Critical care – Page 6 – Critical Care Update

Timing of renal replacement therapy in septic shock

January 1, 2019 by RS

S.D. Barbar, R. Clere-Jehl, A. Bourredjem, R. Hernu et el published a study about timing of renal replacement therapy in patients with septic shock and acute kidney injury. BACKGROUND Patients hospitalized in the intensive care unit (ICU) for septic shock frequently develop acute kidney injury and is associated with high mortality. When to provide the renal replacement … Read more

Month of negative studies

November 25, 2018 by RS

Last 2 months have produced several negative studies in the field of critical care. It is worthwhile to look at these studies altogether. In the first study published in JAMA by Wittekamp BH, Plantinga NL, Cooper BS et el , the effects of chlorhexidine (CHX) mouthwash, selective oropharyngeal decontamination (SOD), and selective digestive tract decontamination (SDD) was compared. … Read more

Do not discard haloperidol yet

November 12, 2018 by RS

T.D. Girard, M.C. Exline, S.S. Carson, C.L. Hough, P. Rock, M.N. Gong et el published the results of MIND-USA(Modifying the Impact of ICU-Induced Neurological Dysfunction-USA) trial in New England Journal of Medicine October 22, 2018 Issue. STUDY It was a randomized, double-blind, placebo-controlled trial comparing patients with acute respiratory failure or shock and hypoactive or hyperactive delirium to … Read more

What should we stop doing in ICU right now ?

October 21, 2018 by RS

Dr Fernando Zampieri MD PhD published a thought provoking article in ICU management and practice. This takes an example of use of CRP in diagnosing ventilator associated pneumonia and various clinician biases. In the end, there is an exhaustive list of things which we do today which are not proven to be beneficial.

Intraosseous Access is associated with lower survival in out of hospital cardiac arrest

October 4, 2018 by RS

Takahisa Kawano, Brian Grunau, Frank X. Scheuermeyer et el published a study comparing intraosseous versus intravenous vascular access on survival as well as neurological outcome in out of hospital cardiac arrest in Annals of emergency medicine. BACKGROUND Intraosseous access (IO) was first pioneered by Drinkler and colleagues in 1922 but it became popular as a substitute to … Read more

It is okay to abruptly stop steroids in resolving septic shock

September 25, 2018 by RS

Kristine A. Sobolewski , Alison Brophy , Yekaterina Opsha et el published a retrospective cohort study comparing abrupt withdrawal versus taper of hydrocortisone in resolving septic shock patients. BACKGROUND Severe sepsis and septic shock remains one of the most common diagnosis as well as cause of death in intensive care units around the world. Hydrocortisone has been shown to quicker … Read more

Laryngeal tube insertion in out of hospital cardiac arrest may save lives

October 10, 2019September 23, 2018 by RS

Henry E.Wang, Robert H. Schmicker, Mohamud R. Daya et el published PART trial (Pragmatic Airway Resuscitation Trial) in which they compared laryngeal tube insertion with endotracheal intubation in out of hospital cardiac arrest. BACKGROUND About 350000 adults in the United States suffer out of hospital cardiac arrest each year, with less than 10%surviving to hospital discharge. More … Read more

No effect of early cycling exercise in ICU

September 8, 2018 by RS

Guillaume Fossat, Florian Baudin, Léa Courtes et el published a trial of in-bed cycling exercises and electrical stimulation versus standard rehabilitation in critically ill patients. BACKGROUND About half of patients admitted to Intensive care units experience muscle weakness and wasting which may persist for up to 5 years. Factors contributing are inflammation, metabolic disorders, sedation and prolonged … Read more

Plasma as pre hospital resuscitation in trauma patients

August 29, 2018 by RS

J.L. Sperry, F.X. Guyette, J.B. Brown, M.H. Yazer et el published a trial of plasma vs standard fluid resuscitation in trauma patients who were at risk of hemorrhagic shock while being transported by air medical services. BACKGROUND In hospital treatment of trauma involves “damage control resuscitation” which aims to prevent coagulopathy by minimization of the use of crystalloid-based … Read more

Epinephrine in Cardiac arrest : Saves lives but not brain

August 1, 2018 by RS

G.D. Perkins, C. Ji, C.D. Deakin, T. Quinn et el published a trial of epinephrine in out of hospital cardiac arrest in NEJM ( PARAMEDIC2 Collaborators ). BACKGROUND Epinephrine causes constriction of arterioles mediated by α-adrenergic receptors. Such constriction increases aortic diastolic pressure during CPR, thereby augmenting coronary blood flow and increasing the chance of a return of spontaneous circulation. It … Read more

FDA approves Sodium Zirconium Cyclosilicate for Hyperkalemia

July 28, 2018 by RS

In May, 2018, FDA approved Sodium Zirconium Cyclosilicate (ZS-9) for treatment of hyperkalemia. This is available as Lokelma in USA, manufactured by AstraZeneca. This is the third drug in the category of Gastrointestinal cation exchangers for treatment of hyperkalemia. Earlier two drugs are sodium polystyrene sulfonate(Kayexalate, approved in 1958) and patiromer(Approved in 2015). Its efficacy … Read more

Flexible Versus Restrictive Visiting Policies in ICUs

July 27, 2018 by RS

Antonio Paulo Nassar Junior, Bruno Adler Maccagnan Pinheiro Besen et el published a meta analysis and systematic review in critical care medicine about restrictive and flexible visiting policies in ICUs. BACKGROUND Most ICUs worldwide place restrictions on visiting patients due to fear of infection, disorganization of care and increased workload on staff. Liberal visiting hours have … Read more