Securing airway in setting of massive vomiting or bleeding can be challanging and following a proper algorithm can save life. Dr. James DuCanto has been a pioneer in developing SALAD algorithm( Suction-Assisted Laryngoscopy Assisted Decontamination System). This video by him shows how to do it perfectly….
Yonathan Freund, Marine Cachanado et el published in JAMA the results of PROPER trial which evaluated safety of PERC criteria in low risk patients at ruling out pulmonary embolism. BACKGROUND PERC criteria were first suggested by Kline JA , Mitchell AM et el in 2004. They include the following Arterial oxygen saturation (SpO2) of 94%or less, Pulse rate … 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
Yongfang Zhou, Xiaodong Jin published a study in Intensive care medicine journal about using APRV early in ARDS. WHAT THEY DID Randomized adult patients with ARDS (Berlin definition, P:F ratio <250) who were on mechanical ventilation to APRV(Airway pressure release ventilation) or LTV(low tidal volume) mode of mechanical ventilation. Patients were enrolled within 48 hours. … 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
Patel KK, Spertus JA , Khariton Y et el published in Circulation a retrospective study of patients of in hospital cardiac arrest looking at timing of Epinephrine in PEA arrest and defibrillation in shockable rhythm. They looked at the data for 36,961 patients aged ≥65 years with an IHCA at 517 hospitals between 2000 and 2011. (National … Read more
The FDA approved angiotensin-II (Giapreza) as a new intravenous vasopressor for septic shock and other forms of distributive shock. The first new FDA-approved vasopressor in decades. This is based on recent trial, which was discussed here. https://wp.me/padfoC-7C
R.G. Nogueira, A.P. Jadhav, D.C. Haussen et el published in NEJM on Nov 18,2017 trial results of delayed(6-24 hours) thrombectomy in acute stroke patients who had a mismatch between the severity of the clinical deficit and the infarct volume, conducted at 26 centers in the United States, Canada, Europe, and Australia. BACKGROUND National Institute of Neurologic Disorders and Stroke … Read more
In a late breaking abstract in the CHEST meeting in Toronto, Matthew Semler, Wesley Self, Todd Rice et el presented finding of their SMART(The Isotonic Solutions and Major Adverse Renal Events Trial) trial. They reported that total of 1,139 patients (14.3%) in the balanced crystalloid group experienced the primary outcome of MAKE30(Major Adverse Kidney Events within 30 … Read more
Recently, two papers were published, one a trial and other one a meta analysis about lung recruitment in ARDS. First study, published in JAMA, was a trial of lung recruitment and Titrated Positive End-Expiratory Pressure (PEEP) vs Low PEEP in ARDS(ART Investigators), published by Cavalcanti AB, Suzumura ÉA et el. They compared total of 1010 patients of … Read more
Two recent studies caught my eye, both about blood transfusion. The first study was published in NEJM by Cooper DJ, McQuilten ZK, Nichol A et el comparing use of freshest vs oldest available blood in critically ill patients. In this international, multi center, randomized, double-blind trial, critically ill adults were assigned to receive either the freshest available, compatible, allogeneic red cells (short-term … Read more
Endotracheal intubation is one of the most common and critical procedure performed in intensive care unit. Two recent studies provide some insight in to the ideal position and use of bougie in intubation. Semler MW and Janz DR et el published in this month’s Chest about optimal positioning for successful intubation. In this Multi center, randomized trial they … Read more