Critical Care & Emergencies

Surgeons withdraw support for heart disease advice – BBC (free)

YouTube Video: European guidelines on heart disease under review – BBC Newsnight (free)

See also: EACTS responds to BBC Newsnight’s investigation on the EXCEL trial – European Association for Cardio-Thoracic Surgery (free)

Commentary: EACTS Pulls Out of Left Main Guidelines After BBC Bombshell Alleging EXCEL Trial Cover-up – TCTMD (free)


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Homepage: CPR Guidelines (free summaries and infographics)

– 2019 Highlights – Guidelines Update for CPR & ECC

– 2019 FAQ – Guidelines Update for CPR & ECC

– 2019 Infographic – ACLS Guidelines Update

– 2019 Infographic – PALS Guidelines Update

Original Guidelines: AHA Updates on Advanced Cardiovascular Life Support (ACLS) (free) AND AHA Updates in Pediatric Life Support (free)


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The effect of remote ischaemic preconditioning on myocardial injury in emergency hip fracture surgery (PIXIE trial): phase II randomised clinical trial – The BMJ (free)

Related Perspective: Remote ischaemic preconditioning: an intervention for anaesthetists? – British Journal of Anaesthesia (free)


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Management of severe acute pancreatitis – The BMJ (free for a limited period)

Related Guidelines: 2019 WSES guidelines for the management of severe acute pancreatitis – World Journal of Emergency Surgery (free) AND American Gastroenterological Association Institute Guideline on Initial Management of Acute Pancreatitis (free) AND Pancreatitis – National Institute for Health and Care Excellence (free) AND American College of Gastroenterology Guideline: Management of Acute Pancreatitis (free)


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Guidelines for safe transfer of the brain‐injured patient: trauma and stroke, 2019 – Anaesthesia (free)


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Randomized Trial of Three Anticonvulsant Medications for Status Epilepticus – New England Journal of Medicine (link to abstract – $ for full-text)

Commentary: Head-to-head comparison finds three anti-seizure drugs equally effective for severe form of epilepsy – NIH News Release (free)


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Toward Increased Understanding of the Steroid Controversy in Septic Shock – Critical Care Medicine (free)

See also: Why Understanding Sepsis Endotypes Is Important for Steroid Trials in Septic Shock (free) AND Why the Adjunctive Corticosteroid Treatment in Critically Ill Patients With Septic Shock (ADRENAL) Trial Did Not Show a Difference in Mortality (free) AND Why My Steroid Trials in Septic Shock Were “Positive” (free)

Related: Review: Adjunctive Corticosteroid Treatment in Septic Shock (free review, guideline, and meta-analysis on the subject)


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Evaluating a digital sepsis alert in a London multisite hospital network: a natural experiment using electronic health record data – Journal of the American Medical Informatics Association (free)

Commentary: Digital monitoring system helps improve hospital care of sepsis patients – OnMedica (free) AND Sepsis digital alert ‘led to faster treatment with antibiotics’ – BBC (free)


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Bedside Optic Nerve Ultrasonography for Diagnosing Increased Intracranial Pressure: A Systematic Review and Meta-analysis – Annals of Internal Medicine (link to abstract – $ for full-text)

Commentaries: Bedside optic nerve ultrasonography may be useful for measuring intracranial pressure – ACP Hospitalist (free) AND Optic Nerve Ultrasound May ID Increased Intracranial Pressure – Physician’s Briefing (free)


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Difficult Airway Society guidelines for awake tracheal intubation (ATI) in adults – Anaesthesia (free)


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Efficacy and Safety of Low-Dose Colchicine after Myocardial Infarction – New England Journal of Medicine (link to abstract – $ for full-text)

Commentaries: Colchicine Cardiovascular Outcomes Trial – COLCOT – American College of Cardiology (free) AND COLCOT Renews Hope for Anti-inflammatory in Secondary Prevention: Colchicine – TCTMD (free)

#AHA19 – Just Presented at the 2019 American Heart Association Annual Meeting


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Intensivist Burnout: Running on Empty?

18 Nov, 2019 | 00:26h | UTC

UPDATE: The FDA Warns that Biotin May Interfere with Lab Tests: FDA Safety Communication – U.S Food and Drug Administration (free)

Commentary: FDA Updates Warning on Biotin Interfering with Lab Results – NEJM Journal Watch (free)

“…the FDA is particularly concerned about biotin interference causing a falsely low result for troponin, a clinically important biomarker to aid in the diagnosis of heart attacks, which may lead to a missed diagnosis and potentially serious clinical implications. The FDA continues to receive adverse events reports indicating biotin interference caused falsely low troponin results.”


Randomized Trial of Perioperative Probiotics Among Patients Undergoing Major Abdominal Operation – Journal of the American College of Surgeons (link to abstract – $ for full-text)

Source: EvidenceAlerts

“A significantly higher readmission rate was observed among those exposed to probiotics. Additional studies remain warranted.”


Genomic and epidemiological evidence of bacterial transmission from probiotic capsule to blood in ICU patients – Nature Medicine (link to abstract – $ for full-text)

Related: Systematic Review: Harms Reporting in Trials with Probiotics (link to abstract and commentaries) AND The Problem With Probiotics – The New York Times (free)


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Early Palliative Care Consultation in the Medical ICU: A Cluster Randomized Crossover Trial – Critical Care Medicine (link to abstract – $ for full-text)

Source: EvidenceAlerts


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Therapeutic-induced hypertension in patients with noncardioembolic acute stroke – Neurology (link to abstract – $ for full-text)


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A management algorithm for patients with intracranial pressure monitoring: the Seattle International Severe Traumatic Brain Injury Consensus Conference (SIBICC) – Intensive Care Medicine (free)


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Sepsis hysteria: excess hype and unrealistic expectations – The Lancet (free)

Commentary: Sepsis myths create ‘unhealthy climate of fear’, say experts – The Guardian (free)

Source: Grupo UTIclínica – HCFMUSP


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Effect of a fluid bolus on cardiovascular collapse among critically ill adults undergoing tracheal intubation (PrePARE): a randomised controlled trial – The Lancet Respiratory Medicine (link to abstract – $ for full-text)

Source: Critical Care Reviews Newsletter


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Review: Ultrasonography of the Lung

10 Oct, 2019 | 09:07h | UTC

Podcast: In-Flight Emergencies

8 Oct, 2019 | 10:06h | UTC

Medical Management vs Mechanical Thrombectomy for Mild Strokes: An International Multicenter Study and Systematic Review and Meta-analysis – JAMA Neurology (link to abstract – $ for full-text)

Commentaries: Medical Therapy Vs Endovascular Therapy: Similar Outcomes for Mild Strokes – Neurology Today (free) AND Similar Benefits for Thrombectomy, Medical Management, in Mild Stroke – Medscape (free)


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Effect of Postextubation High-Flow Nasal Oxygen With Noninvasive Ventilation vs High-Flow Nasal Oxygen Alone on Reintubation Among Patients at High Risk of Extubation Failure: A Randomized Clinical Trial – JAMA (free for a limited period)

Editorial: Added Benefit of Noninvasive Ventilation to High-Flow Nasal Oxygen to Prevent Reintubation in Higher-Risk Patients (free for a limited period)



Effect of Vitamin C Infusion on Organ Failure and Biomarkers of Inflammation and Vascular Injury in Patients With Sepsis and Severe Acute Respiratory Failure: The CITRIS-ALI Randomized Clinical Trial – JAMA (free for a limited period)

Editorial: Is High-Dose Vitamin C Beneficial for Patients With Sepsis? (free)

Commentary: ‘Tantalizing’ Results For A Test Of Vitamin C For Sepsis – NPR (free)

In exploratory analyses that did not adjust for multiple comparisons, 3 secondary outcomes (out of 46 examined) were significantly different between groups. At day 28, mortality was 46.3% (38/82) in the placebo group vs 29.8% (25/84) in the vitamin C group (P = .03). The number of ICU-free days to day 28 was 10.7 in the vitamin C group vs 7.7 in the placebo group (P = .03). The number of hospital-free days in the vitamin C group vs the placebo group was 22.6 vs 15.5, respectively (P = .04).


Protocolised non-invasive compared with invasive weaning from mechanical ventilation for adults in intensive care – Health Technology Assessment (free)

Source: Critical Care Reviews Newsletter

“A protocolized non-invasive weaning strategy did not reduce time to liberation from ventilation. However, patients who underwent non-invasive weaning had fewer days requiring IMV and required fewer antibiotics for respiratory infections.”


What Is Known About Candida auris – JAMA (free for a limited period)

Related: Global Epidemiology of Emerging Candida Auris (reviews and commentaries on the subject)


Chlorhexidine bathing of the critically ill for the prevention of hospital‐acquired infection – Cochrane Library (free)

Summary: Bathing critically ill patients with chlorhexidine to prevent hospital-acquired infections – Cochrane Library (free)

“Due to the very low-certainty evidence available, it is not clear whether bathing with chlorhexidine reduces hospital-acquired infections, mortality, or length of stay in the ICU”


The Task Force for the management of patients with supraventricular tachycardia of the European Society of Cardiology (ESC): Developed in collaboration with the Association for European Paediatric and Congenital Cardiology (AEPC) (free)


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Maximum-fixed energy shocks for cardioverting atrial fibrillation – European Heart Journal (free)

Commentary: Comparison of High vs. Escalating Shocks – CHESS – American College of Cardiology (free)


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Commentaries: HiSTORIC Trial Supports Single-Test Rule-Out of MI Using High-Sensitivity Troponin – TCTMD (free) AND Risk-Based Thresholds for hs-Troponin I Safely Speed MI Rule-Out – MedPage Today (free registration required) AND HISTORIC: Early Rule-Out Strategy Using High-Sensitivity Cardiac Troponin I Reduced Length of Stay, Hospital Readmissions in Suspected ACS Patients – American College of Cardiology (free)

Related Studies: Randomized Trial: High-Sensitivity Troponin in the Evaluation of Suspected Acute Coronary Syndrome (free study and commentaries) AND Cohort Study: The Introduction of High-sensitive Troponins Had No Impact on Survival (free study and commentaries)


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Lazarus in asystole: a case report of autoresuscitation after prolonged cardiac arrest – European Heart Journal Case Reports (free)


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Perioperative covert stroke in patients undergoing non-cardiac surgery (NeuroVISION): a prospective cohort study – The Lancet (link to abstract – $ for full-text)

Commentaries: ‘Silent’ strokes common after surgery, linked to cognitive decline – McMaster University (free) AND ‘Silent’ strokes after elective surgeries in older adults double their risk of later cognitive decline, study finds – The Globe and Mail (free)


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