Hypothermia in Status Epilepticus does not improve outcome

Stephane Legriel, M.D., Virginie Lemiale, M.D., Maleka Schenck, M.D et al published study in NEJM on Dec 22,2016  evaluating use of hypothermia in status epilepticus. Therapeutic hypothermia does not improve outcome but can be a potential tool to treat seizures. The HYBERNATUS (Hypothermia for Brain Enhancement Recovery by Neuroprotective and Anticonvulsant Action After Convulsive Status …

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What the hell is EIP ?

Low tidal volume ventilation in ARDS (acute respiratory distress syndrome) have been shown to improve mortality. However, low tidal volume ventilation invariably leads to hypercapnia. Many strategies have been employed to optimize the ventilation in ARDS using increases in respiratory rate , use of active humidifiers  and the tracheal gas insufflation or aspiration of dead space. …

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You may want this drug in your RSI box!

Finally, an alternative to Succinylcholine in USA (short duration paralytic)   In December, 2015, FDA approved Bridion (sugammadex) injection to reverse the effects of neuromuscular blockade induced by rocuronium bromide and vecuronium bromide. Now finally we have an alternative to succinylcholine (Mainly used for its very short duration of action).(1)   “Bridion provides a new treatment …

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Give that EPI early in non-shockable arrest in hospital cardiac arrest

Rohan Khera, Paul S. Chan published in circulation about timing of epinephrine in non-shockable cardiac arrest (in hospital) across 548 hospitals who participate in “get on with the guidelines” database. What they did They looked at 103,932 adult patients with non-shockable cardiac arrests from 2001 to 2014. 13,213 (12.7%) patients had delays to epinephrine (more than 5 …

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Poor adherence to CLABSI prevention guidelines worldwide

Cristina Valencia, Naïma Hammami et el published a worldwide survey of healthcare professionals in this month’s Antimicrobial Resistance & Infection Control journal. Overall, only 23% of the ICUs strictly adhere to the guidelines to prevent CLABSI. Just for review, here are the components of CLABSI prevention bundle by the Joint Commission  Hand hygiene Hands are …

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Guidelines for reversal of antithrombotics in intracranial hemorrhage

Neurocritical Care Society and Society of Critical Care Medicine just published guidelines for the reversal of antithrombotics in intracranial hemorrhage. Summary is here in this table.     Antithrombotic agent Reversal agent Vitamin K antagonists If INR more than 1.4   vitamin K 10 mg IV, plus 3- or 4-factor PCC IV (dosing based on …

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Effective communication with mechanically ventilated patients

S. Ten Hoorn, P. W. Elbers and A. R. Girbes published a systemic review in critical care journal in Sept, 2016 about how to communicate with patients on mechanical ventilation.  Summary of the review is in this picture In the US, many ICUs use commercially available communication boards. One below is from Vidatak. In the current technology driven era, there are many …

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New recommendations for liberation from mechanical ventilation

Chest/ American thoracic society released new guidelines for liberation from mechanical ventilation. There are six key recommendations. They all are applicable to patients who are mechanically ventilated for more than 24 hours. For all recommendations, strength is conditional except recommendation for NIV after extubation where it is strong. Initial SBT or spontaneous breathing trial should …

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Should you extubate during night ? Yes, if you are there!

Gershengorn et al published in JAMA a very large retrospective cohort study of 97 844 patients from 165 US ICUs who participate in Project Impact from October 1, 2000, to March 29, 2009. Authors created  4518 propensity-matched pairs of patients with less than 12 hours of Mechanical ventilation and 5761 propensity-matched pairs of patients with mechanical ventilation of more …

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Adjunctive early hydrocortisone therapy does not prevent the development of septic shock in patients with severe sepsis

The Hydrocortisone  for Prevention of Septic Shock (HYPRESS) study was published in JAMA on Oct 3, 2016. 380 patients with sepsis (with evidence of infection plus at least 2 systemic inflammatory response syndrome criteria and evidence of organ dysfunction ) were  randomized either to receive a continuous infusion of 200 mg of hydrocortisone for 5 days or placebo. There …

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