Critical Care | Page 59 of 82 | Links Medicus Content Curation & Alerts in Medicine

Data do not support the use of aspirin or apixaban in the outpatient setting to reduce the major adverse cardiovascular or pulmonary consequences associated with symptomatic but clinically stable #SARSCoV2 infection https://t.co/SH6OefXOCj #COVID19

— JAMA (@JAMA_current) October 11, 2021

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

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

Clinical trial found the rate of near-total or total reperfusion at the end of the endovascular procedure was not significantly different for patients receiving thrombectomy with contact aspiration and stent retriever combined vs stent retriever alone https://t.co/SQTEnysFBG

— JAMA (@JAMA_current) September 28, 2021

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

Thromboprophylaxis w therapeutic-dose LMWH reduced major thromboembolism and death by 32% compared with institutional standard heparin without increased major bleeding among #COVID19 inpatients with elevated D-dimers. The effect wasn't seen in ICU patients https://t.co/Wrgj2Ho5lv

— JAMA Internal Medicine (@JAMAInternalMed) October 7, 2021

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

Study suggests a potential small but statistically significant safety concern for #GuillainBarré syndrome following receipt of the @JanssenUS #COVID19 vaccine; findings considered preliminary pending analysis of medical records to establish a definitive Dx https://t.co/yZjJVkp6BA

— JAMA (@JAMA_current) October 7, 2021

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

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

Among patients hospitalized for an exacerbation of #COPD, addition of an active diagnostic strategy for pulmonary embolism to usual care compared with usual care alone did not improve a composite set of health outcomes https://t.co/7mOi5lOBD8

— JAMA (@JAMA_current) October 5, 2021

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

In a randomized clinical trial among patients near the end of life, prophylactic subcutaneous scopolamine butylbromide significantly reduced the occurrence of death rattle https://t.co/e6BDI5yirY pic.twitter.com/hHfhC2iYHh

— JAMA (@JAMA_current) October 5, 2021

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

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

.@DrEricDing convinced many that stopping the #molnupiravir trial early for benefit was a good idea

But it was NOT

Large body of evidence suggests that stopping early for benefit biases the results: overestimates the benefits of the treatment #EBM https://t.co/b3tHEtliO0 https://t.co/LwuCgqcY0C pic.twitter.com/vyPWc0nd37

— Kari Tikkinen (@KariTikkinen) October 2, 2021

(thread – click for more)

💡BREAKING—New oral anti-viral drug *molnupiravir* cuts risk of #COVID19 hospitalization and death **in HALF** in a randomized trial. Results so astounding that the trial is being stopped early, and Merck plans to apply for emergency authorization ASAP. 🧵 https://t.co/g8JGNzvuRg pic.twitter.com/K1SwC3QFXS

— Eric Feigl-Ding (@DrEricDing) October 1, 2021