Author: RS

2019 Focused update on Advanced cardiac life support

RS November 25, 2019November 25, 2019

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 …

Prevention of Early Ventilator-Associated Pneumonia after Cardiac Arrest

RS November 16, 2019

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 …

IDSA/ATS guidelines for community acquired pneumonia

RS November 5, 2019November 5, 2019

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. …

Targeted Temperature Management in Cardiac Arrest with Nonshockable Rhythm

RS October 21, 2019

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 …

Vitamin C in sepsis- Answer is elusive

RS October 8, 2019October 13, 2019

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 …

Critical care trials which showed reduced mortality

RS September 22, 2019September 22, 2019

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 …

Inferior Vena Caval filters in Severely injured patients

RS August 26, 2019August 26, 2019

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 …

Dexmedetomidine in Critically Ill patients

RS July 23, 2019July 23, 2019

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 …

Paralytics in ARDS

RS June 13, 2019

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). …

Newer Antibiotics for Acute Skin Infections

RS May 6, 2019May 6, 2019

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, …

Newer Antibiotics for Community Acquired Pneumonia

RS April 2, 2019

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, …

Norepinephrine superior in cardiogenic shock after myocardial infarction

RS March 21, 2019March 21, 2019

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 …

Update from Critical Care Congress

RS February 23, 2019February 23, 2019

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 …

Steroids in Septic Shock- Debate continues

RS January 28, 2019

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 …

Timing of renal replacement therapy in septic shock

RS January 1, 2019January 1, 2019

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 …

Month of negative studies

RS November 25, 2018

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. …

Do not discard haloperidol yet

RS November 12, 2018 1

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 …

What should we stop doing in ICU right now ?

RS October 21, 2018October 21, 2018

Dr Fernando Zampieri MD PhD published a thought provoking article in ICU management and practice. This takes an example of use of CRP in diagnosing ventilator associated pneumonia and various clinician biases. In the end, there is an exhaustive list of things which we do today which are not proven to be beneficial.

Intraosseous Access is associated with lower survival in out of hospital cardiac arrest

RS October 4, 2018

Takahisa Kawano, Brian Grunau, Frank X. Scheuermeyer et el published a study comparing intraosseous versus intravenous vascular access on survival as well as neurological outcome in out of hospital cardiac arrest in Annals of emergency medicine. BACKGROUND Intraosseous access (IO) was first pioneered by Drinkler and colleagues in 1922 but it became popular as a substitute to …

It is okay to abruptly stop steroids in resolving septic shock

RS September 25, 2018

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 …