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

Faster is better ? : Chest compressions in CPR

Latest AHA guidelines about adult CPR emphasize on high quality chest compression, currently at the rate of 100 to 120 per minute. In a prospective observational study, Kilgannon JH et al demonstrated that chest compression rate of 121–140 compressions/min had the highest odds ratio of ROSC. What they did 222 consecutive patients were enrolled in study,  found … Read more

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