Norepinephrine better than Terlipressin in Septic Shock

Liu ZM, Chen J, Kou Q et el published results of a randomized trial in intensive care medicine comparing Terlipressin with Norepinephrine in septic shock. BACKGROUND Norepinephrine (NE) is first line recommended agent for correcting hypotension in septic shock. Terlipressin is a synthetic long acting analogue of Vasopressin which has higher affinity for V1 receptor. …

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Relief Trial : Liberal fluids (?) in abdominal surgical patients

P.S. Myles, R. Bellomo, T. Corcoran et el published results of Relief trial (Restrictive versus Liberal Fluid Therapy in Major Abdominal Surgery) in New England Journal of Medicine. BACKGROUND Each year, 310 million surgeries happen world wide. These patients end up getting large amounts of intravenous fluids leading to fluid overload.  A study published in 2003, showed that fluid …

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FDA approved First Factor Xa Inhibitor Antidote

An estimated 4 million people are taking factor Xa inhibitors, such as rivaroxaban (Xarelto, Bayer/Janssen Pharmaceuticals) and apixaban (Eliquis, Bristol-Myers Squibb). In the USA, Apixaban generated 4.9 billion dollars for the company last year. Until now, there was no approved reversal agent for these factor Xa inhibitors. In the United States alone, there were approximately …

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Vasopressin in septic shock : Tapering and atrial fibrillation

In last few weeks, two studies on Vasopressin(AVP) were published which shed some light on its profile and use. In the first study, William F. McIntyre, Kevin J. Um et el published a meta analysis and systemic review of use of vasopressin and vasopressin plus catecholamines in distributive shock in JAMA. Authors searched Medline, Embase and …

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Intra abdominal hypertension : More common than thought

Patrick B. Murphy, Neil G. Parry et el published a prospective study of prevalance of intra-abdominal hypertension in mixed medical-surgical critically ill patients . WHERE It was a prospective observational study in a single institute,  Including trauma, medical and surgical patients, in the Canada. WHAT THEY DID All adult (> 18 yr old) patients admitted to the …

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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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