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

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

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

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

Update from Critical Care Congress

Many late breaking trials/studies were announced in this year’s critical care Congress. Here is the summary of few important ones. ANDROMEDA-SHOCK trial compared 424 adults with early septic shock were randomized to 2 alternative 8-hour resuscitation strategies: one based on serial measurements of serum lactate levels and the other on peripheral perfusion, assessed by serial … 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

Timing of renal replacement therapy in septic shock

S.D. Barbar, R. Clere-Jehl, A. Bourredjem, R. Hernu et el  published a study about timing of renal replacement therapy in patients with septic shock and acute kidney injury.  BACKGROUND Patients hospitalized in the intensive care unit (ICU) for septic shock frequently develop acute kidney injury and is associated with high mortality.  When to provide  the renal replacement … Read more

Month of negative studies

Last 2 months have produced several negative studies in the field of critical care. It is worthwhile to look at these studies altogether. In the first study published in JAMA by Wittekamp BH, Plantinga NL, Cooper BS et el , the effects of chlorhexidine (CHX) mouthwash, selective oropharyngeal decontamination (SOD), and selective digestive tract decontamination (SDD) was compared.  … Read more

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