Author: RS

Laryngeal tube insertion in out of hospital cardiac arrest may save lives

Henry E.Wang, Robert H. Schmicker,  Mohamud R. Daya et el  published PART trial (Pragmatic Airway Resuscitation Trial) in which they compared laryngeal tube insertion with endotracheal intubation in out of hospital cardiac arrest.  BACKGROUND About 350000 adults in the United States suffer out of hospital cardiac arrest each year, with less than 10%surviving to hospital discharge.  More …

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No effect of early cycling exercise in ICU

Guillaume Fossat,  Florian Baudin,  Léa Courtes et el  published a trial of in-bed cycling exercises and electrical stimulation versus standard rehabilitation in critically ill patients.  BACKGROUND About half of patients admitted to Intensive care units experience muscle weakness and wasting which may persist for up to 5 years.  Factors contributing are inflammation, metabolic disorders, sedation and prolonged …

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Plasma as pre hospital resuscitation in trauma patients

J.L. Sperry, F.X. Guyette, J.B. Brown, M.H. Yazer et el published a trial of plasma vs standard fluid resuscitation in trauma patients who were at risk of hemorrhagic shock while being transported by air medical services. BACKGROUND In hospital treatment of trauma involves “damage control resuscitation” which aims to prevent coagulopathy by minimization of the use of crystalloid-based …

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Epinephrine in Cardiac arrest : Saves lives but not brain

G.D. Perkins, C. Ji, C.D. Deakin, T. Quinn et el  published a trial of epinephrine in out of hospital cardiac arrest in NEJM ( PARAMEDIC2 Collaborators ). BACKGROUND Epinephrine  causes constriction of arterioles mediated by α-adrenergic receptors. Such constriction increases aortic diastolic pressure during CPR, thereby augmenting coronary blood flow and increasing the chance of a return of spontaneous circulation.  It …

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FDA approves Sodium Zirconium Cyclosilicate for Hyperkalemia

In May, 2018, FDA approved Sodium Zirconium Cyclosilicate (ZS-9) for treatment of hyperkalemia. This is available as Lokelma in USA, manufactured by AstraZeneca. This is the third drug in the category of Gastrointestinal cation exchangers for treatment of hyperkalemia. Earlier two drugs are sodium polystyrene sulfonate(Kayexalate, approved in 1958) and patiromer(Approved in 2015). Its efficacy …

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Flexible Versus Restrictive Visiting Policies in ICUs

Antonio Paulo Nassar Junior, Bruno Adler Maccagnan Pinheiro Besen et el published a meta analysis and systematic review in critical care medicine about restrictive and flexible visiting policies in ICUs.  BACKGROUND Most ICUs worldwide place restrictions on visiting patients due to fear of infection, disorganization of care and increased workload on staff. Liberal visiting hours have …

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Norepinephrine better than Terlipressin in Septic Shock

Liu ZM, Chen J, Kou Q et el published results of a randomized trial in intensive care medicine comparing Terlipressin with Norepinephrine in septic shock. BACKGROUND Norepinephrine (NE) is first line recommended agent for correcting hypotension in septic shock. Terlipressin is a synthetic long acting analogue of Vasopressin which has higher affinity for V1 receptor. …

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Relief Trial : Liberal fluids (?) in abdominal surgical patients

P.S. Myles, R. Bellomo, T. Corcoran et el published results of Relief trial (Restrictive versus Liberal Fluid Therapy in Major Abdominal Surgery) in New England Journal of Medicine. BACKGROUND Each year, 310 million surgeries happen world wide. These patients end up getting large amounts of intravenous fluids leading to fluid overload.  A study published in 2003, showed that fluid …

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FDA approved First Factor Xa Inhibitor Antidote

An estimated 4 million people are taking factor Xa inhibitors, such as rivaroxaban (Xarelto, Bayer/Janssen Pharmaceuticals) and apixaban (Eliquis, Bristol-Myers Squibb). In the USA, Apixaban generated 4.9 billion dollars for the company last year. Until now, there was no approved reversal agent for these factor Xa inhibitors. In the United States alone, there were approximately …

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Vasopressin in septic shock : Tapering and atrial fibrillation

In last few weeks, two studies on Vasopressin(AVP) were published which shed some light on its profile and use. In the first study, William F. McIntyre, Kevin J. Um et el published a meta analysis and systemic review of use of vasopressin and vasopressin plus catecholamines in distributive shock in JAMA. Authors searched Medline, Embase and …

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Intra abdominal hypertension : More common than thought

Patrick B. Murphy, Neil G. Parry et el published a prospective study of prevalance of intra-abdominal hypertension in mixed medical-surgical critically ill patients . WHERE It was a prospective observational study in a single institute,  Including trauma, medical and surgical patients, in the Canada. WHAT THEY DID All adult (> 18 yr old) patients admitted to the …

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PERC rules safely exclude PE in low risk patients(PROPER Trial)

Yonathan Freund, Marine Cachanado et el published in JAMA the results of PROPER trial which evaluated safety of PERC criteria in low risk patients at ruling out pulmonary embolism. BACKGROUND PERC criteria were first suggested by Kline JA , Mitchell AM et el in 2004.  They include the following  Arterial oxygen saturation (SpO2) of 94%or less, Pulse rate …

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Hydrocortisone plus Fludrocortisone in Septic Shock

D. Annane, A. Renault, C. Brun‑Buisson et el published results of APROCCHSS trial by CRICS-TRIGGERSEP Network  which was originally designed to test drotrecogin alfa (activated) in septic shock.   A human recombinant activated protein C, drotrecogin alpha (activated), initially showed a survival benefit in sepsis; this benefit was not confirmed in subsequent trials, resulting in the withdrawal of its commercial form (Xigris) …

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Early APRV in ARDS

Yongfang Zhou, Xiaodong Jin published a study in Intensive care medicine journal about using APRV early in ARDS. WHAT THEY DID Randomized adult patients with ARDS (Berlin definition, P:F ratio <250) who were on mechanical ventilation to APRV(Airway pressure release ventilation) or LTV(low tidal volume) mode of mechanical ventilation. Patients were enrolled within 48 hours. …

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Adrenal Trial : Steroids are down but not out

B. Venkatesh, S. Finfer, J. Cohen, D. Rajbhandari et el published results of eagerly awaited “Adrenal” trial (Adjunctive Corticosteroid Treatment in Critically Ill Patients with Septic Shock). WHAT THEY DID Randomized adult patients with septic shock undergoing mechanical ventilation(documented or strong clinical suspicion of infection, had two or more criteria of the SIRS, on vasopressors or inotropic agents for …

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Delayed thrombectomy in acute stroke effective

R.G. Nogueira, A.P. Jadhav, D.C. Haussen et el published in NEJM on Nov 18,2017 trial results of delayed(6-24 hours) thrombectomy in acute stroke patients who had a mismatch between the severity of the clinical deficit and the infarct volume, conducted at 26 centers in the United States, Canada, Europe, and Australia. BACKGROUND National Institute of Neurologic Disorders and Stroke …

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