Author: RS

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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