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
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
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
Liu ZM, Chen J, Kou Q et el published results of a randomized trial in intensive care medicine comparing Terlipressin with Norepinephrine in septic shock. BACKGROUND Norepinephrine (NE) is first line recommended agent for correcting hypotension in septic shock. Terlipressin is a synthetic long acting analogue of Vasopressin which has higher affinity for V1 receptor. … 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
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
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
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
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
Nyquist, Paul, Jichici, Draga et el recently published evidence based guidelines for prevention of venous thromboembolism in neurocritical care. Risk of venous thromboembolism is present in all hospitalized patients and specially higher in neurocritical patients due to immobility. Combination therapy with chemoprophylaxis (Unfractioned heparin, Low molecular heparin) and mechanical prophylaxis (Intermittent pneumatic compression devices) is superior … Read more
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