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 | UTCStudy 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.
RCT: Propafenone leads to quicker sinus rhythm restoration than amiodarone in supraventricular arrhythmias related to septic shock
1 Oct, 2023 | 15:19h | UTCStudy 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.
Commentary on Twitter:
Propafenone?70 mg bolus+ 400-840 mg/24h vs amiodarone?300 mg + by 600-1800 mg/24h for SVA in septic shock, RCT
?propafenone not better for rhythm control at 24h but excellent hemodynamic safety profile, cardioverting faster & fewer recurrences#FOAMCc
?https://t.co/GVuoxPD7Hy pic.twitter.com/rRlj00x71p— Intensive Care Medicine (@yourICM) September 13, 2023
RCT | Restrictive vs. liberal red blood cell transfusion strategy for critically injured patients
11 Aug, 2023 | 15:08h | UTC
Pictorial Review | Watch out for the early killers: imaging diagnosis of thoracic trauma
9 Aug, 2023 | 15:02h | UTCWatch 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 | UTCFluid treatment in acute pancreatitis: a careful balancing act – British Journal of Surgery
Related:
Update on the management of acute pancreatitis – Current Opinion in Critical Care
Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis – New England Journal of Medicine
Acute Pancreatitis: Diagnosis and Treatment – Drugs
Evidence-Based Disposition of Acute Pancreatitis – emDocs
Pancreatitis – National Institute for Health and Care Excellence
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 | UTCManagement 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
M-A | Efficacy and safety of supraclavicular versus infraclavicular approach for subclavian vein catheterization
7 Aug, 2023 | 14:49h | UTC
Review | Cardiorenal syndrome in the hospital
7 Aug, 2023 | 14:36h | UTCCardiorenal Syndrome in the Hospital – Clinical Journal of the American Society of Nephrology
Commentary on Twitter
The cardiorenal syndrome refers to a group of complex, bidirectional pathophysiological pathways involving dysfunction in both the heart and kidney. This Review focuses on the cardiorenal syndrome encountered in the hospital setting https://t.co/f05vpOPzCx pic.twitter.com/4Is5A2F1km
— CJASN (@CJASN) July 31, 2023
Caring for two in the ICU: pharmacologic management of pregnancy-related complications
7 Aug, 2023 | 14:31h | UTCCaring 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
M-A | Supine vs. nonsupine endotracheal intubation
4 Aug, 2023 | 11:45h | UTC
M-A | Uncertain benefits of blood purification techniques in severe infection or sepsis
4 Aug, 2023 | 11:41h | UTC
RCT | Recombinant human prourokinase demonstrates noninferiority to alteplase in acute ischemic stroke treatment
3 Aug, 2023 | 13:46h | UTCSee also: Visual Abstract
Position Paper | Management of complicated diaphragmatic hernia in the acute setting
3 Aug, 2023 | 13:42h | UTC
Registry Analysis | Takotsubo syndrome outcomes influenced by trigger type and patient characteristics
3 Aug, 2023 | 13:14h | UTCCommentary: 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 | UTCDiagnosing 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
Commentary from the author on Twitter
Very proud to announce our new publication:
Guideline on multimodal rehabilitation for patients with post-intensive care syndrome
Incl. 1 statement, 12 recommendations, and 4 therapy options for prevention & rehab of patients with PICShttps://t.co/NbjIx7zcwR pic.twitter.com/X63epI7ec7
— Peter Nydahl (@NydahlPeter) July 31, 2023
Case Report | Post-myocardial infarction free-wall rupture: rapid diagnosis and management
2 Aug, 2023 | 13:52h | UTCPost-Myocardial Infarction Free-Wall Rupture: Rapid Diagnosis and Management – JACC: Case Reports
Commentary on Twitter
Learn how to evaluate, diagnose and manage #cvMI wall rupture to improve survival in #JACCCaseReports' latest issue: https://t.co/aGPJ1rZ8eu#CardioTwitter #cvSurg #CathLab pic.twitter.com/bPTtJownNf
— JACC Journals (@JACCJournals) July 31, 2023
Consensus Paper | Diagnosis and management of infective endocarditis in adults
1 Aug, 2023 | 14:34h | UTC
ESPEN Updated Guideline | Clinical nutrition in the intensive care unit
1 Aug, 2023 | 14:27h | UTC
International Study | Postoperative acute kidney injury affects one in five patients after major surgery
1 Aug, 2023 | 14:23h | UTC
Commentary on Twitter
? EPIS #AKI, epidemiology of major surgery associated acute kidney injury
➡️ > 10K pts, 1/5 develop PO-AKI: significant burden for health care worldwide!
⬆️ increasing severity of PO-AKI associated with progressive increase in adverse outcomes#FOAMcc
?️ https://t.co/Ps7N7zoMKP pic.twitter.com/gcxkve9OKV— Intensive Care Medicine (@yourICM) July 30, 2023
Guideline | Source control in emergency general surgery
31 Jul, 2023 | 14:32h | UTC
Study | Left ventricular dysfunction in brain-dead heart donors – incidence, reversibility, and implications
31 Jul, 2023 | 14:09h | UTCLeft 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
Commentary on Twitter
Check out this practical guide for the management of bleeding/hemolysis with microaxial flow pump in #JACCINT's new state-of-the-art review: https://t.co/VSu31BPF5d#CardioTwitter @dirkwestermann @ABeneduceMD @MarioGramegnaMD pic.twitter.com/YuyinvWZ0L
— JACC Journals (@JACCJournals) July 26, 2023