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Critical Care

[Preprint] RCT: non-invasive respiratory strategies in acute respiratory failure in patients with COVID-19 – CPAP reduced the composite outcome of intubation or death within 30 days; high-flow nasal oxygenation was not associated with better outcomes.

6 Aug, 2021 | 10:18h | UTC

An adaptive randomized controlled trial of non-invasive respiratory strategies in acute respiratory failure patients with COVID-19 – medRxiv

Commentary: Covid: Pressured oxygen reduces ventilator need – BBC

 

Commentary on Twitter (thread – click for more)

 

Review: Transmission of infections during cardiopulmonary resuscitation.

8 Aug, 2021 | 23:16h | UTC

Transmission of Infections during Cardiopulmonary Resuscitation – Clinical Microbiology Reviews

 

Systematic Review: “Remdesivir probably has little or no effect on all‐cause mortality at up to 28 days in hospitalized adults with SARS‐CoV‐2 infection. We are uncertain about the effects of remdesivir on clinical improvement and worsening”.

6 Aug, 2021 | 10:15h | UTC

Remdesivir for the treatment of COVID‐19 – Cochrane Library

Summary: Remdesivir for the treatment of COVID-19 – Cochrane Library

 

Commentary on Twitter (thread – click for more)

 

Dexamethasone and tocilizumab treatment considerably reduces the value of C-reactive protein and procalcitonin to detect secondary bacterial infections in COVID-19 patients.

6 Aug, 2021 | 10:13h | UTC

Dexamethasone and tocilizumab treatment considerably reduces the value of C-reactive protein and procalcitonin to detect secondary bacterial infections in COVID-19 patients – Critical Care

 

Clinical Picture: Mucormycosis after COVID-19 in a patient with diabetes.

6 Aug, 2021 | 10:09h | UTC

Mucormycosis after COVID-19 in a patient with diabetes – The Lancet

Related:

COVID-19 and mucormycosis superinfection: the perfect storm.

ECMM/ISHAM recommendations for clinical management of COVID -19 associated mucormycosis in low- and middle-income countries.

The “Black Fungus” in India: The Emerging Syndemic of COVID-19–Associated Mucormycosis – careful use of antibiotics and corticosteroids and closely monitoring blood glucose levels are some of the strategies suggested by the authors.

Multicenter Epidemiologic Study of Coronavirus Disease–Associated Mucormycosis, India – Uncontrolled diabetes mellitus was the most common underlying disease; improper glucocorticoid use was independently associated with the disease.

Opinion | “Doctors have been blamed for the rise in black fungus in India, but the COVID treatment guidelines could be contributing” – improper use of antibiotics and higher than usual doses of corticosteroids may be contributing to the emergence of mucormycosis and other fungal co-infections.

What is mucormycosis, the fungal infection affecting COVID patients in India?

[Preprint] The Emergence of COVID-19 Associated Mucormycosis: Analysis of Cases From 18 Countries.

Mucormycosis: The ‘black fungus’ maiming Covid patients in India

Global Guideline for the Diagnosis and Management of Mucormycosis

 

ESPEN practical guideline: Clinical nutrition in surgery – “Preoperative fasting from midnight is unnecessary in most patients. Patients undergoing surgery, who are considered to have no specific risk of aspiration, shall drink clear fluids until 2 h before anesthesia. Solids shall be allowed until 6 h before anesthesia.”

6 Aug, 2021 | 09:59h | UTC

ESPEN practical guideline: Clinical nutrition in surgery – Clinical Nutrition

 

Review: Rational fluid resuscitation in sepsis for the hospitalist.

6 Aug, 2021 | 09:53h | UTC

A Narrative Review Rational Fluid Resuscitation in Sepsis for the Hospitalist: A Narrative Review – Mayo Clinic Proceedings

 

International, multicenter observational study: Outcomes with percutaneous dilatational tracheotomy in high-risk ICU patients.

6 Aug, 2021 | 08:59h | UTC

Percutaneous dilatational tracheotomy in high-risk ICU patients – Annals of Intensive Care

 

Pre-post study: The implementation of a pathway and care bundle for the management of acute occlusive arterial mesenteric ischemia reduced mortality.

6 Aug, 2021 | 08:55h | UTC

The implementation of a pathway and care bundle for the management of acute occlusive arterial mesenteric ischemia reduced mortality – Journal of Trauma and Acute Care Surgery

 

Commentary on Twitter

 

M-A: Effects of early mobilization on the prognosis of critically ill patients.

6 Aug, 2021 | 08:57h | UTC

Effects of early mobilization on the prognosis of critically ill patients: A systematic review and meta-analysis – International Journal of Nursing Studies (link to abstract – $ for full-text)

 

Commentary on Twitter

 

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.

5 Aug, 2021 | 09:07h | UTC

Therapeutic Anticoagulation with Heparin in Noncritically Ill Patients with Covid-19 – New England Journal of Medicine

Editorial: Surviving Covid-19 with Heparin?

Commentaries:

Full-dose blood thinners reduce the need for organ support in moderately ill COVID-19 patients, but not in critically ill patients – National Institutes of Health

Therapeutic-Dose Heparin in COVID-19: Who Benefits, Who Doesn’t – TCTMD

Canadian-Led International Study: Full-Dose Blood Thinners Benefit Moderately Ill COVID-19 Patients – University of Manitoba

 

Commentary on Twitter

 

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

5 Aug, 2021 | 09:04h | UTC

Therapeutic Anticoagulation with Heparin in Critically Ill Patients with Covid-19 – New England Journal of Medicine

Editorial: Surviving Covid-19 with Heparin?

Commentaries:

Full-dose blood thinners reduce the need for organ support in moderately ill COVID-19 patients, but not in critically ill patients – National Institutes of Health

Therapeutic-Dose Heparin in COVID-19: Who Benefits, Who Doesn’t – TCTMD

 

Commentary on Twitter

 

Myocarditis and pericarditis after vaccination for COVID-19.

5 Aug, 2021 | 08:57h | UTC

Myocarditis and Pericarditis After Vaccination for COVID-19 – JAMA

Related:

Analysis finds benefits of COVID-19 vaccination outweigh risks of rare cases of myocarditis.

CDC: Use of mRNA COVID-19 vaccine after reports of myocarditis among vaccine recipients – “Continued use of mRNA COVID-19 vaccines in all recommended age groups will prevent morbidity and mortality from COVID-19 that far exceed the number of cases of myocarditis expected”.

Case Series: Myocarditis following immunization with mRNA COVID-19 vaccines.

CDC: mRNA vaccines are likely linked to cases of myocarditis and pericarditis – 1,226 cases of myocarditis or pericarditis have been reported mostly in people under 30.

 

RCT: Similar outcomes with Milrinone vs. Dobutamine in the treatment of cardiogenic shock.

5 Aug, 2021 | 08:44h | UTC

Milrinone as Compared with Dobutamine in the Treatment of Cardiogenic Shock – New England Journal of Medicine (link to abstract – $ for full-text)

Visual abstract: Milrinone vs. Dobutamine in Cardiogenic Shock

Commentary: Inotrope Showdown Leaves No Winner in Cardiogenic Shock – MedPage Today (link to abstract – $ for full-text)

 

Position statement: Perioperative management of post-COVID-19 surgical patients.

4 Aug, 2021 | 10:00h | UTC

Perioperative management of post-COVID-19 surgical patients: Indian Society of Anaesthesiologists (ISA National) Advisory and Position Statement – Indian Journal of Anaesthesia

Related:

Guideline: SARS‐CoV‐2 infection, COVID‐19 and timing of elective surgery

Study from 116 countries suggests surgery should be delayed for at least seven weeks following a COVID-19 diagnosis to reduce mortality risk

Cohort study: Postoperative in-hospital mortality of patients with COVID-19 infection was more than double that in patients without COVID-19

WSES Position Paper: The management of surgical patients in the emergency setting during COVID-19 pandemic

Preparing previously COVID-19-positive patients for elective surgery: A framework for preoperative evaluation

 

Commentary on Twitter

 

Antimicrobial stewardship in the ICU in COVID times: the known unknowns.

4 Aug, 2021 | 09:16h | UTC

Antimicrobial stewardship in the ICU in COVID times: the known unknowns – International Journal of Antimicrobial Agents

Related:

IDSA Updated Covid-19 Guidance: Co-Infection and Antimicrobial Stewardship – “bacterial coinfections with SARS-CoV-2 infection are relatively infrequent (likely occurring in less than 10% of hospitalized COVID-19 patients)”.

Antimicrobial stewardship in ICUs during the COVID-19 pandemic: back to the 90s?

Another study shows a high frequency of antibiotic use among patients hospitalized with Covid-19 (85.2%), despite low rates of confirmed secondary bacterial infections.

Too many COVID-19 patients get unneeded ‘just in case’ antibiotics

 

Spontaneous pneumomediastinum in patients diagnosed with covid-19: a case series with review of literature.

4 Aug, 2021 | 09:13h | UTC

Spontaneous Pneumomediastinum in Patients Diagnosed with COVID-19: a Case Series with Review of Literature – Academic Radiology

 

Clinical practice recommendations on the management of perioperative cardiac arrest.

4 Aug, 2021 | 09:03h | UTC

Clinical practice recommendations on the management of perioperative cardiac arrest: A report from the PERIOPCA Consortium – Critical Care

 

2021 Update in the diagnosis and management of acute coronary syndromes for the perioperative clinician.

3 Aug, 2021 | 02:22h | UTC

2021 Update in the Diagnosis and Management of Acute Coronary Syndromes For the Perioperative Clinician – Journal of Cardiothoracic and Vascular Anesthesia

 

Commentary on Twitter

 

What every intensivist should know about Tocilizumab.

2 Aug, 2021 | 00:25h | UTC

What every intensivist should know about Tocilizumab – Critical Care

Related:

Tocilizumab in COVID-19 therapy: who benefits, and how?

A living WHO guideline on drugs for covid-19 – interleukin-6 receptor blockers are now recommended for patients with severe or critical covid-19.

M-A: Association Between Administration of IL-6 Antagonists and Mortality Among Patients Hospitalized for COVID-19 – “The 4% absolute risk reduction in mortality from 25% to 21% with IL-6 inhibition added to glucocorticoids may not translate to patients with a lower baseline mortality risk and likely do not justify the additional expense and risk for toxicities for patients hospitalized with modest oxygen requirements and a stable clinical course (from editorial)”.

RECOVERY trial: In hospitalized COVID-19 patients with hypoxia and systemic inflammation (C-reactive protein ≥75 mg/L), tocilizumab improved survival and other clinical outcomes

Secondary analysis of RCT finds Tocilizumab was beneficial to patients hospitalized with Covid-19 if CRP levels were greater than 15.0 mg/dL, but not if CRP levels were 15.0 mg/dL or less.

M-A: Tocilizumab in COVID-19 – “For hospitalized COVID-19 patients, there is some evidence that tocilizumab use may be associated with a short-term mortality benefit, but further high-quality data are required”.

 

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

30 Jul, 2021 | 12:14h | UTC

COVID-19 rapid guideline: vaccine-induced immune thrombocytopenia and thrombosis – National Institute for Health and Care Excellence

News release: NICE publishes new rapid guideline to diagnose and treat rare blood clotting condition associated with COVID-19 vaccination – National Institute for Health and Care Excellence

Related: 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)

 

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

30 Jul, 2021 | 12:12h | UTC

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

Related: 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)

 

Observational study: Positive Fluid balance linked to worse outcomes in critically ill patients with traumatic brain injury.

1 Aug, 2021 | 23:57h | UTC

Fluid balance and outcome in critically ill patients with traumatic brain injury (CENTER-TBI and OzENTER-TBI): a prospective, multicentre, comparative effectiveness study – The Lancet Neurology (link to abstract – $ for full-text)

Commentary: Traumatic Brain Injury: Fluid Overload Tied to Higher Mortality in ICU Patients – Physician’s Weekly

 

Commentary on Twitter

 

Risk of acute myocardial infarction and ischemic stroke following COVID-19 in Sweden – “the true risk is increased by between three and eight times for acute myocardial infarction and by between three and seven times for ischaemic stroke following COVID-19.”

30 Jul, 2021 | 12:06h | UTC

Risk of acute myocardial infarction and ischaemic stroke following COVID-19 in Sweden: a self-controlled case series and matched cohort study – The Lancet

Invited commentary: What is the association of COVID-19 with heart attacks and strokes? – The Lancet

 

Commentary on Twitter

 

Study: Recommended approaches to minimize aerosol dispersion of SARS-CoV-2 during noninvasive ventilatory support can cause ventilator performance deterioration.

30 Jul, 2021 | 11:59h | UTC

Study Recommended Approaches to Minimize Aerosol Dispersion of SARS-CoV-2 During Noninvasive Ventilatory Support Can Cause Ventilator Performance Deterioration: A Benchmark Comparative Study – CHEST

Editorial: Circuit Set-ups to Reduce Virus Aerosolization During Noninvasive Positive Pressure Ventilation: Dancing in the Dark

 

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