RS Since the discovery of Covid 19(Coronavirus SARS COV 2) in December 2019, flow of information and circumstances are changing everyday. It is hard to keep up with so much information and sort out real from myths. Here is a short and sweet summary from Massachusetts General Hospital to take care of Covid 19 patient. … Read more COVID 19 for critical care
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 Mechanical ventilation without sedation
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 Vit C fails to deliver- VITAMINS trial
Brown RM, Wang L, Coston TD , Krishnan NI et el published a secondary analysis of patients from SMART (Isotonic Solutions and Major Adverse Renal Events Trial) admitted with sepsis to ICU. Original smart trial was published in 2017, which is discussed here . A total of 15,802 patients were enrolled in the trial. It was a pragmatic, cluster-level … Read more Balanced crystalloids are gaining ground in sepsis?
ProPublica published research done by Dr. Nick Asselin on cardiac arrests in Rhode Island and found esophageal intubation by EMS providers in 12 cases. All of the patients died. This story brings the attention back to skills needed to correctly intubate the patient in setting of stress of ongoing CPR. RESEARCH Rhode Island is the … Read more ‘Wrong-Pipe’ Intubation Deaths still common
American Heart Association published focused update on Advanced Cardiac Life Support in conjunction with 2019 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendation from International liaison committee on resuscitation(ILCOR). This focus update provide new recommendations for use of advanced airways, vasopressors and extracorporeal CPR( ECPR). Rest of the guidelines remain … Read more 2019 Focused update on Advanced cardiac life support
Bruno François, Alain Cariou, Raphaël Clere-Jehl et el published a trial of intravenous amoxicillin-clavulanate versus placebo in patients undergoing targeted temperature management and mechanical ventilation for out of hospital cardiac arrest with shockable rhythm. BACKGROUND Targeted temperature management remains cornerstone of therapy for out of hospital cardiac arrest. however targeted temperature management is associated with … Read more Prevention of Early Ventilator-Associated Pneumonia after Cardiac Arrest
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 IDSA/ATS guidelines for community acquired pneumonia
J.B. Lascarrou, H. Merdji, A. Le Gouge et el published the results of HYPERION (Hypothermia after Cardiac Arrest in Nonshockable Rhythm) trial in NEJM. WHAT Open-label, randomized, controlled trial comparing moderate therapeutic hypothermia (33°C during the first 24 hours) with targeted normothermia (37°C) in adult patients with coma(GCS <8) after resuscitation from cardiac arrest with … Read more Targeted Temperature Management in Cardiac Arrest with Nonshockable Rhythm
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 Vitamin C in sepsis- Answer is elusive
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 Critical care trials which showed reduced mortality
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 Inferior Vena Caval filters in Severely injured patients