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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Difficult airway characteristics associated with video laryngoscopy failure

Raj Joshi , Cameron D. Hypes,  Jarrod M. Mosier et el published a single center prospective observational study looking at the risk factors for failure of first attempt at intubation using video laryngoscopy in intensive care unit.   Background Macintosh (1943) and Miller (1941) developed direct laryngoscopes and paved the way for modern direct laryngoscopy.  Mainstay of …

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Conservative Vs Conventional Oxygen therapy : How much or how low ?

Massimo Girardis, Stefano Busani and Mervin Singer et el  published a single center study in October, 2016 issue of JAMA comparing conservative oxygen therapy with conventional one in critically ill patients.    Who All adult patients admitted to an ICU in Italian hospital from 2010 to 2012. Following were excluded pregnancy, ICU readmission, a decision to withhold life-sustaining …

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Timing of intubation for in hospital cardiac arrest ?

Traditional wisdom taught us to secure airway as soon as possible in case of cardiac arrest(at least in hospital arrest), though over the course of years, American hearth association have moved their focus from “ABC” (airway-breathing-circulation) to “CAB” (circulation-airway-breathing). AHA also suggested that if a trained individual is not present to secure airway, bag mask ventilation …

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