Open access
Open access
Powered by Google Translator Translator

Critical Care

RCT supports the use of therapeutic heparin in moderately ill patients admitted to the hospital with Covid-19.

17 Oct, 2021 | 21:35h | UTC

Effectiveness of therapeutic heparin versus prophylactic heparin on death, mechanical ventilation, or intensive care unit admission in moderately ill patients with covid-19 admitted to hospital: RAPID randomised clinical trial – The BMJ

Commentary: High-dose of readily available blood thinner reduces risk of death for moderately ill COVID-19 patients – St. Michael’s Hospital

Related studies (some conflicting results)

RCT: Therapeutic-dose heparin superior to standard prophylactic or intermediate-dose heparins for thromboprophylaxis in high-risk hospitalized patients with COVID-19.

Another meta-analysis suggests standard-dose prophylactic anticoagulation is the best option for patients hospitalized with Covid-19.

M-A: Safety and efficacy of different prophylactic anticoagulation dosing regimens in critically and non-critically ill patients with COVID-19 – According to this analysis, standard-dose prophylactic anticoagulation should be the standard of care for hospitalized patients with COVID-19 who do not have an indication for therapeutic anticoagulation, irrespective of disease severity.

RCT: In noncritically ill patients hospitalized with Covid-19, therapeutic-dose anticoagulation with heparin increased the probability of survival to hospital discharge compared with usual-care thromboprophylaxis.

RCT: In critically ill patients with Covid-19, therapeutic anticoagulation with heparin did not result in improved outcomes compared to usual-care pharmacologic thromboprophylaxis.

RCT: In patients hospitalized with Covid-19 with elevated D-Dimer, a full-dose anticoagulation strategy based on rivaroxaban (full-dose heparins in unstable patients) + rivaroxaban to day 30 was not better than prophylactic anticoagulation and increased bleeding risk.

 

Commentary on Twitter

 


Review: Management of infectious emergencies for the inpatient dermatologist.

17 Oct, 2021 | 21:06h | UTC

Management of Infectious Emergencies for the Inpatient Dermatologist – Current Dermatology Reports (if this link is paywalled, try this one)

 


Review: Timing of antibiotic therapy in the ICU.

17 Oct, 2021 | 21:05h | UTC

Timing of antibiotic therapy in the ICU – Critical Care

 


Intracerebral hemorrhage: diagnosis, emergency management, and prognosis.

15 Oct, 2021 | 02:12h | UTC

Intracerebral Hemorrhage: Diagnosis, Emergency Management, and Prognosis – emDocs

 


Systematic Review: Ultrasound guidance for arterial (other than femoral) catheterization in adults may improve first attempt and overall success rates compared to palpation.

14 Oct, 2021 | 09:41h | UTC

Ultrasound guidance for arterial (other than femoral) catheterisation in adults – Cochrane Library

 


M-A: Frequency of Neurologic Manifestations in COVID-19 – up to one-third of patients (89% hospitalized) experienced at least one neurological manifestation.

13 Oct, 2021 | 01:40h | UTC

Frequency of Neurologic Manifestations in COVID-19: A Systematic Review and Meta-analysis – Neurology

 


Consensus Guidance: Hyperkalemia management in the emergency department.

13 Oct, 2021 | 01:34h | UTC

Hyperkalemia management in the emergency department: An expert panel consensus – Journal of the American College of Emergency Physicians Open

Related: Review: Clinical Management of Hyperkalemia. Classification and monitoring, when to reinitiate RAASi therapy, use oral K+-binding agents, and more

Podcast: Hyperkalemia, Diet, K+ Binders, Exercise

Hyperkalemia: Pathophysiology, Risk Factors and Consequence

Hyperkalemia: Pathophysiology, Risk Factors and Consequence (several articles)

 


RCT: No benefit from antithrombotic therapy (aspirin or apixaban) in outpatients with clinically stable symptomatic COVID-19.

12 Oct, 2021 | 00:28h | UTC

Effect of Antithrombotic Therapy on Clinical Outcomes in Outpatients With Clinically Stable Symptomatic COVID-19: The ACTIV-4B Randomized Clinical Trial – JAMA

Editorial: Antithrombotic Therapy for Outpatients With COVID-19: Implications for Clinical Practice and Future Research – JAMA

 

Commentary on Twitter

 


D-Dimer testing for the exclusion of pulmonary embolism has limited clinical utility among hospitalized patients with COVID-19 – most patients with or without pulmonary embolism have increased levels.

12 Oct, 2021 | 00:26h | UTC

D-Dimer Testing for the Exclusion of Pulmonary Embolism Among Hospitalized Patients With COVID-19 – JAMA Network Open

Commentary: D-Dimer Level Not Useful for Ruling Out PE in COVID-19 Patients – HealthDay

 


How antiviral pill Molnupiravir shot ahead in the COVID drug hunt.

12 Oct, 2021 | 00:18h | UTC

How antiviral pill molnupiravir shot ahead in the COVID drug hunt – Nature

Related:

What we know — and don’t know — about Merck’s new Covid-19 pill.

[Press release – not published yet] Merck announces oral antiviral Molnupiravir reduced the risk of hospitalization or death by approximately 50 Percent compared to placebo for patients with mild or moderate COVID-19.

Merck’s Covid-19 pill is great news but may not be a game-changer.

Video | A Pill For COVID? A Doctor Explains Molnupiravir.

 


RCT: In patients with acute ischemic stroke and large vessel occlusion, thrombectomy with combined contact aspiration and stent retriever was not better than stent retriever alone.

12 Oct, 2021 | 00:04h | UTC

Effect of Thrombectomy With Combined Contact Aspiration and Stent Retriever vs Stent Retriever Alone on Revascularization in Patients With Acute Ischemic Stroke and Large Vessel Occlusion: The ASTER2 Randomized Clinical Trial – JAMA (link to abstract – $ for full-text)

Commentaries:

Little Benefit From Adding Aspiration to Thrombectomy for Stroke – Medscape (free registration required)

Combo Thrombectomy Approach No Better for Large Vessel Strokes – MedPage Today (free registration required)

 

Commentary on Twitter

 


Cluster RCT: An antimicrobial stewardship intervention safely reduced the use of broad-spectrum antibiotics among patients hospitalized with moderately severe community-acquired pneumonia.

11 Oct, 2021 | 23:55h | UTC

Narrow-spectrum antibiotics for community-acquired pneumonia in Dutch adults (CAP-PACT): a cross-sectional, stepped-wedge, cluster-randomised, non-inferiority, antimicrobial stewardship intervention trial – The Lancet Infectious Diseases (link to abstract – $ for full-text)

 


RCT: Therapeutic-dose heparin superior to standard prophylactic or intermediate-dose heparins for thromboprophylaxis in high-risk hospitalized patients with COVID-19.

10 Oct, 2021 | 21:53h | UTC

Efficacy and Safety of Therapeutic-Dose Heparin vs Standard Prophylactic or Intermediate-Dose Heparins for Thromboprophylaxis in High-risk Hospitalized Patients With COVID-19: The HEP-COVID Randomized Clinical Trial – JAMA Internal Medicine

Invited commentary: Anticoagulant Therapy in Patients Hospitalized With COVID-19 – JAMA Internal Medicine

Related studies (some conflicting results)

Another meta-analysis suggests standard-dose prophylactic anticoagulation is the best option for patients hospitalized with Covid-19.

M-A: Safety and efficacy of different prophylactic anticoagulation dosing regimens in critically and non-critically ill patients with COVID-19 – According to this analysis, standard-dose prophylactic anticoagulation should be the standard of care for hospitalized patients with COVID-19 who do not have an indication for therapeutic anticoagulation, irrespective of disease severity.

RCT: In noncritically ill patients hospitalized with Covid-19, therapeutic-dose anticoagulation with heparin increased the probability of survival to hospital discharge compared with usual-care thromboprophylaxis.

RCT: In critically ill patients with Covid-19, therapeutic anticoagulation with heparin did not result in improved outcomes compared to usual-care pharmacologic thromboprophylaxis.

RCT: In patients hospitalized with Covid-19 with elevated D-Dimer, a full-dose anticoagulation strategy based on rivaroxaban (full-dose heparins in unstable patients) + rivaroxaban to day 30 was not better than prophylactic anticoagulation and increased bleeding risk.

 

Commentary on Twitter

 


Study shows an increased risk of Guillain-Barré Syndrome with the J&J vaccine; the estimated observed to expected rate ratio was 4.18 for the 42-day window.

8 Oct, 2021 | 10:40h | UTC

Association of Receipt of the Ad26.COV2.S COVID-19 Vaccine With Presumptive Guillain-Barré Syndrome, February-July 2021 – JAMA

 

Commentary on Twitter

 


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

7 Oct, 2021 | 10:35h | UTC

Immediate versus Postponed Intervention for Infected Necrotizing Pancreatitis – New England Journal of Medicine

 


SILENCE Randomized Trial: In patients at the end of life, prophylactic subcutaneous scopolamine butylbromide reduces the occurrence of the death rattle (noisy breathing caused by mucus in the upper respiratory tract).

6 Oct, 2021 | 09:54h | UTC

Effect of Prophylactic Subcutaneous Scopolamine Butylbromide on Death Rattle in Patients at the End of LifeThe SILENCE Randomized Clinical Trial – JAMA (free for a limited period)

Editorial: Preventing Death Rattle With Prophylactic Subcutaneous Scopolamine Butylbromide – JAMA (free for a limited period)

Author interview: Scopolamine Butylbromide for Preventing End-of-Life Death Rattle – JAMA

 

Commentary on Twitter

 


RCT: An active strategy for diagnosing pulmonary embolism did not improve outcomes in patients hospitalized for COPD exacerbation.

6 Oct, 2021 | 09:52h | UTC

Effect of a Pulmonary Embolism Diagnostic Strategy on Clinical Outcomes in Patients Hospitalized for COPD Exacerbation: A Randomized Clinical Trial – JAMA (free for a limited period)

 

Commentary on Twitter

 


RCT: Another study shows convalescent plasma does not improve outcomes in critically ill patients with Covid-19.

5 Oct, 2021 | 10:06h | UTC

Effect of Convalescent Plasma on Organ Support–Free Days in Critically Ill Patients With COVID-19 A Randomized Clinical Trial – JAMA

Commentary: Convalescent plasma futile as treatment for critically ill COVID-19 patients, study finds – University of Pittsburgh

Related:

RCT: Convalescent plasma does not improve outcomes and may be harmful to hospitalized patients with COVID-19.

NIH study shows no significant benefit of convalescent plasma for COVID-19 outpatients with early symptoms.

M-A: Convalescent plasma is safe but does not improve outcomes in the treatment of COVID-19.

RECOVERY Trial: No benefit from convalescent plasma in patients admitted to hospital with COVID-19.

 


AHA Scientific Statement: Diagnosis and management of patients with myocardial injury after noncardiac surgery.

5 Oct, 2021 | 09:01h | UTC

Diagnosis and Management of Patients With Myocardial Injury After Noncardiac Surgery: A Scientific Statement From the American Heart Association – Circulation

News Release: 1 in 5 adults has high levels of heart enzymes after any surgery, monitoring advised – American Heart Association

Commentary: AHA: More Screening Needed to Catch Myocardial Injury After Noncardiac Surgery – TCTMD

 


Intra-abdominal hypertension and abdominal compartment syndrome in critically ill patients: A narrative review of past, present, and future steps.

5 Oct, 2021 | 08:52h | UTC

Intra-abdominal hypertension and abdominal compartment syndrome in critically ill patients: A narrative review of past, present, and future steps – Scandinavian Journal of Surgery

 


Review: Optimizing care for critically ill older adults.

5 Oct, 2021 | 08:51h | UTC

Optimizing care for critically ill older adults – Canadian Medical Association Journal

 


[Press release – not published yet] Merck announces oral antiviral Molnupiravir reduced the risk of hospitalization or death by approximately 50 Percent compared to placebo for patients with mild or moderate COVID-19.

3 Oct, 2021 | 23:02h | UTC

Merck and Ridgeback’s Investigational Oral Antiviral Molnupiravir Reduced the Risk of Hospitalization or Death by Approximately 50 Percent Compared to Placebo for Patients with Mild or Moderate COVID-19 in Positive Interim Analysis of Phase 3 Study

Commentaries:

Expert reaction to interim analysis of oral antiviral molnupiravir – Science Media Centre

Merck’s antiviral pill reduces hospitalization of Covid patients, a possible game-changer for treatment – STAT

Covid antiviral pill can halve risk of hospitalization – BBC

Why Merck’s Covid-19 pill molnupiravir could be so important – Vox

‘Unquestionably a game changer!’ Antiviral pill cuts COVID-19 hospitalization risk – Researchers excited about Merck drug, but caution data are preliminary and price is high – Science

 

Commentaries on Twitter

(thread – click for more)

 


Vaccine induced immune thrombocytopenia and thrombosis: summary of NICE guidance.

3 Oct, 2021 | 22:59h | UTC

Vaccine induced immune thrombocytopenia and thrombosis: summary of NICE guidance – The BMJ

Original Guidance: NICE COVID-19 rapid guideline: vaccine-induced immune thrombocytopenia and thrombosis.

Related:

Clinical features of vaccine-induced immune thrombocytopenia and thrombosis.

Review: Clinical characteristics and pharmacological management of COVID-19 vaccine–induced immune thrombotic thrombocytopenia with cerebral venous sinus thrombosis.

Vaccine-induced immune thrombotic thrombocytopenia: what we know and do not know.

Very rare cases of thrombosis with thrombocytopenia syndrome (TTS) after AstraZeneca vaccine: a global safety database analysis – the estimated rate of TTS after the first dose was 8.1 per million vaccinees; after the second dose, the estimated rate was 2.3 per million vaccinees. (several articles and resources on the subject)

 


Intensive care triage under exceptional resource scarcity.

3 Oct, 2021 | 22:48h | UTC

Intensive care triage under exceptional resource scarcity – Swiss Medical Weekly

 


Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021.

3 Oct, 2021 | 22:41h | UTC

Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 – Intensive Care Medicine

 


Stay Updated in Your Specialty

No spam, just news.