Covid 19 : Current Knowledge and gaps

Since the beginning of the pandemic with covid-19, We have learned a lot  regarding prevention and treatment. However,  the knowledge Gap exists. Recent JAMA  editorial summarized this for severe covid-19.   PREVENTION Social distancing, frequent hand washing and mask wearing by the general public reduces the transmission  of covid 19. Contact tracing and isolation are … Read more

COVID 19 for critical care

Updated 7/22/2020 Since the discovery of Covid 19(Coronavirus SARS COV 2) in December 2019, flow of information and circumstances are changing everyday. It is hard to keep up with so much information and sort out real from myths. In general, following points are important to remember which are referenced from reputable sources Tolicizumab is the … Read more

IV Thiamine fails again in Septic Shock

Miyamoto, Yoshihisa, Aso, Shotaro et el published results of retrospective Cohort study in critical care medicine. With ongoing covid 19, all possible medications are being tried for which they were not originally intended. Similarly several medications have been tried in septic shock but failed. Recent trial was discussed here. Given there was a lot of … Read more

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

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

Steroids in Septic Shock- Debate continues

Fang Fang, Yu Zhang, Jingjing Tang et el published a meta-analysis of use of corticosteroids in septic shock in Dec, 2018 in JAMA internal medicine. This ignites the age old debate of use of steroids in septic shock.  You may recall that B. Venkatesh, S. Finfer, J. Cohen, D. Rajbhandari et el published adrenal trial which showed that … Read more

SeptiCyte : RNA transcript based test for sepsis

In February, 2017,  FDA approved a new assay (Rt-Qpcr) for Mrna Transcript Immune Biomarkers to detect sepsis.  It is a quantitative gene expression assay using reverse transcription polymerase chain reaction to quantify the relative expression levels of host response genes isolated from whole blood. This test is not widely available, and currently it takes about … Read more

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) … Read more

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 … Read more

Bundle to reduce ventilator associated events

Nishi Rawat, Ting Yang,  Kisha J. Ali et el  published a two state multifaceted intervention study showing benefits of improved compliance with evidence based practices can reduce ventilator-associated event, infection-related ventilator- associated complication, and probable ventilator-associated pneumonia. It was a longitudinal quasi-experimental study involving 56 ICUs at 38 hospitals in Maryland and Pennsylvania from October 2012 to March 2015. PROBLEM … Read more

Another retrospective study proving early antibiotics in sepsis improves mortality

Christopher W. Seymour, Foster Gesten et el published a retrospective study in NEJM looking at impact of implementation of bundle treatment in sepsis. WHAT THEY DID Looked at the data(On patients with sepsis and septic shock, community acquired only) reported to New York Health Department from April 1, 2014, to June 30, 2016. More than 98% of … Read more