Lewis Satterwhite

Stroke volume guided resuscitation in severe sepsis and septic shock improves outcomes

ABSTRACT To determine whether stroke volume (SV) guided fluid resuscitation in patients with severe sepsis and septic shock alters Intensive Care Unit (ICU) fluid balance and secondary outcomes, this retrospective cohort study evaluated consecutive patients admitted to an ICU with the primary diagnosis of severe sepsis or septic shock. Cohorts were based on fluid resuscitation guided by changes in SV or by usual care (UC). The SV group comprised 100 patients, with 91 patients in the UC group. Net fluid balance for the ICU stay was lower in the SV group (1.77 L) than in the UC group (5.36 L) (p = 0.022). ICU length of stay was 2.89 days shorter (p = 0.03) and duration of vasopressors was 32.8 h less (p = 0.001) in the SV group. SV group required less mechanical ventilation (RR, 0.51; p = 0.0001). The SV group was less likely to require acute hemodialysis (6.25%) compared with the UC group (19.5%) (RR, 0.32; p = 0.01). In multivariable analysis, SV was an independent predictor of lower fluid balance, LOS, time on vasopressors, and not needing mechanical ventilation. This study demonstrated that SV guided fluid resuscitation in patients with severe sepsis and septic shock was associated with reduced fluid balance and improved secondary outcomes. Graphical abstract: Figure. No Caption available. HighlightsPatients with severe sepsis and septic shock that received SV guided resuscitation received less IVF during the ICU stay.Patients with severe sepsis and septic shock that received SV guided resuscitation had a shorter ICU length of stay.Patients with severe sepsis and septic shock that received SV guided resuscitation spent less time on vasopressors.Patients with severe sepsis and septic shock that received SV guided resuscitation were less likely to need hemodialysis.

Diagnostic Yield of Endobronchial Ultrasound-guided Transbronchial Needle Aspiration for Sarcoidosis

INTRODUCTION Sarcoidosis is a multisystem granulomatous disease characterized by diffuse non-caseating granulomas predominantly consisting of epithelioid cells and macrophages (1, 2). There have been numerous environmental associations proposed, but the exact etiology remains unknown. Sarcoidosis can affect many organ systems, but it most commonly affects the eyes, lungs, and skin. It frequently presents with hilar lymphadenopathy and pulmonary infiltrates (3). The clinical course is variable and can range from lifeand organthreatening manifestations to self-limiting diseases in some variants, including Löfgren’s syndrome, characterized by arthritis, hilar adenopathy, and erythema nodosum (1, 4).