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Critical Care

RCT: No difference in ICU length of stay or 90-day mortality between tight and liberal glucose control

2 Oct, 2023 | 11:25h | UTC

Study Design and Population: This randomized controlled trial assessed the effects of tight versus liberal glucose control on the length of ICU stay in critically ill patients. A total of 9,230 patients were included, with 4,622 in the liberal-control group (insulin initiation when blood glucose levels exceeded 215 mg/dL) and 4,608 in the tight-control group (blood glucose targeted between 80 and 110 mg/dL). In both groups, parenteral nutrition was withheld during the first week of ICU admission. The primary endpoint was the duration of ICU stay, and 90-day mortality served as a key safety outcome.

Main Findings: No significant differences were observed in the primary endpoint, the length of ICU stay, between the two groups (hazard ratio 1.00; 95% CI, 0.96 to 1.04; P=0.94). The 90-day mortality rates were also similar (10.1% in the liberal-control group vs. 10.5% in the tight-control group, P=0.51). Incidences of severe hypoglycemia were low and statistically similar in both groups (1.0% in the tight-control group vs. 0.7% in the liberal-control group). Secondary outcomes, including new infections and the duration of respiratory and hemodynamic support, showed no significant differences. However, lower incidences of severe acute kidney injury and cholestatic liver dysfunction were observed in the tight-control group.

Implications & Limitations: The study supports existing evidence that tight glucose control doesn’t provide substantial benefits in reducing ICU stay duration or mortality. This suggests that a more liberal approach to glucose control may be preferable in most ICU settings, especially to minimize hypoglycemia risk. Key limitations of the study include its narrow focus on the absence of early parenteral nutrition, which could limit generalizability, and the inability to blind caregivers to treatment assignments. Future research should investigate the impact of tight glucose control in various patient subgroups and under different nutritional conditions.

Article: Tight Blood-Glucose Control without Early Parenteral Nutrition in the ICU – New England Journal of Medicine


RCT: Propafenone leads to quicker sinus rhythm restoration than amiodarone in supraventricular arrhythmias related to septic shock

1 Oct, 2023 | 15:19h | UTC

Study Design & Population: The research was a two-center, prospective, controlled parallel-group, double-blind trial involving 209 septic shock patients who had new-onset supraventricular arrhythmia and a left ventricular ejection fraction above 35%. Patients were randomized to receive either intravenous propafenone (70 mg bolus followed by 400–840 mg/24 h) or amiodarone (300 mg bolus followed by 600–1800 mg/24 h).

Main Findings: The primary outcomes focused on the proportion of patients in sinus rhythm 24 hours post-infusion, time to the first sinus rhythm restoration, and arrhythmia recurrence rates. No significant difference was observed in 24-hour sinus rhythm rates between the propafenone (72.8%) and amiodarone (67.3%) groups (p=0.4). Time to the first rhythm restoration was significantly shorter for the propafenone group (median 3.7 hours) compared to the amiodarone group (median 7.3 hours, p=0.02). Recurrence of arrhythmia was notably lower in the propafenone group (52%) than in the amiodarone group (76%, p<0.001). In the subgroup of patients with a dilated left atrium, amiodarone appeared to be more effective.

Implications & Limitations: The study suggests that while propafenone doesn’t offer better rhythm control at 24 hours compared to amiodarone, it does provide faster cardioversion and fewer arrhythmia recurrences, especially in patients with a non-dilated left atrium. No significant differences were observed in clinical outcomes, such as ICU or long-term mortality, between propafenone and amiodarone in the trial. Limitations include potential underpowering of the study and the inability to fully account for the impact of multiple covariates involved in the complex therapy of septic shock.

Article: Balik, M., Maly, M., Brozek, T. et al. Propafenone versus amiodarone for supraventricular arrhythmias in septic shock: a randomised controlled trial. Intensive Care Med (2023)


Commentary on Twitter:


RCT | Restrictive vs. liberal red blood cell transfusion strategy for critically injured patients

11 Aug, 2023 | 15:08h | UTC

The Restrictive Red Blood Cell Transfusion Strategy for Critically Injured Patients (RESTRIC) trial: a cluster-randomized, crossover, non-inferiority multicenter trial of restrictive transfusion in trauma – Journal of Intensive Care


Pictorial Review | Watch out for the early killers: imaging diagnosis of thoracic trauma

9 Aug, 2023 | 15:02h | UTC

Watch Out for the Early Killers: Imaging Diagnosis of Thoracic Trauma – Korean Journal of Radiology


Proposed algorithm for appropriate fluid management in acute pancreatitis

8 Aug, 2023 | 13:33h | UTC

Fluid treatment in acute pancreatitis: a careful balancing act – British Journal of Surgery


Update on the management of acute pancreatitis – Current Opinion in Critical Care

Intravenous fluid therapy in patients with severe acute pancreatitis admitted to the intensive care unit: a narrative review – Intensive Care Medicine

Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis – New England Journal of Medicine

Acute Pancreatitis: Diagnosis and Treatment – Drugs

Revised Clinical Practice Guidelines of the Korean Pancreatobiliary Association for Acute Pancreatitis – Gut and Liver

Guidelines for the management of patients with severe acute pancreatitis, 2021 – Anaesthesia Critical Care & Pain Medicine

Evidence-Based Disposition of Acute Pancreatitis – emDocs

2019 WSES guidelines for the management of severe acute pancreatitis – World Journal of Emergency Surgery

American Gastroenterological Association Institute Guideline on Initial Management of Acute Pancreatitis

Pancreatitis – National Institute for Health and Care Excellence

The optimal timing and intervention to reduce mortality for necrotizing pancreatitis: a systematic review and network meta-analysis – World Journal of Emergency Surgery

Long-term follow-up of a RCT | Endoscopic versus surgical step-up approach for infected necrotizing pancreatitis.

RCT: Immediate drainage did not improve outcomes compared to postponed intervention in patients with infected necrotizing pancreatitis.

An Endoscopic Transluminal Approach, Compared With Minimally Invasive Surgery, Reduces Complications and Costs for Patients With Necrotizing Pancreatitis – Gastroenterology

Research: Endoscopic or Surgical Step-up Approach for Infected Necrotising Pancreatitis

Evidence-Based Approach to the Surgical Management of Acute Pancreatitis – The Surgery Journal


Review | Management of hypocalcemia in the critically ill

8 Aug, 2023 | 13:19h | UTC

Management of hypocalcaemia in the critically ill – Current Opinion in Critical Care


Nationwide Study | Examining survival rates and risk factors in 237 drowned patients receiving ECMO

8 Aug, 2023 | 13:13h | UTC

Results from 237 extracorporeal membrane oxygenation runs with drowned patients: a nationwide retrospective study – Critical Care


M-A | Efficacy and safety of supraclavicular versus infraclavicular approach for subclavian vein catheterization

7 Aug, 2023 | 14:49h | UTC

Efficacy and safety of supraclavicular versus infraclavicular approach for subclavian vein catheterisation: An updated systematic review and meta-analysis of randomised controlled trials – Indian Journal of Anaesthesia


Review | Cardiorenal syndrome in the hospital

7 Aug, 2023 | 14:36h | UTC

Cardiorenal Syndrome in the Hospital – Clinical Journal of the American Society of Nephrology


Commentary on Twitter



Caring for two in the ICU: pharmacologic management of pregnancy-related complications

7 Aug, 2023 | 14:31h | UTC

Caring for two in the ICU: Pharmacologic management of pregnancy-related complications – Pharmacotherapy (free for a limited period)


Review | Diagnosis and management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome

4 Aug, 2023 | 11:50h | UTC

Diagnosis and management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome – Cleveland Clinic Journal of Medicine


M-A | Supine vs. nonsupine endotracheal intubation

4 Aug, 2023 | 11:45h | UTC

A Systematic Review and Meta-Analysis of Randomized Controlled Trials on Supine vs. Nonsupine Endotracheal Intubation – Critical Care Research and Practice


M-A | Uncertain benefits of blood purification techniques in severe infection or sepsis

4 Aug, 2023 | 11:41h | UTC

Blood Purification for Adult Patients With Severe Infection or Sepsis/Septic Shock: A Network Meta-Analysis of Randomized Controlled Trials – Critical Care Medicine


RCT | Recombinant human prourokinase demonstrates noninferiority to alteplase in acute ischemic stroke treatment

3 Aug, 2023 | 13:46h | UTC

Efficacy and Safety of Recombinant Human Prourokinase in the Treatment of Acute Ischemic Stroke Within 4.5 Hours of Stroke Onset: A Phase 3 Randomized Clinical Trial – JAMA Network Open

See also: Visual Abstract


Position Paper | Management of complicated diaphragmatic hernia in the acute setting

3 Aug, 2023 | 13:42h | UTC

Management of complicated diaphragmatic hernia in the acute setting: a WSES position paper – World Journal of Emergency Surgery


Registry Analysis | Takotsubo syndrome outcomes influenced by trigger type and patient characteristics

3 Aug, 2023 | 13:14h | UTC

Trigger‐Associated Clinical Implications and Outcomes in Takotsubo Syndrome: Results From the Multicenter GEIST Registry – Journal of American Heart Association

Commentary: Takotsubo Trigger Type Matters, With Physical Shocks Linked to Worse Outcomes – TCTMD


Review | Diagnosing delirium in perioperative and intensive care medicine

3 Aug, 2023 | 13:09h | UTC

Diagnosing delirium in perioperative and intensive care medicine – Current Opinion in Anesthesiology


Guideline on multimodal rehabilitation for patients with post-intensive care syndrome

2 Aug, 2023 | 14:04h | UTC

Guideline on multimodal rehabilitation for patients with post-intensive care syndrome – Critical Care


Commentary from the author on Twitter


Case Report | Post-myocardial infarction free-wall rupture: rapid diagnosis and management

2 Aug, 2023 | 13:52h | UTC

Post-Myocardial Infarction Free-Wall Rupture: Rapid Diagnosis and Management – JACC: Case Reports


Commentary on Twitter


Consensus Paper | Diagnosis and management of infective endocarditis in adults

1 Aug, 2023 | 14:34h | UTC

Guidelines for Diagnosis and Management of Infective Endocarditis in Adults: A WikiGuidelines Group Consensus Statement – JAMA Network Open


ESPEN Updated Guideline | Clinical nutrition in the intensive care unit

1 Aug, 2023 | 14:27h | UTC

ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit – Clinical Nutrition


International Study | Postoperative acute kidney injury affects one in five patients after major surgery

1 Aug, 2023 | 14:23h | UTC

Epidemiology of surgery associated acute kidney injury (EPIS-AKI): a prospective international observational multi-center clinical study – Intensive Care Medicine


Commentary on Twitter


Guideline | Source control in emergency general surgery

31 Jul, 2023 | 14:32h | UTC

Source control in emergency general surgery: WSES, GAIS, SIS-E, SIS-A guidelines – World Journal of Emergency Surgery


Study | Left ventricular dysfunction in brain-dead heart donors – incidence, reversibility, and implications

31 Jul, 2023 | 14:09h | UTC

Left Ventricular Dysfunction Associated With Brain Death: Results From the Donor Heart Study – Circulation (free for a limited period)


Review | Management of bleeding and hemolysis during percutaneous microaxial flow pump support

28 Jul, 2023 | 14:10h | UTC

Management of Bleeding and Hemolysis During Percutaneous Microaxial Flow Pump Support: A Practical Approach – JACC: Cardiovascular Interventions


Commentary on Twitter


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