COVID 19 for critical care

Updated 5/27/2020 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. An update on sedation requirements in COVID 19 patients.  Summary  Unusually high sedation requirements in large proportion … Read more COVID 19 for critical care

IV Thiamine fails again in Septic Shock

Miyamoto, Yoshihisa, Aso, Shotaro et el published results of retrospective Cohort study in critical care medicine. With ongoing covid 19, all possible medications are being tried for which they were not originally intended. Similarly several medications have been tried in septic shock but failed. Recent trial was discussed here. Given there was a lot of … Read more IV Thiamine fails again in Septic Shock

Balanced crystalloids are gaining ground in sepsis?

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?

Prevention of Early Ventilator-Associated Pneumonia after Cardiac Arrest

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

Steroids in Septic Shock- Debate continues

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 … Read more Steroids in Septic Shock- Debate continues

SeptiCyte : RNA transcript based test for sepsis

In February, 2017,  FDA approved a new assay (Rt-Qpcr) for Mrna Transcript Immune Biomarkers to detect sepsis.  It is a quantitative gene expression assay using reverse transcription polymerase chain reaction to quantify the relative expression levels of host response genes isolated from whole blood. This test is not widely available, and currently it takes about … Read more SeptiCyte : RNA transcript based test for sepsis

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) … Read more Hydrocortisone plus Fludrocortisone in Septic Shock

ESICM/ESCMID/ALAT guidelines for the management of HAP and VAP

European Respiratory Society (ERS), European Society of Intensive Care Medicine (ESICM), European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and Asociación Latinoamericana del Tórax (ALAT) Recently published guidelines for management of hospital acquired pneumonia(HAP), and ventilator associated pneumonia. These guidelines are sligtly different then presented by IDSA and ATS published in July 2016. Some of the differences in … Read more ESICM/ESCMID/ALAT guidelines for the management of HAP and VAP

Bundle to reduce ventilator associated events

Nishi Rawat, Ting Yang,  Kisha J. Ali et el  published a two state multifaceted intervention study showing benefits of improved compliance with evidence based practices can reduce ventilator-associated event, infection-related ventilator- associated complication, and probable ventilator-associated pneumonia. It was a longitudinal quasi-experimental study involving 56 ICUs at 38 hospitals in Maryland and Pennsylvania from October 2012 to March 2015. PROBLEM … Read more Bundle to reduce ventilator associated events

Another retrospective study proving early antibiotics in sepsis improves mortality

Christopher W. Seymour, Foster Gesten et el published a retrospective study in NEJM looking at impact of implementation of bundle treatment in sepsis. WHAT THEY DID Looked at the data(On patients with sepsis and septic shock, community acquired only) reported to New York Health Department from April 1, 2014, to June 30, 2016. More than 98% of … Read more Another retrospective study proving early antibiotics in sepsis improves mortality

Vit C, Thiamine and Hydrocortisone in Sepsis : New trial needed

Paul Marik et el published a “retrospective before after ” study in Chest, Dec, 2016 about use of combination of parenteral Vit C, Thiamine and Hydrocortisone in sepsis and reported a mortality of 8.5% in treatment group compared with 40.4% in control group(p =<0.001). Results are astonishing if you believe in the study. There are several … Read more Vit C, Thiamine and Hydrocortisone in Sepsis : New trial needed

Culture Negative Severe Sepsis

Shipra Gupta, Ankit Sakhuja Gagan Kumar et el published a retrospective study of culture negative sepsis in December, 2016  issue of Chest.   PATIENT POPULATION Nationwide Inpatient Sample (NIS) database (USA) from 2000 to 2010, total of 6,843,279 admissions of patients with severe sepsis were studied, 3,226,406 (47.1%) had culture-negative results.   WHAT DID THEY … Read more Culture Negative Severe Sepsis

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