Critical care

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

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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 … Read more

Inform Trial : No effect of blood storage time on mortality after transfusion

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Inform trial results were published in NEJM on Oct 24, 2016. 31,497 adult patients  at six hospitals in four countries (Australia, Canada, Israel and the U.S) were randomized to receive short or long term stored blood. There was no difference in mortality among two groups. Earlier, a meta analysis of 12 randomized trials showed no … Read more

Pulmonary Embolism presenting as Syncope : Scare mongering at best

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PESIT INVESTIGATORS published in this week of NEJM, reported that 17.3% of patients had PE who were admitted with first syncope to the hospital. This study has been circulated in various newspapers (1, 2, 3) as if  physicians are missing the big deadly cause of fainting spells, which is plain scare mongering. Emergency room physicians are already overusing … Read more

New Nomogram to predict Surgical ICU readmission

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Martin et el  from the University of Utah School of Medicine, Salt Lake City developed a new nomogram to predict Surgical ICU readmission. What they did Studied 3,109 SICU admissions, with 141 patients readmissions within 72 hours of discharge from ICU. Came up with following risk factors patient age respiratory rate (breaths per minute) history of … Read more

Journal club : Empiricus trial

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Empirical Micafungin Treatment and Survival Without Invasive Fungal Infection in Adults With ICU-Acquired Sepsis, Candida Colonization, and Multiple Organ Failure The EMPIRICUS Randomized Clinical a multicenter, randomized, double-blind, and parallel-group study Background Few randomized trials compared antifungals (fluconazole and capsofungin) to placebo empirically in critically ill septic patients. They failed to provide any benefit, however, empirical antifungal therapy is recommended … Read more

Time to say good bye to routine stress ulcer prophylaxis in ICU

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Accepting that the world is full of uncertainty and ambiguity does not and should not stop people from being pretty sure about a lot of things. Julian Baggini WHATS NEW Pantoprazole or Placebo for Stress Ulcer Prophylaxis (POP-UP Study) In this randomized Double-Blind Exploratory Study by Selvanderan et el 214 patients were randomized to pantoprazole … Read more