General Critical Care

I finished Pain, Agitation, Delirium, Immobility and Sleep Disruption in the ICU (PADIS Guidelines) 🌸 thank you Dr. mazen for this informative and interested course

A 47-year-old man with past medical history significant for tobacco use, prior alcohol use, presumed COPD, and recent evaluation for a possible esophageal mass status post EGD on 7/22 with findings of stenosis and circumferential ulceration involving the distal esophagus status post dilation and biopsy.

Patient was admitted on 7/29 for acute hypoxic respiratory failure, ARDS, and septic shock with findings of left-sided pleural effusion and pneumothorax confirmed to be esophageal perforation. S/P chest tubes, EGD, and stenting.

CT of the chest confirming extravasation of water-soluble contrast from the left lateral wall of the esophagus at the level of the GE junction.

The area of extravasation distal esophigus

70-year-old male presents with one month of hemoptysis and shortness of breath. Acute renal failure, anemia, bilateral infiltrates on chest X-ray.

CT scan of the chest:

Kidney profile:

Bronchoscopy

Analgesia and Sedation Use During Noninvasive Ventilation for Acute Respiratory Failure

Critical Care Medicine (lww.com)

This study examines the use of analgesia and sedation during noninvasive ventilation (NIV) for acute respiratory failure (ARF) across 1,017 U.S. hospitals. Among 433,357 patients, 26.7% received analgesia or sedation, with opioids (11.7%) and benzodiazepines (9.4%) being most common. Medication use was linked to higher odds of intubation (7.4%) or death (5.6%). Patients receiving any study medication had a 38% increased odds of intubation or mortality (aOR 1.38, 95% CI 1.35–1.40). The study highlights potential risks, especially with combinations like opioids and benzodiazepines, and calls for further research.