STUDY OBJECTIVE We examine the central venous catheter placement rate during the implementation of an ultrasound-guided peripheral intravenous access program. METHODS We conducted a time-series analysis of the monthly central venous catheter rate among adult emergency department (ED) patients in an academic urban ED between 2006 and 2011. During this period, emergency medicine residents and E...

BACKGROUND Heart rate variability (HRV) has been used to assess cardiac autonomic activity in critically ill patients, driven by translational and biomarker research agendas. Several clinical and technical factors can interfere with the measurement and/or interpretation of HRV. We systematically evaluated how HRV parameters are acquired/processed in critical care medicine. METHODS PubMed, MED...

IntroductIon Delirium is a significant independent indicator of poor prognoses for critically ill patients (including in‐hospital mortality, prolonged hospitalization, increased medical costs, and long‐term cognitive impairment). Intensive care medicine experts have been paying attention to and carried out research on delirium for better prediction, prevention, management, and treatment, and ev...

Critically ill elderly patients' nutritional needs are not well understood and vary with the phase of illness and recovery. Patients' nutritional needs should be assessed early in hospitalization and re-assessed throughout the stay with additional attention during the transitions from critical illness, to severe illness, to post-hospital rehabilitation. In this review, we summarize recent findi...

The metabolic support of the critically ill patient is a relatively new target of active research and little is as yet known about the effects of critical illness on metabolism. The nonthyroidal illness syndrome, also known as the low T3 syndrome or euthyroid sick syndrome, describes a condition characterized by abnormal thyroid function tests encountered in patients with acute or chronic syste...

OBJECTIVE Report an unusual cause of thrombocytopenia in a burn patient and provide a brief review of causes of thrombocytopenia in critically ill patients. METHODS Case report format and selected review of PubMed search including the search terms thrombocytopenia, critical illness, and vancomycin. RESULTS Reports of vancomycin-induced thrombocytopenia are uncommon. CONCLUSION Drug-induce...

Venous thromboembolism is a relatively frequently occurring complication in critically ill patients admitted to the ICU despite prophylactic treatment with subcutaneous low molecular weight heparin. Several studies show that critically ill patients have significantly lower plasma anti-factor-Xa activity levels compared to control patients after administration of subcutaneous heparin. Robinson a...

Fever is a common occurrence in the intensive care unit, and pharmacologic approaches are limited, particularly in patients unable to tolerate enteral medications. Although a study by Morris and colleagues in the previous issue of Critical Care suggests that intravenous ibuprofen is safe and effective in critically ill patients, the study is small and the drug was given over only a 24-hour peri...

Microcirculatory alterations are frequently observed in critically ill patients undergoing major surgery and those who suffer from trauma or sepsis. Despite the need for adequate fluid administration to restore microcirculation, there is no consensus regarding optimal fluid therapy for these patients. The recent recognition of the importance of the endothelial glycocalyx layer in capillary flui...