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

Tranexamic Acid fails to work in Gastrointestinal hemorrhage

Ian Roberts, Haleema Shakur-Still , Adefemi Afolabi, Christopher Hawkey et el (HALT-IT trial investigators) published a trial in Lancet  comparing tranexamic acid to placebo in gastrointestinal hemorrhage. Background Tranexamic acid(TXA) is known to prevent the  fibrinolysis.  Early use of TXA reduces surgical bleeding and death related to bleeding from traumatic injury and has reduced 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

Mechanical ventilation without sedation

Hanne T. Olsen, Helene K. Nedergaard et el published a trial of no sedation versus light sedation in mechanically ventilated patients in NEJM. WHAT Multi center  randomized controlled trial,  in a 1 : 1 ratio,  comparing be mechanically ventilated ICU patients to  no sedation  versus  light sedation strategy( RASS  Richmond agitation and sedation Scale score … Read more

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

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

Vitamin C in sepsis- Answer is elusive

Alpha A. Fowler , Jonathon D. Truwit , R. Duncan Hite et el published results of CITRIS-ALI trial in JAMA on Oct1, 2019. WHAT It was a randomized double blind placebo controlled multi Center trial  conducted in 7 medical ICUs in the USA,  comparing placebo to  vitamin-C infusion( 50 milligram/kilogram,  every 6 hours for 96 … Read more

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

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

Newer Antibiotics for Acute Skin Infections

Skin and soft-tissue infections (SSTIs) or Acute bacterial skin and skin-structure infections (ABSSSIs) encompass a variety of pathological conditions that involve the skin and underlying subcutaneous tissue, fascia, or muscle, ranging from simple superficial infections to severe necrotizing infections. Two terms are used interchangeably in literature but according to FDA, ABSSSIs include cellulitis/erysipelas, wound infection, … Read more

Newer Antibiotics for Community Acquired Pneumonia

Community-acquired pneumonia (CAP) is the leading cause of death worldwide, with a significant impact on morbidity rates. Increasing antibiotic resistance amongst the common bacterial pathogens associated with CAP, especially staphylococci and Streptococcus pneumoniae, has made the empiric treatment of this infection increasingly problematic. Approximately 6% of CAP are caused by antibiotic-resistant pathogens. During recent decades, … Read more

Norepinephrine superior in cardiogenic shock after myocardial infarction

Levy B, Clere-Jehl R, Legras A et el published results of prospective double-blind multicenter randomized control trial comparing Epinephrine and norepinephrine in patients with cardiogenic shock secondary to percutaneous coronary intervention treated acute myocardial infarction. BACKGROUND Use of vasopressor agents during severe cardiogenic shock is  to maintain the adequacy of and organ blood flow, which … Read more

Steroids Have No Effect on ICU Outcomes in Intubated Patients With Angioedema.Read more
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