Emergency Medicine
Cohort Study | Multimodal prediction of favorable outcome after cardiac arrest
6 Apr, 2023 | 13:01h | UTC
ERS/ESICM/ESCMID/ALAT guidelines for the management of severe community-acquired pneumonia
5 Apr, 2023 | 13:45h | UTC
Commentary on Twitter
Management of severe community-acquired pneumonia: @EuroRespSoc @ESICM @ESCMID @ALATorax international guidelines
➡️ evidence-based recommendations for diagnosis, empirical treatment, ABTs
➡️ current knowledge gaps
➡️ recommendations for future research
?️ https://t.co/qhe1wlgN9t pic.twitter.com/LMNCbauYfs— Intensive Care Medicine (@yourICM) April 4, 2023
Review | Diagnosis and treatment of acute myocarditis
5 Apr, 2023 | 13:40h | UTCDiagnosis and Treatment of Acute Myocarditis: A Review – JAMA (free for a limited period)
RCT | Endovascular treatment vs. no treatment after 6-24h in ischemic stroke patients with collateral flow on CT angiography
5 Apr, 2023 | 13:38h | UTCEndovascular treatment versus no endovascular treatment after 6–24 h in patients with ischaemic stroke and collateral flow on CT angiography (MR CLEAN-LATE) in the Netherlands: a multicentre, open-label, blinded-endpoint, randomised, controlled, phase 3 trial – The Lancet (link to abstract – $ for full-text)
RCT | Comparable results in endovascular therapy using general anesthesia vs. procedural sedation for stroke treatment
4 Apr, 2023 | 13:45h | UTCOutcomes After Endovascular Therapy With Procedural Sedation vs General Anesthesia in Patients With Acute Ischemic Stroke: The AMETIS Randomized Clinical Trial – JAMA Neurology (free for a limited period)
See also: Visual Abstract
Related: M-A | General Anesthesia vs. to Non-GA in endovascular thrombectomy for ischemic stroke
RCT | Comparable efficacy of cefotaxime, ceftriaxone, and ciprofloxacin in treating spontaneous bacterial peritonitis
3 Apr, 2023 | 14:01h | UTCSummary: This multicenter, prospective, open-label, randomized controlled trial compared the efficacy of cefotaxime, ceftriaxone, and ciprofloxacin as initial treatments for spontaneous bacterial peritonitis (SBP) in patients with cirrhosis and ascites. The study included 261 patients aged 16 to 75, with liver cirrhosis, ascites, and a polymorphonuclear cell count of >250/mm3. Researchers performed follow-up paracentesis at 48 hours to evaluate the assigned antibiotics, and assessed resolution rates at 120 and 168 hours of treatment.
The primary endpoint, resolution rates at 120 hours, showed no statistically significant difference between the groups: 67.8% for cefotaxime, 77.0% for ceftriaxone, and 73.6% for ciprofloxacin. One-month mortality rates were also similar. The study concluded that these antibiotics are equally effective as initial treatments for SBP, particularly for community-acquired infections, when administered based on response-guided therapy.
Article: Response-Guided Therapy With Cefotaxime, Ceftriaxone, or Ciprofloxacin for Spontaneous Bacterial Peritonitis: A Randomized Trial: A Validation Study of 2021 AASLD Practice Guidance for SBP – American Journal of Gastroenterology (free for a limited period)
Review | Acute respiratory distress syndrome, mechanical ventilation, and inhalation injury in burn patients
3 Apr, 2023 | 13:38h | UTC
M-A | Incidence and prognostic role of pleural effusion in patients with pulmonary embolism
31 Mar, 2023 | 13:40h | UTC
Review | Evaluation and management of hypernatremia in adults
30 Mar, 2023 | 14:20h | UTC
Update on the management of acute pancreatitis
30 Mar, 2023 | 14:10h | UTCUpdate on the management of acute pancreatitis – Current Opinion in Critical Care
Related:
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
Brief Review | Acute mesenteric ischemia
30 Mar, 2023 | 13:44h | UTCAcute mesenteric ischaemia – British Journal of Surgery
M-A | Incidence of multiple organ failure in adult polytrauma patients
30 Mar, 2023 | 13:30h | UTC
M-A | Aggressive IV hydration may increase mortality risk in severe acute pancreatitis
29 Mar, 2023 | 13:26h | UTCSummary: This systematic review and meta-analysis investigated the outcomes of aggressive and non-aggressive intravenous hydration in patients with severe and non-severe acute pancreatitis (AP). The study included nine randomized controlled trials with a total of 953 participants.
The findings revealed that aggressive intravenous hydration significantly increased mortality risk in severe AP cases, and fluid-related complication risk in both severe and non-severe AP cases. However, the study has some limitations, as only one study with 249 participants was judged to have a low risk of bias in all domains, while the remaining eight studies had non-low risk of bias, raising concerns about the reliability of the findings.
Despite these concerns, the findings still suggest that more conservative intravenous fluid resuscitation protocols for AP may be preferable. Further research with more rigorous study designs is needed to provide robust evidence on the effectiveness of different intravenous hydration strategies in treating acute pancreatitis.
Review | Supplemental oxygen and noninvasive ventilation
29 Mar, 2023 | 13:18h | UTCSupplemental oxygen and noninvasive ventilation – European Respiratory Review
Practice Guidance | On-site treatment of avalanche victims
28 Mar, 2023 | 14:48h | UTC
Acute heart failure: diagnostic–therapeutic pathways and preventive strategies — a real-world clinician’s guide
28 Mar, 2023 | 14:45h | UTC
M-A | Examining shorter antibiotic treatment durations for community acquired pneumonia in adults
27 Mar, 2023 | 13:29h | UTCSummary: The systematic review and duration-effect meta-analysis included nine randomized trials with a total of 2,399 patients, analyzing antibiotic treatment durations for community-acquired pneumonia (CAP) in adults. The primary outcome was clinical improvement on day 15, with secondary outcomes including all-cause mortality, serious adverse events, and clinical improvement on day 30.
The study found that shorter treatment durations (3–9 days) were likely to be non-inferior to the standard 10-day treatment, and no significant difference in all-cause mortality or serious adverse events was observed. The study suggests that a 3–5 day treatment duration likely offers the optimal balance between efficacy and treatment burden if patients are clinically stable. However, the results are limited by the small number of included studies, the overall moderate-to-high risk of bias, and the varying severity of CAP among patients in the studies. Therefore, further research focusing on the shorter duration range is required.
Related:
Position Paper | Prehospital hemorrhage control and treatment by clinicians
27 Mar, 2023 | 13:20h | UTC
Guideline | Diagnosis and treatment of myocarditis
23 Mar, 2023 | 12:55h | UTCJCS 2023 Guideline on the Diagnosis and Treatment of Myocarditis – Circulation Journal (see PDF)
Guideline | Diagnosis and treatment of vasospastic angina and coronary microvascular dysfunction
23 Mar, 2023 | 12:53h | UTCJCS/CVIT/JCC 2023 Guideline Focused Update on Diagnosis and Treatment of Vasospastic Angina (Coronary Spastic Angina) and Coronary Microvascular Dysfunction – Circulation Journal (see PDF)
M-A | Efficacy of intraosseous access for trauma resuscitation
23 Mar, 2023 | 12:52h | UTC
RCT | Hydrocortisone reduces mortality in severe community-acquired pneumonia
22 Mar, 2023 | 13:44h | UTCSummary: Practice-changing! In a phase 3, multicenter, double-blind, randomized controlled trial involving 800 patients with severe community-acquired pneumonia admitted to the ICU, hydrocortisone treatment was found to reduce the risk of death by day 28 compared to a placebo group. The hydrocortisone group had a 6.2% death rate, while the placebo group had an 11.9% death rate.
Hydrocortisone also led to fewer endotracheal intubations among patients not on mechanical ventilation at baseline and reduced the need for vasopressor therapy in patients not receiving it at baseline. There was no significant difference in hospital-acquired infections or gastrointestinal bleeding between the two groups, but patients in the hydrocortisone group required higher daily doses of insulin during the first week of treatment.
Article: Hydrocortisone in Severe Community-Acquired Pneumonia – New England Journal of Medicine (link to abstract – $ for full-text)
Commentary: Steroid drug reduces death rate in severe pneumonia, study shows – STAT
Commentary on Twitter
In this randomized trial, hydrocortisone treatment decreased mortality among patients with severe community-acquire pneumonia in the ICU. https://t.co/DZadFMcA5o#ISICEM23 pic.twitter.com/yhkVCjBMWX
— NEJM (@NEJM) March 21, 2023
RCT | 4F-PCC fails to reduce blood product consumption and raises thromboembolic events in trauma patients
22 Mar, 2023 | 13:41h | UTCSummary: The PROCOAG Randomized Clinical Trial aimed to investigate the efficacy and safety of 4-factor prothrombin complex concentrate (4F-PCC) in trauma patients at risk of massive transfusion. Conducted in 12 French trauma centers, this double-blind, randomized, placebo-controlled superiority trial involved 324 patients. All patients were treated according to European traumatic hemorrhage guidelines and received early ratio-based transfusion (packed red blood cells:fresh frozen plasma ratio of 1:1 to 2:1). The primary outcome measured was 24-hour blood product consumption (efficacy), while arterial or venous thromboembolic events were assessed as a secondary outcome (safety).
The trial revealed no significant difference in 24-hour blood product consumption between the 4F-PCC and placebo groups, with median consumption of 12 units and 11 units, respectively. However, the study identified a statistically significant higher risk of thromboembolic events in the 4F-PCC group, with 35% of patients experiencing at least one event compared to 24% in the placebo group.
In conclusion, the study found no beneficial effect of incorporating 4F-PCC into a ratio-based transfusion strategy for patients with severe trauma at risk of massive transfusion. Furthermore, the higher rate of thromboembolic events in the 4F-PCC group indicated potential harm. The findings do not support the routine use of 4F-PCC in patients experiencing trauma who are at risk for extensive transfusion.
Article: Efficacy and Safety of Early Administration of 4-Factor Prothrombin Complex Concentrate in Patients With Trauma at Risk of Massive Transfusion: The PROCOAG Randomized Clinical Trial – JAMA (free for a limited period)
See also: Visual Abstract
M-A | Risk factors of hemorrhagic transformation in acute ischaemic stroke
22 Mar, 2023 | 13:21h | UTC
Pro-con debate | Should videolaryngoscopy be standard of care for tracheal intubation?
21 Mar, 2023 | 13:19h | UTCPro-Con Debate: Videolaryngoscopy Should Be Standard of Care for Tracheal Intubation – Anesthesia & Analgesia (free for a limited period)