RS 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 … Read more
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 … Read more
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 … Read more
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 … Read more
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 … Read more
Shipra Gupta, Ankit Sakhuja Gagan Kumar et el published a retrospective study of culture negative sepsis in December, 2016 issue of Chest. PATIENT POPULATION Nationwide Inpatient Sample (NIS) database (USA) from 2000 to 2010, total of 6,843,279 admissions of patients with severe sepsis were studied, 3,226,406 (47.1%) had culture-negative results. WHAT DID THEY … Read more
Michael J. Murray Heidi DeBlock et al published revised guidelines for use of sustained neuromuscular blocking agents in critical care in November issue of critical care medicine. It is an extensive review of current evidence. Here is a summary of recommendations Indications For recommendation Acute ARDS Continuous IV infusion early in the course … Read more
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 … Read more
New surviving sepsis guidelines were just been released, incorporating new evidence and new sepsis definition. It is a 38 page document(excluding references) . Here is a concise summary of the new guidelines. FOR RECOMMENDATIONS Treatment and resuscitation should begin immediately. 30 mL/kg of IV crystalloid fluid should be given within the first 3 hours. … Read more
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 … Read more
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. … Read more
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 … Read more