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

Do not discard haloperidol yet

T.D. Girard, M.C. Exline, S.S. Carson, C.L. Hough, P. Rock, M.N. Gong et el  published the results of MIND-USA(Modifying the Impact of ICU-Induced Neurological Dysfunction-USA) trial in New England Journal of Medicine October 22, 2018 Issue.  STUDY It was a randomized, double-blind, placebo-controlled trial comparing patients with acute respiratory failure or shock and hypoactive or hyperactive delirium to … Read more

It is okay to abruptly stop steroids in resolving septic shock

Kristine A. Sobolewski , Alison Brophy , Yekaterina Opsha et el published a retrospective cohort study comparing abrupt withdrawal versus taper of hydrocortisone in resolving septic shock patients. BACKGROUND Severe sepsis and septic shock remains one of the most common diagnosis as well as cause of death in intensive care units around the world. Hydrocortisone has been shown to quicker … Read more

Epinephrine in Cardiac arrest : Saves lives but not brain

G.D. Perkins, C. Ji, C.D. Deakin, T. Quinn et el  published a trial of epinephrine in out of hospital cardiac arrest in NEJM ( PARAMEDIC2 Collaborators ). BACKGROUND Epinephrine  causes constriction of arterioles mediated by α-adrenergic receptors. Such constriction increases aortic diastolic pressure during CPR, thereby augmenting coronary blood flow and increasing the chance of a return of spontaneous circulation.  It … Read more

FDA approves Sodium Zirconium Cyclosilicate for Hyperkalemia

In May, 2018, FDA approved Sodium Zirconium Cyclosilicate (ZS-9) for treatment of hyperkalemia. This is available as Lokelma in USA, manufactured by AstraZeneca. This is the third drug in the category of Gastrointestinal cation exchangers for treatment of hyperkalemia. Earlier two drugs are sodium polystyrene sulfonate(Kayexalate, approved in 1958) and patiromer(Approved in 2015). Its efficacy … Read more

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. … Read more

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 … 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

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 … Read more

New class of drug for septic/ Vasodilatory shock

Ashish Khanna, M.D., Shane W. English, M.D., Xueyuan S. Wang, M.D et el Published in NEJM a new trial Of angiotensin II in vasodilatory shock [Treatment of High-Output Shock (ATHOS-3) trial]. Background Vasodilatory shock is the most common cause of shock in the critical care world. It is charecterized by peripheral vasodilatation and reduce blood pressure … Read more

New assay to diagnose late acetaminophen toxicity

Roberts DW, Lee WM, Hinson JA et el published a observational cohort study in Clinical Gastroenterology and Hepatology journal about utility of  point-of-care assay to detect acetaminophen protein adducts in patients suspected to have acetaminophen toxicity. They compared the accuracy of AcetaSTAT vs high-pressure liquid chromatography with electrochemical detection (HPLC-EC; a sensitive and specific quantitative analytic assay) to … Read more

Remdesivir, Hydroxychloroquine, Lopinavir/Ritonavir and Interferon, all fail in Solidarity trial.Read more