Critical care

ESICM/ESCMID/ALAT guidelines for the management of HAP and VAP

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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

ATS/ESICM/SCCM Guidelines for mechanical ventilation : ARDS

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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

New class of drug for septic/ Vasodilatory shock

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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

Head position in acute ischemic stroke

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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

Bundle to reduce ventilator associated events

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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

New assay to diagnose late acetaminophen toxicity

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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

Another retrospective study proving early antibiotics in sepsis improves mortality

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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

No difference between Balanced Crystalloids versus Saline in critical care

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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

Steroids to prevent post extubation stridor and reintubation

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Kuriyama A, Umakoshi N, Sun R published a systemic review and meta- analysis of recent trials regarding use of steroids to prevent post extubation stridor and reintubation. BACKGROUND Earlier meta-analysis of trials of steroids by Fan T et el, Jaber S et el , Khemani RG et el and McCaffrey J et el suggested the potential of corticosteroids to … Read more

Difficult airway characteristics associated with video laryngoscopy failure

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Raj Joshi , Cameron D. Hypes,  Jarrod M. Mosier et el published a single center prospective observational study looking at the risk factors for failure of first attempt at intubation using video laryngoscopy in intensive care unit.   Background Macintosh (1943) and Miller (1941) developed direct laryngoscopes and paved the way for modern direct laryngoscopy.  Mainstay of … Read more

Conservative Vs Conventional Oxygen therapy : How much or how low ?

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Massimo Girardis, Stefano Busani and Mervin Singer et el  published a single center study in October, 2016 issue of JAMA comparing conservative oxygen therapy with conventional one in critically ill patients.    Who All adult patients admitted to an ICU in Italian hospital from 2010 to 2012. Following were excluded pregnancy, ICU readmission, a decision to withhold life-sustaining … Read more