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NEWS - Critical Care & Emergencies

IOTA – Liberal vs Conservative Oxygen Therapy in the Critically Ill – The Bottom Line (free)

Original Meta-Analysis: Liberal vs Conservative Oxygen Therapy in Acutely ill Adults (link to abstract and commentary)

“Hyperoxia is BAD –> Aim for lowest safest inspired O2 in critically ill pts & titrate FiO2 down if SpO2 >95%” (via @srrezaie see Tweet)


Controversy: Is there still a place for the Swan-Ganz catheter? – Intensive Care Medicine

YES (free for a limited period) / NO (free for a limited period) WE ARE NOT SURE (free for a limited period)


Effect of Negative Pressure Wound Therapy vs Standard Wound Management on 12-Month Disability Among Adults With Severe Open Fracture of the Lower Limb: The WOLLF Randomized Clinical Trial – JAMA (free for a limited period)

Commentaries: High-tech treatment of open leg wounds no better than using regular dressings – University of Warwick (free) AND Negative-Pressure Therapy No Better for Open Fractures – Medscape (free registration required)

“Negative pressure wound therapy did not improve 12-month disability for patients with severe open fracture of the lower limb compared with standard wound dressing”


Performing CPR? Humming the Macarena could help – The Guardian (free)

Related Commentary: La Macarena could be the answer to staying alive, heart study finds – The Telegraph (free)

“Using the song “La Macarena” to keep time improves the quality of chest compressions during cardiopulmonary rescuscitation” (via @kamleshkhunti see Tweet)


Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome – New England Journal of Medicine (link to abstract – $ for full-text)

See also: NEJM Tweet with visual abstract

Commentary: Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome – The Bottom Line (free)

“There is something very disturbing about a trial with HR=0.76, 95% CI 0.55-1.04 for the primary endpoint being stopped early for futility”. This TWEETORIAL by @ADAlthousePhD is a huge help in interpreting the results of this important trial (see more on the rise of “Tweetorial” here).


Rapid Recommendations: Atraumatic (pencil-point) versus conventional needles for lumbar puncture: a clinical practice guideline – The BMJ (free)

We issue a strong recommendation for use of atraumatic needles in all patients (adults and children) undergoing lumbar puncture because they decrease complications and are no less likely to work than conventional needles”


Low-dose corticosteroids for adult patients with septic shock: a systematic review with meta-analysis and trial sequential analysis – Critical Care Medicine (free for a limited period)

Source: Critical Care Reviews Newsletter

“In adults with septic shock treated with low dose corticosteroids, short- and longer-term mortality are unaffected, adverse events increase, but duration of shock, mechanical ventilation and ICU stay are reduced”.


Propranolol Versus Metoprolol for Treatment of Electrical Storm in Patients with Implantable Cardioverter-Defibrillator – Journal of the American College of Cardiology (link to abstract – $ for full-text)

“The combination of IV amiodarone and oral propranolol is safe, effective, and superior to the combination of IV amiodarone and oral metoprolol in the management of ES in ICD patients”.


Acute chest pain evaluation using coronary computed tomography angiography compared with standard of care: a meta-analysis of randomised clinical trials – Heart (link to abstract – $ for full-text)

See commentary in: Articles of the month (March 2018) – First10EM (free)

Se related meta-analysis published recently with similar results: Outcomes of non-invasive diagnostic modalities for the detection of coronary artery disease: network meta-analysis of diagnostic randomised controlled trials – The BMJ (free)

“Bottom line: In the RCTs we have to date, CCTA demonstrate no benefit, but leads to an increase in unnecessary invasive procedures” (from First10EM).


Effects of supplemental oxygen therapy in patients with suspected acute myocardial infarction: a meta-analysis of randomised clinical trials – Heart (link to abstract – $ for full-text)

Related guideline: BTS Guideline for oxygen use in healthcare and emergency settings – British Thoracic Society (free)

“These findings from eight RCTs support departing from the usual practice of administering oxygen in normoxaemic patients”.


Time to Endovascular Treatment and Outcome in Acute Ischemic Stroke: MR CLEAN Registry Results – Circulation (link to abstract – $ for full-text)

Commentary: Time to endovascular therapy predicted functional outcome after stroke in registry study – ACP Hospitalist (free)

“Every hour of delay from stroke onset to the start of endovascular therapy resulted in a 5.3% decreased probability of functional independence” (from ACP Hospitalist)


The Effect of Door-to-Diuretic Time on Clinical Outcomes in Patients With Acute Heart Failure – JACC Heart Failure (free)

Commentaries: Quicker Diuretics Not Associated With Better Outcomes in Acute Heart Failure – TCTMD (free) AND Door-to-Diuretic Time in Acute Heart Failure – American College of Cardiology, Latest in Cardiology (free) AND Door-to-diuretic time didn’t affect mortality from heart failure in Korean registry – ACP Hospitalist (free)

“Overall, there isn’t strong evidence of benefit from early use of diuretics and “the overriding consideration should remain ‘get it right’ rather than ‘do it fast,’” the editorial concluded”. (from ACP)


Endovascular treatment for acute ischaemic stroke in routine clinical practice: prospective, observational cohort study (MR CLEAN Registry) – The BMJ (free)

Related guideline: 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association / American Stroke Association (free PDF) AND Summary for ED-relevant care: 2018 AHA/ASA Ischemic Stroke Updates – emDocs (free)

“In routine clinical practice, endovascular treatment for patients with acute ischemic stroke is at least as effective and safe as in the setting of a randomized controlled trial”.


N-Terminal Pro–B-Type Natriuretic Peptide in the Emergency Department – Journal of the Americana College of Cardiology (link to abstract – $ for full-text)

Commentary: NT-proBNP cutpoints validated for diagnosing and ruling out heart failure in the ED – ACP Hospitalist (free)

Related review: BNP in the emergency department: The evidence – First10EM (free)

“In acutely dyspneic patients seen in the ED setting, age-stratified NT-proBNP cutpoints may aid in the diagnosis of acute HF. An NT-proBNP <300 pg/ml strongly excludes the presence of acute HF”.


New Guide to Infection Control in The Hospital – International Society for Infectious Diseases (free)

A free, online resource on the principles and interventions needed to reduce healthcare associated infections, with suggested control measures across different resource levels.


Balanced Crystalloids versus Saline in Critically Ill Adults – New England Journal of Medicine (free)

Related article: Balanced Crystalloids versus Saline in Noncritically Ill Adults – New England Journal of Medicine (free)

Commentary: Balanced Crystalloids May Be Better Than Saline for Critically Ill Patients – NEJM Physician’s First Watch (free)

“Balanced crystalloids may be superior to saline in critically ill patients — but not in patients hospitalized outside an ICU” (from Physician’s First Watch)


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