Open access

Critical Care & Emergencies

Efficacy and safety of stress ulcer prophylaxis in critically ill patients: a network meta-analysis of randomized trials – Intensive Care Medicine (free)

“PPIs are the most effective agents in preventing CIB, but they may increase the risk of pneumonia”.


Prolonged Infusion Piperacillin-Tazobactam Decreases Mortality and Improves Outcomes in Severely Ill Patients: Results of a Systematic Review and Meta-Analysis – Critical Care Medicine (link to abstract – $ for full-text)

Source: ACP Journal Wise ($)

“Receipt of prolonged infusion of piperacillin-tazobactam was associated with reduced mortality and improved clinical cure rates across diverse cohorts of severely ill patients”.


Systematic Review and Meta-analysis Comparing the Efficacy of Nonsteroidal Anti-inflammatory Drugs, Opioids, and Paracetamol in the Treatment of Acute Renal Colic – European Urology (free) (via @KariTikkinen and @EUplatinum)

“In kidney stone–related acute pain episodes in patients with adequate renal function, treatment with nonsteroidal anti-inflammatory drugs offers effective and most sustained pain relief, with fewer side effects, when compared with opioids or paracetamol”.


Oxygen therapy for acute myocardial infarction: A systematic review and meta-analysis – International Journal of Nursing Studies (link to abstract – $ for full-text)

Source: Supplemental Oxygen Is Associated with Excess Risk for Recurrent Myocardial Infarction – Journal Watch ($)

See related article – “Oxygen Therapy in Suspected Acute Myocardial Infarction” – and commentaries in our August 29th issue (see #1)

“Supplemental Oxygen Associated w/ Excess Risk for Recurrent Myocardial Infarction. It’s time to stop the free flow of oxygen when not absolutely needed” (RT @JWatch see Tweet)


Timing of Angiography and Outcomes in High-Risk Patients With Non–ST-Segment–Elevation Myocardial Infarction Managed Invasively – Circulation (free)

“High risk NSTEMI undergoing cath within 12 hours had lower risk of death and MI at 180 days” (RT @CircAHA see Tweet)


Glucocorticosteroids for people with alcoholic hepatitis – Cochrane Library (free)

Original article: Glucocorticosteroids for people with alcoholic hepatitis – Cochrane Library (link to abstract – $ for full-text)

“We found no evidence of a difference between glucocorticosteroids and placebo or no intervention on all-cause mortality, health-related quality of life, and serious adverse events during treatment”.


High-flow oxygen via nasal cannulae in patients with acute hypoxemic respiratory failure: a systematic review and meta-analysis – Systematic Reviews (free)

“In patients with acute hypoxemic respiratory failure HFNC was not associated with a difference in mortality compared to Noninvasive ventilation or standard oxygen”


Testing blood procalcitonin levels to decide when to start and stop antibiotics in adults with acute respiratory tract infections – Cochrane Library (free)

Original Article: Procalcitonin to initiate or discontinue antibiotics in acute respiratory tract infections – Cochrane Library (link to abstract – $ for full-text)

“the use of procalcitonin to guide initiation and duration of antibiotic treatment results in lower risks of mortality, lower antibiotic consumption, and lower risk for antibiotic-related side effects”.


Local nerve blocks can improve outcomes for people with hip fracture – NIHR Signal (free)

Original article: Peripheral nerve blocks for hip fractures – Cochrane Library (link to abstract – $ for full-text)

“One case of pneumonia prevented for every 7 hip fracture patients given pain relief with nerve block” (RT @NIHR_DC see Tweet)


#LIVES2017 – Effect of Lung Recruitment and Titrated Positive End-Expiratory Pressure (PEEP) vs Low PEEP on Mortality in Patients With Acute Respiratory Distress Syndrome: A Randomized Clinical Trial – JAMA (free)

Editorial: Lung Recruitment and Titrated PEEP in Moderate to Severe ARDS: Is the Door Closing on the Open Lung? (free)

Commentary: Open Lung Ventilation May Worsen ARDS Mortality – MedPage Today (free registration required)

“A strategy using a lung recruitment maneuver and titrated PEEP, in association with volume-assist control ventilation, increased mortality of patients with moderate to severe ARDS”.


Intravenous Versus Nonintravenous Benzodiazepines for the Cessation of Seizures: A Systematic Review and Meta-analysis of Randomized Controlled Trials – Academic Emergency Medicine (link to abstract – $ for full-text)

Source: Hospital Medicine Virtual Journal Club

“Should you give your preferred benzo by the fastest means possible? Or establish an IV and administer via that route? The short answer provided by this study, is to give your benzo IM or IN. While seizures stopped sooner after IV administration, the additional time needed to establish an IV resulted in overall longer seizure time when administered via that method” (by Jeremy Fried in Research and Reviews in the Fastlane 182).


Comprehensive assessment may reduce risk of delirium after hip fracture – NIHR Signal (free)

Original article: Comprehensive Geriatric Assessment for Prevention of Delirium After Hip Fracture: A Systematic Review of Randomized Controlled Trials – Journal of The American Geriatrics society (link to abstract – $ for full-text)

“Comprehensive geriatric assessment reduced the risk of delirium by 20% in patients having hip fracture surgery” (RT @NIHR_DC see Tweet)


Intravenous Corticosteroid Premedication Administered 5 Hours Before CT Compared with a Traditional 13-Hour Oral Regimen – Radiology (link to abstract – $ for full-text)

Source: Journal Watch ($)

“Accelerated intravenous premedication with corticosteroids beginning 5 hours before contrast-enhanced CT has a breakthrough reaction rate noninferior to that of a 13-hour oral premedication regimen”.


Community-acquired Pneumonia Visualized on Computed Tomography but Not Chest X-Ray: Pathogens, Severity, and Clinical Outcomes – Chest (link to abstract – $ for full-text)

Source: Hospital Medicine Virtual Journal Club (free resource to find articles of interest)

“Adults hospitalized with CAP who had radiologic evidence of pneumonia on CT but not concurrent CXR had similar pathogens, disease severity, and outcomes compared with patients who had signs of pneumonia on CXR”.


Prevention of acute kidney injury and protection of renal function in the intensive care unit: update 2017 – Intensive Care Medicine (free)

Expert opinion of the Working Group on Prevention, AKI section, European Society of Intensive Care Medicine


Delirium and Benzodiazepines Associated With Prolonged ICU Stay in Critically Ill Infants and Young Children – Critical Care Medicine (free)

Editorial: Benzodiazepines and Delirium in the Young and Old: Truth Be Told or Still Not Sold? (free)

“Benzodiazepine exposure is associated with the development and longer duration of delirium, and lower likelihood of ICU discharge”.


Acute Kidney Injury After Computed Tomography: A Meta-analysis – Annals of Emergency Medicine (link to abstract – $ for full-text)

Commentary: When kidneys are injured, CT contrast isn’t the culprit – Health Imaging (free)

Related article: Risk of Acute Kidney Injury After Intravenous Contrast Media Administration – Annals of Emergency Medicine (free)

Source: Hospital Medicine Virtual Journal Club

Compared with noncontrast CT, contrast-enhanced CT was not significantly associated with either acute kidney injury, need for renal replacement therapy, or all-cause mortality.


A comparison of early versus late initiation of renal replacement therapy for acute kidney injury in critically ill patients: an updated systematic review and meta-analysis of randomized controlled trials – BMC Nephrology (free)

Source: Critical Care Reviews Newsletter

Early initiation of RRT in critically ill patients did not result in reduced mortality, change in renal function recovery, dependence, duration of RRT, renal recovery time, mechanical ventilation time or complications.


Effect of scheduled second-look endoscopy on peptic ulcer bleeding: a prospective randomized multicenter trial – Gastrointestinal Endoscopy (link to abstract – $ for full-text)

Source: No Benefit of Second-Look Endoscopy After Endoscopic Hemostasis – Journal Watch ($)

“A single EGD with endoscopic hemostasis is not inferior to scheduled second-look endoscopy in terms of reduction in rebleeding rate of peptic ulcer bleeding. Repeat endoscopy would be helpful in the patients with unsatisfactory initial endoscopic hemostasis, use of NSAIDs, and larger amounts of transfused blood”


Mechanical Thrombectomy Outcomes With and Without Intravenous Thrombolysis in Stroke Patients: A Meta-Analysis – Stroke (link to abstract – $ for full-text)

Commentary: Better outcomes seen in patients who received IV thrombolysis before thrombectomy – ACP Hospitalist (free)

“The results support current guideline recommendations to give intravenous thrombolysis to eligible patients even if they are being considered for mechanical thrombectomy, according to the meta-analysis authors” (from ACP)


Procalcitonin: a promising diagnostic marker for sepsis and antibiotic therapy – Journal of Intensive Care (free)

“it is unlikely that a single biomarker serve as an effective diagnosis tool”


Suicide Prevention in an Emergency Department Population: The ED-SAFE Study – JAMA Psychiatry (link to abstract – Free Full Text PDF via @unpaywall)

Commentaries: Intervention Phone Calls May Save The Lives Of Suicidal Patients, Reduce New Attempts, Trial Finds – Medical Daily (free) AND National study shows interventions like telephone calls can reduce suicides – EurekAlert (free) AND Intervention Curbs New Suicide Attempts in At-Risk ED Patients – Medscape (free registration required)

Source: Psychiatry Research Review

“Patients who received a multifaceted intervention that included follow-up telephone calls resulted in a 30 percent reduction in future suicide attempts” (from Medical Daily)


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