Critical Care

A

• Acute Kidney Injury in the ICU - CRRT vs Intermittent Dialysis

  Renal replacement therapy in ICU acute kidney injury is initiated for complications that cannot be controlled medically, not for a creatinine threshold alone. Continuous therapy is favored when hemodynamic instability, severe fluid intolerance, or intracranial pressure concerns make rapid intermittent shifts undesirable, while intermittent hemodialysis is efficient in stable patients who need rapid solute removal.
• Acute Respiratory Distress Syndrome - Low Tidal Volume and PEEP Strategy

  ARDS ventilation centers on low tidal volume based on predicted body weight, limitation of plateau and driving pressures, adequate PEEP, avoidance of unnecessary oxygen toxicity, and early prone positioning for severe hypoxemia. The ventilator strategy should be adjusted to respiratory mechanics and gas exchange while treating the precipitating cause and avoiding fluid overload after shock is controlled.
• Acute Respiratory Distress Syndrome — Lung‑Protective Ventilation, Proning, and Adjuncts

  Use low tidal volume ventilation (4–8 mL/kg PBW) and limit plateau pressure ≤30 cm H2O; apply appropriate PEEP and early prolonged prone positioning in moderate–severe ARDS. Consider neuromuscular blockade and conservative fluid strategy; ECMO in refractory hypoxemia.

I

• ICU Analgesia and Sedation - Targets and Protocols

  Modern ICU sedation is analgesia-first, target-driven, and reassessed frequently. Treat pain, choose the lightest sedation compatible with safety and ventilator synchrony, prefer non-benzodiazepine strategies for routine ventilation, use validated pain and sedation scales, coordinate daily awakening and mobility, and reserve deep sedation or neuromuscular blockade for clear time-limited indications.
• ICU Delirium - Prevention and Management

  ICU delirium is acute fluctuating brain dysfunction caused by illness, medications, sleep disruption, immobility, pain, withdrawal, and environmental stress. Screen routinely with a validated tool, identify reversible causes, minimize deliriogenic drugs and deep sedation, promote mobility, sleep and orientation, and reserve antipsychotics for selected dangerous agitation rather than routine delirium treatment.
• ICU Nutrition - Early Enteral Feeding

  Enteral nutrition is preferred for most critically ill adults once initial resuscitation is complete and the gastrointestinal tract is usable. Begin feeding early, advance according to tolerance and metabolic risk, provide adequate protein, prevent refeeding syndrome, and delay or reduce enteral delivery during uncontrolled shock or suspected bowel ischemia rather than treating feeding targets as fixed quotas.

M

• Mechanical Ventilation - Initial Settings in Adults

  Initial invasive ventilator settings should match the reason for intubation, protect the lung from excessive tidal volume and pressure, provide adequate oxygenation and ventilation, and be reassessed promptly with clinical examination, blood gas data, waveforms, and respiratory mechanics. A safe default uses predicted body weight rather than actual weight and avoids both unnecessarily high oxygen exposure and injurious pressures.

P

• Propofol Infusion Syndrome — Recognition, Prevention, and ICU Management

  Critically ill patient on high‑dose or prolonged propofol sedation develops unexplained metabolic acidosis, rhabdomyolysis, acute kidney injury, and cardiac dysfunction—concerning for propofol‑related infusion syndrome (PRIS).

R

• Refractory Hypoxemia - ICU Rescue Strategies

  Refractory hypoxemia requires a structured search for reversible causes before escalation. Confirm airway and circuit function, optimize lung-protective ventilation and PEEP, prone severe ARDS, manage secretions and fluid balance, consider short-term neuromuscular blockade or inhaled pulmonary vasodilators as bridges, and involve an ECMO-capable center early when severe hypoxemia persists despite optimized conventional care.

S

• Sepsis — Early Recognition & Management

  Sepsis is life-threatening organ dysfunction caused by a dysregulated response to infection. Recognition depends on clinical evidence of infection plus new organ dysfunction, not on a single score or biomarker. Management requires immediate resuscitation, appropriately timed antimicrobials, early source control, and repeated assessment of perfusion while avoiding both under-resuscitation and fluid overload.
• Sepsis and Septic Shock - Early Recognition and Bundle

  Screen early, obtain cultures, start broad-spectrum antibiotics, give fluids and vasopressors to maintain MAP, and monitor lactate and perfusion.
• Sepsis and Septic Shock — 1‑Hour Bundle, Source Control, and Vasopressors

  Apply Surviving Sepsis bundles: obtain cultures, start broad antibiotics, and give 30 mL/kg balanced crystalloids for hypotension or lactate ≥4. Use norepinephrine as first‑line vasopressor to target MAP ≥65; add vasopressin or epinephrine as needed. Achieve early source control.
• Sepsis and Septic Shock — Early Management

  Sepsis is life-threatening organ dysfunction caused by a dysregulated response to infection, and septic shock is the subset with severe circulatory and metabolic dysfunction. Current 2026 Surviving Sepsis Campaign guidance emphasizes rapid recognition, risk-stratified antibiotic timing, balanced-crystalloid resuscitation for hypoperfusion, frequent reassessment rather than fixed fluid loading, and norepinephrine as first-line vasopressor therapy.
• Sepsis and Septic Shock — Hour-1 Bundle and Vasopressor Strategy

  Early recognition and treatment with cultures, broad-spectrum antibiotics, 30 mL/kg crystalloid for hypotension or lactate ≥4, and norepinephrine as first-line vasopressor to MAP ≥65; add vasopressin and corticosteroids for refractory shock.
• Septic Shock — Early Antibiotics, 30 mL/kg Fluids, and Norepinephrine-First

  Suspected infection with hypotension requiring vasopressors to maintain MAP ≥65 mmHg or lactate ≥2 mmol/L despite fluids. Begin antibiotics within 1 hour, give initial 30 mL/kg crystalloid, use norepinephrine as first-line vasopressor (add vasopressin), target MAP and perfusion, and ensure early source control.

V

• Vasopressors in Septic Shock - Selection and Titration

  Norepinephrine is the first-line vasopressor for adult septic shock after initial fluid resuscitation has begun. Titrate vasoactive therapy to perfusion and a usual initial MAP target near 65 mm Hg, add vasopressin when norepinephrine requirements escalate, and add epinephrine when pressure remains inadequate. Reassess volume status, cardiac function, lactate, capillary refill, and source control rather than escalating vasopressors reflexively.
• Ventilator Liberation - SAT and SBT Protocols

  Ventilator liberation requires more than passing a breathing trial. Use a daily readiness screen, minimize unnecessary sedation, perform a spontaneous breathing trial with low or no additional support, and separately assess airway protection, secretion burden, cough, mental status, and post-extubation risk before removing the endotracheal tube.