Neurocritical Care Society and Society of Critical Care Medicine just published guidelines for the reversal of antithrombotics in intracranial hemorrhage. Summary is here in this table. Antithrombotic agent Reversal agent Vitamin K antagonists If INR more than 1.4 vitamin K 10 mg IV, plus 3- or 4-factor PCC IV (dosing based on … Read more
S. Ten Hoorn, P. W. Elbers and A. R. Girbes published a systemic review in critical care journal in Sept, 2016 about how to communicate with patients on mechanical ventilation. Summary of the review is in this picture In the US, many ICUs use commercially available communication boards. One below is from Vidatak. In the current technology driven era, there are many … Read more
Chest/ American thoracic society released new guidelines for liberation from mechanical ventilation. There are six key recommendations. They all are applicable to patients who are mechanically ventilated for more than 24 hours. For all recommendations, strength is conditional except recommendation for NIV after extubation where it is strong. Initial SBT or spontaneous breathing trial should … Read more
Gershengorn et al published in JAMA a very large retrospective cohort study of 97 844 patients from 165 US ICUs who participate in Project Impact from October 1, 2000, to March 29, 2009. Authors created 4518 propensity-matched pairs of patients with less than 12 hours of Mechanical ventilation and 5761 propensity-matched pairs of patients with mechanical ventilation of more … Read more
The Hydrocortisone for Prevention of Septic Shock (HYPRESS) study was published in JAMA on Oct 3, 2016. 380 patients with sepsis (with evidence of infection plus at least 2 systemic inflammatory response syndrome criteria and evidence of organ dysfunction ) were randomized either to receive a continuous infusion of 200 mg of hydrocortisone for 5 days or placebo. There … Read more
Inform trial results were published in NEJM on Oct 24, 2016. 31,497 adult patients at six hospitals in four countries (Australia, Canada, Israel and the U.S) were randomized to receive short or long term stored blood. There was no difference in mortality among two groups. Earlier, a meta analysis of 12 randomized trials showed no … Read more
Bracard S et el in recently published THRACE trial compared mechanical thrombectomy in addition to standard Alteplase for stroke. Mechanical thrombectomy in addition to standard care improved clinical outcomes (functional independence at 3 months (odds ratio 1.55, 95% CI 1.05-2.30; p=0.028). There was no difference in mortality or symptomatic intracranial hemorrhage in two groups. Common adverse … Read more
PESIT INVESTIGATORS published in this week of NEJM, reported that 17.3% of patients had PE who were admitted with first syncope to the hospital. This study has been circulated in various newspapers (1, 2, 3) as if physicians are missing the big deadly cause of fainting spells, which is plain scare mongering. Emergency room physicians are already overusing … Read more
Martin et el from the University of Utah School of Medicine, Salt Lake City developed a new nomogram to predict Surgical ICU readmission. What they did Studied 3,109 SICU admissions, with 141 patients readmissions within 72 hours of discharge from ICU. Came up with following risk factors patient age respiratory rate (breaths per minute) history of … Read more
Expert consensus recommendations were published in CCM journal on Oct 3, 2016. RS
Empirical Micafungin Treatment and Survival Without Invasive Fungal Infection in Adults With ICU-Acquired Sepsis, Candida Colonization, and Multiple Organ Failure The EMPIRICUS Randomized Clinical a multicenter, randomized, double-blind, and parallel-group study Background Few randomized trials compared antifungals (fluconazole and capsofungin) to placebo empirically in critically ill septic patients. They failed to provide any benefit, however, empirical antifungal therapy is recommended … Read more
In first of its kind study, Mehrotra et el, compared 234 physicians (mostly residents and fellows) to Human Dx (a web and app based program to generate diagnosis). Overall, they compared diagnoses for 45 clinical vignettes( 15 high, 15 medium, and 15 low-acuity condition vignettes and 26 common and 19 uncommon condition vignettes). No physical exam details … Read more