will take place on:
Tuesday, December 11th
2:00 pm CET (Berlin / Paris)
9:00 pm SGT / CST (Singapore / China)
3:00 pm SAST (South Africa)
8:00 AM EST (Boston, New York)
]]>
High-Frequency Oscillation for Acute Respiratory Distress Syndrome
New England Journal of Medicine January 2013
Hosted by Tom Piraino RRT
To test if your computer is compatible with the Webinar Service CLICK HERE
Please note that we are trying a new Webinar service so if you have registered for a Journal Club before, please check that your computer is compatible with this service as it is different.
Registration has ended.
]]>High-Frequency Oscillation in Early Acute Respiratory Distress Syndrome
New England Journal of Medicine January 2013
Hosted by Tom Piraino RRT
To test if your computer is compatible with the Webinar Service CLICK HERE
Please note that we are trying a new Webinar service so if you have registered for a Journal Club before, please check that your computer is compatible with this service as it is different.
Register and download the article HERE
]]>
Dead Space Fraction Changes During PEEP Titration Following Lung Recruitment in Patients With ARDS
Respiratory Care October 2012
Hosted by Tom Piraino RRT
To test if your computer is compatible with the Webinar Service CLICK HERE
Please note that we are trying a new Webinar service so if you have registered for a Journal Club before, please check that your computer is compatible with this service as it is different.
Register and download the article HERE
Deadline to register is Friday February 15th, 2013
]]>For more information & to register:
www.hopkinscme.edu/CourseDetail.aspx/80031092
cmenet@jhmi.edu
]]>Learning Objectives
Presenting is eligible for 4 education credits!
]]>
will take place on:
Tuesday, December 11th
2:00 pm CET (Berlin / Paris)
9:00 pm SGT / CST (Singapore / China)
3:00 pm SAST (South Africa)
8:00 AM EST (Boston, New York)
]]>
Context Protocolized sedation and daily sedative interruption are 2 strategies to minimize sedation and reduce the duration of mechanical ventilation and intensive care unit (ICU) stay. We hypothesized that combining these strategies would augment the benefits.
Objective To compare protocolized sedation with protocolized sedation plus daily sedation interruption in critically ill patients.
Design, Setting, and Patients Randomized controlled trial of 430 critically ill, mechanically ventilated adults conducted in 16 tertiary care medical and surgical ICUs in Canada and the United States between January 2008 and July 2011.
Intervention Continuous opioid and/or benzodiazepine infusions and random allocation to protocolized sedation (n = 209) (control) or to protocolized sedation plus daily sedation interruption (n = 214). Using validated scales, nurses titrated infusions to achieve light sedation. For patients receiving daily interruption, nurses resumed infusions, if indicated, at half of previous doses. Patients were assessed for delirium and for readiness for unassisted breathing.
Main Outcome Measure Time to successful extubation. Secondary outcomes included duration of stay, doses of sedatives and analgesics, unintentional device removal, delirium, and nurse and respiratory therapist clinical workload (on a 10-point visual analog scale [VAS]).
Results Median time to successful extubation was 7 days in both the interruption and control groups (median [IQR], 7 [4-13] vs 7 [3-12]; interruption group hazard ratio, 1.08; 95% CI, 0.86-1.35; P = .52). Duration of ICU stay (median [IQR], 10 [5-17] vs 10 [6-20]; P = .36) and hospital stay (median [IQR], 20 [10-36] vs 20 [10-48]; P = .42) did not differ between the daily interruption and control groups, respectively. Daily interruption was associated with higher mean daily doses of midazolam (102 mg/d vs 82 mg/d;P = .04) and fentanyl (median [IQR], 550 [50-1850] vs 260 [0-1400]; P < .001) and more daily boluses of benzodiazepines (mean, 0.253 vs 0.177; P = .007) and opiates (mean, 2.18 vs 1.79; P < .001). Unintentional endotracheal tube removal occurred in 10 of 214 (4.7%) vs 12 of 207 patients (5.8%) in the interruption and control groups, respectively (relative risk, 0.82; 95% CI, 0.36-1.84; P = .64). Rates of delirium were not significantly different between groups (53.3% vs 54.1%; relative risk, 0.98; 95% CI, 0.82-1.17; P = .83). Nurse workload was greater in the interruption group (VAS score, 4.22 vs 3.80; mean difference, 0.41; 95% CI, 0.17-0.66; P = .001).
Conclusion For mechanically ventilated adults managed with protocolized sedation, the addition of daily sedation interruption did not reduce the duration of mechanical ventilation or ICU stay.
]]>Acute Respiratory Distress Syndrom
The Berlin Definition
JAMA. 2012;307(23):2526-2533
Hosted by Dr. Peter Papadakos
Register HERE
Download the article HERE
Deadline to register is Friday November 23rd, 2012
]]>