Fight Fire with Fire? Should We Be Using Probiotics in Critically Ill Patients

Fight fire with fire.  What does this mean?  Some of you may think this is a song by Metallica (others may think it is a song by Kansas).  While that is true, I am not referencing Metallica when I use it in the title for this blog post.  Instead, I am referencing the definition which suggests you treat something with its likeness, or respond to something with more of that same thing.  You treat aggressiveness with more aggression.  In ecological terms, it might be viewed as a controlled burn – using fire to burn out areas in a controlled manner ahead of a forest fire to halt its progression.

The use of probiotics is a bit akin to this.  The definition of probiotics is “living organisms that have a beneficial effect in the prevention and treatment of disease.”  The purpose of probiotics is to replenish (or maintain) the natural flora of the human body, especially the gastrointestinal tract.  Research has demonstrated that a significant portion of illness comes from bacteria in the intestinal tract – more than just Clostridium dificile infections, although they clearly result in disease in the intestinal tract.  Bacterial translocation across the GI tract and into the bloodstream has been implicated in numerous conditions, especially in critical illness.

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Forecast for Targeted Temperature Management: Partly Cloudy and a Bit Warmer

Modern CPR began a little over a half century ago when clinicians started performing chest compressions in patients who had in-hospital cardiac arrest.  It improved survival from none to slightly more than none.  Since that time, continued research in cardiopulmonary resuscitation has resulted in ACLS courses, mainstream use of defibrillators, and most importantly, slowly, but steadily improving survival rates.  Unfortunately, brain injury begins within minutes of cardiac arrest, and survival with good neurological recovery remains unacceptably low.  Many who survive are alive but with devastating neurological dysfunction. Continue reading “Forecast for Targeted Temperature Management: Partly Cloudy and a Bit Warmer”

Intensive Blood Pressure Control in Intracerebral Hemorrhage: Dealing with “Low Value” ICU Interventions

It is uncommon in medicine to encounter an intervention that historically was thought of as unsafe, then some evidence suggests potential benefit, and finally the best evidence swings us back to harm. Enter the story of intensive blood pressure lowering for intracerebral hemorrhage (ICH).

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