Should you extubate during night ? Yes, if you are there!

Gershengorn et al published in JAMA a very large retrospective cohort study of 97 844 patients from 165 US ICUs who participate in Project Impact from October 1, 2000, to March 29, 2009. Authors created  4518 propensity-matched pairs of patients with less than 12 hours of Mechanical ventilation and 5761 propensity-matched pairs of patients with mechanical ventilation of more … Read more

Adjunctive early hydrocortisone therapy does not prevent the development of septic shock in patients with severe sepsis

The Hydrocortisone  for Prevention of Septic Shock (HYPRESS) study was published in JAMA on Oct 3, 2016. 380 patients with sepsis (with evidence of infection plus at least 2 systemic inflammatory response syndrome criteria and evidence of organ dysfunction ) were  randomized either to receive a continuous infusion of 200 mg of hydrocortisone for 5 days or placebo. There … Read more

Inform Trial : No effect of blood storage time on mortality after transfusion

Inform trial results were published in NEJM on Oct 24, 2016. 31,497 adult patients  at six hospitals in four countries (Australia, Canada, Israel and the U.S) were randomized to receive short or long term stored blood. There was no difference in mortality among two groups. Earlier, a meta analysis of 12 randomized trials showed no … Read more

THRACE TRIAL : Mechanical thrombectomy is better than Alteplase alone in Stroke

Bracard S et el  in recently published THRACE trial compared mechanical thrombectomy in addition to standard Alteplase for stroke. Mechanical thrombectomy in addition to standard care improved clinical outcomes (functional independence at 3 months (odds ratio 1.55, 95% CI 1.05-2.30; p=0.028). There was no difference in mortality or symptomatic intracranial hemorrhage in two groups. Common adverse … Read more

Pulmonary Embolism presenting as Syncope : Scare mongering at best

PESIT INVESTIGATORS published in this week of NEJM, reported that 17.3% of patients had PE who were admitted with first syncope to the hospital. This study has been circulated in various newspapers (1, 2, 3) as if  physicians are missing the big deadly cause of fainting spells, which is plain scare mongering. Emergency room physicians are already overusing … Read more

New Nomogram to predict Surgical ICU readmission

Martin et el  from the University of Utah School of Medicine, Salt Lake City developed a new nomogram to predict Surgical ICU readmission. What they did Studied 3,109 SICU admissions, with 141 patients readmissions within 72 hours of discharge from ICU. Came up with following risk factors patient age respiratory rate (breaths per minute) history of … Read more

Journal club : Empiricus trial

Empirical Micafungin Treatment and Survival Without Invasive Fungal Infection in Adults With ICU-Acquired Sepsis, Candida Colonization, and Multiple Organ Failure The EMPIRICUS Randomized Clinical a multicenter, randomized, double-blind, and parallel-group study Background Few randomized trials compared antifungals (fluconazole and capsofungin) to placebo empirically in critically ill septic patients. They failed to provide any benefit, however, empirical antifungal therapy is recommended … Read more

Your job is safe : For now

In first of its kind study, Mehrotra et el, compared 234 physicians (mostly residents and fellows) to Human Dx (a web and app based program to generate diagnosis). Overall, they compared diagnoses for 45 clinical vignettes( 15 high, 15 medium, and 15 low-acuity condition vignettes and 26 common and 19 uncommon condition vignettes). No physical exam details … Read more

Blood transfusion: Less is more

In the current issue of JAMA, published October 12, Carson et el have updated red blood cell (RBC) transfusion guidelines by AABB (American Association of Blood Banks). Based on review of 31 randomized clinical trials (RCTs) performed in a variety of different clinical settings involving more than 12 587 patients.   Main recommendations Transfusion  not indicated … Read more

Time to say good bye to routine stress ulcer prophylaxis in ICU

Accepting that the world is full of uncertainty and ambiguity does not and should not stop people from being pretty sure about a lot of things. Julian Baggini WHATS NEW Pantoprazole or Placebo for Stress Ulcer Prophylaxis (POP-UP Study) In this randomized Double-Blind Exploratory Study by Selvanderan et el 214 patients were randomized to pantoprazole … Read more

Don’t cool for in hospital cardiac arrest

Targeted temperature management (TTM, therapeutic hypothermia) after cardiac arrest first came to use in clinical setting since the publication of two landmark articles in 2002. Evidence was mainly for out of hsopital cardiac arrest patients. Recently, it was noted that there was no difference in outcome between temperatures of 33 and 36 Celsius. However, based … Read more

As of April 4, the EMA had received reports of 169 cases of cerebral clotting and 53 cases of abdominal clotting out of about 34 million AstraZeneca vaccine.Read more