PERC rules safely exclude PE in low risk patients(PROPER Trial)

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 …

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Hydrocortisone plus Fludrocortisone in Septic Shock

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) …

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Early APRV in ARDS

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. …

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Adrenal Trial : Steroids are down but not out

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 …

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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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