The critical care literature 2020.

Area of Science:

• Emergency Medicine
• Critical Care Medicine
• Resuscitation Medicine

Background:

• Increasing numbers of critically ill patients in emergency departments (EDs) necessitate updated medical knowledge.
• Persistent patient boarding in EDs highlights the need for efficient critical care management.
• Emergency physicians require current information on resuscitation and critical care advancements.

Purpose of the Study:

• To review significant critical care and resuscitation articles from 2020.
• To inform emergency physicians about key findings relevant to critically ill ED patients.
• To provide evidence-based recommendations for managing critical conditions.

Main Methods:

• Annual review of key critical care, emergency medicine, and general medicine journals.
• Selection of articles based on author opinion regarding importance for ED critical care.
• Synthesis of findings from selected 2020 publications.

Main Results:

• Dexamethasone is recommended for mechanically ventilated or oxygen-dependent COVID-19 patients.
• Lower positive end-expiratory pressure (PEEP) levels are advised for patients without acute respiratory distress syndrome (ARDS).
• Early extracorporeal membrane oxygenation (ECMO) may benefit out-of-hospital cardiac arrest patients with refractory ventricular fibrillation, if resources permit.

Conclusions:

• Tranexamic acid should not be administered for acute gastrointestinal bleeding.
• The combination of vitamin C, thiamine, and hydrocortisone is not recommended for septic shock.
• Titrate vasopressors to individual chronic perfusion pressure rather than a universal mean arterial pressure target of 65 mmHg for all critically ill patients.