RS Two recent studies caught my eye, both about blood transfusion. The first study was published in NEJM by Cooper DJ, McQuilten ZK, Nichol A et el comparing use of freshest vs oldest available blood in critically ill patients. In this international, multi center, randomized, double-blind trial, critically ill adults were assigned to receive either the freshest available, compatible, allogeneic red cells (short-term … Read more
Endotracheal intubation is one of the most common and critical procedure performed in intensive care unit. Two recent studies provide some insight in to the ideal position and use of bougie in intubation. Semler MW and Janz DR et el published in this month’s Chest about optimal positioning for successful intubation. In this Multi center, randomized trial they … Read more
H Yao, C He, L Deng, G Liao et el published in the European Journal of nutrition a meta analysis of small trials, comparing enteral versus parenteral nutrition in cases of severe pancreatitis. They analyzed the evidence from 348 patients from 5 small randomized trials. Meta-analysis showed significantly lower overall mortality risk with EN than with PN (risk ratio, 0.36; … Read more
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European Respiratory Society (ERS), European Society of Intensive Care Medicine (ESICM), European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and Asociación Latinoamericana del Tórax (ALAT) Recently published guidelines for management of hospital acquired pneumonia(HAP), and ventilator associated pneumonia. These guidelines are sligtly different then presented by IDSA and ATS published in July 2016. Some of the differences in … Read more
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 … Read more
Ashish Khanna, M.D., Shane W. English, M.D., Xueyuan S. Wang, M.D et el Published in NEJM a new trial Of angiotensin II in vasodilatory shock [Treatment of High-Output Shock (ATHOS-3) trial]. Background Vasodilatory shock is the most common cause of shock in the critical care world. It is charecterized by peripheral vasodilatation and reduce blood pressure … Read more
C.S. Anderson, H. Arima and P. Lavados et el published in NEJM a new cluster randomized trial about head position in acute ischemic stroke showing no difference between head elevation and flat position for first 24 hours (HeadPost Trial). BACKGROUND Earlier animal and non randomized small human studies showed that flat position may increase the … Read more
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 … Read more
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 … Read more
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 … Read more
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 … Read more