P.S. Myles, R. Bellomo, T. Corcoran et el published results of Relief trial (Restrictive versus Liberal Fluid Therapy in Major Abdominal Surgery) in New England Journal of Medicine. BACKGROUND Each year, 310 million surgeries happen world wide. These patients end up getting large amounts of intravenous fluids leading to fluid overload. A study published in 2003, showed that fluid … Read more
In February, 2017, FDA approved a new assay (Rt-Qpcr) for Mrna Transcript Immune Biomarkers to detect sepsis. It is a quantitative gene expression assay using reverse transcription polymerase chain reaction to quantify the relative expression levels of host response genes isolated from whole blood. This test is not widely available, and currently it takes about … Read more
An estimated 4 million people are taking factor Xa inhibitors, such as rivaroxaban (Xarelto, Bayer/Janssen Pharmaceuticals) and apixaban (Eliquis, Bristol-Myers Squibb). In the USA, Apixaban generated 4.9 billion dollars for the company last year. Until now, there was no approved reversal agent for these factor Xa inhibitors. In the United States alone, there were approximately … Read more
In last few weeks, two studies on Vasopressin(AVP) were published which shed some light on its profile and use. In the first study, William F. McIntyre, Kevin J. Um et el published a meta analysis and systemic review of use of vasopressin and vasopressin plus catecholamines in distributive shock in JAMA. Authors searched Medline, Embase and … Read more
Patrick B. Murphy, Neil G. Parry et el published a prospective study of prevalance of intra-abdominal hypertension in mixed medical-surgical critically ill patients . WHERE It was a prospective observational study in a single institute, Including trauma, medical and surgical patients, in the Canada. WHAT THEY DID All adult (> 18 yr old) patients admitted to the … Read more
Yonathan Freund, Marine Cachanado et el published in JAMA the results of PROPER trial which evaluated safety of PERC criteria in low risk patients at ruling out pulmonary embolism. BACKGROUND PERC criteria were first suggested by Kline JA , Mitchell AM et el in 2004. They include the following Arterial oxygen saturation (SpO2) of 94%or less, Pulse rate … Read more
D. Annane, A. Renault, C. Brun‑Buisson et el published results of APROCCHSS trial by CRICS-TRIGGERSEP Network which was originally designed to test drotrecogin alfa (activated) in septic shock. A human recombinant activated protein C, drotrecogin alpha (activated), initially showed a survival benefit in sepsis; this benefit was not confirmed in subsequent trials, resulting in the withdrawal of its commercial form (Xigris) … Read more
Yongfang Zhou, Xiaodong Jin published a study in Intensive care medicine journal about using APRV early in ARDS. WHAT THEY DID Randomized adult patients with ARDS (Berlin definition, P:F ratio <250) who were on mechanical ventilation to APRV(Airway pressure release ventilation) or LTV(low tidal volume) mode of mechanical ventilation. Patients were enrolled within 48 hours. … Read more
B. Venkatesh, S. Finfer, J. Cohen, D. Rajbhandari et el published results of eagerly awaited “Adrenal” trial (Adjunctive Corticosteroid Treatment in Critically Ill Patients with Septic Shock). WHAT THEY DID Randomized adult patients with septic shock undergoing mechanical ventilation(documented or strong clinical suspicion of infection, had two or more criteria of the SIRS, on vasopressors or inotropic agents for … Read more
In a late breaking abstract in the CHEST meeting in Toronto, Matthew Semler, Wesley Self, Todd Rice et el presented finding of their SMART(The Isotonic Solutions and Major Adverse Renal Events Trial) trial. They reported that total of 1,139 patients (14.3%) in the balanced crystalloid group experienced the primary outcome of MAKE30(Major Adverse Kidney Events within 30 … Read more
Recently, two papers were published, one a trial and other one a meta analysis about lung recruitment in ARDS. First study, published in JAMA, was a trial of lung recruitment and Titrated Positive End-Expiratory Pressure (PEEP) vs Low PEEP in ARDS(ART Investigators), published by Cavalcanti AB, Suzumura ÉA et el. They compared total of 1010 patients of … Read more
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