Since the beginning of the pandemic with covid-19, We have learned a lot regarding prevention and treatment. However, the knowledge Gap exists. Recent JAMA editorial summarized this for severe covid-19. PREVENTION Social distancing, frequent hand washing and mask wearing by the general public reduces the transmission of covid 19. Contact tracing and isolation are … Read more
Marcus J. Schultz, Anna Geke Algera, Luigi Pisani et el published a trial in JAMA comparing lower versus higher PEEP in Non ARDS patients who needed mechanical ventilation in intensive care unit. Background Higher PEEP has shown some beneficial effects in patients with ARDS. Effect of this observation has resulted in use of higher PEEP … Read more
Ashish Panchel, Jason Bartos, Jose Cabanas et el published uptdated guidelines for cardiac resuscitation in Circulation. Salient features are summarized in this picture. Now a days the guidelines are updated on a continuous basis but these are the salient changes summarized in a table form. Most updated treatment recommendations for cardiac arrest resuscitation FOR … Read more
Ian Roberts, Haleema Shakur-Still , Adefemi Afolabi, Christopher Hawkey et el (HALT-IT trial investigators) published a trial in Lancet comparing tranexamic acid to placebo in gastrointestinal hemorrhage. Background Tranexamic acid(TXA) is known to prevent the fibrinolysis. Early use of TXA reduces surgical bleeding and death related to bleeding from traumatic injury and has reduced the … Read more
Updated 7/22/2020 Since the discovery of Covid 19(Coronavirus SARS COV 2) in December 2019, flow of information and circumstances are changing everyday. It is hard to keep up with so much information and sort out real from myths. In general, following points are important to remember which are referenced from reputable sources Tolicizumab is the … Read more
Miyamoto, Yoshihisa, Aso, Shotaro et el published results of retrospective Cohort study in critical care medicine. With ongoing covid 19, all possible medications are being tried for which they were not originally intended. Similarly several medications have been tried in septic shock but failed. Recent trial was discussed here. Given there was a lot of … Read more
Hanne T. Olsen, Helene K. Nedergaard et el published a trial of no sedation versus light sedation in mechanically ventilated patients in NEJM. WHAT Multi center randomized controlled trial, in a 1 : 1 ratio, comparing be mechanically ventilated ICU patients to no sedation versus light sedation strategy( RASS Richmond agitation and sedation Scale score … Read more
Tomoko Fujii, Nora Luethi, Paul J. Young et al published the results of much awaited VITAMINS (The Vitamin C, Hydrocortisone and Thiamine in Patients With Septic Shock) trial. WHAT It was an investigator-initiated, multicenter, open-label, parallel-group randomized trial comparing vitamin-C, thiamine and hydrocortisone to hydrocortisone alone in patients with septic shock. WHERE 10 intensive … Read more
Brown RM, Wang L, Coston TD , Krishnan NI et el published a secondary analysis of patients from SMART (Isotonic Solutions and Major Adverse Renal Events Trial) admitted with sepsis to ICU. Original smart trial was published in 2017, which is discussed here . A total of 15,802 patients were enrolled in the trial. It was a pragmatic, cluster-level … Read more
ProPublica published research done by Dr. Nick Asselin on cardiac arrests in Rhode Island and found esophageal intubation by EMS providers in 12 cases. All of the patients died. This story brings the attention back to skills needed to correctly intubate the patient in setting of stress of ongoing CPR. RESEARCH Rhode Island is the … Read more
American Heart Association published focused update on Advanced Cardiac Life Support in conjunction with 2019 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendation from International liaison committee on resuscitation(ILCOR). This focus update provide new recommendations for use of advanced airways, vasopressors and extracorporeal CPR( ECPR). Rest of the guidelines remain … Read more
Bruno François, Alain Cariou, Raphaël Clere-Jehl et el published a trial of intravenous amoxicillin-clavulanate versus placebo in patients undergoing targeted temperature management and mechanical ventilation for out of hospital cardiac arrest with shockable rhythm. BACKGROUND Targeted temperature management remains cornerstone of therapy for out of hospital cardiac arrest. however targeted temperature management is associated with … Read more