Critical Care & Emergencies (all articles)
CDC report reveals escalating Candida auris transmission and resistance in the US
28 Mar, 2023 | 15:10h | UTCWorsening Spread of Candida auris in the United States, 2019 to 2021 – Annals of Internal Medicine
Commentaries:
CDC reports dramatic increase in US Candida auris cases – CIDRAP
An emerging fungal threat spread at an alarming rate in US health care facilities, study says – CNN
Related:
CDC Report: Transmission of pan-resistant Candida auris in health care facilities.
Case reports: Multidrug-resistant Candida auris infections in critically ill Covid-19 patients
Candida auris: A Review of Recommendations for Detection and Control in Healthcare Settings
Global Epidemiology of Emerging Candida Auris (reviews and commentaries on the subject)
The superbug Candida auris is giving rise to warnings — and big questions – STAT
Candida Auris – “A Mysterious Infection, Spanning the Globe in a Climate of Secrecy” (reviews and commentaries on the subject)
Commentary on Twitter
New Annals of Internal Medicine study finds cases of deadly fungus, Candida auris, rose drastically between 2019 and 2021. Increase included treatment resistant strains: https://t.co/J3SkmfWDr5 @CDCgov pic.twitter.com/ZJBRqMIOy1
— Annals of Int Med (@AnnalsofIM) March 21, 2023
Brief Review | Antifungal stewardship in critically ill patients
28 Mar, 2023 | 14:57h | UTCAntifungal stewardship in critically ill patients – Intensive Care Medicine (if the link is paywalled, try this one)
Commentary on Twitter
Antifungal stewardship in #ICU
🧪 biomarkers
⬇️ de‑escalation
🍄 other methods to improve AFs use
Empirical AFs commonly used (poor prognosis if inappropriate/delayed): AFS can ⬆️ performance measures/⬇️ AFs consumption, no negative impact on outcome
🖇️ https://t.co/eS9EJdjo2a pic.twitter.com/4FMV9NBndb— Intensive Care Medicine (@yourICM) March 24, 2023
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
Brief Review | Admission to intensive care unit after major surgery
28 Mar, 2023 | 14:39h | UTCAdmission to intensive care unit after major surgery – Intensive Care Medicine
Commentary on Twitter
🏥 Major surgeries common reason for #ICU admission (expected/scheduled or unplanned), with varying practices & mortality. 4 major determinants driving decision
1️⃣ intrinsic procedure risk
2️⃣ patient risk
3️⃣ crashing risk
4️⃣ support outside ICU#FOAMcc
🖇️ https://t.co/CluprKlYM9 pic.twitter.com/PZC4zmymOp— Intensive Care Medicine (@yourICM) March 23, 2023
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:
Selected articles from the Annual Update in Intensive Care and Emergency Medicine 2023
27 Mar, 2023 | 13:23h | UTCHemodynamic Implications of Prone Positioning in Patients with ARDS
Host Response Biomarkers for Sepsis in the Emergency Room
Quality improvement in the determination of death by neurologic criteria around the world
Setting and Monitoring of Mechanical Ventilation During Venovenous ECMO
A structured diagnostic algorithm for patients with ARDS
Interrogating the sepsis host immune response using cytomics
Managing the Physiologically Difficult Airway in Critically Ill Adults
Metagenomic Sequencing in the ICU for Precision Diagnosis of Critical Infectious Illnesses
The Role of Transcriptomics in Redefining Critical Illness
Position Paper | Prehospital hemorrhage control and treatment by clinicians
27 Mar, 2023 | 13:20h | UTC
Brief Review | Long-term outcomes of intensive care unit delirium
27 Mar, 2023 | 13:09h | UTCLong-term outcomes of intensive care unit delirium – Intensive Care Medicine
Commentary on Twitter
#ICU delirium
🏥 well described short-term effects: ⬆️ hospital mortality, MV duration, ICU/hospital LoS
📚 more recent findings related to long-term outcomes (≥ 6 months post-ICU)
How to mitigate this serious acute BI & its long-term burden? #FOAMcc
🖇️ https://t.co/kg5TIOmVHm pic.twitter.com/Hnbc1ISKnI— Intensive Care Medicine (@yourICM) March 25, 2023
Guidelines for neuroprognostication in comatose adult survivors of cardiac arrest
27 Mar, 2023 | 12:54h | UTC
Guidelines for neuroprognostication in adults with Guillain-Barré Syndrome
27 Mar, 2023 | 12:52h | UTCGuidelines for Neuroprognostication in Adults with Guillain–Barré Syndrome – Neurocritical Care
Study shows increased bleeding complications in ESKD patients undergoing AF ablation
24 Mar, 2023 | 13:09h | UTCSummary: The study analyzed 347 procedures in 307 patients with end-stage kidney disease (ESKD) undergoing atrial fibrillation (AF) catheter ablation in 12 referral centers in Japan.
Despite a vast majority of patients having subtherapeutic international normalized ratio (INR) values during the peri-procedural period, 35 patients (10%) experienced major complications, with the majority being major bleeding events (19 patients; 5.4%), including 11 cases of cardiac tamponade (3.2%). There were also two peri-procedural deaths (0.6%), both related to bleeding events. A pre-procedural INR value of 2.0 or higher was identified as the only independent predictor of major bleeding.
Current peri-procedural anticoagulation guidelines state that patients undergoing AF ablation should be under therapeutic anticoagulation throughout the peri-procedural period. The findings of this study suggest that these guidelines may not be appropriate for ESKD patients undergoing the procedure, and the role of peri-procedural anticoagulation in this population should be further investigated.
Commentary on Twitter
Peri-procedural anticoagulation in patients with end-stage kidney disease undergoing #afib ablation 👉 despite undertreatment with warfarin, the rate of haemorrhagic complications is high! https://t.co/3W8gEtZYdy#kidney #afib #anticoagulation #ablation #cardiotwitter #europace pic.twitter.com/vI27UeIpRf
— European Society of Cardiology Journals (@ESC_Journals) March 16, 2023
Review | Unapparent systemic effects of regional anticoagulation with citrate in continuous renal replacement therapy
24 Mar, 2023 | 13:04h | 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 | Low-calorie, low-protein feeding improves recovery time in ventilated adults with shock
22 Mar, 2023 | 13:42h | UTCSummary: The NUTRIREA-3 study aimed to determine the optimal calorie and protein intakes during the acute phase of severe critical illness. The study was a randomized, controlled, multicenter, open-label, parallel-group trial conducted in 61 French intensive care units (ICUs) involving 3044 adults receiving invasive mechanical ventilation and vasopressor support for shock. During the first seven ICU days, participants were randomly assigned to early nutrition with either low or standard calorie and protein targets. The primary endpoints were time to readiness for ICU discharge and day 90 all-cause mortality, while key secondary outcomes included secondary infections, gastrointestinal events, and liver dysfunction.
The study found that early calorie and protein restriction did not decrease mortality. However, it was associated with faster recovery and fewer complications compared to standard calorie and protein targets. The low-calorie, low-protein group had a shorter median time to readiness for ICU discharge and lower proportions of patients with vomiting, diarrhea, bowel ischemia, and liver dysfunction. The proportions of patients with secondary infections did not differ significantly between the two groups.
In conclusion, the NUTRIREA-3 study provides evidence that patients may benefit from restricted calorie and protein intakes during the acute phase of critical illness, as it expedites recovery and reduces the risk of complications.
Article: Low versus standard calorie and protein feeding in ventilated adults with shock: a randomised, controlled, multicentre, open-label, parallel-group trial (NUTRIREA-3) – The Lancet Respiratory Medicine (free registration required)
Commentary on Twitter
NEW Research—Early calorie & protein restriction did not decrease mortality but was associated w/ faster recovery & fewer complications than standard intake targets
NUTRIREA-3 from Prof Jean Reignier & co https://t.co/VCS72qxLPD
Being presented @ISICEM today! #ISICEM23 pic.twitter.com/TpoJnwHP8P
— The Lancet Respiratory Medicine (@LancetRespirMed) 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
Mechanical power of ventilation and driving pressure: two undervalued parameters for pre ECMO ventilation and during daily management?
22 Mar, 2023 | 13:24h | UTCRelated: Brief Review | Mechanical power: meaning, uses and limitations
M-A | Intravenous vitamin C in sepsis and septic shock – no influence on mortality outcomes
22 Mar, 2023 | 13:23h | UTCRelated:
Parenteral Vitamin C in Patients with Severe Infection: A Systematic Review – NEJM Evidence
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)
RCT | Videolaryngoscopy improves first-pass tracheal intubation success compared with direct laryngoscopy
21 Mar, 2023 | 13:21h | UTC
Critical care outreach teams: a service without walls
20 Mar, 2023 | 13:27h | UTCCritical care outreach teams: a service without walls – Intensive Care Medicine
Commentary on Twitter
Critical care outreach teams
🏥 unanswered questions
🏥 future directions
Early recognizing deterioration/implementing time-critical interventions save lives! CCOTs offer holistic, supportive approach pre/post #ICU, beyond clinical assessment.#FOAMcc
🖇️ https://t.co/s9F9v25cNO pic.twitter.com/5uwPvZ04Ye— Intensive Care Medicine (@yourICM) March 18, 2023