Critical Care Update – Page 6 – Whats New in Critical Care

Paralytics in ARDS

June 13, 2019 by RS

The National Heart, Lung, and Blood Institute PETAL Clinical Trials Network published a large randomized controlled trial comparing NMBs(neuromuscular blocker) to placebo in patients with moderate to severe adult respiratory distress syndrome(PEEP of at least >8 with ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen of <150 mm Hg). … Read more

Newer Antibiotics for Acute Skin Infections

May 6, 2019 by RS

Skin and soft-tissue infections (SSTIs) or Acute bacterial skin and skin-structure infections (ABSSSIs) encompass a variety of pathological conditions that involve the skin and underlying subcutaneous tissue, fascia, or muscle, ranging from simple superficial infections to severe necrotizing infections. Two terms are used interchangeably in literature but according to FDA, ABSSSIs include cellulitis/erysipelas, wound infection, … Read more

Newer Antibiotics for Community Acquired Pneumonia

April 2, 2019 by RS

Community-acquired pneumonia (CAP) is the leading cause of death worldwide, with a significant impact on morbidity rates. Increasing antibiotic resistance amongst the common bacterial pathogens associated with CAP, especially staphylococci and Streptococcus pneumoniae, has made the empiric treatment of this infection increasingly problematic. Approximately 6% of CAP are caused by antibiotic-resistant pathogens. During recent decades, … Read more

Norepinephrine superior in cardiogenic shock after myocardial infarction

March 21, 2019 by RS

Levy B, Clere-Jehl R, Legras A et el published results of prospective double-blind multicenter randomized control trial comparing Epinephrine and norepinephrine in patients with cardiogenic shock secondary to percutaneous coronary intervention treated acute myocardial infarction. BACKGROUND Use of vasopressor agents during severe cardiogenic shock is to maintain the adequacy of and organ blood flow, which … Read more

Update from Critical Care Congress

February 23, 2019 by RS

Many late breaking trials/studies were announced in this year’s critical care Congress. Here is the summary of few important ones. ANDROMEDA-SHOCK trial compared 424 adults with early septic shock were randomized to 2 alternative 8-hour resuscitation strategies: one based on serial measurements of serum lactate levels and the other on peripheral perfusion, assessed by serial … Read more

Steroids in Septic Shock- Debate continues

January 28, 2019 by RS

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

Timing of renal replacement therapy in septic shock

January 1, 2019 by RS

S.D. Barbar, R. Clere-Jehl, A. Bourredjem, R. Hernu et el published a study about timing of renal replacement therapy in patients with septic shock and acute kidney injury. BACKGROUND Patients hospitalized in the intensive care unit (ICU) for septic shock frequently develop acute kidney injury and is associated with high mortality. When to provide the renal replacement … Read more

Month of negative studies

November 25, 2018 by RS

Last 2 months have produced several negative studies in the field of critical care. It is worthwhile to look at these studies altogether. In the first study published in JAMA by Wittekamp BH, Plantinga NL, Cooper BS et el , the effects of chlorhexidine (CHX) mouthwash, selective oropharyngeal decontamination (SOD), and selective digestive tract decontamination (SDD) was compared. … Read more

Do not discard haloperidol yet

November 12, 2018 by RS

T.D. Girard, M.C. Exline, S.S. Carson, C.L. Hough, P. Rock, M.N. Gong et el published the results of MIND-USA(Modifying the Impact of ICU-Induced Neurological Dysfunction-USA) trial in New England Journal of Medicine October 22, 2018 Issue. STUDY It was a randomized, double-blind, placebo-controlled trial comparing patients with acute respiratory failure or shock and hypoactive or hyperactive delirium to … Read more

What should we stop doing in ICU right now ?

October 21, 2018 by RS

Dr Fernando Zampieri MD PhD published a thought provoking article in ICU management and practice. This takes an example of use of CRP in diagnosing ventilator associated pneumonia and various clinician biases. In the end, there is an exhaustive list of things which we do today which are not proven to be beneficial.

Intraosseous Access is associated with lower survival in out of hospital cardiac arrest

October 4, 2018 by RS

Takahisa Kawano, Brian Grunau, Frank X. Scheuermeyer et el published a study comparing intraosseous versus intravenous vascular access on survival as well as neurological outcome in out of hospital cardiac arrest in Annals of emergency medicine. BACKGROUND Intraosseous access (IO) was first pioneered by Drinkler and colleagues in 1922 but it became popular as a substitute to … Read more

It is okay to abruptly stop steroids in resolving septic shock

September 25, 2018 by RS

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