reintubation in High-risk Extubations

Joseph Esherick, M.D., FAAFP, FHM
More Articles – extubation, HPC Updates, Mechanical Ventilation
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The overall incidence of extubation failure is about 15%, but this failure rate may be increased in patients with high risk characteristics.  Patients who have prolonged mechanical ventilation, those with high cuff pressures, poor cuff leaks, and those who have…
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Summary of Sepsis and Septic Shock Treatment in 2017

Joseph Esherick, M.D., FAAFP, FHM
More Articles – ARDS, Arterial Lines, central lines, hemodynamic monitoring, HPC Updates, Mechanical Ventilation, Sepsis, Septic Shock, vasopressors
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Definitions Presumed source with SIRS criteria = infection Infection with life-threatening organ dysfunction = sepsis Sepsis refractory to intravenous fluid challenge = septic shock Treatment of sepsis or septic shock Draw blood cultures x 2 Analyze any fluid that may…
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Fentanyl-Based Ventilator Sedation Decreased Ventilator Days in ICU Patients

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Fentanyl-Based Ventilator, HPC Blog Updates, HPC Updates, ICU, Intubation, Mechanical Ventilation, RASS, Richmond Agitation-Sedation Scale
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Complications from long-term deep sedation and the lack of adequate pain control for mechanically ventilated intensive care unit (ICU) patients has resulted in the development of sedation protocols emphasizing pain control over sedation. These protocols use either remifentanyl or fentanyl.…
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MRSA antibiotics are overprescribed in patients hospitalized for community-acquired pneumonia

Joseph Esherick, M.D., FAAFP, FHM
More Articles – antibiotic stewardship, community-acquired pneumonia, HPC Updates, Mechanical Ventilation, MRSA, pneumonia
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Are MRSA Antibiotics Overprescribed for Community-Acquired Pneumonia? – NEJM Journal Watch Nearly 30% of hospitalized CAP patients received antibiotics for MRSA, even though fewer than 1% had MRSA-associated CAP. A recent multicenter, prospective, active-surveillance study of 2259 patients hospitalized with…
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Conservative Fluid Management Decreases Ventilator Days but not Mortality Compared with Liberal Fluid Management in ARDS

Joseph Esherick, M.D., FAAFP, FHM
More Articles – ARDS, Central venous pressure, Conservative fluid management, CVP, FACTT, FACTT Conservative, FACTT Liberal, FACTT Lite, Fluid and Catheter Treatment Trial, HPC Updates, Mechanical Ventilation, Pulmonary artery occlusion pressure
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A retrospective study compared the performance of Fluid and Catheter Treatment Trial (FACTT) Lite, FACTT Conservative, and FACTT Liberal. The prior FACTT demonstrated that conservative fluids is superior to liberal fluids for ARDS. A simplified conservative fluid protocol (FACTT Lite)…
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New Classification of ARDS Predicts Hospital Mortality

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Acute respiratory distress syndrome, ARDS, HPC Updates, Mechanical Ventilation
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Presently, the mortality of patients in the hospital with acute respiratory distress syndrome (ARDS) is higher than 40%.  A sixteen month long observational study was conducted to determine if certain cutoff points of PaO2/FiO2 (less than or equal to 200…
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Steroids are beneficial for hospitalized patients with community-acquired pneumonia

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Endotracheal Intubation, HPC Updates, Intubation, Mechanical Ventilation, pneumonia, respiratory failure
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A recent meta-analysis and systematic review of 13 randomized, placebo-controlled trials analyzed over 2000  patients hospitalized for CAP.  The analysis examined whether the addition of systemic corticosteroids doses (20–60 mg of prednisone or steroid equivalent) to empiric antibiotics was any better than…
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Noninvasive Ventilation is Extremely Effective for Severe COPD Exacerbations

Joseph Esherick, M.D., FAAFP, FHM
More Articles – BiPAP, COPD exacerbations, HPC Updates, Intubation, Mechanical Ventilation, noninvasive ventilation
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Based on meta-analysis of randomized, controlled trials, noninvasive positive pressure ventilation (NPPV) is the only intervention that improves mortality in patients hospitalized for exacerbations of chronic obstructive pulmonary disease (COPD). However, many patients who are eligible for this intervention go…
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