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?

2019 Focused update on Advanced cardiac life support

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 … Read more 2019 Focused update on Advanced cardiac life support

Targeted Temperature Management in Cardiac Arrest with Nonshockable Rhythm

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 … Read more Targeted Temperature Management in Cardiac Arrest with Nonshockable Rhythm

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

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

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 Plasma as pre hospital resuscitation in trauma patients

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

Elusive answer : Balanced fluids vs saline in critical care

In a late breaking abstract in the CHEST meeting in Toronto, Matthew Semler, Wesley Self, Todd Rice et el presented finding of their SMART(The Isotonic Solutions and Major Adverse Renal Events Trial) trial. They reported that  total of 1,139 patients (14.3%) in the balanced crystalloid group experienced the primary outcome of MAKE30(Major Adverse Kidney Events within 30 … Read more Elusive answer : Balanced fluids vs saline in critical care

Don’t cool for in hospital cardiac arrest

Targeted temperature management (TTM, therapeutic hypothermia) after cardiac arrest first came to use in clinical setting since the publication of two landmark articles in 2002. Evidence was mainly for out of hsopital cardiac arrest patients. Recently, it was noted that there was no difference in outcome between temperatures of 33 and 36 Celsius. However, based … Read more Don’t cool for in hospital cardiac arrest

Faster is better ? : Chest compressions in CPR

Latest AHA guidelines about adult CPR emphasize on high quality chest compression, currently at the rate of 100 to 120 per minute. In a prospective observational study, Kilgannon JH et al demonstrated that chest compression rate of 121–140 compressions/min had the highest odds ratio of ROSC. What they did 222 consecutive patients were enrolled in study,  found … Read more Faster is better ? : Chest compressions in CPR

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