Critical Care & Emergencies

Early Use of Norepinephrine in Septic Shock Resuscitation (CENSER) : A Randomized Trial – American Journal of Respiratory and Critical Care Medicine (link to abstract – $ for full-text)

See Commentary by Wellington ICU

“This is a promising result, and more and larger studies are needed to confirm the findings.” (from Wellington ICU)


Fever control in critically ill adults. An individual patient data meta-analysis of randomised controlled trials – Intensive Care Medicine (free)

Note: if the above link is not working, try this one

“Our findings do not support the hypothesis that more active fever management increases survival compared with less active fever management overall or in patients with limited physiological reserves.”


Fluid administration for acute circulatory dysfunction using basic monitoring: narrative review and expert panel recommendations from an ESICM task force – Intensive Care Medicine (free for a limited period)

Note: if the above link is paywalled, try this one


Related Commentary on Twitter


Podcast: Hyperkalemia Master Class

6 Feb, 2019 | 00:52h | UTC

International Consensus Guidelines for the Optimal Use of the Polymyxins – Pharmacotherapy (free)

Endorsed by the American College of Clinical Pharmacy (ACCP), European Society of Clinical Microbiology and Infectious Diseases (ESCMID), Infectious Diseases Society of America (IDSA), International Society for Anti‐infective Pharmacology (ISAP), Society of Critical Care Medicine (SCCM), and Society of Infectious Diseases Pharmacists (SIDP).


Humanizing the intensive care unit – Critical Care (free)


Related Commentary on Twitter


10 Myths About Frusemide

30 Jan, 2019 | 23:31h | UTC

10 myths about frusemide – Intensive Care Medicine (free)

Note: if the above link is paywalled, try this one


Perspective: Debates in Sepsis

30 Jan, 2019 | 23:20h | UTC

Patient-reported complications related to peripherally inserted central catheters: a multicentre prospective cohort study – BMJ Quality & Safety (free)


Related Commentary on Twitter


Mechanisms and diagnostic evaluation of persistent or recurrent angina following percutaneous coronary revascularization – European Heart Journal (free)

Summary: Angina After PCI – American College of Cardiology (free)


Related Commentary on Twitter


Sepsis associated acute kidney injury – The BMJ (free)


Related Commentary on Twitter


The use of diuretics in heart failure with congestion — a position statement from the Heart Failure Association of the European Society of Cardiology – European Journal of Heart Failure (free)


Related Commentary on Twitter

Review: Scleroderma Renal Crisis

4 Jan, 2019 | 19:33h | UTC

Clinical Practice Guidelines by the Infectious Diseases Society of America: 2018 Update on Diagnosis, Treatment, Chemoprophylaxis, and Institutional Outbreak Management of Seasonal Influenza – Clinical Infectious Diseases (free)

News Release: Flu is Serious for Pregnant Women and Others at High Risk: Testing and Treatment are Key, Say IDSA Guidelines (free)


Related Commentary on Twitter


Dual antiplatelet therapy with aspirin and clopidogrel for acute high risk transient ischaemic attack and minor ischaemic stroke – The BMJ (free)

Commentary: Guidelines Recommend Dual Antiplatelet Therapy Immediately After TIA or Minor Stroke NEJM Journal Watch (free)


Related Commentary on Twitter

Review: Confounders of Severe Asthma

5 Dec, 2018 | 00:01h | UTC

Focus on randomised clinical trials – Intensive Care Medicine (free PDF) (via @CritCareReviews)

Related: What should we stop doing in the ICU? – ICU Management & Practice (free)

“Their results add to what appears to be a constant theme in critical care, ‘less is more’ based on RCT results”


WHO Guide: Basic Emergency Care

9 Nov, 2018 | 02:44h | UTC

Graduated compression stockings for prevention of deep vein thrombosis – Cochrane Library (free)

Summary: Graduated compression stockings for prevention of deep vein thrombosis during a hospital stay – Cochrane Library (free)

“There is high-quality evidence that GCS are effective in reducing the risk of DVT in hospitalised patients who have undergone general and orthopaedic surgery”


Pantoprazole in Patients at Risk for Gastrointestinal Bleeding in the ICU – New England Journal of Medicine (free for a limited period)

Editorial: Proton-Pump Inhibitor Prophylaxis in the ICU — Benefits Worth the Risks? (free for a limited period)

“Proton pump inhibitors are minimally effective to reduce GI bleeding among the critically ill folks at high risk for stress ulcers. Takeaways: no role for routine PPI for any patients on the WARDS, and shouldn’t be considered ‘routine’ in the ICU” (via @AnilMakam see Tweet)


Effect of a Low vs Intermediate Tidal Volume Strategy on Ventilator-Free Days in Intensive Care Unit Patients Without ARDS: A Randomized Clinical Trial – JAMA (free for a limited period)

Editorial: Lessons From ARDS for Non-ARDS Research: Remembrance of Trials Past (free)

“Among patients in the ICU receiving invasive ventilation, a strategy with low tidal volume was not more effective than a strategy using intermediate tidal volume.”


Energy-Dense versus Routine Enteral Nutrition in the Critically Ill – New England Journal of Medicine (free for a limited period)

Energy-dense formulation for enteral delivery of nutrition was not associated with better outcomes.


Decontamination Strategies and Bloodstream Infections With Antibiotic-Resistant Microorganisms in Ventilated Patients: A Randomized Clinical Trial – JAMA (free for a limited period)

Editorial: Decontamination of Oral or Digestive Tract for Patients in the Intensive Care Unit (free for a limited period)

“Among patients receiving mechanical ventilation in ICUs with moderate to high ABX resistance prevalence, use of chlorhexidine mouthwash, selective oropharyngeal decontamination, or selective digestive tract decontamination was not associated with reductions in ICU-acquired bloodstream infections caused by MDRGNB vs standard care” (via @JAMA_current see Tweet with visual abstract)


Effect of Protocolized Weaning with Early Extubation to Noninvasive Ventilation vs Invasive Weaning on Time to Liberation From Mechanical Ventilation Among Patients With Respiratory Failure: The Breathe Randomized Clinical Trial – JAMA (free for a limited period)

Editorial: Weaning From Mechanical Ventilation: What Should Be Done When a Patient’s Spontaneous Breathing Trial Fails? (free for a limited period)

“Among patients requiring mechanical ventilation in whom a spontaneous breathing trial had failed, early extubation to noninvasive ventilation did not shorten time to liberation from any ventilation.”


Review: Treatments Targeting Inotropy

16 Oct, 2018 | 23:37h | UTC

Review: Demystifying Serotonin Syndrome

16 Oct, 2018 | 23:23h | UTC

Timing of Renal-Replacement Therapy in Patients with Acute Kidney Injury and Sepsis – New England Journal of Medicine (link to abstract – $ for full-text)

Video Summary: Renal-Replacement Therapy for AKI (free)

Commentary: Is Kidney Dialysis Always Needed When Septic Shock Strikes? – HealthDay (free)

“Trial comparing early vs. delayed strategies of renal-replacement therapy in patients with early-stage septic shock who had severe acute kidney injury finds no significant between-group difference in overall mortality at 90 days.” (via @NEJM see Tweet)


Updated German Polytrauma Guideline

11 Oct, 2018 | 21:38h | UTC

Laparoscopic cholecystectomy versus percutaneous catheter drainage for acute cholecystitis in high risk patients (CHOCOLATE): multicentre randomised clinical trial – The BMJ (free)

“Laparoscopic cholecystectomy compared with percutaneous catheter drainage reduced the rate of major complications in high risk patients with acute cholecystitis.”


Antibiotics for acute rhinosinusitis in adults – Cochrane Library (free for a limited period)

Summary: Antibiotics for sinus infection of short duration in adults – Cochrane Library (free)

“Considering antibiotic resistance, and the very low incidence of serious complications, we conclude there is no place for antibiotics for people with uncomplicated acute rhinosinusitis.”


NICE Guideline: Pancreatitis

14 Sep, 2018 | 01:30h | UTC

Review: Cardiorenal Syndrome Revisited

2 Sep, 2018 | 02:26h | UTC

Six-Month Outcomes after Restrictive or Liberal Transfusion for Cardiac Surgery – New England Journal of Medicine (free for a limited period)

“In moderate-to-high-risk patients undergoing cardiac surgery, six-month outcomes show that a restrictive red-cell transfusion strategy is noninferior to a liberal strategy” (via @NEJM see Tweet with Visual Abstract)


High-sensitivity troponin in the evaluation of patients with suspected acute coronary syndrome: a stepped-wedge, cluster-randomised controlled trial – The Lancet (free)

Commentaries: Diagnosing myocardial infarction: a highly sensitive issue – The Lancet (free) AND Hs-TnI in Suspected ACS: High-STEACS Trial – American College of Cardiology (free) AND Is High Sensitivity Troponin Too Sensitive? – NEJM Journal Watch (free)

“Introduction of a high-sensitivity cardiac troponin I assay reclassified 1 in 6 patients with previously undetected myocardial necrosis, but did not lead to improved clinical outcomes in this large randomised trial” (via @chapdoc1 see Tweet)

“Very important study. What’s weird is that the “better” (more sensitive) troponin assays get, the less helpful the test becomes at the bedside. Look for a coming tsunami of iatrogenesis from overzealous evaluation of troponin bumps.” (via @drjohnm see Tweet)


ESC Council on hypertension position document on the management of hypertensive emergencies – European Heart Journal – Cardiovascular Pharmacotherapy (free) (@Abraham_RMI)

“Patients that lack acute hypertension-mediated end organ damage to the heart, retina, brain, kidneys, or large arteries do not have a hypertensive emergency and can be treated with oral BP-lowering agents and usually discharged after a brief period of observation.”


Extended antibiotic infusions could save lives: Here’s how to do it – PulmCCM (free)

Related Research: Mortality lower with prolonged vs. short-term IV infusion of antipseudomonal beta-lactams (free)

“The simplest (and cheapest) technique is simply to reduce the time between doses.”


Seven days of antibiotics were as good as 14 for gram-negative bacteremia – PulmCCM (free)

Related Commentary: Seven-day antibiotic course delivers similar outcomes to 14-days for Gram-negative bacteraemia – European Society of Clinical Microbiology and Infectious Diseases, via EurekAlert (free)

“It’s important to note that source control was believed to be achieved in all enrolled patients. If source control cannot be achieved (e.g., an abscess, or an infected heart valve or indwelling catheter that cannot safely be removed), prolonged antibiotic courses are often advisable.”


Guideline: Acute Kidney Injury

23 Aug, 2018 | 23:24h | UTC