Critical Care & Emergencies (all articles) | Links Medicus Content Curation & Alerts in Medicine

Updated Guideline: Recommended drugs and biologics in adult patients with COVID-19.

24 Jan, 2022 | 08:52h | UTC

Clinical Practice Guideline Summary: Recommended Drugs and Biologics in Adult Patients with COVID-19 – Covid-19 Advisory for Ontario

Commentary on Twitter (thread – click for more)

🔥JUST RELEASED: New clinical guidelines for COVID now including #Paxlovid (nirmatrelvir/ritonavir).

A 🧵 on why Paxlovid is NOT first-line.https://t.co/h0puYpiFOK

— Andrew Morris (@ASPphysician) January 22, 2022

A guide to immunotherapy for COVID-19.

24 Jan, 2022 | 08:29h | UTC

A guide to immunotherapy for COVID-19 – Nature Medicine

The WSES/SICG/ACOI/SICUT/AcEMC/SIFIPAC guidelines for diagnosis and treatment of acute left colonic diverticulitis in the elderly.

24 Jan, 2022 | 08:24h | UTC

The WSES/SICG/ACOI/SICUT/AcEMC/SIFIPAC guidelines for diagnosis and treatment of acute left colonic diverticulitis in the elderly – World Journal of Emergency Surgery

ACP Guideline: Diagnosis and management of acute left-sided colonic diverticulitis.

Review: Changing paradigms in the management of acute uncomplicated diverticulitis.

RCT: Another study shows that non-antibiotic outpatient treatment in mild acute diverticulitis is safe.

Review: Elective surgical management of diverticulitis

State of the Art Review | Management of colonic diverticulitis

Drains, germs, or steel: Multidisciplinary management of acute colonic diverticulitis

Diverticulitis: Observational study in outpatients suggests amoxicillin-clavulanate is a safe and effective option compared with metronidazole-fluoroquinolone

Randomized trial: Laparoscopic lavage vs. primary resection for perforated purulent diverticulitis; similar long-term results, but recurrence was more common after laparoscopic lavage

Randomized trial: In patients with recurrent, complicated, or persistent painful diverticulitis, sigmoid resection improved quality of life but was associated with a small but significant risk of major complications

Systematic review: Management of colonic diverticulitis

WSES Guidelines for the Management of Acute Colonic Diverticulitis

ASCRS Guidelines for the Treatment of Left-Sided Colonic Diverticulitis

Perioperative guidelines on antiplatelet and anticoagulant agents: 2022 Update.

21 Jan, 2022 | 09:53h | UTC

Perioperative Guidelines on Antiplatelet and Anticoagulant Agents: 2022 Update – Current Anesthesiology Reports

M-A: No difference in outcomes with Beta-lactam monotherapy vs. combination therapy for bloodstream infections or pneumonia due to P. aeruginosa.

21 Jan, 2022 | 09:37h | UTC

Beta-lactam monotherapy or combination therapy for bloodstream infections or pneumonia due to P. aeruginosa: a meta-analysis – International Journal of Antimicrobial Agents (link to abstract – $ for full-text)

M-A: In comatose survivors of cardiac arrest, targeted hypothermia is not associated with improved survival or better neurological outcomes vs. targeted normothermia.

21 Jan, 2022 | 09:29h | UTC

Targeted Hypothermia Versus Targeted Normothermia In Survivors of Cardiac Arrest: A Systematic Review and Meta-Analysis of Randomized Trials – American Journal of Medicine

RCT: In comatose survivors of out-of-hospital cardiac arrest, there was no difference in mortality and neurologic outcomes with mild (target temperature of 34 °C) vs. moderate therapeutic hypothermia (target temperature of 31 °C).

M-A: Targeted temperature management following out-of-hospital cardiac arrest – “Routine use of moderate or deep hypothermia in comatose survivors of OHCA may potentially be associated with more harm than benefit”.

RCT: In patients with coma after out-of-hospital cardiac arrest, targeted hypothermia did not improve outcomes.

Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis.

20 Jan, 2022 | 09:17h | UTC

Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis – The Lancet

News Release: An estimated 1.2 million people died in 2019 from antibiotic-resistant bacterial infections, more deaths than HIV/AIDS or malaria – The Lancet

Editorial: Antimicrobial resistance: time to repurpose the Global Fund – The Lancet

Commentary: Antimicrobial resistance now a leading cause of death worldwide, study finds – The Guardian

Commentary on Twitter

NEW—An estimated 1.2 million people died in 2019 from antibiotic-resistant bacterial infections, more deaths than HIV/AIDS or malaria.#GRAMPaper reveals the scale of antimicrobial resistance (#AMR), now a leading cause of death worldwide: https://t.co/2h5UEKemEq #AMRSOS pic.twitter.com/aWLhmdirJ8

— The Lancet (@TheLancet) January 20, 2022

RCT: In non–critically ill hospitalized patients with COVID-19, the use of a P2Y12 Inhibitor (ticagrelor in 63% of patients and clopidogrel in 37%) in addition to a therapeutic dose of heparin did not improve survival free of organ support compared to therapeutic heparin alone.

19 Jan, 2022 | 08:56h | UTC

Effect of P2Y12 Inhibitors on Survival Free of Organ Support Among Non–Critically Ill Hospitalized Patients With COVID-19: A Randomized Clinical Trial – JAMA

Editorial: Antiplatelet Therapy in Patients With COVID-19—More Is Less? – JAMA

Commentary: Adding a P2Y12 Inhibitor Does Not Improve Outcomes in COVID-19 – HealthDay

RCT: In critically ill adults, using a balanced multielectrolyte solution did not lower the risk of death or acute kidney injury compared to standard saline.

19 Jan, 2022 | 08:41h | UTC

Balanced Multielectrolyte Solution versus Saline in Critically Ill Adults – New England Journal of Medicine (link to abstract – $ for full-text)

Commentary: Australian study set to guide the treatment of critically ill patients worldwide – George Institute for Global Health

BaSICS RCT: Among critically ill patients requiring fluid therapy, treatment with a balanced solution did not lead to reduced mortality compared to a 0.9% saline solution.

BaSICS RCT: Among critically ill patients requiring fluid therapy, there was no difference in mortality with slower (333 mL/h) vs. faster (999 mL/h) intravenous fluid bolus rates.

Cochrane Review: Buffered Solutions Do Not Improve Mortality in Critically Ill Adults and Children Compared to 0,9% Saline

Commentary on Twitter

Trial of critically ill patients compared balanced multielectrolyte solution (BMES) with saline as fluid therapy in the ICU. There was no evidence that the risk of death or acute kidney injury was lower with the use of BMES than with saline. https://t.co/bmlg4BYaw8 pic.twitter.com/OlKGOM0Dmm

— NEJM (@NEJM) January 18, 2022

Clinical practice guidelines for therapeutic drug monitoring of teicoplanin.

19 Jan, 2022 | 08:27h | UTC

Clinical practice guidelines for therapeutic drug monitoring of teicoplanin: a consensus review by the Japanese Society of Chemotherapy and the Japanese Society of Therapeutic Drug Monitoring – Journal of Antimicrobial Chemotherapy

M-A: Evaluation of interventions to reduce opioid prescribing for patients discharged from the emergency department.

19 Jan, 2022 | 08:13h | UTC

Evaluation of Interventions to Reduce Opioid Prescribing for Patients Discharged From the Emergency Department: A Systematic Review and Meta-analysis – JAMA Network Open

Invited commentary: Optimizing Opioid Prescriptions for Patients in the Emergency Department—How Much Is Almost Never? – JAMA Network Open

Commentary on Twitter

This meta-analysis of 63 studies showed that most interventions were able to reduce opioid prescription rates but not the prescribed opioid quantity for ED-discharged patients. Almost no data on patients-centered outcomes were assessed in these studies. https://t.co/Cd1D7EjCkI

— JAMA Network Open (@JAMANetworkOpen) January 13, 2022

COVID-19 updated evidence: a Cochrane round-up.

18 Jan, 2022 | 09:53h | UTC

COVID-19 evidence: a Cochrane round-up – Cochrane Library

ACP Guideline: Diagnosis and management of acute left-sided colonic diverticulitis.

18 Jan, 2022 | 09:38h | UTC

Diagnosis and Management of Acute Left-Sided Colonic Diverticulitis: A Clinical Guideline From the American College of Physicians – Annals of Internal Medicine

Related Systematic Reviews:

Diagnostic Imaging and Medical Management of Acute Left-Sided Colonic Diverticulitis: A Systematic Review – Annals of Internal Medicine

Evaluation and Management After Acute Left-Sided Colonic Diverticulitis: A Systematic Review – Annals of Internal Medicine

Annals Video Summary: Diagnostic Imaging and Medical Management of Acute Left-Sided Colonic Diverticulitis: A Systematic Review – Annals of Internal Medicine

News Release: ACP releases two new clinical guidelines on the diagnosis and management of diverticulitis – American College of Physicians

Pro-Con Debate: Cardiac Troponin measurement as part of routine follow-up of myocardial damage following noncardiac surgery.

18 Jan, 2022 | 09:36h | UTC

Pro-Con Debate: Cardiac Troponin Measurement as Part of Routine Follow-up of Myocardial Damage Following Noncardiac Surgery – Anesthesia & Analgesia

Cluster-randomized trial: Antiseptic bathing with 2% chlorhexidine-impregnated cloths and 0.08% octenidine wash mitts were not effective for preventing central-line associated bloodstream infections in intensive care patients.

18 Jan, 2022 | 09:18h | UTC

Effect of antiseptic bathing with chlorhexidine or octenidine on central-line associated bloodstream infections in intensive care patients: a cluster-randomised controlled trial – Clinical Microbiology and Infection

WHO recommends two new drugs (Baricitinib and Sotrovimab) to treat COVID-19.

17 Jan, 2022 | 00:48h | UTC

News release: WHO recommends two new drugs to treat COVID-19 – World Health Organization

Infographic with the updated recommendations: A living WHO guideline on drugs for covid-19 – The BMJ

Commentaries:

WHO Recommends Two New COVID-19 Treatments – Cost and Availability Likely Barriers – Health Policy Watch

Expert reaction to WHO recommending two drugs, sotrovimab and baricitinib, to treat patients with COVID-19 – Science Media Centre

Commentary on Twitter (thread – click for more)

WHO has also conditionally recommended the use of sotrovimab for treating mild or moderate #COVID19 in patients who are at high risk of hospitalization: patients who are older, immunocompromised, with underlying conditions & those unvaccinated https://t.co/UAc21Wgxbl https://t.co/Z39mSKrOv5

— World Health Organization (WHO) (@WHO) January 14, 2022

Viewpoint: COVID-19 therapeutics for nonhospitalized patients.

17 Jan, 2022 | 00:31h | UTC

COVID-19 Therapeutics for Nonhospitalized Patients – JAMA

Editorial: Realizing the Potential of Anti–SARS-CoV-2 Monoclonal Antibodies for COVID-19 Management – JAMA

Guidelines for the provision of nutrition support therapy in the adult critically ill patient.

16 Jan, 2022 | 23:19h | UTC

Guidelines for the provision of nutrition support therapy in the adult critically ill patient: The American Society for Parenteral and Enteral Nutrition – Journal of Parenteral and Enteral Nutrition

Multi-Disciplinary Guideline: Management of nephrolithiasis in pregnancy.

16 Jan, 2022 | 23:17h | UTC

Management of Nephrolithiasis in Pregnancy: Multi-Disciplinary Guidelines From an Academic Medical Center – Frontiers in Surgery

Commentary from the author on Twitter

https://t.co/bFtOYFgBmr Started as an assigned resident presentation. Turned into a set of multi-d guidelines implemented at the university level. Now published for all to reference! Thank you all authors for input & guidance @peepeeDoctor @willrobe1 @amy_krambeck @sapanambani

— Matthew Lee (@MSLee_MD) December 23, 2021

RCT: In patients undergoing emergency endotracheal intubation, 7-day survival was significantly lower with etomidate vs. ketamine (77.3% versus 85.1%), but 28 survival rates were not significantly different (etomidate 64.1% vs. ketamine 66.8%, p = 0.294).

16 Jan, 2022 | 23:09h | UTC

Etomidate versus ketamine for emergency endotracheal intubation: a randomized clinical trial – Intensive Care Medicine

Commentary: SGEM#356: Drugs are gonna knock you out – etomidate vs. ketamine for emergency endotracheal intubation – The Skeptics’ Guide to EM

Commentary on Twitter

Etomidate vs ketamine for emergency endotracheal intubation, RCT
💉801 critically ill pts assigned to receive etomidate (0.2–0.3 mg/kg) or ketamine (1–2 mg/kg)
💉day 7 survival significantly lower with etomidate
💉no significantly different day 28 survivalhttps://t.co/CkxufORC8A pic.twitter.com/xQ4AtCifc7

— Intensive Care Medicine (@yourICM) December 17, 2021

Editorial: Towards evidence-based staffing: the promise and pitfalls of patient-to-intensivist ratios.

16 Jan, 2022 | 22:45h | UTC

Towards evidence-based staffing: the promise and pitfalls of patient-to-intensivist ratios – Intensive Care Medicine (free for a limited period)

Commentary on Twitter

Evidence-based staffing, beyond pt-to-intensivist ratio: understanding tipping point of when workload is too much & quality of critical care diminishes essential for #ICU organization, beyond #COVID19 crisis.
📖Editorial https://t.co/63IrhL3MD6
📖Refers to https://t.co/eZAzwu4EbI pic.twitter.com/QpAtj4fcqc

— Intensive Care Medicine (@yourICM) January 13, 2022

Fluvoxamine for Covid-19: What Prescribers and Pharmacists Need to Know.

14 Jan, 2022 | 08:37h | UTC

Fluvoxamine: What Prescribers and Pharmacists Need to Know – Covid-19 Advisory for Ontario

Fluvoxamine for the early treatment of SARS-CoV-2 Infection: a review of current evidence.

RCT: Early treatment with fluvoxamine reduced the risk of emergency care and hospitalization among patients with COVID-19.

[Preprint] RCT: Fluvoxamine reduced the risk for ER visits and hospitalization among patients with Covid-19.

Opinion | Could this be our first effective, inexpensive, widely available outpatient treatment for COVID-19? (It’s fluvoxamine).

Preliminary study shows fluvoxamine may reduce clinical deterioration in outpatients with symptomatic COVID-19

Commentary on Twitter

Thinking of prescribing fluvoxamine for covid 19? Ontario has a nice infographichttps://t.co/MKT8PqlJpM

— Todd Lee (@DrToddLee) January 12, 2022

AAN Position Statement: Consent Issues in the Management of Acute Ischemic Stroke.

14 Jan, 2022 | 08:24h | UTC

Consent Issues in the Management of Acute Ischemic Stroke: AAN Position Statement – Neurology

News Release: Who gives consent for treatment when a person with stroke cannot? – American Academy of Neurology

Systematic Review: Restrictive transfusion thresholds can safely decrease transfusions by 41% across a broad range of clinical contexts.

14 Jan, 2022 | 08:18h | UTC

Transfusion thresholds for guiding red blood cell transfusion – Cochrane Library

Summary: Is it safe to use lower blood counts (haemoglobin levels) as a trigger for blood transfusion in order to give fewer blood transfusions? – Cochrane Library

RCT: Among patients with acute MI and anemia, a restrictive transfusion strategy resulted in a noninferior rate of major cardiovascular events compared to a liberal transfusion strategy

Randomized trial: Liberal vs. restrictive transfusion thresholds in extremely low-birth-weight infants

Meta-Analysis: Effects of Restrictive vs. Liberal Transfusion Strategies on Longer-term Outcomes After Cardiac Surgery

Randomized Trial: In Patients Undergoing Cardiac Surgery, A Restrictive Transfusion Approach Does Not Increase the Risk of Acute Kidney Injury

Effects of restrictive red blood cell transfusion on the prognoses of adult patients undergoing cardiac surgery: a meta-analysis of randomized controlled trials – Critical Care

Research: Restrictive or Liberal Red-Cell Transfusion for Cardiac Surgery

Transfusion Requirements After Cardiac Surgery: The TRACS Randomized Controlled Trial – JAMA

Commentary on Twitter

Less can be more: updated Cochrane review strengthens conclusions on safety of restrictive transfusion thresholds https://t.co/uKkvX5UJrS @EUBloodAlliance @WHO @AABB @NIHRresearch @CochraneLibrary @NICEComms @NHSBT @RutgersU @LSHTM @RDMOxford #transfusionmedicine pic.twitter.com/2QXQNqzvPK

— Cochrane Injuries (@cochraneINJ) December 22, 2021

RCT: Early Remdesivir in outpatients can prevent progression to severe Covid-19.

13 Jan, 2022 | 08:54h | UTC

Early Remdesivir to Prevent Progression to Severe Covid-19 in Outpatients – New England Journal of Medicine

Editorial: The Goldilocks Time for Remdesivir — Is Any Indication Just Right?

Commentary: Three days of remdesivir cuts risk for severe COVID-19 in outpatients – MedicalXpress

Commentary on Twitter

Among nonhospitalized patients with Covid-19–related symptoms, a 3-day course of remdesivir resulted in an 87% lower risk of hospitalization or death than placebo. #COVID19 #IDTwitter https://t.co/YFflw5nBxB pic.twitter.com/4NCD9AcnYH

— NEJM (@NEJM) December 22, 2021

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