ATS/ESICM/SCCM Guidelines for mechanical ventilation : ARDS

Fan E, Del Sorbo L, Goligher EC, Hodgson CL et el published official guidelines for mechanical ventilation in ARDS which were published recently. Guidelines are in a question answer format and they answer 6 questions. They did not comment on  Airway pressure release ventilation and use of NM blockade. Here is the summary Future studies are needed to resolve following …

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Bundle to reduce ventilator associated events

Nishi Rawat, Ting Yang,  Kisha J. Ali et el  published a two state multifaceted intervention study showing benefits of improved compliance with evidence based practices can reduce ventilator-associated event, infection-related ventilator- associated complication, and probable ventilator-associated pneumonia. It was a longitudinal quasi-experimental study involving 56 ICUs at 38 hospitals in Maryland and Pennsylvania from October 2012 to March 2015. PROBLEM …

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New assay to diagnose late acetaminophen toxicity

Roberts DW, Lee WM, Hinson JA et el published a observational cohort study in Clinical Gastroenterology and Hepatology journal about utility of  point-of-care assay to detect acetaminophen protein adducts in patients suspected to have acetaminophen toxicity. They compared the accuracy of AcetaSTAT vs high-pressure liquid chromatography with electrochemical detection (HPLC-EC; a sensitive and specific quantitative analytic assay) to …

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Another retrospective study proving early antibiotics in sepsis improves mortality

Christopher W. Seymour, Foster Gesten et el published a retrospective study in NEJM looking at impact of implementation of bundle treatment in sepsis. WHAT THEY DID Looked at the data(On patients with sepsis and septic shock, community acquired only) reported to New York Health Department from April 1, 2014, to June 30, 2016. More than 98% of …

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No difference between Balanced Crystalloids versus Saline in critical care

Isotonic saline is the most commonly used crystalloid in the ICU. There is some evidence that chloride rich solution use (saline) may be associated with increased risk of renal injury as well as death. Matthew W. Semler, Jonathan P. Wanderer et el just published a  cluster-randomized, multiple-crossover trial comparing saline with balanced crystalloids in a …

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Vit C, Thiamine and Hydrocortisone in Sepsis : New trial needed

Paul Marik et el published a “retrospective before after ” study in Chest, Dec, 2016 about use of combination of parenteral Vit C, Thiamine and Hydrocortisone in sepsis and reported a mortality of 8.5% in treatment group compared with 40.4% in control group(p =<0.001). Results are astonishing if you believe in the study. There are several …

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Guidelines for VTE prophylaxis in Neurocritical Care

Nyquist, Paul, Jichici, Draga et el recently published evidence based guidelines for prevention of venous thromboembolism in neurocritical care. Risk of venous thromboembolism is present in all hospitalized patients and specially higher in neurocritical patients due to immobility. Combination therapy with chemoprophylaxis (Unfractioned heparin, Low molecular heparin) and mechanical prophylaxis (Intermittent pneumatic compression devices) is superior …

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Steroids to prevent post extubation stridor and reintubation

Kuriyama A, Umakoshi N, Sun R published a systemic review and meta- analysis of recent trials regarding use of steroids to prevent post extubation stridor and reintubation. BACKGROUND Earlier meta-analysis of trials of steroids by Fan T et el, Jaber S et el , Khemani RG et el and McCaffrey J et el suggested the potential of corticosteroids to …

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