Delayed thrombectomy in acute stroke effective

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 …

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Elusive answer : Balanced fluids vs saline in critical care

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 …

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Lung Recruitment in ARDS

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 …

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Old blood and female blood

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 …

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Enteral nutrition is better in Severe Pancreatitis : Another study

H Yao, C He, L Deng, G Liao et el  published in the European Journal of nutrition a meta analysis of small trials, comparing enteral versus parenteral nutrition in cases of severe pancreatitis. They analyzed the evidence from 348 patients from 5 small randomized trials. Meta-analysis showed significantly lower overall mortality risk with EN than with PN (risk ratio, 0.36; …

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ESICM/ESCMID/ALAT guidelines for the management of HAP and VAP

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 …

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