Aggressive fluid therapy in Acute Pancreatitis is harmful

Enrique de-Madaria, M.D., Ph.D., James L. Buxbaum, M.D., Patrick Maisonneuve, Dipl.Eng., Ana García García de Paredes, M.D et el published study in NEJM comparing aggressive versus moderate fluid therapy in Acute pancreatitis.  BACKGROUND Early aggressive hydration is widely recommended for the management of acute pancreatitis.  This is based on animal model observation of regional hypoperfusion … Read more

Difficult airway algorithm

The American Society of Anesthesiologists (ASA) released their much anticipated difficult airway guidelines.  The new guidelines emphasize following-  Oxygenation prior to and throughout attempts at airway management. Use of end tidal CO2 after each attempt at airway management, regardless of the airway device or technique used. The role of clinical measures (eg, chest rise and fall, … Read more

Inferior Vena Caval filters in Severely injured patients

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

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 … Read more

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 … Read more

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 … Read more