Daily Archives: March 22, 2023
AHA Scientific Statement | Supervised exercise training for chronic heart failure with preserved ejection fraction
22 Mar, 2023 | 13:46h | UTCNews Release: Exercise therapy is safe, may improve quality of life for many people with heart failure – American Heart Association
Key Points: Supervised Exercise Training for Chronic HFpEF – American College of Cardiology
RCT | Hydrocortisone reduces mortality in severe community-acquired pneumonia
22 Mar, 2023 | 13:44h | UTCSummary: Practice-changing! In a phase 3, multicenter, double-blind, randomized controlled trial involving 800 patients with severe community-acquired pneumonia admitted to the ICU, hydrocortisone treatment was found to reduce the risk of death by day 28 compared to a placebo group. The hydrocortisone group had a 6.2% death rate, while the placebo group had an 11.9% death rate.
Hydrocortisone also led to fewer endotracheal intubations among patients not on mechanical ventilation at baseline and reduced the need for vasopressor therapy in patients not receiving it at baseline. There was no significant difference in hospital-acquired infections or gastrointestinal bleeding between the two groups, but patients in the hydrocortisone group required higher daily doses of insulin during the first week of treatment.
Article: Hydrocortisone in Severe Community-Acquired Pneumonia – New England Journal of Medicine (link to abstract – $ for full-text)
Commentary: Steroid drug reduces death rate in severe pneumonia, study shows – STAT
Commentary on Twitter
In this randomized trial, hydrocortisone treatment decreased mortality among patients with severe community-acquire pneumonia in the ICU. https://t.co/DZadFMcA5o#ISICEM23 pic.twitter.com/yhkVCjBMWX
— NEJM (@NEJM) March 21, 2023
RCT | Low-calorie, low-protein feeding improves recovery time in ventilated adults with shock
22 Mar, 2023 | 13:42h | UTCSummary: The NUTRIREA-3 study aimed to determine the optimal calorie and protein intakes during the acute phase of severe critical illness. The study was a randomized, controlled, multicenter, open-label, parallel-group trial conducted in 61 French intensive care units (ICUs) involving 3044 adults receiving invasive mechanical ventilation and vasopressor support for shock. During the first seven ICU days, participants were randomly assigned to early nutrition with either low or standard calorie and protein targets. The primary endpoints were time to readiness for ICU discharge and day 90 all-cause mortality, while key secondary outcomes included secondary infections, gastrointestinal events, and liver dysfunction.
The study found that early calorie and protein restriction did not decrease mortality. However, it was associated with faster recovery and fewer complications compared to standard calorie and protein targets. The low-calorie, low-protein group had a shorter median time to readiness for ICU discharge and lower proportions of patients with vomiting, diarrhea, bowel ischemia, and liver dysfunction. The proportions of patients with secondary infections did not differ significantly between the two groups.
In conclusion, the NUTRIREA-3 study provides evidence that patients may benefit from restricted calorie and protein intakes during the acute phase of critical illness, as it expedites recovery and reduces the risk of complications.
Article: Low versus standard calorie and protein feeding in ventilated adults with shock: a randomised, controlled, multicentre, open-label, parallel-group trial (NUTRIREA-3) – The Lancet Respiratory Medicine (free registration required)
Commentary on Twitter
NEW Research—Early calorie & protein restriction did not decrease mortality but was associated w/ faster recovery & fewer complications than standard intake targets
NUTRIREA-3 from Prof Jean Reignier & co https://t.co/VCS72qxLPD
Being presented @ISICEM today! #ISICEM23 pic.twitter.com/TpoJnwHP8P
— The Lancet Respiratory Medicine (@LancetRespirMed) March 21, 2023
Opinion | The rapid growth of mega-journals: threats and opportunities
22 Mar, 2023 | 13:40h | UTCThe Rapid Growth of Mega-Journals: Threats and Opportunities – JAMA (free for a limited period)
RCT | 4F-PCC fails to reduce blood product consumption and raises thromboembolic events in trauma patients
22 Mar, 2023 | 13:41h | UTCSummary: The PROCOAG Randomized Clinical Trial aimed to investigate the efficacy and safety of 4-factor prothrombin complex concentrate (4F-PCC) in trauma patients at risk of massive transfusion. Conducted in 12 French trauma centers, this double-blind, randomized, placebo-controlled superiority trial involved 324 patients. All patients were treated according to European traumatic hemorrhage guidelines and received early ratio-based transfusion (packed red blood cells:fresh frozen plasma ratio of 1:1 to 2:1). The primary outcome measured was 24-hour blood product consumption (efficacy), while arterial or venous thromboembolic events were assessed as a secondary outcome (safety).
The trial revealed no significant difference in 24-hour blood product consumption between the 4F-PCC and placebo groups, with median consumption of 12 units and 11 units, respectively. However, the study identified a statistically significant higher risk of thromboembolic events in the 4F-PCC group, with 35% of patients experiencing at least one event compared to 24% in the placebo group.
In conclusion, the study found no beneficial effect of incorporating 4F-PCC into a ratio-based transfusion strategy for patients with severe trauma at risk of massive transfusion. Furthermore, the higher rate of thromboembolic events in the 4F-PCC group indicated potential harm. The findings do not support the routine use of 4F-PCC in patients experiencing trauma who are at risk for extensive transfusion.
Article: Efficacy and Safety of Early Administration of 4-Factor Prothrombin Complex Concentrate in Patients With Trauma at Risk of Massive Transfusion: The PROCOAG Randomized Clinical Trial – JAMA (free for a limited period)
See also: Visual Abstract
Review | Diagnosis and treatment of chronic lymphocytic leukemia
22 Mar, 2023 | 13:39h | UTCDiagnosis and Treatment of Chronic Lymphocytic Leukemia: A Review – JAMA (free for a limited period)
Audio clinical review: Diagnosis and Management of Chronic Lymphocytic Leukemia – JAMA
Guidelines for Gastric Cancer | An evidence-based, multidisciplinary approach
22 Mar, 2023 | 13:33h | UTC
Consensus Paper | Treatment of sexual dysfunction after surgery for prostate cancer
22 Mar, 2023 | 13:34h | UTC
Guidelines for post polypectomy colonoscopic surveillance
22 Mar, 2023 | 13:31h | UTCRelated:
USPSTF Statement: Start colorectal cancer screening at 45 years for most patients.
ACG Clinical Guidelines: Start colorectal cancer screening at 45
RCT | 3-6 month DAPT noninferior to 12 month DAPT in patients undergoing PCI with third-generation DES
22 Mar, 2023 | 13:29h | UTCSummary: In a randomized trial involving 2,013 patients across 37 centers in South Korea, researchers compared the effectiveness of 3-6 month dual antiplatelet therapy (DAPT) versus 12 months of DAPT after percutaneous coronary intervention (PCI) using third-generation drug-eluting stents.
The primary outcome was net adverse clinical events (NACE), a composite of cardiac death, target vessel myocardial infarction, clinically driven target lesion revascularization, stent thrombosis, or major bleeding.
The study found that 3-6 month DAPT was non-inferior to 12-month DAPT for NACE (3.7% vs. 4.1%, respectively), with a consistent treatment effect across various subgroups. No significant differences were observed in target lesion failure or major bleeding between the two groups.
Despite these findings, further research is needed to generalize the results to other populations and to determine the ideal regimen for 3-6 month DAPT.
Article: Comparison Of 3-6 Month Versus 12 Month Dual Antiplatelet Therapy After Coronary Intervention Using the Contemporary Drug-eluting Stents With Ultrathin Struts: The HOST-IDEA Randomized Clinical Trial – Circulation (link to abstract – $ for full-text)
Commentary: Short DAPT Noninferior to 1 Year After Ultrathin DES PCI: HOST-IDEA – TCTMD
Related:
Long-term Effects of P2Y12 Inhibitor Monotherapy After Percutaneous Coronary Intervention: 3-Year Follow-up of the SMART-CHOICE Randomized Clinical Trial – JAMA Cardiology (link to abstract – $ for full-text)
Commentary on Twitter
#OriginalResearch simpub #CircACC23: The HOST-IDEA RCT showed DAPT duration of 3-6mo was non-inferior to 12mo for net adverse clinical events in patients undergoing PCI with 3rd-gen DES @drlsj https://t.co/uD8RKc03Ci pic.twitter.com/DXPvoyiNke
— Circulation (@CircAHA) March 5, 2023
Elevated pre- & postoperative BNP tied to complications in hypertensive & diabetic patients undergoing surgery
22 Mar, 2023 | 13:28h | UTCSummary: This study aimed to assess if preoperative and postoperative serum B-type natriuretic peptide levels (BNP) could predict postoperative complications in hypertensive and diabetic patients after non-cardiac surgery. The study involved 260 adult participants and measured BNP levels before and after surgery. The primary outcome was the change in BNP levels and the development of postoperative complications within 30 days of surgery.
Results showed that patients who developed postoperative complications had significantly higher serum BNP levels both before and after surgery. The preoperative BNP levels (baseline BNP) in patients with complications were 152.02 pg/mL ± 106.56 compared to 44.90 pg/mL ± 44.22 in patients without complications. Similarly, postoperative BNP levels in patients with complications were 313.99 pg/mL ± 121.29, while in patients without complications, they were 83.95 pg/mL ± 70.19.
Although the study does not provide specific cutoff values, higher BNP levels both preoperatively and postoperatively are associated with an increased risk of complications in hypertensive and diabetic patients undergoing non-cardiac surgery. Further multicenter prospective studies with a larger population are needed to confirm the role of BNP in predicting surgical prognosis.
Related:
Review | The evolution of the labor curve and its implications for clinical practice
22 Mar, 2023 | 13:25h | UTCThe evolution of the labor curve and its implications for clinical practice: the relationship between cervical dilation, station, and time during labor – American Journal of Obstetrics & Gynecology (free for a limited period)
Commentary on Twitter
AJOG Expert Review in Labor: The evolution of the labor curve and its implications for clinical practice: the relationship between cervical dilation, station, and time during labor https://t.co/oUU9eGuFuo pic.twitter.com/YgAR1Zc93r
— AJOG (@AJOG_thegray) March 21, 2023
RCT | Comparable 5-year relapse-free survival for laparoscopic vs. open distal gastrectomy in advanced gastric cancer
22 Mar, 2023 | 13:27h | UTCSummary: The JLSSG0901 randomized clinical trial aimed to compare the 5-year survival outcomes of laparoscopy-assisted distal gastrectomy (LADG) and open distal gastrectomy (ODG) with D2 lymph node dissection for locally advanced gastric cancer.
The study involved 507 patients from 37 institutes in Japan. The primary endpoint was 5-year relapse-free survival. The results showed that the 5-year relapse-free survival rates were 73.9% and 75.7% for the ODG and LADG groups, respectively, confirming the noninferiority of LADG, and no significant differences were observed in severe postoperative complications between the two groups.
The study concluded that LADG with D2 lymph node dissection, when performed by qualified surgeons, was proven noninferior to ODG, and could become a standard treatment for locally advanced gastric cancer.
Article: Five-Year Survival Outcomes of Laparoscopy-Assisted vs Open Distal Gastrectomy for Advanced Gastric Cancer: The JLSSG0901 Randomized Clinical Trial – JAMA Surgery (link to abstract – $ for full-text)
Related:
Commentary on Twitter
Study results provide robust evidence suggesting that laparoscopic gastrectomy for locally advanced gastric cancer may be an appropriate treatment approach when performed by skilled surgeons. https://t.co/Dvnzk5YI9u pic.twitter.com/GDCdT4DJhp
— JAMA Surgery (@JAMASurgery) March 15, 2023
Mechanical power of ventilation and driving pressure: two undervalued parameters for pre ECMO ventilation and during daily management?
22 Mar, 2023 | 13:24h | UTCRelated: Brief Review | Mechanical power: meaning, uses and limitations
M-A | Intravenous vitamin C in sepsis and septic shock – no influence on mortality outcomes
22 Mar, 2023 | 13:23h | UTCRelated:
Parenteral Vitamin C in Patients with Severe Infection: A Systematic Review – NEJM Evidence
Cohort Study | Outcomes in critically Ill HIV-infected patients between 1997 and 2020
22 Mar, 2023 | 13:22h | UTC
M-A | Risk factors of hemorrhagic transformation in acute ischaemic stroke
22 Mar, 2023 | 13:21h | UTC
Phase 2b RCT | New oral PCSK9 inhibitor reduces LDL cholesterol by 40% to 60%
22 Mar, 2023 | 13:20h | UTCCommentary: Oral PCSK9 Inhibitor Reduces LDL Cholesterol in Phase IIb Study – TCTMD
M-A | Posterior pericardiotomy reduces the risk of atrial fibrillation after cardiac surgery
22 Mar, 2023 | 13:18h | UTCPosterior pericardiotomy for the prevention of atrial fibrillation after cardiac surgery: a systematic review and meta-analysis of 25 randomised controlled trials – EuroIntervention (link to abstract – $ for full-text)
Related:
M-A | Maternal and neonatal complications following Kielland’s rotational forceps delivery
22 Mar, 2023 | 13:17h | UTC
Exploratory analysis | Hypoglycemia incidence is lower with linagliptin vs. glimepiride in patients with early type 2 DM
22 Mar, 2023 | 13:15h | UTC
RCT | Short-term indwelling foley catheters do not reduce the risk of postoperative urinary retention in THA and TKA
22 Mar, 2023 | 13:14h | UTCShort-Term Indwelling Foley Catheters Do Not Reduce the Risk of Postoperative Urinary Retention in Uncomplicated Primary THA and TKA: A Randomized Controlled Trial – The Journal of Bone and Joint Surgery (link to abstract – $ for full-text)
RCT | Electronic nudges resulted in modest increase in influenza vaccination uptake in older adults
22 Mar, 2023 | 13:10h | UTCElectronic nudges to increase influenza vaccination uptake in Denmark: a nationwide, pragmatic, registry-based, randomised implementation trial – The Lancet (link to abstract – $ for full-text)
News Release: Electronic Messages Improved Influenza Vaccination Rates in Nationwide Danish Study – Brigham and Women’s Hospital
Commentary: Linking Flu Vaccine to Cardiovascular Benefit Could Increase Uptake in Older Adults – HCP Live
RCT | Hyperfractionation vs. standard fractionation in IMRT for patients with locally advanced recurrent nasopharyngeal carcinoma
22 Mar, 2023 | 13:12h | UTCHyperfractionation compared with standard fractionation in intensity-modulated radiotherapy for patients with locally advanced recurrent nasopharyngeal carcinoma: a multicentre, randomised, open-label, phase 3 trial – The Lancet (link to abstract – $ for full-text)
Review | Graves’disease in children
22 Mar, 2023 | 13:08h | UTCGraves’ disease: moving forwards – Archives of Disease in Childhood