Vit C fails to deliver- VITAMINS trial

Tomoko Fujii,  Nora Luethi,  Paul J. Young et al  published the results of   much awaited VITAMINS (The Vitamin C, Hydrocortisone and Thiamine in Patients With Septic Shock) trial.   WHAT It was an investigator-initiated, multicenter, open-label, parallel-group randomized trial comparing vitamin-C, thiamine and hydrocortisone to hydrocortisone alone in patients with septic shock. WHERE 10 intensive … Read more Vit C fails to deliver- VITAMINS trial

Balanced crystalloids are gaining ground in sepsis?

Brown RM, Wang L, Coston TD , Krishnan NI et el published a secondary analysis of patients from SMART (Isotonic Solutions and Major Adverse Renal Events Trial) admitted with sepsis to ICU. Original  smart trial  was published in 2017,  which is discussed here .  A total of 15,802 patients  were enrolled in the trial.  It was a pragmatic, cluster-level … Read more Balanced crystalloids are gaining ground in sepsis?

‘Wrong-Pipe’ Intubation Deaths still common

ProPublica published research done by Dr. Nick Asselin on cardiac arrests in Rhode Island and found esophageal intubation by EMS providers in 12 cases.  All of the patients died.  This story brings the attention back to skills needed to correctly intubate the patient in setting of stress of ongoing CPR. RESEARCH Rhode Island is the … Read more ‘Wrong-Pipe’ Intubation Deaths still common

2019 Focused update on Advanced cardiac life support

American Heart Association published focused update on Advanced Cardiac Life Support in conjunction with 2019 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendation from International liaison committee on resuscitation(ILCOR). This focus update  provide new recommendations for use of advanced airways, vasopressors and extracorporeal CPR( ECPR).  Rest of the guidelines remain … Read more 2019 Focused update on Advanced cardiac life support

Prevention of Early Ventilator-Associated Pneumonia after Cardiac Arrest

Bruno François, Alain Cariou, Raphaël Clere-Jehl et el published a trial of  intravenous amoxicillin-clavulanate versus placebo  in patients undergoing  targeted temperature management and mechanical ventilation for out of hospital cardiac arrest  with shockable rhythm. BACKGROUND  Targeted temperature management remains  cornerstone of therapy for  out of hospital cardiac arrest.  however targeted temperature management is associated with … Read more Prevention of Early Ventilator-Associated Pneumonia after Cardiac Arrest

IDSA/ATS guidelines for community acquired pneumonia

Joshua P. Metlay, Grant W. Waterer, Ann C. Long et el published the official IDSA /ATS guidelines for treatment of community-acquired pneumonia. BACKGROUND Last IDSA/ATS Guidelines for community-acquired pneumonia were updated in 2007 . In 2016,  IDSA/ATS updated guidelines on  ventilator-associated pneumonia as well as Hospital-acquired pneumonia which were discussed in comparison with European guidelines here. … Read more IDSA/ATS guidelines for community acquired pneumonia

Targeted Temperature Management in Cardiac Arrest with Nonshockable Rhythm

J.B. Lascarrou, H. Merdji, A. Le Gouge et el published the results of HYPERION (Hypothermia after Cardiac Arrest in Nonshockable Rhythm) trial in NEJM. WHAT Open-label, randomized, controlled trial comparing moderate therapeutic hypothermia (33°C during the first 24 hours) with targeted normothermia (37°C) in adult patients with coma(GCS <8) after resuscitation from cardiac arrest with … Read more Targeted Temperature Management in Cardiac Arrest with Nonshockable Rhythm

Critical care trials which showed reduced mortality

Carlos A. Santacruz, Adriano J. Pereira et el published a systematic review in Critical Care Medicine about trials which showed reduced mortality. All trials published since inception to April, 2019 were searched in MEDLINE and pubmed (Adult, multicenter randomized controlled). A total of 212 trials were included. 27 trials reported reduction in mortality. 16 trials … Read more Critical care trials which showed reduced mortality

Inferior Vena Caval filters in Severely injured patients

Kwok M. Ho, Sudhakar Rao, Stephen Honeybul Whereet el published results of a multicenter randomized trial of early prophylactic IVC filters in severely injured patients with contraindication to anticoagulation  in NEJM. BACKGROUND Venous thromboembolism is very common after major trauma and leads to major morbidity and mortality. In the prospective study of trauma patients who … Read more Inferior Vena Caval filters in Severely injured patients

Dexmedetomidine in Critically Ill patients

Y. Shehabi, B.D. Howe, R. Bellomo et el recently published results of SPICE III trial (Sedation Practice in Intensive Care Evaluation), dexmedetomidine as the sole or primary sedative comparing to receive usual care (propofol, midazolam, or other sedatives). BACKGROUND Dexmedetomidine was initially approved by the United States Food and Drug Administration (FDA) in 1999 for the … Read more Dexmedetomidine in Critically Ill patients

Paralytics in ARDS

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 Paralytics in ARDS

First spontaneous unilateral moderate to large pneumothorax can be treated conservatively. Read more
+