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ObjectivesTo characterize the association between the use of physiologic assessment (central venous pressure, pulmonary artery occlusion pressure, stroke volume variation, pulse pressure variation, passive leg raise test, and critical care ultrasound) with fluid and vasopressor administration 24 hours after shock onset and with in-hospital mortality.DesignMulticenter prospective cohort study between September 2017 and February 2018.SettingsThirty-four hospitals in the United States and Jordan.PatientsConsecutive adult patients requiring admission to the ICU with systolic blood pressure less than or equal to 90 mm Hg, mean arterial blood pressure less than or equal to 65 mm Hg, or need for vasopressor.InterventionsNone.Measurement and main resultsOf 1,639 patients enrolled, 39% had physiologic assessments. Use of physiologic assessment was not associated with cumulative fluid administered within 24 hours of shock onset, after accounting for baseline characteristics, etiology and location of shock, ICU types, Acute Physiology and Chronic Health Evaluation III, and hospital (beta coefficient, 0.04; 95% CI, -0.07 to 0.15). In multivariate analysis, the use of physiologic assessment was associated with a higher likelihood of vasopressor use (adjusted odds ratio, 1.98; 95% CI, 1.45-2.71) and higher 24-hour cumulative vasopressor dosing as norepinephrine equivalent (beta coefficient, 0.37; 95% CI, 0.19-0.55). The use of vasopressor was associated with increased odds of in-hospital mortality (adjusted odds ratio, 1.88; 95% CI, 1.27-2.78). In-hospital mortality was not associated with the use of physiologic assessment (adjusted odds ratio, 0.86; 95% CI, 0.63-1.18).ConclusionsThe use of physiologic assessment in the 24 hours after shock onset is associated with increased use of vasopressor but not with fluid administration.

B Discussion: b COVID-19 itself has been associated with hyponatremia of unclear mechanism, however two large studies of 1099 & 5700 patients hospitalized for COVID-19 showed average Na levels of 138 & 136 mEq/L, respectively. Use of the Liverpool COVID-19 interaction checker revealed a potential weak interaction in only 1 of 4 patients that venlafaxine concentrations could potentially be increased and venlafaxine has been associated with hyponatremia. [Extracted from the article]

B Conclusions: b The most common iatrogenic risk factors for hypoglycemia in the ICU identified in this review were the initial 24 hours of ICU admission, active insulin orders and both periprocedural and NPO status. B Introduction: b Hypoglycemia is associated with increased mortality in the ICU. The primary objective of the study was to identify modifiable risk factors for hypoglycemia in our ICUs in order to decrease its incidence. [Extracted from the article]

B Learning Objectives: b Dexmedetomidine is a first-line agent for sedation in the 2013 SCCM Pain, Agitation and Delirium guidelines, but can cause hypertensive crisis in patients who withdraw when weaned. Ultimately, the patient required reintubation, nitroglycerin 50mcg/min and nicardipine 10mg/hr concomitantly to control the hypertensive crisis. Risks and benefits of dexmedetomidine use should be weighed carefully in post-operative patients that need specific blood pressure parameters to prevent graft compromise. [Extracted from the article]

B Learning Objectives: b Multiple randomized trials have shown reduction in recurrent cardiovascular events with high intensity statins. In 57% pre and 31% post, patients prescribed an appropriate statin leaving the ICU were converted back to their previous home dose at the point of discharge medication reconciliation. [Extracted from the article]