Critical Care
M-A | Pretest probability assessment and D-Dimer are preferred for the initial evaluation of suspected PE in pregnant women
15 Mar, 2023 | 14:50h | UTC
AHA Scientific Statement | Atrial fibrillation occurring during acute hospitalization
14 Mar, 2023 | 14:04h | UTC
Mortality rates and clinical manifestations of severe hypothyroidism in the ICU: a French multicenter cohort study
14 Mar, 2023 | 13:44h | UTCSummary: This article presents the findings of a retrospective multicenter cohort study conducted over 18 years in 32 French ICUs to investigate severe hypothyroidism (SH) requiring ICU admission.
The study included 82 patients with SH, with thyroiditis and thyroidectomy being the primary causes, and levothyroxine discontinuation, sepsis, and amiodarone-related hypothyroidism being the most frequent triggers.
Patients with SH presented with various clinical symptoms, including hypothermia, hemodynamic failure, and coma, with in-ICU and 6-month mortality rates being 26% and 39%, respectively. The study also found that patients with hemodynamic and respiratory failure on admission to the ICU had a higher likelihood of mortality.
Levothyroxine replacement was provided to all patients, but the administration route and loading dose varied. The authors recommend early diagnosis, prompt levothyroxine administration, and close monitoring of cardiac and hemodynamic parameters for SH patients admitted to the ICU.
Risk factors for Carbapenem-Resistant Enterobacterales infections: a matched case-control study
14 Mar, 2023 | 13:43h | UTCSummary: The study aimed to investigate risk factors for infections caused by carbapenem-resistant Enterobacterales (CRE) and identify variables that increase the probability of CRE infection among admitted patients in hospitals with high CRE incidence.
The study was performed in 50 hospitals in Southern Europe from March 2016 to November 2018 and included patients with complicated urinary tract infection, complicated intraabdominal infection, pneumonia, or bacteremia from other sources due to CRE. Control groups were patients with infection caused by carbapenem-susceptible Enterobacterales and non-infected patients, matched according to the same criteria as the CRE group (type of infection, ward, and duration of hospital admission).
The results showed that the main risk factors for CRE infections were previous colonization with CRE, use of urinary catheters, and exposure to broad-spectrum antibiotics.
The study’s findings offer evidence to inform decisions about preventive measures and empirical treatment for patients with suspected CRE infections. Additionally, the study can guide the efficient design of future randomized trials focusing on high-risk patients.
Related:
RCT | Colistin monotherapy vs. combination therapy for carbapenem-resistant organisms
Podcast and Brief Review | TIA/Stroke pearls for the hospitalist
14 Mar, 2023 | 13:36h | UTC#385 TIA/Stroke for the Hospitalist featuring Dr. Karima Benameur – The Curbsiders
Perspective | Embracing complexity in sepsis
14 Mar, 2023 | 13:31h | UTCEmbracing complexity in sepsis – Critical Care
Perspective | How I prescribe prolonged intermittent renal replacement therapy
14 Mar, 2023 | 13:26h | UTCHow I prescribe prolonged intermittent renal replacement therapy – Critical Care
Review | Guideline-based management of acute respiratory failure and acute respiratory distress syndrome
14 Mar, 2023 | 13:17h | UTC
Findings of daily point-of-care ultrasound assessment of CVC-related thrombosis in critically ill patients
14 Mar, 2023 | 13:19h | UTCDaily point-of-care ultrasound-assessment of central venous catheter-related thrombosis in critically ill patients: a prospective multicenter study – Intensive Care Medicine (free for a limited period)
Commentary on Twitter
#POCUS assessment of CVC related thrombosis in #ICU
➡️ common (16.9%) mostly in IJV
➡️ can occur soon: 12% 1st day, 82% in 7 days
➡️ ⅓ small, ⅓ extensive
➡️ often nonprogressive, rarely occlusive; gradual ⬇️ after removal
⬆️ #ICU LoS but = mortality
?️ https://t.co/AyBrMOTyBb pic.twitter.com/qMmxuNYdvT— Intensive Care Medicine (@yourICM) March 10, 2023
RCT | Immediate complete revascularization non-inferior to staged approach in ACS patients with multivessel disease
13 Mar, 2023 | 15:10h | UTCSummary: Patients with an acute coronary syndrome and multivessel disease not presenting with cardiogenic shock usually benefit from complete revascularization by percutaneous coronary intervention (PCI). Complete revascularization involves treating all significant blockages in the coronary arteries, including those not causing symptoms (non-culprit lesions).
The BIOVASC randomized non-inferiority trial investigated whether patients with acute coronary syndrome and multivessel coronary disease should undergo immediate complete revascularization during the index procedure or undergo a staged approach with PCI of the culprit lesion only during the index procedure followed by another procedure within 6 weeks of all non-culprit lesions deemed to be clinically significant. The exclusion criteria were:
- Previous coronary artery bypass surgery.
- Cardiogenic shock.
- Single-vessel coronary disease.
- The presence of a chronic coronary total occlusion.
A total of 1525 patients with acute coronary syndrome and multivessel coronary disease were randomly assigned to either an immediate complete revascularization group (764 patients) or a staged complete revascularization group (761 patients). The primary outcome was a composite of all-cause mortality, myocardial infarction, unplanned ischemia-driven revascularization, or cerebrovascular events at 1 year after the index procedure. The study found that immediate complete revascularization was non-inferior to staged complete revascularization for the primary outcome.
Article: Immediate versus staged complete revascularisation in patients presenting with acute coronary syndrome and multivessel coronary disease (BIOVASC): a prospective, open-label, non-inferiority, randomised trial – The Lancet (free registration required)
Commentaries:
Revascularisation in acute coronary syndromes: change in practice? – The Lancet (free registration required)
No Downside to Immediate Complete Revascularization in ACS: BIOVASC – TCTMD
Immediate Complete Revascularization Non-Inferior to Staged Procedure in BIOVASC Trial – HCP Live
Related:
One-Year Outcomes after PCI Strategies in Cardiogenic Shock – New England Journal of Medicine
M-A | Routine anaerobic coverage for aspiration pneumonia: limited evidence of benefit
13 Mar, 2023 | 15:03h | UTCSummary: Treating aspiration pneumonia with antibiotics that cover anaerobic bacteria has become common practice in many services, but recent studies suggest that this may not necessarily improve prognosis.
Out of 2523 publications, this systematic review and meta-analysis only included one randomized control trial and two observational studies. The study found no clear benefit of anaerobic coverage and concluded that there is not enough data to evaluate the necessity of anaerobic coverage in the antibiotic treatment of aspiration pneumonia.
The authors suggest that covering anaerobic bacteria with antibiotics may not be needed as an initial treatment for aspiration pneumonia if there is no formation of abscess or empyema and the patient has good oral hygiene.
Related: BTS clinical statement on aspiration pneumonia – Thorax
Brief Review | How we escalate vasopressor and corticosteroid therapy in patients with septic shock
13 Mar, 2023 | 15:04h | UTCHow We Escalate Vasopressor and Corticosteroid Therapy in Patients With Septic Shock – CHEST (free for a limited period)
M-A | Age, tracheal intubation time, tracheostomy, and APACHE II score are risk factors for post-extubation dysphagia in ICU patients
13 Mar, 2023 | 14:59h | UTCSummary: Post-extubation dysphagia is a common complication in ICU patients who have undergone intubation and mechanical ventilation, leading to a risk of aspiration and pneumonia.
The review included 15 studies involving 50,669 patients and found that: 1 – age; 2 – duration of tracheal intubation; 3 – tracheostomy; and 4 – APACHE II score were significant risk factors for post-extubation dysphagia.
By identifying these risk factors, clinicians can better identify patients at risk of developing dysphagia after extubation and take measures to prevent and manage the condition.
Article: Risk factors for post-extubation dysphagia in ICU: A systematic review and meta-analysis – Medicine
ISCCM Guidelines | Hemodynamic monitoring in the critically ill
13 Mar, 2023 | 14:58h | UTC
ISCCM Guidelines for the use of procalcitonin for rational use of antibiotics
13 Mar, 2023 | 14:57h | UTC
ISCCM Guidelines on acute kidney injury and renal replacement therapy
13 Mar, 2023 | 14:55h | UTC
ISCCM Consensus Statement | Prevention of venous thromboembolism in the critical care unit
13 Mar, 2023 | 14:53h | UTC
ISCCM Consensus Recommendations | Competencies for point-of-care ultrasonography in ICU
13 Mar, 2023 | 14:51h | UTC
ISCCM Position Statement | Recommendations for evaluation and selection of deceased organ donor
13 Mar, 2023 | 14:50h | UTC
Brief Review | Mechanical power: meaning, uses and limitations
13 Mar, 2023 | 14:44h | UTCMechanical power: meaning, uses and limitations – Intensive Care Medicine
Commentary on Twitter
Mechanical power, meaning, uses & limitations:
➡️ derivation of mechanical power
➡️ components of mechanical power and risk of VILI
➡️ association between MP and outcome
➡️ mechanical power normalisation
Open access #FOAMcc on @ICM
?️ https://t.co/nuhPh0qIXn pic.twitter.com/kBSTBdj54o— Intensive Care Medicine (@yourICM) March 8, 2023
Review | How to use nebulized antibiotics in severe respiratory infections
10 Mar, 2023 | 14:31h | UTCHow to Use Nebulized Antibiotics in Severe Respiratory Infections – Antibiotics
Guideline | Management of severe peri-operative bleeding
8 Mar, 2023 | 14:18h | UTC
M-A | Real-time ultrasound guidance as compared to landmark technique for subclavian central venous cannulation
8 Mar, 2023 | 14:04h | UTCReal-Time Ultrasound Guidance as Compared to Landmark Technique for Subclavian Central Venous Cannulation: A Systematic Review and Meta-Analysis With Trial Sequential Analysis – Critical Care Medicine (link to abstract – $ for full-text)
M-A | Comparison of a short vs. long-course antibiotic therapy for ventilator-associated pneumonia
7 Mar, 2023 | 13:18h | UTCSummary:
This systematic review and meta-analysis of randomized controlled trials aimed to compare the rates of recurrence and relapse of ventilator-associated pneumonia (VAP) between short-course (≤8 days) and long-course (≥10-15 days) antibiotic therapy strategies. Five relevant studies involving 1069 patients were identified.
Compared to long-course therapy, short-course therapy increased the number of antibiotic-free days without any impact on recurrence and relapses of VAP, 28 days mortality, mechanical ventilation duration, number of extra-pulmonary infections, and length of ICU stay.
However, the study’s limitations, such as the small sample size and the lack of standardized definitions of the assessed outcomes, should be considered when interpreting the results.
Commentary: Study finds benefits in short-course antibiotics for ventilator-associated pneumonia – CIDRAP
Review | Acquired disorders of hypomagnesemia
7 Mar, 2023 | 13:09h | UTCAcquired Disorders of Hypomagnesemia – Mayo Clinic Proceedings