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
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
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
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
Fang Fang, Yu Zhang, Jingjing Tang et el published a meta-analysis of use of corticosteroids in septic shock in Dec, 2018 in JAMA internal medicine. This ignites the age old debate of use of steroids in septic shock. You may recall that B. Venkatesh, S. Finfer, J. Cohen, D. Rajbhandari et el published adrenal trial which showed that … 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
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
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
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
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
Paul Marik et el published a “retrospective before after ” study in Chest, Dec, 2016 about use of combination of parenteral Vit C, Thiamine and Hydrocortisone in sepsis and reported a mortality of 8.5% in treatment group compared with 40.4% in control group(p =<0.001). Results are astonishing if you believe in the study. There are several … Read more