Tranexamic Acid fails to work in Gastrointestinal hemorrhage

Ian Roberts, Haleema Shakur-Still , Adefemi Afolabi, Christopher Hawkey et el (HALT-IT trial investigators) published a trial in Lancet  comparing tranexamic acid to placebo in gastrointestinal hemorrhage. Background Tranexamic acid(TXA) is known to prevent the  fibrinolysis.  Early use of TXA reduces surgical bleeding and death related to bleeding from traumatic injury and has reduced the … Read more Tranexamic Acid fails to work in Gastrointestinal hemorrhage

COVID 19 for critical care

Updated 7/22/2020 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. In general, following points are important to remember which are referenced from reputable sources Tolicizumab is the … Read more COVID 19 for critical care

Intense renal replacement therapy may lead to delayed extubation

Shilpa Sharma, Yvelynne P. Kelly et el published a study in Chest  comparing  intense vs usual renal replacement  therapy in patients  undergoing mechanical  ventilation. It was a secondary analysis of already completed ATN study. BACKGROUND Randomized clinical trials have failed to show benefit from increasing intensity of renal replacement therapy (RRT). RRT is associated with an increase in … Read more Intense renal replacement therapy may lead to delayed extubation

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

Mechanical ventilation without sedation

Hanne T. Olsen, Helene K. Nedergaard et el published a trial of no sedation versus light sedation in mechanically ventilated patients in NEJM. WHAT Multi center  randomized controlled trial,  in a 1 : 1 ratio,  comparing be mechanically ventilated ICU patients to  no sedation  versus  light sedation strategy( RASS  Richmond agitation and sedation Scale score … Read more Mechanical ventilation without sedation

Vit C fails to deliver- VITAMINS trial

Tomoko Fujii,  Nora Luethi,  Paul J. Young et al  published the results of   much awaited VITAMINS (The Vitamin C, Hydrocortisone and Thiamine in Patients With Septic Shock) trial.   WHAT It was an investigator-initiated, multicenter, open-label, parallel-group randomized trial comparing vitamin-C, thiamine and hydrocortisone to hydrocortisone alone in patients with septic shock. WHERE 10 intensive … Read more Vit C fails to deliver- VITAMINS trial

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?

‘Wrong-Pipe’ Intubation Deaths still common

ProPublica published research done by Dr. Nick Asselin on cardiac arrests in Rhode Island and found esophageal intubation by EMS providers in 12 cases.  All of the patients died.  This story brings the attention back to skills needed to correctly intubate the patient in setting of stress of ongoing CPR. RESEARCH Rhode Island is the … Read more ‘Wrong-Pipe’ Intubation Deaths still common

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

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

IDSA/ATS guidelines for community acquired pneumonia

Joshua P. Metlay, Grant W. Waterer, Ann C. Long et el published the official IDSA /ATS guidelines for treatment of community-acquired pneumonia. BACKGROUND Last IDSA/ATS Guidelines for community-acquired pneumonia were updated in 2007 . In 2016,  IDSA/ATS updated guidelines on  ventilator-associated pneumonia as well as Hospital-acquired pneumonia which were discussed in comparison with European guidelines here. … Read more IDSA/ATS guidelines for community acquired pneumonia

Tocilizumab in hospitalized adults with severe COVID-19–associated pneumonia did not meet its primary end point of improved clinical status or key secondary end pointsRead more
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